The Health Resources Services Administration defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications”.
Here at Physio Fusion, we will be conducting video consultations for existing and new clients. You will see the same, experienced staff as you would on site at either our New Windsor Branch. With the exception of the hands on aspects, we strive to continue to provide you with the same level of education, advice and exercise progression as you would receive in person.
Telehealth Benefits for Patients:
Better access to services for residents/ workers in remote areas (Al-Shorbaji 2013, Bourne et al 2017, Cooper & Allen 2017, Nelson et al 2017) found that this can improve access to care services for clients in isolated areas and virtual consults can address access barriers for patients living in rural locales.
More convenient access to services (people avoid the travel and scheduling challenges of attending face-to-face appointments and can access some services after-hours).
The ability for patients to ask quick questions without having to book a full consultation
Access to high-quality online resources, including videos and digital tools
Telehealth benefits for Physiotherapists:
Access to an untapped pool of clinical resources: (Hunt et al 2014): Virtual health programmes offer benefits to clinicians who are looking for increased flexibility in their working life (e.g. semi-retired clinicians or those seeking an improved work/life balance). If offered, this may enable healthcare providers to attract and retain a high-quality workforce, improve staff satisfaction, and access highly specialized resources to improve quality of care.
What is Physitrack and how does it work?
Physitrack is an exercise prescription platform that lets you prescribe home exercises to our clients. It is a program that you as a customer can download for free on your smartphone, tablet or open it with your computer. The videos show how you can perform an exercise correctly and clearly. There are also more than 90 standard exercise protocols and videos with clear explanations about specific complaints or conditions.
How does it work?
Together we determine which exercises are most suitable for you and add these to your program. You will then receive an email with the link to download the Physitrack / app and the link to the program online. Your personal login code is also stated in the same email. If you have downloaded the Physitrack or clicked on the link and enter your password, you can enter your preferences in the program, such as setting reminders. Then you can start with the exercises in a correct and clear manner and contribute to your own recovery!
The attached document is designed to help you prepare for your Telehealth call. PhysiApp_Telehealth_call
What will happen once my appointment is booked?
Your Physiotherapist will send an email with more details on how the consultation will take place.
Before your appointment you will receive another email from Physitrack with a link to where the consultation will take place.
Make sure that you have a working camera and microphone.
Make sure you’re using a modern browser, such as Chrome, Firefox, Safari or Microsoft Edge.
If you are using a mobile device for your consultation, you will be prompted to download Physitrack app Please do this and then click join as a guest.
We ask that you get online 10 minutes before your appointment and click on a link to join the consultation.
If you are using a computer, make sure your camera and microphone are available and enabled.
Please ensure that you have enough space in case you are required too perform exercises.
What happens if internet is interrupted or my technology fails during the consultation?
If we can call you, we will attempt to continue and complete the consultation via face time.
Here’s how to book your first Telehealth Consultation with us
Save time and book your appointments online with Physio Fusion 24 hours a day, 7 days a week. You can book your appointments via phone or online
The shoulder is made up of two joints. These are the acromioclavicular joint (collar bone meets shoulder blade) and the glenohumeral joint (upper arm meets shoulder blade). The shoulder is protected by ligaments (joining bone to bone) and muscles known as the rotator cuff. These muscles form tendons (joining muscle to bone) and play a major role is stabilising the shoulder. Under some of these muscles and tendons, there are small fluid filled sacs ((known as bursae) to allow easy gliding of muscles over bone. The upper arm also joins the shoulder blade with the help of the Labrum (soft tissue around the glenoid cavity). Finally, this is all surrounded by a fluid filled sac which lubricates the shoulder joint for better movement known as the shoulder capsule.
History taking and assessment
You can expect questions regarding the history of your shoulder injury from your physiotherapist such as:
How the injury happened
Where the pain is in your shoulder
Whether you have a ‘dead arm’ feeling
If you feel a different sensation from the other side or some weakness
Aggravating and easing activities
Past history and family history of shoulder injuries or pain
Once these questions have been asked and answered, your physiotherapist will proceed to perform an assessment of you and your shoulder. This can range from:
Posture assessment
Strength and sensation testing
Testing of ROM (movement of the shoulder)
Special testing to check joint stability, muscle integrity and possible signs of shoulder damage
Investigations
Based on your history and examination findings, your clinician will suggest the best possible investigation for you.
In most cases, initial X – rays are done to rule out broken bones.
Ultrasounds can be used to diagnose some ligament and tendon damage such as rotator cuff tears.
