MSK Physiotherapy

As a team we aim to promote, restore and maintain your physical capabilities, function and wellbeing. We provide specific advice and treatment to help you improve your function, return to your activities, and improve and maintain your quality of life.

Here at NHFT our physiotherapists are highly skilled, independent practitioners. Each specialises in their own areas of further learning and specific skill sets.

Musculoskeletal (MSK) physiotherapy relates to physiotherapy for the injured and/or problematic areas of the muscular and skeletal system. This includes:

• Muscles and tendons
• Joints, ligaments and cartilage
• Fractures / broken bones
• Nerves

Advanced Physiotherapist Practitioners (APPs) are highly specialised clinicians who work at a higher level of varied advanced practice. Skills include:

• Diagnostics* (such as x-rays, MRIs and blood tests)
• Injection therapy
• Independent prescribing
• Provision of a fit note (Med3)

* Please note, we cannot request diagnostics for anyone under the age of 18 years.

Our care for you as a patient of the MSK Physiotherapy service aims to give you:

1. A better understanding of your problem
2. Treatment to help resolve your physical problems
3. The ability to better manage your problem day-to-day
4. More confidence while living with your problem
5. Support to live a less limited life

During your appointment - the initial conversation

The most underrated part of your appointment is our initial conversation with you about your symptoms. This give us the foundations we need to help you most.

We want to know

1. What the problem is
2. How the problem is affecting you
3. What you have been through
4. How you want us to help you
5. What you want to achieve with physiotherapy

This allows us to build a picture of everything that has come before and helps us to make the next steps as effective as possible.

During your appointment - the assessment

We use this part of the appointment to confirm our diagnoses from the questions we have previously asked.

On completion of the assessment, we will

1. Fully explain our findings and your problem to you
2. Explain the possible options for your treatment

This allows YOU to be involved in each step of this assessment and allows us to provide the most successful and personalised treatment possible. This is based on the best and most recent clinical evidence and our own clinical experience.

To fully assess and observe how a joint or area of your body is working, we may need to ask you to undress that area of the body. If you don't feel comfortable to do so, please let us know.

If you would like to register yourself for the MSK Physiotherapy service you can do so in three different ways.

1. Complete a self-referral form (this cannot be used if your problem relates to your neck, back, hands, wrists or feet, or for women's pelvic health-related issues)
2. Contact your GP practice to book a first-contact physiotherapy appointment (if available)
3. Book an appointment with your GP to discuss referral to physiotherapy

Find out more about registering for MSK Physiotherapy

Before your first appointment, we've put together a check list for you to work through to help you be most prepared for your physiotherapy session.

1. We would recommend you take the NHS 'How are you' quiz online. This quiz is for over-18s and helps to give you a personalised health score. It's a 10-minute quiz, so grab a cuppa and spend some time focusing on you. 
    
2. Before you refer to physiotherapy think about your expectations or goals. Think about the following questions and consider writing your thoughts down.
   • What would you like to achieve from physiotherapy?
   • What would you consider as success from your treatment?
   • What would I do if I didn't have pain or this injury?
   • What hobby or activity would you like to take up as your activity levels and normal function start to return?
      
3. When you come to your appointment make sure you know your height and your weight. You can check your BMI on the NHS website.
    
4. Print and fill out a copy of our Musculoskeletal Health Questionnaire[pdf] 208KB before your appointment. It is important that you fill this out because it helps identify factors which may be contributing towards your pain and it allows our physiotherapists to keep a close eye on how well you are responding to treatment. If you don't have a printer, you can complete the form when you arrive for your appointment - but please make sure you arrive 5 to 10 minutes early so that you can do this before your appointment begins.
    
5. When you book your first appointment with us, please let us know whether you will need an interpreter or chaperone during the assessment, and let us know of any additional needs you may have.

Download and print a copy of this checklist

When you come to your first appointment a full check (also called a comprehensive assessment) will be completed by one of our trained Musculoskeletal Specialist Physiotherapists.

We will ask you a number of questions about:

• The history of your symptoms 
• Your past medical history
• Your past social history (including what you do for work and also any current or past hobbies)

We ask these questions to help us understand more about the current pain or issue. We can then also look at how we can identify what you want to achieve from the treatment sessions.

As well as asking questions, we will do a physical assessment with you. It is important you come in loose fitting clothing and the right type of footwear. We would recommend you wear trainers. To check the area giving you problem, we might ask you to undress or remove a piece of clothing to reveal the area.

If you would like another person in the room at the time, please just ask the therapist and will accommodate this for you.

You can expect our physiotherapists to explain what they have found, discuss contributing factors, how long your condition will take to improve and any available treatment options.

