The Physical Assessment
In my three previous blogs on physiotherapy assessment
A Different Perspective On Your Physiotherapy Assessment
The Subjective Physiotherapy Assessment
The Subjective Physiotherapy Assessment - Part 2
I discussed concepts and steps which for most will not have been considered and most will have assumed that the physical assessment was the first step.
That is the mistake that so many make, missing out on the vital steps of creating the right environment to build connection and trust and gaining a deeper understanding of your important beliefs. Make that mistake and you are destined to gain so much less.
So the physical part of the assessment. What do we do? Well, in a private room we may ask you to take off some of your clothes, so you might want to be wearing clothes you're comfortable in and can take off quickly. If you're too shy to take off your clothes, just say it, it's not a problem.
Many of the assessments we make at my clinic are not common in the UK or anywhere else in the world. I am fortunate to have studied and qualified at the highest level in specific pain relief techniques and as a result I have learnt and ingrained advanced assessment techniques in myself and the rest of my team.
Then we'll be looking structurally at your skin. What does it look like? How healthy it is? What are the hairs like? Are there hairs missing? Does that mean the nerves are not working properly in that area? What's the temperature of the skin? Is it sweaty? Is it dry? How does the limb move? Does it move normally? If not, it will tell us is it’s likely to be arthritis in the joint that's blocking it. Or is it likely to be a tendon? Or a muscle or ligament? Or is it the nerves? Are they transmitting messages normally?
Or is it the brain? Has your brain created the pain felt in the body, possibly locked in from an emotional trauma many years earlier, even back to when you were a child? Chronic pain is created in many parts of the brain (evident in scans). Mindmapping physiotherapy techniques help to unwire the pain felt in the body.
So we're assessing the physical aspect. And that tells us so much about where we believe the problem is, or which systems are mostly causing the problem. Is it mostly the muscles? Is it mostly the nerves innovating the muscles? Is a blood flow problem? Is it something to do with what you are eating or if you don't move enough you are too weak. Or are you so stressed up, that you’re just pumping out inflammation into the area and you’re getting a more aggressive form of arthritis. And you don't need to. By looking at and at the same time feeling the response of your body, we learn a lot. If we hold a patient's hand that's sore, your eyes tend to move very differently than if you hold part of the body that isn't. Also there's a feeling about the hand, there's a hesitancy and there's a sort of a difference in the tone or strength.
There is so much in our senses, that we pick up on when we're assessing physically. Clearly this can only be done physically, face to face. Most of the above would be totally impossible to achieve by virtual means.
In my next blog Your Physiotherapy Prescription I’ll take you through how we develop a Physiotherapy treatment prescription, or plan, which takes you through the steps needed to achieve a successful outcome and let you get on with your life.
In the meantime, if you are in pain right now and you feel confident we can help, then why not call now. Erica, Jean and Charlotte will be happy to help.
Call 01889 881488 Now
p.s. Don’t try to book online at this time as that is only suitable for existing clients already being treated for an existing problem.
Ok, you are in pain, you have tried the obvious remedies, like pain killers and anti-inflammatories or a bit of exercise, but they didn’t fix the problem. You don’t want to be on drugs for too long, so you are thinking about getting to see a physiotherapist to assess you properly and find out what the problem really is and how best to fix it.
This presents you with a number of problems, such as where is the best physiotherapy clinic to go to and is it experienced with helping your type of problem. If you have friends or family who can provide help, based on their own experiences, then great. If not, the next best thing is to look at Google reviews and /or ask on social media. If you want some help on how to choose a clinic and what you need to ask, then click on this link How to Choose A Physiotherapy Clinic
You may have assumed that a physical assessment will be the first step.
That is the mistake that so many make, missing out the vital steps of creating the right environment to build connection and trust, and gaining a deeper understanding of your important beliefs. Make that mistake and you are destined to gain so much less.
