Q: What is the difference between orthopaedist, physiotherapist, bonesetters (thit-ta in Cantonese), masseuses and chiropractors? Each has its own approach and place in dealing with both non-specific and traumatic pain, and injury. However, there are vast differences in their training certification, areas and ethics of safe practice, whether they are evidence-based, the clinical reasoning behind each, and whether it is recognised by the Ministry of Health and insurance companies.
More importantly, when you seek treatment beyond just pain relief, you should look at a more holistic approach – from treatment right through until bringing you back to what you like or want to do in your life – reduce or no further injuries, except of course, traumatic injury by an external force.
Other considerations would also be, if your interest are kept, are you given rights to correct information, effectiveness of the results in the shortest possible time, the rehabilitation after an injury, and how to prevent recurrences, for instances. Most important, of course, is the dynamics of each profession with the other in cross-referrals and recognition of each other’s skills and forte.
On the other hand, we also work very closely with doctors on some conditions that had been screened by them which requires physiotherapy or medical fitness intervention.
Q: What do I need to bring with me? Doctor’s report and X-ray usually. A doctor’s referral or a guarantee letter will help facilitate those who need to make company and insurance medical claims.
Q: Can you please run me through what I will be subjected to during my first visit? Our friendly front-desk team will greet you and get you to fill up your details so we will get to know you more. Therefore, we encourage you to come in 10-15min earlier at least for your first session. They will ensure you are comfortable. Do let our team members know should you need a different seating, such as if you are having an acute painful attack. They will be your customer ambassador, ensuring that you will have a positive experience from the point of contact, entry, and right until discharge.
The physio will walk you to your treatment room and introduce themselves to make you feel at ease so that you may share with them your conditions. They will ask you some questions pertaining to your issue(s) which help set the direction of clinical analysis and the appropriate detailed assessments which will follow. You will be requested to change into something tight and light coloured to help us in our assessments of your movements. However, should you not feel comfortable, feel free to let us know.
At times, videos and photographs may be taken (without showing your face and the photo shoots will be as discreet as possible) for use as a comparison of the "before" and "after" of your condition, and which may be later used as educational material. It is strictly for your personal viewing and they will be kept highly private and confidential in your digital folder. Should you not feel comfortable, you may request for the videos and photographs to be deleted. But we will encourage you to keep them until at least you have gone through your course of treatment as it is important for you to “see” your dynamic movements as they give us insights that no static films can.
There will also be some highly technical motion analysis tests which we may advice you to do as a more objective form of measurement for your record-keeping. This will help monitor the changes in your movements and the correction of your physical issues.
At the end of the session you will be briefed on the findings (your videos/photographs will be shown to you), followed by a discussion of the best possible rehab program you may undertake within the shortest time-frame. This is done with the priority of delivering your goals as well as achieving ours. However, this has to be agreed upon by you in terms of compliance, time and financial commitment.
As you leave, our customer ambassador will check in with you on your experience and will get you to give us your honest opinion of your sessions as a constructive feedback. We want to ensure that all our clients will have a positive seamless experience with us.
Q: Who will be seeing me or should I tell you first about my condition first and leave the recommendation of a physiotherapist to you? During your first contact with us, be it over the phone, message or email, we may ask you to describe briefly your conditions and your best available time for the first consultation. We will try our best to match your condition with the key therapist in this area as well as the time you are available. We will also choose the best personality to match yours as we believe that a good partner makes the best healing journey.
After the first consultation, our customer ambassador will check in with you if the entire partnering is working well. If there is a request, we may put you under another therapist.
Q: How long will each session last and how many sessions do I need? Each session lasts 45 min but with time taken for changing and re-evaluation, the actual session may be around 40-min. Depending on each case, normally the best results are achieved when a person goes through the entire THREE phases of our recommended rehab program:
Phase 1 :
Treating the local area with aim to reduce the inflammation and facilitate the healing process, cutting from 6 weeks to 2 weeks. It is important to facilitate the tissue to heal in the normal way rather than to inhibit it but cutting down to shortest possible time without impeding on the natural course of healing.
This stage teaches you when/how to protect, be aware of good or bad compensation as well when to load which is necessary to lay the right foundation for the next stage.
