Low back pain is extremely common. According to the National Institute of Clinical Excellence (NICE), back pain will affect 80% of us at some point and cost the NHS in excess of £1 billion annually! Not surprisingly, back pain is one of the most common conditions we treat. Our local, Horsham based team of expert physiotherapists have huge experience in helping people with back pain. We will help you to restore normal movement and get back to work and normal function as quickly as possible. Back pain can be very severe and quite frightening but thankfully the condition is normally self-limiting and will typically settle within a few days or weeks.
The spine is made up of 4 distinct areas, the cervical, thoracic, lumbar and sacral spine regions. The spine is made of 33 bones (vertebrae) in total. The low back (lumbar spine) has 5 vertebrae. Contrary to what many people think the spine is an enormously strong structure. The vertebrae are tightly bound together with ligaments, joints and muscles. Joints do generally not ‘pop’ out of place.
‘Mechanical’ low back pain is by far the most common type of back pain seen in physiotherapy clinics. ‘Mechanical’ refers to a problem with the moving parts of the back such as the muscles, ligaments or joints. Mechanical back pain is rarely serious and usually settles on its own. A mechanical strain can be caused by lifting awkwardly, repetitive movements or sustained postures. Often the patient will tell the physio that they cannot recall a specific injury.
Physiotherapy treatment normally involves education and gentle mobilisation and manipulation to help to relieve the initial discomfort and muscle spasm followed by some exercise based rehabilitation to regain confidence and return to full function. Overactive muscles may need to relax, weak muscles may need to be strengthened and tight muscles may need to be stretched. Normally a combined approach is required. It is recommended to stay fit and active to prevent episodes of back pain from re-occurring.
Nerve root pain or sciatica occurs much less frequently than mechanical back pain. The symptoms may be caused by a disc prolapse which may cause irritation to a descending or exiting nerve. Sciatic pain can be extremely painful. Typically people describe the pain as ‘burning’ or ‘shooting’. If the nerve function becomes affected the pain may be accompanied by pins and needles or numbness in the distribution of the affected nerve. In more severe cases the muscles supplied by the nerve may become weaker. Again root pain/sciatica will normally settle down on its own given time.
Physio treatment typically involves gentle mobilisation and manipulation in the early stages followed by progressive exercise based rehabilitation to help the patient back to full function. Should treatment fail to help or in the event of significant root compromise causing weakness, other treatment options may be considered such as an epidural injection or a surgical opinion. Any patients with back pain who experience numbness between their legs or around their back passage, or who have developed problems with their bladder or bowel functions should seek urgent medical attention as this may indicate compromise to the nerves supplying the bladder and bowel. This is a medical emergency.
The chance of something serious causing your back pain is very small indeed. Physiotherapists are specially trained to watch out for ‘red flags’ which may be signs of more serious problems. If anything serious is suspected we liaise with your doctor urgently.
MRI imaging is only generally helpful when looking for serious pathology, fracture or nerve root compression. For simple back pain, investigations are rarely needed. One of the main reasons for this is that ‘abnormalities’ are very common even in those without back pain. If you have a look at the table below from a recent study you will see that there is a very high prevalence of degenerative changes on MRI in the asymptomatic population. With simple mechanical back pain therefore, it is often impossible to distinguish incidental findings from those which may be causing symptoms. Furthermore, a specific diagnosis is not generally necessary for physiotherapy treatment. The study by Brinjikji and colleagues (2014) can be found here.
Shoulder pain may results from numerous causes. Firstly it is important to rule put any spinal causes. Diagnosis of shoulder injuries therefore involves detailed history and a thorough assessment of various joints and soft tissue structures. At Flex physio, our local, East Grinstead and Horsham based team of expert physiotherapists have a wealth of experience in helping people with shoulder pain.
The shoulder has a collection of tendons, termed the rotator cuff providing the shoulder with stability and strength. Other pain sensitive structures including bursas (sacks of fluid) are located within the shoulder. Shoulder impingement results from the tendons and / or bursas becoming irritated and inflamed within the shoulder leading to pain and limited movement.
Physiotherapy treatment will aim to improve strength and mobility through the use of various manual therapy techniques and home exercises. Modification of activities may be advised.
Frozen shoulder is a condition that leads to pain and stiffness of the shoulder. It is also known as adhesive capsulitis. Frozen shoulder occurs when the flexible tissue that surrounds the shoulder joint, known as the capsule, becomes inflamed and thickened.
It is not fully understood why frozen shoulder occurs, and it’s not always possible to identify a cause. However, a number of factors can increase your risk including diabetes, previous trauma and age (more prevalent between 40-60 years old).
Physiotherapy treatment is the first option for frozen shoulder treatment. Treatment may include manual therapy, further pain relieving modalities (including acupuncture) in conjunction with home exercises to restore movement and function.
Hip joint problems often lead to pain in the groin but just because you have groin pain, it doesn’t necessarily mean that you have a problem with your hip! We often see groin pain in the physio clinic. Causes of groin pain vary from a strain to the muscles in the groin which may result from a forced stretch or contraction to the groin (adductor) muscles, a strain to the junction between the adductor muscles and the abdominal muscles (Gilmore’s groin) or pain from the pubic symphysis joint. Groin problems can also result from overuse injuries such as stress fractures. If the problem is emanating from the hip joint this may be due to osteoarthritis or femoacetabular (hip) impingement.
