The shoulder is vulnerable to a many differing problems due to its complex nature - combining several joints, tendons and muscles which allow for a broad range of movement. The shoulder is inherently unstable and its function can be likened to a seal trying to balance a ball on it's nose! It is very reliant of good muscle strength and function for support and stability and when this is not present, one of the common painful conditions which may develop is shoulder impingement also referred to as rotator cuff tendinopathy or impingement syndrome.

Treatments include Physiotherapy (usually the first approach) which may involve exercise, manual therapy and medical acupuncture/dry needling, as well as other procedures such as local injections and surgery in certain cases.

Over the years the scientific understanding of "unexplained" chronic pain has increased. Some examples of "unexplained" chronic pain include conditions such as chronic low back pain or chronic whiplash or fibromyalgia or chronic fatigue syndrome.

The research now shows that a concept of central sensitization is the underlying cause of this "unexplained" phenomena. Central sensitization is a process where the brain is receiving too many messages from the nerves to inform the brain that there is a problem with the body, which causes an over-sensitization of the problem.The brain is being over-bombarded with alarm bells that there is something wrong with the body.

By being educated on this concept and how central sensitization works can help to improve understanding of pain and how pain works.

A review on chronic unexplained pain discusses practice guidelines for explaining "unexplained" pain. This educational process involves two sessions lasting 30 minutes each approximately.

The first step in this process is to meet face-to face with a therapist in order to improve your knowledge on pain inlcuding:

Adequate preparation as well as appropriate rest and recovery from sport and activity can help prevent overuse injuries from occurring. However with every good intention an overuse injury is easily sustain and is a common type of injury we see here in our Physiotherapy practice.

To fully understand the nature of the overuse injury, how to treat it and prevent it from happening again we must take a look at some background information about this common condition.

What is an overuse injury?

As a result of our sport or activity we can sustain one of two types of injuries - acute or overuse types.

Acute injury

This type of injury can be characterised by the sudden onset of a ‘sharp’ pain with the potential for the sudden loss of function, usually as a result of a traumatic event. Some examples of acute injuries would be sprains of the ankle, dislocation of the shoulder, bone fractures, etc.

Overuse injury

This type of injury is quite different from the acute injury in that the presence of pain and in some cases inflammation too can be totally absent. Instead of the sudden onset of pain and dysfunction there are numerous and repetitive micro traumas that occur to the muscles, tendons, joints and bones. These micro traumas are subtle and if frequent enough they will eventually lead to pain and dysfunction due to the eventual breakdown of the affected body part.

Lorraine and I are enjoying a busy 2014 with our young family, the busy clinic and Pilates studio as well as our University tutoring and lecturing roles. We are proud to be involved in higher education supporting upcoming students as well as fellow medical professionals and we’d like to share some of the details of what we have been up to.

Lorraine has been regularly lecturing as well as examining on the undergraduate physiotherapy programme as well as the prestigious Masters in Neuromusculoskeletal Physiotherapy at UCD over the last number of months. Given such positive student feedback she has once again been asked to be a clinical tutor for Masters degree students on placement at the Mater hospital over the coming weeks. Lorraine will again this month present a lecture in lower limb biomechanics and injury management to the Irish College of General Practitioners.

Its that time of year again when I am fortunate and privileged to offer my experience and clinical expertise at the UCD School of Physiotherapy. I am currently teaching as an external lecturer on the Musculoskeletal module with my main role to cover the more practical ‘hands on’ aspects of managing patients with spinal conditions.

There is a bridge to gap between the world of academia and course work as offered in the University setting, and the application of this knowledge in a real world clinical setting. This is where I come in as I try to help students learn the manual therapy, exercise and patient management skills to be able to help the patients they encounter as students and upon graduation.

This brings me to some criticism of the University system, which is that of attendance. Given that these skills are only taught once in this setting, I am concerned when the lecture and practical classes don't have a 100% attendance by the physiotherapy students. These are the basic skills anyone wanting to work in musculoskeletal physiotherapy requires to be effective, they are the bread and butter of our practice. The time to gain the knowledge is now, so why not make attendance a priority? The University are trying to address the issue by making practical attendance contribute to the final module grade, however as yet this has not quite made the full impact. I feel that students have to want to learn and that if the passion and enthusiasm is there, attendance would never be an issue.

