Physiotherapy

At Randell’s, our service is led by an experienced clinician with a rich background in musculoskeletal health and first contact physiotherapy. We prioritise ‘getting it right the first time’ meaning we assess and diagnose accurately to then ensure you are guided down the most appropriate treatment pathway. This may include utilising our direct multi-disciplinary access between podiatry/biomechanics and physiotherapy in our clinics. Exercises, one of the most important aspects of physiotherapy, will also be tailored to you specifically rather than being given a generic template or without adjustments. This includes being considerate of your daily life, schedule, preferences, and goals.

A musculoskeletal condition, at a basic level, is typically a group of symptoms stemming from muscles, bones, joints, and/or nerves. These seldomly occur in isolation, but direct trauma or repetitive strain are the most common causes. You may experience pain, weakness, swelling, bruising, pins and needles, or numbness. Symptoms will normally worsen during or after activity, worsen in certain positions, and improve while resting, however, some conditions will feel stiff for a few minutes while starting to move again. There are overlaps with other body systems, but the underlying cause is different. For example, the neurological system can feel similar but requires a different specialist approach. Our team can help differentiate between the two if there is uncertainty by asking a range of questions and completing a physical assessment. If a non-musculoskeletal condition is suspected, we will recommend the next best steps for you.

Although nerves are included in the musculoskeletal system, they are also part of the neurological system. Different treatments are required depending on the underlying cause to your symptoms. Currently, we are unable to assist in neurological rehabilitation due to the specialist care it requires. If you are unsure whether it is neurological or musculoskeletal, we recommend an assessment to help differentiate the two. We will then make a recommendation on next steps depending on the outcome. Here is a list of common nerve-related conditions we treat:

· Carpal tunnel syndrome (hand/wrist) – usually tingling/numbness into the thumb, index, and middle fingers. May experience weakness.

· Guyon’s canal syndrome (hand/wrist) – usually tingling/numbness into the ring and little fingers. May experience weakness.

· Sciatica (low back) – usually burning/shooting pain and tingling/numbness down the back of the leg and into various parts of the low leg/foot.

· ‘Trapped nerve’ in the neck – usually burning/shooting pain and tingling/numbness down various parts of the upper back, arm, and hand.

· Radiculopathy/radicular pain – sciatica and ‘trapped nerves’ are examples of this but can refer to any nerve arising from the area where nerves exit the spine.

· Tarsal tunnel syndrome (foot/ankle) – usually causing pain and tingling/numbness from the inner ankle into the foot and toes.

· Cubital tunnel syndrome (elbow) – usually tingling/numbness into the ring and little fingers.

· Meralgia Paraesthetica (thigh) – usually a patch of burning pain and tingling/numbness on the front/outer part of the thigh.

An assessment is always essential before starting physiotherapy. The 45-minutes allows us to put together the best treatment package based on your symptoms, goals, previous treatments, and preferences. It also ensures any information that changes the safety of certain treatments is considered. The first step is to understand where your symptoms are, how long you have had them for, and how they are affecting your quality of life. We will also ask questions around what you’d like to achieve with treatment. It is good to be as specific as possible with this, for example, walking a certain distance again, being able to do a certain event, or even be able to do carry out certain responsibilities at home. It is also helpful to understand what thoughts you have about your own symptoms, what about them worry you, and if you’re interested in a particular type of treatment. We will need to ask ‘red flag’ questions which highlight potential symptoms that need to be investigated further, possibly before starting treatment. Once we both feel like we have covered everything thoroughly, we will start a physical assessment including looking at and feeling the area, testing your range of motion, strength, and function, amongst other things as appropriate. Brief initial treatment may be provided at the end of the appointment depending on what therapies are required, how much time was needed during the appointment, and the safety between the therapies and the diagnosis.

