Non-specific low back pain

Low back pain is the most common musculoskeletal complaint. Acute low back pain is normally self-limiting and improves quickly with appropriate management. However, a significant proportion of the population experience recurrent episodes of low back pain with a smaller group experiencing persistent pain over long time periods. The majority of low back pain (85%) is classified as non-specific in nature, meaning that no specific structure or tissue can be identified as the source of the pain.
It is well established in the research that the degree of pain a patient experiences, is dependent on the interplay between a number of factors. These include physical factors (posture, strength, endurance, motor control), psychosocial factors (mood, catastrophizing, fear, anxiety), cognitive factors (beliefs, previous pain experiences), lifestyle factors (physical activity, sleep, stress), personal factors (work) and neurophysiological factors (pain physiology). The significance of each of these factors will vary between patients and therefore an individually-tailored intervention is essential for the resolution of the pain.

Cognitive functional therapyTM, based on the pioneering research of Prof. Peter O\'Sullivan is a novel and evidence-based approach to the management of complex low back pain disorders. It aims to identify and subsequently target the unique factors (as described above) that are involved in an individual\'s experience of pain. Through a combination of education and a graded exercise-based intervention, the aim of the treatment is to gradually restore the individual to normal functioning and improve their quality of life.

At Tralee Physiotherapy Clinic we have extensive experience in the assessment and management of complex spinal pain disorders and we have undertaken specific training in the use of Cognitive Functional TherapyTM.

Nerve root pain (Sciatica)

A proportion of patients with low back pain or neck pain will report associated leg pain (‘sciatica\') or arm pain respectively. In the leg, this is commonly termed ‘sciatica\', although this term is inaccurate. In the vast majority of cases there is no damage to the sciatic nerve. Patients, in addition to their pain, may reports symptoms such as pins and needles or areas of altered sensation. The pain normally originates from the nerve root (initial segment of a nerve leaving the spinal cord) which has become hypersensitive. This hypersensitivity may develop due to mechanical compression or chemical irritation (e.g. due to inflammation) of the nerve root. Importantly, the latest evidence suggests that in many cases, the pain may occur in the absence of any overt nerve injury.

Nerve root pain can be initially quite painful and will often require additional pharmacological management to ensure adequate reduction in pain intensity. Our physiotherapists will promptly identify when this is necessary and liaise with your GP accordingly. Although the evidence is limited in the management of nerve root pain, physiotherapy treatment will normally consist of a combination of patient education and manual therapy together with a graded exercise program. Similar to other pain problems, the degree of pain will be influenced by a patient\'s mood status, beliefs regarding their condition, fear, anxiety, physical activity levels etc and therefore these must be addressed as part of a comprehensive rehabilitation program.

At Tralee Physiotherapy Clinic, we will work closely with the patient to develop an individually tailored treatment program in line with the patient\'s goals and expectations.

Sports Injuries

Regular activity and exercise is proven to be extremely important in preventing and managing chronic diseases, such as cardiovascular disease, as well as maintaining longevity and health. Unfortunately during physical activity injuries can occur and these can usually be categorized as either being an acute or an overuse injury depending on how the injury occurred and the symptoms experienced.

It is extremely important that injuries sustained during sport are correctly and thoroughly assessed and treated, if necessary, to prevent any long term complications which may lead to chronic and recurrent injuries. At Tralee Physiotherapy Clinic, we work closely with players and coaches in the prevention and treatment of sporting injuries. We offer in depth pre and mid season screening to players. This is beneficial to prevent injury occurring by identifying areas of weakness or movement dysfunction.

Some of the common sporting injuries treated at Tralee Physiotherpay Clinic include ankle sprains, hamstring and groin strains, knee ligament injuries, overuse injuries, tendinopathies (Achilles, patellar) and shoulder injuries (strains and dislocations).

Our physiotherapists are also available for attending games and training. Please contact the clinic for more information regarding match attendance and fees.

