Manual Therapy is a broad term which includes all of the hands-on approaches that provide pain relief for musculoskeletal conditions. At Collins Avenue Physiotherapy Clinic, our team are all highly trained manual therapy specialists. Our treating team are all current members of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT). We can use joint manipulation or mobilisations, soft tissue release, accessory joint movements, passive and active assisted movement patterns to encourage normal movement patterns and relieve pain. Most of the recent research suggest that the best results are achieved when we combine manual treatments with an effective exercise programme and appropriate patient education. On occasion we may decide that a hands-off approach is the best strategy for you. We would discuss this in detail with you should this be your suggested path.

Many people who present to us in pain, with or without a 'musculoskeletal diagnosis', do not realise how the behaviour of our complicated pain system can be a real obstacle to our recovery. All the recent developments in pain science have shown that tissue injury is only one of the factors that determines how much pain we feel and how long it will last. Other factors that can sensitise our pain system are poor sleep patterns, high levels of stress and the fear that may come with your specific condition. Our beliefs and perceptions (sometimes misconceptions) about our painful conditions can indeed be major obstacles to full recovery. Education about your specific condition and your pain system is often an integral part of our management plan. Research shows that including this in the plan can improve your recovery outcomes.

Musculoskeletal problems may involve many painful tissues, one of which might be our muscle tissue. Occasionally some problems may appear to be arising from painful muscle tissue alone. Following our assessment should we wish to directly target painful muscle tissue we can use a tool called Dry Needling. This technique involves using single use sterile fine needles to target taut bands (otherwise known as trigger points) deep in muscle tissue. Often when a sensitive trigger point is targeted you may feel an involuntary muscle twitch. While the treatment can cause some immediate discomfort, usually the muscle feels less painful, softer and looser following the treatment. Dry Needling is based on western principles of physiology and anatomy and as such is quite different to Acupuncture, although the needles used are the same. At Collins Avenue Physiotherapy, many of our team are trained in this technique and can use it as a tool to relieve pain, thereby creating the opportunity for you to better manage your recovery.

Our assessment of all musculoskeletal problems involves an investigation of how you move and how your body disperses its load though your joints and soft tissues. Many painful conditions arise out of tissue overload. Ideally, we should all be trying to raise our tolerance to load by keeping strong and fit, and by gradually increasing our activity levels. Sometimes the shape of our skeleton or the way we use our body can increase the load on some of our tendons, muscles or joints. We call this increased biomechanical load. We may suggest accelerating recovery with the temporary or long term use of an insole (orthotic) that may change your biomechanics (reduce the load on your painful tissue). At Collins Avenue Physiotherapy, we may prescribe off-the-shelf orthotics, or may take more detailed measurements for custom-made orthotics in more complex cases.

Cognitive functional therapy is a specific approach designed to manage complex pain conditions. It is a patient centred approach that targets the beliefs, fears and associated behaviours of each individual presenting with musculoskeletal problems. All of our team believe that our results improve when we address all of the components of your presenting problem and many recent research papers are supporting these beliefs. We use the principles of cognitive functional therapy in various ways during the management of almost all of our clients. We can discuss this in more detail with you during your consultation.

The vestibular system, in the inner ear, provides information about balance and the body's position in space. A problem with this system can lead to symptoms such as dizziness, poor balance, nausea, light-headedness or vertigo. Vestibular rehabilitation is the branch of physiotherapy that treats disorders of the vestibular system. Treatment can help improve balance and reduce symptoms such as vertigo, nausea and vomiting. Many conditions can be successfully treated with vestibular rehabilitation. These include:

• Benign Paroxysmal Positional Vertigo (BPPV)
• Cervicogenic Dizziness
• Vestibular Neuritis
• Labyrinthitis
• Dizziness associated with migraine
• Poor balance associated with aging

This is a specialised area of physiotherapy requiring post-graduate training. Our Chartered Physiotherapist, Sarah Brady, is trained and experienced in this area. Sarah offers the vestibular rehabilitation service at Collins Avenue Physiotherapy. On your initial visit with Sarah, you will need to tell her about all of the symptoms you have been experiencing. She will then conduct some tests to help determine the cause of these symptoms. This can include: balance tests, walking tests, investigating how eye movements, or moving the head into certain positions, may bring on dizziness. If the diagnosis is BPPV a series of head movements known as the Epley manoeuvre may be performed. This has been shown in research to be very helpful for this condition. For other conditions therapeutic exercises may be prescribed. Sarah will advise you on any appropriate after-care requirements following your treatment. Please allow 1 hour for your initial visit. Caution: Some of the treatments and techniques that Sarah uses to assess your condition may provoke symptoms of dizziness. We would advise that someone accompany you to your first visit and that you don't plan on driving yourself home.

Our physiotherapy assessment may involve an analysis of how you move (or how you don't move) during your daily activities. We can advise you on the current recommendations for an efficient work station. The most recent research suggests that how, and where we sit, may not be as important as how often we need to move. Rather than any one posture being a full solution, it seems we probably need to adopt a variety of postures as we complete our daily tasks. Keeping fit and active outside of the workplace may be an essential part of keeping well if we must work in sedentary postures for long periods every week. We can advise you on what may be the most efficient lay-out of your specific work station.