Biomechanics of joint manipulation

Manipulation can be distinguished from other manual therapy interventions such as joint mobilisation by its bio mechanics, both kinetics and kinematics.

Kinetics

Until recently, force-time histories measured during spinal manipulation were described as consisting of three distinct phases: the preload (or prethrust) phase, the thrust phase, and the resolution phase. Evans and Breen added a fourth ‘orientation’ phase to describe the period during which the patient is oriented into the appropriate position in preparation for the prethrust phase.

When individual peripheral synovial joints are manipulated, the distinct force-time phases that occur during spinal manipulation are not as evident. In particular, the rapid rate of change of force that occurs during the thrust phase when spinal joints are manipulated is not always necessary. Most studies to have measured forces used to manipulate peripheral joints, such as the metacarpophalangeal (MCP) joints, show no more than gradually increasing load. This is probably because there are many more tissues restraining a spinal motion segment than an independent MCP joint.

Kinematics

The kinematics of a complete spinal motion segment when one of its constituent spinal joints are manipulated are much more complex than the kinematics that occur during manipulation of an independent peripheral synovial joint. Even so, the motion that occurs between the articular surfaces of any individual synovial joint during manipulation should be very similar and is described below.

Early models describing the kinematics of an individual target joint during the various phases of manipulation (notably Sandoz 1976) were based on studies that investigated joint cracking in MCP joints. The cracking was elicited by pulling the proximal phalanx away from the metacarpal bone (to separate, or 'gap' the articular surfaces of the MCP joint) with gradually increasing force until a sharp resistance, caused by the cohesive properties of synovial fluid, was met and then broken. These studies were therefore never designed to form models of therapeutic manipulation, and the models formed were erroneous in that they described the target joint as being configured at the end range of a rotation movement, during the orientation phase. The model then predicted that this end range position was maintained during the prethrust phase until the thrust phase where it was moved beyond the 'physiologic barrier' created by synovial fluid resistance; conveniently within the limits of anatomical integrity provided by restraining tissues such as the joint capsule and ligaments. This model still dominates the literature. However, after re-examining the original studies on which the kinematic models of joint manipulation were based, Evans and Breen[2] argued that the optimal prethrust position is actually the equivalent of the neutral zone of the individual joint, which is the motion region of the joint where the passive osteoligamentous stability mechanisms exert little or no influence. This new model predicted that the physiologic barrier is only confronted when the articular surfaces of the joint are separated (gapped, rather than the rolling or sliding that usually occurs during physiological motion), and that it is more mechanically efficient to do this when the joint is near to its neutral configuration.

Cracking joints

Main article: Cracking joints

Joint manipulation is characteristically associated with the production of an audible 'clicking' or 'popping' sound. This sound is believed to be the result of a phenomenon known as cavitation occurring within the synovial fluid of the joint. When a manipulation is performed, the applied force separates the articular surfaces of a fully encapsulated synovial joint. This deforms the joint capsule and intra-articular tissues, which in turn creates a reduction in pressure within the joint cavity. In this low pressure environment, some of the gases that are dissolved in the synovial fluid (which are naturally found in all bodily fluids) leave solution creating a bubble or cavity, which rapidly collapses upon itself, resulting in a 'clicking' sound. The contents of this gas bubble are thought to be mainly carbon dioxide. The effects of this process will remain for a period of time termed the 'refractory period', which can range from a few minutes to more than an hour, while it is slowly reabsorbed back into the synovial fluid. There is some evidence that ligament laxity around the target joint is associated with an increased probability of cavitation.

Clinical effects and mechanisms of action

The clinical effects of joint manipulation have been shown to include:

▪   Temporary relief of musculoskeletal pain.

▪   Shortened time to recover from acute back sprains (Rand).

▪   Temporary increase in passive range of motion (ROM).

▪   Physiological effects upon the central nervous system.

▪   No alteration of the position of the sacroiliac joint.

Common side effects of spinal manipulative therapy (SMT) are characterised as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort.

Shekelle (1994) summarised the published theories for mechanism(s) of action for how joint manipulation may exert its clinical effects as the following:

▪   Release of entrapped synovial folds or plica

▪   Relaxation of hypertonic muscle

▪   Disruption of articular or particular adhesion

Unbuckling of motion segments that have undergone disproportionate displacement

Information about Musculoskeletal Disorders

Physiotherapy is clinically effective and cost effective in the management and treatment of musculoskeletal disorders (MSD). MSDs are on

Physiotherapy

Early intervention with physiotherapy can reduce the amount of time people are off sick and are vital in order to prevent an acute problem becoming chronic.

