Physiotherapy

Arthritis is an umbrella term for a group of conditions characterized by inflammation and/or degeneration of one or more joints, leading to pain, stiffness, swelling, reduced range of motion, and functional limitation. It is not a single disease, but a category that includes over 100 different joint disorders with distinct causes and mechanisms.

Back Pain: Strain or Sprain

A back strain or sprain is an acute or subacute musculoskeletal injury involving excessive tensile or shear loading of the soft tissues of the spine, resulting in microscopic or macroscopic damage to muscles and tendons (strain) and/or ligaments and joint capsules (sprain), leading to localized pain, muscle spasm, stiffness, and temporary limitation of spinal movement without structural damage to the vertebrae or intervertebral discs.

• Strain: Injury to muscle or tendon fibers of the back

• Sprain: Injury to ligaments or joint capsules that stabilize the spinal segments

These injuries most commonly affect the lumbar (low back) region, but can also occur in the thoracic or cervical spine.

Back Pain: Sciatica

Sciatica is a symptom complex characterized by pain radiating from the lower back or buttock down the posterior or lateral aspect of the leg, caused by irritation or compression of one or more lumbosacral nerve roots (most commonly L4–S1). It may be accompanied by numbness, tingling, or muscle weakness in the affected nerve distribution.

Back Pain: Bulging Disc (Disc Protrusion)

A bulging disc refers to circumferential, symmetric extension of the intervertebral disc beyond the margins of the vertebral bodies, due to degeneration or mechanical stress, without focal rupture of the outer annulus fibrosus. It may or may not compress nearby nerve roots and is often asymptomatic.

Chronic pain is pain that persists or recurs for longer than the normal expected time of tissue healing, typically defined as lasting more than 3 months, and is associated with ongoing biological, psychological, and social factors that may maintain or amplify the pain experience, even in the absence of ongoing tissue damage.

Neck pain is an unpleasant sensory experience arising from actual or potential tissue injury or dysfunction in the cervical spine and surrounding structures, including muscles, ligaments, intervertebral discs, facet joints, and neural tissues, resulting in pain, stiffness, and/or reduced movement in the neck region, with or without radiation into the head, shoulders, or upper limbs.

Shoulder pain is an unpleasant sensory experience arising from actual or potential tissue injury or dysfunction of the structures of the shoulder complex, including the glenohumeral joint, acromioclavicular joint, scapulothoracic articulation, rotator cuff tendons, bursae, ligaments, capsule, and surrounding muscles, resulting in pain, stiffness, weakness, and/or restricted upper-limb movement, with possible radiation into the upper arm or neck.

Elbow pain is an unpleasant sensory experience arising from actual or potential tissue injury or dysfunction of the structures of the elbow region, including the humeroulnar, humeroradial, and proximal radioulnar joints, surrounding ligaments, tendons, muscles, bursae, and neural tissues, resulting in pain, tenderness, stiffness, weakness, and/or limitation of arm and hand function.

Wrist pain is an unpleasant sensory experience arising from actual or potential tissue injury or dysfunction of the structures of the wrist complex, including the radiocarpal and midcarpal joints, carpal bones, intercarpal ligaments, triangular fibrocartilage complex (TFCC), tendons, tendon sheaths, bursae, and peripheral nerves, resulting in pain, stiffness, weakness, instability, and/or limitation of hand and forearm function.

Hand pain is an unpleasant sensory experience arising from actual or potential tissue injury or dysfunction of the structures of the hand, including the metacarpophalangeal (MCP), proximal and distal interphalangeal (PIP, DIP) joints, phalanges, intrinsic and extrinsic muscles, tendons and tendon sheaths, ligaments, fascia, vascular tissues, and peripheral nerves, resulting in pain, stiffness, swelling, weakness, altered sensation, and/or impaired fine motor function.

Hip pain is an unpleasant sensory experience arising from actual or potential tissue injury or dysfunction of the structures of the hip region, including the femoroacetabular joint, acetabular labrum, articular cartilage, joint capsule, surrounding ligaments, muscles, tendons, bursae, and nearby neural or vascular structures, resulting in pain, stiffness, weakness, and/or limitation of lower-limb and trunk function.

Knee pain is an unpleasant sensory experience arising from actual or potential tissue injury or dysfunction of the structures of the knee joint and surrounding region, including the tibiofemoral and patellofemoral joints, menisci, articular cartilage, ligaments, joint capsule, synovium, muscles, tendons, and bursae, resulting in pain, stiffness, swelling, instability, weakness, and/or limitation of lower-limb function.

