What can we treat?

This list has been compiled to give patients, doctors and surgeons an idea of the types of conditions that we treat. We have provided a description of the most common problems, their symptoms and possible treatment that might be offered. If you are unable to find your problem or it sounds a little different from our description it is probably because we can't fit everything in. Individual perception of pain also differs drastically and whatever symptoms you are experiencing these are personal and therefore can only be described by you.

As Chartered Physiotherapists, we are trained to deal with injuries and have the skills and knowledge to assess and treat pain and injuries that are of a musculoskeletal origin (bone, muscle, joint, tendon, nerve). We have specialist training in manual therapy, electrotherapy and sport specific exercise. Some of our therapists practice acupuncture as a compliment to treatment. Acupuncture is now considered a mainstream and conventional treatment option.

If you are unsure whether we can help, please call and speak to one of our experienced physiotherapists who will advise you on the most appropriate course of action.

HEADACHES

Headaches are one of the most common reasons for visiting a health care professional. We treat two types, cervical (neck related) and tension headaches, both of these can be related to joint inflammation, disc irritation, muscle spasm, nerve irritation or muscle trauma. Such factors can cause the small joints in the neck to become stiffened and lose normal gliding movements. The surrounding soft tissue such as muscle, fascia, and tendons shorten and are less mobile causing the nerves and blood vessels around the upper back of the upper neck to become trapped. The upper mid spine (thoracic) is sometimes stiff and this causes tension though the neck.

Causes:

Poor posture
Inappropriate desk set up
Poor sleeping position i.e. pillow and/or mattress
Trauma
Stress
Neck problems

Symptoms:

Headaches present as a dull and aching discomfort and are often spread over the head and sometimes into the face. They can start at the base of the neck and radiate over the top to the forehead (Frontal), around the sides (Temporal) and can be one (Unilateral) or both (Bilateral).

Treatment:

Techniques to correct the dysfunction by freeing up the soft tissues and joints include manipulation and mobilization which are highly effective at releasing stiff joints. Stretches and massage techniques correct muscle imbalances and relieve muscular tension. Ergonomic assessments help prevent a recurrence of the problem by altering sitting and sleeping postures.

NECK PAIN

The neck has a hard time in general, holding your head on your shoulders! It is little wonder that it is one of the most commonly injured or problematic areas. Over two thirds of the population will encounter a form of neck pain at some point in their lives. It is as common as and is often related to headache pathology. Pain can be attributed to disc pain, disc herniation/slipped disc, facet inflammation, nerve irritation, muscle spasm and/or muscle/ligament damage.

Causes:

Poor posture
Trauma i.e. Whiplash
Poor sleeping position
Inappropriate desk set up at work/home
Poor driving position

Symptoms:

Symptoms vary from mild to severe discomfort, and intensity of pain does not relate directly to the cause. Typically pain is emitted by the small joints either side of the neck. The neck often feels stiff and sore and may be stiff in the morning. Movement will be restricted and reversing the car may seem impossible. Pain or discomfort into the shoulder, arm or hand might be the result of a trapped nerve caused from a disc bulge (commonly called 'slipped disc') or joint inflammation irritating the nerve. If the nerve is irritated or compressed, a loss of sensation or pins/needles and loss of strength in the arm may be experienced.

Treatment:

Manual treatment is clinically supported to have a positive impact on neck pain. This can range from very gentle techniques to higher graded manipulative treatments. It really depends on the problem diagnosed.

Electrotherapy is useful and helps aid healing and settle pain allowing greater movement. Ultrasound and interferential (stimulation) are most commonly used.

Acupuncture has found great application in the treatment of pain and stiffness. It is a technique using needles. The application of the needles helps the body to restore its natural defence mechanisms and release endorphins to combat pain. Exercise is very important in order to strengthen muscles and improve posture and therefore prevent a recurrence of pain

ELBOW and FOREARM PAIN

olfer or Tennis elbow are less common in tennis and golfers and more frequently seen in the general population who engage in manual tasks or who operate a computer daily. The tendons of the forearm become tethered and inflamed, with the nerve sometimes being implicated, the joints can become inflamed and therefore stiff reducing ranges of movement and strength.

