Organic Search engine optimisation services (SEO) is a procedure that online retailers cannot afford to neglect if they want a successful online business and the best organic seo specialist can make all the difference. The success of an internet based company can hinge on how well you implement your online marketing strategy, and in particular, search engine optimisation. The best SEO Consultants know how to implement this
The key to online success relies on good organic SEO practises with some of the best organic search engine optimisation specialist and adhering to the rules stipulated by the major search engines. Frustratingly, search engines update their algorithms on a regular basis and lately we have seen some major changes with big updates being rolled out. Every time the goal posts are moved by the major engines, website owners and retailers are forced to alter the way they are carrying out their search engine optimisation. This is where a good organic seo specialist can make all the difference like https://www.pkseo.com.au/
Saying this however, there remain a few constants in organic SEO; that if carried out correctly, will see you flourish in the results pages. Keywords
Keywords are the very foundation of search engine optimisation. They are fundamental to an organic SEO campaign and are the primary tools in a website owner’s toolbox. For this reason keyword research is critical to every strategy and campaign. Successful websites; those that feature at the top of search engine result pages have a very good understanding of what their core audience are searching for.
By identifying the right keywords for your business and optimising your website for them, you will increase the number of visitors to your website and soon begin to enjoy the extra business that this brings.
Before setting up your website or online store, draft a list of keywords that best describe your business and compare them to companies within your niche market to see if they carry any value.
You can also get help with your list by using one of the many online keyword tools available, they will show you how often a certain keyword gets searched for each month, how competitive it is and which websites are ranking for it. They will also suggest alternative keywords that you may have missed.
The title tag is a very important part of the web page when you are optimising your site. Search engine spiders use the title tag to determine what the content is about and which keywords are being targeted.
It is important that every page has a unique and descriptive title that is appealing to a human visitor and clearly tells the search engine spiders what each page is about. The Description Tag
The meta description tag is also an important element of the web page, not just for search engine optimisation, but also for the end user. This will be the first thing that a potential visitor to your website will read and you will want to make sure that your link is clicked ahead of all the other results on the page. Like the title meta, make sure the description is unique on each page, optimised for your chosen keyword and clearly explains what a user will see once they have clicked on your link. On-Page Content
The recent algorithm updates implemented by the major search engines have focused a lot of attention on content. They are making website owners concentrate on quality copy that will ensure a visitor has the best experience possible when they visit your site.
In the past, many website owners had neglected the importance of producing an informative website with quality, well written content. In the clamour to make sure their websites rank well; they have been guilty of producing keyword saturated copy with wafer thin and repetitive content.
Websites like these have seen their rankings in search engines diminish spectacularly, or, have vanished completely. Back Link Profile
For years, website owners would labour long and hard to create a large back link profile that would guarantee an improvement in rankings. This is because search engines would treat each back link as a vote of approval. Lately though, the emphasis has switched from quantity to quality and a poor link profile can have a detrimental effect.
The quality of links is determined by the authority of the site that is linking to you and the relevancy it has to your website. This has led to website owners blog commenting, forum posting and guest writing on websites that share a common theme.
It is also important not to use keyword heavy anchor text in your links, as search engines take a dim view of spammy anchor text and will penalise your website.Social Networking
Social networking has gradually become more important to good search engine optimisation. You will need to set up accounts for your business on all major social platforms and start sharing information, links, videos and ideas.
This is an excellent way to build trust between you and potential customers. Creating a splash on social networking sites is a great way to spread the word about your business and encourage visitors to your site.
Make sure you engage other users in a friendly and informative manner. No one likes a bore, and if you are forever boasting about your product or service instead of listening to other people’s opinions and views, you will soon find yourself very lonely. Optimised Images
You may have noticed that search engines have started to serve up a lot of images in their results and most give you the option to specifically search for images only. The images are shown in the results based on keywords; so it is important to consider this when you add images to your site.
Use keywords in your image filenames and always fill out the ‘alt’ and ‘title’ attributes with descriptive content. This will help the search engines understand what your images represent and index them correctly. Conclusion
Good search engine optimisation is essential for all online businesses. If you don’t optimise your website properly, then you will lose your target audience to your competitors.
It is important to be aware of any changes that search engines make to their algorithms and adjust your SEO strategy accordingly. It’s what any good organic SEO Specialist does
Some of these dating websites also provide some of the best gay dating for older me, as well.
If you have wanted to date a gay man or see some gay profiles online with live webcam chat or coatrooms online with free sign up access to gay dating sites, and you have always wondered the best way to do it, you do not have to worry.Gay dating sites Sydney Australia should be the best way to consider in finding you best gay match online.. The online gay dating sites are the first thing or scene next to absolutely none you will find in this world.
