Physiotherapy and Postgraduate Qualifications
Cranio-Sacral Therapy IAO ( International Acadamy of Osteopathy ).
Connective Tissue Massage / Fascia Release Technic
Chair Massage at Company Offices
Jaw problems / Orophacial Therapy / Orophacial Physiotherapy
Three-dimensional Arthro-kinematic Mobilization. D.A.M.
Manipulations & Soft Tissue Techniques. I.A.O.
Complaints of the head, neck, neck region & shoulder girdle. (KANS problematic).
Medical Taping Concept
Forced Use Therapy / Constraint induced Movement Therapy ( CIMT ).
Echography ( Musculo Skeletal Ultrasound, M.S.U. )
Percutane Needle Electrolysis P.N.E.
Physiotherapy can be defined as the treatment of injuries and ailments by physical and mechanical means; including massage, mobilisation and professionally regulated exercise. The physiotherapist is specially trained to treat a very diverse range of anatomical disorders. Commonly these are; localised or general pain, a reduction in physical strength, limited mobility experienced in specific or more wide spread areas, breathing difficulties and oedema ( abnormal swelling caused by the accumulation of liquid between tissue cells ). Many of the above complaints can be attributed to circumstances familiar to us all; including general wear and tear through the ageing process, poor working practices ( e.g. posture, lifting etc. ), sports related injuries as well as incapacity caused by an accident or illness.
A good physiotherapist will not only treat the symptoms related to a physical disorder, but will also identify and treat the root cause. The cause of a physical malfunction can stem from an area of the body which is totally different to where symptoms are experienced. The treatment also consists of advice and ongoing guidance involving exercise programmes designed to speedily assist in the all important process of a successful rehabilitation. As one would expect, treatments are many and varied – but always work towards an identifiable goal for each individual. Treatment of injuries to muscles, tendons, ligaments and joints often involve advice over posture as well as improving mobility.
Techniques employed include; massage, mobilisation and stretching. Typical goals achieved by these are to reduce or eradicate pain, to achieve muscular relaxation and to improve blood circulation. Other important techniques that may be used during treatment are; ‘Exercise Therapy’ & ‘Movement Therapy’. These are especially designed to strengthen muscles, increase the range of mobility & improve one’s general physical condition. Exercises in relaxation, breathing & developing good posture play a significant part within these therapies.
Physiotherapy treatment not only addresses anatomical complaints but can also greatly assist an individual suffering symptoms resulting from physiological disorders of the nervous system, the heart, the lungs, the blood vessels and also the skin. The locomotor-driven functions of the body are often taken for granted until neck, back or joint discomfort is experienced. Treatment, advice & guidance by the physiotherapist is undertaken only after a professional assessment of the circumstances of each individual case.
Cranio-Sacral therapy can be applied to relieve diverse complaints including:
Chronic pain, Eye disorders, Headaches, Whiplash, Chronic tiredness, Jaw problems, TMJ syndrome, Balance & Hearing problems, etc.
- What is Cranio-Sacral Therapy ?
Cranium – the skull. Sacrum – the part of the spinal column that is connected to the pelvis, consisting of five fused vertebrae.
The concept of Cranio-Sacral Therapy was developed by the American Osteopath, William Sutherland (1873-1954), and other Osteopaths have gone on to develop C-ST since Sutherland’s discovery.
Sutherland’s breakthrough came when he realised the Bones that form the Cranium are designed to move. They are not fused together, as conventional medicine teaches. Sutherland found that the Sacrum, which is the bone at the base of the spine, also moves in sequence with the cranial bones.
The Cranio Sacral System moves in a specific manner.
If this is not the case, pain and discomfort may arise.
The Brain has 4 ventricles, or internal spaces, which produce cerebro-spinal fluid. There is a subtle pulse that is felt as the cerebro spinal fluid moves around the brain and central nervous system. This pulse is around 10 cycles per minute. With practice, this subtle pulse can be felt.
This is the basis of Cranio Sacral Therapy.
Following the subtle, bony movements of the cranium and pelvis with regard to the slow, rhythmic pulse of cerebro-spinal fluid. Cranial treatments can be used to treat most areas of the body, as all tissue is influenced by the cranio sacral rhythm.
Cranio Sacral Therapy is very gentle, suitable for people of all ages. It helps with stress and tension related conditions, chronic neck and back pain, migraine and tension headaches, jaw & facial pain, whiplash and brain & spinal cord injuries.
