Physiotherapist in Madrid and Collado Villalba
More than 10 years of experience and 14 of ongoing professional training have led me to become a specialized physical therapist in various fields and a passionate practitioner of my profession.
When I finished my degree at Universidad Complutense, I realized that my training was very general, with little specialized knowledge. I then studied Osteopathy, which meant I was better trained in the osteoarticular aspects of physical therapy, but less so in aspects regarding connective or conjunctive (soft tissue: muscle, ligament, tendon,…) That is why I decided to study a Master in Myofascial and that forever changed the way I work and feel with my hands. Yet there were still many questions I could not answer about the body’s functioning, until I trained in GDS or Muscular Chains. That was when I could provide answers to the “Why?” behind many injuries, understand how these muscle chains work and how a body responds. This, along with other specializations, such as dry needling, perinatal care, neuromeningeal treatment, has enabled me to successfully work with my patients throughout these years.
After 8 years in practice, I decided to open my own office and I can now say I work as I had always dreamed of doing, taking the time that is need for each patient, in an individualized way and in very pleasant surroundings.
One thing that is fundamental for me in my practice and which I like to transmit to every patient is the importance of the diagnosis. And by diagnosis, I do not mean the name of something (like, for instance, cervicalgia, which simply means pain in the cervical area). I mean being able to establish why the cervical area hurts, that is, what the damaging mechanism is that is causing pain in this area. The success of a treatment does not lie in using one technique or another, but rather in using it where it is needed: not confusing what is reactive or secondary (what the pain actually is, a symptom) with what is causal or primary (the true origin of the restriction).
The Importance of Diagnosis
A patient’s description of his or her pain during an interview reveals practically all the information about the injury.
One of the most complicated issues when we talk about pain is subjectivity, the difficulty we have in measuring it. There is no machine or test that calculates what hurts or how much it hurts. That is why it is so important to have an interview with a patient that takes all the time needed. This conversation will provide us with the necessary clues to know if the injury is inflammatory or mechanical, neurological, muscular or visceral, acute or chronic, local or referred, etc.
For instance, when a patient tells us that pain wakes her in the morning, always at the same time, that it runs down her entire leg to her big toe, which is left numb; that she’s noticed it for many months and it is getting progressively worse, we are given a great deal of information. We can conclude that it is chronic pain (longer than three months), that she has almost certainly undergone a process of central sensitization (fixing the pain information to the motor cortex as a result of dealing with it for more than three months), that it has to do with the patient’s routine (always being awoken at the same time): for example, with the position she works in or also with her gastrointestinal motility (another typical characteristic of pain that always occurs at the same time), that it has neurological characteristics (pain and filiform dysesthesia all along the nerve) etc.
And on the basis of all this valuable information, as well as on other test results, a diagnosis can be made and treatment can be proposed.
DIAGNOSIS: THE KEY
It is not giving the injury a name or deducing what structure has been damaged. It is finding out the why of the injury, the cause, what the chain is that has led to the injury.
I have been diagnosed with supraspinitus tendinitis. Is that enough to provide physical therapy treatment? No, of course not. Unfortunately, for many years in physical therapy all forms of tendinitis have been treated in the same way, and that destines the treatment to failure (the injury becomes chronic, it leads to another or it recurs at later times).
It is fundamental to understand that diagnosis is not deciding on the mere name (tendinitis only means the inflammation of a tendon). Rather it is the why of the injury (why is the supraspinus tendon inflamed?). We must find the cause of the injury. If it was not a fall or an impact, that is to say, something by chance and an isolated incident, we can say that the supraspinus tendon has become inflamed little by little with use, or more accurately, with incorrect use. Since no muscle functions in isolation from the others (due to myotatic reflex, a muscle’s contraction is transmitted to its neighbor) when one is functioning incorrectly, the remainder do as well. And in the case of our example, this supraspinus tendon is functioning incorrectly because other muscles are doing so as well. The key for treatment will not only be to diagnose tendinitis due to bad mechanics, but also to identify the injury chain produced throughout the body which has led to the bad mechanical functioning of the supraspinus tendon.
The example that concerns us, tendinitis of the right supraspinus tendon, is very common; and in a great number of cases, it is due to pelvic distortion. The left gluteus muscles are extremely retracted; transmitting excess tension to the right lateral muscle (we will probably see a lower right shoulder). This leads to excessive elongation of the supraspinus tendon, which, when it is functioning, it is doing so in bad conditions and, over time, it will be injured. And as we said earlier, reaching this conclusion is the key. We need a diagnosis of the chain to the injury in order to set a treatment along the entire chain: left hip, right lat and right supraspinus tendon. We do not limit ourselves to the symptom that was the pain or inflammation of the tendon.
And herein lies the success of the treatment we lay out.
TREATMENT: Always based on an accurate, personalised and innovative diagnosis.
Treating an injury must be personalized and based on the diagnosis of this patient, made at this time. Not all injuries should be treated in the same way on all people nor does what once worked for a person always work on successive occasions.
Establishing an accurate diagnosis is fundamental. If the cause is not a fall or accidental trauma, we must base treatment on a diagnosis of the chain of the injury. And once we have an accurate diagnosis, physical therapy offers a multitude of tools for treatment: electrotherapy, therapeutic exercise, hydrotherapy, dry needling, etc. But, above all else, our emphasis is on manual therapy.
Manual therapy permits the therapist to test treatment little by little and adjust it to what is being encountered and to the patient’s response. In this way, each treatment can be personalized for each patient. As previously stated, these are some of the tools that physical therapy offers in treating injuries, However, what must never be forgotten is that treatment must be global, integrated, and, if necessary, handled in a multidisciplinary way, together with other professionals: rheumatologists, dentists, nutritionists, psychologists, etc.
Nor should we forget that “I only know that I know nothing”; innovation and ongoing professional training is fundamental to always be able to offer the best possible treatment.