MAR
15th
15th
Steroid injections can be administered into an inflamed joint (intra-articular injection) or into inflamed tissue near to a joint like a ligament attachment or tendon sheath (peri-articular injection). The steroid injection will reduce inflammation, swelling and pain within the area and thereby help reduce the healing time.
The steroids we use are Hydrocortisone, Kenalog and Depo-medrone. We also use a local anaesthetic (Lidocaine or Bupivacaine) to produce a suitable numbing down of the area being injected.
The steroid is delivered in a slow release form. Once it has been injected it starts working almost immediately but it usually takes up to 48 hours before there is a significant improvement in your symptoms. The improvement usually continues for up to about 14 days though patients often report a further gain over the following 4/52.
The commonest injections we carry out are to and around the shoulder area. These include tendon injections to the rotator cuff, intra-articular injection for frozen shoulders and arthritic pain and to the shoulder bursa for impingement problems.
Tennis and golfers elbow are another group of conditions that respond well to
peri-articular injections after a course of deep frictional massage and stretching.
De Quervains teno-synovitis of the thumb and trigger finger both respond well to local infiltration of the tendon sheath, as does the joint at the base of the thumb and the dorsal ganglions around the wrist.
The various bursa around the hip joints can often be settled down with a course of electrotherapy and selective soft tissue stretching along with an appropriately timed steroid injection.
We have also been having good results around the knee with joint and bursa aspiration followed by a suitably placed steroid injection.
Steroid injections are a useful adjunct to deep ultrasound and soft tissue stretching for plantar faciitis and chronic ligament strains around the ankle.
In the vast majority of cases one injection is all that is needed to relieve symptoms, however, a second and occasional a third injection is sometimes required.
There are far fewer side effects from the correct use of injected steroids as opposed to when using oral anti-inflammatory medication. Here at the clinic we are always very careful to select the lowest dose possible to produce a suitable improvement.
We liaise closely with your own doctor as to the suitability of injection therapy in the management of any musculo-skeletal disorder. If you have any concerns with having an injection as part of your treatment, Iain would be very happy to discuss these with you.
Some of the more common side effects include:-
Anaphylaxis is an allergic response to the injection. Although extremely rare it is potentially serious. Injections are only carried out at our York Bridge Site where we have a full medical team trained in its management and we carry the full range of anti-anaphylactic drugs.
Infection can complicate an injection procedure. Injections are carried out using a non- touch aseptic technique. The steroid injection may lower the auto-immune response locally allowing an infection already present in the body to attack the weakened area. For this reason we do not carry out injections on patients who are feeling unwell or just getting over an infection i.e. chest infection or urinary tract infection. For your safety we may choose to re-schedule a planned injection appointment.
There can be a slight increase in symptoms for first 24 hours. This is known as post injection flare.
Steroid injections can cause a temporary upset to the normal diabetic control and it is always a good idea to be vigilant of this if your diabetic control is unstable. There have also been cases of temporary increase of blood pressure.
Steroids can interfere slightly with the normal hormonal levels in the body. This can manifest in facial flushing often experienced the following morning. It is rare for this to last more than a few hours. Minor disturbances of the menstrual cycle in females are less common and will self-correct by the end of the next full cycle.
Steroid injections can cause slight alterations in the sub-cutaneous skin pigmentation and also atrophy in the subcutaneous fat layer. Very few injections are administered so close to the skin layer that this is likely to be a problem.
Remember that to date we have carried out over 1000 successful injections since 2003 with no complications. You could be our next success ?!
MAR
25th
25th
What is Pilates?
The Pilates method of training is based on the original works of German born Joseph Pilates who designed a series of exercises that used both physical and mental techniques to condition the body.
His method of exercise was devised for actors, dancers and athletes. In the 1920’s he used his studio in New York to run exercise programmes to help build strength, improve posture and increase flexibility.
In recent years Pilates has gone from being virtually unknown to becoming popular in studios, health clubs and private classes.
What is Modern Pilates?
Modern Pilates brings his work into the 2st Century by using all the latest research and knowledge we have about safe and effective exercise.
Developed by physiotherapists and fitness experts, Modern Pilates classes aim to re-balance the body by improving posture, muscle tone, flexibility and core stability.
