Back-in-Rehab is an innovative rehabilitation approach for the treatment of chronic low back pain. You are placed at the centre of your own rehabilitation and are guided on how to move, feel, pace and exercise in order to reduce symptoms. The Back-in-Rehab Programme targets five key components of rehabilitation, specific to each individual. It draws on 30 years of experience and has taken over 3 years to develop. Contact the clinic for more information.
What is extracorporeal radial shockwave therapy
Extracorporeal Shockwave Therapy (ESTW) is a non-invasive technology that delivers intense sound waves to afflicted areas of the body and aids recovery. It has become widely accepted in clinical practice for the treatment of chronic soft tissue injuries. NICE (the National Institute for Health and Care Excellence) has reviewed ESTW and approved its use in the treatment of six conditions.
How does it work
The treatment produces an inflammatory response and puts the cells into repair mode. The body responds by increasing metabolic activity around the site. This stimulates and accelerates the healing process, promoting the remodeling of dysfunctional collagenous tissues, such as tendinopathies, trigger points and muscle strains. Pain is diminished through neurological mechanisms. Shockwaves can also be used to break down scar tissue or calcification in a tendon.
Common treatments (but not limited to):
- Achilles Tendinopathy
- Plantar Fasciitis
- Heel spurs
- Patellar Tendinopathy
- Osgood Schlatter disease
- Greater trochanter pain syndrome
- Shin splints
- Tennis or golfer's elbow
- Periarticular shoulder pain
- Calcifying tendinopathy of the shoulder
- Rotator cuff tendinopathy
- Adductor tendinopathy syndrome
- Pes-Anserinus tendinopathy
- Rotator cuff tendinopathy without calcification
- Carpal Tunnel Syndrome
- Adductor tendinopathy syndrome
- Pes-Anserinus tendinopathy syndrome
- Peroneal tendinopathy
- Foot and ankle tendinopathies
- Dupuytren disease
- Plantar fibromatosis (Ledderhose disease)
- De Quervain disease
- Trigger finger
- Low Back Pain (Facet joint syndrome)
What are the benefits of Shockwave Treatment
This therapy stimulates blood circulation and metabolism in the impact area which in turn accelerates the body’s own healing processes. The shockwaves can also break down calcification and scar tissue. There is often an immediate reduction of pain and improved range of motion.
How long does the treatment last
Approximately 2000 shocks (usually less than 5 minutes) are administered per treatment area. Some conditions require more shocks and duration, depending on severity and chronicity.
Shockwave treatment is £10 in addition to your consultation fee. If you are insured you are advised to check whether your insurance company will cover the cost of this treatment.
How many treatments will I need
Normally three to five treatments are necessary at weekly intervals. There is a small possibility that 2 or more additional treatments may be necessary. It is important that any side effects have resolved before the next treatment. A gap of 4 weeks after the last treatment is needed to assess response.
Does the treatment hurt
It may be uncomfortable and most people are able to tolerate it. If you cannot tolerate it, adjustments on the machine can decrease the pressure you feel.
What should I do if I am in pain after the treatment
The shockwave will trigger an inflammatory response, which is the body's natural process of healing. For this reason, do not use anti-inflammatory medications. Do not use ice on the area. The pain should subside within 24 hours. See your GP or Pharmacist for pain relief medication if required.
What if I feel fine after the treatment
Even if you feel fine, we recommend decreased activity for 48 hours following the treatment.
What is the success rate of this kind of treatment?
Successful treatment is considered as having at least a 75% reduction in pain within 3 months. Worldwide, success rates are around 80 to 90%.
What if it doesn't work for me
Although the short-term effects alone are exceptional, the long-term benefits of this treatment may take up to 3-4 months. If after this time there has not been any marked improvement, you should see your doctor for further treatment options.