Two government departments in Northern Ireland provided early access to physiotherapy for staff
with musculoskeletal disorders. 80 per cent indicated that physiotherapy had prevented them from going absent and, of those already off sick, over 80 per cent indicated that physiotherapy had shortened their absence. Respondents indicated that the service shortened their absence by an average of six weeks.(1)

West Suffolk hospital trust, Bury St Edmunds, was commended in the Boorman report for having achieved savings of £170,000 through a system of priority referrals to a local Physio for injured staff. For a cost of £21,000 it had achieved a 40 per cent reduction in lost days through sickness absence and savings of £170,000 in the cost of MSDs.

Based on the latest available statistics from the HSE (3) 227,000 people have an MSD of the back, 215,000 of the upper limbs or neck and 96,000 of the lower limbs. Low back pain is the number one cause of long term absence amongst manual workers and MSDs are the most common reason for repeat consultations with GPs, accounting

For up to 30 per cent of primary care consultations.

Self referral

Self-referral to physiotherapy has been proven to be clinically successful with high patient satisfaction as well as cost effective. The self referral pilots that took place across six
NHS England sites between 2006 and 2008 were found to reduce the number of associated NHS
costs, particularly for investigations and prescribing, with 75 per cent of patients who self referred not requiring a prescription for medicines. In addition
there was no increase in demand for services and self-referral reduced work absence amongst patients.

An analysis of self-referral in Scotland found that the average cost of an episode of care was established as £95.48 for a self-referral, £113.24 for a GP-suggested referral and £126.17 for a GP referral. The average cost benefit to NHS Scotland of self-referral was identified as being approximately £2.5 million per annum.

Doncaster and Bassetlaw Trust piloted a successful self-referral Physio service for 6500 staff in
2005. The service was

Made permanent after
an evaluation identified
potential savings of more
than £330,000. It is
used by employees from
all corners of the trust,
and it offers an average
waiting time of 2.8 days.
More than half the users say
they would have taken time off
work if the service were not available.

In Cambridge, self-referral for MSD outpatient services has reduced costs due to less GP use of prescribing and diagnostic tests. 75 per cent of patients who self- referred did not require a prescription for medicines, giving an average saving of £12,000 per GP practice.

Telephone assessment and support

Assessing the severity of a patient’s condition over
the telephone has been found to be very resource efficient. This telephone triage saves patient and physiotherapist time as well as costs and ensures those needing the most urgent treatment are prioritized.

Where appropriate, follow up support by telephone has also been found to be a clinically and cost effective way of enabling patients to self manage their condition, helping to prevent relapses.

An occupational health physiotherapy service used telephone triage and follow up support as part of a program to tackle MSDs experienced by staff of NHS Lothian. Over £300,000 was saved in salaries alone by reducing sickness absence and there was a 74 per cent reduction in recurrence of MSDs nine months following the program

Conclusion

Speedy Access to physiotherapy for people with MSDs is clinically and cost effective for the health service, including GPs, for employers and for society. Physiotherapist has helped to pioneer innovative ways of providing speedy access within existing services.

PHYSIOTHERAPY + SPORT INJURIES

PHYSIOTHERAPY + SPORT INJURIES

Sports injuries are injuries that occur to athletes participating in sporting events. In many cases, these types of injuries are due to overuse of a part of the body when participating in a certain activity. For example, runner's knee is a painful condition generally associated with running, while tennis elbow is a form of repetitive stress injury at the elbow, although it does not often occur with tennis players. Other types of injuries can be caused by a hard contact with something. This can often cause a broken bone or torn ligament or tendon
Injuries are a common occurrence in professional sports and most teams have a staff of Athletic Trainers and close connections to the medical community. Controversy has arisen at times when teams have made decisions that could threaten a players long-term health for short term gain.

Sports injury Classification

Sports injuries can be broadly classified as either traumatic or overuse injuries. Traumatic injuries account for most injuries in contact sports such as Association football, rugby league, rugby union, Australian rules football, Gaelic football and American football because of the dynamic and high collision nature of these sports. These injuries range from bruises and muscle strains, to fractures and head injuries.
A bruise or contusion is damage to small blood vessels which causes bleeding within the tissues. A muscle strain is a small tear of muscle fibers and a ligament sprain is a small tear of ligament tissue. The body’s response to these sports injuries is the same in the initial five day period immediately following the traumatic incident - inflammation.