Although sometimes used interchangably the titles 'Physiotherapist' and 'physical therapist' are actually quite distinct from each other. Inspired by a recent question from one of our clients I will share some details that should help to explain what the difference is between a Chartered Physiotherapist and a physical therapist.

Definition - Physiotherapist

Physiotherapy is a health profession concerned with helping to restore well-being to people following injury, pain or disability. Using knowledge from our extensive scientific and clinical background Chartered Physiotherapists can help to assess, diagnose and treat conditions and illnesses that affect people of all ages and social groups.

Chartered Physiotherapists use manual therapy including manipulation, mobilisation and massage as well as alternative modalities including electrotherapy and acupuncture. The Chartered Physiotherapist also utilises prescriptive exercise as a rehabilitative tool to help patients achieve their full potential. While traditionally, physiotherapy was regarded as rehabilitative and mainly hospital-based, the profession has expanded greatly into other health care areas. We have invaluable expertise to offer in educational and preventative roles in the community, the workplace and in private practice.

Definition - Physical Therapist

The Institute of Physical Therapy and Applied Science Limited defines Physical Therapy as a holistic approach based on the manual treatment of soft tissue, i.e., muscles, tendons, ligaments and fascia.

It is often the case that the effectiveness of your treatment is a combined effort by our entire team. In this article I wish to share a brief insight in the amazing value of collaboration between healthcare professionals.

Starting with a coffee

Every Monday Katie, Paula, Lorraine and myself sit down to a cup of coffee (and often a treat from the Good Food Shop just next door to the clinic) for a team meeting.

We usually start by running through any household or general administration matters which may need discussing. This ensures the smooth running of the clinic and brings us all up to speed with any changes or advances in what we are doing to deliver our Physiotherapy service. Its essential we are all on the same page and to be consistency amongst us in terms of how we do what we do. It is also a great platform for feedback between team members which provides further opportunity for refinement and improvement our internal systems.

During your first consultation with us your Chartered Physiotherapist will conduct a thorough physical assessment. This essential first step will assist us in determining what the structural source of your musculoskeletal pain complaint is most likely to be and enable us to provide a diagnosis followed by a planned course of treatment.

Your assessment will involve a combination of you answering relevant questions and your Physiotherapist conducting a hands-on, physical assessment of the affected body area.

Questions we will ask you

Firstly we will need to understand, in as much detail as possible, the history of your condition. Your Physiotherapist will ask you:

• When did the problem start
• Was there an injury sustained, or
• Did the problem arise for no apparent reason

In order to get an impression of how your symptoms respond to certain activities we also need to know:

A combination of medical intervention and lifestyle modifications are needed in order to offer a cure for a repetitive strain injury (RSI).

RSI, also referred to as upper limb work related disorder, is a general term used to describe pain of muscles, nerves and tendons caused by repetitive movement and overuse (National Health Service). It most frequently occurs in those who work with computers or in repetitive manual labour. This condition mostly affects parts of the upper body including the neck, shoulder, elbow, wrists and forearm.

There are common causes of knee pain in children but it can be difficult to determine which aches and pains need medical attention and which they may “grow out of”.

Osgood Schlatters

A common cause of knee pain, particularly in boys, is Osgood Schlatters. Your child may complain of pain and tenderness below their knee cap and could recently have had a growth spurt. The pain is due to irritation of a ligament, called the patellar ligament, which connects the kneecap to the shin bone. This is sensitive to touch and your child may have pain with walking or jumping activities or on the stairs.

The initial treatment for Osgood Schlatters is “RICE” Rest Ice Compress Elevate which can help ease pain symptoms. Symptoms usually subside when the growth spurt ends…unfortunately this could take 1-2 years! Gentle stretching of the quadriceps muscle is also advised as it can reduce the tension on the patellar tendon. It is also important to consider lower limb biomechanics and gluteal/ hip muscle strength and intervene with Physiotherapy treatment where necessary to help accelerate the healing process.