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MUSCULOSKELETAL PAIN
Musculoskeletal pain usually occur due to a strain in the soft tissue of the body that can be brought about by trauma, prolonged poor static posture, poor movement pattern or repetitive movements.
1. Neck and Low back pain:
Muscle strain​
Joint sprain
Slipped/ herniated disc
Spondylolisthesis
Spondylosis
Whiplash
2. Shoulder pain
Shoulder impingement​
Rotator cuff muscle strain/ tear
3. Elbow pain
Tennis elbow
Golfer's elbow
4. Wrist pain
De Quervain's disease
Carpal tunnel syndrome
In most cases, musculoskeletal pain will resolved by itself if the tissue damage is minor. The self healing for soft tissue such as muscles, ligaments and tendons usually takes about 6 to 8 weeks with the pain gradually reduced overtime. The healing period may be affected by degree of injury, age and lifestyle.
You will need to seek medical help if you have:
High impact injury or accident causing substantial pain
Suspicion of fracture
Swelling, warmth and high intensity of pain over injured area
Severe weakness with or without numbness or tingling sensation of the skin
Gradual or sudden onset of unexplanatory pain that is not triggered by trauma or any possible physical stress on the body
A Certified Musculoskeletal Physiotherapist is trained to assess your condition through a series of questions and physical testings before concluding on your diagnosis.
A treatment plan is then decided based on The International Classification of Functioning, Disability and Health (ICF) framework. The framework will factor in not just the patient's health aspect but also the function, level of activity, type of participation, environment and personal factors of the patient which helps the patient reach his/ her rehabilitation goal.
Types of treatment may include but not limited to:
Advice on correct posture and movements
Advice on use of walking aid or orthotics to offload or support injured area
Manual therapy
Soft tissue or deep tissue massage
Supportive taping
Pilates
Light strengthening and stretching exercises
SPORTS INJURY
Sport injury is defined as any injury that occur due to exercising, recreational sports or athletic activities.
1. Ankle injuries
2. Lower back injuries
3. Knee injuries​
4. Groin and thigh strain
5. Shoulder injuries
POST SURGERIES
Orthopaedic surgeries such as:
Spinal surgeries
Ligament reconstruction
Muscle repair
Partial or total joint replacement
Fracture stabilibisation
Breast surgery:
Mastectomy with or without reconstruction
Depending on your condition and surgery, physiotherapy rehabilitation usually starts the next day after an operation even while you are still in the hospital. Physiotherapy session may include:
Assessment on physical function such as getting out of bed, sit to stand or walking ability
Teaching the use of walking aid if needed
Simple exercises to improve movement and swelling
Advice on RICE (Rest, ice, compress, elevate) to reduce swelling
Gentle lymphatic massage to reduce swelling
Upon discharge, Physiotherapy is either conducted at:
Home immediately as Home Physiotherapy
Outpatient clinic between 2nd to 4th week post surgery depending on patient's wound healing and surgeon's recommendation.
A treatment plan is decided based on The International Classification of Functioning, Disability and Health (ICF) framework. The framework will factor in not just the patient's health aspect but also the function, level of activity, type of participation, environment and personal factors of the patient which helps the patient reach his/ her rehabilitation goal.
Types of treatment may include but not limited to:
1. Advice on correct posture and movements
2. Advice on use of walking aid or orthotics to offload or support injured area
3. Manual therapy
4. Soft tissue or deep tissue massage
5. Supportive taping
6. Pilates
7. Strengthening and stretching exercises
The duration of post surgery Physiotherapy depends on a few factors:
Type of surgery
Key hole surgery or open surgery
Type and number of soft tissues involved or extend of the injury
Patient's recovery
Pain intensity
VESTIBULAR REHAB
Vestibular system consist of a vestibular apparatus in our inner ear called the vestibular labyrinth.
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The Vestibular labyrinth picks up the information about our head and body position which the vestibular nerve will then send this information to the brain. The brain interprets the information and sends signal to our eye and postural muscles that maintains our balance and posture.
A vestibular disorder may occur because of damage to the vestibular system. The damage may be due to aging, head injury, brain injury, medicine or diseases. People who suffers from vestibular disorder will usually experience dizziness or spinning sensation known as vertigo.
Vertigo can greatly impact our daily function as it affects our balance and increases risk of fall.
Benign paroxysmal positional vertigo (BPPV)
Labyrinthitis
Vestibular neuritis
Ménière’s disease
Secondary endolymphatic hydrops
Perilymph fistula.
Superior canal dehiscence
Acoustic neuroma
Ototoxicity
Enlarged vestibular aqueduct syndrome
Mal de débarquement
BPPV is the most common vestibular disorder accounting for up to 50% of the dizziness in elderly.
Our Physiotherapy will screen with specified questions to help to differentiate the vestibular disorders. The therapist will then perform appropriate vestibular differential tests to determine the diagnosis.
A treatment plan and goal will be discussed with patient followed by the appropriate treatment
LYMPHATIC DRAINAGE
Lymphatic massage (Manual lymphatic drainage) is a certified massage technique done by a certified lymphoedema therapist that treats swelling in the body.
Other benefits of Lymphatic drainage include:
Reduce swelling due to pregnancy and poor blood circulation
Reduce swelling, lymphoedema, caused by removal of lymph nodes in cancer patients
Improve immune system
Removal of toxic waste in the body
Treats headache
Reduce post liposuction swelling
Our lymphatic system is another system in the body just as important as our blood circulation. It is made up of a network of varying sizes of lymphatic vessels and lymph nodes throughout our body.