Through Cranio-Sacral Therapy the blockages within the Cranio-Sacral system are detected and relieved by means of specific manual techniques, in which we are trained.
In this way the body is given the opportunity to recover and heal, physical symptoms being reduced and eventually remedied.
The skin and the subcutaneous connective tissue react on irritation of tissue in the body such as; organs, muscles, vertebrae, tendons, lymph nodes, hormone regulators, blood vessels and nerves.
The skin and the subcutaneous connective tissue draw together in the area of the irritation. The result is a visible area on the skin, where the skin is also hypersensitive to heat, cold, touch and pressure.
Such an area is called a ‘Connective Tissue Zone’.
Around 1900 a Dr. Head discovered connective tissue zones, and gave them his name, hence ‘Zones of Head’.
Treatment involves loosening the skin and the subcutaneous connective tissue about these zones, by means of specific massage techniques.
People have likened the massage treatment as a “cutting feeling”. During the procedure trigger points are also treated.
Due to this specific massage technique, blood supply is improved to the affected area, so that the underlying irritated tissue can relax and help the process of repair.
The Sports Physiotherapist.
A physiotherapist who specializes in sports and athletes. This is a post graduate course, after fully studying physiotherapy. The sports physio knows the demands of particular sports on the body, movements involved and what motivates athletes.
This enables the sports physio to advise, guide and treat in the field of sports & health.
One can make an appointment directly, without needing to be referred by your GP.
Depending on your health insurance policy ( basic or with additional cover ) your appointment and subsequent treatment can be reimbursed.
Novice, or returning to sporting activity? – Advice & Guidance.
Many people wish to do sport or exercise – but maybe unsure of the best manner in which to begin, in light of their current physical fitness or conditioning.
We find in many cases that this is not unusual – indeed it is prudent to seek advice before indulging in a particular sport or an exercise regime, just to make sure your condition is up to muster.
This advice and guidance can also involve the best and safest way of improving your fitness levels before you embark on your chosen activity.
We see many people who after years of relative inactivity wish to return to exercising for fun as well as general wellbeing, as well as people who are less mobile due to illness or physical handicap.
Due to knowledge of sport and the physical excursion and movement these activities entail, the sports physiotherapist can help you choose an activity that suits you.
During your appointment, please let the sports physiotherapist know what activities you are interested in taking up, and as well as advice and guidance you can also participate in our specially designed Health Check.
Our stated philosophy is to encourage as many people as possible back into participating and more importantly enjoying their sporting activity of choice.
If you enjoy something, then you are much more likely to continue – and gradually improve your condition and general wellbeing in an enjoyable way.
If you are not at peak fitness – please do not despair!! The sports physiotherapist is here to assist you, and you will be in the right hands to get fitter in the knowledge that you will be guided in your expectations by a professional.
In combination with your training, you can also consult our dietician to ensure you are giving your body the best chance to achieve your aims.
Sports People & Athletes – Advice and Guidance
With much enjoyment you exercise regularly, play competitive sports, maybe go out for a run twice a week – with the idea in the future to maybe complete a half or even a full marathon.
Does it sometimes occur to you whether you are getting the best out of yourself? Is your training is effective enough? Are you fully hydrated on a Sunday morning before the weekly cycling tour? Are you looking to buy some new running shoes and get a bit dizzy from conflicting advice? Are you pregnant and would like to keep active for as long as possible in a safe & responsible manner?
Why not pop in to see the Sports Physiotherapist?
This professional has a physiotherapy specialization in sports.
He can place himself in your shoes – and through his experience can provide you with the optimum advice on how you can get the best out of your chosen sport.
Massage is a form of treatment that stimulates blood circulation and breaks through muscle tension.
Increased muscle tension and impaired blood circulation are symptomatic of mental stress, and also occur at the work place if you are too long in the same working position or your posture is poor for long periods of time.
Common results of the above are neck and back pain, as well as RSI.
Chair massage is a form of preventative treatment designed to maintain physical capability before symptoms occur.
Chair massage is carried out at the office in a restful, quiet space. The special chair is brought along by the therapist. It is designed to offer all the comfort required to relax. The sessions are each of 20 minutes duration.
During these sessions the employee is:
2. Advised on posture at work, avoiding undue strain from lifting, and guidance on exercises to practice at work in order to keep the body mobile.
As well as receiving the preventative massage, the employee is also made aware of the effects on her or his body in relation to their every day work activities.
Prior to undertaking a period of chair massage, the employee is requested to fill out an introductory ‘intake’ form on admission.
