Physical therapy treatments

A physiotherapist is an expert in the field of the posture and musculoskeletal system. He or she advises, supervises and treats patients with all kinds of different physical complaints such as low back pain.

All our physiotherapists have completed at least a four-year HBO study program supplemented with follow-up courses and courses.

Which diseases and conditions does he / she deal with?
A physiotherapist deals with complaints of the musculoskeletal system. This can include sports injuries, complaints due to overload, complaints due to an accident, illness or wrong movement or simply because the body is getting older.
A physiotherapist is furthermore concerned with the treatment of pain, swelling or breathing problems, the assistance with recovery from a bone fracture or after an operation. A physiotherapist can also learn to walk someone with a prosthesis, for example.

At the first appointment, the physical therapist forms as complete a picture as possible of the symptoms by asking questions and conducting a physical examination. On this basis, the physical therapist establishes a personal treatment program.

Manual therapy

 What is Manual Therapy?

The goal of manual therapy is on the one hand to improve the functioning of the joints and on the other hand to improve your posture and movements. For this the manual therapist uses a number of specific techniques that can be applied in the joints. The effects of manual therapy are often immediately noticeable: you feel an improvement in the freedom of movement and a decrease in pain. 

The manual therapist's treatment program furthermore consists of giving good instructions, advice, guidance and insight into healthy exercise. 

A manual therapist is a physiotherapist who has undergone training for manual therapy after training for physiotherapy. With this he gained extra knowledge of the movement possibilities of the body and in particular of the spine. Thanks to its specialized training, the manual therapist is perfectly capable of assessing the cause of your complaints. In this way he can propose a tailor-made solution for every body. 

When to go to an manual therapist

If you can move a joint badly, or if you are in pain, manual therapy can provide a solution. The effects of manual therapy are often noticeable immediately after the treatment; joints function better and exercise is easier. 

Examples of complaints that a manual therapist can treat: 

head and neck pain in combination with the poor movement of the spine

neck and shoulder complaints with radiation to the arms; low back pain, with or without a look to the legs

high back complaints, whether or not in combination with rib and chest pain; dizziness when moving the neck

jaw complaints, whether or not in combination with neck complaints; hip complaints

Already during the investigation at the first appointment will show if and how your specific complaint can be remedied. Immediately after the first appointment you have clarity about the further treatment. 

Method of manual therapist

Intake: quick clarity After an initial screening, your first appointment consists of two parts: an interview and a physical examination. In the conversation, the manual therapist asks questions about your complaints; for example how they arise and when they increase or decrease. This is followed by a physical examination, in which the manual therapist assesses your posture and movements and examines your joints. This way it is determined where the causes of your complaints are. Together with the patient, the manual therapist or manual therapy makes sense. If that is the case, then the manual therapist discusses with the patient an approach for further treatment. So you have clarity about the follow-up immediately after the first appointment.

Treatment: effective therapy The manual therapist has a number of specific techniques that can be applied in the joints, in order to make the joints function better and to improve your posture and movements. The effects are often immediately noticeable: you feel an improvement in the freedom of movement and a decrease in pain. The manual therapist's treatment program furthermore consists of giving good instructions, advice, guidance and insight into healthy exercise. 

Treatment: specifically effective therapy Manual therapeutic assistance takes place in a practice room that has been set up for this purpose and not in patients at home. Proper manual therapeutic assistance presupposes a specific treatment space, specific equipment and measuring instruments. Only in very exceptional cases, and at the express request of a general practitioner or medical specialist, can this be deviated from, but only for the performance of a diagnostic consultation.

On this site you will find information about various subjects that concern daily practice. 

In the Practice News section you will find current information concerning practice. 

You can use the contact form to make a first appointment. 

Of course you can also contact us by telephone:

070-3853366 and 070-3857153. 

You can find a film (specialization, physiotherapy) (see youtube KNGF corporate film) where you can get an impression in a few weeks about the possibilities of physiotherapy. 

Under specializations, manual therapy you will find a similar video (see youtube commercial manual therapy), specially made to get an impression about manual therapy. 