The fluid found in the lymphatic system which is known as lymph contains water, fat, waste product, protein and antibodies. Unlike our blood circulation, the function of our lymphatic system is to remove waste product and lymph from the tissue.
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However, the numbers of lymph nodes, pathway and location of the lymphatic vessels may varies in everyone.
Lymphoedema​ usually develops when the lymphatic system is impaired or when the amount of lymph fluid increased far more than what our lymphatic system can cope. Our lymphatic system can be damaged during operation such as when lymph nodes are removed as in the case of cancer spreading to the lymph node or from radiotherapy subsequently. Unfortunately, our lymph nodes does not regrown. Hence, lymphodema is an incurable condition.
The massage works by diverting the lymph from an obstructed region of our body to the lymph nodes in another part of the body. Consistency in this massage has shown to promote the growth of the new lymphatic vessels connecting the obstructed region to the other lymph nodes. However, massage alone is not enough in containing lymphoedema.
Compression bandaging or application of compression stocking or arm sleeve is necessary in the management of lymphoedema.
WOMEN'S HEALTH
Women's health refers to conditions that varies from low back pain to urine incontinence that can arise from pregnancy or after pregnancy. Physiotherapy will be able to help to treat these conditions with professional advice, manual therapy and appropriate exercises.
During pregnancy, our body goes through tremendous change to accommodate the growth of a baby. As we patiently awaits for our newborn, this are the possible physical changes we may anticipate:
Change in our posture​
Centre of gravity shifts forwards​ causing a change in spinal alignment
Stretched and weakened muscles
Upper back muscles
Abdominal muscles​
Gluteal (buttock) muscles
Hamstrings
Pelvic floor muscles (The muscle that holds our bladder and womb in women)
Tight shortened muscles
Neck extensors​
Lower back muscles
Lower back pain
Pelvic pain
Pubic pain
Urine Incontinence
Water retention
Diastasis recti (Separation in abdominal muscles)
Advice on correct posture and movements
Pain relief
Supportive taping
Pilates
Light strengthening and stretching exercises
Kegel exercises with biofeedback/ electrical stimulation ( Urine incontinence)
Manual lymphatic drainage ( A very gentle massage to treat water retention)
Yes. Our Physiotherapist will be able to help you with your musculoskeletal pain that is caused by the physical stress from pregnancy or from caring of your baby after delivery.
However, you may want to consult your obstetrician or doctor first to make sure you are suitable to start exercising.
INCONTINENCE REHAB
Urinary incontinence is defined as the involuntary leakage of urine. A condition that is more prevalent in women than men due to pelvic floor muscles weakness. Urine leakage can happen from a cough, lifting heavy object or just physical exertion. This is known as stress urinary incontinence.
Urinary leakage or urge to pass urine from the sight of a toilet or from the sound of running water is usually urge urinary incontinence or overactive bladder.
It is also possible to have both type of urinary incontinence which is known as mixed urinary incontinence.
In Women
Commonly, the pelvic floor muscle is stretched and weakened during pregnancy by the weight of the baby. This affects the tone of the urethral sphincter, the muscle which controls the retention and release of urine from the bladder. Multiple pregnancies can further weaken this muscle.
In Men
Patients with prostate cancer or benign prostatic hyperplasia (a non-cancerous enlargement of the prostate) may undergo surgery to remove the gland. The operation may subject them to the risk of damage in the genital nerve or urethra, which in turn can weaken this muscle.
Continence rehabilitation is a holistic programme that will assess and treat the possible type of incontinence you may be experiencing. Different type of incontinence will require different type of approach. Our Physiotherapist will be able to assess, diagnose and treat accordingly.
The treatments that you may require:
1) Pelvic floor muscles training
2) Lifestyle modification
3) Dietary advice
4) Physical strengthening
Please read our blog:
Oops! I need to go again.
PILATES
Pilates exercise is a form of low impact exercise that works on core strength, muscular endurance and flexibility of the body. It is usually performed either on the mat or reformer.
Yes. Pilates exercise is a low impact exercise and the exercise can be modify to meet the level of your fitness.
Clinical Pilates as its name would have suggested that it is use clinically to treat population with spinal conditions. It combines the knowledge of movement pattern dysfunction in spinal disorders such as slipped discs or spinal instability with Pilates exercise principle to help patient regain their core strength and slows down recurrence of low back pain.
It is always better to start off with one-on-one session with a Pilates instructor than to join the class straight away. That is crucial for one who already has some form of musculoskeletal pain or injury. However, our Pilates Introductory class is mild and suitable for anyone with no Pilates or exercise background. It is a small class of maximum 8 participants to ensure that you get the necessary adjustment on your posture and form of you movement.
Nonetheless, it is advisable that you check with your doctor if you are unsure if you are physically well to perform any form of exercise.
ELECTROPHYSICAL AGENT
Electrophysical agents are adjuvant treatment that helps to enhance the Physiotherapy manual treatment. It is often not used as the first line of treatment for patient.
The type of electrophysical agents are:
1) Interferential therapy and TENS for pain management
2) Neuromuscular electrical stimulation that helps to improve strength in really weak muscles
3 ) Ultrasound therapy to reduce swelling, scar tissues and pain management
4) EMG biofeedback which is used for activation and strengthening of muscles
5) Spinal traction whereby a distraction force is exerted on the neck or lower back spine to relieve tension in the spinal joints, ligaments and muscles. Conditions like disc herniation, nerve impingement, lumbar stenosis and degenerative disc disease (DDD) may benefit from traction.