After three months there is an evaluation with the employee by means of a questionnaire. This comprises the following points:
- How did the employee find the massage and the advice given.
- How did the employee use the advice.
- What would the employee change with the massage for the next period.
People can choose between two methods of massage:
1. Traditional Massage
This is where the upper body is unclothed and the back, neck and arm muscles are massaged with oil.
2. Shiatsu Massage
This is where the employee keeps their clothing on, and the back, neck, arms and hands are treated with a specific ‘pressure point’ technique.
If required, at the same time, we can examine the workplace of the staff and deliver advice to the employee regarding ergonomics and posture.
In the case of employees suffering from incapacity for work, we can consult with the company doctor.
Contact us for a quote at: Tel: 070 364 9200 // email@example.com
The masticatory system basically consists of the jaw muscles, the temporomandibular joint ( TMJ ) and teeth.
The most common symptoms concerning jaw problems are; pain or fatigue in the jaw muscles, the inability to fully open the mouth, pain around the TMJ joint ( just in front of the ear ), ‘clicking’ or ‘popping’ in the TMJ, painful or hypersensitive teeth and wearing down of teeth in localized areas.
Also, ear pain, headaches and neck pain may also originate from disorders of the masticatory system.
Should you recognize any of the above symptoms – then the chance is high that you may be suffering from jaw problems.
The medical term for jaw problems is temporomandibular dysfunction ( TMD ).
Over 1 in 5 people in Netherlands has experienced TMD, but only around 3% have actually sought professional help.
What Causes Jaw problems ?
This can happen through; grinding of teeth in sleep, fitted bridges, nail biting and chewing gum. Stress can also play a role in overloading these muscles.
The temporomandibular joint TMJ acts as both a hinging joint & a sliding joint. Problems occur when the articular disc of cartilage protecting bone end and facilitating movement becomes displaced. On opening and closing the mouth, ‘pops’ and ‘clicks’ can be heard and felt in the TMJ.
This can lead to restrictions in opening the mouth and is highly painful.
Jaw problems can also be the result of dental complaints.
Osteopathy and Manual Therapy techniques are used to treat jaw problems.
Jaw problems frequently occur due to the over loading of the masticatory ( jaw ) muscles.
The abbreviation D.A.M. stands for: Three-dimensional Arthro-kinematic Mobilization. The post-HBO courses are designed for (para) medics who wish to become proficient in mobilizing handgrips, aimed at eliminating malfunctions in joints. All courses are accredited by the KNGF. The D.A.M. course is a 2 year program.
By means of these techniques, and our full understanding of the biomechanics of the human body, we aim to restore joints to their proper movement and functional ability. The D.A.M. training allows us to solve problems through related / connected thinking, rather than taking symptoms in isolation.
This means that, for example, if you suffer from ‘tennis elbow’ – we also examine the spine in order to help us locate the root cause of your complaint.
Chances are that, for instance, a vertebra is not moving properly – consequences being that the whole arm can be out of sync – which can cause discomfort or pain around the elbow region ( or wrist or shoulder ).
This is a two year course from the professional discipline of Osteopathy. It is a technical course whereby the manual work is refined to include; mobilization techniques, manipulation techniques and muscle-tissue techniques. The background of these techniques lies in the method of analysis and solution taught in the field of Osteopathy, see below.
The interaction between structure and function
For a structure to function properly – it is essential that it is complete. For example; a car that has lost a wheel will not drive properly. It follows that the proper functioning of a structure is essential to its maintenance. For example; should a car remain unused and stationary for too long, it is more likely to break down. It is just the same when considering human physical function and structure. We can help to repair and restore lost movement ( function ) in the particular affected area ( structure ) of the body.
The body is a biological entity
All of its structures and functions are inextricably linked together. One can view living nature in terms of holism – as being composed of interacting wholes that are more than simply the sum of their constituent parts. A problem in our body not only creates local symptoms but also ‘remote’ symptoms. For example; a car with a punctured tyre. There exists not only a local problem ( the hole in the tyre ), but also a remote problem ( the car does not drive as well as it should ). We take the view that the loss of motion in a foot can not only result in pain in that localized area, but can also cause pain in the lower back.
The body possesses self-regulatory mechanisms
The human body shows the natural characteristic of maintaining for itself as good a balance as possible. We are not aware of the fact that our body is in a permanent state of conflict against such aggressors as climatic changes, microbes and gravity etc. In the case of restriction or loss of movement, we treat all structures which in turn enables us to stimulate these self-healing powers of the body. But unfortunately this is not always sufficient to cure all ills.
