My approach to treating orthopedic conditions centers around root-cause identification. An initial thorough evaluation is followed by the definition of objectives and the creation of a treatment plan to reach them.
After identifying the root cause, I combine hands-on treatment with well-tailored exercises and patient education to achieve the best result in the shortest possible time.
Some of the techniques I use include:
- Therapeutic exercises
- Manual therapy
- Various instant pain relief methods
Typically, the first session for most patients goes as follows:
- Brief discussion (subjective account by the patient)
- A few direct questions from me related to the condition (onset, frequency, pattern, and intensity of pain/discomfort etc.)
- Tests – visual inspection, touch, and simple movement tests (most times to reproduce the pain or discomfort where applicable) etc.
- Special tests – to confirms the diagnosis from the prescribing physician
- Creation of a treatment plan
- Therapeutic exercise
- Hands-on treatment
Once I confirm my findings to be consistent with the medical diagnosis, I choose the most appropriate technique, to begin with. This decision depends on the findings from the assessment, the patient’s condition, and any other factor that should be taken into consideration.
In most cases, my treatments are painless (pain = STOP!) or with very minimal discomfort. For misalignments (e.g., sacroiliac joint dysfunction) I correct the positional fault first before applying the pain reduction technique.
For muscle injuries, tendinopathies, movement restrictions, I apply a technique that immediately increases range of motion while increasing blood circulation and reducing pain simultaneously. The basic premise is to use other remote areas of the body to reduce pain in other distant parts of the body. This works for most musculoskeletal pain/restrictions including those of the knee (knee injuries for which conservative treatment is recommended), shoulder, elbow, neck, etc.
This technique also provides significant neuromodulation and analgesic benefits, instantly eliminating or greatly reducing pain radiating down the legs (sciatica) and down the arms (cervical radiculopathy).
Manual therapy is usually indicated in sub-acute and chronic cases of movement restriction e.g., restriction in neck movement, plantar fasciitis, carpal tunnel syndrome, frozen shoulder, etc., though in acute situations such as ankle sprain, knee sprain, epicondylitis joint mobilizations may be required.
I primarily apply Mulligan’s concept of manual therapy but also incorporate other ideas from Maitland and Kaltenborn’s concepts. Patient feedback during treatment is the main guide as to how much mobilization is needed during treatment. Re-assessment at the end of each treatment helps to monitor the progress made in relation to the period prior to treatment and to the expected goal already set during the initial evaluation.
Microcurrent, transcranial direct current (tDCS), and in very rare cases ultrasound, are forms of electrotherapy I use. Application of microcurrent probes or tDCS electrodes on myofascial referral points produces the same effects (instant pain relief and range of motion improvement in a distant part of the body) as manual stimulation of these points. Thus, I use this method when the points to be stimulated are painful either due to chronicity or any other reason. Most of my ultrasound application is sometimes for certain forms of calcification, tenosynovitis, and in rare cases muscle adhesions following recovery from tears.
To provide added strength or stability in case of muscle weakness or temporary joint instability due to injury, kinesiotaping and mulligan taping techniques are my preferred approaches. Taping is rarely part of my treatment protocols except when treating athletes. For the occasions when taping is indicated, patients will be informed ahead of time to come in appropriate clothing (see Practical Info for more details).
This is the most important aspect of my treatment protocols and patient compliance is very vital. Carefully assembled therapeutic exercises designed to target specific muscles address the root cause of most musculoskeletal problems I treat [see conditions listed here – What I Treat]. Combining these exercises with the treatment methods described above has led to 9 out of 10 patients who followed them correctly recovering fully within 30 to 35 days.
It is very important to note that these exercises account for at least half of the recovery process. Thus, it is worth mentioning that exercise without treatment or treatment without exercise will yield the same result which non-recovery or injury reoccurrence.
Disclaimer: Full recovery is as much of a patient’s responsibility as it is that of a physiotherapist’s. In other words, therapeutic exercises and hands-on treatment are equally important. Failure to do the exercises or doing them incorrectly will not yield the desired result.