You need to follow your therapist’s recommendations to make the necessary changes in your daily routine to see faster results
Normally you will need to commit 2-3 sessions for this stage as it is important to avoid wrong or lack of treatment which may lead to further complications.
Phase 2 :
With pain reduced by at least 75%, you should continue this phase of gradually loading you back, allowing your tissues to be under certain amount of natural stress and restoring the correct movements again
The session will be less frequent as we need you to exercise more and making the changes necessary in your routine to restore you back in your usual environment
Phase 3 :
By now your pain should be almost gone and you are able to perform 75% of your normal duties
Either on a weekly or fortnightly, we slowly see less of you while empowering you to do a lot more with your usual routines as we monitor your patterns of movement
For some of you, this stage is mandatory due to the nature of your job, physical routines, athleticism, lifestyle and tissue types whereby your body needs regular maintenance for the optimal physiological performances
It is also recommended as a form of continuous monitoring, prevention as well as performance enhancement taking your body to the next level.
Q: Will I be able to get 100% better? With any cut, sprains, strains, trauma or an “overuse” injury, the body has to go through 3 phases of healing process. Once “healed” the injured tissue has to be prepared and loaded up gradually. Usually an inflammation process takes 2-6 weeks depending on the severity to “heal” and the loading phase, another 2- 6 weeks, depending on the demand of an activity.
Phase 1 (inflammatory) This is the acute bleeding phase which happens immediately and with maximum effects around 3 days. This is the stage whereby medications and rest help to reduce pain especially the first 2 weeks. We will teach you how to move correctly to minimise further stress on the area, modify important activities, and take a break from those unnecessary ones.
Phase 2 (proliferation/swelling) Under normal circumstances, tissue healing takes place, forming scar or fibrosis. This scarred area is restricted and not able to withstand forces during movement or loading. Professional hands-on and stretching techniques are crucial at this stage. We empower you with the necessary knowledge on how far you can move and how much you can do safely, preparing you for the next phase to hasten your return to routines.
Phase 3 (tissue re-growth) However as you return to activities, the scar area is not able to withstand the stresses in terms of mobility, loading and long hours. Our program is safe, efficient and effective in getting you back to activities you need to perform through a proper recovery process:
1. .Our PMAT® assessment finds the root cause to your problem instead of looking for a pathology.
2.. There are four weeks of hands-on treatment, specific exercises and education on the changes necessary. We will guide you through gradual increment of loading and you should recover enough to about 80% to return to your normal activity
3.In the last 2 weeks, we empower you to be more independent in managing your issue in long term.
Q: How soon can I get an appointment? Give us a call, an sms or an email and we will respond within 30 minutes. It is our target to give you an appointment within 3 days or the next availability of the time you asked.
Q: What's the difference between your centre and other physio centres? We are at the forefront in understanding movement dysfunctions. We started being a physiotherapy and rehabilitation center but we are now moving forward to be the first movement center in Malaysia. This is in tune with more research showing proof that the diagnosis of a “pathology” does not correlate well with one’s symptoms and functional capacity.
We do not just treat pain. We go for prevention and optimization of your physical performance. We do not just treat an area, we look at the entire chain of movement because the root cause(s) could be from elsewhere.
Some of us are athletes and some are “patients” ourselves, therefore we understand you and know exactly how to make you better. We believe in empowering you to understand your body with our screenings — what you should do to make it better and modify those actions that make it worse before further damage is done.
We do not separate the body into parts or joints. We believe the body is an amazingly complex multi-system unit that makes you unique as an individual. Therefore, no machine can replace our bodies to give the most effective results
We are not just physiotherapists who merely follow protocols. We always come up with new concepts and approaches to issues. We are our own guinea pigs, tried and tested to know exactly what works and what doesn’t.
And we walk the talk! Check our profiles out – seeing is believing!
Q: What is the difference between normal masseur/spa and physio. Is it the same if I go for a massage outside? Our Bodywerkz® techniques/strokes are very specific to a certain movement dysfunctions or complaints, clinical diagnosis and highly dependent on tissue type and to achieve certain therapeutic goals.
In addition, as your body progresses with EACH treatment session, it may respond differently and our therapists will change the strokes according to each tissue that responded differently.