Shiatsu is a manipulative therapy developed in Japan and incorporating techniques of anma (Japanese traditional massage), acupressure, stretching, and Western massage. Shiatsu involves applying pressure to special points or areas on the body in order to maintain physical and mental well being, treat disease, or alleviate discomfort.
This therapy is considered holistic because it attempts to treat the whole person instead of a specific medical complaint. All types of acupressure generally focus on the same pressure points and so-called energy pathways, but may differ in terms of massage technique. Shiatsu, which can be translated as finger pressure, has been described as needle-free acupuncture.
In 1964 the Japanese Ministry for Health and Education officially confirmed Shiatsu as a recognized and stand-alone therapeutic treatment method, under the following definition:
“Therapy, whereby pressure with thumbs and palms applied to certain points of the body, corrects irregularities, maintains and improves health, contributes to alleviating various diseases ( diverse pains, stress, disturbances in the nervous system, etc ) and activates the self-healing ability of the organism. Has no side effects.”
Shiatsu has a strong reputation for reducing stress and relieving nausea. It is also believed to improve circulation and boost the immune system. Shiatsu can be used to relieve muscular pain or tension, especially neck and back pain. It also appears to have sedative effects and may alleviate insomnia. In a broader sense, shiatsu is believed to enhance physical vitality and emotional well being.
Reflexology is a therapeutic method of relieving pain by stimulating predefined pressure points on the feet. This controlled pressure alleviates the source of the discomfort. Foot Reflexologists work from maps of predefined pressure points that are located on the feet. These pressure points are reputed to connect directly through the nervous system and affect the bodily organs and glands. The reflexologist manipulates the pressure points according to specific techniques of reflexology therapy. By means of this therapy, any part of the body that is the source of pain, illness, or potential debility can be strengthened through the application of pressure at the respective foot location.
Reflexology promotes healing by stimulating the nerves in the body and encouraging the flow of blood. In the process, reflexology not only quells the sensation of pain, but relieves the source of the pain as well. Reflexology applied properly can alleviate allergy symptoms, as well as stress, back pain, and chronic fatigue. The techniques of reflexology can be performed conveniently on the hand in situations where a session on the feet is not practical, although the effectiveness of limited hand therapy is less pronounced than with the foot pressure therapy.
Selected organs, glands and functions that can be stimulated by foot reflexology:
1. Kidney. 2. Adrenal gland. 3. Ureter/Urethra. 4. Bladder. 5. Skull. 6. Sleep. 7. Brain. 8. Pituitary. 10. Brainstem. 11. Neck. 12. Forehead. 13. Eye. 14. Ear. 16. Thyroid. 17. Shoulder. 18. Lungs. 19. Liver/Heart. 20. Gallbladder/Spleen. 22. Stomach. 23. Pancreas. 24.–27. Intestines/Bowels. 28. Sciatic nerve.
Pilates or Physical Mind method, is a series of non-impact exercises designed by Joseph Pilates to develop strength, flexibility, balance, and inner awareness.
Pilates is a form of strength and flexibility training that can be done by someone at any level of fitness. The exercises can also be adapted for people who have limited movement or who use wheel chairs. It is an engaging exercise program that people want to do. Pilates promotes a feeling of physical and mental well-being and also develops inner physical awareness. Since this method strengthens and lengthens the muscles without creating bulk, it is particularly beneficial for dancers and actors. Pilates is also helpful in preventing and rehabilitating from injuries, improving posture, and increasing flexibility, circulation, and balance. Pregnant women who do these exercises can develop body alignment, improve concentration, and develop body shape and tone after pregnancy.
Training of the deep supportive, or postural, muscles is important for everyone – whether they are naturally athletic or non-athletic. These deep postural muscle are literally hidden beneath the superficial muscles and are therefore less visible and for most people also more difficult to feel. The transverse abdominal muscle, for example, is a deep seated muscle that stabilizes the lower back and pelvis like a corset. Activation of this muscle through learning how to train it, results in a stabilizing effect on the back. Often, it takes one to two years of training to be made fully aware of these muscles. In the beginning it is difficult to believe that there really are muscles situated there! And so it is the case for all deep muscles. It takes some work to enable the patient to become conscious of these muscles. It is therefore important to do the basic exercises often and in a precise manner. Every time these exercises are carried out, new capabilities will be discovered, and one will increasingly use these deeper muscles in daily life. This is possible, because of the gradual build up of strength and coordination through the exercises.
