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

Simple Neck and Shoulder Girdle Exercises

Slow performance of the exercises is important, taking up to five seconds to get to the end of each individual direction of movement. The neck should be moved in each of the standard directions which are: turning the head left and right; side flexing left and right (ear down to same shoulder with face facing forward); bending head forward and back; tucking the head in (a bit like a chicken). It is important to do each movement separately so the maximum range is obtained as the ends of the movement are where the value is in exercising.

Shoulder movements are useful as they may be stiff or the shoulder girdle may not be moving well, and shoulder movements stress the neck to some extent. Shrugging shoulders and rolling them backwards are an example of this movements as are circling of the arms either backwards or forwards. Once the movements are easy then some auto-resisted neck strengthening can be performed with the neck being held in place as one of the hands tries to push it out of position. Holding this for about ten seconds forces the muscles to work hard to maintain the neck position.

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.