Causes:

Manual tasks
Poor seating posture
Sedentary occupations
Golf - poor technique
Tennis - poor technique
Trauma

Symptoms:

Pain on the outer (tennis) and inner (golfers) of the elbow. The bones are sore to touch and there is an ache at rest with soreness or sharp pains developing when objects are lifted with the hand. Pain may radiate into the hand and might even stem from the neck and shoulder. This is a consequence of the nerves being implicated. The nerves run through the outer and inner regions of the elbow and can become tight and irritated. It can be painful when gripping or reaching out with the hand. It may be difficult to type or use a computer mouse.

Treatment:

A combined approach is often needed with manual mobilisation or massage utilised, along with electro-therapeutic modalities such as ultrasound. Ergonomic assessment and questions about the work environment including postural habits are often indicated and may result in modifications to the work environment. The cervical spine is also assessed and often found to have tensioning around the small joints where the nerves feeding the forearm exit.

Graded strengthening is very important in restoring functional capacity to the muscles of the elbow and forearm.

Acupuncture is very effective as an addition to treatment. It helps restore the body's natural defence mechanism and can help stimulate the release of endorphins and natural anti-inflammatory chemicals.

SHOULDER

The shoulder is a very complex joint so this section will be broken into sub-sections of INSTABILITY, IMPINGEMENT/CUFF TEARS and CAPSULITIS.

The shoulder is held in place partly by a thin membrane called a capsule. This is then supported by strands of tough ligaments that help fix the arm bone (humerus) to the shoulder blade (scapula). Attached to the scapula are the rotator cuff muscles, a group of flat muscles with thin tendoninous insertions onto the humerus. The collar bone (clavicle) fixes to the top of the scapula forming the acromio-clavicular joint which sits over the top of the humerus preventing upward movement.

Possible diagnosis:

Rotator cuff Tear
Impingement
Dislocation/Instability
Frozen shoulder

Impingement/Cuff tears:

Impingement occurs when a structure, such as a tendon, becomes trapped between the arm bone and shoulder blade. The tendon is squashed and may become tethered resulting in inflammation and therefore pain. A Cuff Tear denotes a lesion affecting the tendons surrounding the shoulder joint. It may be traumatic or occur in association with an impingement.

Causes:

Poor posture i.e. sitting, computer work, manual occupations
Trauma to the acromioclaviular joint
Congenital abnormalities (problems since birth)
Falling onto an out stretched arm
Stretching beyond normal ranges

Symptoms:

Symptoms include: Difficulty putting on a coat; tucking in trousers; reaching behind to grasp safety belt; reaching for a cupboard. Pain may be elicited when rolling onto the shoulder at night. The arm may be weak where a tear has occurred and movement will be noticeably obscure.

Treatment:

Treatment is directed at the cause to ensure the causative factors are resolved. Electrotherapeutic modalities like ultrasound can help reduce pain and inflammation around the tendon and help optimize healing where a tear has occurred. The joint often becomes stiff and limits mobility therefore stretching and mobilizing techniques are indicated. Prevention measures and rehabilitation will often include postural exercises, core training, shoulder strengthening and ergonomic intervention (changes to work environment). Surgery is indicated where conservative methods have failed.

Frozen shoulder (Idiopathic Adhesive capsulitis):

Frozen shoulder is characterized by severe pain and a gradual loss of movement. Generally speaking it refers to a sticky joint where adhesions from inside the capsule and cause a restriction of movement.

Causes:

Sometimes Unknown
More Prevalent in Type II Diabetes
Posture
Trauma (may result in capsulitis)
After a Broken arm (may result in capsulitis)
Post dislocation in the older patient (typically 40 and above)

Symptoms:

Initially Severe Pain
Gradual loss of movement
Increasing pain with movement
Difficulty sleeping at night

Treatment:

Stretching, mobilisation, electrotherapy, acupuncture and manipulative therapy to the spine have been shown to provide benefit, relief and in some cases complete resolution. A cortisone injection is often helpful, particularly in the early stages and your GP should be consulted on this. The condition can resolve after 3 months with appropriate treatment. Untreated there have been reports of it lasting for up to 5 years. Surgery is sometimes indicated if all conservative methods have failed, however only after trying non-surgical treatment for at least 4 months.

Instability:

This is where the joint capsule and ligaments becomes loose and the muscles surrounding the joint become weak, this may predispose the joint to dislocation. It is sub categorized in to traumatic and a-traumatic.