General massage merely follows the logic of protocol, by the book, which is helpful with a good feel after-effects. They may not necessarily deal with the therapeutic components or regard tissue response as important. Lastly, hands-on technique is just one part of the whole picture of managing pain and movement issues.
Q : Can I do self-massage : If it is meant to achieve a feel-good feeling for temporary pain relief and if the area is reachable, yes. However, you may not be in the best position to apply the right depth and direction of force to get the most effective results, and you are most likely to end up straining the arm/hand used.
Q : Why did my masseuse said that I have “wind (angin)”? That is a traditional belief - not scientifically based. Some masseurs even purportedly “burped” you to release the “wind/angin”
Q : Why does an achy lump feel better with a massage? And why does it keep returning? Be careful with lumps and bumps in your body. It is best to speak to us or your doctor about it before any treatment is done. If it is something sinister or growing in size, it is best not to massage it. Get it checked.
On the other hand, there might be muscular lumps which are made of tangled up tissues due to overuse, strains and sprains, which we call scar tissue or fibrosis. A fibrotic scar is a natural healing process of your body after an injury which you can see on the skin if you have a cut. This area, if seen under the microscope, are a messy bundle of muscle and connective fibers that are less stretchy, harder, thicker, weaker and poor in micro-circulation. Other adjacent healthy tissues such as skin, nerves and layers of other muscle fibers may get “pulled in” too as the injured tissue heals. This will produce an area of pain, ache and weakness which is easily re-injured again which we commonly see in chronic conditions.
Therefore, when a certain force is applied on it (just like both normal and professional massage), it overrides the impinged/stuck nerves, giving rise a feel-good sensation. However, this is very short-lived and returns quickly due to our daily grind on the weakened tissues.
We had been asked whether we are just doing a massage when we work with your body with our hands as it would appear so at first glance. It is not. Each of our Bodywerkz® hands-on technique is designed in a very specific and detailed manner based on the scientific theories. Our therapeutic goals are very clear — when to use, which strokes, at what depth, which direction, with positive/negative pressures and in which order of priority. Be it breaking the scar tissues down, realigning the fibers, improving micro-circulation, each stroke is effective in giving you a more lasting effect.
Together with our Mobifit® exercise program, we help you rehabilitate the weakened or injured tissues, make them ready to meet demands of your body. Besides that, you have to retrain a new movement pattern to prevent compensation or bring your physical body to a much higher level of performance, thinking ahead to prevent potential future injuries.
Lastly but most importantly, our Body Mechanix® ; program helps you identify if there is an issue with your lifestyle or ergonomic awareness and provide you with simple, practical and effective solutions to keep pain at bay
Q : Should I use one or a combination of these: Koyok (medicated plaster)/medicine/acupuncture? Your doctor will be the best person to advice you on medication. Medication may be necessary during the initial phase of inflammation. During this stage, we work with your doctor in helping you decrease pain in a safe manner, teaching you steps to protect the area of injury to facilitate healing.
All the above may offer temporary relief of your pain by blocking off the chemicals from being detected by your brain’s pain receptors. But they don’t make any physical or mechanical changes to the injured tissues or correct your wrong movements, which is some pain recur the moment you return to your routines.
Instead of looking at pain relief, we work with you on your alignment, correcting your basic movements, reducing compensations and rectifying the root causes so as to make a more long-lasting effect, prevent further injuries and bring you up to better performance.
Q : Can I do a workout if I am in pain? Can I go back to dead-lifts/aggressive gym routines after this? You have to listen to your body especially during the first two weeks. Pain is a biological alarm telling you that something is not right. Reduce or rest for full protection. However, you can and should return (and we will guide you stage by stage) to your activities by Week 2 onwards and gradually load up by Week 4 following the theory of healing process. However, it is important to find out if your workout routines are done correctly and safely.
Q: My doctor says I have a disc problem and directed me for a MRI. The MRI confirmed it. Can physiotherapy help? Many recent studies showed the poor co-relationship of what you feel, your ability to function, with the MRI findings. It can be a false positive (accidental finding) or false negative (pain is real and most likely from other structures) due to the nature of spinal pain is multi-factorial. Nonetheless, what you see on the MRI is a consequence what had happened. More important is to find out why it happen AND how to resolve your pain, and most importantly, how to prevent that and other pain. Our PMAT’s system assessment will find out the root cause of your problem and right through to treatment teaches you about your body, your movement, your routines and know how to manage and prevent it from further occurrences.
