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We will be offering Short Seminars on common conditions to be delivered soon. 
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Women's Health Coffee Morning
We arranged a small, invite only, coffee morning in May 2018. The target demographic was women aged 50 years of age and over. Our Lead PT presented a 30 minutes talk, touching on some of the more frequent complaints that women in this demographic may experience. The topics covered included some basics of the Pelvic Floor Anatomy (PFA), the role of the Pelvic Floor Muscles (PFM) and symptoms that could be addressed by a Physiotherapist. Other topics touched upon included chronic constipation and strategies and exercises to help discussed issues.
There was time set aside for discussion and a brief Q&A. The objective of the morning being - to create awareness and increase the knowledge base for women; about their own bodies. 

Cupping/ Vacuum Therapy

Cupping or Vacuum therapy treats several medical conditions such as headaches, arthritis, post injury trauma, rheumatism, fibromyalgia, fatigue and musculoskeletal problems.

It promotes self-healing by regenerating capillaries, enhancing blood flow to the problem area, maintaining homeostasis, and reducing inflammation and toxins.
Suction from the cup helps loosen rigid tissues and increase blood supply and lymph (defense mechanism of the body) flow to the muscles and skin.

It also triggers the nervous system, which helps in relaxing your body and mind.
The therapy helps reduce muscle weakness, tiredness, pain, cramps, spasms, numbness, tightness, stiffness swelling and scarring.


Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systematic autoimmune inflammatory disease that results in persistent inflammation of the synovial tissue especially of the wrists, hands and feet. The structures around the joint can also be affected, such as the tendon sheath and bursae The synovium is a soft tissue which lines the joint space where there is no cartilage. It lines the spaces of the diarthrodial joints, tendon sheaths and bursae. Due to the inflammation, production of enzymes occur which break down the cartilage.

The inflammation associated with rheumatoid arthritis can cause bone erosion and joint deformity over long periods of time frequently leading to disability. This pathology causes pain, stiffness in the morning and after periods of inactivity, joint swelling, weakness, fatigue and restricted joint mobility leading to reduced function.
Without treatment, RA can lead to irreversible damage i.e. deformity and finally provoke considerable physical functional loss or even permanent disability. RA thus causes dramatic interference with quality of life if early diagnosis and appropriate treatment are not obtained.


Epidemiology /Etiology
The cause of Rheumatoid Arthritis remains unknown and can therefore not be prevented.
There is some evidence that life style factors might influence in development of rheumatoid arthritis, however there is also evidence of a genetic component. When RA affects the pediatric population, it is called Juvenile Idiopathic Arthritis (JIA) and usually begins before the age of 16.

Characteristics/Clinical Presentation
In RA joint complaints are on the foreground.
 Typically in the first stage there is a chronic, symmetrical inflammation of the joints of the hands and the feet, especially the metatarsophalangeal joints (MTP), the wrists, the metacarpophalangeal joints (MCP) and the proximal interphalangeal joints (PIP).

 Softening of the ligaments can lead to deformation of the fingers, such as subluxation/dislocation of the metacarpophalangeal joints.


 Rheumatoid Arthritis causes deformity, pain, weakness and restricted mobility which consequently results in loss of function.


 The three most important complaints are; pain, morning stiffness and fatigue.


 Muscular strength, muscular endurance and aerobic endurance are typically reduced.


 In 80-90% of the patients, the cervical spine is involved, which can lead to instability, caused by the ligamentous laxity (When joints are too
loose).
 This instability can lead to pain and neurological symptoms, such as headache and tingling in the fingers.

Diagnosis
Rheumatoid arthritis can be difficult to diagnose in its early stages because the signs and symptoms mimic those of many other diseases.


Blood Tests
The blood tests will measure inflammation levels and look for biomarkers such as antibodies (blood proteins) linked with RA.


Inflammation
Erythrocyte sedimentation rate (ESR, or “sed rate”) and C-reactive protein (CRP) level are markers of inflammation. A high ESR or CRP is not specific to RA, but when combined with other clues, such as antibodies, helps make the RA diagnosis.