Physiotherapy practice Letzer and Doesema is contracted with almost all health insurers, including Agis, Achmea, Menzis, Uvit (VGZ-UNIVE), CZ group.

This includes tariff agreements. This means that the costs for physiotherapy are reimbursed and submitted directly to your health insurer.

Podiatry

 For whom? Podiatry (pedis = foot) offers a solution for a very large group of people who experience a lot of disruption in daily life from: 

1) Foot complaints as a result of a primary foot deviation i.e. the flat or hollow foot with characteristic problems such as forefoot pain, heel spurs, deviations of the toes, fatigue, etc. 

2) Complaints to the musculoskeletal system of legs and / or back (muscles and joints) caused by a primary foot deviation or leg length difference.

Pain symptoms in the lower leg, knee, and lower back are a good example of this. 

The following therapeutic options exist for these complaints: 

1) fitting podological insoles that are made to measure. 

2) applying orthotics (toe corrections) 

3) podiatric physiotherapy: not all deviations can or should be remedied with soles / orthoses. 

Specific physiotherapeutic knowledge can be used to improve muscle and joint functions by means of stabilization training and / or mobilizations. 

4) a combination of the possibilities described above. 

The added value of physiotherapeutic knowledge in the field of the whole! musculoskeletal system in combination with podiatry is unique and leads to a total 

customized treatment and advice. 

Advice 

We offer both athletes and non-athletes the opportunity to obtain independent advice with regard to: 

- complaints of the foot, leg and / or back

- choice of (sports) footwear

- daily tax

- prevention

- use of soles

- training programs / therapy

Revalidation 

We are also specialized in the rehabilitation of foot / ankle and knee injuries. These injuries often have a chronic character and require expert guidance. Our practice has modern training possibilities where you can optimally rehabilitate. 

Research 

In order to determine the cause of your complaints and to assess whether these complaints are related to other factors, the investigation will always start with a 

personal interview (the anamnesis). Together we will try to get an idea of ​​your complaint, the related factors and the consequences this has on your daily life. Subsequently, the research begins which, depending on the complaints, looks at: 

- the position and function of the feet in relation to others

joints, such as the knee and hip 

- the function of the feet and other joints / muscles

by means of an extensive orthopedic examination. 

- analysis of the gait pattern 

- assessment of the footwear 

Combining these data leads to an accurate diagnosis of your complaints.

Therapy 

Based on the deviations found, a proposal will be made with regard to the right treatment, advice, use of soles etc.

Reference 

Via your GP or specialist but you can also consult us without a referral. 

compensation 

Always consult your insurance policy in advance of the reimbursement for podiatric assistance. Referral based on physical therapy is almost always reimbursed if you have additional insurance. 

J.G. Doesema

Physiotherapist / Podiatrist

What is CranioSacral Therapy?

The gentle touch that treats the craniosacral system

CranioSacral Therapy (CST) is a hands-on therapy, where the touch is gentle, non-invasive and usually subtle. But do not be fooled! It is also a powerful therapy that affects the central nervous system to assist in improving function in the whole body.

We are aiming to treat the craniosacral system. This is the term Dr Upledger originally coined to describe the structures that produce and enable a rhythm he observed while assisting in a spinal surgery. (He was trying to hold a structure called the dural tube still while a colleague operated, but he couldn’t as it was moving all by itself!

He eventually called this rhythm the craniosacral rhythm and saw it as being created within the craniosacral system: structures that enable this are the meningeal membranes that surround and support the brain and spinal cord, the bones of the head to which they attach and the cerebrospinal fluid that surrounds and protects the brain – beautifully illustrated in the image here.

Ideally, this fascia and structures are all well aligned, the fluid can flow round the brain and spinal cord easily and the rest of the body is not having any less-than-optimal impact on this system (the fascia and nerves affect this system as much as they influence the rest of the body) but, life happens, from in utero onwards, and this system may not be as well aligned and flowing as it could be.