MRI is the best form of imaging but this does come at a higher cost and higher exposure to radiation. The MRI scan can identify bone, ligament and tendon injuries in the shoulder.
A CT scan is not usually performed in cases of the shoulder.
Possible injuries to the shoulder
Instability:
If you have dislocated your shoulder in the past or continue to experience shoulder dislocations, you may have some instability of the shoulder. Normally you may develop a “dead arm”. You may also feel a sense of heaviness, numbness or an inability to move the arm which persists for a few minutes. If you are experiencing these episodes more frequently with less force, it is advised that you see your healthcare professional.
Treatment:
Non-surgical management involves a period of rest with a parallel shoulder strengthening program for stability. This is done when the injury is acute and non-recurrent.
Surgical management is opted for when there has been damage to the ligament and Labrum as well as ongoing recurrence of shoulder dislocation. Surgery is associated with a reduced rate of recurrence.
Rotator cuff:
The four muscles that make up the rotator cuff are Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. Rotator cuff injuries are one of the most common disorders of the shoulder. It is believed that most of these injuries are caused by overuse of the shoulder. Often heavy lifting, sports involving the shoulder and repetitive shoulder movements are associated with rotator cuff pathology. These injuries cause pain and stiffness with overhead activity (eg: throwing a ball or putting a shirt on) and pain is worse at night. You may also feel some weakness in your injured arm because of pain.
Treatment:
A partial thickness tear in the rotator cuff can heal with non-surgical management. These are managed with physiotherapy exercises, corticosteroid (cortisone) injections and most importantly, time. It is important to know that the pain will improve over time.
A Full thickness tear in the rotator cuff will normally be managed with surgery. This is followed by immobilisation of the arm for up to 6 weeks in a sling. After these 6 weeks, you should begin a physiotherapy program in order to aid your recovery.
Acromioclavicular joint (ACJ):
This is a fairly common injury and normally occurs in athletes involved in contact sport or when falling directly onto the point of the shoulder. You may experience some pain and swelling in the upper shoulder. This pain can sometimes occur with no reason at all and it is important to voice this to your clinician.
Treatment:
You will be treated surgically or non-surgically according to the severity of your injury.
Non-surgical management includes a brief spell of rest and sling use for protection and healing. This is followed by early mobilisation of the shoulder and a subsequent strengthening program. Your physiotherapist can also assist you with taping in order to return to activity.
Surgical management is followed by a physiotherapy program as outlined by the shoulder surgeon. This is normally done for a quicker return to play in contact sports or when pain is severe and a trial non-surgical management has not worked.
Fractures:
These normally occur as a result of direct trauma to the arm such as a fall. They can be very painful and are usually associated with a lot of swelling around the area.
Treatment:
Depending on where and how severe the injury is, the doctor may opt for surgical or non-surgical management.
In either of these cases, you will undergo a period (6 weeks maximum) of immobilisation of the upper limb to allow for healing. At the end of this period, it is important to see your physiotherapist to begin rehabilitation of your arm.
What to expect
Acute phase:
Immediately following an injury, you should be offered adequate pain relief. A sling can be very effective and can be combined with simple analgesia, anti-inflammatory medications and ice therapy.
Passive range-of-motion (ROM) exercises, including pendulum and active-assisted exercises, should be considered. You will be encouraged to maintain fitness (if comfortable) using a stationary bike or general walking.
Early Rehabilitation phase:
When your pain has settled and your ROM has improved to 60-70% of the unaffected side, you can progress with rehabilitation.
Exercises that might be useful in this phase include:
Stretch of the shoulder
Progressive ROM exercises with the goal of achieving full ROM
Strengthening of the rotator cuff and scapular stabilisers
Late Rehabilitation phase:
You will progress to this phase when you have a normal (full and painless) ROM and 75% strength of the unaffected side.
The types of exercises that might be useful in this phase include:
Progressive multi-planar exercises
The addition of further resistance exercises, including weights and the use of medicine balls and more functional activity
Plyometric exercises
Return to sport:
When you have a normal range of motion and more than 90% strength of the uninjured side, you can progress to return to sport. This should be done in a gradual manner.
A return-to-sport programme may involve:
Initial unopposed training
Opposed training in a controlled setting
Match practice
Return to sport when this full progression has occurred
In conclusion:
Your shoulder injury will be treated and tailored to you. With most shoulder injuries, physiotherapy can be helpful in operative and non-operative management.
Early management or rehabilitation of your injury could go a long way in speeding up your recovery process and avoiding re-injury in the future.
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