Contraindications and Precautions
- Pregnancy or trying to conceive
- Application over open growth plates
- Over the heart, lung, eyes, brain, major blood vessels, major nerves, implanted devices or implanted hormones
- Over malignant tumours
- Infection in the local area, open wounds, clotting disorders, nerve or circulation disorders
- A history of achilles tendon rupture or plantar fascia rupture
- A steroid injection into the affected area in the previous 6 weeks
Side effects include: (These side effects generally abate after 5 to 10 days.)
- Reddening of the skin
- Pain and bruising 5%
- Less common complications included swelling, migraine, syncope, nausea and dizziness.
- You may also experience some transient side effects such as local red spots (petechiae) and numbness. All of these should resolve in a few days.
Many people are helped by acupuncture every year.
A chemical-free, up-to-date and safe way is through western evidence-based acupuncture by a qualified health professional. The AACP, as the largest acupuncture organisation in the UK, represents Chartered Physiotherapists who are qualified to use acupuncture as part of their treatments. By managing a patient’s pain, acupuncture often enhances physiotherapy treatments, such as exercise, therefore aiding recovery.
Acupuncture is supported by scientific research and clinical evidence and may benefit a range of conditions, such as Low Back Pain, Osteoarthritis, Tension-type Headaches, Migraines, Anxiety and others.
What is acupuncture?
Acupuncture involves the insertion of very ﬁne stainless steel needles into the skin. It has been used in China for over 2,000 years and increasingly in Western medicine with a growing body of scientiﬁc evidence and clinical research supporting its effectiveness. Acupuncture may be used alongside physiotherapy treatment modalities to treat a wide range of common health problems and to reduce pain. For example in September 2012, NICE recognised acupuncture’s beneﬁts for migraines and tension-type headaches. It can also be used when other more conventional treatments have failed.
How does acupuncture work?
Acupuncture stimulates the body to produce endorphins and oxytocin, its own pain and stress-relieving chemicals. lt may promote sleep by stimulating the release of melatonin in the body and may encourage a sense of well-being by stimulating the release of serotonin. Acupuncture also stimulates nerve ﬁbres to block out pain signals and helps to reduce the sensitivity of tender points in the body. What happens when I see my physiotherapist for acupuncture? You should aim to have something to eat in the 2 hours before your treatment. This will help reduce the risk of you feeling faint during your session by keeping your sugar levels up. When you ﬁrst see your physiotherapist, he or she will take your full medical history and ask you about your current health problems. You may be asked to complete an "Acupuncture in Physiotherapy Consent Form”. The number of needles used will vary according to your condition and symptoms, but typically will range from 1 to 10 in your ﬁrst session.
The needles are inserted through the skin either at the sites where you feel pain, away from the pain or a combination of both. The needles are usually left in for as little as a few seconds or for up to 30 minutes. During the treatment, your physiotherapist may stimulate the needles by gently rotating them. The needles may also be stimulated using electrical impulses, this is called electro-acupuncture. The needles are removed at the end of the session. You will then be asked to rest for a few minutes before you leave. How many sessions will I have? Some people may require just one or two treatments and some a course of 6-10 treatments, whereas others may want to receive occasional treatments as and when required. The overall number of treatment sessions required will depend on you, your condition and your physiotherapist’s assessment. The frequency of treatments will be guided by how you respond to the treatment. It is generally clear after around 3 sessions whether or not acupuncture will beneﬁt you and if the treatment should be continued. How long until I see an improvement in my condition? Different people respond in different ways and at different rates. Some people may feel immediate relief of their symptoms whilst others may see a gradual improvement after a few treatments whereas some may see no beneﬁt. Some people may ﬁnd that their condition/symptoms ﬂare up for up to 24 hours after the treatment but then see a marked improvement. Although acupuncture can help reduce pain, particularly when other more conventional treatments have failed, it does not work for everyone.
Can anyone have acupuncture?