Sports Injury Signs & Symptoms

Inflammation is characterized by pain, localized swelling, heat, redness and a loss of function.

Mechanism

All of these traumatic injuries cause damage to the cells that make up the soft tissues. The dead and damaged cells release chemicals, which initiate an inflammatory response. Small blood vessels are damaged and opened up, producing bleeding within the tissue. In the body’s normal reaction, a small blood clot is formed in order to stop this bleeding and from this clot special cells (called fibroblasts) begin the healing process by laying down scar tissue.
The inflammatory stage is therefore the first phase of healing. However, too much of an inflammatory response in the early stage can mean that the healing process takes longer and a return to activity is delayed. The sports injury treatments are intended to minimize the inflammatory phase of an injury, so that the overall healing process is accelerated. intrinsic and extrinsic factors.

What Do You Want?

Hey guys,

Just a quick post to you today, All of us here at Therapyworks wanted to know what would you like us to post about next?

We've got a few ideas but would love to hear what you think.

Our next blog post will mostly likely be towards the end of the week, possibly Wednesday or Thursday.

If you could leave us a comment on what you would like us to give you more information on that would be fab.

If you have any questions please leave a comment below or visit our

Facebook - www.facebook.com/TherapyworksLtdPontypridd

Twitter - https://twitter.com/#!/therapyworksltd

Website - www.therapyworks.co.uk/pontypridd

We'd be happy to help you

From all at

Therapyworks

So what is a Physiotherapist?

Todays blog post is going to tell you more about what a physiotherapist is, the training they have had and what to expect when first meeting your Physiotherapist.

so first things first what is a physiotherapist?

The web definition is as follows:

Physical Therapist: therapist who treats injury or dysfunction with exercises and other physical treatments of the disorder.


Not much of an explanation is it. Let me give you our definition of a physiotherapist.

A Physiotherapist is a therapist who helps patients recover from injury and illness. Physiotherapy is a profession, which is very popular in the UK, Europe and Australia.

What is a Physiotherapist?

•    A physiotherapist is a health care professional who specialises in maximising human movement, function and potential.

•    A physiotherapist may work with someone after injury, accident or surgery, or may work to prevent injury for instance with sporting clubs or in the workplace.

•    Physiotherapists work in a wide variety of settings: hospital; private clinics; hospices; nursing homes; a patients own home; the workplace; sports clubs and gyms.

Physiotherapists are the British equivalent of a Physical Therapist

What training does a Physiotherapist have?

•     In July 2005 a law was passed in the United Kingdom protecting the title “physiotherapist” and “physical therapist” restricting its use in the UK to persons who are eligible to register as a physiotherapist with the Health Professions Council.

•    In order to receive a certificate to practice and register with the Health professions council Physiotherapists study for three years to gain a BSc in Physiotherapy. Some universities now also offer an accelerated two year course to students who hold a previous degree in a relevant subject.

•    Once registered with the Health professions council Physiotherapists must maintain a portfolio documenting their continuous professional development, undertaking extra courses and study.

You can check whether your therapist is registered with the HPC on their web site.   

What should I expect if I consult a Physiotherapist? 



First of all the physio will undertake a comprehensive assessment of your problem. This will include asking you a lot of detailed questions about the problem such as how it started, what activities make it better or worse, as well as more general questions about your general health and work, hobbies and sporting activities.
Treatment options depend on the problem that you are having but may include exercises 

to stretch tight structures, strengthen weak ones, improve balance, or change the way you move; hands on mobilisation to move joints; or electrotherapy which is the use of machines such as ultrasound or TENS

I hope you found this helpful and that you now fully understand the term Physiotherapist. Again why not click on the links at the side on this post and come visit our sites. We'd be happy to hear from you.


Also if there is anything you would like to ask, please feel free to leave a comment below and i shall reply to you asap.


TherapyWorks


x

Our Services

Hey Everyone!


I hope you are all doing fine on the first day of February! Hasn't it gone quick.


Anyway today i'm going to blog about all the services we provide here at Therapyworks.

As a client of Therapyworks we want your rehabilitation not only to be a comfortable and enjoyable one, but an effective one too.   

 We are a Physiotherapy led organisation and as such your care will be delivered at all times by a Chartered Physiotherapist who will also be a member of the Health Professions Council (HPC). 

 Your care will be delivered on an individual basis within a private and comfortable environment.  

