Tag Archive Musculoskeletal

Physiotherapist or Sports Rehabilitator: Not The Same!

By Chris Liversidge In Armitage Bridge, Berry Brow, Chris Liversidge, Expertise, HCPC, HD1, HD2, HD3, HD4, HD5, HD6, HD7, HD8, HD9, Holme Valley, Holmfirth, Honley, Huddersfield, Injury, Medical, Musculoskeletal, Netherthong, Netherton, North Light, North Light Physio, Physio, Physiotherapy, Rehabilitator, Sports Rehab, UK, Upperthong, West Yorkshire

With the advent of Sports Rehabilitation as an Undergraduate Degree, and Sports Rehabilitators appearing in the marketplace, I’m often asked what the difference is ~ and whether someone should seek help from a Physiotherapist or Sports Rehabilitator for a musculoskeletal condition.

What is a Physiotherapist?

The term “Physiotherapist” describes a professional who uses physical and manual methods to restore function, and rehabilitate ‘patients’ with physical conditions
Both “Physiotherapist” and “Physio” are legally protected titles. This prevents anyone without a certified degree in Physiotherapy from
- using the title of Physiotherapist
- or describing their role as that of a Physiotherapist
Physiotherapists are, alongside all other Professions Allied to Medicine (PAMs), required to have registration with the Health and Care Professions Council (HCPC), a regulatory body requiring members to demonstrate appropriate continuing professional development, to maintain their registration. Without this, a Physio is not entitled to practice

To complete the undergraduate degree, a Physiotherapist must study and demonstrate competence in the care of a range of conditions – not only musculoskeletal in nature, but also neurological conditions, respiratory disease, general surgical and orthopaedic surgical conditions and more.

The qualified Physiotherapist is then armed (as most do initially) to take up a post in the NHS or other medical institution, to continue to develop their practice. It is during the initial 2-3 years that the Physio will work across all fields of the profession, and also begin to develop a special interest in a specific area (e.g. musculoskeletal, neurology, etc.). As experience and depth of knowledge is gained, there is too much ongoing learning required to maintain expertise in more than one area.

Having said that, the early broad learning in the Physiotherapist’s career is essential, as there is a great deal of overlap in some areas. For example, some neurological knowledge is key to musculoskeletal rehabilitation, as the two systems are not mutually exclusive.

What is a Sports Rehabilitator?

Having completed an undergraduate degree in Sports Rehabilitation, this practitioner has knowledge specifically in the assessment and rehabilitation of sporting/musculoskeletal complaints
As the title suggests, the emphasis is often on returning a ‘patient’ to a specified level of sporting capacity. Manual/hands-on therapies are also used by a Sports Rehabilitator
However
- There is no training offered in a broader systems rehabilitation approach (e.g. neurological rehab)
- This practitioner is currently not a “Professional Allied to Medicine”
- The qualification is not currently regulated by the HCPC, and practitioners are therefore not required to meet their standards to practice
There is also currently no avenue for the Sports Rehab practitioner to work in the NHS or medical institutions, nor to register with health insurance providers such as BUPA, AXA, etc.

Overlap
There is a great deal of overlap. Both practitioners are able to provide hands on treatments and exercise prescription, to improve symptoms. Technically and literally, a Physiotherapist practicing in the musculoskeletal specialism, rehabilitating patients back to sport, is a sports rehabilitator.

However at the time of writing this blog, the lack of HCPC registration means the Sports Rehabilitator is not found working in the field of elite sport, because of the extent of medical overlap often required in musculoskeletal roles within professional sport.

Extended Scope
It is also worth noting that, critically, a large number of medical conditions can masquerade as musculoskeletal problems. The key here, is to have a practitioner who has the correct experience to differentially diagnose whether your condition is truly musculoskeletal, or is masquerading for an underlying medical problem.

Physiotherapists with this level of expertise are highly experienced, usually having worked in a hospital/medical setting in musculoskeletal care, for at least 8, or up to 10 years, and have seen a very large volume of differing conditions over many years. They are referred to as Extended Scope Physiotherapists (ESPs).

The key skill of an ESP is knowing what is a rehabilitation problem, what isn’t a rehabilitation problem, and for the latter, who is the correct professional to refer to.

Summary

The key thing to remember, whichever practitioner you choose, is experience
A Sports Rehabilitator has a good depth of training, and many offer a good service in managing the recreational athlete
However, one must bear in mind the breadth of training in Physiotherapy, and the advantage of the medical training incorporated in the Physiotherapy degree

Of course, the extent of experience of your chosen clinician is vital too. For me, the choice to open a Clinic was one I gave a lot of consideration to. I felt this choice was realistic after I had accumulated 10 years of experience, knowing I felt confident to assess whoever walked in through our front door – but I also continue to humbly accept that I have, by no means, learnt all there is to know!