Gay Dating For Men And Woman
Gay dating websites in Australia aren’t just about single men but also woman as well. There are lesbian matches which you can meet online in Australia as well.
Gay Dating Apps And Advice.
On the internet you will find millions of gay men who are willing and wish to date at their convenience upon agreement. You just need to sing up like any other site with your email address then wait for a phone call or an email. It is time to get serious about meeting up with a guy out of awkward meetings from a bar counter or through hook ups from friends. If you need something that will surely work for you, something perhaps to rely on, that
is what online gay dating sites Australia is all about.
Gay Dating Do’s and Dont’s
Usually the best online gay dating sites are the ones that have multiple options for you to choose from. You find that in most cases a lot of individuals are shy, thus Melbourne dating sites ensures that your chat thread is kept private through sharing what you want with only those who you are interested with. Gay dating Sydney engages men with a web chat; their gay dating services are just what you might be looking after. Through gay dating sites you just not have to get involved more than you want to be to get someone to suit you. If you select a gay dating site form the ones which are best in the world out there you will get the best experiences ever as you wished to. It does not matter what kind of interactions you’re interested in.
For safety while dating online you have to adhere to certain precaution. It might be involve some problems even thou fun and exciting if you do not follow some set out basic guidelines. A much as there are some serious single guys looking to find their suitors online it usually involves a lot multiple challenges. Below are some things that you should bear in mind while dating online.
Beware of total disclosure
Whether it is chatting through email or phone calls or perhaps meeting up in person, try as much as you can not to disclose personal details to your potential partner. Refrain from getting too emotional or personal to avoid the risk of spilling the beans about you to the other party. While speaking in general about matters concerning salary, financial status or any other
issues are usually considered to be safe since these are usually the most vulnerable areas.
Always have a plan to escape
Sometimes you can’t tell how a date will be because you can sometimes misjudge the other person naivety or innocence. Be smart enough and set be a guard or how you can escape if the situation gets messy at some point. It is worth it to always be wise to steer clear of any potential problem that might arise in any sense. The best way here is to listen to your gut feelings and instincts and stay away if they are telling you something nasty might come up or smell
Google some solutions
If you have some authenticity issues with someone you have picked as your potential date. Make sure you rule it out by means of social networking sites or prefer to use some search engines to reveal their status. Never be ashamed or embarrassed of letting the other party know that you are smart enough to smell a rat.
The following are some of the highly cited benefits of online gay dating sites.
� It is very easy when you are dating someone of the same sex online. This is
because you treat each other as equals during the entire process even before
you meet up.
� While dating online using gay dating sites you do not have to play the old fashioned
gender roles that usually looks forward for a guy to as for a girl out, carry
all the bills and then be the one to make the initial move sexually.
� When two guys go out for a date after meeting online they usually have a lot of
freedom than their straight peers. This is because same sex relationships are
quite new to different peoples, fewer families and perhaps social expectations
to live up for.
� You find that gay online dating usually gives more satisfaction than any other kind
of a relationship as a study carried done in Vermont states. This suggests that
a relationship that stems online of can take toll and lead to more satisfaction
on the parties involved.
� More so same couple relationship tends to involve many fights in comparison to guy
online dating as the same study suggests. Therefore, when you date a person of
same sex you will likely experience little emotions and controlled hostility since you can understand each other easily.
The following are dangers of meeting through clubs or hangouts.
coming up: most dates held in clubs sometimes face difficulty when chaos rise
after the both parties get drunk. They tend to argue over little things and end
up picking a fight out of nothing. Dating in clubs is not the best way to do as
most relationship researchers suggests in their articles.
� Uncommitted creep: you find that most of the dates that are done in clubs usually have
little committed creep. This relationship tends to wither over time which is the highly cited drawback of dating for those who have been in this path in the past. Statistics cites that those who date in club are usually there for sex or finding the other part of the potential date they are dating.
� Raping: most hangouts meeting end up with one of the parties involved being indulged in
unwanted sex. They usually get themselves forced to have sex with their potential
suitors they have dated. This is because in the club no one would care to know
what is happening in the next table. It is up to you..!
Gay Dating and Online Safety
The struggle for gay rights and identification has come faster and further, in aspects of changes in perception than for any other movement. Gay dating online is facilitated through Internet platforms, which facilitates anyone seeking to form a new relationship to meet and interact. The sites vary from websites, mobile applications and social media sites for example Facebook and twitter. Gay online dating is also facilitated by online platforms, which facilitates meeting as a group in the Internet. Thanks to the Internet a person looking for a new gay relationship in gay online dating services. In these sites getting a new relationship is almost a guarantee; the only worry is getting into the right relationship. Some sites have made it easier for interaction and promoting credibility, making it easy to meet a gay partner. Traditionally, looking for a new gay partner is hard, consumes time and may be intimidating in societies where a gay relationship is referred as taboo, although it may allowed by law. Research showed that more than three men out of four men struggles to find guys to who they can connect with. On the same breath six men out of ten men indicated they fear being shot down when they introduce themselves, this was more complex when striking a conversation with a potential guy at bars or hangouts.