They may also speak to you about:

• Creating a bespoke rehabilitation exercise programme which will be available through the app
• Self-management advice 
• Booking a follow up appointment (if required) to check your progress towards agreed goals
• Increasing your activity levels or joining an exercise or activity class in your local community. Find out more about local activities[LINK TO #MSKPhysiotherapyfurtherinformation-MSKwellbeing]
• Ask you if there is anything we can do better! We are always looking to improve our service. If you have any ideas, suggestions, or feedback for us, please discuss it with your physiotherapist or complete a feedback form available online or from our reception desk

Please note: this information is for people who have been referred to the pelvic health physiotherapy service by their GP or consultant. The service is only available to those referred by a healthcare professional.

What is pelvic health physiotherapy?

Pelvic health physiotherapy is a part of physiotherapy that helps with the health and function of organs in the pelvis, like the bladder, bowel, and uterus, as well as the muscles around them.

Our experienced physiotherapists can assist with issues such as leaking urine or stool, pelvic organ prolapse, and painful conditions in the pelvis, including vulvodynia, vaginismus, and pelvic pain.

These problems are often related to how well your pelvic floor muscles are working.

What can I expect at my physiotherapy appointment?

Your assessment will happen in a private room, and everything discussed will stay confidential. It's normal to feel a bit nervous before your appointment, but our team is here to help you feel comfortable and supported.

When you arrive, someone at Reception will welcome you and take you to the room for your assessment. To better understand your condition, your physiotherapist will ask you some questions about your symptoms, such as:

• When did your symptoms start, and what are they?
• Are there any activities or movements that make your symptoms feel better or worse?
• How many times do you go to the toilet during the day and night?
• How much and what types of drinks do you usually have?
• Have you had any tests or procedures for this issue?
• What medications are you currently taking?
• What do you hope to achieve through physiotherapy?

After going through these questions, your physiotherapist will talk with you about the physical examination, which may include an internal check-up.

What is an internal examination?

An internal examination is a way to check the health and condition of the muscles in your pelvic area. It can be done through the vagina or the anus. Your physiotherapist will first show you a model of the pelvis to explain what will happen during the exam.

The process is gentle, and we don't use any tools like speculums. We will only continue if you agree, and you can stop the exam whenever you want. You are welcome to bring a friend or family member with you, or you can ask for someone to be there with you for support if that makes you more comfortable.

What happens next?

Your physiotherapist will talk to you about what they found during your assessment, using pictures and models to make things clearer. Together, you'll create a treatment plan, which will probably include exercises tailored for your pelvic floor muscles and other related muscles. Feel free to ask questions anytime during your assessment. Your physiotherapist will usually schedule another appointment for you about 4 to 6 weeks later to check on how you're doing.

Further information

You may find the following leaflets and online resources useful.

• Patient information from the Pelvic Obstetric and Gynaecological Physiotherapy website
• Booklets and resources from the Pelvic Obstetric and Gynaecological Physiotherapy website
• Squeezy - a smartphone app reminding you to do your pelvic floor exercises and providing pelvic health advice and information (£2.99 download cost)
• Leaflets from the International Urogynaecology Association (IUGA) (variety of Languages available)
• Your Pelvic Floor website
• Bladder Health UK website
• Bladder and Bowel Community website
• Pelvic floor exercises information leaflet [pdf] 567KB
• Pelvic floor trauma information leaflet [pdf] 334KB
• Overactive bladder information leaflet [pdf] 336KB
• Pelvic Floor Breathing Exercises Leaflet [pdf] 268KB
• Pelvic Girdle Pain during pregnancy [pdf] 247KB

Most surgical wounds heal up rapidly without and problems. However, a minority of surgical wounds do become infected. This occurs when germs enter the cut that the surgeon makes through your skin in order to carry out the operation.

Many germs live in and on our bodies and also in our environment. Most are harmless or even useful. Our bodies have natural defences against the germs that can cause harm. Our skin normally prevents germs from entering our bodies, but any break in the skin (whether due to injury or surgical incision) can allow them to enter and cause an infection.

URGENT: Any suspected infection should be taken seriously. If it is left untreated it can progress into a much more serious problem.

Signs and symptoms

• The skin round your wound gets red or sore or it feels hot and swollen
• Your wound has a fluid discharge, often green or yellow coloured pus
• Your wound opens up
• You feel generally unwell or feverish, or you have a temperature.

If you experience any of the above symptoms, you should seek urgent medical attention at your GP or A&E at your local hospital.

Don't be put off by common terminology

You may have heard terms like these in relation to discs, joints or bones:

1. "Out of place"
2. "Slipped"

Research has clearly shown that what is described by these terms does not happen to discs, bone or joints in your back.

Anatomically, your back is a strong, stable structure which is capable of lots of movement. If a person experiences a severe episode of back pain when lifting, nothing has fallen out of place - even though it might feel like it!

Don't worry about what you read in MRI reports

When you have a scan the report will always show "stuff" (things like disc bulges, degeneration, dehydration and facet joint degeneration). However, research has shown this is rarely linked with pain.

People who have never had low back pain also have "stuff" on an MRI. This "stuff" can create a lot of worry that can distract from helpful activities like exercise. These things are normal parts of the ageing process - like grey hairs or wrinkles.

A scan is only essential if serious disease is suspected.

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