Chiswick Physio

2012-01-22T08:11:00.000-08:00

Ankylosing Spondylitis

Talk given by Dr Alexander Brand a consultant Rheumatologist on the 19-1-12.

Ankylosing spondylitis is a chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and nonarticular structures.

It mainly affects joints in the spine and the sacroiliac joint in the pelvis, and can cause eventual fusion of the spine.

Presentation

- predominently in35 year old males

- always starts inthe sacroiliac joint

- may suffer fromsome other inflammatory disorder – psorasis, iritis, IBS

- morningstiffness that is prolonged – 60-90 minutesbuttock pain and into the thighs

- systemicallyunwell – continual flu symptoms

- CRP and ESR maybe normal

- HLA B27+ is highin only 90% of cases. If it is high does not mead you have AS. If it is low youstill may have AS. Not definitive in diagnosis.

Main diagnosis test is MRI –will show bone marrow oedema of the SIJ.

Physiotherapy treatment

– The main aim ismaintain range of movement.

– Swimming, is one of thepreferred exercises since it involves all muscles and joints in a low-impact,buoyant environment.

– Slowmovement muscle extending exercises like stretching, yoga, climbing, t'ai chi, Pilates method, is recommended.

– Moderate-to-highimpact exercises like jogging aregenerally not recommended or recommended with restrictions due to the jarringof affected vertebrae that can worsen pain and stiffness in some patients.

– Manipulationis contraindicated and has sometimes led to spinal fractures.^[1]

Medication

- Pain relievingdrugs – NSAID’s and opiod analgesics

- Disease-modifying antirheumatic drugs (DMARDs) - used to reduce theimmune system response through immunosuppression.

- TNFα blockers (also known as biologics), are indicated forthe treatment of and are effective immunosuppressants inAS as in other autoimmune diseases.

2012-01-22T07:58:00.000-08:00

Lumber symptoms - to operate or not?

Talk given by Mr Colin Natali on 19-1-12, a consultant spinal surgeon working out of the Lister Hospital , London.

- 66% of the population willhave spinal problems. 44% will have a reoccurring yearly problem.

Mr Natali follows 5 steps of treatmentwith surgery being the final step.

- rest, NSAID’s andphysiotherapy are the first 3 and grouped together

- facet joint injection(FJI) if the above 3 steps have no effect

- spinal surgery if all elsefails

Facet Joint Injections

Aim : to give you apain free period to strengthen the supporting muscles with physical therapy.

There is no restriction post injections.

Physiotherapy should start thefollowing day, not be left 7-10 days as often prescribed. An injection's effect will last 4-6 weeks, therefore physiotherapy should be started immediately and be directed towards strengthening of the core muscles.

Spinal decompression

Aim : Only done in patients with leg referral/sciatica.

Causes the back to becomeunstable, therefore no heavy lifting for 2 months.

Rehabilitation is related tosymptoms. Do not do activities that cause pain. If it is painful lying then walk, if it is painful walking then lie.

Swimming and walking is recommended.

Disc replacement

Currentresearch indicates that there is a 30-40% failure in 15 years.

Very difficultto reverse and can be life threatening to try and reverse.

Tending to do lessof these due to long term research.

High chance of risk in operation witharterial occlusion.

My First Blog

2011-12-30T02:30:00.000-08:00

This was awesome