(Reference: Correlation of Lateral Stenosis in MRI with Symptoms, Walking Capacity, and EMG Findings in Patients with Surgically Confirmed Lateral Lumbar Spinal Canal Stenosis. BMC Musculoskeletal Disorders15(1):247 · July 2014 )
Q: I have scoliosis and read tonnes of materials on it. It seems no one has the answer to what caused it, how to prevent it, or the right treatment as everyone seems to say different things and respond differently to all the different treatments that are available in the market. What do you have in your ScolioX® program that is so different from the rest? And does it guarantee a 100% improvement? Are there diagnostic tools that can be used to detect the condition? What are the chances of physiotherapy reversing it?
Yes, you are absolutely right. Even in our own search for answers the past many years, our experience is not any better. However, interestingly enough with each question we had and answer we couldn’t get, we found our pictures getting clearer due to our PMAT approach to movement dysfunctions in the entire chain of the body instead of just relying on assessing the spine.
Combining with years of experience dealing with scoliosis, strength in movement analysis, the many scoliosis-specific courses attended and confirming our findings with a hi-tech German technology in 4D motion, we have designed the ScolioX program that has been proven to be effective. The program is able to thoroughly assess all aspects of a person, explain the possible reasons and process of the development of their curvatures (which many couldn’t explain why one curve is different from another) and the effectiveness of our Bodywerkz manual techniques in combination of our Scoliosis-specific and Mobifit exercises.
As for the results, what we could say it is highly dependent on the compliance, commitment, awareness and ability of our patient to make the corrections needed.
Q : Doctors say I can’t bend forward, what can I do? My ortho says that I should not to do a rotation of the body anymore. Is it true? Research has shown that forward bends causes increased pressure on the disc and rotations can have the highest strain on the ligaments that hold the disc together. But we believe that the spine is made of many vertebrae that allow the trunk to move multi-directionally. In addition, looking at anatomy, our muscles (which are the main engine/motor for movements) are formed in such a way to support and move the body again in multi-direction. Therefore, a “healthy or normal” spine is meant to bend, rotate and in normal circumstances should be able to do that safely.
However, your ortho is right that forward bend and rotation may make your pain worse during an acute inflammation. But once the pain has subsided, you should move again and not fear these two natural meant-to-be motions. Instead, get your body assessed, treated and relearn how to bend and rotate correctly, and safely.
Q : I have pain and did all the necessary scans but my specialist could not find a problem. I was prescribed with the usual painkillers, muscle relaxants and anti-depressants. It didn’t seem to work as my pain comes on and off. What is happening? As mentioned, many studies are showing that scans and symptoms may not necessary correlate due to the multifactorial causes to the development of non-specific musculoskeletal pain. In some cases there may not be an actual “pathological” disorder at all.
Wrong mechanical loading can produce pain but at an early stage, it may not be severe enough to result in joint deformity or with a localized severe inflammation that can be picked up on scans. This process of wrong motor patterning and repeated mechanical strains will further cause a series of derangement, wear-and-tear over a period of time before its extensiveness is noticeable or be picked up on film which is what is known as a visible “pathology”.
Therefore at this stage of your problem, it is best to look for movement assessment and the right form of treatment approach.
Q: I am an accountant and I frequently get headaches and dizziness around the end of every month. My doctor says they are caused by work tension. Can physiotherapy help? This is a common issue known as “the office neck” which affects at least 30% of all office workers. As you can tell, your symptoms are related to a certain time in the month which follows the pattern of your work and hence, your stress level.
Yes, physiotherapy is definitely being recommended as the first line of intervention globally. We assess your physical body in your working environment which we call ergonomics and pay attention to your other aspects of health that may also contribute to this, including sleep, nutrition, psycho-emotional management and hormonal changes.
We will treat you, refer you to appropriate specialists to address some of these issues, and advice you on the little changes you can adopt to your work station as well as offer some self-help tips in general.
