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

Ligament-Bone and Tendon-Bone Conditions - Bone Formation

The behaviour of the bone around the joint varies in differing arthritic conditions. In rheumatoid arthritis the inflammatory joint condition is linked with loss of bone and this contributes to the damage to the joint and the disability which ensues. However, in ankylosing spondylitis (AS) the inflammation is accompanied by the formation of new bone at the inflamed sites. This new bone forms at each insertion site, growing together in the spine to form bony bridges across the vertebrae, stiffening the spine in a poor position in some cases which can cause significant disability. Since inflammation usually breaks bone down this is difficult to understand.

New bone typically forms at normal ligament or tendon insertions as we get older, but in arthritis the inflammatory phase which erodes bone does settle and then bony spurs can form as the bone laying down phase occurs next in time. In the case of AS, if a bony formation phase follows the inflammatory phase, then suppressing the inflammatory phase with medication might accelerate the bony formation process, increasing the disability. AS patients may continue to fuse their joints even in the presence of new biological treatments but they may be shown to inhibit bone formation at the insertions and thereby reduce disability.

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.