No, not necessarily. While neuromusculoskeletal (NMSK) physiotherapists are exceptionally well trained in orthopaedics and movement impairment diagnosis, they are part of a multidisciplinary team. The physiotherapist may refer you to specialists or to other team members pending a thorough assessment, and, of course, your response to treatment.

Patient compliance and active participation in rehabilitation are key factors that any health professional has to capitalise on. Ask if you don’t know what to do at home, or if you are unsure of what you can do to contribute to your recovery. It is incredibly important to note that you have a key role to play in your recovery. Be an active participant and not a passive recipient!

Clicking or popping of spinal joints does not mean that joints were ‘out of alignment’ are put back into alignment. For example, you can look at your hand, ‘click’ your knuckles, and look at it afterwards only to see that it appears 100% the same as before, while feeling looser. We refer to the clicking of joints as manipulation, and the sound that is generated is called ‘cavitation’. This sound is likely the result of gaseous pressure change in the joint, and involves a stretch of the capsule and ligaments with a feedback message into the adjacent muscles that can cause them to relax more – in effect, loosening the joint. Manipulation is not proven to be the only method of restoration of joint mobility. True malalignment is seen in scoliosis and is not correctable by manipulation. Note that clicking one’s own spine is not advisable! The physiotherapist, after mobilising or manipulating the spine and releasing the soft tissue (muscle and fascia), will give you exercises that will strengthen the weaker muscles and lengthen any shortened muscles. In this way your muscles will be able to provide a strong pillar of support during daily activities and sport.

The disc is adhered to the adjacent two vertebrae and will not separate from the vertebrae even in severe injury. The disc can therefore not ‘slip’  – this is just poor terminology. The lumbar discs are cushions between the vertebrae and assist in shock absorption and movement. A disc has an outer layer of cartilage (annulus), and a softer gel-like centre (nucleus pulposus). With ageing, trauma, overuse or misuse, small cracks can develop in the cartilage with the soft centre distorting the cartilage (like a ‘tyre bubble’) or even pushing through (like a ‘burst toothpaste tube’). 

Medical terms like herniation, prolapse or protrusion are used to describe the severity of the disc injury. This can cause swelling and inflammation resulting in pain, or push directly on nerve tissue causing local or limb (referred) pain. In the leg this referred pain is called ‘sciatica’.  Worse yet, nerve compression can result in weakness and numbness and may require urgent surgery.  An MRI is the tool typically used to make the most accurate diagnosis as an X-ray only shows bone, as prescribed by an Orthopaedic Spine Surgeon or Neurosurgeon.  

Manipulation is typically avoided by physiotherapists or other manipulative practitioners (such as Chiropractors) in the presence of a disc injury. Thorough assessment and solid clinical reasoning will help the physiotherapist determine what approach is to be used.

Nerves are not ‘pinched’ but can become compressed due to disc problems (see preceding FAQ) or bony osteophytes (spurs) pressing on them. If that is the case, pain (in the typical distribution of that nerve), tingling, numbness or weakness may result. It is possible to have pain and NO weakness/numbness/tingling, or weakness/numbness/tingling and NO pain, or BOTH. This depends on where the nerve is compressed. By the way, pain in the leg does not necessarily mean you have sciatica – let your practitioner make that diagnosis. Weakness and numbness are considered to be far more serious than pain and require urgent attention.

Dry needling is the use of the same monofilament acupuncture needles for treating muscle dysfunction. It is not the same as acupuncture per se, which is applied according to certain Chinese medicine principles. Physiotherapists claiming to perform acupuncture must be registered as acupuncturists, thus be cerfitied Chinese medicine practitioners.  The concept of dry needling evolved from trigger point injection using a syringe (‘wet’ needle).  The action of the needle itself was observed to have more effect on healing than the medication it administered, hence the ‘dry’ needle. Dry needling is used to elicit a natural healing response from your body by increasing blood flow to specific muscle structures, eliciting a muscle spindle reflex (twitch) and stimulating your body’s many natural pain inhibition systems, thus also stimulating the secretion of natural pain inhibitors. Not all conditions require dry needling! The decision to offer this rests with the therapist and the patient, who can make an informed decision to accept or not accept this approach.