Symptoms:

Traumatic - where the joint comes out of place, this looks visually out of position and is often very painful.
A-traumatic - the feeling of impending dislocation, intermittent and non-specific pains which may be multi-directional.

Causes:

Traumatic - Violent blow, arm stretched beyond physiological ranges.
A-traumatic - Posture, upper thoracic stiffness, congenital (since birth)

Treatment:

If the instability occurs via a traumatic episode a period of rest will be indicated and the patient will be asked to abstain from their chosen activity or occupation if manual for a few weeks. In the older patient, usually above 40 years (average), mobilization is encouraged early on to avoid stiffness developing. In the younger athlete the joint is already lax and therefore will need a period where the joint can stiffen up. In both traumatic and A-traumatic cases strengthening, core and postural work is essential. Local work to the shoulder can also be indicated if there are areas of soft tissue damage or there is a pre-existing spinal stiffness. Where conservative methods have failed or significant shoulder damage has been identified, surgery may be indicated.

BACK PAIN (Lumbar- lower and Thoracic - mid)

The most common reason for taking time off work. Back pain is complex, painful, debilitating and will affect 80% of us at some point in our lives.

There are many structures in the spine that can emit pain. As clinicians we can be 90% sure that we have identified the problem structure. Many structures in the spine respond to similar treatments therefore making intervention very effective.

When presented with a spinal problem our therapists will perform a thorough assessment and examination. This is to identify and exclude problems that would require further investigation. Through this process we can decide the best and most effective way to treat your back pain. In addition to treating the problem we can educate you about the pain and condition and help you to recover. We tend to group back pain into categories of mechanical or non-mechanical.

Causes:

Disc sprain
Disc herniation/slipped
Facet inflammation
Sciatica
Muscle spasm
Rib sprain
Ligament sprain

Symptoms:

Pain can be centred around the back; may spread to the buttocks; upper, front and back of thigh, groin or into the lower leg and foot where the nerve is involved. If the nerve is irritated or compressed then pins and needles can appear and there may be muscle weakness. Pain may be a constant ache, sharp upon movement or there may be a loss of movement. Pain may occur only when walking or sitting down. It may be difficult to get comfortable at night and the region is generally stiff after sustained postures and on rising in the morning.

Pain caused by the mid section of the back could manifest in chest pain. Chest pain is first and foremost a complaint that should come to the attention of your GP, particularly where it is associated by palpitation, breathlessness and general malaise. However, this pain is often associated with the spine and can be successfully treated. Mid back or 'Thoracic' pain will additionally be characterised by stiffness and difficulty straightening up in the back.

Treatment:

Manual therapy, including manipulation and mobilisation, is supported through scientific evidence in the treatment of lower back pain. The difference being the force of application, where manipulation is a sudden thrust, mobilisation tends to be a graded and repetitive movement.

Electro-therapy is useful for the reduction of inflammation and pain, and includes TENS, ultrasound and interferential. Massage is also helpful in reducing painful spasms and acupuncture can be beneficial as it stimulates the release of endorphins and natural anti-inflammatory chemicals within the body.

Rehabilitation following back pain is important in the reduction of recurrent problems. Exercises and postural training restore to the core regions and enhance the body's awareness in space.

WRIST AND HAND

The wrist and hand areas are complex as they are comprised of many bones and cartilage formations. There are many different conditions which may cause pain and restriction of movement. Structures that may be the source of pain include: Carpal Tunnel inflammation; Tendonitis, i.e. from repeated movements; Fracture/broken bones; Sprain of ligament, joint, tendon.

Causes:

Poor manual technique i.e. work, instrument
Trauma i.e. fall
Use of mouse/keyboard
Poor Work place set up

Symptoms:

Difficulty moving the hand in simple tasks such as turning a key, lifting a kettle, dressing. Pain may be at any point on the wrist depending on the structure involved. Pins and needles in the fingers will often indicate the involvement of the carpal tunnel, where the nerves become compressed or inflamed. Fractures are often characterised by a constant and unrelenting pain. It is best to get an x-ray when this is the case.