Using our ‘listening hands’, tuned to the feeling of the craniosacral rhythm, we feel how well the rhythm is reflecting out to the rest of the body and what we may be able to do to improve its function. This may mean simply encouraging it, as if you are gently flushing more fluid through a slightly sticky pipe, or it could mean using gentle techniques to unwind kinks in the body’s fascia – sort of like straightening out a sleeve or sock that isn’t on quite squarely!

An important part of our approach (that is completely born out in practice), is that it is the person’s body that knows exactly what to do in order to straighten out the above mentioned kink itself, and all we are really doing is listening to what it needs and helping it to do it! So we do not try and figure out what is wrong and then try to fix it. This can mean that the area we treat is sometimes different from the area in which symptoms are experienced, as our bodies can be very clever in how they adapt to stresses and strains.

Patients find CranioSacral Therapy effective for a wide range of problems associated with discomfort, pain and dysfunction. Interestingly, this approach also appears to complement and stimulate the body's natural healing processes, so CST is increasingly used as a preventive health measure to keep us on the straight and not so narrow!

What is different about the approach of practitioners in Upledger CST ?

Compared with other bodywork approaches, the main differences are that the touch / pressure used is much gentler and that we do not aim to diagnose or fix anything from what our ‘head’ thinks needs to happen – or even where our clients say their problem is! Rather, we simply (it is, in fact, far from simple!) do our very best to ‘listen with our hands’ to a person’s body tissues and invite them to show us what they need to do. Osteopathic traditions have always believed that the body has an inherent self-healing mechanism, and we do our best to honour and access this at all times.

In terms of other craniosacral approaches, some focus more exclusively on the flow of the cerebrospinal fluid (biodynamic), and some incorporate many similar techniques but have a different way of working with the emotional components of our experience that can be held in body tissues. Dr Upledger called his approach to this SER or SomatoEmotional Release. You can find out all about it here: What is SER?

Intermittent Claudication

Intermittent Claudication is caused by narrowing or blockage in the main artery taking blood to your leg (femoral artery). This is due to hardening of the arteries (atherosclerosis). The blockage means that blood flow in the leg is reduced. Blood circulation is usually sufficient when resting, but when you start walking the calf muscles cannot obtain enough blood. This causes cramp and pain which gets better after resting for a few minutes. If greater demands are made on the muscles, such as walking uphill, the pain comes on more quickly.

Claudication usually occurs in people aged over fifty years; however it can occur much earlier in people who smoke and those who have diabetes, high blood pressure or high levels of cholesterol in the blood.

Unfortunately, the blockage which causes the claudication will not clear itself, but the situation can improve. Smaller arteries in the leg may enlarge to carry blood around the block in the main artery, this is called collateral circulation. Many people notice some improvement in their pain as the collateral circulation develops. This normally happens within six to eight weeks of the start of the claudication symptoms.

The following information will help to explain the diagnosis and treatment of claudication:

How is Claudication detected?  
A blockage in the circulation can be detected by examining the pulses and blood pressure in the legs. A blockage will lead to loss of one or more pulses in the leg. The blood pressure in your feet is measures using a handheld ultrasound device called a continuous wave Doppler.

The blood pressure in the foot can be measured and compared with arm blood pressure (which is usually normal). This measurement is called the ABPI (ankle brachial pressure index) and is expressed as a ratio. The ABPI provides an objective measure of the lower limb circulation.

Sometimes an arteriogram may be performed. An arteriogram is an x-ray of the arteries performed by injecting contrast (dye) into the artery at groin level. The contrast outlines the flow of blood in the arteries as well as any narrowings or blockages.

Treatments  
Claudication is not usually limb threatening and it is not necessary to treat it if the symptoms are mild. Claudication often remains stable, with no deterioration in walking distance over long periods. Less than one in ten patients will notice any reduction in walking distance during their lifetime. However if your symptoms worsen, there are treatments available which you can discuss with your vascular surgeon.

General measures to improve walking distance include stopping smoking, taking more exercise and making sure you are not overweight. Blood tests to rule out other causes of atherosclerosis are often done. These will include a blood sugar test to exclude diabetes, thyroid and kidney function tests and a cholesterol test.