Gay dating online facilitates meeting new partners from far, extending to outside their countries, which is not possible when meeting at bars and hangouts. Online dating has a very high chance of meeting and forming relationships, these sites hosts only the guys who subscribe and appreciate guys rights while in meeting at bars and hangouts it is never assured and connecting with a new partner is extremely hard. Online dating will also allow interactions and knowing each other better before meeting physically while meeting gays at bars or hangouts does not have time for earlier interactions which may later turn risky. Advantages of online gay dating are immense; the platform enhances chances of meeting a partner outside their geographical area or social circles who have similar interests. This mean allows meeting people of different races, religions and careers. Also allows learning their interests in the relationship, a date, marriage partner, mate or a relationship. Online Gay dating is efficient and available 24 hours in a day. The Internet sites will be full of potential guys anytime time of the day. It is possible to interact and know each other, and claim for credibility assurance before real dating.
Online dating also spoils one with choice, the online dating sites host almost 40 million singles. This will allow for perfect choosing and personalized interaction through the enabled emails exchange capability and matching tools. Meeting gays on the bars or hangouts has potential negative points, which includes, you can never be sure of their current relationship status. Some will not be looking for new partners if they already in a relationship. Singles will also find it hard to ask for a date, it is hard to break ice in the conversation. This mean of dating limits interactions within a geographical area, hence hard meeting a partner from different social circles.
Gay Dating Rights and Marriage
Equal rights and freedom to everyone are fundamental in today’s world; they create a social norm and harmonious living. However gays have not fully enjoyed the fruits of these equal rights. Associations such as Lesbian, Gays, bisexual and Transgender (LGBT) have been formed to fight for their rights. Gays have been having difficult time to access certain services due to their sexual orientation. For instance, adopting agencies often discriminate them when it comes to child adoption.
Gay rights for marriage have been substituted with civil union;
This denies them marriage licenses to grant innumerable rights similar married
couples. Sexuality-based discrimination also exists in hospitals. It is illegal to allow gay partners to visit their loved ones or receiving medical reports or information about their condition without presence of a blood relative. This undermines the authenticity of their relationship and denies the partners important medical rights. Gays are often discriminated and disrespected due to their sexual orientation. Legalized gay marriage will assist to establish a strong social norm which includes acceptance and respect of their lifestyles. There are mixed reactions about gays legal right to marry. There has been a lot of pressure on several governments to legalize
gay marriages. The proponents of gay marriages argue that, this marriage will decrease the number of teenage suicides that are related to sexual harassment and bulling in schools due to sexual orientation. This can be achieved by legalizing gay marriage. The gay marriage can also increase the number of children adopted. However, most adoption agencies discriminate gay couples making it difficult for them to adopt the children.
The same sex marriages will not impact in any way on heterosexual communities. The separation of church and state will also help in acceptance and respecting of homosexuals;
homosexuals should not be regarded as sinners. It’s a matter of equal rights, in the current century it will be unjust to deny couples who love each other an opportunity to get married.
This will be taking away their fundamental freedom, the proponents also argue that the gay marriage is here to stay, it is already increasing numbers Those against the same sex marriage argue that, gay marriage is not marriage. Marriage is a covenant between a man and a woman.
This is the order towards procreation and continuity of human race. Homosexual marriage violates natural law. Marriage is relationship that is rooted in human nature. Therefore marriages should be governed by natural law. Same sex marriage denies a child a father or a mother. The marriage is not in the interest of the child being raised by natural father
and/or mother influences.
The opponents of gay marriage also argue that, the marriage validates and promotes the homosexual lifestyle, it also changes a moral wrong to a civil right, and the marriage doesn’t create a family since they are intrinsically sterile. Several countries like Argentina, Canada, Denmark, the Netherlands, Norway, Spain, the United Kingdom and Uruguay and South
Africa is the only country to have legalized gay marriage in Africa On the other hand in other countries such as Uganda, Nigeria and Saudi Arabia have criminalized same sex marriage.
Uganda Anti-Homosexuality Act, 2014 had originally proposed the penalty to be death but was overruled by life imprisonment for homosexuals.
Gay Dating In The 21st Century
It doesn’t matter if you are gay or straight. Love and affection are the key components of any relationship. It is what we are all looking for. Who doesn’t want to be loved? Who doesn’t want to get infinite attention from the one they love? Commitment, companionship and connection are the three most wanted things in any relationship.