Many of the assessment skills we use at my clinic are not common in the UK or anywhere else in the world. I am fortunate to have studied and qualified at the highest level in specific pain relief techniques and as a result, I have learnt and ingrained advanced assessment techniques in myself and the rest of my team.
Thus today, I want to approach this from a different angle, one you might not have thought of as being important, but trust me, it’s vital to a successful outcome. It’s the environment of the assessment room, and that means not only your room but the physiotherapists as well when the assessment is being done virtually.
You see, we all have an inherent ability to recognise if there is a true focus on the problem and that you are being listened to. If the environment is full of distractions or interruptions, then your physiotherapist’s thoughts will be disrupted and you will sense it. Your physiotherapist needs to be in the present moment, focussed and not allowing other thoughts to clutter up their head.
That’s my number one piece of advice.
Clearly, the environment is much better when you are face to face with the physiotherapist who is assessing you. There’s much less probability of distraction and that vital bond of trust is so much easier to build.
If your physiotherapist practices mindfulness techniques, they will induce a mental state capable of focussed attention on you. Your healing will commence as soon as you sense the caring intention.
I’m going to continue this explanation of how to achieve a successful assessment in more blogs. If you want me to keep with me on this journey, look out for my next instalment ‘The Subjective Physiotherapy Assessment’, which continues to look at this topic from a new perspective.
In the meantime, if you are in pain right now and you feel confident we can help, then why not call now. Erica, Jean and Charlotte will be happy to help.
Call 01889 881488 Now
p.s. Don’t try to book online at this time as that is only suitable for existing clients already being treated for an existing problem.
In my two previous blogs A Different Perspective On Your Physiotherapy Assessment and The Subjective Physiotherapy Assessment, I discussed the importance of getting that connection and really listening to get the patients story. Why are you here, what are your beliefs about treatment?
Now it’s time to go further, honing it down with specific questions about the problem.
Let’s use an example to help illustrate. Someone comes to me and they've had chronic pain in their foot for a very long time. I would be asking questions about the possibility of arthritis. Questions regarding the nervous system. Looking at the way that the body moves. Seeing if the pain is transmitting down from the spinal cord, because it could be a problem in the spine itself and not the foot at all. Having a look at the function of the foot, seeing if biomechanically the patient is walking in a strange way, and is that is making it worse?
How does it feel? How does the tissue feel? Is there any swelling? Are there problems with circulation? Is the sensation there? Are the nerves working properly? Is there an amplification of pain so that when I touch, the tissue is overly sensitive? What are the clues as to what's going on?
This is a very important start to this part of the assessment, which leads to the physical assessment.
To recap, the first part is establishing the connection and the story, the background, the beliefs, the values. The next part is to do with the Four Keys, to do with your immune system and your general health.
The next part is to hone it down into the particular problem today and how it's starting to manifest itself physically.
The final step is to go into the physical, which we can't do remotely by zoom. The physiotherapist has to get hands-on and assess physically, face to face.
In my next blog The Physical Assessment I will delve into the actual hands-on physical assessment. Many of you may have thought that this would be the first step in an assessment and that is the mistake that so many make, missing out on the vital steps of building connection and trust and gaining a deeper understanding of the all-important beliefs of the client. Make that mistake and you are destined to gain so much less.
In the meantime, if you are in pain right now and you feel confident we can help, then why not call now. Erica, Jean and Charlotte will be happy to help
Call 01889 881488 Now
p.s. Don’t try to book online at this time as that is only suitable for existing clients already being treated for an existing problem.
I get asked a lot of questions about physiotherapy assessment. What do we do at my clinic? How do I assess? How do I teach assessing?
In my previous blog A Different Perspective On Your Physiotherapy Assessment, I mentioned that the first and most important thing is to have a safe, quiet environment that builds a connection and trust. If you don't feel that with your physiotherapist, you're not going to want to proceed to any kind of medicine or treatment and your outcome won't be as successful. There won't be that connection.