Treatments:

Typically mobilisation if there is a restriction of movement involving stretches and traction techniques. Manipulation is indicated where the bones in the hand are displaced or stiff. Electrotherapy utilizing ultrasound and TENS are effective for pain relief and optimizing the healing time of damaged tissues. Acupuncture for pain and the reduction of inflammation. Exercise is important for the restoration of movement and in order to capitalize on benefits gained during the treatment session.

SACROILIAC JOINT

The Sacroiliac joints are located at the very base of the spine. They attach the pelvis to the spine via the sacrum (fused base of the spine). Like all other joints in the body they have cartilage, a capsule, fluid and ligaments. Unlike other joints, they are relatively immobile and have very little movement taking place. Pain is emitted from the Sacroiliac joints when abnormal movement has taken place. This results in inflammation and, consequently, pain.

Causes:

Direct trauma
Posture
Poor training technique
Ligament sprain
Ligament Laxity i.e. during pregnancy where joint is hyper-mobile

Symptoms:

Sacroiliac pain can often occur in conjunction with lower back pain and the two are usually treated together. The Joint itself can refer to the side of the leg, buttock and even outer side of the foot. The patient will often point to an area of local soreness on the very lower aspect of the back.

Treatment:

Manual therapy and exercise to restore alignment will reduce pain and correct dysfunction. On examination the joint will often look out of alignment and the therapist will conduct an examination to identify the problem side and not necessarily treat the painful side in the initial phases.

HIP PAIN

The Hip joint is a very stable and robust structure. Like the shoulder joint there is a ball and socket like arrangement between the Femur (long leg bone), where the ball shape is located at the top of the bone, and the Pelvis, where a complementary ball socket shape receives the femur. The joint is held well into place by the shape of the pelvic cup, unlike the shoulder, and by virtue of the shape is a Very stable joint. The Capsule and fluid in the joint add to the stability by creating suction within the joint.

Possible diagnosis:

Osteoarthritis - changes to the cartilage inside the joint; Impingement - a catching sensation indicating changes to the bones surface, may be congenital; Pain referred from the lumbar spine masquerading as hip pathology; Bursa swelling - sac of fluid between muscles which help to reduce friction; Groin strain.

Causes:

Poor posture
Poor running technique
Congenital abnormalities (since birth)
Muscle imbalance

Symptoms:

Hip joint pains are often described as stiffness or catching through movement. They are typically felt in the groin or over the buttock region and are associated with the joint itself. Pain may be experienced when rolling in bed. The hip may be stiff in the morning when rising out of bed and could take a few minutes to get going. Where pain and soreness occurs over the side of the hip, trochanteric (troc, an, teric) bursitis is often the cause. Groin strains are classical of pain developing while kicking football or when pushing off during ice hockey.

Treatment:

Stretching, mobilisation, electrotherapy and acupuncture all have application within the treatment of hip pain. The correction of muscle balance is paramount to remove any abnormal stresses placed through the joint. This may incorporate stretches and/or strengthening techniques. The lumbar spine is always checked for possible signs of involvement. Groin strains require relative rest but must be mobilized early for a speedy recovery.

THIGH STRAIN - HAMSTRING, QUADRICEPS and ADDUCTORS

The thigh essentially has three compartments: The anterior (front) Quadriceps (group of four muscles); The posterior (back) Hamstrings (group of three muscles); and the medial (inside) Adductors (group of 4 muscles). The site of injury is usually indicated by the location of pain. Common sites tend to include the mid section of the quads, top of the hamstrings near to the buttocks or half way down the hamstrings toward the outer margin of the muscles. Strains are diagnosed according to severity of injury and are graded according to functional deficit.

Causes:

Poor flexibility
Insufficient exercise preparation i.e. at the start of a session
Fatigue i.e. at the end of a training session
Over-training
Muscle imbalances between front and muscles

Symptoms:

Low grade strains tend to be characterized by a small twinge or tightness developing thought the muscle. This may result in the individual having to stop and stretch but could then allow them continue training. Grade 2 strains will result in discontinued participation and a rehab period of 2-4 weeks pain will sometimes occur during normal activity. Grade 3 strains are usually a significant rupture of the muscle with continued exercise impossible. Pain will usually be experienced at rest and function will be hindered severely. Grade 3 strains will usually take anything from 6 weeks to 3 months to rehabilitate. This grading system can be used to grade ant muscle injury.