A treatment session will naturally vary depending on the package that was put together with you and the physiotherapist. Typically, the 30-minute appointment will start with a few minutes of review. This is to ensure that it is still safe to proceed with treatment. If all cleared, treatment will start as early as possible to get the most out of the appointment duration. Depending on the therapy, a more detailed consent form will need filling out prior to the appointment. See our treatment offerings page for more details, however, here is a brief list of our current services:

· Kinesiology taping

· Sports and therapeutic massage

· Exercise programme review and guidance

· Shockwave therapy

· Joint mobilisations

You should wear something comfortable and loose to allow for free movement. Athletic wear is a good option due to its coverage and flexibility. The area will need to be easily visible or treated (e.g. massage). This may be as simple as rolling up a pair of trousers to see the low leg but may also require complete removal of trousers or shirts depending on the body area. We have towels to help you feel comfortable by covering any area that doesn’t need to be exposed. You are welcome to ask for a chaperone at any point, including bringing your own family or friend. We will never ask to remove underwear. If there are any items of clothing or footwear that relates to your symptoms, please bring those in to help our assessment.

Fitting multiple issues into one appointment is difficult due to the range of questions we need to ask, aspects to physically assess, and possibly provide initial treatment. Being thorough allows us to be safe, accurate, and provide effective treatment. We kindly ask to book an extended physiotherapy initial consultation to provide enough time to complete a full assessment.

We champion preventative care at Randell’s. If you have a previous injury you are worried will return or simply want to work on your health and fitness, we are happy to help.

Physiotherapists are some of the best clinicians to see with a recent injury. This is even more applicable in our clinics due to our physiotherapist having senior experience in a first contact role where he was the first person to assess patients. He has a strong record of accurate diagnoses from anything between an injury within hours of the consultation to symptoms ongoing for years. He can recommend next steps such as imaging, blood tests, immediate medical assessment, alternative therapies, or simply reassurance alongside a physiotherapy treatment package. Nonetheless, we would recommend immediate medical assessment with any of the following symptoms:

· Difficulty weight-bearing, severely restricted range of movement, or visible deformity following a trauma

· Significant swelling, heat, redness, or bruising

· Acutely unwell including fevers, chills, breathlessness, chest/abdominal pain, dizziness, vomiting, or sudden altered mental state including confusion

· Facial drooping, difficulty speaking, vision changes, severe headache, new balance/coordination issues, or inability to hold both arms up

· Changes to bladder or bowel function (difficulty controlling urine or bowel movements, difficulty differentiating between a full or empty bladder), numbness or tingling in/around the genitals (unaware of leaking, altered sensation when wiping), or change in sexual function

The NHS is incredibly helpful when it comes to more advanced treatments such as splinting, hydrotherapy, or surgeries requiring close monitoring. The NHS also has access to a wider range of professionals to work together. Private healthcare, however, have access to potentially more costly treatments such as shockwave therapy. We also benefit from time allowing us to go through your concerns in detail and provide more manual therapies like massage. Speaking about time, accessing private healthcare is normally considerably quicker than the current NHS waiting lists, particularly for physiotherapy. Here at Randell’s, we’re fortunate to have physiotherapy, podiatry, and biomechanics to still provide that multi-disciplinary care.

Our current clinic set up focuses on musculoskeletal health. This is your typical pains, sprains, or strains. We cover any part of the body from the neck to the toes. We have a separate page for your perusal that goes into more detail but here is a short list of common examples:

· Spine-related symptoms (muscles, joints, nerves, or discs)

· Osteoarthritis

· Ligament sprains

· Tendinopathy/Tendonitis/Tendinosis

· Muscle pulls and strains

· Sport or work accidents

· Balance and coordination (not related to neurological conditions)

The specific number of physiotherapy sessions widely varies depending on the recommendations of the physiotherapist, the specific treatment protocols, and your preferences. We normally expect at minimum four sessions spaced a month apart if you feel confident to self-manage between appointments with the advice and guidance discussed with you in the initial consultation. For more acute or severe symptoms, we typically see patients no more than two weeks apart to help maintain treatment momentum, ensure appropriate progress, and review efficiently. These weekly/bi-weekly sessions can take a month or two to get through, then we normally see things settle nicely so other sessions can be spaced apart more. Overall, the average time we have patients under our care for a particular issue is three to four months with anywhere between four and eight appointments.