The gay dating scene (whether you are a man or a woman), is an unforgiving and highly competitive place. It is far more competitive than the straight dating pool. Still, there is no secret to the gay dating scene.When you’re online, you need to let the community know you are ready to “play”. Sitting out of the game and waiting for someone to notice you is as good as never coming out of the closet in the first place. You need to get in there and let people know you are there.
You are an option.You don’t want to stick to the same game when dating. It helps to try new things, get a different approach and get out of your comfort zone. Doing the same thing over and over will not get you any different results. Don’t frequent the same places (either physical locations or online sites) too long and expect to find something new.
Your comfort zone limits you to certain guys (or girls). There are only so many times you can find new people and new personalities in your comfort zone. It would help to make new gay friends and get new hobbies that will give you the opportunity to meet new people.
You want to attract a certain type of man, hence you need to act a certain type of way. If you like open relationships, you are best served hanging around people with such relationships. If you like monogamy and single-person commitment, then spending your time with people who have open relationships will disappoint you.
You should say and show what you desire without being afraid of what others around you may think. If your dating life is not working out, the first step towards repairing it is to accept your situation. You may want to justify your not-so-good dating life by giving a series of excuses and things like that. Once you accept that you are in a rut, you will start fixing your dating life. When looking for Mr. Right, you want to be your very best yet natural self. You know you don’t want a guy who puts on a fake personality just to impress you, so you shouldn’t do the same. Be fun. Be fearless. Be foolish if you need to be.
Anyone looking for a companion must be fearless. Fear is the reason mistakes are made so frequently. A lot of things are going through your head and you are thinking of every possible thing that could go wrong. Where you can’t hide your fear, use it. Use it to show an adorable foolishness. At least this way you will show your true feelings. What is
most important, though, is to have fun. What better way to have fun than to be fun? Gay dating is not as daunting a task as it may seem. All you need to do is create the correct situation for yourself. Your gay dating life will in turn be fun and fruitful.
Online dating has changed the dating game in a superb way. This has revolutionized the way gay men meet. They work that well because they encourage even the shy ones to meet partners online using the single click of a button. Here are some of the benefits of online gay dating chat rooms. Many people will tend to say that true loves finds itself but online gay dating chat rooms help to narrow down the search and improve the chances of one meeting a soul mate.
They break the location barrier. This is because one can talk to different gay people around the world without having to go where they are. This saves a lot of time and money. Real life dates can be very expensive, the food, hotels and even gas money. As I said gay dating chat rooms are very helpful to shy people. They allow a person to get used to someone before the actual meeting and this very much helps to reduce nervousness among very many people. One will find that many people find it easier to disclose certain issues online rather than face to face.
This creates a lively dating experience. One is able to meet more a lot of people from all over the world. This helps gay men to gain experience on dating and also increases the chances of one meeting his soul mate. It is very likely that gay dating chat rooms will expose the user to a lot of people that he couldn’t have met at school or at work.
Online gay dating chat rooms help avoid disappointments’. Rejection is very hard to face and can break ones hope of finding a soul mate, online dating helps one to specify his/her intentions.
This helps to show the category of people one would like to meet and thus decreasing the chances of getting disappointed and rejected. It is very fast. Joining a gay dating site is very fast and doesn’t take a lot of time. Once you are online one meets people almost immediately.
This is way faster than walking down the street or going in into a restaurant hoping that a person will notice you. Going to dates is also time consuming, gay dating sites help to find a partner and knowing them well without spending a lot of time with them.
one is able to increase chances of meeting his soul mate here than anywhere else. This is because you say who you what and what you expect on your profile so high chances are that only the ones you are interested in will message you. This is much more effective than meeting strangers in clubs or restaurants whom you don’t know what to expect from them. The
effectiveness of gay dating chatting rooms is unbeatable.
Online gay dating chat rooms are very important because they help people to talk deeply about issues. This helps the dating couple to talk about issues comfortably that they would have felt embarrassed to talk about face to face. It also helps to know the person behind the pretty face that when meeting face to face will fool you. Meet gay singles online trough the best gay dating sites online in Australia and the globe
Back physiotherapy or physical therapy is a treatment for patients who are experiencing limited motion, strength or function in an area of their body. The patient may experience these limitations as a result of an injury, accident, or may have limitations from birth. Work injury physiotherapy can help restore movement, and improve the quality of life for its patients.
Back Physiotherapy Treatments
Almost everyone could benefit from back physiotherapy at some time in their lives. Day to day living is hard on our backs, we continually put them to the test with sports and work activities, and sometimes experience injuries through no fault of our own, such as in the case of a car accident.