Treatment:

Acutely, or directly after the injury, the patient should apply ice for 15 minutes with the leg elevated above the level of the hip to allow for drainage. Ice should then be re-applied every hour for 10 minutes. The ice should provide adequate pain relief, if one finds pain is unrelenting then a medical or healthcare professional should be consulted.

Physiotherapy would typically consist of mobilization and stretching techniques. Ultrasound and interferential help optimize healing and therefore hasten healing times. Strengthening is very important in re-establishing structural integrity within the muscle, and this should be followed up with sport or functional specific drills to enable the patient to return to their chosen activity/sport/occupation. Knowledge of preventative techniques will also be provided to help avoid future injuries.

KNEE PAIN

The knee is a fairly stable joint with many ligaments and muscle passing over and around. The knee joint consists of two joints: the patello-femoral joint (between the femur and knee cap), and the tibio-femoral joint (between the upper and lower leg bones).

Causes:

Meniscal Lesion
MCL/LCL strain
Bursa inflammation
Knee cap dislocation
ACL rupture
Osteoarthritis
Incorrect foot wear

I was just gardening, getting out of the car, crossing the road, getting out of bed when I felt a pain in my knee.

Symptoms:

Soreness around the kneecap, locking, giving way, pain on climbing stairs, swelling, heat, redness and muscle weakness are all possible symptoms.

Within and surrounding the knee and patella are a number of ligaments and muscles which may emit pain. Within the knee there are ligaments which contribute to stability and are essential in sports where pivoting and turning is required.

We may look at the feet as a possible cause. Poorly fitting shoes/trainers may twist the knee and therefore better in-soles may be the answer. Weakness around the hip and also running posture may be the cause, as without appropriate hip strength it is difficult to control the knee and foot placement.

The Menisci are two semi-circular rings of cartilage. They sit on top of the tibia and contribute to stability and shock absorption. 'Locking' and 'Giving-way' are the common signs of a meniscal lesion.

Treatment:

Conservative management aims to reduce swelling and restore range of movement. To decide whether or not surgery is indicated movement is paramount, particularly the ability to straighten the knee.

Electrotherapy is useful in order to optimise the healing of tissues by accelerating blood flow, reducing inflammation and helping to remove waste chemicals.

Manual therapy involving the mobilisation of the knee is useful in restoring movement and easing pain. Exercise is essential to restore and maintain the muscles around the knee as without appropriate strength, the knee cannot function optimally.

There is a huge emphasis on rehabilitation with all injuries, particularly the knee joint, especially if you are thinking of returning to a contact or high impact sport. Whole bodily rehabilitation, incorporating leg and core exercises with a particular focus on balance, coordination and plyo-metric (Bounding) activities.

CALF STRAIN or PAIN and ACHILLIES INJURY

The large muscles situated at the back of the lower leg constitute the 'Calf' muscles providing body balance and the capacity for explosive activities. They are therefore prone to injury during sporting activities. The area behind the ankle, the Achilles, can also be a source of pain. Injuries can vary from mild strains to complete ruptures.

Causes:

Repeated or new activities i.e. distance running
Ballistic activities
Tight muscles
Muscle imbalances
Poorly fitting Shoes
Low Arches in the foot
Degeneration (ware and tear) i.e. distance running

Symptoms:

A tear or rupture is a serious injury and something that should be looked at by a professional (Physiotherapist/Doctor). It will be characterized by tightness if very minor, or a sensation as though one has been kicked in the leg if more serious. Mobilisation immediately after may not be possible and the muscle may cramp. A snapping sound upon injury will require immediate medical attention and surgery might ensue.

More minor strains will be stiff after periods of rest and upon rising in the morning but will improve with movement.

Pain after or at the start of a run denotes degeneration in the tendon behind the heel or may be a result of recurrent small strains. Tendon injuries are typically stiff in the morning and take a few minutes to a few hours for them to loosen up, depending on the seriousness of the strain.

Treatments

Severe tears or ruptures of the calf muscle of Achilles tendon may need a scan and a surgical opinion. Where minor strains are identified ice should be applied in conjunction with rest for the first 48 hours. Where the tendon is injured, treatments are directed at stimulating a degree of controlled and purposeful healing to stimulate new tissue. Most problems only require conservative techniques and respond well to electrotherapy, mobilization and sometimes acupuncture. Exercise is very important after the injury in order to restore strength, ranges of movement, tendon regeneration and ultimately to allow the return to sport. Assessment of footwear and the provision of orthotics is sometimes indicated where a biomechanical abnormality exists which may have pre-dispose an individual to an injury.