There are a number of drugs on the market which claim to improve walking distance. These are not used by vascular surgeons, as the evidence for their effectiveness is very limited. There is evidence that taking Aspirin or Clopidogrel is generally good for people with circulation disorders (heart, brain and legs). Please consult either your G.P or vascular surgeon for more information.

There are three approaches to treating the claudication itself:

Exercise
Exercise has been shown to more than double walking distance. Some hospitals can offer an exercise programme with structured exercises. If this is not available, a brisk (the best you can do) walk three times a week lasting thirty minutes will normally noticeably improve walking distance over three to six months.

Angioplasty
Angioplasty (stretching the artery where it is narrowed with a balloon) may help to improve walking distance for some people. Overall it is less effective in the longer term than simple exercise. Angioplasty is usually limited to narrowings or short complete blockages (usually less than 10cm) in the artery.

Surgery
Bypass surgery is usually reserved for longer blockages of the artery, when the symptoms are significantly worse. There may be very short distance claudication, pain at rest, ulceration of the skin in the foot, or even gangrene in the foot or toes.

Is treatment successful? 
The simple exercise program is very successful at increasing the walking distance. It provides a long term solution for the majority of people, and most importantly it is safe.

Because surgery (and to a lesser extent angioplasty) is not always successful, it can normally only be justified when a limb is threatened. There will usually be pain keeping you awake at night, or ulceration or gangrene of the foot or toes. Half of the bypasses performed will need some “maintenance” procedure to keep them going. This may be an X-ray procedure or might involve further surgery.

What is the risk of losing my leg?  
Very few patients with intermittent claudication will ever be at risk of losing a leg through gangrene. It is the vascular surgeon’s job to prevent this outcome at all costs. If there is thought to be any risk to the limb a vascular surgeon will always act to save the leg if at all possible. You can minimise the risk of progression of your symptoms by following the advice below. It is the simple measures which are the most effective. The vast majority of patients do not need x-ray or surgical procedures to treat their symptoms.

How can I help myself?  
There are several things you can do which can help. The most important are to stop smoking and take regular exercise. If you are a smoker, you should make a determined effort to give up completely. Tobacco is particularly harmful to claudicants for two reasons:

• Smoking speeds up the hardening of the arteries, which is the cause of the trouble
• Cigarette smoke prevents development of the collateral vessels which get blood past the blockage.

The best way to give up is to choose a day when you are going to stop completely, rather than trying to cut down gradually. If you do have trouble giving up, please ask your doctor who can give you advice on additional help, or put you in touch with a support group.

It is also important not to be overweight. The more weight the legs have to carry around, the more blood the muscles will need. If necessary, your doctor or dietician will give you advice about a weight reducing diet.

More information and advice about vascular health.

Whilst we make every effort to ensure that the information contained on this site is accurate, it is not a substitute for medical advice or treatment, and the Circulation Foundation recommends consultation with your doctor or health care professional.

The Circulation Foundation cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link.

The information provided is intended to support patients, not provide personal medical advice.

Whiplash

 
Whiplash is the collective term for complaints that can occur after the head has made a sudden violent movement. This may have been a movement forward, backward and / or to the side. 

A so-called 'classic whiplash' occurs when someone is hit from behind. The head of the occupant of the car that has been hit will first be pushed back vigorously. The moment the stopped car comes to a halt again, the head is strikingly forward. The neck then made a movement of a 'whiplash': the literal translation of whiplash. 

With a whiplash, the head has always made a violent movement with respect to the rest of the body. To more accurately indicate which movement has made head, some doctors also call the whiplash acceleration injury (head struck forward) or deceleration injury (head struck backwards). The term Cervical Acceleration Injury (CAL), also referred to as acceleration injury in the neck vertebra region, is used. 

These movements are accompanied by a lot of speed and power. As a result, stretching, compression and shift (micro) injuries can result in various structures such as vertebral bodies, vertebral joints, intervertebral discs, ligaments, muscles, neural pathways and brain tissue. If the head was turned at the moment of the accident, the risk of injury is greater. 