The slow and controlled approach to exercise that Modern Pilates adopts can also help to relieve stress and tension, help with back problems, assist in injury rehabilitation and improve body awareness.
Who is Modern Pilates suitable for?
Modern Pilates is suitable for all ages and abilities and is particularly recommended for the
following :-
Back and neck problems
Poor abdominal tone
Recovery from musculo-skeletal injury
Osteoporosis
Pelvic floor problems
Stress
Poor posture
ME (myalgic encephalisis)
MS (multiple sclerosis)
Following childbirth
Modern Pilates classes are ideal for the first time exerciser, clients returning to exercise after injury or childbirth and for those who live a busy and stressful lifestyle.
Where can I find out more about Pilates?
We would recommend you discuss your Pilates requirements with Janet Butler who is an Advanced Pilates Instructor, having completed an extensive training taught by physiotherapists.
We have worked closely with Janet since 1993 firstly as a fitness instructor and more recently as an Advanced Pilates Instructor. We have found Pilates to be of great benefit to all our patients particularly those recovering from neck and back pain helping them to regains their optimum flexibility and postural control.
Janet has suffered from back pain herself following years of teaching high impact exercise and knows firsthand of the considerable benefit of the Modern Pilates method of exercise.
Modern Pilates – Educating Minds to Strengthen Bodies
Why not give Janet a call on 01524 833154 or 07968 372 039
or check out her website
www.janetbutlerpilates.co.uk
JUL
28th
28th
We are pleased to be able to inform you that this practice has been recognised as an Approved Physiotherapy Provider in the newly formed BUPA Physiotherapy Network.
Our Clinic Provider Number is: - 80009840, you may be asked for this when authorising your treatment with Bupa. All our Physiotherapists (Carol Forrest, Iain Briggs and Helen Seward) are covered under this agreement and provider number.
This means that payment for your treatment fees will be paid by Bupa directly to us, but it also means that there are a few new pieces of information that we will need from you.
In short we need you to provide us with:-
The name of the policyholder (if different to the patient)
The policy number
The authorisation code that you will need to have obtained from Bupa before treatment can commence.
The requirements under the new Bupa Physiotherapy scheme make this information necessary.
In addition you need to be sure that your policy covers you. This is because, although we submit invoices directly to BUPA, we will have to seek payment from you for any amount not covered under the BUPA policy e.g. if there is an excess. We feel it is important that you are aware of this commitment at the beginning of your treatment.
JUL
22nd
22nd
Whiplash can be caused by a road traffic accident (RTA) or sustained whilst participating in a variety of sports. It is commonly caused when the neck is jolted suddenly from behind and then recoils in a forward direction. This is the typical onset in a car accident where there is a rear end shunt. It may also happen in the opposite direction if you are unlucky enough to run into the vehicle in front.
With our roads getting busier ever day more and more of us are involved in road traffic accidents. It is estimated that 1 in 200 will suffer from whiplash at some time in our lives. If you follow a few simple guidelines in the early stages following a whiplash type injury you can really take control of your symptoms and help yourself to a speedy recovery.
A whiplash is rarely serious, however, there a few occasions when you should be checked over by your GP or nearest Accident and Emergency Unit. If you are experiencing any of the following symptoms or have been in a major accident we would advise you make an appointment to see your GP before seeking the help of a Chartered Physiotherapist. These include:- have severe neck pain, loss of consciousness, have a severe headache, disturbed vision, drowsiness, confusion, nausea, vomiting, balance problems or pain with numbness or pins and needles in your arms.
It is normal to feel under some stress and anxiety following a whiplash injury but remember that being in pain does not mean that you have a major problem. It is important to stay as active as possible and carry on with every day normal life. Try and stay at work and carry on with hobbies. Let your employer know that you have had an accident and they will be more understanding and may be able to offer a lighter work load for a few weeks.
To help you carry on normally it is important to control the pain adequately. This can be done with the help of some over the counter pain killers. We do not recommend the use of anti-inflammatories in these early weeks as they have been shown to slow the healing process even though they do help control pain. Pain can be felt almost immediately after a whiplash injury, however, it is quite common for it to come on more slowly over the first 48 hours. This is as the inflammation builds up. This is nothing to worry about and is part of the normal cascading inflammatory process that is in fact essential to normal healing
If your pain is not controlled we would recommend seeing your GP who would be able to prescribe a stronger combination of drugs as appropriate.