FOOT PAIN

The foot is another of those complicated joints with many bones and tendons crossing over and into the region. It also has to bear the weight of the whole body and is many times smaller than the rest of the skeleton, hardly surprising it encounters a few problems.

Possible pathologies include:

Heel spurs;
Planterfacitis;
Fracture;
Ligament sprain;
Bunions;
Dropped arches - weakness/structural;
Tendon sprain/degeneration.

Causes:

Poorly Fitting trainers/shoes
Ankle sprain
Poor posture
Hip weakness

Symptoms:

Pain associated with a foot abnormality may be characterized by: Pain at the base of the foot, on the sole of the foot, heel pain when getting out of bed in the morning or when walking though the day, pain over the toes when mobilizing the joint, discomfort with certain shoe types.

Treatment:

Footwear assessment and modification is very important in resolving pain, particularly where the problem occurred during normal activity without obvious injury. Strapping is very useful particularly when considering orthotics (modified and prescribed in-soles) are indicated.

Electrotherapy and manual techniques where the soft tissue are mobilised can be helpful in reducing pain and helping to establish a sound healing process.

ANKLE PAIN

The ankle is relatively stable given the degree of demand placed on it. Most people have experienced a sprained ankle and these can vary in intensity. People often describe a rolling action where the foot gives way. The ankle usually becomes inflamed and is painful with movements

Causes:

Inversion Sprain (rolling over on the ankle)
Eversion Sprain (rolling inward on the ankle)
Muscle weakness
Poor foot posture
Unstable joint

Symptoms:

Sudden pain is often felt with a sprain and a snapping or popping sensation may be experienced. If you find you are unable to walk on the ankle after the injury then it is best to get an x-ray, it may be broken/fractured. The ligaments can sometimes rupture and this will be characterized by a feeling of instability.

Pain can develop in the joint over a period of time i.e. when running or walking and will often be evident when you have been exercising for a period of time several minutes to a few hours.

Recurrent sprains will occur where there is laxity on the joint or muscle weakness persists

Treatment:

The rule of thumb tends to be that if in doubt take a trip to A & E, generally if you are unable to weight bear, an X-ray is the best way to be sure. Strapping is very important early on in order to immobilise the joint and prevent further injury. Ice is often advocated to stem blood flow. The ankle being at the bottom of the body will not have the benefit of gravity to draw fluid away from the region and therefore we often tell people to elevate the foot when at rest. Mobilisation is important to reduce scarring, and ultrasound helps to establish a good scar formation. Exercise is essential in restoring normal muscle function and stability. Balance exercises and activities which retrain the ability to deal with sudden changes in direction are essential for normal function and sport. If the muscles are weak then there is greater risk of the ankle re-spraining.

POST OPERATIVE REHABILITATION

Rehabilitation and recovery after surgery can be long and often entail hard work and persistence. As Chartered Physiotherapists we are appropriately trained to ensure you receive the best possible chance of making a full recovery. Our skills and training provide us with a sound understanding of the anatomical and physiological make up of the body and therefore a complete understanding of the procedure/operation you have undergone. We have close relationships with Consultant surgeons and this makes for smooth and effective communication.

Many surgical procedures have post operative protocols. These are step-by-step guidelines which have been devised by surgeons and physiotherapists working together to find the most appropriate and effective methods for regaining movement, strength and function.

The protocols are designed for patients to identify progression and have time allocated milestones so that as a patient you are able to identify where you are and should be in your rehabilitation.

Treatment post-op will combine exercise, electrotherapy, manual therapy and coaching as a combined approach in-order for you, the patient, to get the best out of the operation and back to functioning as soon as possible.

Here are a few of the most common procedures we specialise in:

Knee surgery - ACL reconstruction, Meniscal Repair
Total Knee Replacement
Total Hip replacement
Hip resurfacing
Shoulder Surgery - Sub-acromial decompression, rotator cuff repair, stabilisation
Lumbar spine - fusion, discectomy, stabilisation
Achilles Tendon Repair
Post Fracture (after a broken bone has been fixed with a plate or screws)