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Thinking about trying physiotherapy for endometriosis pain? Here’s what to expect

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/peter-stubbs-1531259">Peter Stubbs</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/caroline-wanderley-souto-ferreira-1563754">Caroline Wanderley Souto Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a></em></p> <p>Endometriosis is a condition that affects women and girls. It occurs when tissue similar to the lining of the uterus ends up in other areas of the body. These areas <a href="https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656">include</a> the ovaries, bladder, bowel and digestive tract.</p> <p>Endometriosis will <a href="https://endometriosisaustralia.org/understanding-endometriosis/">affect</a> nearly one million Australian women and girls in their lifetime. Many high-profile Australians are affected by endometriosis including <a href="https://www.endofound.org/bindi-irwin-shares-her-endometriosis-story-in-detail-as-she-prepares-to-receive-endofounds-blossom-a">Bindi Irwin</a>, <a href="https://www.endofound.org/actress-sophie-monk-reveals-endometriosis-diagnosis">Sophie Monk</a> and former Yellow Wiggle, <a href="https://endometriosisaustralia.org/emma-watkins-ambassador/">Emma Watkins</a>.</p> <p><a href="https://www.sciencedirect.com/science/article/pii/S0092867421005766">Symptoms</a> of endometriosis include intense pelvic, abdominal or low back pain (that is often worse during menstruation), bladder and bowel problems, pain during sex and infertility.</p> <p>But women and girls wait an average of <a href="https://www.epworth.org.au/newsroom/reducing-time-to-an-endometriosis-diagnosis">seven years to receive a diagnosis</a>. Many are living with the burden of endometriosis and not receiving treatments that could improve their quality of life. This includes physiotherapy.</p> <h2>How is endometriosis treated?</h2> <p>No treatments cure endometriosis. Symptoms can be reduced by taking <a href="https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/treatment">medications</a> such as non-steriodal anti-inflammatories (ibuprofen, aspirin or naproxen) and hormonal medicines.</p> <p>Surgery is sometimes used to diagnose endometriosis, remove endometrial lesions, reduce pain and improve fertility. But these lesions can <a href="https://pubmed.ncbi.nlm.nih.gov/39098538/">grow back</a>.</p> <p>Whether they take medication or have surgery, many women and girls continue to experience pain and other symptoms.</p> <p>Pelvic health physiotherapy is <a href="https://australian.physio/inmotion/physiotherapists-can-help-endometriosis">often recommended</a> as a non-drug management technique to manage endometriosis pain, <a href="https://www1.racgp.org.au/ajgp/2024/january-february/endometriosis">in consultation</a> with a gynaecologist or general practitioner.</p> <p>The goal of physiotherapy treatment depends on the symptoms but is usually to reduce and manage pain, improve ability to do activities, and ultimately improve quality of life.</p> <h2>What could you expect from your first appointment?</h2> <p>Physiotherapy management can differ based on the severity and location of symptoms. Prior to physical tests and treatments, your physiotherapist will comprehensively explain what is going to happen and seek your permission.</p> <p>They will ask questions to better understand your case and specific needs. These will include your age, weight, height as well as the presence, location and intensity of symptoms.</p> <p>You will also be asked about the history of your period pain, your first period, the length of your menstrual cycle, urinary and bowel symptoms, sexual function and details of any previous treatments and tests.</p> <p>They may also assess your posture and movement to see how your muscles have changed because of the related symptoms.</p> <p>They will press on your lower back and pelvic muscles to spot painful areas (trigger points) and muscle tightness.</p> <p>If you consent to a vaginal examination, the physiotherapist will use one to two gloved fingers to assess the area inside and around your vagina. They will also test your ability to coordinate, contract and relax your pelvic muscles.</p> <h2>What type of treatments could you receive?</h2> <p>Depending on your symptoms, your physiotherapist may use the following treatments:</p> <p><strong>General education</strong></p> <p>Your physiotherapist will give your details about the disease, pelvic floor anatomy, the types of treatment and how these can improve pain and other symptoms. They might <a href="https://pubmed.ncbi.nlm.nih.gov/38452219/">teach you about</a> the changes to the brain and nerves as a result of being in long-term pain.</p> <p>They will provide guidance to improve your ability to perform daily activities, including getting quality sleep.</p> <p>If you experience pain during sex or difficulty using tampons, they may teach you how to use vaginal dilators to improve flexibility of those muscles.