Symptoms

The whiplash condition is divided into different stages related to the severity of the complaints. The elapsed time can also be divided into phases. 

The clinical symptoms (WAD = 'whiplash associated disorders') can be divided into five degrees.

0 - no complaints, no subjective and objective deviations

1 - pain, stiffness and sensitivity in the neck, but no objective deviations

2 - neck complaints and other complaints of the postural and musculoskeletal system (eg reduced mobility, pressure point sensitivity)

3 - neck complaints and neurological deficits (for example decreased or disappeared tendon reflexes, muscle weakness and sensory disorders)

4 - neck complaints and fractures or dislocations * Symptoms such as deafness, dizziness, ringing in the ears, headaches, loss of memory, swallowing disorders and pain in the temporomandibular joint can occur at any level of severity. 

The elapsed time since the accident can be divided into six phases:

up to four days;

four days to three weeks;

three to six weeks;

six weeks to three months;

three to six months

and longer than six months.

Symptoms of whiplash 

The most common whiplash complaint is a painful, often stiff neck. Many whiplash patients also suffer from headaches, low back pain and radiating pain to the arms and face. However, there are many more complaints that can be part of a whiplash trauma, such as loss of strength in the arms, dizziness, balance disorders, nausea, tinnitus, poor vision or staining of the eyes and sleep and concentration problems. Not only the nature, but also the seriousness of the complaints is very different. Half of the patients were recovered within a month, but sometimes the consequences are so serious that it leads to incapacity for work. 

Diagnosis

Because the whiplash trauma is often associated with a head-to-tail collision, the diagnosis is often made much less quickly or not in patients with a different accident. What exactly is being damaged at that moment is still not properly demonstrated. However, there are different theories about it. The most plausible of these is that (as with a sports injury) ligaments are stretched and / or muscle fibers are damaged. Most abnormalities are difficult to visualize with current medical techniques such as X-ray photography, CT scan, EEG and MRI, which makes some people tend to see the symptoms as psychological. The diagnosis is made on the basis of the known complaints of the patient. 

Causes

The main cause of the whiplash trauma is the rear-end collision, where the head, which usually weighs 5 kilos, swings back and forth at great speed. 

The whiplash trauma is regarded as a typical disorder of the twentieth century, because the increasing number of patients is mainly due to the fast-growing motorized traffic. If you look at the rear-end collision, the following happens: There is a car waiting for the traffic light. And the driver of the car coming back does not pay attention and crashes with great speed on the waiting car. 

If you now assume that the moving car is traveling at 50 km / h, this causes a rearward acceleration of the head of 250 km / h when the vehicle is stationary. The muscles do not get the chance to prepare for the blow and therefore the head swings backwards and pulls the vertebrae. Then an acceleration emerges, after which the neck vertebrae again shift with the surrounding bands. All this gives the whiplash trauma. 

Causes that cause the symptoms to become chronic.

Whiplash related factors: 

decreased mobility of the neck (just after accident)

rather head trauma

higher age

the way of dealing with complaints

psychosocial factors: eg passive coping, anxiety, less satisfied with work situation

Course 

In 70% of the victims the symptoms disappear within 3-6 months. At 30%, however, chronic complaints develop with limitations in daily activities. At 10% there are serious pain complaints indefinitely.

The main problem is that, for unclear reasons, the symptoms do not disappear but become chronic, despite the fact that no physical abnormalities can be found. In this phase of chronic becoming, all kinds of behavioral factors occur, so that the course is even more unfavorably influenced, sometimes even in such a way that these factors are caused by the injury itself predominating. 

Epidemiology

Epidemiological data with regard to the occurrence of whiplash are usually derived from the number of insurance claims submitted. Partly because of this, the annual incidence rates of whiplash vary greatly from country to country. For the Netherlands, the number of new patients with a whiplash is estimated at 94 to 188 per 100,000 inhabitants per year. These figures are much higher than the international figures because they are derived

accident statistics. No Dutch data are available on the prevalence of certain symptoms after whiplash. 

