Pillows – Is your pillow hurting your neck?.

We spend an average of 7.6 hours asleep each night (2774 hours in a year!) and so our choice of pillow can be important in contributing towards a restful sleep and a healthy spine.

Clients with neck pain will often ask us to recommend a pillow that would suit their neck, and so we hope the advice below will be helpful for many people.

If you have any questions that are not answered below, our physiotherapists will be happy to discuss these with you on your next visit.

Interesting Fact!

‘Memory foam’ was invented by NASA-funded researchers looking for ways to keep test pilots cushioned during flights. Its use in pillows was developed by the Tempur company – although astronauts themselves never get to rest their heads on a pillow in space!

Understanding Your Sleep Position

Your sleep position is one of the most important factors in determining which pillow will provide you with the best support. Here’s how it affects your choice:

Back Sleepers

For back sleepers, a medium-firm pillow is usually the best choice. It should be thick enough to keep your head in line with your spine, but not so thick that it tilts your head forward. Memory foam and latex pillows can be excellent for this purpose, offering a balance of support and comfort. As physiotherapists we would suggest that you also place a second pillow under your knees which will keep your lower back in a neutral position for a more comfortable night’s sleep.

https://www.emma-sleep.ie/emma-premium-foam-pillow/?sku=EPWDD040070AAA

Side Sleepers

Side sleepers would benefit from more supportive and in some cases ‘contoured’ pillows to support the gap between the head and shoulders. The research from scientific papers would suggest that those who sleep with latex pillows usually report the best quality of sleep with least wakings. They are also naturally resistant to dust mites and mould, making them ideal for allergy sufferers. We suggest you place a second pillow between your knees to support the alignment of your lower back.

A study by Australian physiotherapists* used 99 patients with chronic neck pain. They were all Side Sleepers. The parameters checked were the degree of night pain, degree of waking pain and the quality of sleep obtained. The conclusions drawn from the study were that:

• Latex pillow is likely to provide the most support and best value

• The shape of the pillow made no difference to waking pain or abolition of night pain.

• The contour pillow was less comfortable & provided poorer quality sleep.

• The feather pillow was a consistent poor performer in all outcome measures

• The latex pillow performed consistently well & was a better performer than the subject’s own pillow in all outcome measures.

A more recent study** found that ‘there is moderate evidence that some of the following pillow parameters could improve sleep quality/spinal alignment, and decrease sleep-related neck pain. These are: a latex pillow material, a contoured pillow design (higher sides to accommodate side sleepers and a lower, flattened middle to accommodate back sleepers), and a cooling surface’.

Our recommendations to try:

https://www.groovepillows.co.uk/products/the-original-groove-adjustable-pillow

https://www.reflexpillow.com/

Stomach Sleepers

Stomach sleepers can be more susceptible to waking up with a stiff neck if they have underlying stiffness in the small joints of their neck – the facet joints. Clinically, we would observe that they have less issues with morning neck and stiffness that one might expect and it is likely that if a person has always been a stomach sleeper that their neck joints and soft tissues have adapted to this end of range rotated position over many hours of many years of sleep. Indeed it is more likely that it is either their work posture or a distinct injury eg whiplash that brings them to the care of a physiotherapist to begin with!

If you are someone who sleeps on your stomach, a soft, thin pillow is recommended to keep your spine in a neutral position and prevent strain.

UK company Tempur have designed a star shaped pillow, to allow for easier breathing for front sleepers which may reduce the angle of neck rotation needed.

Our recommendation to try:

https://uk.tempur.com/pillows/browse-by-collection/shaped-pillows-UKOMBRACIO.html

Final Thoughts: Comfort is Key

While all of these guidelines can help narrow down your pillow choice, the most important factor is comfort. There’s no one-size-fits-all when it comes to pillows, so don't be afraid to try different options to find the one that helps you wake up feeling refreshed and pain-free. Whether you prefer the cushy softness of down or the firm support of memory foam, the right pillow can make all the difference in your sleep quality.

Investing in a quality pillow is a simple yet significant step toward better sleep and overall well-being.

Pillows should be changed every two years for optimal support.

Need more personalised advice? Visit one of our experienced physiotherapists for a neck assessment and further help to start each day with a painfree neck and a healthy spine.