</p> <p><strong>Pelvic muscle exercises</strong></p> <p>Pelvic muscles often contract too hard as a result of pain. <a href="https://www.physio-pedia.com/Pelvic_Floor_Exercises">Pelvic floor exercises</a> will help you contract and relax muscles appropriately and provide an awareness of how hard muscles are contracting.</p> <p>This can be combined with machines that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843943/">monitor muscle activity or vaginal pressure</a> to provide detailed information on how the muscles are working.</p> <p><strong>Yoga, stretching and low-impact exercises</strong></p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/27869485/">Yoga</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/37467936/">stretching and low impact aerobic exercise</a> can improve fitness, flexibility, pain and blood circulation. These have <a href="https://pubmed.ncbi.nlm.nih.gov/28369946/">general pain-relieving properties</a> and can be a great way to contract and relax bigger muscles affected by long-term endometriosis.</p> <p>These exercises can help you regain function and control with a gradual progression to perform daily activities with reduced pain.</p> <p><strong>Hydrotherapy (physiotherapy in warm water)</strong></p> <p>Performing exercises in water improves blood circulation and muscle relaxation due to the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049052/">pressure and warmth of the water</a>. Hydrotherapy allows you to perform aerobic exercise with low impact, which will reduce pain while exercising.</p> <p>However, while hydrotherapy shows positive results clinically, scientific studies to show its effectiveness studies <a href="https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001611112">are ongoing</a>.</p> <p><strong>Manual therapy</strong></p> <p>Women frequently have small areas of muscle that are tight and painful (trigger points) inside and outside the vagina. Pain can be temporarily reduced by <a href="https://pubmed.ncbi.nlm.nih.gov/37176750/">pressing, massaging or putting heat on</a> the muscles.</p> <p>Physiotherapists can teach patients how to do these techniques by themselves at home.</p> <h2>What does the evidence say?</h2> <p>Overall, patients report <a href="https://www.wmhp.com.au/blog/endo-story">positive experiences</a> pelvic health physiotherapists treatments. In a <a href="https://pubmed.ncbi.nlm.nih.gov/37176750/">study of 42 women</a>, 80% of those who received manual therapy had “much improved pain”.</p> <p>In studies investigating yoga, one study <a href="https://pubmed.ncbi.nlm.nih.gov/27869485/">showed</a> pain was reduced in 28 patients by an average of 30 points on a 100-point pain scale. Another study showed yoga was beneficial for pain in <a href="https://pubmed.ncbi.nlm.nih.gov/27552065/">all 15 patients</a>.</p> <p>But while some studies show this treatment <a href="https://pubmed.ncbi.nlm.nih.gov/36571475/">is effective</a>, a review <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740037/">concluded</a> more studies were needed and the use of physiotherapy was “underestimated and underpublicised”.</p> <h2>What else do you need to know?</h2> <p>If you have or suspect you have endometriosis, consult your gynaecologist or GP. They may be able to suggest a pelvic health physiotherapist to help you manage your symptoms and improve quality of life.</p> <p>As endometriosis is a chronic condition you <a href="https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&amp;q=10960">may be entitled</a> to five subsidised or free sessions per calendar year in clinics that accept Medicare.</p> <p>If you go to a private pelvic health physiotherapist, you won’t need a referral from a gynaecologist or GP. Physiotherapy rebates can be available to those with private health insurance.</p> <p>The Australian Physiotherapy Association has a <a href="https://choose.physio/find-a-physio">Find a Physio</a> section where you can search for women’s and pelvic physiotherapists. <a href="https://endometriosisaustralia.org/">Endometriosis Australia</a> also provides assistance and advice to women with Endometriosis.</p> <p><em>Thanks to UTS Masters students Phoebe Walker and Kasey Collins, who are researching physiotherapy treatments for endometriosis, for their contribution to this article.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236328/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/peter-stubbs-1531259">Peter Stubbs</a>, Senior Lecturer in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/caroline-wanderley-souto-ferreira-1563754">Caroline Wanderley Souto Ferreira</a>, Visiting Professor of Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/thinking-about-trying-physiotherapy-for-endometriosis-pain-heres-what-to-expect-236328">original article</a>.</em></p> </div>

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Physio ‘dry needling’ and acupuncture – what’s the difference and what does the evidence say?

