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

Tendon-Bone and Ligament-Bone Conditions . Mechanical Factors

Problems with the junctions between bone and ligaments or tendons can occur because of mechanical rather than inflammatory factors, with overuse injuries, trauma and sport examples of causative factors. MRI scanning may show a pathological change in the insertion or enthesis but the differences between changes caused by inflammation and mechanical factors is not great. It is fairly clear at the Achilles tendon as changes caused by mechanical factors occur two to six centimetres above the insertion while inflammatory changes will occur at the insertion itself. Degenerative changes in the insertions may give similar effects to the changes from inflammation.

Enthesis in osteoarthritis may show the same, if more limited, changes which occur in inflammatory conditions. Modern investigations have improved our knowledge of these conditions, with spinal problems best imaged by magnetic resonance imaging (MRI) and areas of the body which are more easily reached can better be checked out using ultrasound. Swelling of the bony areas around the insertion can be present on scanning, as is soft tissue swelling of the enthesis and its surrounding region. However, a normal MRI and a negative blood test do not exclude an inflammatory arthritis as both tests are not specific enough.

Acute Joint Management

An acute joint is a joint which has suffered an insult, either trauma or arthritic, and has flared up into an inflammatory phase with pain, swelling, loss of range of movement and limited function. Physiotherapists routinely manage acute joints in a variety of situations. The initial management of an acute joint concentrates on controlling the pain and inflammation with analgesics, anti-inflammatories, compression and ice. Reduction in pain and swelling allows the patient to start to get their joint moving so that mechanical stimuli can start to be received by the nervous system. Compression may be a very important treatment as the development of an effusion, fluid within a joint, is known to compromise the muscular control of the joint.

After the initial period the patient is instructed to perform regular contractions of the muscles around the joint to restore control, and to move the joint gradually through a greater and greater range of motion until full range is achieved. Once the ranges of motion are improving and the joint is settling more functional work such as weight bearing or loaded exercises can be started to stress the joint in a graded programme to restore the joint.s full strength and function.