Together, the deep postural muscle form a coordinated whole. In Pilates one speaks of the powerhouse or centre of strength. This gives rise to stability and strength – providing there are no open doors or windows in this powerhouse! Therefore, we first learn to activate the internal unit or powerhouse, just before starting an actual movement. This is a natural process; it appears in healthy people that prior to carrying out a movement the centre of strength is activated. This provides a protective effect and helps to prevent back complaints and injuries. With people who experience more back problems than usual, it appears that in many cases the internal unit is not activated.
Activate your internal unit as follows:
- Switch on the deep back muscles by hollowing the back.
- Switch on the transverse abdominal muscles by pulling in your lower abdomen.
- Activate the pelvic-floor ( 20%-30% ) with the feeling of ‘holding back your pee’.
- Activate your diaphragm through ‘flank-breathing’.
Joseph Pilates, the founder of the Pilates method (also simply referred to as “the method”) was born in Germany in 1880. As a frail child with rickets, asthma, and rheumatic fever, he was determined to become stronger. He dedicated himself to building both his body and his mind through practices which included yoga, zen, and ancient Roman and Greek exercises. His conditioning regime worked and he became an accomplished gymnast, skier, boxer, and diver.
While interned in England during World War I for being a German citizen, Pilates became a nurse. During this time, he designed a unique system of hooking springs and straps to a hospital bed in order to help his disabled and immobilized patients regain strength and movement. It was through these experiments that he recognized the importance of training the core abdominal and back muscles to stabilize the torso and allow the entire body to move freely. This experimentation provided the foundation for his style of conditioning and the specialized exercise equipment associated with the Pilates method. Pilates emigrated to the United States in 1926 after the German government invited him to use his conditioning methods to train the army. That same year he opened the first Pilates studio in New York City. Over the years, dancers, actors, and athletes flocked to his studio to heal, condition, and align their bodies. Joseph Pilates died at age 87 in a fire at his studio. Although his strength enabled him to escape the flames by hanging from the rafters for over an hour, he died from smoke inhalation.
Pilates believed that ideal fitness is “the attainment and maintenance of a uniformly developed body with a sound mind fully capable of naturally, easily, and satisfactorily performing our many and varied daily tasks with spontaneous zest and pleasure.”
The practice of assessing or describing symptoms, signs, and laboratory findings by means of scales, indices, and other quantitative instruments.
The KNGF has developed its own ‘evidence-based products’ ( EBPs ) which are documents that define physical therapy in accordance with applicable and relevant scientific evidence.
A section of these EBPs concerns Clinimetrics. We utilize measuring instruments that are available to physiotherapists to be used as diagnostic, prognostic or evaluative means in order to assist in and maintain the transparency of treatments carried out by the physiotherapist.
It is very important that the recommended clinimetrics are easy to consult, so that as much as possible their use and application is facilitated within the practice. In order to increase the accessibility of clinimetrics, the KNGF have joined the national database of Zuyd Hogeschool in Heerlen, where all our clinimetrics documents are included. This research institute has extensive experience in clinimetrics and can therefore ensure that the database contains state of the art information concerning our EPBs.
In order to facilitate the correct use of measuring instruments, explanatory notes are kept with each instrument.
Breakthrough pain and stress patterns
The therapy is aimed at looking out for, and breaking through, pain and stress patterns.
We do this by making use of various models taken from neuroscience ( brain layered / neuroplasticity and memory / pain analysis ) and from psychology ((emotional) reflection model / core quadrants ).
It has become clear that automatic patterns are not readily changed. At the very least that calls for reflection, introspection and discipline.
During the treatments, use is made of techniques which allow us to look together at the patterns, and where and how these can be broken through. The aim is to ensure that stress in the body decreases and/or disappears – and that pain symptoms are resolved or at least substantially reduced.
This post graduate qualification especially addresses health problems that patients experience which are characterized by pain and other symptoms in the arm, neck, neck region and shoulder.
The onset of these symptoms and their continued presence can be influenced by physical activity and its repetition during activities at work and leisure.
These symptoms can have multiple causes, however usually hinge on an upset or disturbance in the fundamental balance between applied load and load capacity of the human body.
In many cases, the symptoms are brought about by the performance of lengthy activities where movements are repetitive. Also situations where a prolonged, sustained, fixed position can lead to the same complaints. Areas involved and subsequently affected are the arm, neck and shoulder.