Best Wishes,
Chris

Chris Liversidge (MSc, BSc (Hons) 1998,2001, MCSP) is an Extended Scope Physiotherapist (Musculoskeletal/Orthopaedics) and Practice Prinicpal at North Light Physiotherapy Associates, UK.

To book an appointment with the experts at North Light Physiotherapy, PLEASE DO NOT LEAVE A COMMENT HERE!

Call us on 01484 660663, or click on our Contact page

Shockwave Therapy at North Light Physiotherapy

By Chris Liversidge In Achilles, Achilles Tendinopathy, Armitage Bridge, Athlete, Berry Brow, Chris Liversidge, CrossFit, ESWT, HD1, HD2, HD3, HD4, HD5, HD6, HD7, HD8, HD9, Holmfirth, Honley, Huddersfield, Lockwood, Medial Tibial Stress Syndrome, Meltham, MTSS, Musculoskeletal, Netherton, Newsome, North Light Physio, North Light Physiotherapy, pain, Patellar Tendinopathy, Physiotherapy, Plantar Faciitis, Plantar Fasciopathy, Running, Shockwave, Shockwave Therapy, Shoulder, South Crosland, Tendonitis, Ultrasound, West Yorkshire

Extracorporeal Shockwave Therapy for Musculoskeletal Conditions

Extracorporeal Shockwave Therapy (ESWT) has been successfully used for the management of a variety of musculoskeletal conditions for over 20 years. It is now available at North Light Physiotherapy!

In Urology, shockwaves are used to disintegrate kidney stones, whereas in Musculoskeletal medicine, its use is to induce tissue repair and regeneration on a cellular level. The mechanism by which this takes place is not fully understood, despite many studies showing positive outcomes in a variety of conditions.

Principle of Treatment

Shockwave patterns differ from Ultrasound waves, in that ESWT generates significantly higher pressure. Primarily, this generates a mechanical force focussed on the target tissue. This generates a response within the target cells, and in areas around the target tissue. Many patients we treat with ESWT present with tendon pain- commonly in the Achilles, knee-cap (Patellar) tendon, the Plantar Fascia, and at the elbow (so called “tennis elbow”, or lateral epicondylitis), or shoulder.

Problems with tendons seem to occur more frequently with a big and relatively sudden increase in physical workload. Examples include suddenly running much further than usual, suddenly lifting more heavily in the gym or other physical activity, such as CrossFit.

When people are new to physical exercise, problems can occur during the time it takes for the body to develop the robustness to tolerate more physical work. For this reason, ESWT will only ever form part of the overall treatment, because sensible management of physical workload, in view of individual physical capacity, is the key to success.

If you believe ESWT may be appropriate to help manage your problem, we will always consider this as a management option as part of a comprehensive assessment. ESWT as a standalone treatment, is likely to be less effective than when combined with comprehensive Physiotherapy care.

Plantar Fasciopathy (Fasciitis)

Many studies have shown ESWT to be effective in the treatment of Plantar Fasciopathy. Success rates vary between 34% to 88%. This may depend on severity of the problem, and how long the condition has been present before treatment. Good quality evidence suggests that treatment must incorporate a suitable loading programme (Physiotherapy-type exercise). This ensures the Plantar Fascia retains/improves its ability to tolerate the force required for exercise.

Achilles Tendinopathy (Tendonitis)

A common problem with runners, the Achilles tendon may generate symptoms in the mid-portion (half way up), or at its insertion into the heel bone (calcaneus). The insertional Achilles pains tend to be more stubborn to settle. However, studies have shown that both insertional and mid-portion Achilles problems are responsive to ESWT. In many cases, runners will present to our specialist running clinic, during which we may discuss and suggest modifications to running gait, and recommend modifications to running workload (distance, intensity).

Patellar Tendinopathy (Tendonitis)

Another frequent problem with running athletes, powerlifters and CrossFit-ers. Success rates have been reported to be as high as 74-88% with ESWT. Commonly, knee and hip control issues can play a part in the onset of problems, and will need addressing as part of a comprehensive treatment regime. Our specialist Running Clinic often identifies related areas to improve on, to modify and improve on pain and control of the knee.

