Common Conditions, Pathologies & Injuries

Whiplash Associated Disorder (WAD)

This type of soft tissue injury often happens after a motor vehicle accident. When the patient is rear-ended, the passenger’s head gets thrusted backward (hypertension) and the body is thrown forward. The reverse tends to happen wherein a car hits a solid stationary object. Here the head keeps moving forward (hyperlfexion) as the body suddenly stops.

Usually the patient tends to report increasing stiffness and pain over the next few hours with the symptoms peaking in a few days. Depending on age, pre-existing condition of the patient, this soft tissue injury appears to resolve within 6-8 weeks.

Medical management with anti-inflammatory, analgesics and muscle relaxants are recommended by physician in conjunction with physiotherapy. Physiotherapy initially tends to focus on pain management, hot, cold and electrical modalities to assist with pain management. Additionally education on proper positioning and sleep is discussed initially and education on proper biomechanics, pacing, self management strategies are consistently provided through out the course of the treatment. Manual therapy techniques like manual tractions, mobilizations, stretches and exercise is added subsequently to maximize strength and function to restore pre-accident status at work and home.

Frozen Shoulder:

Also known as adhesive capsulitis is characterized by pain and loss of motion or stiffness in the shoulder. The causes of frozen shoulder are not completely understood but the process involves thickening and contracture of the capsule surrounding the joint. Frozen shoulder appears to be more common with individual’s diabetes, hypo/hyperthyroidism, Parkinson’s diseases and cardiac disease or surgery.

Frozen shoulder has three stages:

  • Stage one: In the “freezing” stage, the patient develops a slow onset of pain. Increasing pain results in increasing loss of shoulder motion. This stage appears to last 6 to 9 months.
  • Stage two: The “Frozen” stage, which is marked by decreasing pain with continued limited range of motion. This stage may last 4 to 9 months.
  • Stage three: The final stage “thawing” stage’ during this stage the motion slowly starts returning to normal. This stage may last 5 to 26 months.

Usually treatment entails anti-inflammatory medications and physiotherapy is recommended to assist with restoring normal movement patterns and capsular mobility. Exercise to assist with range, endurance, strength and functional retraining are incorporated within the sessions. Modalities such as heat therapy acupuncture and electrotherapy is applied to assist with pain management and maximize movement.

Colles's Fracture:

A Colles’s Fracture is a break of the end of the forearm bones namely radius and ulna. Often occurs with a sudden fall on an outstretched hand. If the fracture is clean then the hand is casted for few weeks and progressive exercise with the help of physiotherapy to maximize flexibility and strength is recommended. However, if the fracture is displaced then a closed or open reduction is performed wherein screws and plates maybe required. Cast for 6-8 weeks is required and due to immobilization effects exercises for range, endurance and strength, in addition to manual therapy may be recommended.

Osteoarthritis:

This is most common form of arthritis and is also abbreviated as OA. These conditions caused by breakdown of cartilage inside certain joints resulting in varying symptoms from minor pain, to very uncomfortable pain, inflammation and resultant decreased tolerance for functional activities.

OA cannot be cured but with proper medical management and physiotherapy in some cases surgery is used to effectively manage the patients. Treatment includes manual therapy, education, active/functional exercises and modalities for pain management including but not limited to Interferential current, TENs machine, acupuncture and heat/cold therapy.

Disc Herniations:

A disc is a structure between the two vertebras whose main function is shock absorption, supports the weight of the upper body and allows friction free movement within the spine. It has a fluid-filled central nucleus surrounded by ligamentous, annulus fibrosis.

Disc problems can be caused by various activities including but not limited to poor lifting techniques, motor vehicle accident and twisting/bending especially with load in the hands. The disc problems are caused by the buldging portion which may press on a nerve root resulting in radicular pain into the legs or arm as appropriate based on the level of herniation. Patient may experience varying degree of symptoms based on the true impingement of the nerve root and/or underlying myotomal/dermatomal changes and resultant decreased length tension relationship.

Overall treatment would include medical management to assit with pain management, and physiotherapy approaches like McKenzie protocol, Manual therapy, traction and specific core exercises to maximize functional independence with regular day to day activities at work/home.

Patello-Femoral Syndrome:

Displacement of the knee cap as it tracks over the femur resulting inflammation and pain at the underside of the patella. The patient reports nagging pain beneath the knee cap or on the sides of the kneecap during activities like walking up stairs, getting in/out of cars, getting on/off the toilet seat and a dull ache is reported after a sports activity like running. There are various reasons for this condition but the most common one is excess internal tibia rotation (squinted patella position) which results in excessive probation (flattening of the arch) of the foot. The causes increased transfer of force via the cartilage of the patella causing inflammation and pain. The cartilage becomes damaged due to improper tracking of the patella. Physiotherapy treatment for this condition is very successful and is focused on education of proper footwear, custom orthotics; proper en is very successful and is focused on education of proper footwear, custom orthotics, and proper exercise regime to maximize quadriceps (VMO) strength which assists in restoring normal tracking of the patella on the femur.

Plantar Fasciitis:

This condition is marked by inflammation of the plantar fascia (on the sole of feet). The patient usually reports pain with first few steps from rest to weight bearing activity which subsides with few minutes. The pain is worst in the morning. Treatments for this included medial management like anti-inflammatory medication and analgesics as appropriate. Physiotherapy intervention includes modalities like ultra sound, acupuncture, heat and cold therapy to assist with scar breakdown and pain management. Orthotics, active exercise regime focused on range, strength, stretch and functional independence is provided. Furthermore some patients need a night splint to assist with gentle sustained stretch on the fascia.

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