Physiotherapists in Bristol treat many different conditions including the issues profiled below.

Diagnosing Discogenic Back Pain

Low back pain is very common and a significant cause of pain, disability and work loss in western societies. Diagnosing low back pain is difficult and relating examination and investigation findings to treatments or successful intervention has proved to be elusive. MRI scanning is the investigation of choice for back pain syndromes and can indicate disc narrowing, disc dehydration, annular tears and joint abnormalities. If the disc level identified on the scan fits with the examination and x-ray findings, the surgeon may have some confidence that the painful segment has been identified. However this may not be accurate and treatment based on this can be unreliable.

Discography is an investigative technique where a needle is introduced into the suspect disc and a small amount of contrast material is injected. If the test is to be positive then the individual must complain of their typical pain on this stimulation and not just general discomfort. The injected material may also give some idea of the internal structure of the disc and any disruption which may be present. Injection of local anaesthetic can also be performed, a so called discoblock, may be performed, allowing for the patient to report a reduction in their typical pain for a positive response to the test.

Physiotherapy for Fractures of the Humeral Head and Neck

Fractures of the upper part of the upper arm, the neck or head of the humerus, are common in older people who have fallen onto the arm but can occur in younger people who fall hard on the upper arm. The surgeon determines if the fracture is stable and not likely to require intervention. Physiotherapy checks difficulties with the hand, wrist and elbow and gives instruction in maintaining the ranges of motion of these joints. The ranges of the shoulder joint can be maintained in more stable fractures by the performance of pendular exercises, where the patient leans on their good hand and bends over at the waist, allowing the arm to hang forward like a pendulum and to swing back and forward gently as instructed.

At around three weeks from fracture the exercises are progressed to active assisted movements where the other arm is used to bring the arm up into flexion, and usually before six weeks the arm can be raised actively on its own to begin to restore strength into the shoulder muscles. Rotatory movement behind the back and behind the neck are also practiced to restore the vital rotation movements of the shoulder.