Ankle Pain

Anterior impingement

This is when a piece of soft tissue is trapped between the tibia and talus when you bend forwards at the ankle. It can lead to a persistent pain following an ankle sprain. It is common in ballet dancers and footballers. The pain usually starts as a vague discomfort over the front of the ankle and becomes more sharp. Usually the pain is produced when doing activities such as running, lunging, kicking.

Physiotherapy techniques which can help include advice, provision of heel lifts, exercise programmes, examining your walking pattern, manual therapy and taping.

Tibialis anterior tendinopathy

This can result from overuse of the tibialis anterior muscle and pain develops in the tendon which attaches the muscle to the bones in the ankle and foot. Symptoms include pain, swelling and stiffness which becomes worse on activities such as running and walking up hills and stairs.

Physiotherapy techniques which help this condition include manual therapy, advice, massage, taping, ultrasound, examining your walking/running pattern, exercise programmes and acupuncture.

Inferior tibiofibular joint injury

This joint is the connection at the lower end of the small outside bone of the lower leg (fibula) with the main shin bone (tibia). This joint can be sprained following an ankle injury and can cause pain at the front of the ankle.

Physiotherapy techniques including advice, exercise programmes, manual therapy, acupuncture and taping can help this condition.

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis can occur in any joint in the body and is a the process of ‘wear and tear’ where the cartilage covering the area of bone that makes up the joint is gradually worn away over time. Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. In both conditions joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.

We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment which includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massage, taping, acupuncture and mobility programmes.

We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:

• Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
• Wheelchair assessments
• Splinting

Chronic Pain

Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.

Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top Singapore pain consultants who can help you.

Complex Regional Pain Syndrome

This condition as the name suggests is complex. The pain is often constant and of a burning type. The body part affected is often very sensitive to touch and just a stroke can cause pain. There can be changes in temperature and colour of the body part and on occasions growth of excess hair and swelling. The ankle can be affected by this syndrome and the pain can extend up the leg and over the foot. The exact cause of it is not clearly known and can happen with no cause but there can be an event before it occurs such as a fracture. ‘The sympathetic nervous system’ has been shown to be involved which controls blood flow and skin temperature.

Physiotherapy can help with this condition by keeping the part of the body affected moving and stop it stiffening up. They can help to use techniques to desensitise the area and acupuncture can help the pain in some cases. Your physiotherapist will also recommend a top London pain consultant to you who can use treatments to block the sympathetic nervous system from firing and provide appropriate medication to help with the pain.

Other possible causes

Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:

• cardiovascular symptoms
• respiratory (breathing) symptoms
• gynaecological symptoms
• urinary or genital symptoms
• digestive symptoms
• immune system symptoms
• lymph system symptoms
• hormonal symptoms
• neurological symptoms
• dermatological (skin) symptoms
• medication side-effects
• virus
• infection
• cancer
• disease process
• psychological problem ie. depression, anxiety

Achilles Rupture

The 2 main calf muscles that allow you to rise up onto your toes and jump are the gastrocnemius and soleus. The tendons of these 2 muscles combine to form the Achilles tendon which attaches to the back of the heel. This tendon can tear or rupture. This can happen if too much stress is put on the calf muscles or too much of a pull is put on tendon by foot being bent backwards too much. If there is a deep cut to the back of the leg this can also injure the Achilles tendon. Symptoms include immediate pain and a feel of having been kicked in the back of the leg. You may not be able to put weight on the leg or if you can you will not be able to walk properly and rise up onto your toes/walk on your toes. Your physiotherapist will be able to perform special tests to diagnose if this has happened. If suspected immediate attention by a specialist foot and ankle surgeon that we can recommend to you is required. If not seen straight away you are unlikely to recover as well. The consultant will decide whether to repair your tendon surgically or conservatively by wearing a supportive specialized boot.

Physiotherapy is extremely important following this injury to ensure the best rehabilitation is carried out. We have devised information leaflets and protocols of what to expect during your rehabilitation – please refer to post surgery physiotherapy.