<p>Physiotherapists are increasingly offering needling therapies in addition to their standard care. Many Australian <a href="https://australian.physio/research/prf/translation/five-facts-about-acupuncture-and-dry-needling-musculoskeletal-pain" target="_blank" rel="noopener">physiotherapists</a> in private practice now offer dry needling or Western medical acupuncture as part of a treatment approach.</p> <p>Is it just a fad or does science support it?</p> <h2>Needling, three ways</h2> <p>Physiotherapists can be trained to use dry needling, Western acupuncture and/or traditional acupuncture.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/23801002/" target="_blank" rel="noopener">Dry needling</a> involves penetrating the skin with needles to altered or dysfunctional tissue in order to improve or restore function. This often involves needling muscle trigger points to activate a reflexive relaxation of the muscle.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/28739020/" target="_blank" rel="noopener">Western acupuncture</a> uses traditional needling <a href="https://www.sciencedirect.com/science/article/pii/S2005290110600143" target="_blank" rel="noopener">meridians</a> (the ancient idea of energy channels through the body) and trigger points. But these ideas are applied to Western understandings of anatomy. In Western acupuncture, points are stimulated to create local tissue changes, as well as spinal and brain effects. The goals is to trigger pain-relieving chemicals, muscle activation or relaxation.</p> <p>Even though traditional acupuncture points are used with this style of needling, Western acupuncture is not viewed as traditional Chinese medicine.</p> <p><a href="https://healthtimes.com.au/hub/pain-management/44/research/kk1/acupuncture-for-pain-management/1581/" target="_blank" rel="noopener">Traditional acupuncture</a> uses meridian lines or other points based on traditional Chinese medicine assessment methods and approaches.</p> <p>All physiotherapists trained in either acupuncture or dry needling meet safety standards which are viewed as within scope by the <a href="https://www.ahpra.gov.au/" target="_blank" rel="noopener">Australian Health Practitioners Regulatory Agency</a> and the <a href="https://www.physiotherapyboard.gov.au/" target="_blank" rel="noopener">Physiotherapy Registration Board</a>. These standards cover the level of training required, registration to practice and safety standards that include needle safety and hygiene to protect the public.</p> <p>Minor reported <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015026/#:%7E:text=Examples%20of%20minor%20adverse%20reactions,pain%20during%20or%20after%20treatment." target="_blank" rel="noopener">side effects</a> related to acupuncture including pain and bleeding or bruising from needle insertion are fairly common. But major adverse events – pneumothorax (collapsed lung), excessive bleeding, prolonged aggravation – are rare.</p> <h2>What’s needling good for?</h2> <p>Research into the effectiveness of acupuncture and dry needling is variable. Some studies show comparable results between dry needling and acupuncture, while others show more favourable results for one or the other depending on the condition being treated.</p> <p>A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedling" target="_blank" rel="noopener">review</a> that assessed the effects of acupuncture and dry needling for the treatment of low-back pain found they may be useful add-on therapies but could not make firm conclusions due to a lack of quality trials.</p> <p>Another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600071/#CIT0034" target="_blank" rel="noopener">review</a> reported the growing popularity of dry needling world wide and across disciplines and points out that many questions still remain regarding the use of needling.</p> <p>For <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001218.pub3/full?highlightAbstract=acupuncture%7Cmigraine%7Cmigrain%7Cacupunctur" target="_blank" rel="noopener">migraine</a> and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007587.pub2/full?highlightAbstract=acupuncture%7Cheadach%7Ctension%7Cacupunctur%7Cheadache%7Ctype" target="_blank" rel="noopener">tension</a> headaches, experts say acupuncture seems to reduce the frequency and intensity of attacks – though more research is needed to compare it to other treatments.