A qualified back physiotherapist can help you recover from an injury or simply help relieve your pain and bring you more movement in the case of medical conditions such as cerebral palsy or after a stroke.
He or she will do an assessment on you to determine what the problem is, take a medical history, and explain to you what is needed for recovery. Diagnostic tests such as x-rays or an MRI may be necessary to determine the nature of the condition. Next comes a treatment plan, involving the physiotherapist and you, as he or she will most likely give you some exercises to do on your own at home to help aid in your recovery and speed up the healing process.
Sports Physiotherapy Clinics South Western Sydney
Some of the treatment choices for physiotherapy are exercise programs geared towards the specific condition and patient ability and lifestyle, massage, heat or ice packs to assist with pain and reduce inflammation, muscle re-education, and joint manipulation and/or mobilisation to help regain movement in the affected area.
A physiotherapist may also prescribe the use of a mobility aid, such as crutches, a walker, cane or wheelchair as either a temporary or permanent measure.
Another instance where physiotherapy may come in to play is post surgery. Post operative patients having had surgery for a fracture or joint replacement may need assistance in re learning how to use the limb or joint, and physiotherapy can help. In the case of amputation, physiotherapy can help a patient learn how to live with and make use of a new prosthetic limb.
Physiotherapy plays an important role in health care and overall well being. Whether you come to need physiotherapy as the result of a disability, an injury, surgery, stroke or medical condition, you will be working with a trained professional who can help you get the most out of life.
The Importance of Back Physiotherapy.
Many times individuals seek the help of a physiotherapist in order to minimize the amount of pain that they may be feeling throughout their muscles and general body. The majority of individuals who seek the help of back physiotherapists are experiencing pain and/or discomfort from age, injury, or diseases.
The main priority of embarking on a physio therapeutic journey is to identify what the issues with the body are and determining a course of treatment in order to maximize the life potential of the patient and to increase their general mobility throughout the day. With the implementation of treatments, and rehabilitation, physiotherapy can drastically create a better living experience for the patient.
With the combination of the patient’s history and a physical examination, physiotherapists will be able to determine a diagnosis and a reputable treatment and management plan that should be followed. Physio is used throughout a variety of different medicinal fields including: cardio, geriatrics, neurology, orthopedics, pediatrics, and other common areas of medicine. With the ability to practice medicine within any practice in the world, physiotherapists are easily and readily available whenever the patient seeks assistance.
If you have determined that your body has been giving you an abundance of pain, you can expect physiotherapy to assist you with:
1. Reducing overall body pain
2. Improving joint movements
3. Increasing the overall strength of an individual
4. Helping with rehabilitation from sports injuries
5. Aiding in the recovery of the individual after an injury
6. Recovery aspects before and after a surgery
7. Maintaining a treatment for chronic pain
8. Reducing headaches
9. Improving respiratory functions
Absolutely anyone will be able to benefit from the use of physiotherapy, regardless of whether they are experiencing an injury or if their age has reduced their range of movement. With the ability to attend a few sessions of muscle and strength building, individuals are provided with the opportunity to completely revolutionize their lives. For individuals who are old or young, physiotherapists can actively diagnose the issue and then come up with a method of treatment that is suitable for every individual. As one of the most popular methods for reducing pain and increasing mobility, physiotherapy has drastically changed the lives of many individuals throughout the world
Physiotherapy For Knee Injuries.
If you have ever experienced an injury to the knee then you will know that it can be one of the most painful places to get hurt. Its not an experience that you would wish upon anyone. It can really be a killer especially for those that play sports. There are athletes all over the world that experience the pain of knee injuries every year, and it can be as simple as a small sprain to something as serious as a tear. Thankfully most of the injuries that athletes experience are minor and they do not have to go into surgery. The great thing with small injuries is that an athlete can do physiotherapy treatment to the injured area to relieve the pain that they may be experiencing and get themselves back in action for the sport that they play in.
The first thing that doctors recommend to most patients that have experienced a knee injury is to seek physiotherapy treatment. More specifically they recommend it those that have experienced any kind of strain, torn ligaments, or torn tendon. Where an injury is serious and physiotherapy is not working to relieve the patient of the pain that they are experiencing then will a doctor consider the option of surgery to be done. Surgery is the last thing that the doctor considers, and never seen as the first resort, when a person has injured their knees. The problem of doing knee surgery on a patient is that the pain experienced can be horrific and recovery can take a long time.
There are many different kinds of knee injuries that a patient would experience some pain. The most common type of injury caused to the knee is a ligament sprain which happens when there is a sudden twist caused to the knee usually done by jumping or running. If a ligament gets torn then it can cause internal bleeding in the knee which will result in the knee swelling up. In some cases a torn ligament does require surgery but it can often be fixed with physiotherapy, but a sprained ligament can usually be sorted with just physiotherapy treatment.