To recap, the most important thing for the patient is that the physiotherapist has created a sacred space, a quiet office, where the phones are switched off, the computer is not a distraction, and you eyeball each other to get that connection. And then your physiotherapist listens to your story. And how you describe what's going on with you. And then, in that moment of connection, your physiotherapist can get glimpses of the real authentic self behind the story, who you really are.
Once your physiotherapist glimpses the story of the problem, he or she can start to elicit some background which is past medical history. So we'll ask questions like the health of your family to see if there are relevant genetic links. We may also explore your beliefs and values and more about your family so we'll know how difficult it is for you to attend and for you to have the necessary treatment. We may touch on your past experiences of treatment because if you've been scared or let down previously, you're going to have very different expectations. We need to address that head-on.
And then, of course, my favourite four keys questions (see my first book ‘The Four Keys To Health’ available on Amazon), which looks into your mindset, lifestyle, fitness and what you eat. All these help us assess how well your immune system is working, and your general health, which helps refine our treatment prescription.
That, in a nutshell, is the first part of the physiotherapy assessment.
In my next blog ‘The Subjective Physiotherapy Assessment – Part 2’ I will continue on this journey of helping you understand how to really get the most out of this process.
In the meantime, if you are in pain right now and you feel confident we can help, then why not call now. Erica, Jean and Charlotte will be happy to help.
Call 01889 881488 Now
p.s. Don’t try to book online at this time as that is only suitable for existing clients already being treated for an existing problem.
How can I relieve neck pain? The first thing to understand is how this happened, neck pain can be caused by other conditions such as muscle weakness in the shoulders, perhaps lifestyles such as workplace seating or even sports. Take a moment to consider what could be causing yours. While doing this, think about the type of pain you have. Is it a strain or a trapped nerve?
What does a trapped nerve in neck feel like?
A trapped never typically feels more painful in certain positions, and the pain again can be shooting, described as electric or pulsing. A trapped nerve can throb and jolt when you are moving. A strain usually feels more like a burn or a tear; these sensations can be confusing, so please do not worry if you struggle to distinguish between the two - Our team can help you understand this better and decide the best ways to help you.
How long does neck strain take to heal?
A strain can take between 24-hours and a week to recover. If you are concerned Nicky Snazell can help you with pain relief, it is still worth considering what caused this. The underlying source is always the best way to provide you with long-term pain relief, and maintenance can reduce reoccurrence.
What is the fastest way to fix a stiff neck?
If you are not ready to consider treatment, we recommend gentle stretches and a gentle massage in-between cooling and warming treatments like an ice-pack and a hot water bottle/wheat/rice bag. Be careful when doing this yourself. If you are unsure how to manage this effectively, contact us.
Which massage is best for neck pain?
This depends on how you got the neck pain; if it was doing sports, then as you might expect, sports massage could be the proper treatment. Typically, massage is the right treatment for neck pain; manipulating the soft tissue can relax the problem and promote blood flow and healing.
Where can you go for help with neck pain?
Nicky Snazell pain relief clinic in Stafford can help with neck pain. Please view this page for more information on neck pain, or contact us. Our experienced team of physiotherapists will help you navigate your pain and provide the most effective advice to help you long term.
Rotator Cuff Physiotherapy
Many have heard of the rotator cuff in the shoulder and, not surprisingly, believe it to be a single part of the shoulder. The rotator cuff is, in fact, a group of four muscles that work together to provide dynamic stability of the shoulder joint, helping to control the joint during rotation:
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres Minor
The Supraspinatus is a small muscle which you can feel above the bony ridge on the back of your shoulder blade (scapula). It attaches to the top of the arm bone (humerus), just below the shoulder joint. The task of this muscle is to move the arm sideways away from the body for the first 15 degrees. After that other muscles take over most of the load, it is an area of the should that can be torn and is popular for 'Rotator Cuff Physiotherapy'
The Infraspinatus is a thick triangular muscle, which occupies the main part of the sculptured dent in the back of the shoulder blade, below the bony ridge. As one of the four muscles of the rotator cuff, the main function of the infraspinatus is to turn the arm out as in the backhand in tennis and stabilise the shoulder joint.
