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

Patellar Dislocation

The patella is a small bone embedded in the tendon of the quadriceps muscle which is the main power muscle controlling the knee. The patella has two facets at a slight angle on its under surface which articulate with the femoral condyles, the large rounded ends of the thigh bone at the knee. The outside femoral condyles is slightly larger in a frontwards direction and helps act to hold the patella in place. Due to the angle of the thigh bone coming down from the hip and then joining the tibia which is horizontal there is a bowstring effect as the quadriceps muscle contracts, pulling the kneecap sideways.

If the person rotates their leg with their weight on the foot, the sideways force on the kneecap can be enough to force it outwards over the condyle ridge and off its joint surface completely. This is immediately extremely painful and if the person straightens their knee the patella usually relocates itself automatically. Because the tissues on the inside of the knee have been stretched and torn as the kneecap dislocated the knee is usually kept straight in a splint or plaster for a few weeks to allow this area to tighten up as it heals.

Disc Pain

It is not possible to diagnose discogenic pain by clinical examination of a patient as there are no specific examination techniques for this condition. Various physiotherapy techniques, such as testing centralisation and peripheralisation, show some connections with having disc-related problems, but do not go as far as to solidly diagnose disc pain. The accepted way of diagnosing this type of problem is to attack the disc itself with techniques such as discography. Discography involves inserting a needle right into the disc and injecting a contrast material which will show up on x-ray examination. The most important point is that the test is only positive if it brings on the typical pain the patient is normally complaining of.

The injected material allows the shape of the nucleus to be seen inside the disc and whether there any problems with it. The discs nearby are also tested and they should be negative if there is to be sufficient confidence in the findings from the symptomatic disc. Internal disc disruption (IDD) is quoted as the underlying pathology responsible for lumbar pain of disc origin, where the internal structure of the disc is altered by fissures occurring radially from the centre towards the outside.