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

Back Pain - Red Flags for Serious Conditions

Most people with back pain have just that, back pain secondary to injury, time and the mechanical stresses of holding a posture or performing an activity. However, a small proportion of people present with back pain when the underlying reason is a serious pathology of some sort. The signs that indicate that mechanical back pain may not be the reason for the patient's pain are called red flags. Physiotherapists routinely ask the red flag questions to try to exclude the likelihood of a patient having a serious underlying condition which might also be worsened by physio treatment. Examples of red flags for back pain are: age over 55 or under 20 when back pain first presents and significant trauma involved (like a fall).

Other red flags include: significant weight loss; significant night pain; use of steroids; a history of cancer; bladder or bowel disturbance and loss of sensation in the saddle area around the genitals and anus. A degree of judgement is required as the outcome of the questions is rarely clear cut and most red flag situations turn out not to be serious conditions but physios routinely evaluate these to ensure safe treatment and refer questionable cases on for medical evaluation.

Tendon Bone and Ligament Bone Junctions

Tendons and ligaments have important functions in the body and their ability to perform their functions depends on their connections to the skeleton, on which they exert their forces or their restraining influences. The junction between a tendon or ligament and the bone is called an enthesis and inflammation of that area is known as enthesitis. There is an important group of arthritis conditions where the enthesis is the main site of inflammatory change, as well as normal musculoskeletal problems secondary to injury or degenerative changes. Typical conditions include ankylosing spondylitis, psoriatic arthritis and reactive arthritis.

Entheses vary in their structure: fibrous ones have the ligament or tendon continuing in their normal structure until they contact the bone; fibrocartilaginous ones have a piece of fibrocartilage on the site of attachment and it is this latter group that are mostly of interest in arthritic diseases. The cartilage makes the end of the tendon stiffer and cushions the sudden changes from flexible tendon or ligament material to the hardness of the bone. The management of the stresses which are transmitted through ligaments and tendons to the bone are complex and the body has adapted with a series of anatomical modifications.