|
Our Masters trained Physiotherapists have an in-depth
understanding of the body as a whole and have advanced
skills in the management of all general musculoskeletal
conditions with a special interest in back &
neck conditions.
We
delve into the origin of the condition and take
corrective measures directed at the primary problem
and not merely the symptoms that the condition causes.
To this end, our physiotherapists are Tier 2 Musculoskeletal
and Manipulative Physiotherapists with Masters level
qualifications and we take a special interest in
the management of longer-term difficult conditions
that have perhaps failed to respond to other treatments.
In this section, we have addressed:
Transversus / abdominis & multifidus stability back program with our biofeedback ultrasound-imaging scanner
Levator scapulae syndrome
Benign Paroxysmal positional vertigo
Biofeedback Ultrasound Imaging Scanner / Stability
Program
This
ultrasound unit gives real-time images of transversus
abdominis (TrA) and lumbar multifidus (M). Recent
research has shown that in people without chronic
or persistent low back pain (LBP), TrA contracts
before movement to protect the lumbar spine. This
feature of TrA function occurs with all movements
of all limbs in all directions. With the presence
of LBP, the contraction of TrA occurs after the
movement has occurred, exposing the unprotected
lumbar spine to excessive shear forces and propagating
the persistent LBP.
(See
diagram below, EMG of musculature)
The dysfunction is that of co-ordination of TrA.
Treating the problem involves re-training TrA to
contract prior to the spine's exposure to external
stresses and has been shown to markedly reduce pain
and instability. The use of real-time ultrasound
imaging is being used as an additional form of facilitation,
biofeedback and monitoring to help in re-training
and in progressing the neural control of this important
stabilizing muscle.
as
the patient contracts TrA only and assists in the
specific training without the activation of external
and internal oblique.
S=
Skin, ST= Subcutaneous Tissue, OE= External Oblique,
OI= Internal Oblique.
Below
is an image of TrA that is obtained from real-time
ultrasound. The image is monitored
Concurrently,
in patients without a history of LBP, the multifidus
muscle is symmetrical between sides at all levels.
The
image below is a transverse section through L5 in
a patient with LBP.
SP=
Spinous Process, L= Lamina.
The
left multifidus is some 25% smaller than the corresponding
right side. This change occurs rapidly in response
to injury and a return to normal activity does not
automatically correct this imbalance. Hides et al
(1996) demonstrated that 80% of patients with this
imbalance would experience a reoccurrence of their
LBP within one year. Real-time ultrasound is used
to specifically rehabilitate and monitor multifidus
recovery.
The
transversus abdominis\multifidus program, forms
an integral part of the Masters program, and is
used at Royal Brisbane, Princess Alexandria, the
Mater and QEII hospitals. This program plays an
integral part in the management of chronic LBP.
Patients examined with persistent or recurrent low
back pain, all had deficiencies when examined using
real-time ultrasound in these hospitals and they
all made varying degrees of improvement on the program,
taking into account all the features of their condition
and commitment to the program.
References:
Hides
J A, Richardson C A, Jull G W. (1996)
Multifidus muscle recovery is not automatic following
resolution of acute first episode low back pain.
Spine 21:2763-2769.
Hodges
P W, Richardson C A. (1996)
Inefficient muscular stabilization of the lumbar
spine associated with low back pain: a motor control
evaluation of transverses abdominis. Spine 21:2640-2650.
Cervical Levator Scapulae Syndrome
A common chronic condition treated at the Back &
Neck Centre is Levator Scapulae Syndrome (LSS).
This condition can be due to a number of issues,
sometimes out of our control, that arise from injury,
postural changes, work habits and lifestyle issues.
LSS is where the patient has been using the levator
scapula and rhomboid muscles to control the way
the shoulder blade is positioned on the rib cage,
instead of using the correct muscles, being the
lower trapezius and serratus anterior.
This persistent load being transferred through the
levator scapula to the cervical spine, causes chronic
neck pain whilst the inability of the rhomboid to
keep the shoulder blade flat on the rib cage causes
it to ‘wing’ off the rib cage. This may
inturn lead to rotator cuff impingement under the
acromial arch.
The treatment program is a motor control program
that is designed to retrain the patient to use the
correct musculature at the correct time. The program
is relatively easy to learn and is usually performed
for three months to correct the condition and to
ensure the correct muscles are automatically engaged.
Benign Paroxysmal Positional Vertigo
Benign
Paroxysmal Positional Vertigo (BPPV) is a common
cause of dizziness that affects the Australian community.
A description of the condition must be preceded
by a brief overview of the anatomy of the inner
ear that is involved in the manifestation of BPPV.
One of the ways in which the brain receives information
about where our bodies are in space is through the
semicircular canal located deep within the skull.
They consist of three canals at right angles to
each other and filled with a fluid called endolymph.
Located within walls of these canals are fine hair
like structures called cilia with small calcium
balls called catholiths on the tip. As inertia causes
the endolymph to flow through the canals as we move
about performing our daily activities, the catholiths
ebb and flow through the fluid causing the cilia
to stimulate nerves that are attached to their base.
Our brain receives this nerve stimulation and along
with our other senses, determines how we are moving.
BPPV
occurs as a result of these catholiths breaking
away from the cilia and causing stimulation of the
nerves at the base of the cilia at inappropriate
time. This is what we know as one type of dizziness
called BPPV. The procedure that physiotherapists
use to control this condition is called the Epley-Parnese
maneuver. This involves moving the patient through
a very slow and specific series of positions that
drains these free catholiths to an area of the inner
ear called the utricle, where they cannot cause
any of this inappropriate stimulation.
This
completed, the dizziness caused by BPPV, is resolved
for the time being. It is possible for the catholiths
to work their way out again in which case the maneuver
is repeated.
The
beauty of the procedure is that it simple to learn
and has no risk associated with it. If correctly
diagnosed, the patient can only improve.
|