Achilles tendinopathy

This is pain in the Achilles tendon as described above which may start suddenly or gradually. The pain can be in the middle of the tendon, at the top of the tendon where it inserts into the calf or at the bottom where it attaches to the back of the heel. It normally occurs with an activity that involves walking or running and becomes worse as you continue. There can be a swelling where the pain is.

Physiotherapy can be very effective for this condition. Treatments that can help are soft tissue therapy, working on tight or weak muscles that may be contributing, advising on footwear and insoles and correcting any issues with your walking or running style. A very effective rehabilitation programme has been developed by Alfredson et al (1998) which they can take you through. If physiotherapy is not effective we can recommend a top foot and ankle consultant to review you. There is a new treatment called electroshockwave therapy which has been found to be effective for this condition and your consultant will be able to provide this or alternatively we can recommend where to have electroshockwave therapy done.

Posterior impingement

Pain can occur in the back of the heel due to impingement and normally happens when you rise fully onto your toes and repeat this action. There can be a formation of bone within the ankle or the presence of a bony structure called an ‘os trigonum’ which can cause the impingement.

Physiotherapy can perform special tests to determine if this is the cause of your pain. Treatments that can help include mobilizing other joints in the foot and ankle, correcting your sporting technique and advising on how to reduce any inflammation. If physiotherapy is not effective we can recommend a top Singapore foot and ankle consultant to review you.

Accessory soleus muscle

This small mass of soft tissue being present between the end of the tibia (leg bone) and Achilles tendon is very rare. It causes pain in the Achilles when exercising with swelling. If this is suspected by your physiotherapist they will recommend a review with a top Singapore foot and ankle consultant.

Other ankle fractures

Fractures of other parts of the ankle will tend to cause pain throughout the ankle and a lot of swelling. If you have injured your ankle and have a lot of swelling and pain and standing on the leg is difficult without pain, we advise you seek urgent medical attention to confirm if you have sustained a fracture to the ankle. We can recommend top Singapore foot and ankle consultants to you. If you do have a fracture it is likely you will have to have the ankle joint fixed in a cast or boot for a period of time. Physiotherapy is important during this time to maintain strength in the rest of the leg. Following removal of the cast or boot physiotherapy is vital to regain full movement, strength and stability around the ankle and help you return to activities you were doing before the fracture.

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis can occur in any joint in the body and is a the process of ‘wear and tear’ where the cartilage covering the area of bone that makes up the joint is gradually worn away over time. Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. Affected joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.

We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment that includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmmes, massage, taping, acupuncture and mobility programmes.

We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:

• Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
• Wheelchair assessments
• splinting

Chronic Pain

Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.

Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top Singapore pain consultants to help you.

Other possible causes

Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:

• cardiovascular symptoms
• respiratory (breathing) symptoms
• gynaecological symptoms
• urinary or genital symptoms
• digestive symptoms
• immune system symptoms
• lymph system symptoms
• hormonal symptoms
• neurological symptoms
• dermatological (skin) symptoms
• medication side-effects
• virus
• infection
• cancer
• disease process
• psychological problem ie. depression, anxiety

Medial ligament sprain (deltoid ligament)

The deltoid ligament is a large ligament that can be sprained or torn. This ligament is much more unlikely to be injured compared to the ligaments on the outside of the ankle.

Physiotherapy can ensure you return to your normal activities with full strength and stability of the ankle. They can advise, ice, tape, ultrasound and apply soft tissue techniques to the ankle as well as set strengthening and stability exercises.

Tibialis posterior tendinopathy

This is pain in the tendon which joins the tibialis posterior muscle to the inside of the foot. This muscle helps you to rise up onto your toes and turns the sole of the foot inwards. There are different degrees of severity of the condition. If overused over a long time can lead to rupture of the tendon. There will be pain on the inside of the ankle along the tendon which will be worse when doing weight bearing activities. Swelling is quite unusual. Rising up onto the toes may be difficult. If rupture is suspected we can recommend a top Singapore ankle consultant to review you.

Physiotherapy techniques which can help include advice, massage, acupuncture, soft tissue techniques, exercise and taping.