The health issue manifests itself by the extent of disorder to the physical functions or anatomical features. Symptoms are expressed by the limitations of movement experienced when participating in day to day work & leisure activities.
The basis for the Medical Taping Concept originated in Japan & South Korea during the 1970s. During this time, methods of taping were developed with the idea, or concept, that movement and muscle activity is fundamental to maintaining and restoring physical health.
The idea behind this was that muscles are not only necessary for movement but also to control, for example, blood and lymph circulation and body temperature. When muscles do not function properly, this can cause a range of symptoms and complaints.
Building on this concept, several types of elasticated tapes were developed that could support the muscles in their function without restricting movement. Due to the affected muscles being treated in this manner, the body’s recovery process is triggered. During the development of this method it soon appeared that the scope was broader than just treating muscles.
The tape which is used ( CureTape ) has the equivalent weight and elasticity of the human skin. In this way the tape has a kind of ‘lifting effect’ on the upper skin, or epidermis. This in turn creates more space in the subcutis – where all kinds of receptors, blood and lymph vessels are located. By using different taping techniques, various beneficial effects can be achieved.
For example; after tissue trauma the tissue reacts with inflammation. This results in localized swelling, which in turn increases pressure on the surrounding tissue. The swelling impedes blood circulation and proper lymph drainage. It also increases the pressure on pain receptors. The ‘lifting effect’ of the CureTape gives an immediate pressure relief through which the blood circulation and lymph drainage are restored. Pressure on the pain receptors decreases, leading to an immediate reduction in pain experienced. Through this pain relief a more correct physiological pattern of movement can be attained.
Conventional sport tape, or bandaging, is designed to restrict movement. When this normal tape is applied – there is a considerable pressure increase to the affected area, blood circulation and lymphatic drainage become restricted. This delays recovery. Moreover, prolonged partial or total immobilization of muscles and joints causes contractures – leading to additional physiotherapy being required to rehabilitate the affected area.
Ideally, the immobilization of joints and muscles should be kept as short as possible, and the healing processes of physiotherapy be employed as quickly as possible. If the immobilization period is short, then this in turn prevents natural immobilization occurring in the affected area !
With the Medical Taping Concept, the elasticity of CureTape allows the tissues support in their function and motion is maintained. The disadvantages of conventional immobilization are therefore prevented. Physiological movement is thus supported, which in turn allows the body’s natural recovery process to be activated. In other words, CuraTape techniques supports exactly how the body itself would behave under optimal conditions.
The ‘lifting effect’ of the tape on the skin promotes subcutaneous blood flow and enhances proper lymph drainage away from the affected area. Through reduction in pressure, the initial lymph vessels can open properly to their normal operating size. This process corresponds precisely to that of the objectives of manual lymph drainage.
In summary, the effects of Medical Taping Concept can be classified as follows:
- Improve muscle function through regulation of muscle tone.
- Relieving obstacles to correct blood flow and lymphatic drainage.
- Pain relief
- Support of Joint function by; stimulating the return to proper usage, correcting the direction of movement, and increasing future stability in the joint.
- Neuro-reflexive manipulation.
What is Dry Needling?
Dry Needling is a recent treatment method originating in Canada and is already being used in conjunction with traditional physiotherapy. By means of specially learnt techniques, trigger points in muscles are needled in order to alleviate local or remote pain, and promoting long term relaxation.
Dry needling utilizes a solid filament needle, as used in acupuncture, and relies on the stimulation of specific reactions in the target tissue for its therapeutic effect. This can be contrasted with Injection Needling which uses a hypodermic syringe to introduce liquid agents ( e.g. local anaesthetic ) to the tissue.
Dry Needling – Not the same as Acupuncture
Acupuncture often uses many needles placed superficially at different points on the body. These needles remain on these points for some time and influence the energy patterns of the body. Dry Needling usually utilises a single needle where the muscle is stimulated only short term. Dry Needling works upon specific points in the muscles called ‘trigger points’ and is not an ‘energy’ treatment.
What is a Trigger Point?
A trigger point is a ‘knot’ in the muscle that, as well as localized pain, often causes remote pain in the body at a distance from the ‘knot’. The Physiotherapist examines these trigger point locations, as they can be the main cause of your symptoms elsewhere in your body.
