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

Hand Injuries - Acute Management

Most injuries, apart from the most minor, benefit from being seen and assessed by a doctor as a relatively minor dysfunction in the hand can cause long term functional disability. Initial management of a hand injury should be to control any bleeding by applying gauze or a clean cloth to the wound and putting some pressure on it. In a closed injury (i.e. no wound) then ice can be applied to the damaged area to reduce inflammation and pain. Jewellery such as rings needs to be immediately removed as hand swelling can be very dramatic, rendering easy removal later impossible.

Once in the Emergency Department the doctor will x-ray the hand routinely and may inject the nerve at the wrist level or at the base of one of the fingers to numb the hand or the finger so that they can examine the area without too much pain. Wounds will be cleaned if they are dirty and then closed by stitching or a related method, with antibiotics prescribed to prevent infection developing. Splinting is often used to immobilise the hand in a specific position to prevent further injury or maintain anatomical integrity. A referral to a hand specialist or a plastic surgeon is typically written and pain control medication will be encouraged for a few days.

Rehabilitation after Knee Replacement

Rehabilitation after knee replacement starts before the operation as the patient is educated on what to expect and instructed in range of motion and strengthening exercises so the knee is in as good a condition as it can be before the operation. On the first day after operation the physiotherapist will get the patient up, begin their mobilisation, and also start the patient with range of motion exercises and re-establishment of muscle control around the knee. Quadriceps contractions are encouraged many times hourly as the patient must be able to hold the knee stable against the weight of the body if they are to walk safely.

Knee flexion is practised routinely with an eye on the health of the wound which is down over the front of the joint and so stretched by knee bending movements. Analgesia and cold therapy may be required to control pain and swelling and facilitate exercise compliance. An angle of bend of 90 degrees is aimed for over five or six days and eventually the knee may bend to 110 degrees or more, the amount required to ascend stairs normally. On discharge physiotherapy is typically continued with emphasis on quadriceps strength, good range of motion and natural gait.