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

Tiredness and Fatigue - Normal and Abnormal

Patients easily distinguish between normal tiredness and the tiredness they suffer as a consequence of their musculoskeletal conditions. Healthy adults report fatigue after stressful activity or physical work which is relieved by rest or sleep completely. Fatigue in sufferers from long term musculoskeletal conditions is very common, more intense, not predictable and does not resolve with rest. Fibromyalgia consists mainly of widespread muscular pain with fatigue whilst chronic fatigue syndrome is primarily fatigue with degrees of pain. Chronic fatigue syndrome is diagnosed by the presence of unexplained fatigue for more than six months which is not connected to activity and not eased by resting. Severe reduction in activity levels is common.

Fatigue is common also in musculoskeletal disorders such as osteoarthritis and rheumatoid arthritis, with patients often rating the fatigue as or more severe than the pain itself. Research work has found that the levels of fatigue have strong effects on the quality of life in rheumatoid arthritis and if severe it is connected with a deterioration of the ability to live life normally. As tiredness is as or more difficult to cope with than the pain of these arthritic diseases it is understandable that patients consider fatigue to be an important aspect of their presentation.

Losing and Gaining Muscle

Muscle is a dynamic tissue, changing greatly to accommodate to changing requirements. If a person.s leg is immobilised the thickness of the quadriceps muscle decreases by 15-20% in six weeks as the Type 1 muscle fibres reduce their protein production. This is the reason why immobilisation of a fracture or sprain is kept to an absolute minimum as losses of muscle and bone tissue are important, with joint stiffness another potential damaging side effect. Muscle will also respond quickly and strongly to increases in loading, with a maximum weight to be lifted increasing by 100% over a 12 month training period.

Much of the increased strength of muscle is due to hypertrophy of the muscle fibres, although other factors contributing are muscle endurance and learned coordination of the movement. A 30% increase of muscle mass can occur in four days after a muscle is overloaded in a stretched position, indicating the speed by which this part of the musculoskeletal system can adapt to new conditions. Exactly what makes muscles increase in strength is under discussion, but unexpectedly high activity, particularly in eccentric contractions, can cause the exercise induced damage which leads to repair and hypertrophy.