The Subscapularis is a large triangular muscle at the front of the shoulder blade, between the shoulder blade and the rib cage. It attaches to the top of the arm bone (humerus) and into the front of the shoulder capsule. Its role is to turn the arm in.
The Teres Minor muscle sits below the Infraspinatus. It is quite a small rounded muscle and its primary task is to stop the arm moving up when it is moved out sideways (abducted). It also helps the Infraspinatus turn the arm out.
TREATMENTS FOR ROTATOR CUFF TENDINITIS
Rotator cuff tendinitis describes the inflammatory response of one or more of the four rotator cuff tendons, due to impingement or overuse, and leading to more and more micro-trauma that can then lead to a tendon rupture and will require Rotator Cuff Physiotherapy.
The inflamed thickening of the tendons often causes the rotator cuff tendons to become trapped under the acromion (the bony projection of the shoulder blade over the shoulder joint) – like a carpet stuck under a door – causing sub-acromial impingement. Failure to heal then leads to further damage. Early treatment of tendinitis, therefore, is necessary in order to prevent the development of more chronic and serious conditions.
Treatment can include: first and foremost scapula re-education exercises, postural exercises to lessen the impingement, gentle shoulder mobilisations and massage, aided by local electrotherapies, such as laser, pulsed shortwave, shockwave and deep oscillation. Specific rehab exercises can help guide you back to full fitness.
You can now book your next appointments online via our website
You will see an orange box at the top left of each page. Click on that and it will take you to the launch page.
Online booking is only suitable for existing clients:
- You are an existing client AND
- You are being treated for an existing episode SO
- You know which therapist to book
New clients and existing clients with a new problem should either fill in a webform or preferably call the clinic on 01889 881488.
Existing clients with a current treatment episode can click the link to take them to online booking. You will need to enter your first name, surname, date of birth, email and mobile number. Please make sure you enter your name as you provided to us when we first registered you or we will not be able to identify you on our system (Your browser should save the above details except your date of birth)
Then choose:
- the type of appointment
- the practitioner (even if there is only 1 option, you still have to choose)
- the time of day you would like an appointment
- the date that best suits you
- the time that best suits you (even if there is only 1 option, you still have to choose)
You will then get a confirmation screen to check all the details and click the Opayo (formerly Sagepay) button to enter payment details below.
Opayo will require your first name, surname and address. (apologies for some repetition here. We are waiting for our management software developers to update their software)
Please note that your appointment booking will not complete until payment is made.
At Nicky Snazell’s Wellness & Physiotherapy Clinic, we get to treat quite a lot of sports injuries and by far the number one sport for injuries we see is for horse riding, perhaps not surprising given how popular this pastime is in the area
A recent large scale study in the USA supported our observations, while focussing on the previously unrecognised scale of the problem and its potentially high rehabilitation costs.
The 10 year study of nearly 25,000 patients who had suffered horse riding injuries, uncovered some concerning facts about the level of injury and although not yet determined, it suggested the real cost of rehab could be high.
To put into perspective, the risk of hospital admission was higher than football, car racing, motorbike racing and skiing.
The most common sites of injury were:
- chest 37%
- arms and legs 26.5%
- head injuries 23%
- abdominal injuries 13.5%
Most injuries were classified as either mild, which was 33%, or moderate at 43.5%, but of these 88% required hospital admission for an average of 4.5 days, 28% needed intensive care and 10% required surgery. Fortunately, most (57%) were discharged from hospital and required no ongoing rehab but 7% had to transferred to a rehab centre for ongoing care.
The death rate was 1.3%, of which by far the majority at 75%, were due to head or neck injuries.
Surprisingly a large fraction of the riders involved in injury were not wearing helmets at the time of their accident. This emphasises the need for awareness of the importance of wearing adequate protective clothing, in particular wearing a helmet to protect against head injury and death.