Q: My staff are complaining of shoulder and lower back aches. As a result, the management bought ergonomic chairs and workstations for them. However, these helped but only for a while. Is there anything your physiotherapy centre can recommend so that we can reduce lost man-hours and medical bills? These common desk-bound issues are not solely caused by the physical set-up. It is good that proactive actions had been taken to address one aspect. Time, stress, constantly in one position, lack postural awareness and break time all may contribute to it. And on top of it all, each individual has a different sizing, body and tissue type that respond differently in the same physical set-up. Therefore, it will be more important to have an ergonomic assessment to understand the entire cause-effect and wellness program to tackle the loss of manpower and rising medical bills for conditions that can be prevented.
Q: My daughter fell down the stairs when she was four. Apart from some bruises, our family physician gave her a clean bill of health. Now she’s 12 and recently I just noticed that her left shoulder is lower than her right. Friends say it’s because of lugging a heavy school bag. I fear for the worst – that she might be having a curved spine due to the fall. Can you help? Yes, we need to run our PMAT assessment on her to see where the main problem of her lower shoulder lies. An x-ray is a way to see if there is any bony deformity related to the fall at 4 years old, check if there are any deviation of her spine and the degree of her lower shoulder. However, it will not be able to pinpoint what is causing the deviation physically and not able to determine the course of action needed to correct it physically.
Q: I am an avid sportsman and recently, while training for my cross-country run, I pulled my hamstring. Two weeks rest was recommended by my doctor and painkillers were prescribed. Now I am back on my feet but I still feel tightness in my left leg and I don’t feel as flexible as I was. Can physiotherapy help me loosen that? Absolutely. What you experience is the typical side-effects after a sports injury which is part of a normal healing process. We call it fibrosis. This scar tissue restricts extreme range and movement as a form of protective mechanism. The goal at this stage is to manually “soften” the scar for more pliability and the right strengthening exercises specific to runners to restore its capacity again. Besides that, we will also assess using our PMAT system if the real reason behind the initial insult to see if it may be from elsewhere.
Q: I fell and sprained my ankle two weeks ago. Now my back is also aching. Should I go see a thit-ta (bonesetter) or opt for physiotherapy? Can back pain be related to a sprained ankle? Your backache is most likely due to compensation of your injured ankle. We do not only aid the recovery of the ankle and treat your back but also assess your movement and identify what form of compensations that you had taken on. We will teach you how to rectify and retrain your movement again back to normal.
Q: I am a golfer and after working out on the fairways for a few days, I feel my back tighten up. Do you offer sports massages as part of physiotherapy services? Yes, our team has the experience and privilege to work with the big international names in the golf arena. We know exactly how a golfer ends up with a bad back and trust us – most of the time it is not from the back! Our GOlfitxio program specialises in golfer’s management — from treating acute pain to sports massage for maintenance, and onwards to hitting an additional 30 yards!
Q: My 15-year-old daughter is interested in taking up ballet. I think she’s a bit old to take up such a flexible dance routine. Is there any diagnostic test in a physio lab that can find out if she is ready to start ballet from ground zero? I don’t want her to be injured. Do check our Dancer Risk Assessment (DRA)!® After years of treating dancers of novice to professional level, we knew exactly what is lacking in them and our assessment is one that covers all aspects of a dancer. From the assessment, we will derive a holistic plan to prepare them physically, mentally and nutrition-wise, so as to ensure that their growth are not stunted, and that they have enough nutrition and muscular strength for their vigorous training and performance precision.
Q: My 70-year-old father in law used to be very active until he retired from active work at his company. For the past six months, he has been sitting in front of the computer, enjoying social media and watching online programmes. Recently he was complaining of dizziness. Scans later and several costly trips to several hospitals yielded nothing physically wrong with him and gave him a diagnosis called BPPV or vertigo. How can physiotherapy assist him? There are a few possible causes of dizziness which hopefully the doctors had ruled out :
Carotid blood flow
Visual-motor dysfunction (Nystagmus)
Benign Postural Paroxymal Vertigo or vestibular dysfunction can be tested using Epley’s manoeuvre. Our physiotherapists all are trained in handling vestibular rehab which involves a few systems:
DISCLAIMERs The content in this site is provided for general information only. They do not constitute professional advice or an offer. Physiowerkz Systems Sdn Bhd takes no responsibility or liability for any injury, loss or damage incurred as a result of your use or reliance upon the information and material contained within or downloaded from its website. Please refer to our disclaimer here