Physiotherapists and how we differ from other therapists

Here at the Therapy Centre we often get asked about the differences between a physiotherapist and a chiropractor or an osteopath for example, to help explain this we've added some new content which you can read by clicking the links above.

We hope that's useful and please don't hesitate to contact us if you've any questions at all about how we can help you.

Risk factors for low back pain

The most consistent factors that predict low back pain are:
Work related psychosocial factors;  high job demands and low job control
Mechanical factors; prolonged standing,awkward lifting and squatting or kneeling
Work-related Psychosocial and Mechanical Risk Factors for Low Back Pain
A 3-year Follow-up Study of the General Working Population in Norway

Tom Sterud, Tore Tynes
Occup Environ Med. 2013;70(5):296-302

If you're worried about back pain then physiotherapy can help, both in the short and long term. Come and see us at the Physio Therapy Centre to find out more

Fish Oil doesn't reduce the chance of death or problems related to heart diease

In a large study with a 5 year follow-up, it was shown that taking daily doses of fish oil did not prevent the chances of death or problems related to heart disease.

New England Journal of Medicine 2013 368:1800-1808

Use it or lose it

Use it or lose it is the message from this study. The elder person who maintains a high level of aerobic fitness will live longer.

While age is associated with decrease in muscle mass, strength, endurance and aerobic fitness the elderly respond well to exercise and it could help in preventing age related problems.

A study looked at aerobic fitness in 2077 hypertensive men aged 70 or over. Overall mortality was 15% lower in those with moderate levels of aerobic fitness; 37% lower in higher levels of fitness. Many of us spend hours sitting through a day and this has a negative effect

American Soc of Hypertension(ASH) 2013 scientific sessions

Also there is a strong association between  mid-life fitness and later heart failure

Circulation:Heartfailure Berey et al 2013

Illness perception,work,back pain, and significant others

People out of work due to persistent low back pain tended to self limit their ability to work and were supported in their beliefs by their partner.

To justify this, this group became fixed in the belief that this was so and it became crucial that the individual with back pain was perceived as completely disabled.

It is suggested that partners of individuals with low back pain are a potentially detrimental source of support. It may be useful to include partners in vocational rehabilitation programmes

Brooks et., Musculoskeletal Disorders 2013 14(48)

Pain in the older person

Older people are different. The physiological changes that occur with ageing, the co-morbidities, prescription of medication, frailty and psychosocial changes mean that  considering pain control for these individuals can be challenging.  The British Geriatric Society and British Pain Society have made some recommendations 

Pharmacology

For many analgesic medicines, a lower initial dose may be required than prescribed for younger adults and should be titrated to response. The first line pharmacological treatment, particularly in musculoskeletal pain is paracetamol. It has demonstrated efficacy and a good safety profile, but it is important that the maximum daily dose is not exceeded. Although NSAIDs are effective analgesics, their side effect profile requires cautious use. If essential, the lowest dose should be used for the shortest period and reviewed regularly. Opioids are effective in the short term, but evidence for long-term efficacy is much more limited and hence patients prescribed opioids should have regular review, both for efficacy and tolerability. Side effects, particularly constipation, should be anticipated and prophylactic treatments prescribed. Excessive sedation can be problematic and should be monitored carefully. Tricyclic antidepressants or anti-epileptics may be considered for neuropathic pain, although side effects often limit their use. Topical analgesics have a role in localised pain; both lidocaine and capsaicin have limited efficacy in localised neuropathic pain and topical NSAIDs may be suitable for non-neuropathic pain.

Combination therapy using different classes of analgesics may provide greater pain relief through synergistic action with fewer side effects compared with higher doses of a single medicine.