So there you have it if you do experience a knee injury then in most cases the doctors advise would be to seek out physiotherapy treatment which will most likely solve the problem. Only if a doctor sees the injury as serious will surgery ever be considered.
Treating Sports Injuries With Physiotherapy
There is nothing more devastating than a sports injury in the life of an athlete. For people fueled with passion for a career in sports and athletics, being physically hampered is the least they want to be. The dreadful thought of not being able to get back on track is often the culprit of frustration; however, it is also the driving force that pushes athletes to seek for immediate means of recuperation. Aside from athletes, more and more people are submitting themselves into the thrill and hype of sports for recreation and health reasons. Because majority of these people are not skillfully trained in this field of action, they easily succumb to the pressures of physically demanding activities, thus becoming highly predisposed to the likelihood of ending up with sports-acquired injuries.
Muscles of an injured body part if left immobile or unused will atrophy – this is a medical condition that suggests decreased muscle mass possibly leading to complete or partial muscle wasting. To avoid such, physicians, after a series of lab work-ups and medical regimen, would recommend rehabilitation measures to injury-inflicted individuals to hasten recovery. Physiotherapy is an option highly suggested because it allows recovery of strength and function of the injured part.
In physiotherapy, patients who have had sports-induced musculoskeletal injuries would be subjected to manual therapies, massage treatment, electrotherapy techniques or range of motion exercise programs with the aid of a competent physiotherapist. All of these treatment procedures are aimed to rejuvenate the function of affected areas by inducing blood supply and regaining muscle strength. The duration of this rehabilitation option might take weeks, months or even close to a year depending on the severity of acquired sports injury. Through physiotherapy, a previously injured athlete or sports enthusiast can be assessed as to whether or not they are capable to get back on track and resume their enthusiasm for that sport activity that they do best.
Physiotherapy for Shoulder Rotator Cuff Injury.
The shoulder is one of the most mobile joints in the body, allowing us to reach out and grab an object and place it almost anywhere. This is all possible because of our rotator cuff muscles, which are always active during arm movements to keep the ball of the shoulder in the socket. It is no surprise then that the rotator cuff is subject to overuse and injuries are commonplace in the physiotherapy clinic.
The rotator cuff is made up of 4 small but important muscles which play a key role in the stability of the shoulder. These are the supraspinatus, infraspinatus, subscapularis and teres minor muscles. More often than not, it is the supraspinatus that is at fault however any one of these muscles can be injured either in isolation or in conjunction with one another.
While injury can occur from an acute incident, such as falling onto an outstretched arm, it is more likely to be caused from repetitive overload of the shoulder musculature and come on gradually. Due to this fact, these conditions usually affect people over the age of 35, however they are also quite common in the sporting population, especially “overhead athletes” such as swimmers, throwers and those involved in racquet sports.
Common complaints are:
1. Pain when moving the arm out to the side
2. Difficulty sleeping on the injured side
3. Difficulty doing overhead activities, such as hanging out the washing, putting things away on the top shelf
4. Dull ache in shoulder after activity
Several things can predispose a person to a rotator cuff disorder, however the most common cause is impingement of the rotator cuff due to abnormal scapulo-humeral rhythm (the integrated movement of the shoulder blade and arm) and weak rotator cuff muscles. Poor scapulo-humeral rhythm is often the result of muscular tightness and strength imbalances and can be effectively treated by physiotherapy. It is important to get your assessed early on. the longer you leave getting your shoulder treated the harder it becomes to treat and the more likely you are to get secondary problems.
Physiotherapists are well trained in assessing the shoulder and identifying the cause of rotator cuff disorders. A consult with one of these health professionals should involve a thorough examination of the shoulder biomechanics, the spine, and the muscles of both the rotator cuff and scapula. They will then go on to treat the problems that they find using evidence-based treatment techniques such as massage, mobilisation and dry needling. Furthermore, a rehabilitation program specific to you will be prescribed and should include a range of exercises and stretches to help correct the abnormalities and strengthen the rotator cuff.
Physiotherapists have the clinical skills to assess and treat posture and muscle imbalances, and overuse injuries of the shoulder muscles. The physiotherapist will develop a strengthening program to restore normal function of the shoulder and prevent recurrence of
Physiotherapy For Spinal Cord Injury.