Shin Splints (Medial Tibial Stress Syndrome- MTSS)

Often seen in running athletes, and more frequently in females- sufferers will experience pain at the inner side of the shin. Particularly evident on landing, during running. Modifications can often be made to the ankle and foot, in respect of strength and control of the rear part of the foot during landing. Sometimes orthoses (in-soles in the trainers) can make a difference. ESWT has been shown in some studies to make a positive contribution to symptoms of MTSS, and others not so much. Again, ESWT will be considered as part of a course of Physiotherapy, which will address any contributing factors.

(Calcifying) Tendonitis of the Shoulder

Success rates for treatment with ESWT have been reported in the 78-91% range, in studies, with ongoing relief beyond 2 years. The benefits include improved joint movement, and therefore improved ability to use the arm, particularly in overhead activities. Swimmers and other overhead athletes, such as racket-sport players, and bowlers (cricket) can tend to be affected. The effectiveness of ESWT is again supplemented by a good course of Physiotherapy rehab, and workload modification principles.

If you are affected by a problem for which ESWT may be useful, please do get in touch – North Light Physiotherapy will be pleased to support you. You can get in touch via our Contact page, or on 01484 660663. See you soon!

Chris Liversidge (MSc, BSc (Hons) MCSP, SRP) is Practice Principal at North Light Physiotherapy Associates, Huddersfield HD4 7NR. Visit www.northlightphysio.co.uk or call 01484 660663

Extended Scope Physiotherapy at North Light

By Chris Liversidge In Ankle, Arm, Back Pain, Chris Liversidge, Elbow, Expert, Expertise, Extended Scope Physiotherapy, Foot, Hand, Hip, Huddersfield, Injury, Joint Pain, Knee, Musculoskeletal, Neck, North Light Physio, North Light Physiotherapy, pain, Physiotherapy, Shoulder, Sports Injury, West Yorkshire

North Light Physiotherapy Associates’ Practice Principal, Chris Liversidge, is an Extended Scope Physiotherapist (ESP)

What does Chris’s expertise mean for you?

In a nutshell, being treated by an Extended Scope Physiotherapst often means faster differential diagnosis of acute physical injuries, and many other longer term musculo-skeletal conditions.

ESPs are able to work beyond what is usually recognised as standard Physiotherapy practice.

However, many people will suffer an injury or acute muscular problem (for example, following a fall or accident, an episode of back pain or a sporting injury) and assume their GP is the best place to go.

Waiting times can be long, and GPs don’t always have the depth of up-to-date developments in physical medicine – so whilst they may usefully prescribe painkillers or anti-inflammatories, combining this with a course of immediate Physiotherapy treatment may actually be far more successful than pain relief alone.

When you are suffering acute pain, an Extended Scope Physiotherapist (ESP) often provides:

a faster differential diagnosis of the injury/problem
more specific treatment
a faster recovery and return to normal function
If tests or other medical investigations are required, an Extended Scope Physiotherapist can recommend which is most suitable to request, and in many cases, directly order investigations.

A faster solution to pain – that’s got to be a winner!

What does the term “Extended Scope Physiotherapy” actually mean?

Extended Scope Physiotherapy (ESP) practice is growing in prominence, both in private medicine and in the NHS. On their website, Cumbria Partnership NHS Foundation Trust describe an ESP as:

“A Clinical Physiotherapy Specialist with an extended scope of practice. This implies working beyond the recognised scope of Physiotherapy practice, for example requesting investigations (ultrasound scans/nerve conduction studies), using the results of investigations to assist clinical diagnosis and appropriate management of patients; listing for surgery, and referring to other professionals. ESP’s hold post-graduate qualifications (eg. MSc), Society of Orthopaedic Medicine (SOM) membership or equivalent, and most have a Diploma in Injection Therapy.”

You can also find out more about the work of Extended Scope Physiotherapists at www.CSP.org.uk

To work at this level requires a number of years of experience, with a wide variety of conditions. Critically, this involves identifying conditions which are not suitable for Physiotherapy, as quicly as possible, and referring on to the correct specialist, as soon as possible.

To make an appointment with Chris Liversidge or any of our expert Team at North Light Physiotherapy, use our Contact form or call 0845 177 0780

Physiotherapist in Low Back Pain Shock!

By Chris Liversidge In Back Pain, Chris Liversidge, Holmfirth, Huddersfield, Musculoskeletal, pain, Physio, Physiotherapy, Rehabilitation, West Yorkshire, Yorkshire

Hi everyone-
Just wanted to send a quick message of encouragement to those carrying back injuries, frustrated at being unable to exercise “normally”, however that may be. There is always hope!!

Physio Develops Back Pain!