Interventional therapies

Interventional therapies in the management of chronic pain include a variety of neural blocks and minimally invasive procedures. The recommendations produced in this section are limited to specific interventions in clinical conditions common in older people. Intra-articular (IA) corticosteroid injection in osteoarthritis of the knee is effective in relieving pain in the short term with little risk of complications and/or joint damage. Hyaluronic acid is also effective but appears to have a slower onset of action and lasts longer than steroids. The evidence for IA injection of other joints, however, is limited.

The evidence for facet joint interventions is mixed, although there is some support for radiofrequency lesioning for both cervical and lumbar facet joint pain in appropriately selected patients. There is also limited data to support consideration of epidural steroid injections 

Psychological interventions

It is well recognised that psychological factors often influence the manner people respond to and cope with pain, and techniques may modify beliefs and attitudes. However, few studies have focused on older adults and sample sizes are small. Nonetheless, psychological interventions such as cognitive behavioural therapy (CBT) or behavioural therapy may be effective in decreasing chronic pain in adults and improving disability and mood. Elderly nursing home residents with chronic pain may benefit from CBT pain management interventions. Psychological interventions may be used as an adjunct to pharmacological intervention and/or other modalities.

 Physical activity

 Physical activity and assistive devices encompass a wide range of

interventions. The available evidence supports the use of programmes that

comprise strengthening, flexibility and endurance activities to increase

 physical activity, improve function and pain.^]There are many different forms of

exercise and the choice of exercise type can pose a dilemma. Given the

 absence of evidence to recommend one type of exercise over another,

 patient preference should be a key factor and programmes should be

customised to individual capacity and need.  A large range of potential

options includes progressive resistance exercise, walking, water-based

exercise/hydrotherapy. Golf , bowls and adaptations of Tai-Chi and Yoga  and

advances in gaming technology such as Wii are also opening up new

possibilities and are useful in balance control

 Complementary therapies

Some types of complementary therapy [e.g. acupuncture, transcutaneous electrical nerve stimulation (TENS), massage] have been used for older adults with painful conditions, although the available studies lack methodological rigour. Acupuncture applied singularly or in combination with other modalities has an impact on pain and quality of life in patients with osteoarthritis. Conventional TENS can be used for relief of musculoskeletal pain. Similarly, percutaneous electrical nerve stimulation combined with physiotherapy reduces pain and self-reported disability for up to 3 months. Other therapies such as massage can be used to treat chronic pain, in particular shoulder or knee pain.

Physical Therapy as Effective as Surgery for Meniscal Tear

Patients with knee osteoarthritis and a meniscal tear who received physical therapy without surgery had good functional improvement 6 months later, and outcomes did not differ significantly from patients who underwent arthroscopic partial meniscectomy, a new trial shows.

Patients with a meniscal tear and osteoarthritis pose a treatment challenge because it is not clear which condition is causing their symptoms.

Currently, millions of people are being exposed to potential risks associated with a surgical treatment that may or may not offer specific benefit, and the costs are substantial.

The physical therapy in both regimens  involved 1 or 2 sessions a week for about 6 weeks and home exercises. The average number of physical therapy visits was 7 in the surgery group and 8 in the non-surgery group.

 Mean Improvement in Osteoarthritis Index at 6 Months

Treatment Group	Mean Improvement (Points)	95% Confidence Interval
Surgery+ physical therapy	20.9	17.9–23.9
Physical therapy	18.5	15.6–21.5

The 12-month results were similar to the 6-month results. 

 John Mays, MD, an orthopaedic surgeon practicing in  Louisiana, USA, who was asked to comment on the findings, said most patients don't choose physical therapy. "In the real world, most people want a quick fix" and choose surgery, he noted.

Dr. Mays said he would have liked to have seen a group of patients who underwent surgery but did not receive postoperative physical therapy. He explained that his patients with osteoarthritis and meniscal tear rarely get physical therapy after arthroscopic meniscectomy; they most often do home-based exercises.

He added that "most insurance plans have limits on the number of physical therapy sessions they allow."

N Engl J Med. Published online March 19, 2013. Abstract, Editorial