Spinal cord injuries (SCI) are one of the most serious consequences of high speed accidents or sporting activities, a rare but devastating injury which can also occur after infections, tumours or ischaemic damage. The largest risk group are younger people due to their propensity to perform risky activities but a person of any age can suffer from SCI. Car and motorcycle accidents account for the highest proportion of injuries and due to the complicated picture after this injury a multi-disciplinary team of professionals is vital to ensure the patient reaches the highest level of independence for their particular condition. The terms quadriplegia and paraplegia are used to describe the resulting disability.
The initial medical evaluation is performed to establish the respiratory status of the patient and deal with any other of the likely multiple injuries. Once the patient is stabilised the doctors try and work out the level in the spine where the damage has occurred, an important fact as it relates closely to medical and therapy management. A low lumbar fracture will have no effect on the arms or the ability to breathe so the patient will have good trunk and arm power and the aerobic ability to develop independence. Cervical and upper thoracic injuries impair the respiratory ability of the patient and limit arm function, making rehabilitation much harder.
The first thing to establish is the level of the injury, a diagnosis that is very important as it indicates the whole path of medical and physiotherapy management. If the spine is fractured low down in the back there should be few, if any, respiratory consequences and the patient will have full power in their arms and chest to achieve independence. If the injury is high, in the thorax or the neck, this may compromise the patient’s ability to breathe spontaneously and will mean a much more difficult rehabilitation period with limited independence overall.
Respiratory physiotherapy consists of assessing the patient’s respiratory ability, teaching the patient to deep breathe and expand the lungs fully, and cough to expectorate. If the lower abdomen is paralysed the patient may need to stabilise the area with their arms to allow a propulsive cough. In more disabled patients the physiotherapist may stabilise, helping the air to exit suddenly in coughing. A cough assist machine can be used to provoke a cough, and initial management in intensive care may also involve respiratory suction.
If the spine is unstable, which it often is in spinal trauma resulting in paraplegia, a spinal surgeon will stabilise the spine, usually with instrumentation and bone grafting. This allows the patient to start their rehabilitation without the long wait for the spinal fractures to heal naturally. Initial physiotherapy management is to monitor the respiratory status, encourage active movement of unaffected areas and perform passive movements of paralysed body parts to retain and improve the ranges of motion which will be required later for independence.
The physiotherapist will progress the patient gradually into a more upright posture by putting the back of the bed up. If got up too quickly, the patient’s blood pressure can drop suddenly and this must be avoided, so the patient is eventually transferred into a wheelchair with a sloping back and elevating leg rests. Gradually they become more upright and can start practising sitting balance on a plinth as trunk control is often poor and must be mastered before arm and trunk strengthening and wheelchair transfers can be safely practised.
By this time the patient will have learned trunk control in sitting, wheelchair transfers and strengthening work, so at this stage they should be routinely transferred to a unit specialising in spinal injuries. Experienced advice from the multidisciplinary team about the large number of skills they need to learn is available there to foster the highest level of independence. Many factors impact on whether the patient can lead a fully independent life including their age, other medical difficulties, family support, motivation and attitude and the spinal level affected. Some people with higher lesions may need routine care from a pool of carers throughout the day.
Physiotherapist Treatment of Acute Lower Back Pain
Acute Lower Back Pain is one of the most common conditions that Physiotherapists see. It can occur from even the most minor of events, such as leaning over to pick something small off the floor, or sneezing. The pain experienced can range from being reasonably mild to the point of being unable to move. The area in which the pain is felt can also vary – from being concentrated in the Lower Back to being felt into the leg. The Lumbar Spine (lower back) has a number of structures in it that can be affected when an injury is sustained. The major ones include: – the discs between vertebrae – the Facet joints (the joints joining vertebrae together) – and/or the muscles in the lower back. In many cases, there will be a combination of the above.
So what does diagnosis actually mean?
When you first consult your Physiotherapist, you will be made to perform a series of movements and tests that will help the therapist get a better idea of where the pain is actually coming from. When the disc is involved, it usually means that the outer ring, the Annulus Fibrosis, is damaged, and could be causing a “disc bulge”. In severe cases, the disc can tear right through, causing what is known as a Disc Herniation or more commonly known (but incorrectly) as a “slipped disc”. When the facet joints are involved, the pain may be more concentrated on one side of the lower back, with accompanying restriction in movement.
The Joints in the lower back can be injured in the same way as other joints in the body, such as the ankle. This means that they can also suffer from sprains, and cartilage dysfunction. Commonly with injuries to the facet joints the swelling process is set off, as with any other joint injuries. This means that swelling will occur, which puts pressure on the surrounding structures in the lower back, and increases the intensity and area of the pain felt. In many conditions, there will be an element of neural or ‘nerve’ involvement, with either tightness or a loss of sensation being felt in your extremities. Although indicative of a more serious problem, this does not mean that the problem cannot be resolved reasonably quickly.