* Reference: Gordon, S et al (2009) Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy, 14, 6, 671-678

**Effect of different pillow designs on promoting sleep comfort, quality, & spinal alignment: A systematic review

Ahmed Radwan a b, Nicholas Ashton a, Trever Gates a, Austin Kilmer a, Michael VanFleet a

European Journal of Integrative Medicine,Volume 42, February 2021, 101269

Nocturnal, or Sleep related Back Pain – Should you change your mattress?

Back pain is a common issue that can significantly affect your quality of life – especially when it interrupts your sleep. One of the main reasons a person may decide to see a doctor or a physiotherapist for their back pain is because they are awake at night due to the pain, or they have difficulty getting out of bed in the morning due to stiffness and discomfort.

Here is one of the most common questions we are asked on a regular basis – you may find the answer helpful too!

Should I change my mattress?

Many people who experience nocturnal back pain feel that changing their mattress would improve their sleep quality and that a new or firmer mattress would help their spinal alignment. From a physiotherapist’s perspective, spines undergo most loading ‘axial loading’ when we are in an upright position, during the day. When we are standing and sitting in sustained postures over a long period of time, this causes load or ‘deformation’ of the tissues such as ligaments, discs, muscles and fascia or connective tissue. If the tissue can’t cope with the load being applied, it triggers pain sensitive tissues, or can initiate inflammation in these tissues. Overnight, when we are at rest several hours later, the inflammatory process takes place, in which the body tries to start healing itself with the formation of new tissue, a rudimentary type of scar tissue. When you turn during the night or load the spine as you move into sitting or standing in the morning time, this is when you feel the effects of the previous day’s load or activity – the result of the inflammatory process.

There are times when eg a large disc protrusion can directly affect your sleep position and keep you awake at night, but usually pain in the early hours of the morning is more related to low grade inflammation of the soft tissues of the spine from persistent loading the day before.

Our advice?

Try to move your spine and change position more regularly during the day and observe if this makes a difference to your nighttime or early morning back pain before changing your mattress which can be an expensive option with no guarantee of success. A suggestion would be to do some simple pelvic tilts in your chair at work every 15-20 minutes to begin and reach down to touch your toes and then raise your arms overhead.

‘Motion is lotion’ is a key concept in maintaining a healthy, pain-free spine, and backs not only love to move – they need to move.

Find reasons to get up and move from your desk to walk around the office or house during the day,  -getting a glass of water is a simple and often overlooked mini-task - try to avoid getting engrossed in a task to the detriment of movement and keeping up your hydration. Dehydrated tissues are more likely to become painful tissues.

 Our next blog will continue the focus on Nocturnal or Sleep related back pain, where will we suggest some mattress choices and explore good options for those who are due a mattress change.

*Please note that nocturnal back pain is sometimes associated with underlying medical issues, and in particular if it is persistent over a number of weeks with no improvement, or associated with night sweats, unexplained weight loss or bladder and bowel changes or any new symptoms of concern it is important to seek assessment from your doctor or physiotherapist.

Waking up with numb hands recently?

Every year we see an increase in patients presenting with numbness in their hands in the summer months. There are a few reasons for this – and you may be surprised at what the causes are!

Numbness is a loss of skin sensation. It is due to a problem with nerves being unable to transmit messages along their length. One of the reasons for this is compression of the nerve, which blocks the ability of the signals to move along the length of the nerve into the spinal cord. In mild cases it can be described as a ‘dead sensation’, associated with tingling or ‘pins and needles’ – an example of this would be the sensation we feel when we sit with our legs crossed for too long and the nerve at the back of our knee is temporarily affected. This usually recovers within a minute or so – but this depends on how long the nerve has been compressed.

In the Summer months, there are a few lifestyle changes that we undergo as the weather improves and we spend more time outdoors, like at Taylor Swift or Coldplay concerts!

When a patient presents to physiotherapy with altered sensation in their arms, we consider a wide range of potential causes for this. In Summertime, we can often see a rise in Carpal Tunnel Syndrome, where the median nerve is compromised at the wrist joint. In pregnant women, who may experience swelling in their hands and feet during the third trimester, this is a factor which can affect their ability to sleep at night.

Summertime is often a time for people to get DIY jobs around their house and garden. Painting and other overhead activities can compress the delicate nerves as they exit the neck area and have to pass over the top of our first rib on their journey to supply the arms and hands.