Ankle and foot pain is an unpleasant sensory experience arising from actual or potential tissue injury or dysfunction of the structures of the ankle and foot, including the talocrural and subtalar joints, midfoot and forefoot joints, bones, articular cartilage, ligaments, plantar fascia, muscles, tendons, bursae, and peripheral nerves, resulting in pain, swelling, stiffness, weakness, altered gait, and/or limitation of weight-bearing and balance activities.

Muscle, tendon, or ligament injuries are acute or subacute musculoskeletal injuries characterized by excessive tensile loading that exceeds the tissue’s capacity, resulting in microscopic or macroscopic disruption of fibers, local inflammation, pain, swelling, reduced strength or stability, and impaired movement or function.

They are classified by tissue type and mechanism:

• Strain: An injury to muscle or tendon fibers caused by overstretching or excessive contraction, often occurring during rapid acceleration, deceleration, or heavy loading.

• Sprain: An injury to ligament fibers caused by excessive joint movement beyond normal physiological limits, leading to partial or complete tearing of stabilizing structures.

Severity is commonly graded:

• Grade I: Mild fiber disruption, minimal strength loss

• Grade II: Partial tear, moderate pain and functional limitation

• Grade III: Complete rupture, significant instability or loss of function

Tendinitis (Tendonitis)

Tendinitis is an acute inflammatory condition of a tendon characterized by pain, swelling, warmth, and impaired function, typically occurring shortly after sudden or excessive loading. It reflects a short-term inflammatory response and is relatively uncommon in chronic tendon pain.

Key features:

• True inflammation present

• Usually short-term and reactive

• Often follows sudden overload or trauma

Tendinopathy

Tendinopathy is a chronic tendon disorder characterized by tendon pain, thickening, and impaired load tolerance associated with degenerative changes in tendon structure, altered collagen organization, and minimal or absent inflammation. It represents a failed or dysregulated healing response to repeated mechanical loading.

Key features:

• Degenerative and structural changes, not classic inflammation

• Often chronic and recurrent

• Pain related to load and activity

• Includes subtypes such as:

  • Reactive tendinopathy

  • Tendon disrepair

  • Degenerative tendinopathy (continuum model)

Bursitis is an inflammatory condition of a bursa, characterized by increased synovial fluid production, bursal wall thickening, and localized pain, swelling, and tenderness, resulting from mechanical irritation, repetitive friction, direct trauma, infection, or systemic inflammatory disease.

A bursa is a small, fluid-filled sac located between tissues (such as tendon and bone or skin and bone) that reduces friction and allows smooth movement.

Orthopedics is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders, injuries, and diseases of the musculoskeletal system, including bones, joints, muscles, tendons, ligaments, cartilage, and related neurovascular structures, using both surgical and non-surgical approaches to restore function, reduce pain, and improve quality of life.

Orthopedic care spans:

• Traumatic injuries (fractures, dislocations, ligament tears)

• Degenerative conditions (osteoarthritis, spinal degeneration)

• Congenital and developmental disorders (scoliosis, hip dysplasia)

• Overuse and sports injuries

• Post-surgical rehabilitation and long-term functional recovery

Pre- and post-surgery rehabilitation refers to a structured, evidence-based program of assessment, education, and therapeutic interventions delivered before and after a surgical procedure, designed to optimize physical and psychological readiness for surgery, enhance tissue healing, restore function, prevent complications, and promote safe return to daily activities, work, and sport.

It includes two complementary phases:

Pre-Surgery Rehabilitation (Prehabilitation)

Prehabilitation is the process of improving a patient’s physical capacity, movement quality, and health behaviors prior to surgery in order to improve surgical outcomes and accelerate post-operative recovery.

Goals include:

• Improving strength, mobility, and cardiovascular fitness

• Educating the patient on post-op expectations and exercises

• Reducing pain, inflammation, and fear of movement

• Optimizing comorbidities and lifestyle factors (sleep, activity)

Post-Surgery Rehabilitation

Post-surgery rehabilitation is the progressive restoration of movement, strength, neuromuscular control, and functional capacity following surgical intervention, while respecting tissue healing timelines and surgical precautions.

Goals include:

• Protecting surgical repair and supporting healing

• Restoring range of motion and strength

• Re-training movement and load tolerance

• Preventing complications (stiffness, weakness, falls, re-injury)

• Returning to work, sport, and independent living

The temporomandibular joint (TMJ) is the paired synovial joint connecting the mandible (lower jaw) to the temporal bone of the skull, allowing complex movements required for chewing, speaking, and yawning, including hinge (rotation) and sliding (translation) motions.

TMJ disorders (collectively termed Temporomandibular Disorders, or TMD) are a group of musculoskeletal and neuromuscular conditions affecting the temporomandibular joint, the articular disc, and the surrounding masticatory muscles, characterized by jaw pain, joint noises, restricted or asymmetric jaw movement, and sometimes associated head, neck, or ear symptoms.