Flexor hallucis longus tendinopathy

The flexor hallucis longus muscle bends the big toe downwards and helps you to rise up onto your toes. The tendon joins the muscle to the big toe. Tendinopathy can occur due to overuse, a tear to the tendon and from inflammation of the tendon. Common causes include sports that involve excessive rising up onto the toes such as ballet. There will be pain along the tendon and when rising up onto the toes.

Physiotherapy techniques which can help include advice, manual therapy, soft tissue techniques, massage, ultrasound, taping and acupuncture.

Tarsal tunnel syndrome

This is when the tibial nerve which runs down the inside of the leg and ankle becomes trapped. It can occur out of the blue, after trauma or if the arch of the foot is flat. Rubbing of boots (inc.ski boots) over the inside ankle can also contribute. The sensation around your inside ankle and along the inside of the sole of your foot can change and usually the condition is made worse by weight bearing and activity and eased by resting. Symptoms are often worse at night and relieved by getting up and moving or massaging the foot. There may be some swelling around the inside of the ankle and sole of the foot.

Physiotherapy techniques which can help include advice and taping and advice on anti-inflammatory measures and avoidance of aggravating the nerve.

Sinus tarsi syndrome

There is a tunnel that passes between bones through the foot in front of the ankle joint known as the sinus tarsi. Inflammation can occur in this tunnel following an ankle sprain or over time as a result of poor foot posture. Pain will be felt mainly on the outside of the ankle/foot but pain can also be felt on the inside of the ankle. Due to the inflammation the pain tends to be more severe in the morning.

Potts fracture

This is a fracture of the medial malleolus which is the lower inside part of the leg bone (tibia) which forms the joint of the leg with the foot. The pain will be severe and it will be difficult to stand on the leg. Can sometimes be mistaken for an ankle sprain. If this is suspected you seek urgent medical attention. We can recommend a top Singapore foot and ankle consultant to you in this case. . It is likely you will have to have the ankle joint fixed in a cast or boot for a period of time. Physiotherapy is important during this time to maintain strength in the rest of the leg and following removal of the cast or boot physiotherapy to regain full movement, strength and stability around the ankle.

Other ankle fractures

Fractures of other parts of the ankle will tend to cause pain throughout the ankle and a lot of swelling. If you have injured your ankle and have a lot of swelling and pain and standing on the leg is difficult without pain we advise you seek urgent medical attention to confirm if you have sustained a fracture to the ankle. We can recommend top Singapore foot and ankle consultants to you. If you do have a fracture it is likely you will have to have the ankle joint fixed in a cast or boot for a period of time. Physiotherapy is important during this time to maintain strength in the rest of the leg. Following removal of the cast or boot physiotherapy is vital to regain full movement, strength and stability around the ankle and help you return to activities you were doing before the fracture.

Referral of pain

Pain felt on the inside of the ankle may be coming from other parts of the body ie. trigger points in other muscles or from a problem in the pelvis, lower back, hip or knee.

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis can occur in any joint in the body and is a the process of ‘wear and tear’ where the cartilage covering the area of bone that makes up the joint is gradually worn away over time. Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. In both conditions joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.

We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment which includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massage, taping, acupuncture and mobility programmes.

We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:

• Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
• Wheelchair assessments
• Splinting

Chronic Pain

Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.

Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top Singapore pain consultants who can help you.

Complex Regional Pain Syndrome

This condition as the name suggests is complex. The pain is often constant and of a burning type. The body part affected is often very sensitive to touch and just a stroke can cause pain. There can be changes in temperature and colour of the body part and on occasions growth of excess hair and swelling. The ankle can be affected by this syndrome and the pain can extend up the leg and over the foot. The exact cause of it is not clearly known and can happen with no cause but there can be an event before it occurs such as a fracture. ‘The sympathetic nervous system’ has been shown to be involved which controls blood flow and skin temperature.

Physiotherapy can help with this condition by keeping the part of the body affected moving and stop it stiffening up. They can help to use techniques to desensitise the area and acupuncture can help the pain in some cases. Your physiotherapist will also recommend a top Singapore pain consultant to you who can use treatments to block the sympathetic nervous system from firing and provide appropriate medication to help with the pain.