</p> <p>Acupuncture and dry needling may reduce pain and improve function for people with <a href="https://pubmed.ncbi.nlm.nih.gov/17224820/" target="_blank" rel="noopener">neck pain</a>. A systematic review found significant differences between acupuncture and “sham acupuncture” (which is performed away from acupuncture points) when used to treat <a href="https://pubmed.ncbi.nlm.nih.gov/22965186/" target="_blank" rel="noopener">certain types of chronic pain</a>. However, some research only shows <a href="https://pubmed.ncbi.nlm.nih.gov/33066556/" target="_blank" rel="noopener">small and temporary</a> relief for neck pain with dry needling.</p> <p>Results from randomised control trials support the use of needling for <a href="https://pubmed.ncbi.nlm.nih.gov/27062955" target="_blank" rel="noopener">shoulder pain</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32301166/" target="_blank" rel="noopener">tennis elbow</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/32186030/" target="_blank" rel="noopener">osteo arthritic knee pain</a>. But a recent systemic review of research reported only weak evidence to support needling to treat <a href="https://pubmed.ncbi.nlm.nih.gov/33760098/" target="_blank" rel="noopener">plantarfasciitis and chronic ankle instability</a>.</p> <h2>Not just for sporting injuries</h2> <p>Similarly, small randomised control trials have shown acupuncture and dry needling might reduce <a href="https://pubmed.ncbi.nlm.nih.gov/17095133/" target="_blank" rel="noopener">problematic jaw pain</a> (<a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd#:%7E:text=Temporomandibular%20disorders%20(TMD)%20are%20disorders,may%20result%20in%20temporomandibular%20disorder." target="_blank" rel="noopener">temporo mandibular disorder</a>) and improve mouth opening.</p> <p>Systematic reviews have reported needling and acupuncture were safe and effective recommendations for the treatment of broad conditions of <a href="https://www.healthline.com/health/tendinopathy" target="_blank" rel="noopener">tendinopathy</a> (the breakdown of collagen in tendons) and <a href="https://pubmed.ncbi.nlm.nih.gov/30787631/#:%7E:text=At%20follow%2Dup%20in%20the,for%20the%20management%20of%20FM." target="_blank" rel="noopener">fibromyalgia</a> (chronic pain in the muscles and bones).</p> <p>For women’s health, acupuncture has been shown to be effective for reducing pain with <a href="https://pubmed.ncbi.nlm.nih.gov/29879061/" target="_blank" rel="noopener">periods</a>, compared to no treatment or non-steroidal pain relief medications – but the research had design limitations.</p> <p>Though <a href="https://www.cochrane.org/CD002962/PREG_acupuncture-or-acupressure-induction-labour#:%7E:text=Acupuncture%20involves%20the%20insertion%20of,with%20onset%20of%20labour%20contractions." target="_blank" rel="noopener">widely used</a> in pregnancy, research into the use of acupuncture to <a href="https://pubmed.ncbi.nlm.nih.gov/32032444/" target="_blank" rel="noopener">induce labour</a> reports it may increase satisfaction with pain management and reduce pain intensity. But it may have little to no effect on the rates of caesarean or assisted vaginal birth.</p> <p>In summary, it appears needling techniques – whether dry needling or acupuncture – generally show positive effects over no treatment or “sham” treatments, but more research and high quality trials are needed.</p> <h2>Just one part of a treatment program</h2> <p>Needling <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedlin" target="_blank" rel="noopener">may be useful</a> as part of multimodal care – that is, when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780149/" target="_blank" rel="noopener">more than one treatment</a> is used in conjunction to treat a problem.</p> <p>Physiotherapists may combine needling therapies with exercise prescription, hands-on care including massage, mobilisations and manipulations, and taping techniques. They may also employ therapies that apply external energy such as ultrasound, laser, transcutaneous (under the skin) electrical nerve stimulation and biofeedback.</p> <p>Finally, while the various needling techniques all use a filiform needle (with a solid filament as opposed to a hollow bore needle), the styles with each can be quite different. Ask what style of needling is being employed to treat you, and if you have a history of finding one style works better for you, discuss this with your practitioner.</p> <p><em><strong><span id="docs-internal-guid-f5f791d3-7fff-a98b-c7e6-d9bb3a886f0f">This article originally appeared on <a href="https://theconversation.com/physio-dry-needling-and-acupuncture-whats-the-difference-and-what-does-the-evidence-say-181939" target="_blank" rel="noopener">The Conversation</a>.</span></strong></em></p> <p><em>Image: Shutterstock</em></p>

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Difference between chiro and physio: which do you need?