Trigger Points can manifest themselves as:
Pain / stiffness locally and remote ‘pain’ elsewhere in the body Limitation of movement in associated joints Strength reduction in the mauscle(s) involved Pain avoidance behaviour; you move differently to compensate for the local pain Tingling in the arm or leg, headaches, dizziness
How can Trigger Points arise in the first place?
Can be many & varied!
Acute incident – for example; a muscle strain in moving or an accident / sport injury Chronic – for example; prolonged poor posture, RSI etc Long-term absence of movement – e.g.; plaster caste, brace or sling ‘Slack’ ligaments – for example; ankle and/or knees Psychological factors such as stress, depression, sustained fatigue Foot abnormalities; instability or differences in leg length following fracture / surgery Restrictive clothing or improper wearing of a backpack / rucksack
CIMT has for many years been used in treating adult stroke victims. This therapy focuses on the affected hand making it possible to demonstrate movements which have been temporarily lost, and to recover proper function. In recent years there has been increasing attention to using this form of treatment on children suffering from Hemiplegia ( paralysis of one side of the body due to disease or injury to the motor centres of the brain ). By limiting the use of the non-affected ‘good hand’, children can learn to regain use of the affected hand.
Who looks further, sees more !! If we can get under the skin of our patient, then our diagnosis is given an extra dimension. Musculo Skeletal Ultrasound allows us to view internal structures in real time. Not only can we view through crystal clear imagery abnormality in anatomical structures, but also observe actual movement through dynamic imaging.
Ultrasound imaging gives our practice an extra dimension.
Musculo Skeletal Ultrasound allows us to view the affected area, most importantly this assists us in providing an accurate functional assessment. It follows that the starting point of the treatment recommended is derived from real time observation both externally and internally.
Repeated observation through M.S.U. ensures that during the treatment process the success of the treatment method can be monitored & adjusted if necessary.
As the patient you can also view the imaging to see for yourself what is happening internally, and observe your progress during the treatment process.
Lymphedema is a build-up of lymph fluid in tissue just under the skin. It occurs when your lymph vessels cannot drain lymph fluid normally. The build-up causes swelling (or edema), usually in the arms or legs, though it can occur in the face, neck, abdomen or trunk. Lymphedema differs from the typical swelling you may get from a sprained ankle or bruise, and will not go away on its own. There is no cure for lymphedema; however, it can be managed effectively with proper treatment.
There are two types of lymphedema:
Primary lymphedema is the rare type that occurs in people who are born with too few lymph nodes, or with lymph nodes and vessels that do not work as they should. Typically, symptoms are present at birth, although they may appear in the teen years and even, rarely later in life.
Secondary (or acquired) lymphedema, is the common type that can be caused by infection, surgery, radiation, trauma, malignant tumors and anything that changes or damages your lymph system. Cancer treatment, especially radiation or surgery that removed some lymph nodes, is the most common cause of lymphedema in this country. If yourlymphedema is caused by cancer treatment, you may not notice any swelling until months or even years later. Not everyone who has cancer treatment will develop lymphedema, and it is not known why some people get it and others do not.
The symptoms of lymphedema vary a lot in people, but they may include:
- Swelling in part or all of your arm or leg
- Sensation of fullness or heaviness in the affected limb
- Limited movement in the arm or leg
- Discolored skin on the limb
- Dry or thick skin on the limb
- Discomfort and aching in the limb
- Infections in the affected limb
Lymphedema treatment focuses on reducing swelling and controlling discomfort. Treatment is individualized for each person, but generally involves two phases: acute treatment with a therapist followed by self-management for maintenance. First, your therapist will conduct a detailed assessment of your lymphedema and review your medical history to make sure there are no barriers to treatment. Treatment during the acute phase typically lasts 2-3 weeks if you have lymphedema in one arm, and 2-4 weeks if you have lymphedema in one leg. Therapy for lymphedema includes: Manual lymphatic drainage (MLD) is a gentle massage-like treatment that reroutes the excess lymphatic fluid into other areas of the body where the lymphatic system is working more efficiently. It may include special techniques to break up fibrotic deposits of protein that can occur and to help soften your skin. MLD is not for everyone, and your therapist may choose to avoid this part of your treatment if you have an active infection, blood clots, severe arteriosclerosis or congestive heart failure. Compression bandaging uses elastic bandages wrapped around your limb to encourage proper lymph flow and prevent further swelling. Your therapist will wrap your limb, then show you how to wrap it yourself when you are at home. The bandages are worn day and night if possible.
