Physiotherapists in Norwich 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.

Spinal Cord Stimulation for Chronic Pain

The use of spinal cord stimulation for the treatment of chronic pain syndromes is taking an increasing part in the management of these complex and difficult problems. Scientific work support the usefulness of this therapy in the pain due to poor circulation in the legs, angina and neuropathic pain. SCS is a technological intervention and chronic pain is a multidimensional problem including physical and psychological aspects which bear on the likely success of the treatment. SCS aims to stimulate the large sensory nerves in the spinal cord which interfere with the transmission of pain towards the brain along the small pain nerves and it also has affects on the circulation although the exact mechanisms of action are not known.

When used to treat neuropathic pain the treatment can be given intermittently as then the pain relief may last for some hours afterwards, indicating that the stimulate causes changes in the nerve transmissions which can last for some time. SCS may also alter the behaviour of heart nerves and by various mechanisms reduce the pain of angina. Apart from the effects on circulatory problems there is good evidence for effectiveness in nerve root problems and complex regional pain syndrome.