Last April, I had a sudden onset of Lower Back Pain. In the initial stages, it took me an hour to get from the bedroom to the kitchen!! Not the usual story for someone with my energy levels!

Out of Hours GP

So, I had to put my own advice into action-as it was a Saturday, with the GP closed, I had to go to the out-of hours GP at the Hospital (**Note- I didn’t go to A&E**). Armed with Naproxen and strong Co-Codamol, I was able to get my pain levels under control (this was my new 10/10 pain!). The key here, is that exercise/mechanotherapy is the critical component, but without pain relief, this would have been impossible! Don’t fall into the trap of believing that pain relief “masks” further damage- normal movement **doesn’t cause damage**!! However, even at this stage, simple tasks such as getting on/off the bed, putting shoes/socks on etc, were a major undertaking, and remained painful.

From there, I was slowly able to exercise/position myself in my direction of preference, and things started to ease. However, I was still a long way off either running or cycling- my 2 main exercise passions. This really did demoralize me, and scramble my brain.

Turning a Corner

By the time June arrived, I felt my pain was under sufficient control to begin a light jog. We were in Scarborough, and I was covering a game with Yorkshire Cricket, I had 1/10 pain, and the sun was shining.
I plodded very slowly, for a 1/2 mile, and on arriving back at the hotel, was in 6/10 pain!
“So you’ve caused more damage again” I hear you say! But how I reply? Movement is physiologically normal, and running didn’t cause me trauma or damage in the absence of back pain, so why should it cause me damage in the presence of back pain?!

At this stage, the tissues in my back were still sensitive, and so would register pain more readily- the brain has a clever way of sensitising tissues if it perceives a threat, a bit like an over-anxious parent wanting to protect their child if they try to climb a tree, for example.
The key thing was, on arrival back at the hotel, I had some Paracetamol, did my back exercises, and my pain was quickly back to 1/10!

From there, the process was repeated- I managed to slowly increase my running distances- setting off with little or no pain, returning with 3-4/10 pain, but reassured that I was progressing, each time getting a bit further, with slowly decreasing pain (at this point, remember that 2 months earlier I was in 9/10 pain just to put on my socks!!) It still took a bit of convincing for Mrs. L. to believe that although I set of running with no pain, and came home in 4/10 pain, I was not “damaging/worsening” my back!

And so it continued- and now, here I am having run two 10k races (my favourite distance), in 42 and 41 mins respectively!!

Physios are made of the same stuff

Now don’t get me wrong- there were dark times-I did doubt myself- pain messes with your head in that way-, and I did come in for some criticism too (“you’re a Physio, you shouldn’t have problems like this-what hope is there for the rest of us?”). This was hard to take, but I had to reassure myself I could sort the problem. The thing is, I’m made of the same stuff as everyone else, so there’s no reason I shouldn’t develop back pain. The measure of me was, whether I was good enough to solve the problem? The answer was a resounding yes!

Reassurance

So what can one learn from this experience? I am clearly able to empathize with sufferers of lower back pain. But I’m proof it can be managed- and the 2 keys were: pain control allowing me to then do the bit that works- rehab exercises!
Whatever happens- don’t give up- when the pain was at its worst, I did question whether I’d ever get back to running and cycling- that’s just human. The human body is extremely adaptable, resilient and robust- trust this, and with a good dose of patience, you can get there!

Send us a message, or call 0845 177 0780 to see how we can help!

Chris Liversidge is Practice Principal and Extended Scope Practitioner at North Light Physiotherapy Associates, Huddersfield, UK.

Posterior Ankle Impingement

By Chris Liversidge In Ankle, Chris Liversidge, Elite Sport, Expertise, Huddersfield, Musculoskeletal, North Light, North Light Physio, Orthopaedic, Physio, Physiotherapy, Rehabilitation, UK

Afternoon!

Here’s the latest #Advent instalment in our series. A daily evidence-based info-hit from the North Light world of physical health, wellbeing & performance! This is a day late-you know, like when you forget to open your calendar on one day, so you get 2 the following day? (Another instalment to uploaded earlier this afternoon!!)

Also look out for an announcement in the next couple of days in the run-up to Christmas – you can be involved, as long as you’re not on the naughty list!.

So…
I had the privilege recently of attending the operating theatres at Leeds Nuffield hospital to observe Mr Mark Farndon carry out a hindfoot endoscopy (keyhole surgery approaching from the back of the ankle). These opportunities are a key part of the ongoing development of our private service provision at North Light Physio, our individual professional development and in our responsibilities to the sporting partners we provide to. Critically, a great means of reinforcing well-grounded knowledge, and developing relationships with surgical staff – collaborative working being critical to patient care.