Please remember that by controlling your pain effectively it will help you remain active and stop your joints from stiffening up. Hot or cold packs are also very useful in helping to control your pain and we would recommend trying either to see which helps you the most.
If your pain is not settling and you neck remains stiff after a week following the above advice we would recommend having an assessment with a Chartered Physiotherapist who is specialised and experienced in treating whiplash disorder. They will carry out a thorough examination of your injury and give you education and advice specific to your problem.
Physiotherapists will also use a variety of other treatments to help control your pain and to get you moving again. Massage may be used to reduce tension and pain around your neck muscles. Electrotherapy or acupuncture may be used to help reduce your pain. Joint mobilisation and manipulation have been shown to be particularly helpful when used soon after the whiplash injury to restore normal movement.
Please remember that if you have been involved in an accident and have sustained a whiplash injury you can speed up your recovery by following a few simple rules.
It is usual to experience some pain and discomfort after your injury but this does not normally mean you have sustained a serious injury.
Get your pain under control with some over the counter analgesia. Use hot packs or wheat bags as well.
Take care of your neck posture and keep your neck moving by gently turning it to one side a few times then to the other.
If your pain is not lessening and your movements remain restricted after 7-10 days consider having a thorough assessment by one of our team and let us help speed up your recovery.
Please remember be positive and stay active.
APR
8th
8th
Pain is often a sign that you are ill (e.g. appendicitis), or that an area of your body is injured (e.g. broken arm). However, sometimes people have pain even though an injury or illness has fully healed up.
An understanding of the healing process can help us to work out the best way to treat healing or healed tissue. It can also help us to see some of the reasons why we may feel stiffness even years after injury/operations.
Unlike a machine the human body can heal itself. With few exceptions every kind of tissue heals in the same way e.g. bone heals by making new bone, ligaments/muscles/skin heal with gristle (scar tissue).
Healing begins immediately after as injury has taken place, and there are several different stages of healing.
1) Bleeding - - this stage lasts about 10 minutes. Blood vessels are damaged whenever tissue is damaged. Bleeding soon stops as the blood clots. The blood can spread out under the skin (i.e. forms a bruise).
2) Inflammation and Swelling - this stage lasts up to 10 days. Within 10 mins of injury inflammation begins. The blood supply to the area is increased and chemicals are released, causing the area to go red and feel hot. At the same time a fluid called serum (which comes from the blood) builds up. Serum is a thick, sticky, yellow fluid which contains protein. This protein will eventually form scar tissue.
The body tends to produce so much serum that it causes swelling e.g. sprained ankle. As serum is sticky, it binds the tissues in the injured area so that they cannot move easily and feel stiff.
Consequently, during this stage of healing it is important to gently move the area to minimise stiffness and swelling, and to help the serum to be absorbed once it has done its job. Movement can be started very gently, with frequent rest periods, and gradually built up.
3) Repair - begins 2-3 days after injury and continues for 3 months. The protein in the serum joins together to form scar tissue, which repairs the gaps left by the injury. From 3 weeks after the injury the scar tissue begins to contract and tighten. It is therefore important to stretch the healing tissue to increase its elasticity and strength.
Unfortunately, healthy tissue can become glued to the serum making the area stiff and tight so it is important to keep moving.
4) Remodelling - 3 months onwards. The scar tissue changes, for example a scar on the skin turns from purple to white. Movement of the area helps the process of remodelling and helps to stretch and strengthen the scar tissue.
5) Contraction - starts at 2 months and is ongoing
The scar tissue tightens and shortens. It continues to occur as the years go by.
However, it is never too late to stretch the scar tissue and make it more flexible and supple.
In summary: Most tissues heal by making scar tissue, and this process is complete by 3 months. There is usually some sensitivity left within the tissues. However, healed but scarred tissue can become less sensitive once it is stronger and more elastic.
Different tissues in the body heal at different rates. It depends on the site and size of the injury, the blood and nerve supply to the tissue and the age of the person.
So, if your body has healed up properly, there is no need to think it is damaged or fragile. Gentle exercises and getting back to everyday activities (but pacing it) is good for you.
