Gp’s Prognosis resource / NHS / professional
PATIENTS APPROPRIATE FOR TREATMENT AT THE WELWYN AND HATFIELD PRACTICE
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The following descriptions are simply for guidance. They are not an absolute guide and are quite possibly contentious. However, these subjective observations and classified by diagnosis. I hope that these are borne out by patients at the Welwyn and Hatfield Practice who have later been seen by a doctor.
A truly progressive approach requires one to not only look at the tissue (s) causing the symptoms, but also the aetiology, maintaining and predisposing factors.
To truly assess and treat patients well, efficiently and in a cost effective manner one should not only be helping their present problem, but also educating the patient to help prevent future recurrences. So often poor treatment and rehabilitation can lead to more pain, loss of motivation, long term analgesic use and increased cost to the NHS .
The Welwyn and Hatfield Practice approach and perhaps the general efficiency of private practice, enables us to help patients who are often considered untreatable by other manual therapists.
We specialise in triage based care offering ( at a basic level ) osteopathy for acute / chronic spinal pain.
Physiotherapy for rehabilitation, occupational or quality exercised based programs.
Tcm Acupuncture is increasingly scientifically proven and well researched. This therapy has enormous potential and a far reaching ability to help conditions that other treatments have been ineffective. Many conditions such as : – osteoarthritis / chronic degenerative conditions, irritable bowel, in – fertility, shingles, bells palsy, chronic fatigue, blood pressure, many tendinitis based conditions such as Achilles tendinitis and ” frozen shoulder “.
As well as providing treatment Welwyn and Hatfield Practice practitioners will provide a detailed examination if needed. This is often helpful to assess if a further referral (particularly to a surgeon) might be more appropriate e.g. An ” O/A’” hip or knee or perhaps a painful ” meniscus tear “ or perhaps a pathology that has presented as a musculoskeletal condition perhaps often requiring surgery / Dr. specialist referral if there is evidence of :-
a) Absence of cartilage
b) Constant pain (even off weight bearing)
c) Hyper-mobility in one or two directions (due to lost joint space and consequently lax ligaments)
d) suspicion of rheumatological / pathological condition
Some of the Conditions we Treat
1. Chronic Spinal Problems (Spondylotic, Stenotic, Complex chronic postural etc. Cervical, Thoracic, Lumbar and rib Mechanics )
Response time: short term: 2-10 visits
Long term: may require occasional return visits depending on patient compliance to exercises
Effectiveness: generally respond really well (unless very advanced) and are very grateful for the pain relief / advice.
Value: highly significant improvements to quality of life, significant reduction in analgesic usage and although patients generally need to return intermittently they are usually happy to self fund this if necessary.
2). Acute or Sub-acute spinal problems ( non-disc ), i.e. ligamentous, capsular strains , muscular spasms, joint pain, adhesive etc. Cervical, Thoracic, Lumbar and Rib problems:
Response time: short term: return to full mobility is rapid, with complete recovery in 1-5 visits (occasionally, if severe, as many as eight ).
Effectiveness: Recommended by the NICE report and considerably greater than 95% success rate (although with acute patients a number will inevitably improve anyway! they wont of had the first hand professional advice or rehabilitation which may stop it all happening all over again potentially becoming chronic over time ).
Value: return to work /sport should be a lot quicker ( patient possibly more knowledgable ) . The treatment of predisposing and maintaining factors often helps to reduce the likelihood of recurrence and the possible development of a long term injury (especially with shoulder injuries; to ‘’prevent’’ a frozen shoulder etc.
3). Disc injuries: (Accurate differential diagnosis is not always easy between annular and true disc injuries:
i)With true sciatica (i.e. lower motor neuron lesion):
Response time: short term: 4-10 visits
Long term: possible future episodes as the disc fissures or degenarates
Effectiveness: generally good, with majority having a good prognosis acupuncture at this point provides very efficient pain relief.
ii) Without referred pain in lower extremity:
Response time: short term: 3-6 visit
Long term: occasionally future episodes may occur, although simple exercises (if continued) often help.
Effectiveness: generally good, with majority having a good prognosis
i) and ii)
Value: This sort of problem without effective, high quality musculoskeletal treatment, can easily become chronic, often leading to specialist referral (even though this type of intervention treatment may not be applicable anyway).
B) Nucleus Pulposus ( genuine prolapsed disc ).
i) With true sciatica and specific nerve root / dermatomal /paresthesia / awful pain etc…
Response time: short term: 2-4 visits to assess risk / nerve damage, potential efficiency of treatment and stability of disc.
Long term: if responding, generally takes 6-12 visits. May require 2-3Maintenance visits.
Much better in children young adults, although other diagnostic possibilities must be accurately assessed.
ii) Without lower motor neuron lesion or referred pain in lower extremity:
Response time: short term: 1-3 visits to assess potential efficiency of treatment.