In recent years, we have seen an increase in middle aged individuals presenting with loss of sensation or power in an arm for no immediately identifiable reason. We do a full examination including neurological exam in such patients, as we need to be able to rule out any more serious pathology and send them for further imaging tests if necessary. We always discuss their activities of the previous weeks – have they done anything differently to their normal routine…. The answer in many of these cases has been festival and concert attendance! With concerts running for over three hours and festivals running over two to three days, people can stand waving and clapping their arms overhead which puts considerable pressure on the delicate nerve roots and brachial plexus in a phenomenon known as Thoracic Outlet Syndrome.

If you’re lucky enough to be heading to Taylor Swift this weekend in Dublin, or any of the many festivals taking place this weekend, remember to take a few breaks from overhead waving, try to avoid tipping your head too far back when you’re gazing at the stage for hours, and bring a good pillow if you are camping or glamping or sleeping on a friend’s couch!   

Neuropraxia or mild nerve injuries like these can resolve themselves over a few weeks if they are given a good chance to recover. If your symptoms are persisting beyond two weeks with no sign of recovery, it is advisable to see your physiotherapist or doctor for further advice and treatment.

Exercises you can do to manage a back- pain flare up

When experiencing a back pain flare-up, gentle exercises can help alleviate discomfort and improve mobility. Here are five exercises that are effective in managing back pain flare-ups:

1. Cat-Cow Stretch

This yoga pose helps to stretch and mobilize the spine.

Starting Position: Begin on your hands and knees with your wrists directly under your shoulders and your knees under your hips.

Cat Pose: Arch your back towards the ceiling, tucking your chin to your chest and drawing your belly button towards your spine.

Cow Pose: Drop your belly towards the mat, lifting your head and tailbone towards the ceiling.

Repetitions: Move between these two positions slowly and gently, repeating 10-15 times.

2. Child's Pose/ Lumbar extension

This stretch helps to relieve tension in the lower back.

Starting Position: Kneel on the floor with your big toes touching and knees spread apart.

Stretch: Sit back on your heels and extend your arms forward, lowering your chest towards the ground. Rest your forehead on the floor.

Hold: Stay in this position for 30 seconds to 1 minute, breathing deeply.

3. Lumbar rotations

This exercise helps to relax the lower back and relieve tension.

Starting Position: Lie on your back with your knees bent and feet flat on the floor.

Stretch: Bring one knee up towards your chest, clasping your hands around your shin. Keep the other foot flat on the floor.

Hold: Hold the stretch for 15-30 seconds, then switch legs. Repeat 2-3 times for each leg.

4. Pelvic Tilts

Pelvic tilts help strengthen the abdominal muscles and support the lower back.

Starting Position: Lie on your back with your knees bent and feet flat on the floor, arms at your sides.

Movement: Flatten your lower back against the floor by tightening your abdominal muscles and tilting your pelvis slightly up.

Hold: Hold for a few seconds, then relax. Repeat 10-15 times.

5. Pilates leg taps

This exercise strengthens the muscles that support the lower back.

Starting Position: Lie on your back with your knees bent and feet flat on the floor, arms at your sides.

Movement: Lift your hips towards the ceiling, squeezing your glutes and engaging your core. Your body should form a straight line from your shoulders to your knees.

Hold: Hold for a few seconds, then lower your hips back down slowly. Repeat 10-15 times.

Tips for Performing These Exercises:

Go Slowly: Perform each exercise slowly and gently, avoiding any movements that cause pain.

Breathe Deeply: Focus on deep, steady breathing to help relax your muscles.

Consistency: Regular practice of these exercises can help manage and reduce back pain over time.

Is it ok to exercise into Pain?

 Each of these exercises can be performed gently in a comfortable mid-range position to begin with.

As your back pain eases you will be able to move the full, end range positions shown in the videos.

If you feel that any of the movements cause discomfort, which persists for more than ten minutes please contact your physiotherapist for back pain advice.

Should I rest my back or try to do exercises when I have back pain?

 Gentle active movement is encouraged in almost all cases of back pain *(some exceptions will apply here, e.g. fracture, fever, night sweats, weight loss, bladder or bowel changes or unassessed back pain following trauma).

 Bed rest is not usually encouraged- there can be times when 48 hours of bed rest can help to reduce spasm and irritability, but prolonged rest is inadvisable.