Hamstring strains

Hamstring strains are the most common injury sustained during sport. Hamstring strains most often occur during sprinting and less commonly during movements that require excessive hamstring lengthening. A number of factors may predispose an individual to developing a hamstring strain. Major risk factors according to the research include a history of a previous hamstring strain and eccentric strength deficits. Other factors including flexibility, ‘core stability\' and age may also play a role, however there is less research evidence to support their involvement in hamstring injuries. However, the interplay between these factors is likely more important than any single factor alone. At Tralee Physiotherapy Clinic we have considerable experience in the management of both amateur and elite athletes with hamstring injuries. We will assess each individual to identify individual-specific risk factors and tailor the treatment accordingly. Treatment may involve some ‘hands-on\' but in line with the research evidence; the primary focus will be on exercise-based rehabilitation. This will be undertaken in our state of the art rehabilitation studio.

Ankle sprains

Ankle sprains account for approximately 25% of all injuries which occur during sport. Ankle sprains may be of varying severity and may result in pain, reduced functioning and limited sports participation. Priority is initially given to excluding any significant bone injury (i.e. fracture). Importantly, all ankle sprains do not require an X-ray. At Tralee Physiotherapy Clinic we will examine your ankle and determine if an X-ray is indicated or not and refer if appropriate. In the majority of ankle sprains, there is no associated fracture. In line with the best available research evidence, at Tralee Physiotherapy Clinic you will undertake a supervised rehabilitation program targeting lower limb strength, balance and neuromuscular control specific to the individual and their sport. We will also use ‘hands-on\' therapy if and when indicated. Failure to comply with a comprehensive treatment program may result in chronic ankle pain and instability especially if the initial injury is severe.

Groin Pain

Groin pain is a common complaint amongst athletic and non-athletic populations. The anatomy of the groin is complex and pain may originate from a number of different structures. The most commonly diagnosed problems in the groin area include adductor strains, tendinopathy and osteitis pubis. At Tralee Physiotherapy Clinic we take great care to exclude other potential sources of your pain such as referred pain from the low back or hip. The specific management of the patient will depend on the specific diagnosis. For example, for patients with adductor (groin) strains or tendinopathy, there is considerable research evidence on the importance of a progressive strengthening program that targets the muscles of the hip and groin area. At Tralee Physiotherapy Clinic, we will assist the patient in designing such a program and the patient will have the opportunity to carry out the exercises under the supervision of one of our physiotherapists in our state of the art rehabilitation studio. When indicated we will supplement the rehabilitation program with additional ‘hands-on\' therapy.

Anterior Cruciate Ligament (ACL)

Injuries to the ACL are common in a number of sports including soccer, gaelic football, hurling, basketball and skiing. Factors predisposing an individual to sustaining an ACL appear to be many and varied and include individual specific factors (biomechanics, age, strength, gender) as well as sport-specific risk factors. ACL injuries have recently gained more attention in GAA circles; however we await future research studies to determine the precise cluster of risk factors involved. The results of a recent, high-quality Scandinavian study on the exercise management of patients following ACL injuries has shown very positive results. At Tralee Physiotherapy Clinic, our physiotherapists will design, in conjunctions with the patient, a comprehensive and progressive rehabilitation program. The precise nature of the intervention will be dependent on the stage of the injury but in line with the best available evidence, will likely include pain management strategies, range of motion, strengthening and neuromuscular control exercises, carried out in a progressive manner in our rehabilitation studio as well as part of a home exercise program. For post-operative patients, we will liaise closely with your consultant to ensure an optimal outcome. ACL rehabilitation is lengthy and to date there is currently no evidence to recommend an early return to sport.

Whiplash Associated Disorder (WAD)

Whiplash injuries are common and are usually the result of a motor vehicle collision. The recent research literature reports that up to 60% of patients may report persistent symptoms. Major risk factors identified for the development of persistent pain after whiplash include a high initial pain level, age and pain hypersensitivity (nerves in the spinal cord become hypersensitive and can lead to pain out of proportion to the injury). At Tralee Physiotherapy Clinic, our main priority initially is to reduce the severity of your pain. To achieve this, we will occasionally need to consult with your GP regarding appropriate medication. Once the acute pain has settled, treatment will normally consist of a combination of patient education, manual therapy and exercise. At Tralee Physiotherapy Clinic, we recognise that as a result of the trauma, many patients may feel anxious, stressed or fearful. Due to their significant influence on pain and functioning, these factors will be considered and appropriately managed as part of a comprehensive rehabilitation program.

 

Nerve root pain (Sciatica)