Physiotherapists in Cobham 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.

Whiplash Syndrome

Whiplash syndrome is typically the result of low velocity car crashes. Usually affecting the neck, whiplash can also affect the lumbar spine as it is almost fully flexed in sitting, allowing the spine to be over flexed by even a small further movement. Most tissues in the neck can be injured in a rear shunt collision but the evidence points to facet joint injury as being the most likely cause of chronic pain and disability. Any warning about the impact can result in the individual tightening up the stabilising muscles around the spine but also increases the forces compressing the spine at the same time. This could allow the discs and vertebrae themselves to be damaged in a compressive injury.

If there is no warning of the accident then there will be no protective muscle contractions to prevent spinal injury, with the posterior ligaments taking stress as the head is bent forward and the posterior bony elements impinging as the head is bent back. The exact position of the head at the moment of impact is also important as if it is rotated then the structures can suffer a rotational injury which could involve the facet joints.