What Do to Do?
STAGE 1: Pain Management Rest:
Avoid using the back in anything even remotely strenuous. Ice: Early; Often in the first 48 hours, over the area of pain; 15-20 minutes every 2-4 hours. Try to keep the back moving within your range without pain – this will reduce stiffness and prevent muscle wasting. Contrary to popular belief, complete immobility is not ideal. Taping may be an option to help with immediate pain relief.
STAGE 2: Sub-Acute Management.
Pain reduction and Restoration of movement will be the focus of treatment at this stage. Manual Therapy applied by the Physiotherapist will likely be the main treatment modality used. Soft Tissue (e.g. Muscle) manipulation are likely to be used by the Physiotherapist. Your Physiotherapist will guide you as to what you should expect, according to you individual condition.
STAGE 3: Return To Function.
Once movement has started to return, and pain begins to subside, the focus of treatment will turn towards restoration of function. In some cases, a graded rehabilitation programme will begin, aiming at ensuring that no muscle strength is lost, and that core stability is maintained. Your Physiotherapist will guide you through any rehabilitation programme step by step. Return to normal function at work will be a major goal – ensuring that you are able to perform your work tasks safely and comfortably. In this stage, time frames can be hard to quantify for injury resolution. The initial severity and the structure injured in many cases is the main determinant as to how long the injury may take to resolve. If you are at all concerned about how long the injury is taking to resolve, do not hesitate to speak with your therapist.
Physiotherapy Management of Hamstring Injuries.
The accurate diagnosis of the injury and the degree of its severity is the crucial factor to be decided initially as this indicates how the injury is to be expected to improve and how long it will be until the patient has functionally recovered. The mainstay of treatment is physiotherapy and the physio has to decide the how to progress the treatment according to the level of tissue injury and the time which has elapsed since the event. There is no effective scientific evidence for managing this kind of injury and the physiotherapist will design the rehabilitation programme individually to suit the particular and variable requirements.
There are three initial phases which hamstring injuries can be classified into: the acute phase, the sub-acute phase and the remodeling phase. There is a different treatment plan and strategy for each phase and the time elapsed since injury. The acute stage can last up to the end of the week since injury and the main aims are to reduce the levels of inflammation, pain and swelling secondary to the tissue damage. Treatment normally follows the PRICE system: protection; rest; ice; compression; elevation. Protection is aimed at eliminating any significantly harmful stresses to the damaged tissues, with the treatment options of using crutches to limit the amount of weight on the leg or bracing the knee in flexion.Rest is the second requirement to protect the damaged muscle tissue by eliminating force through the area although athletes find this difficult to adhere to. Ice is a primary treatment for acute injuries and reduces pain when applied for approximately 20 minutes, with a check after 10 to ensure skin health. Cold inhibits inflammatory changes in the local area by reducing metabolism and so the amount of circulation coming to the area. Compression may be more useful than cold, which is typically used by physios, and controls local swelling, with elasticated bandages applied to the limb an effective strategy.
For acute injuries elevation of the affected parts is usually advised with the part lifted above heart level to give the best effect in providing build up of tissue fluid. The position of the injury to the hamstrings makes elevation impractical and it may be unnecessary. A reduction in the levels of pain and inflammation allows the physiotherapist to start passive movements to the limb and to prescribe active assisted movements. Physios avoid stretching at this point as this may aggravate the symptoms and damage the area. Minor hamstring injuries typically recover in a few days but should still be managed appropriately.
Soft tissue injuries take at least six weeks to heal, even minor ones, so once feeling much better athletes should be encouraged to ease slowly into doing more stressful activities and should pay attention to strengthening muscles, stretching and balance to reduce the likelihood of the injury recurring. In the sub acute phase, which lasts until about three weeks after injury, the pain and inflammation of the acute injury should be reducing and so the physiotherapist can progress the treatment on to active range of motion exercises and then to muscle strengthening.
To facilitate hamstring rehabilitation without a high degree of weight bearing on the limb it can be appropriate to use pool therapy and patients can continue with their aerobic training to maintain their cardiovascular ability and arm training. The injured area will be exercised with sub maximal training effort. The phase of remodelling takes the injury towards the six week time after the injury and the physio will test to see if the patient can cope with a full strength contraction without any pain. If successful the rehab can be progressed via through range exercises (isotonic) with light weights and high repetitions.
The patient starts this process in prone with light ankle weights, progressing to heavier and heavier resistance provided the pain in the injured area is not provoked. The progression of weights should be conservative as too rapid an increase may lead to relapse and a more long term problem. Once the patient has achieved good strengthening with the muscle shortening (concentric contraction) they should be progresses to strengthening with the muscle lengthening (eccentric contraction).