The only exception is if the back is in an acute condition requiring emergency care or surgery. The exercises that will help with lower back pain the most will be assigned and supervised by a physiotherapist. They may be done at home, but it will be necessary to follow instructions and check in frequently. Neck injuries can cause quadriplegia, which requires special treatments. An important issue in spinal cord injury is the level of the damage. If a physiotherapy program is not followed faithfully, the spine will begin to atrophy below the level of the spinal cord injury. The spine will shrink and the whole body below that point will become weaker as time goes by. Physiotherapists use stroke rehabilitation to make sure that patients do indeed work to use their impaired limbs. They can do this in a number of ways. Sometimes it helps for the physiotherapist to tap or stroke the limb they want the patient to use. If the patient will not easily participate in active range of motion exercises, passive ones can be used where the physiotherapist moves the limb herself. It is one of the common sports injuries in people who play sports that challenge their knees, such as hockey, skating, skiing, basketball, and of course, football. It can limit the range of a player's motion in that leg, and make the leg weak. Surgery is sometimes done for these sports injuries, but physiotherapy is always a part of the treatment. The first step is for nurses or doctors to administer a stress test to determine how much exercise one can handle. This involves walking on a treadmill or riding on a stationary bike while having one's vital signs monitored. When the data is gathered and analyzed, a program of physical therapy will be put into place. A person with the stiffness that accompanies rheumatoid arthritis can be very limited in how far he can move his joints. Massage improves movement and increases this range dramatically. One of the most important functions a physiotherapist serves for patients with rheumatoid arthritis is as a motivational coach.