Whatever the cause of your groin pain, our local, Horsham based teamof expert physiotherapists have huge experience in helping people with groin pain. Physiotherapy treatment may include manual treatment such as mobilisation, gentle stretches and rehabilitation exercises to help you return to normal function or sport.
Pain around the outside of the hip is often termed trochanteric pain as the bony prominence on the outside of the hip is called the greater trochanter. This is a very common condition seen by a physiotherapist. The pain may emanate from muscle, ligament or bursa (a fluid filled sac). Typically trochanteric pain is tender to touch and you may feel this when lying on that side, walking or going from sitting to standing.
Importantly there are often biomechanical causes to persistent trochanteric pain and physio will often aim to correct underlying issues such as weakness around the hip which may be maintaining the condition.
There may be a number some precipitating factors to cause such injuries. Generally Soft tissue injuries result from:
Ligaments are connective tissue attaching bones and joints together. Over stretching may lead to stretching or tearing ligaments. Our physiotherapy team will guide through a tailored treatment plan for speedy recovery.
A strain may result from a muscle or tendon. These may be minor tearing or more severe tearing of the soft tissue leading to significant pain. Our team will assess the extent of your injury and formulate a robust treatment plan.
A bruise secondary to bleeding into the muscle. Most of these injuries respond well to time and graded exposure to movement.
Is a very common condition affecting both the upper and lower limb. Expansive research suggests tendons do not become inflamed (hence the use old terminology tendinitis is not so commonly used) but weakens with degenerative changes within the tendon itself. The most common tendinopathy include the Achilles tendon and rotator cuff.
Our physio team will provide you with the correct management pathway likely involving strengthening the tendon in an appropriate manner whilst addressing other biomechanical factors influencing your recovery.
Joint pains and in particular arthritis are routinely managed in the physio clinic. There are in excess of 200 types of arthritis and related conditions! Osteoarthritis is by far the most common type of arthritis. Osteoarthritis is often termed ‘wear and tear’ arthritis. Unfortunately like grey hair or wrinkles, joints can show signs of wear as we age, although importantly osteoarthritic joints are not always painful. Rheumatoid arthritis is a more inflammatory arthritis where the immune system attacks the joints leading to pain, redness and swelling. It is much less common to see angry rheumatoid joints these days as autoimmune medications are very effective.
The Flex Physiotherapy team in East Grinstead and Horsham are very experienced in the management of joint pain and arthritis. Treatment may include advice and education, pain relief including acupuncture and strategies to self manage your condition including exercise based rehabilitation and home exercise maintenance exercises. We can also help with joint movement and your mobility. We aim to help you stay mobile, independent and active.
RSI is pain felt in muscles, nerves and tendons caused by repetitive movement and overuse. The condition mostly affects parts of the upper body, in particular the forearm, elbow, wrist, hands. The neck and shoulders can also become affected. Office workers, particularly having to use key boards for extended period of times are a common group of patients reporting RSI. Symptoms are variable between individuals including stiffness, sensory changes and diffuse pain, requiring our physiotherapy team to examine and explore a variety of avenues that may be causing your symptoms. Treatment may involve postural reeducation, soft tissue and joint mobilisation whilst addressing peripheral nerve sensitivity.
Some of the most common injuries include ankle injuries , knee injuries and soft tissue injuries. Although many sporting injuries will settle on their own accord our physio team will provide a comprehensive assessment and managementplan. This will involve determining the source of your symptoms but as important assessing any biomechanical influences to get you back to your sporting demands as soon as possible and prevent further injury in the future.
At flex physiotherapy in East Grinstead and Horsham we have a team of physiotherapists who are experts at evaluating all different types of work related injuries from acute soft tissue injuries to postural problems or repetitive stress and overuse injuries.
We will work with you to understand your problem and suggest strategies you can use overcome your work difficulties. If necessary we can help you work with your employer to find a solution. Physio treatment may include stretches or mobilising of tight structures or strengthening weak structures. We may give you an exercise program which you can use at home to help strengthen and recondition the injured area with a view to helping you back to full fitness.
Many musculoskeletal disorders have a postural component but it is important that we do not overstate the importance of posture to our musculoskeletal health. Of course if I were to hold my little finger in an extended position all day it would get sore. In the same way if you have a ‘poking chin’ posture or a ‘sway back’ posture some structures will be stretched whilst other structures will be compressed potentially leading to discomfort. We must however be careful not to ‘pathologize posture’, it is not a disease but simply a possible component of a musculoskeletal problem. In other words, if a posture causes unnecessary strain on structures it may lead to problems.
The problem with being told you have poor posture is that inevitably we become hypervigilent. We force a posture which may be uncomfortable to us, we may start to sit or stand abnormally or we may start to change the way we move. The problem is that these strategies we adopt may in themselves lead to more discomfort, possibly in different structures!
At flex physiotherapy in East Grinstead and Horsham we have a team of physiotherapists who are experts at evaluating posture and suggesting appropriate postural strategies to address postural problems over the long term. Physio treatment may include stretches or mobilising of tight structures or strengthening weak structures with the goal of taking the stress off tissues which are unduly under strain.
Our team at Flex Physiotherapy work closely with a variety of surgeons across Sussex. Whether you have undergone a minor procedure or more extensive surgery including joint replacement or spinal surgery our team will guide you through the post-operative period incorporating a variety of physical treatment strategies and advice to get you back to full recovery. If you a directly referred by your surgeon we will always keep them closely informed of your progress.