Antibodies
Rheumatoid factor (RF) is an antibody found in about 80 percent of people with RA during the course of their disease. Because RF can occur in other inflammatory diseases, it’s not a sure sign of having RA. But a different antibody – anti-cyclic citrullinated peptide (anti-CCP) – occurs primarily in patients with RA. That makes
a positive anti-CCP test a stronger clue to RA. However, anti-CCP antibodies are found in only 60 -70 percent of people with RA and can exist even before symptoms start.

Imaging Tests
An X-ray, ultrasound or magnetic resonance imaging scan may be done to look for joint damage, such as erosions – a loss of bone within the joint – and narrowing of joint space. But if the imaging tests don’t show joint damage that doesn’t rule out RA. It may mean that the disease is in an early stage and hasn’t yet damaged thejoints.


Physical Exam
The doctor will examine each joint, looking for tenderness, swelling, warmth and painful or limited movement. The number and pattern of joints affected can also indicate RA. For example, RA tends to affect joints on both sides of the body. The physical exam may reveal other signs, such as rheumatoid nodules or a low-grade fever.


Treatment
There is no cure for rheumatoid arthritis. But recent discoveries indicate that remission of symptoms is more likely when treatment begins early with strong medications known as disease-modifying antirheumatic drugs (DMARDs).


Physiotherapy Management
As mentioned, there is no specific therapy that can completely cure RA. However there are treatments that achieve pain relief and the slowdown of the activity of RA, to prevent disability and increase functional capacity. Physiotherapists play an integral role in the non-pharmacological management of RA. The therapy goals in most cases are:


 Patient education.
 Improvement in disease management knowledge
 Pain control
 Improvement in activities of daily living
 Improvement in Joint stiffness (Range of motion)
 Prevent or control joint damage
 Improve strength
 Improve fatigue levels
 Improve quality of life
 Improve aerobic condition
 Improve stability and coordination
 Joint protection advice
 Provision of functional splinting and assistive devices


Physiotherapy Modalities
Cold/Hot Applications:
Cold - for acute phase
Heat - for chronic phase and used before exercise.


Electrotherapy
Electrical Stimulation: Administering of electric energy by means of alternating
current. (TENS= Transcutaneous electrical nerve stimulation) this used to
relieve pain.
Other options can include: Infrared lamps/ Ultrasound/ PSWD/ Interferential
Therapy etc (these modalities would be used based on the patients needs and
recommendations by a physiotherapist)


Hydrotherapy-Balneotherapy:
Allows exercise with minimal load on the joints.
Simply being in another environment, where the patient can relax has a
positive effect on the disease's progression (physically as well as on mentally)
 Rest & Splinting:
Orthosis and splinting prevent the development of deformities and support
joints


Therapy Gloves:
 To control and manage hand pain,
 To maintain or restore the patient’s hand function
 To psychologically help to relax or calm the wearer.
 Wearing therapy gloves lead to the improvement in hand grip
strength.
 The glove can be worn during the day or at night.
Compression Gloves: Moderate joint swelling and consequently reduce the
pain

Assistive Devices and Adaptive Equipment:
Working in close proximity with the Occupational Therapist to adapt the patient’s environment to promote independence in activities of daily living (including Raised chairs/ toilet seats/ Supports/ rails etc)

Massage Therapy:
Massage and the manual trigger of an articular movement focused on the improvement of function, pain reduction, reduction of disease activity improve flexibility and welfare (dimension of: depression, anxiety, mood and pain)


Therapeutic Exercise:
Before beginning an exercise program, it is important to have a global evaluation of the situation: joint-inflammation local or systemic, state of the disease, age of the patient and grade of collaboration.
Exercise therapy is used by patients with RA with the aim of improving daily functioning and the social participation by means of improvement of the strength, aerobic condition, range of motion, stabilization and coordination. In general we can say that patients with RA need a high-intensive exercise program which is aimed at improving aerobic capacity, strength and endurance.


Alternative Therapies:
Some patients fine great relief and comfort in alternative remedies including Acupuncture and Cupping. Certain Physiotherapists will have the appropriatequalification and training to provide said treatments.
Acupuncture and Cupping provide a great source of pain relief and thus overall contribute to the patient already feeling an improved quality of life.