Is it okay to back pain exercises if I have sciatica?

In almost all circumstances, gentle walking and movement is encouraged during episodes of sciatica. If your pain is moderate to severe, please consult your physio for tailored advice and exercises.

Title: Understanding Achilles Tendinopathy: Causes, Symptoms, and Treatment

Achilles tendinopathy (formerly known as ‘tendonitis’) can put a halt to your active lifestyle if left untreated. The Achilles tendon, the largest tendon in the body, connects the calf muscles to the heel bone. This crucial structure facilitates movement such as walking, running, and jumping. However, repetitive stress or sudden increases in activity like tennis can lead to overload and degeneration of the Achilles tendon, resulting in Achilles tendinopathy.

Causes:

Achilles tendonitis often occurs due to overuse or strain on the Achilles tendon. Athletes who engage in activities such as tennis that require repetitive jumping, running, or sudden changes in direction are particularly susceptible. Other contributing factors include changes in footwear, recent weight gain, hill running, and biomechanical issues such as overpronation or high arches. Additionally, individuals who suddenly increase the intensity or duration of their workouts without proper conditioning are at risk.

Symptoms:

The hallmark symptom of Achilles tendonitis is pain and stiffness along the back of the heel, especially upon waking up or after periods of inactivity. This pain may worsen at the start of activity and subside with rest. Swelling and tenderness may also be present along the tendon. In severe cases, individuals may experience difficulty walking or standing on tiptoe.

Treatment:

Early intervention is crucial in resolving Achilles tendinopathy and expediating return to sport and activities. Here are some effective treatment options:

1. Relative rest and symptom recognition: Resting the affected leg from excessive loading (e.g. avoid playing tennis on consecutive days and applying ice packs when necessary to manage pain can be useful. It's essential to identify the activities that aggravate the symptoms and discuss these with your physiotherapist.

2. Stretching and Strengthening Exercises: Gentle stretching exercises for the calf muscles and Achilles tendon can improve flexibility and reduce tension. Strengthening exercises targeting the calf muscles are considered the most evidence based treatment strategy for Achilles tendinopathy.  

3. Orthotics and Supportive Footwear: Wearing supportive footwear with proper arch support and cushioning can alleviate stress on the Achilles tendon. Orthotic inserts may be recommended to correct biomechanical issues and improve foot alignment, or your physiotherapist will suggest the best type of runners for your foot type eg Hoka, Asics etc and where best to shop for runners in Dublin.

4. Physiotherapy: A physiotherapist can provide personalized treatment plans focusing on stretching, strengthening, and biomechanical correction techniques to address Achilles tendonitis.

5. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate pain and inflammation. However, long-term use should be avoided due to potential side effects.

6. Modalities: Modalities such as extracorporeal shockwave therapy and Platelet Rich Plasma injections may be used to promote healing and reduce pain. Your physiotherapist can advise you on these options.

Prevention:

Load management is important in Achilles Tendinopathy prevention. Gradually increase the intensity and duration of workouts, and avoid sudden changes in training regimens. Additionally, wearing appropriate footwear and maintaining flexibility and strength in the calf muscles can reduce the risk of injury.

In conclusion, Achilles tendonitis can be a debilitating condition, but with prompt treatment and preventive measures, individuals can effectively manage symptoms and resume their active lifestyle. If you experience persistent heel pain or suspect Achilles tendonitis, Eva, Kaitlyn or Lorraine at Physiofusion can assess for an accurate diagnosis and personalised treatment plan.

Book Now with one of our team members.

Pelvic Girdle Pain

Lessons learned from treating PGP over a 20 year career.

Pelvic Girdle Pain is a broad term which describes pain in the buttock, pubic and groin region during pregnancy.

I first treated pubic symphysis pain in sportspeople- usually men- in the early years of my career when I worked with rugby players, GAA players and elite soccer players. In many areas of medicine, the techniques which we use in day to day life trickle down from research and evidence based medicine developed in the highest levels of sports medicine. In the sports world, the accurate diagnosis of pelvic pain and the ability to develop a strategy for recovery to high level sport and high loads and forces on the pelvis are essential for a sport physiotherapist.

The first key element of treating pelvic girdle pain in women is establishing the severity and irritability of the pain –

·         How is it affecting this patient?

·         Is she able to sleep at night?

·         Is she able to eg walk where she needs to in day to day life?