 We will also endeavour to ensure that you are given an appointment within forty eight hours of first contact with us and that you continue to see the same Physiotherapist throughout you care.

As a practice we specialise in Musculosketelal Physiotherapy and offer many effective methods to treat conditions such as :

• Neck and Back Pain
• Sports Injuries
• Whiplash
• Arthritis 
• Post Surgery Rehabilitation
• Headache
• Post Fracture Rehabilitation

• Ligamant Injuries
• Muscle Injuries
• Work Related Injuries
• Overuse Injuries
• Sciatica 

If you suffer with one of the above then why not give us a call and arrange an appointment. Many people who suffer with these problems find physiotherapy a great help on the road to recovery. Why not give us  call on 01443 841181 we'd be happy to help

It's all about us!

Hello fellow bloggers!


Thank you to all yesterday who came along and read our blog. Today I will be telling you all about Therapyworks and what we do. I hope you find it interesting an can clear up any questions you might have about us here.


ok so lets get started.


First things first did you know that according to the The British Pain Society almost 10 million people suffer with Chronic Pain. Chronic Pain has the power to put your life on hold. As you've probably found, if you suffer with this, simple day to day functions can be daunting, or even impossible - and the impact can be felt in your private and professional life.
Historically, the management of disease, injury, and even childbirth involved long periods of hospitalization, bed rest, and convalescence. Health care practitioners used a narrow disease/impairment-based model in which patients were passive recipients of care. Physical therapists working within such a "rest for recovery" framework developed skills and techniques of which many were passive, some were modality-based, and most were lengthy.

Health care has changed in recent decades. Early activity for recovery of function is now encouraged, and the impairment model has broadened to include psychosocial components. A multidisciplinary team approach now includes the patient as an educated and active participant, and physical therapy treatments emphasize activity. The therapist's role has changed from healer to helper. Therapists help patients address and overcome physical and psychological obstacles, return to activities, and achieve personal goals.

How can physiotherapy help?

Here at Therapyworks, we take an holistic approach to pain. Naturally, as physiotherapists, our first priority is to relieve your symptoms – but we’re just as concerned with the root causes of pain and helping you to prevent (or at least limit) your pain in the future.
At our private physiotherapy clinic, we treat clients with all types of injury, from whiplash to sports or work injuries, through to simple overuse. Using the very latest physiotherapy techniques, we’ll explore every aspect of your pain - then work with you to restore a healthy and active way of life.


Welcome to Therapyworks

Therapyworks is a Physiotherapy service dedicated to providing high quality service to all our clients. Therapyworks has gone from strength to strength -with an impressive list of clients and a well established local support base.


Our Philosophy


Our Philosophy is the relentless pursuit of excellence in physiotherapy. We are dedicated to ensure that our clients receive the best service available. We may be small but we have a perfectly formed team of experts dedicated to delivering you excellence. Our lead physiotherapists are renowned for their experience and quality.


Why come to us?

• Specialist Expertise 
  Physiotherapists at Therapyworks have a wide ranging experience of all medical treatments. Our staff our highly qualified and registered members of the CSP and HPC.
• Convenience Open 5 Days a week with late night appointments on a Tuesday and Thursday 
• Flexibility
  We aim to help provide a service that fits in with your lifestyle.
• Speed of Service 
  We aim to provide an appointment option within 48 hours
• Education & Advice 
  Understanding the problem is half the battle, understanding what to do and why is the key!
• Individual Attention & Treatment 
  Our success is based upon our individually tailored treatment approach. Using current research we identify, treat and inform how to resolve it for good.
  
  
  Therapyworks has created an environment that looks and feels professional.

  
  

  Relax in the knowledge that we will look after you!

  
  

  And thats us. Why not click on one of the links below and visit our :-

  Website - Website

  Twitter - Twitter

  Facebook - Facebook

  
  

  If you have any questions please feel free to ask, after all we are here to help.

  
  

  Look out for our next posting telling you all about the kind of treatment we do here at Therapyworks.

  
  

  Until next time.

  
  

  
  

  
  

Hello There

Hello! My name is vicky and i work here at Therapyworks Pontypridd, We are new to this but me personally not. I have a few blogs here myself so i thought why not set one up for my workplace

I'm the administer here at Therapyworks Pontypridd and i look after the office. I'll be blogging things about the company and sending you links to our websites and other blogging sites.

I hope you will enjoy, our next post will be giving you more information about TherapyWorks and what we do here!

Until next time

Vicky Cross
Therapyworks Pontypridd