Bragg Creek Physiotherapy

Stiff & Sore?

Are you finding it difficult to get moving in the morning or after you’ve driven into the city, or been sitting for a period of time?  So many people attribute the stiffness and soreness to age and let their mobility slip away from them.  Weather it is age or Osteoarthritis or a lack of movement, if you don’t you it you really will lose it!  Don’t be discouraged!  There is something that can be done about it, a little bit of treatment from us and a change in your daily activities can make a dramatic improvement to how you feel.

We often speak about manual therapy as it’s our mainstay of physiotherapy treatment.  It requires “hands-on” therapy which includes joint mobilizations or manipulations.  But what exactly does that mean, how do we achieve it and, most importantly, how will it help you?

Manual therapy refers to the technique of using our own hands to move or mobilize tissues of the body.  Massage is one form of manual therapy – using our hands to mobilize soft tissues such as muscles, tendons and ligaments.  The purpose of mobilizing soft tissue is to break down scar tissue and adhesions, increase pliability (or elasticity) of both normal and scar tissue, and to increase circulation.  We often see a dramatic improvement in symptoms after just one treatment and outcome measures:  improve range of motion, increase flexibility and decrease pain.  IMS, ART™ (active release therapy), trigger point release, myofascial release are a number of the techniques we use to improve the health of soft tissue which is so often responsible for restricting ROM and causing symptoms.

Once the muscles, tendons and ligaments have been treated then the joints are able to move a little more freely.  We can further improve your mobility by mobilizing the joints and taking them further into a range they have not previously been able to reach.  Each and every joint in the body (including the spinal joints) have minute movement directly between the joint surfaces called accessory movements or joint play.  In order to achieve the gross range of motion (for example, lifting your arm overhead), the joint surfaces of the shoulder (one being the top of the arm bone, or head of the humerus, the other being the socket of the shoulder blade) must glide or slide in a specific way.  If this accessory movement is restricted in any way, you cannot lift your arm overhead the full range of motion.  However, it is very difficult to perform this movement on your own in most joints.  The two bones must be physically moved across each other.  This is where manual therapy comes in.  A physiotherapist will stabilize one bone, and move the other, so as to facilitate the accessory movement.

Joint mobilizations are performed with varying degrees of movement.  We can move the joint surfaces just a little bit or a large amount; we can move only the first part of the glide, the middle part or the last part.  And we can perform a manipulation, which is a “hands-on” treatment involving the skilful movement of 2 specific joint surfaces beyond their active limit of motion, but within anatomical limits.  It is a localized, high-speed controlled thrust, and may cause an audible click or “popping” sensation that is usually painless.  Manipulation can be performed on any spinal joints, from the top of the neck to the low back, including the ribs and the sacroiliac joint.  They can also be performed on joints in the hand, wrist, elbow, knee, ankle and foot. The benefits of manipulation are decreased pain, improved joint motion and function.  However, manipulation is not indicated for everybody of every condition.  It should be avoided in those with osteoporosis and rheumatoid arthritis, among other conditions.  Your health care practitioner is well educated in both the indications and contra-indications of manipulation and will provide the best available treatment for your specific condition.

In any injury where immobilization has been required for treatment, such as in the case of casting after a fracture, you will see a loss in the accessory movement.  There will also be a loss of accessory movement when there has been a decrease in use.  For example, any time an area is painful to move, we tend not to move it.  The old adage holds true – use it or lose it.  If you are not going through the full range of motion for any given joint, you will lose range of motion.  Soft tissues will tighten up, the capsule (or encasing which keeps the joint and its fluid separate from the body) shrinks, and often there will be a decrease in joint nutrition.  All of this will inhibit joint play.   The longer joints are immobilized for the more difficult it is to restore it’s full ROM. 

This is a particularly important point when looking at osteoarthritis. Joint mobilizations, accompanied by exercise will maintain, and often improve the loss of range of motion experienced with arthritis.  Moving the joint surfaces will improve joint nutrition and circulation (think of it as a massage for the joints), help to stretch out the soft tissues such as the capsule and ligaments, as well as stimulate nerve fibres to help block out pain.