Therapy

A whiplash is treated in different ways. The treatment prescribed by the doctor depends on the severity of the injury, the complaints you have and your medical history (for example, head-and-neck injury). It goes too far here to discuss all forms of treatment. 

Many people with whiplash injuries are prescribed a collar and / or physiotherapy. The neck collar is meant to temporarily relieve the neck. The effect of a neck collar over time has not been clearly demonstrated. In some cases this can actually maintain the complaints. Your doctor or physiotherapist can advise you best about the use and use of the neck collar. Wearing a neck collar may in any case not last longer than six weeks. This is because keeping the neck joints more or less immobile can lead to a permanent restriction of movement. 

If you come to the doctor or general practitioner shortly after the accident, he or she may be referred to you to have x-rays taken. This is done to exclude other injuries. It can also refer you to a specialist or physiotherapist for further treatment. 

Physiotherapy

For more than 25 years we have been treating whiplash patients with good results. Special courses have been followed for this.

We work with treatment protocols that have been developed in collaboration with the whiplash institute PELS and other organizations. The physiotherapeutic treatment is mainly concerned with movement therapy. We also check whether no vertebral movements have occurred as a result of the accident. These are corrected with very gentle techniques if necessary. After this, the muscles of your shoulders, back and neck are strengthened so that you can do more. This is because after a whiplash accident, you often do not use the muscles because it is painful. As a result, the muscles relax and you get complaints more quickly if you have to use the muscles again. By strengthening the muscles under good supervision of the physiotherapist you can do more without getting complaints 

The general aim of physiotherapy is to let the patient return to a full (or desired) level of activities and to prevent chronic complaints with whiplash. In the first three weeks after a whiplash the physical therapist observes and supports the natural course of the consequences of whiplash. From 3 to 6 weeks, the physical therapist will respond to the patient's handling of the complaint if necessary. The physical therapist makes use of behavior-oriented principles, in which the moving functioning is central. Paying too much attention to pain symptoms and low stimulation of activities can adversely affect the recovery. 

For more detailed information, please refer to: www.whiplash.nl

RSI / CANS

What is RSI? 

This difficult and painful condition can be treated well with techniques from the English RSI specialist Prof. J. Greening and with the trigger point therapy developed in New Zealand. Supplemented with a spinal column treatment and medical training therapy, this approach gives very good results! If desired, a video recording can be made of your posture during computer work, for example, to achieve an optimal working posture. 

Search on the internet what RSI is and you will find 1001 different descriptions. Moreover, there are many other national and international terms for the same group of disorders, such as Work-related Complaints to the Movement Equipment or Occupational Overuse Syndrome. However, RSI seems to be the most widely used and known term worldwide. RSI stands for Repetitive Strain Injury. RSI in itself is not a disease, but an understanding of a certain degree of disorders and complaints in the 'work area of ​​RSI'. 

General description RSI

RSI is a collective name for complaints, symptoms and syndromes that occur in upper back, neck and shoulder area, arms, elbows, wrists, hands and fingers.

The complaints are usually caused by repetitive movements, a prolonged static posture or a combination of both. Furthermore, personal and work-related factors can play an important role in the development, worsening or maintenance of RSI. RSI occurs in many professional groups. 

Scientific description

On behalf of the Minister of Health and the State Secretary for Social Affairs and Employment, a committee of the Health Council has carried out research into the state of science concerning RSI. In 2000, this committee released a report (download here) and, among other things, formulated a scientific definition of RSI.

For a complex condition such as RSI, the following complex description fits: 

RSI is a multifactorial symptom syndrome affecting disability or participation problems at the neck, upper back, shoulder, upper and lower arm, elbow, wrist or hand or a combination thereof characterized by a disturbance of the balance between load and load capacity, preceded by activities with repeated movements or a static posture of one or more of the said body parts as one of the presumed etiological factors. 

The complaints

The use of the three phases (explanation) to indicate the severity of the complaints or problems is fairly common with both patients and practitioners. According to the Health Council report, this frequently used classification is unclear and there is no clear relationship between the different phases and the prognosis of the complaints.