Exercises focus on gentle contractions of the muscles while you are wearing compression bandages to help move lymph fluid out of your limb. These are light exercises that should not make you tired. Skin and nail care education helps you learn how to inspect your skin and prevent infections such as cellulitis. People with lymphedema are at higher risk for skin infections. Treatment is recommended five days a week during the acute phase, but may vary depending on your situation.
Once swelling has been reduced in your arm or leg, it’s important for you to continue certain treatments on your own at home. Your therapist will teach you or a family member how to massage yourself to drain lymph fluid out of the affected limb. You should also continue with the light exercises and skin care. You may need to wear a compression garment — a long sleeve or stocking designed to compress your limb and encourage lymph fluid to flow away.
During the self-management phase of treatment, you’ll see your therapist less often. You and your therapist will determine the schedule based on your needs.
Manual Therapy has two goals: 1) the recovery of function in the joints, 2) the improvement of posture and movement. For this purpose a manual therapist (MT) utilizes a number of specific techniques that can be applied to these joints.
Usually the effects of manual therapy can be noticed immediatly; more specifically, your range of motion will be larger and you will notice a decrease in pain. Furthermore the treatment plan of an MT consists of instructing, advising, directing his client and giving an insight on a healthier motion.
A manual therapist is a physiotherapist that has furthered his studies into manual therapy. Through this he has additional knowledge of movements of the body, especially that of the spine. Through this specialized education, a manual therapist is highly qualified to evaluate and assess the source of one’s complaints and find a solution that fits the body’s needs
When is seeing an MT the best option?
If you are suffering from stiff and/or painful joint movements, manual therapy is highly recommended. After a treatment the effects are usually apparent, such as, joints having a better function and movement, thus raising one’s mobility.
Examples of complaints that can be treated by a manual therapist:
- Head and neck aches in combination with a stiff back;
- Neck and shoulder pain with referred pain to the arms;
- Lower back complaints, with or without referred pain to the legs;
- Upper back complaints, with or without rib and chest complaints;
- Dizziness during movement of the neck;
- Jaw complaints, with or without neck complaints;
- Hip complaints.
During the assessment in your first appointment it will be apparent if and how your specific complaint can be relieved. Therefore directly after your first appointment you will have the clarity you need for the upcoming treatments.
The Procedure of a Manual Therapist
Intake: Direct Insight
After the initial screening, your first appointment consists of two parts: 1) an interview and a 2) a physical evaluation. During the interview the therapist will ask about your complaints, for example, how they began, and when these complaints grew worse or improved.
Following the interview is a physical evaluation. This is used by the therapist to assess your posture, movements, and examine the joints. This is how the source of your complaints will be found. These findings will be discussed with the patient and together they will decide if manual therapy is useful. If this is not the case, the therapist and the patient will discuss the approach of the treatments to follow. As a result everything should be clear about future treatments after the first appointment.
The Treatment: Effective Therapy
A manual therapist knows a number of specific techniques that can be applied to the joints in order to recover their function, and to improve mobility and posture.
Usually the effects of manual therapy that can be noticed immediatly are:
- your range of motion will be larger and,
- you will notice a decrease in pain. Furthermore the treatment plan of an MT consists of instructing, advising, and directing his client; and giving an insight on a healthier motion.
A innovative treatment method for chronic tendinopathies, bursitis, capsulo- and ligamentary complaints, entrapment neuropathies and acute myogenic complaints.
PNE applies as a short, effectively proven minimal invasive treatment consisting of the use of a galvanic current under guidance of MSU (muskulo skeletal ultrasound)via a dry needle.
What are the benefits of PNE?
PNE provides the ability to treat complex, chronic complaints. It allows faster treatment of acute complaints. The application of PNE involves several
advantages: High evidence of effectiveness in prolonged chronic complaints Good in combination with other forms of active therapy Local treatment directly on the affected tissue, or in its immediate surroundings. No impairment of healthy tissue Very good treatment results in prolonged chronic complaints It is a minimal invasive treatment It is a treatment under MSU- guidance /control The chance of recurrence of complaint is very small. It is efficient, short and rapid treatment
The intake and MSU (muskulo skeletal ultrasound) examination will be reimbursed if you are supplementary insured, only the PNE session carries an extra charge of 55 euros per session. This is not reimbursed by the health insurence. The number of sessions is on average 3 to 5 times. The treatment is carried out by a specially trained PNE specialist / physiotherapist. Possible condition preparatory treatments for performing PNE and for performing a training program are reimbursed by the insurence when you are supplementary insured