The case in question related to a cricket player (bowler) complaining of pain at the back of the (in this case, left) ankle on delivery of the ball. See image of the front foot below, and how the shin bone is angled backwards against the back of the foot/ankle (forced weight-bearing dorsiflexion).

This is not uncommon, but we weren’t able to settle his symptoms sufficiently with Physiotherapy alone. On referral for imaging, an os trigonum (accessory bone at the back of the Talus) was demonstrated- see images below.

The consequence is the likelihood of impingement in the back of the ankle, due to a physical lack of space – the joint lining can become inflamed, and swelling can build. The long tendon flexing the big toe (Flexor Hallucis Longus, FHL), can also become involved, given its proximity.

In this particular case, following surgery to remove the Os Trigonum, recovery has been excellent, and as we speak, the player is taking a full part in pre-season training, with no symptoms at all.

So, what did I learn from this case?

1. As good as we are as Physiotherapists, we can’t solve everything through Physio – knowing when to refer on is critical. The skill of knowing when to refer-on takes years of exposure – especially with conditions which do not appear regularly in our practice.

2. Reinforced my strongly-held belief in team-working across specialities- and how vitally important this is outside of the hospital setting, particularly when working in different geographical areas to the surgical team. Being there to discuss the rehab with the surgeon during the procedure is completely invaluable.

3. Knowing the pathology, the surgeon, the individual, and the feeling from the surgeon as to how well the procedure went, all give us a great advantage in preparing for, and delivering high-quality and timely ankle rehabilitation, to allow a speedy recovery!

An informative case to work on, and rewarding to see excellent progress!

Remember- get in touch below if you want our advice with your ankle problem!

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Christopher Liversidge (MSc, BSc (Hons) MCSP, SRP) is Practice Principal at North Light Physiotherapy Associates, Huddersfield, UK. Click here to contact Chris, or call 01484 660663

5 Keys to Healthy Knees – use our expertise!

By Chris Liversidge In ACL, Armitage Bridge, Berry Brow, HD1, HD2, HD3, HD4, HD5, HD6, HD7, HD8, HD9, Holmfirth, Honley, Huddersfield, Joint Pain, Knee, Meltham, MPFL, MSK, Musculoskeletal, Newsome, North Light Physio, North Light Physiotherapy, patella, Physio, Physiotherapy, Rehab, Rehabilitation

Having specialised in the rehabilitation of lower limb injuries, and particulary knee injuries, for many years now, I have observed 5 key objectives to achieve quickly to optimise knee function. This is irrespective of whether the rehab is post- injury, or post-operative. With these 5 goals in place, the knee will quickly function more normally.

1. Reduce swelling.

After an injury to structures inside the knee, it will swell- an effusion. This is known to cause reflex muscle inhibition, which can cause the quadriceps muscle to switch off, and the knee to feel as though it may give way. Minimise the effusion to optimise quads activity.

2. Restore full Active Extension.

The ability to actively fully straighten the knee is critical. This is the ability for you to switch on and tense your front thigh muscle (Quadriceps) by choice. If this is not possible, you cannot actively keep yourself upright on your feet- the knee will give way.

3. Restore full Passive Extension.

This is the ability of an external force, i.e not you or your quadriceps muscle, to straighten your knee: e.g. ability for it to sag straight under the weight of gravity, or for someone (usually a Physio, when testing the knee), to pull it into a fully straight position. If this is not possible, it may indicate something inside the knee is mechanically blocking it. This must be dealt with quickly, as a block to extension left untreated can leave the knee stiff in the long-term, and will disable your ability to actively straighten your knee, and may again lead to giving-way or buckling of the knee.

4. Mobilise the Patella.

The patella (kneecap) is free to be moved within a specific range when the knee is relaxed. Often, usually after surgery, this ability for the kneecap to be freely moved is limited, and can have a consequential negative impact on the ability to develop quadriceps strength, and cause kneecap pain. This can be restored by manual therapy during Physio sessions.

5. Normalise Gait.

The walking (gait) cycle is often significantly affected by pain/stiffness after injury or surgery. The adaptations to the walking pattern, if left unaddressed, can have significant negative effects on knee health: loss of movement, stiffness, muscle shortening and quadriceps inhibition. Normalising the gait cycle as quickly as possible is critical to knee health!

If you, or anyone you know are affected by these problems, please don’t hesitate to get in touch. Our expertise will get you on the path to healthy knees in no time!!