Other possible causes

Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:

• cardiovascular symptoms
• respiratory (breathing) symptoms
• gynaecological symptoms
• urinary or genital symptoms
• digestive symptoms
• immune system symptoms
• lymph system symptoms
• hormonal symptoms
• neurological symptoms
• dermatological (skin) symptoms
• medication side-effects
• virus
• infection
• cancer
• disease process
• psychological problem ie. depression, anxiety

Posterior Cruciate Ligament (PCL) Tear

An ankle sprain is a common injury and the majority of time the ankle turns inwards so that the ligaments on the outside of the ankle are sprained. As a result of the sprain there can also be injury to the inferior tibiofibular joint as described below. There are 4 main ligaments on the outside of the ankle that can be sprained. Symptoms often include pain on the outside of the ankle, swelling and bruising. Putting weight on the ankle may be difficult. Your physiotherapist will be able to determine which ligaments have been affected and to what degree they have been affected. If the sprain is believed to be severe or the ligament may be ruptured then a medical review will be required and we can recommend top Singapore ankle and foot consultants for you to see.

Physiotherapy can help by advising on ice and other anti-inflammatory measures. Ultrasound can help reduce inflammation and healing in the early stages. Taping, soft tissue techniques, massage and setting an exercise programme to restore movement, strength and stability to the ankle are all important in the recovery following an ankle sprain. Those who do not undergo rehabilitation on their ankle following a sprain are much more likely to sprain their ankle again in the future.

Inferior tibiofibular joint injury

This joint is the connection by ligaments at the lower end of the small outside bone of the lower leg (fibula) with the main shin bone (tibia). This joint can be sprained following an ankle injury and can cause pain at the outside of the ankle. Also it may not be the ligaments that are sprained but a forward movement of the fibula that may be causing the pain.

Physiotherapy techniques including advice, exercise programmes, manual therapy, acupuncture and taping can help this condition.

Sinus tarsi syndrome

There is a tunnel that passes between bones through the foot in front of the ankle joint known as the sinus tarsi. Inflammation can occur in this tunnel following an ankle sprain or over time as a result of poor foot posture. Pain will be felt on the outside of the ankle/foot which tends to be more severe in the morning due to the inflammation. There can also be pain felt on the inside of the ankle.

Anterolateral impingement

Following an ankle sprain there is healing around the ligaments on the front outside of the ankle. If the extra tissue that forms when healing is not reabsorbed then down the line it can form a meniscoid (piece of soft tissue) that becomes trapped in the front outside of the ankle causing pain there. Your physiotherapist can do tests to determine if this is the cause of your pain. You will need to see a top Singapore foot and ankle consultant which we can recommend to treat this either with a corticosteroid injection or minor surgery to remove the piece of tissue.

Posterior impingement

Sometimes if soft tissue is trapped in the back of the ankle it can cause pain on the outside of the ankle. Your physiotherapist can perform special tests to determine if this is the cause of your pain and recommend to a top Singapore foot and ankle consultant if the case.

Peroneal tendinopathy

The peroneal muscles run down the outside of the lower leg and their tendons run behind the bony prominence on the outside of your ankle and down to the attach to the bases of your 1st and 5th metatarsal bones in the foot. Pain in the tendons can arise if the muscle is overused or from inappropriate support from your footwear. The symptoms include pain on outside of ankle and heel and swelling which is worse with activity and better with rest. Your physiotherapist will be able to perform a through assessment and special tests to determine if this is causing your symptoms.

Physiotherapy treatment can help with advice on which activities you can take part in and advice on reducing inflammation. Soft tissue therapy can help and advice on footwear. They will take you through a rehab programme including appropriate stretching, strengthening and stabilising exercises to enable you to return to sport. In severe cases your physiotherapist will be able to recommend you to a top Singapore foot and ankle consultant for a review.

Peroneal tendon tear or rupture

With an injury sometimes the peroneal tendons described above can tear or rupture. If this is suspected by your physiotherapist they will advise you seek urgent medical attention. We can recommend top Singapore foot and ankle consultants if this is the case. Physiotherapy will be required to rehab the ankle with an exercise programme and manual work to restore movement after surgery if it has been carried out.