However, the committee recognizes the existence of different grades of severity of RSI complaints. Starting complaints are characterized by the symptoms without any participation problems. Participation problems are central in a second stage. Finally, there is a stage where chronic pain complaints dominate.

The RSI association as well as the medical world are increasingly moving away from the generally used phase format.

The main reason is that it can lead to wrong conclusions, both on the severity and the approach, and on the prognosis: 

It is a misconception that the complaint progression from phase 1 to 2 and 3 always takes place gradually. Coming complaints can also develop into serious complaints within a very short time.

Another false impression that could arise is that long-term starting complaints would be less serious than having temporary serious complaints. Timely intervention remains of great importance.

The complaints can vary enormously per person. The complaints mentioned are generally recognized, but it does not show exactly in which phase someone is. This must not affect the approach to complaints.

Finally, the main misconception: in the past phase 3 often linked the prognosis to 'irreparable'. This prospect can lead to depression and resignation. The vast majority recognize a slow but certain progression towards recovery.

Diagnostics: specific and non-specific RSI

Many diagnoses fall under the umbrella of RSI. To the specific RSI we can count on the demonstrable disorders such as tendinitis, epicondylitis, Thoracic Outlet Syndrome (TOS), Carpal Tunnel Syndrome, Rotator Cuff syndrome, Tension Neck syndrome, and Quervain syndrome. Aspecific RSI is a form of RSI in which no specific disorders are found. It is of course important that good research is carried out into specific and non-specific disorders. Unfortunately, in practice, this is often omitted. The Health Council assumes a ratio of 87% non-specific RSI and 13% specific RSI. With better research into the disorders, this relationship might be very different.

The RSI center describes RSI as a dome diagnosis. It is stated that many studies can contribute to the diagnosis of RSI, such as a description of the history and symptoms, a function test and the exclusion of other disorders. A clear understanding of the complaints and the right treatment are necessary, according to the RSI center.

In February 1998, by order of the Ministry of Social Affairs and Employment, guidelines were drawn up for the determination of work-related disorders of the musculoskeletal system of the upper extremity. With these guidelines the link between a disease and work can be determined.

These guidelines can be found in the Saltsa report drawn up by the Netherlands Center for Occupational Diseases / Coronel Institute for Work, Environment and Health of the Academic Medical Center of the University of Amsterdam. 

Work definition RSI

How can RSI be recognized? What is the complaint pattern of RSI? In order to improve the recognisability of RSI among the people who suffer from it, Jip Driehuizen & Carien Karsten launch a new work definition of RSI syndrome in their book Dealing with RSI.

This description gives a practical and recognizable picture of how the complaints occur and we therefore consider it worth mentioning. Note: even if you do not fully recognize the below, there can still be RSI complaints. More information about the complaints procedure. 

According to Jip Driehuizen & Carien Karsten in "Coping with RSI, how to prevent it from becoming chronic" (2002), RSI syndrome is described as: 

The complaints are longer than about six weeks.

There is pain or unpleasant, diffuse feelings, deaf feelings or tingling in at least more than one of the following locations: a certain spot between the shoulder blades, in the shoulder muscle, around the shoulder joint, around the elbow (left, right or both), in the forearm (back, front or both), in the wrist or in one or more fingers.

The symptoms worsen quickly by fine movements and sit in the same position for a long time. The most mentioned are: computer work and driving. Often the pain worsens after the job.

The complaints are provoked when force is applied with the hands (wringing, lifting).

Complaints can manifest in stressed conditions (in case of stress).

Complaints often arise during or just after a period of dedication to a certain task, pressure and / or stress.

The symptoms decrease as a result of rest, but they immediately return to the start of the provocative actions.

There is sometimes talk of awkwardness: for example, the handwriting is less beautiful or people drop things. 

Points of attention during physical examination

In the case of good physical examination, the care provider finds (source: Jip Driehuizen & Carien Karsten in "Dealing with RSI: how to prevent it from becoming chronic" 2002): 

A high tension of the neck / shoulder muscles and often also of the forearm muscles.

Painful points when touching between the shoulder blades, on the shoulder muscle, around the shoulder and on the back of the forearm.