<p>Pain – whether short-term or chronic – can significantly affect our quality of life. Pain medications may be the answer for some, but if you’re looking for a more natural approach, seeking out a chiropractor or physiotherapist could be a good idea.</p> <p>But what’s the difference? And when should you see one instead of the other? Over60 spoke to two experts to find out the answer – chiropractor Dr Nicola Horton from <a href="http://www.essentialhealthcentre.com.au/" target="_blank"><strong><span style="text-decoration: underline;">Essential Health Centre</span></strong></a> and physiotherapist Michael Dermansky from <a href="http://www.mdhealth.com.au/" target="_blank"><strong><span style="text-decoration: underline;">MD Health</span></strong></a>.</p> <p><strong>Who can benefit?</strong></p> <p><span style="text-decoration: underline;">Chiro</span>: “Chiropractors help people with lots of different health or body complaints, but the main reasons people see us is for back pain, neck pain, headaches and or migraines, postural problems or sporting injuries,” Dr Horton explains. “Most people tend to see us when they can no longer do something (like pick up the grandkids, swing a golf club), but the earlier you get help the better!”</p> <p><span style="text-decoration: underline;">Physio:</span> “Someone should seek help from a physiotherapist when either pain or a physical limitation stops them from doing what they want to do in their life,” says Dermansky. “For example, if you have pain in the side of your hip that stops you from walking, sitting in the car or bending forward to pick something up off the ground, a physiotherapist’s role is to assess the problem, determine the cause and put in a plan of action to do something about it.”</p> <p><strong>What should I expect from my first appointment?</strong></p> <p><span style="text-decoration: underline;">Chiro</span>: “The first appointment takes a bit longer than the rest,” Dr Horton tells us. “The chiropractor can ask you a series of questions about the reason for your visit, and determine if they can help you. After that, we do some tests to see what’s going on with your problem, and to see if there is anything else that may be related.</p> <p>“A regular visit will often involve some testing to see where you are at on the day, followed by a treatment. This may involve adjustments of joints, muscle stretches or massage based on the area of focus. The good news is that there are lots of ways to adjust a joint, so if you don’t like the ‘crack’ sound we can still help.”</p> <p><span style="text-decoration: underline;">Physio:</span> “There are five things you should expect out of a good physiotherapy consultation,” Dermansky reveals.</p> <ol start="1"> <li>Make sure they start with a good history – “Every consultation should begin with thorough history of your injury, including an understanding of the behaviour of your pain.”</li> <li>Make sure they examine the area thoroughly – “All areas of the body, like the back, knees or shoulders can have a number of things that can go wrong and cause injury, so it is important that each area is assessed properly and completely to determine a specific diagnosis as this will radically alter the required treatment.”</li> <li>They must assess the area above and below the injured area – “The body's biomechanics have a large impact on the function of each individual joint, therefore to effectively treat a knee injury for example, it is important to assess and determine the bio mechanical problems with the hips and ankles to solve the long-term issues.”</li> <li>They should give you a provisional diagnosis – “After your initial session, your physiotherapist or exercise physiologist may not have an exact diagnosis yet, but they will have an idea of the potential diagnoses and need to explain these to you.”</li> <li>They should give you a plan of what to expect from the rest of your sessions – “You deserve to know where your treatment plan is going and what to expect from your treatment in the long term.”</li> </ol> <p><strong>How do over-60s in particular benefit?</strong></p> <p><span style="text-decoration: underline;">Chiro</span>: “People over the age of 60 can see great benefits from seeing a chiropractor to help keep the body more mobile,” says Dr Horton. “As we age, the body starts to lose its ability to spring back after stresses, so looking after ourselves will mean being able to play golf more frequently, or chasing the grandkids around without hurting.”