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Neurodynamics

Simply, our nerves have to move and stretch as well as joints and muscles etc. For example, the sciatic nerve has to be able to stretch 5cm when we bend down to touch our toes. The spinal canal that houses the spinal cord stretches 7 - 10cm depending on the flexibility of the individual.

All of this means that if the nerve is restricted, or squashed as it comes out of the spine then it will cause problems down the length of the nerve. This is how tennis elbow, golfer’s elbow, carpal tunnel syndrome and even plantar fasciitis can be caused by problems with the neurodynamics of the nerves. The nerves can generate inflammation down their length.

This specialist knowledge gives us the tests and ability to fins the cause of the problem and the means of resolving it.

Problems with the movement of the nerves cannot be treated with medication. It requires detailed knowledge and expertise to find the cause and rectify the problem to restore the normal painfree movement of the nervous system.

This work has been proved time and again and is underpinned by research and evidence based practice. Again physiotherapists such as Louis Gifford and Professors David Butler, Lorimer Moseley and many others have led the world in this area.

It is still not common knowledge within the general medical profession. This may well be because the treatment for these conditions does not include medication.

Wendy Emberson completed the first course in neurodynamics in 1995 and has since completed various courses as our understanding has increased with further research and evidence.

These specialist areas of musculo-skeletal medicine, sacro-pelvic dynamics, neurodynamics, Interferential Therapy and advanced rehabilitation programmes are a unique combination that enables us to find the correct diagnosis and provide the right treatment for our patients.

It goes without saying that pain is a feature of almost everything we treat.
Acute pain is generally associated with an injury that is less than 6 weeks old, and will usually resolve as the underlying condition gets better.

We see our work as preventing an acutely painful condition becoming a chronic one.

As a general rule, we like to see patients within the first six days. We can make the diagnosis after a full clinical examination and  it may be that only simple advice is needed, or that by treating the condition quickly then the patient can get back to work or sport quicker than by letting the condition take it’s course.

The problems start when a condition is allowed to continue for more than three months. The original condition may well have resolved, but the patient is still in pain.

This is situation can lead to increased use of medication and ultimately coming under the care of a Pain Clinic. Injections, surgery and long term use of opiods may be used. Cognitive behavioural therapy may also be tried.

However, there is the risk of the pain becoming a permanent feature.

Over the last few years we are seeing an increasing number of patients who are in this situation.

The good news is that something can be done. UK physiotherapists working in the speciality of chronic pain and those carrying out research into this difficult area, now lead the world across all the healthcare professions Louis Gifford FCSP developed his Mature Organism Model, which has become the next notable milestone in our understanding of pain since the Pain Gate Theory of Melzack and Wall in the late 1960’s.

Just before his death in 2014, Louis wrote a three volume, 450,000 word text called Aches and Pains. This is the story of his work coupled with detailed descriptions and references of all that we know at the moment.

His close friend Professor Michael Thacker PhD MSc Grad Dip Phys FCSP

completed his PhD at King’s, his thesis focused on neuro-immune interactions and pain; more specifically the role of the chemokine CCL2 as a key mediator of neuropathic pain.

Prof Thacker and a significant number of other top UK Physiotherapists are continuing to give we clinicians the understanding and tools to help patients with chronic pain to reduce their medication as well as their pain. 

The advancement of our knowledge into pain and pain mechanisms has not been the exclusive domain of the British physiotherapists. The Australian physiotherapists have also been working in this area, notably Professors David Butler and Lorimer Moseley. I have included part of Lorimer Moseley’s biography as an example of how far our profession has progressed particularly in the last 30 years.  Louis Gifford also worked in Australia for 10 years with David Butler and the collaboration between the Australian and British physiotherapists continues to the benefit of patients the world over.

“I am a clinical and research physiotherapist. After working clinically for six years, I undertook a PhD at the University of Sydney Pain Management Research Institute. I completed my PhD in 2002 and had research posts at the University of Queensland, University of Sydney and Oxford University, UK. I was appointed University of South Australia's Inaugural Chair in Physiotherapy, and Professor of Clinical Neurosciences, in 2011. I am supported by an NHMRC Principal Research Fellowship. I am the Chair of Pain Adelaide Stakeholders' Consortium and I lead the Body in Mind Research Group, based here at the University of South Australia and at Neuroscience Research Australia, in Sydney. Lorimer Moseley

The Body in Mind research group investigates the role of the brain and mind in chronic pain. Pain is a huge problem - it affects 20% of the population and costs western societies about as much as diabetes and cancer combined. His research group does experiments in humans - both healthy volunteers and people in pain, and clinical intervention studies and clinical trials of treatments for defined chronic pain conditions. Our research is supported by four NHMRC Project Grants and many of the group have scholarship or fellowship support. We have eight nationalities and several disciplines represented.”

 All the clinicians at Stort Physio are committed to incorporating the work of these world-ranking British and Australian physiotherapists.

There is no doubt that the evidence, research and clinical trials that continue to come from physiotherapists around the world, the more we understand the physiology and complex mechanisms of pain. It is also becoming abundantly clear that the answer to chronic pain does not lie with stronger and stronger pain medication.

We are seeing significant success in this complex area of work. However, it does take time and a great deal of education for the patient.

This is why we offer a fixed price, Cost per Condition Plan for patients with long standing conditions and chronic pain. This means that patients know from the outset what the cost will be and is the most cost effective, and clinically effective way of achieving a successful outcome.