Often a stiff walking wrist movement.

Very often a reduced elastic joint capsule of the shoulder joint.

An irritable large nerve strand in the arm when stretched.

Less good circulation of the arm when lifting that arm.

Sometimes a reduced ability to perform (very) fine motor movements.

Visceral Manipulation (VM)

Visceral Manipulation (VM) was developed by world-renowned French Osteopath and Physical Therapist Jean-Pierre Barral.  Barral's clinical work with the viscera led to his development of a form of manual therapy that focuses on the internal organs, their environment and their influence on many structural and physiological dysfunctions.

Visceral Manipulation is based on the specific placement of soft manual forces looking to encourage the normal mobility, tone and motion of the viscera and their connective tissues. These gentle manipulations may potentially improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body.

Neural Manipulation (NM)

French Osteopath Alain Croibier collaborated with Jean-Pierre Barral to develop Neural Manipulation. Neural Manipulation examines mechanical relationships between the cranium/spine hard frame to the dura and neural elements. It provides assessment and treatment approaches to work with restrictions of the dural and neural components not commonly focused on with musculoskeletal symptoms. Neural Manipulation’s main aim is to identify and release local nerve restrictions whilst at the same time examining the effect these local fixations have on the rest of the body.

Manual Articular Approach (MAA)

The Manual Articular Approach (MAA) courses are based on clinical techniques personally developed by Jean-Pierre Barral combined with Alain Croibier's scientific information.

"Articular" refers to the joints of the body, which are critical points of interconnectivity between all other structures within the body. MAA is a manual therapy modality that applies a comprehensive approach to working with the joints. It integrates all aspects of the joint including the nerve, artery, bone, capsule, meniscus and ligaments, as well as visceral and emotional connections. The application of the gentle MAA techniques aims to improve the body’s ability to restore itself to optimal health.

Relaxation therapy in physiotherapy practice Letzer and Doesema 

Relaxation therapy is aimed at treating an increased stress state, which manifests itself in a locally or generally increased muscle tone.

This can lead to muscle strain complaints that regularly recur in various places in the body, such as neck area, head area and low back area. 

Recognizing and recognizing an increased muscle tone contributes to the fact that the stress level can normalize again.

Relaxation therapy is a form of exercise therapy, which for a large part can be applied in daily life after instruction and training in practice.

 Relaxation therapy uses:

- learning conscious muscle relaxation techniques.

- breathing as a means to relax.

- autogenic training. 

Relaxation therapy can be supported by massage therapy to reduce locally increased muscle tone. 

Breathing and relaxation therapy, Method of Dixhoorn

Breathe, luckily the body has arranged this well and it generally goes without saying. Whether it always is? No. And there are various causes for this. The most obvious are problems with the lungs. But the vast majority of 'breathing problems' or rather a dysfunctional breathing lining is the result of tension. Breathing and relaxation therapy (AOT) can then help.

In fact, it does not matter whether you have a burn-out, anxiety and panic attacks or are recovering from a heart attack, stroke, cancer or chronic lung problems. Spirit and body work together. It does not matter what happened first: the mental tension or the physical component. Eventually it suffers a general span. Everything you do is accompanied by too much tension: breathing, moving or talking.

Breathing and relaxation therapy is not just for people who notice that they breathe 'wrong' or dysfunctional. Overvoltage plays a major role in headaches, fatigue, sleep problems, continuous tension, fears, but also problems with posture, breath, voice and movement.

AOT uses exercises, manual techniques and feedback through conversations and evaluation methods. This ultimately leads to a better understanding of yourself, the control over tensions and a better quality of life. On average 6 sessions are sufficient to be able to continue on your own.

AOT is a method that is solidly substantiated. Sessions are (partially) reimbursed by most health insurers.

The sessions last one hour and cost 70 euros.

Physiotherapy Letzer and Doesema is contracted with almost all health insurers, including Agis, Achmea, Uvit (VGZ-UNIVE), CZ group. This includes tariff agreements. This means that the costs for physiotherapy are reimbursed and submitted directly to your health insurer.