Potts fracture

This is a fracture of the lateral malleolus which is the bony prominence on the outside of your ankle on the end of the fibula bone. The pain will be severe and it will be difficult to stand on the leg. Can sometimes be mistaken for an ankle sprain. If this is suspected you seek urgent medical attention. We can recommend a top Singapore foot and ankle consultant to you in this case. It is likely you will have to have the ankle joint fixed in a cast or boot for a period of time. Physiotherapy is important during this time to maintain strength in the rest of the leg and following removal of the cast or boot physiotherapy to regain full movement, strength and stability around the ankle.

Other ankle fractures

Fractures of other parts of the ankle will tend to cause pain throughout the ankle and a lot of swelling. If you have injured your ankle and have a lot of swelling and pain and standing on the leg is difficult without pain, we advise you seek urgent medical attention to confirm if you have sustained a fracture to the ankle. We can recommend top Singapore foot and ankle consultants to you. If you do have a fracture it is likely you will have to have the ankle joint fixed in a cast or boot for a period of time. Physiotherapy is important during this time to maintain strength in the rest of the leg. Following removal of the cast or boot physiotherapy is vital to regain full movement, strength and stability around the ankle and help you return to activities you were doing before the fracture.

Stress fracture of the talus

The talus is the main bone of the foot connecting the foot to the lower leg. If a stress fracture happens to the outside of this bone then it can lead to a gradual onset of pain on the outside ankle. Tends to occur in athletes who do a lot of impact activity and is worse with running. If this is suspected your physiotherapist can recommend a top Singapore foot and ankle consultant for you to see. It is likely you will have to have the ankle joint fixed in a cast or boot for several weeks. Physiotherapy is important during this time to maintain strength in the rest of the leg and following removal of the cast or boot physiotherapy to regain full movement, strength and stability around the ankle.

Stress fracture of fibula

If a stress fracture occurs to the bottom end of your fibula bone then it can lead to pain on the outside ankle. Feeling the point of stress fracture on the bone will reproduce pain. If suspected by your physiotherapist they can recommend a top Singapore foot and ankle consultant to review you. It is likely you will have to have the ankle joint fixed in a cast or boot for a period of time. Physiotherapy is important during this time to maintain strength in the rest of the leg and following removal of the cast or boot physiotherapy to regain full movement, strength and stability around the ankle.

Referral of pain

Pain felt in the lateral ankle can be coming from somewhere in the body such as the lower back, peroneal nerve or the superior tibiofibular joint (connects top of fibula and tibia together)

Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis can occur in any joint in the body and is a the process of ‘wear and tear’ where the cartilage covering the area of bone that makes up the joint is gradually worn away over time. Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. In both conditions joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.

We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment which includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massage, taping, acupuncture and mobility programmes.

We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:

• Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
• Wheelchair assessments
• Splinting

Chronic Pain

Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.

Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top Singapore pain consultants who can help you.

Complex Regional Pain Syndrome

This condition as the name suggests is complex. The pain is often constant and of a burning type. The body part affected is often very sensitive to touch and just a stroke can cause pain. There can be changes in temperature and colour of the body part and on occasions growth of excess hair and swelling. The ankle can be affected by this syndrome and the pain can extend up the leg and over the foot. The exact cause of it is not clearly known and can happen with no cause but there can be an event before it occurs such as a fracture. ‘The sympathetic nervous system’ has been shown to be involved which controls blood flow and skin temperature.

Physiotherapy can help with this condition by keeping the part of the body affected moving and stop it stiffening up. They can help to use techniques to desensitise the area and acupuncture can help the pain in some cases. Your physiotherapist will also recommend a top Singapore pain consultant to you who can use treatments to block the sympathetic nervous system from firing and provide appropriate medication to help with the pain.

Other possible causes

Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:

• cardiovascular symptoms
• respiratory (breathing) symptoms
• gynaecological symptoms
• urinary or genital symptoms
• digestive symptoms
• immune system symptoms
• lymph system symptoms
• hormonal symptoms
• neurological symptoms
• dermatological (skin) symptoms
• medication side-effects
• virus
• infection
• cancer
• disease process
• psychological problem ie. depression, anxiety