For those who would like to read the full paper: Hearing Hoofbeats? Think head and neck trauma: a 10 year NTDB analysis of equestrian related trauma in the USA, visit https://tsaco.bmj.com/lookup/doi/10.1136/tsaco-2021-000728
You Spoke
Recently we asked for feedback on your thoughts on our clinic and most importantly, how you would like us to improve. I’m really pleased to say that we had some great responses which have given us plenty to think about. We have given all who responded a free massage and of course we held a draw as promised and the winner now has £250 credit in his account. A big thank you to all who took the time to help us.
We Listened
Of course, there were a number of issues raised and we listened. We have already started an action plan to deal with the ideas and concerns raised in order of frequency raised. The number one issue by far was a request for more information. Overwhelmingly, you wanted to see more use of social media, specifically Instagram and Facebook.
You Want More Information & More Social Media
I’m delighted to tell you we already have a new capability up and running and from now on you are going to see a lot more presence on both Instagram and Facebook. Nicky has already created over 50 video’s which will over time be recut and added to these social media platforms. Not only that, Nicky has recently been on USA radio again, being asked for her expert opinion on alternatives to opiates for treating chronic pain. This also provides more content.
You requested more information before your first visit, what to expect when you arrive, more information on what we treat and how we treat and also on the capabilities of the therapists so you understand better who you should see for a particular problem. All of this will gradually be added and one by one we will provide you with the information you requested.
Please Share
We are passionate about preventative health and about the unquestionable merits of face to face, hands on treatment. Sadly, these are services which seem to be disappearing. Could you help spread the message by sharing our posts with your circle of friends. One day, one of those friends may be desperate for real, preventative health care.
Here are the links
Instagram: https://www.instagram.com/nickysnazellsclinic/
Facebook: https://www.facebook.com/painreliefclinic.co.uk
If you are in pain, we can help.
Call Now. 01889 881488. Erica, Jean & Charlotte will be happy to help
This may be difficult to grasp at first, but if you were to be able to look inside your body, down to the tiniest detail, you would see you are a community of cells, trillions of cells.
Development of humans started from a single cell structure. For growth, the only opportunity was to get bigger, but just like a balloon, the cell could only get so big before the cell membrane would rupture. The only other option to grow was to start working together in communities.
All cells have the basic functional capability that we as humans have. They can process food for energy, dispose of waste, detect energy signals etc. They could also get eaten by predators, so survival required working together as a community. As these communities grew, it was clear that it made sense for one cell to specialise in one area and another cell to specialise in another. Thus, some cells specialised in excretion, others fighting infection, energy absorption, or movement.
We do the exactly the same in our human communities, some working in food production, some in health, some in transport, some in communication, some in energy production. The list goes on.
In your body, you can think in terms of speciality cells for muscles, bones, nerves and so on.
Cells, just like humans, can get unhealthy and die. To protect the community as a whole and to avoid one unhealthy cell taking down the whole community, cells developed a suicide capability. Every day, millions of your cells die and are replaced by new healthy ones.
All cells require energy to exist and this energy is produced in what can be considered the cells engine, called the mitochondria. The main task of the mitochondria is to convert glucose into energy. It is also the mitochondria which is equipped with the suicide capability, to destroy the cell if it gets diseased or malignant.
Some diseases, like cancer, have worked out a way around the self destruct. But that’s a whole subject on it’s own and there is a lot of well qualified material available to read on the internet.
What all this tells us is that our cells have worked out a complex and healthy way of surviving as communities and that you have the ultimate responsibility to make sure you play your part to keep those cells as healthy as possible. A good starting point is to eat healthy food and avoid unhealthy food. You don’t have to be a brain surgeon to realise that the latter is going to give all your cells a hard time. Do that for long enough and common sense will tell you there will be problems.
At Nicky Snazell Clinic we have a simple, easily understandable wellness program, taken from Nicky’s published book ‘The 4 Keys To Health’. If you need help to make sure you do the right things to keep your cells healthy, then call us. We can help.
Call Now 01889 881488. Erica & Jean will be happy to help