Specialist Conditions

Highgate St Albans

Specialist Areas

Simple solutions to complex problems

Pain Management

There are unfortunately times when the current medical understanding of the human body and the technology available are unable to provide a suitable solution for some people. In these instances we tend to look at utilising a pain management approach to enhance people’s sense of well-being. At the heart of this approach is a fundamental understanding that the pain being experienced, whilst very real, is no longer a threat to the body, but rather an inappropriate warning mechanism. With this in mind the focus of treatment needs to take a holistic overview of all aspects of a persons' well-being including, physical, mental, emotional, and spiritual (where appropriate).

We have a number of expert clinicians who do provide a discreet service for those patients seeking guidance in this area. We do look to provide a one-to-one tailored program that may incorporate and number of treatment avenues. We do look to follow the best practice guidelines of a goal based approach to rehabilitation. We also hold an extensive network of medical specialists who work along-side us in this complex field of medicine.

Hypermobility

Hypermobilty and Ehlers Danlos Syndrome are becoming increasingly recognised as conditions that may require enhanced rehabilitation intervention from time to time. With almost 20% of the UK population being classified as hypermobile it is no wonder that we are seeing an ever increasing number of patients presenting with various neuromuscular complaints.

The typical trend for patients with hypermobility is that they start life as early walkers (under 12 months), they tend to go on to be extremely high achievers at school and in sports until their adolescence years when they start to develop hip, knee, ankle, and shoulder pain. If poorly managed this can escalate into full joint dislocations which can be extremely debilitating. Patients may also suffer with circulatory dysfunction, hypersensitivity, chronic fatigue, headaches, and irritable bowel disorders. There is also an extremely high association with anxiety and panic attacks which can exacerbate things further.

We have a number of therapists who are experienced in the assessment and management of hypermobile conditions. We believe it is essential to take an individualised approach to the management of each patient. Whilst exercise and muscle control has to form the basis of our treatment strategy, we do took to set a program that is targeted at an appropriate level. We also have an extensive network of Rheumatology, Orthopaedic, Neurology, Pain, and Psychology specialists who also understand the subtle nature of this condition.

We have over 20 years combined experience in treating the entire spectrum of orthopaedic surgery. The reason for this extensive experience is due to the background of the majority of our therapists who have worked at the Royal National Orthopaedic Hospital, Europes largest orthopaedic teaching hospital. We have the ability to rehabilitate everything from the routine hip, knee, foot, shoulder, and spinal procedures through to the most complex salvage operations including muscle transfers, scoliosis corrections, massive pelvic and femoral replacements, customised upper limb prosthesis, elbow replacements, and scapulo-thoracic fusions to name but a few.

We place a huge emphasis on the importance of tailoring a bespoke package of care with the aim of maximising the rehab potential of all our clients. We believe with our focused care and attention we can facilitate the recovery process in a timely fashion. We also have extensive experience in providing second opinions in complex cases where necessary, and facilitating rehab plans for people who live far away from our clinic base.

Orthopaedic Surgery

This is a specialist area of neuro-musculoskeletal medicine that requires years of experience in order to provide effective input. There are 3 key principles to successful recovery from a peripheral nerve injury: early diagnosis preferably within 3 weeks of the injury; aggressive surgical intervention by a specialist nerve injuries team with whom we have close links; and maintenance of joint flexibility during the recovery phase. These types of injuries can take between 6 weeks and 18 months to see definitive signs of recovery depending on the magnitude of the injury. The management of pain, and psychological well-being is critical in the rehabilitation process. We have a number of therapists who have extensive experience in the assessment, diagnosis, and management of peripheral nerve injuries.

There is a role in some cases for the use of electrical stimulation to aid recovery and retard muscle atrophy. The scientific evidence is still limited in this regard in providing specific dose and frequency to optimise recovery. Nonetheless, we believe that the use of electrical stimulation does aid in the activation and recovery of the nerve and muscles in certain cases.

Peripheral Nerve Injuries

Shoulder Instability

There are 3 types of shoulder instability. The first is micro-instability where the balance of muscle control around the shoulder is compromised. This cause pain and a lack of function, but with a focused rehab program most should improve. Occasionally a steroid injection and scan maybe required. The second is the traumatic instability caused by a fall or tackle. The shoulder is forced out causing damage to the bones and ligaments of the shoulder. Depending on the levels of damage and type of lifestyle one has will determine if things can be managed with rehabilitation or surgery. The final type of instability is called atraumatic instability and covers all aspects of congenital laxity and multi-directional instability. This requires a careful team approach between you, a surgeon, and a physio to make sure the right choices are made at the right time for the right reasons. Most of these will not need surgery, rather if you trust the rehab exercises things will improve in 3-6 weeks.

Scapula Dyskinesia

This is a complex area of rehabilitation that I have specialised in over many years. Unfortunately there a very few people who seem to understand the subtle nature of this problem and how wide ranging its impact can be. The majority of my clients with this issue have seen multiple professionals over many years with temporary results. The key to success is to understand what is driving the problem and what is reacting too it. Once the equation has been understood it is a pure case of simple, diligent exercises over a 6-12 week period to resolve a huge majority of this problems.