Long term: if responding well, generally takes 5-8 visits to respond.
i) and ii)
Effectiveness: variable as the prolapse but we are always realistic / positive : If very severe, particularly if symptoms are only in the lower Extremity ( nerve damage / disc pressure ) , surgery etc., can be the best course (this can be ascertained quite quickly). However about 50-60% of patients do resolve (although some may be left with some residual symptoms which tend to improve over time). Obviously, the part of the disc and level involved is also significant.
Value: Those that avoid surgery and/or a specialist’s consultation, are both grateful and save much expense to the NHS. The general level of response has often resulted in very positive comments from Orthopaedic surgeons ( if the patient was due to return for a reappraisal ).
4) Long term (non-specific/non-degenerative/non-disease) mechanical problems:
Response time: short term: 6-8 visits (as many as 12-15 in really severe cases)
Long term: may require a few intermittent check-ups etc..
Effectiveness: variable: Depending on severity (and other underlying factors). Some respond very well in the long term, although this does depend on severity. These are the difficult cases who we often see after ‘’everyone else’’ has seen the patients ( chronic fascia shortening / joint / fibrosis problems ). 75% seem to get a lot better.
Value: Those who respond can have a great improvement in the quality of life (assuming they do not ‘’ need ’’ their symptoms ! ) Also reducing drug demands and GP visits substantially.
5) Acute peripheral joints and sports injuries:
Response time: short term: 1-6 visits
Long term: may require a further 1-2 visits to check on exercises etc
Effectiveness: considerably greater than 95% success rate (although with acute patients, quite a few will inevitably improve anyway!).
Value: return to work/sport should be a lot quicker and treatment of predisposing and maintaining factors should help reduce the likelihood of recurrence and development of a long term injury.
6) O/A Hips and Post – patella O/A knees:
Response time: short term: initially 6-8 treatments
Long term: generally requires 1-2 visits per month.
Effectiveness: patients generally improve, particularly with exercises, and home self treatment. However, this is such a heavily worked weight bearing joint, that it is not usually greatly helped in the long term.
Value: Will not ‘’resolve’’ the problem, but can often defer surgery by a year or two, or can be used to provide considerable relief and maintain good bodily function whilst a patient is awaiting surgery ( many just wait for the surgery and find their rehabilitation slow as they have lost fitness / flexibility and mechanical efficiency ) . Again often viewed as ‘’very difficult’’ by other areas of therapy.
7) O/A knees (tibial plateau):
Difficult to treat, best treated with Acupuncture for pain relief and physiotherapy based exercises. Does really respond well to acupuncture when used as a management / pain killing treatment. Well performed soft tissue (neuromuscular massage) will often bring good local short term relief , osteopathy will work well by improving the bodies ability to compensate and by decreasing the tonicity in the local musculature.
8a) Shoulder and elbow joints:
A) Rotator Cuff /tendinitis problems (e.g. ‘’ tennis elbow “ ” frozen shoulder / impigement )
Response time: 3-8 visits
Effectiveness: variable: Often good and problems which otherwise seem
untreatable can improve when a broad based approach is applied
Value: can avoid steroid injections (and subsequent possible muscle necrosis) and reduce the likelihood of chronicity (i.e.and get better much quickly)
B) ‘’Frozen shoulder’’:
Response time: short term: 6-12 visits
Long term: 1 or 2 – visits to check exercises etc.
Effectiveness: can substantially reduce recovery time (especially helpful in the initial, painful stage) from the ‘’ normal ’’ 12-36 months.
Value: can significantly speed up return of patient to normal life, reduce visits to GP’s reduce use of drugs and may avoid possible referral
Most importantly, treating structurally predisposing factors reduces the likelihood of a (commonly consequent) contra-lateral frozen shoulder.
9) Young children:
Response time: depending on the problem, but children respond well to treatment
Effectiveness: can help avoid the necessity of paediatric /orthopaedic consultations
10) Headaches, ear pain etc.
Response time: 2-6 visits
Effectiveness: these problems can often arise from the neck, and even a long history can often be relieved (even in some cases of ‘’classic’’ migraine.) by specific exercises, manipulation and work based assessments.
Value: relief of pain, better sleep / function and substantial reduction in analgesia/ NSAID usage and overall improvement in health
11) Post-operative and post-fracture recovery, neurological conditions, ‘’tibial plateau O/A knees’’, Adverse Neural Tension problems and conditions which only require exercises
These are best treated by our Physiotherapists and acupuncture.
12) Hay Fever, severe pain problems, lethargy, R/A (earlier stages), other inflammatory disorders, fertility issues, shingles etc.
These can also respond very well to Acupuncture neurological conditions, ‘’tibial plateau O/A knees’’, Adverse Neural Tension problems etc… respond very well to neuromuscular osteopathy and physiotherapy exercises