·         Is she able to look after her other child(ren)?

·         Is she experiencing pain at rest?

·         Is she able to cope with the pain?

This leads into a deep dive into our more general medical training – Could there be anything more sinister causing this pain, either related to the pregnancy or otherwise? Do we need to refer the patient to their GP or hospital for investigations? Physiotherapists are trained to differentiate musculoskeletal pain from other causes of pain, much like a doctor  - and we will liase with the patient’s doctor if we deem it appropriate to do so. This is very rare, as most pelvic girdle pain patients presenting to physiotherapy have a musculoskeletal cause of their pain which can be very successfully managed at physiotherapy.

Many women experiencing pelvic girdle pain try to manage their pain at home with rest and reduced activity. This can be quite effective with mild presentations when it is initiated early. It is my experience that when a woman presents to physiotherapy and has already tried this option and it has not worked, it has already become a significantly more stressful situation, and she has began to worry that it will continue to worsen throughout the pregnancy. Given that the second trimester is a time when PGP usually starts, she may have jumped to thinking that there may be up to 3-5 months of pain ahead.

Fortunately we know that this is not the case. The vast majority of women who attend for treatment with a physio who is experienced with pelvic pain in pregnancy have excellent outcomes. We strive and expect to resolve pelvic girdle pain – not merely prevent it from worsening over time.

So how do we treat Pelvic Girdle Pain?

We take time to analyse the cause of the pain, and the main tissues involved eg referral from the lower back / sacroiliac joint pain/ muscular buttock pain  / hip joint pain / groin tendon pain / pubic joint pain / nerve referred pain.

We give specific guidelines on how far the patient is advised to walk each day / and whether activities such as swimming / yoga /pilates would be helpful for them at that stage of their pregnancy. We recognise the importance of supporting a woman to stay active and involved in physical and fitness activities and we endeavour to work with this as a central goal.

We advise them on positions to avoid or minimise – eg prolonged sitting, or weightbearing mainly on one leg in standing.

We discuss whether a pregnancy support belt would be helpful, and where to source one.

We make recommendations on the use of hot/cold therapy for their condition.

We sometimes show their partner how to do eg massage to a particular area, if having some manual work done regularly at home will be beneficial for them (this also keeps physio bills down!).

We prescribe specific exercises which will help to strengthen the important supporting muscles of the pelvis eg the gluteals. These can be modified around existing conditions also eg co-existing knee pain.

We liase with the relevant hospital care team/midwife/consultant to raise awareness of the condition prior to delivery in order to facilitate early planning for positions for labour etc. This is increasingly rare however as we find most women make huge improvements with treatment and are not fearful of worsening of their condition with labour.

We liase with the woman’s workplace where we can make suggestions eg working from home/ reducing work hours during exacerbations etc and we do this in conjunction with the woman’s GP for enhanced communication across the care team.

Confidence and Reassurance

As a young physiotherapist, I was a little apprehensive about treating pregnant women who were in pain, and I recognised that I had the potential to worsen their pain. As a result, I tended to undertreat them. I don’t think I was alone in this, as it was not an area that received a large amount of focus in our undergraduate University training at the time. Hopefully it has changed and improved since then.

Now with a Masters Degree in MSK physiotherapy, I have twenty years of experience in treating complex groin pain in athletes aswell as pelvic pain from all musculoskeletal sources during pregnancy. I have completed numerous postgraduate courses in Pelvic Girdle pain both in Ireland and abroad and thankfully I feel that those hard days are long behind me. Having had three pregnancies myself, I understand how exhausted women can be while working, minding other children and managing pain, and this is my driver now to do my best for them during their pregnancy. 

I now begin each session knowing that I have the tools to help each patient and the dramatic results we see from treating PGP make it one of the most rewarding aspects of my job as a Musculoskeletal Physiotherapist. We see a refreshed and much happier patient who is excited again about their pregnancy and feels prepared for the weeks and months ahead.

Lorraine O’Reilly

CORU State Registered Physiotherapist, MPhty (MSK Physiotherapy)

Contact: lorraine@physiofusion.ie

From ‘pain’ to ‘chronic pain’

May 2021

At Physiofusion we see many patients who seek treatment for pain that is persistent or chronic, despite taking rest from their usual activities to allow time for the tissues to heal. This can be the case for pain in almost any part of the body, but most commonly we see it as chronic back pain, neck pain and buttock pain.