There are certain health conditions that may stop you receiving acupuncture or mean that the treatment should be used with caution. lt is important to let your physiotherapist know if you:
- have ever experienced a ﬁt, seizure, faint or if you have epilepsy
- have a pacemaker or any other electrical implant
- have a bleeding disorder e.g. haemophilia
- are taking anti-coagulants or any other medication
- have any heart valve problems
- have any risk of active infections
- are pregnant or trying to conceive
- have a known metal allergy — speciﬁcally to stainless steel
- have a needle phobia
- have a known infection or poor skin condition in the area to be treated
- have a deﬁcient or weakened immune system
- have diabetes
- have low blood pressure
- have been prescribed any medicine
- have cold/ﬂu symptoms or feel generally unwell
Does acupuncture hurt?
Acupuncture should not be painful. The needles used are approximately the width of human hair, so having acupuncture does not feel the same as having an injection. When needles are inserted, you may feel a temporary, sharp pricking sensation. During the treatment itself, you may have a feeling of warmth or ‘fullness’, heaviness, pins and needles, numbness, tension around the needle, or a mild ache or discomfort.
You may also feel a little light-headed or relaxed. It should not feel unpleasant. These are signs that your body is reacting to the acupuncture. Alternatively, you may not feel the needle at all.
Are there any side effects to acupuncture?
Any side effects tend to be mild and short-lived. They may include: mild bleeding, bruising, mild pain/aggravation of symptoms, drowsiness, dizziness and nausea. lf you continue to feel tired after a treatment, it is recommended
that you do not drive or operate machinery. If you have, or are concerned about any possible side effects, please speak to your physiotherapist.
ls acupuncture safe?
Acupuncture is a safe treatment when administered by a competent AACP-registered chartered physiotherapist. This is because of the strict safety and hygiene guidelines that AACP members adhere to and the initial training and continued professional development that is required in order to remain an AACP member. The more common side effects are exceptionally minor in nature and pose very little risk. More signiﬁcant side effects are exceptionally rare. Your AACP-registered acupuncture physiotherapist is also bound by a Code of Members’ Professional Values and Behaviour through the Chartered Society of Physiotherapy (CSP) and is regulated by the Health and Care Professions
Council (HCPC). The needles used by your physiotherapist are individually packaged, sterile and disposed of after one use. They may also be supplied in guide tubes for easy insertion which means that there is no risk of anything touching the needle during the process.
from LASER WORLD (Swedish LASER Medical Society)
Q: What is laser therapy?
A: Laser therapy or Laser Phototherapy is a method where light from a laser is applied to tissue (or cells in culture) in order to influence cell or tissue functions with such low light intensity that heating is negligible. The effects achieved are hence not due to heating but to photochemical or photo-biologic reactions like the effect of light in plants. The lasers used are normally called therapeutic lasers or medical lasers. This is in contrast to the use of lasers in surgery and for aesthetic purpose where strong lasers are used and where the biologic effects (cutting, evaporating, coagulating) are based on heat development from the absorption of strong light, i.e. burning glass effect.
Q: Is laser therapy scientifically well documented?
A: Basically, yes. There are more than 130 double-blind positive studies confirming the clinical effect of LLLT. More than 3000 research reports are published. Looking at the limited LLLT dental literature alone (370 studies already in 1999), more than 90% of these studies do verify the clinical value of laser therapy. About 250 papers are annually published in peer reviewed scientific papers.
Q: Can LLLT cause cancer?
A: The answer is no. No mutational effects have been observed resulting from light with wavelengths in the red or infra-red range and of doses used within LLLT.
Q: Are there any contraindications?
A: There are no medical contraindications. In most countries there are legal contraindications, i.e. you should not treat cancer or some other serious diseases. Pregnancy is not a contra indication if treatment is done with common sense. Pacemakers are electronic and are not influenced by light. The most valid contraindication is possible lack of adequate medical treatment.
Q: Does the coherence of the laser light disappear when the light is scattered in the tissue?
A: No. The length of coherence, though, is shortened. Through interference between laser rays in the tissue, very small "islands" of more intense light, called speckles occur. These speckles will be created as deep as the light reaches in the tissue and within a speckle volume, the light is partially polarized. It is easy to show that speckles are formed rather deep down in tissue and the existence of laser speckles prove that the light is coherent.
Further information from THOR Laser