</p> <p><span style="text-decoration: underline;">Physio:</span> “The most common reason why people over the age of 60 cannot do all the things in life that they want to do is NOT because of age, but due to lack of strength and mobility,” explains Dermansky. “Most of the problems I have seen in the last 19 years working in physiotherapy in the over 60s is due to a lack of muscle strength, especially in postural muscles and a lack of joint mobility, which are mostly reversible and due to lack of specifically strengthening and moving these area, rather than due to the process of age.</p> <p>“It is never too late to do something about the aches and pains that stop you from doing everything you want to do (the oldest I have treated is 97 years old) and living the fullest life you can.”</p> <p>Do you receive regular chiro or physio treatment? How has it benefited you? Share your experiences with us in the comments below.</p>

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5 things to look for when choosing a physio

<p><em><strong>Michael Dermansky has been working as a physiotherapist for the last 17 years and directing <a href="http://www.mdhealth.com.au/" target="_blank"><span style="text-decoration: underline;">MD Health Pilates</span></a> for the last 13 years.</strong></em></p> <p>Physiotherapists see patients for a number of reasons, usually to provide treatment for muscular conditions affecting movement or causing pain and discomfort. But how do you choose a physiotherapist? Is there one better suited to treat you than another? If you are looking for a new specialist, we suggest that you consider Michael Dermansky’s five tips before choosing a physio to treat your condition.</p> <p><strong>1. Start with a good history</strong> – Every consultation should begin with a thorough history of your injury, including an understanding of the behaviour of your pain, to determine the reason for the pain, but also to determine whether the pain is mechanical (can be treated by a physiotherapist or exercise physiologist) or more serious and needs to be taken care of elsewhere.</p> <p><strong>2. Examine the area thoroughly</strong> – All areas of the body, like the back, knees or shoulders can have a number of things that can go wrong and cause injury, so it is important that each area is assessed properly and completely to determine a specific diagnosis as this will radically alter the required treatment. Generic treatments will not be effective, they must to specifically based on a diagnosis to work.</p> <p><strong>3. Assess the area above and below the injured area</strong> – The body’s bio mechanics have a large impact on the function of each individual joint, therefore to effectively treat a knee injury for example, it is important to assess and determine the bio mechanical problems with the hips and ankles to solve the long term issues. If there is no time to address this in your first session, these other areas should be assessed in your subsequent sessions.</p> <p><strong>4. Provide a provisional diagnosis </strong>– After your initial session, your physiotherapist or exercise physiologist may not have an exact diagnosis yet, but they will have an idea of the potential diagnoses and need to explain these to you. The diagnosis will vary the treatment radically and will be the difference between an exercise being effective or ineffective in treating your injury or pain.</p> <p><strong>5. Provide a plan for your future sessions</strong> – when you go to the mechanics, your accountant or lawyers, they will give you an idea of what they need to work on, how long it will take and roughly how much it will cost, so why not your physiotherapist or exercise physiologist? You deserve to know where your treatment plan is going and what to expect from your treatment in the long term.</p> <p><strong>Related links:</strong></p> <p><a href="http://www.oversixty.co.nz/health/body/2016/03/new-sleep-times-recommended-by-experts/"><em><strong><span style="text-decoration: underline;">New sleep times recommended by experts</span></strong></em></a></p> <p><a href="http://www.oversixty.co.nz/health/body/2016/04/herbal-tea-for-seniors/"><strong><em><span style="text-decoration: underline;">The herbal tea everyone should drink</span></em></strong></a></p> <p><a href="http://www.oversixty.co.nz/news/news/2016/03/foods-a-nutritionist-would-never-eat/"><em><strong><span style="text-decoration: underline;">5 foods a nutritionist would never eat</span></strong></em></a></p>

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