Q I have decided to do a Physiotherapy degree but I'm not sure the best way to go about it.  I am a qualified Sports Massage Therapist but I have been told that my qualifications are not recognised.  How can I go about applying?

A Sports massage is not a qualification recognised for entry to a physiotherapy degree programme. For most physiotherapy degrees you need 4 or 5 'A' levels at grade A or B (usually you need three at grade A). These need to be in sciences, e.g. biology, chemistry, physics, mathematics rather than non-sciences (e.g. sociology, art etc).

Most of the people I know who have gained entry have taken their 'A' levels (now called AS level) at evening classes over a year prior to entry. Most universities require a minimum of GSCE grade 'A' for mathematics as the research papers you will be reading use statistical analysis to identify whether a treatment is effective or not.

AS levels can be taken all over the country. Most adult education centres offer them.

An alternative route is to work as a physiotherapy assistant and take a part-time physiotherapy degree. The entry requirements for these may be different but I am afraid I do not know what they are.

At your local library you will find the UCAS book. This gives the entry requirements for physiotherapy (and other degrees) all over the country.

Have a look too on the Chartered Society of Physiotherapy (www.csp.org.uk) website for information for mature students..

Q I have a client who has been diagnosed with Bakers Cyst.  He tells me that “it’s nothing to do with muscles or ligaments but basically it’s arthritis and build up of fluid at the back of the knee.”  My client can almost bend their knees fully but not quite as they are quite tender.  His consultant has ruled out everything else. What can I do for him? ?

A Bakers Cyst is simply when the synovial fluid escapes fro the knee joint capsule (named after William Baker, and English surgeon of around the 1850s!).

Things you could do are:
1) Recommend ice to decrease swelling/pain
2) Elevate the knee
3) Active movement within a pain free range to increase lymphatic and venous drainage. ie knee flexion and extension but also dorsiflexion and plantarflexion (as gastrocnemius crosses the knee and ankle joints).
4) Gentle effleurage with the knee elevated (manual lymphatic drainage)
5) Use of a compression bandage or sock or tube provided not too tight.

Q Can a prolapsed disc heal itself in 6 months?

A It usually heals itself but can take 6 months depending on the severity. In extreme cases they operate.

 

Q A client was presenting with pain in the muscle of both lower legs (they thought it could be peroneus longus) when walking fast.  Pain was worse running either on treadmill, grass or pavement.  This person has been told by another professional that the sheath surrounding the muscle is tight and therefore making the muscle tight.

A It sounds like either shin splints (usually at the front of the leg) or chronic compartment syndrome (not acute compartment syndrome). Unusual in peroneals (now called fibularis longus by the way!). Ideas:
1) Rest
2) Ice for pain
3) Lots of stretching. STR better than MET but tricky on fibularis, I know.
4) Stripping to all calf muscles and STR to calf muscles.
5) Check trainers are well cushioned
6) To keep training he could try:
-  swimming (with float between legs) using lots of arm movements combining breast stroke and front crawl and back crawl, for example.
- using a rebounder (one of those small trampolines)
- rowing or cycling but stop if leg pain continues. Walking up hill on treadmill is great exercise too but stop if pain in legs persists.

Q My client has carpal tunnel syndrome, is there anything I can do?

A Rest from using forearms. Use STR to all of upper limb included with holistic massage in attempt to decrease tension in the carpal tunnel.

Q I have a client with very, very tight hamstrings.  She is a runner. I gave her some deep tissue massage few times but they are still tight. I have advised a lot of stretches, almost every day combined with heat therapy and rest (no running) I also advised her to use a tennis ball under the hamstring when sitting in order to relax the muscles. But they are still tight. What else can I do??

A Tight hamstrings often accompany a lordotic back. It may be that she is lordotic so they are trying to overcome this.
1) You could include stretches for the low back
2) Ask her to flatten her back whilst standing
3) Do pelvic tilts whilst standing.

To check whether the hamstrings are long and tight do a straight leg raise. Normal is 80°-90° . If she has this or greater then it suggests her hamstrings are long and tight.

Also, try MET to the opposing muscles, ie the quadriceps and hip flexors. Hamstrings must relax a little when quadriceps contract in this manner so that may help.

Q I saw a client with very swollen knees - she's had right knee pain for some number of years and it's been diagnosed as "wear and tear".  The Clarks Sign test was positive.  The medial side of both knees are v. swollen.
I think this might respond to Manual Lymphatic Drainage (MLD).  Am I right? If so, do you only do MLD and no other massage? Or, do you do MLD and then massage?  Also her right knee looks very slightly thinner than the left.  Is this significant?

A Yes. Oedema from osteoarthritis can be treated with MLD.
You can do MLD as well as other types of massage providing they are suitable.  MLD is slow, you work distal to proximal ie ankle, to knee, to hip, effluraging towards the heart.
1) Strapping can help support the knee temporarily providing it is not too swollen. A compression bandage also helps.
2) Non weight-bearing exercise is good such as swimming, cycling, rowing, providing this does not cause discomfort to the patellofemoral joint.
3) It suggests she is weight bearing more on one side than the other, common when one knee is more painful than the other.

 

Q Is tendonitis the same as muscle-tendon overuse? or muscle-tendon rupture?
How do you assess tendonitis? How do treat tendonitis?

A No, tendonitis is an inflammation of the muscle tendon. To assess:
You need to palpate for heat, swelling and tenderness.
You need to load the joint – the result will be positive
You can treat with general massage to the affect area including STR to reduce
adhesions and stretches .  Recommend that your client REST.  For example, for Supraspinatus Tendinosus refrain from abducting the arm.

Q How do I test for medial (internal) and lateral (external) rotation of the hip joint?

A For medial rotation - Your client in supine, with their hip flexed but their knee bent.  Support the leg with one hand on the lateral side of the knee and one hand on the medial and posterior calf.  Gently use opposing force ie you are pushing the knee away from you and pulling the lower leg towards you, to medially rotate the hip. For lateral rotation, reverse the hand positions and direction of movement

Q Why is the ThomasTest useful when assessing a knee?

A Because quadriceps insert on to the patella, patella ligament & tibial tuberosity and therefore if the quads where tight, this would affect the knee joint.

Q Why for the Ober Test should the client be positioned with their thigh off the couch?  And what happens if the client pulls their knee to their chest when performing this test?

A You keep the thigh off the couch simply so the thigh can be extend.
If the client pulls their knee to their chest, the psoas muscle shortens and gives a false result.

Q Can I advise a client to stretch before their running event?

A For pre-event work, no stretches for 2 hours beforehand. You want the muscle to retain it's 'explosive' quality.

Q Can I perform STR after the event as they suffer from very tight hamstrings after they run?

A For post-event STR you can apply gentle STR as there may be microtrauma and the athlete will be full of natural painkillers so may not feel the pain of a possible bruise/torn muscle..

Q I know that Muscle Energy Technique (MET) and Soft Tissue Release (STR) both stretch a muscle, but can you clarify the difference between the techniques for me?

A MET stretches the entire muscle.
STR stretches part of the muscle. If you happen to do STR on a trigger spot it acts like trigger point work..

Q Am I correct in saying that lactic acid is a toxin and that massage removes these toxins?

A Correct, lactic acid is a toxin, but there is no evidence that massage helps remove toxins.