So why do some aches and pains go away by themselves, and other aches and pains persist?

Most muscle and joint pains (‘musculoskeletal pains’) occur as a result of us increasing our activity levels by doing too much too soon, with insufficient recovery time. Our muscles, tendons and joints need to be strong enough to cope with the loads and demands we place on them every day. When we apply too much load or we do it over too short a time, our tissues react to this and send signals to our brain to tell us that something may be wrong – our brain perceives this as a ‘threat’, and our brain also then acts to produce the sensation of ‘pain’ so that we pay attention to the ‘threat’.

All pain is produced by our brain!

It is true to say that all pain is produced in our brain– even though we feel it in the injured areas of our arms, legs or spine etc.

Usually, we will pay attention to the ‘threat’ or the pain sensation that the threat has produced, and we make a decision of how to react based on a number of influencing factors – whether we have had this pain before and if so what we did to resolve it; maybe we heard that our friend who had the same pain rested for 2 weeks from football and so we choose to copy that as it sounds sensible; or maybe we decide to take pain medications to mask it as it is too inconvenient to rest from sport or work that week, or we decide to continue as normal and to take no action, if we consider that this pain does not represent a strong threat to our wellbeing overall. This might be the case in back pain for example, if we frequently experience a similar type of pain and if we rationalise that it has usually resolved by itself in the past and so no further action may be required.

On the other hand, we are also influenced by other factors as we make our ‘what to do’ decision, and these can escalate the significance of the perceived threat… For example if we know of a neighbour with back pain who went on to be diagnosed as a spinal tumour, our brain might pay more attention to the ‘threat’ of our own back pain and we may then worry that we may also have a tumour and then pay more and more attention to the back pain. If we have other stressful issues going on in our lives at the time the pain starts, this can have an effect on how our brain interprets and deals with the pain also – and our brain can magnify the pain sensation or ‘output’ it produces if we perceive this threat to be significant. A pianist with a sore finger pain may report higher levels of pain for the same injury that a footballer would be expected to report, as the personal and financial significance of the injury is different for both individuals.

So our brain is capable of escalating the level of pain we experience for a given injury or ‘threat’, and this influences the decisions we make as we decide how to protect our injured area. Both conscious an unconscious decisions can drive the course of the recovery – ie the persistence of the pain. Studies show that poor sleep quality, work dissatisfaction and overall stress levels are important predictors of pain outcomes.

“Learning about how your body works, and how it generates and responds to pain signals can help with recovery”.

Knowing this, how can we identify which pain may become ‘chronic pain’?

As physiotherapists, it is important for us to gain a sense of your ‘whole person’ during our initial assessment so that we can create a better understanding of how ‘your’ pain is affecting ‘you’. In acute or ‘recent’ pain or injury, we will take a thorough history and listen to your description of the onset and behaviour of the pain, and how it affects your ability to walk/play sport etc. On another level, we are listening to the words that you might use to describe your pain, and we try to uncover any underlying ‘pain beliefs’ or past experiences of pain which might help us to determine the best approach for us to take when managing your pain.

In pain that has been present for longer duration, we are trying to identify how much of a ‘threat’ you may perceive their pain to be, and we implement strategies that will help to address these issues also.

The best time to intervene in the pain system is within the first three months. Our bodies do their best healing of ‘actual’ tissue damage within the first three months after the injury/onset of the pain.

Pain that persists beyond three (and in particular six months) is less likely to be coming from the tissues themselves, and more likely to involve changes in our pain processing system. This means that chronic or longstanding pain will most likely need a broader approach to treatment than massage or hands-on treatment alone. This is not always the case, but we need to consider it when we treat chronic pain.

At Physiofusion our team of physiotherapists are all senior physiotherapists with over ten years of experience in the diagnosis and treatment of chronic persistent pain. This is particularly valuable when assessing and helping patients who have tried various forms of treatment in the past without results. We take an individualised approach to each patient which involves a thorough initial assessment from your first visit so that you can be assured you of a high quality treatment plan towards a successful recovery.

Watch out for our next blog on the strategies that we use at Physiofusion as we work together with our patients to treat chronic pain.

Please contact us if you wish to speak to one of our physiotherapists to discuss if we can help you with persistent or chronic pain.