Orthopaedic physiotherapy addresses neuro-muscular-skeletal pain and dysfunctions. This is an umbrella term covering complaints arising from dysfunction within our peripheral nervous system, myofascial system, skeletal system as well as the interrelationships between these systems. nerve entrapmentThis article was published in order to try to unpack the term of neuro-muscular-skeletal pain for a better understanding as to what your Physio can treat.

The Fascia

Our myofascial system consists of individual muscles with their tendon-like attachments to the bones, as well as their fascial covering (sheets of connective tissue, made up mainly of collagen). Shortening or lengthening in one area due to posture and/or repetitive activities can cause dysfunction leading to pain in the area or related areas. For more on fascial manipulation treatment used by Lamberti Physiotherapy, read our Blog articles on the subject.

Trigger Points

Overuse/repetitive loading can also lead to the formation of trigger points which can cause a decrease in the muscles’ functional ability, as well as pain. This can be remedied with soft tissue treatment of muscles, tendons or ligaments. If your physio makes the assessment that you need dry needling, then he/she will add that to the therapy. Dry needling is a technique that uses a “dry” needle, one without medication or injection, inserted through the skin into those trigger points.


Tendonitis or tendinopathy can also develop in response to heavy exercise workouts (‘chronic loading’) causing the musculo-tendinous unit (your tendons) not to cope well with the demands placed on it. Orthopaedic physiotherapy treatment can help by releasing the tight muscles, using specific methods to fight inflammation, resulting in getting the problematic tendon back into the correct shape and strengthening areas of weakness.

cartilageBones and Cartilage

Our skeletal system consists of our basic bony skeleton, attached together by various ligaments. Between the bones which join together, there is cartilage of varying amounts and thickness, depending on the job that those bones have to do at each area. For example: between the main bones in our upper and lower leg (the femur and tibia), we have two menisci or cartilage pads. These allow the bony surfaces to roll and glide as we move, as well as absorb impact in activities such as running. Imbalances in our muscular system and biomechanical (movement) problems can lead to stress on the menisci. Orthopaedic treatment can alleviate symptoms and correct issues by working on strengthening the required areas.

In the spine, we have discs between each vertebra and these are another type of specialised ‘shock absorber’. Poor posture, or constant impact by a specific activity, can cause wear and tear of the discs and, on occasion, the constant pressure may cause the disc to slightly bulge out (like a balloon when you squeeze one end lightly).

When diagnosing this kind of condition, your physio would look to fix your posture by releasing tight muscles and fascia, mobilising stiff joints and recommending how you can strengthen specific muscles in the area.  This will help you to function better each day, as well as help to prevent future pain.


Our peripheral neural system consists of the nerves as they exit out of the spine, through the surrounding muscles and fascia. If the nerve’s space is prevented from easily moving throughout the body, irritation or compression of the nerve may occur.  Physiotherapy treatment can aid in reducing the load on the neural system by releasing the relevant tight fascia and muscles, loosening stiff joints through or around which nerves pass, so allowing the nerves to slide and glide along their pathways.

After Operations

Post-operative rehabilitation is an area orthopaedic physiotherapy is better known for. Whilst you are laid up in bed or not being allowed to move, it is important to maintain blood circulation and drainage of the lymph glands for efficient healing. Your muscles also need to be used and the nerves must be allowed their freedom to move. In-hospital treatments are also done by physiotherapists, such as teaching patients to walk safely with crutches and providing exercise programmes, while the patient is in bed, to begin safe strengthening. Once you are “back on your feet” your joints and muscles need to function properly again as soon as possible. Your physio will help you to return to your highest possible level of normal activity in your daily life, as well as sport and other activities important to you.

Injuries to Ligaments

Injuries to ligaments are often overlooked in terms of orthopaedic treatment and rehabilitation. Examples of these are ankle sprains, knee sprains, elbow sprains and wrist sprains. Your physiotherapist can help by:
•    treating inflammation (initial pain and swelling);
•    using Kinesio taping, bracing and other methods to protect your injured areas;
•    getting back your muscle strength, balance, coordination and agility; and
•    giving you the advice to prevent re-injury.

One of the most common causes of pain

orthopaedic physiotherapy helps with bad posture habits

If you look at the example of a computer worker complaining of pain in the right arm, neck and scapula (shoulder blade), possible causes for the symptoms could be:
1.    constantly angling the neck to one side;
2.    continuous use of the right hand on the mouse, leading to stiffness in the neck and upper back;
3.    tightening of some muscles and lengthening of others;
4.    restricting the nerves’ pathway from the neck down into the arm.

Sometimes, pain radiating from one area to another can be accompanied by pins and needles and/or numbness along the nerve’s pathway.

Physiotherapy can help

Your physiotherapist can help your pain using orthopaedic physiotherapy to mobilise stiff joints and/or release tight muscles and fascia in order to open the nerve’s pathway. This will then help your nerve to re-adjust to moving through the body. Treatment will be followed up with exercises to help strengthen the areas with weakness, as well as advice on how best to correct your posture to avoid further strain. If you would like an appointment for an assessment, please feel free to contact us.