Conditions We Treat
- Neck pain and headache
- Whiplash injury
- Shoulder pain
- Elbow wrist and hand problems
- Back pain and sciatica
- Core stability problems
- Hip and groin pain
- Knee ligament injuries
- ACL reconstruction
- Knee meniscus injuries
- Foot and ankle pain and sprains
- Following fractures
- Joint replacement
- Sports injuries, strains and sprains
- Work related repetitive injury
- Rehabilitation after surgery
- Neurological conditions
- Continence promotion
- Antenatal and postnatal health issues
- Pregnancy massage
Neck Pain and Headache
The neck consists of 7 bones (vertebrae), muscles, ligaments, discs and nerves. Neck pain is very common and may occur due to injury, sustained poor posture such as prolonged computer use or general wear and tear.
Sometimes the pain may be referred into the arm or hand due to irritation of the nerves in the neck. Headaches can also be due to stiffness or increased muscle tension in the neck and upper back.
During your first physiotherapy appointment we can identify the tissues causing your pain and plan appropriate treatment.
Whiplash is caused by a sudden uncontrolled movement of the head and neck. It usually occurs during a road traffic accident (RTA) but can also be caused by falls or sporting injury. Permanent damage is rare and the long term outlook is good. Whiplash injuries can be very painful but are usually not serious.
Symptoms of pain and stiffness can occur in the neck and back and usually develop a day or two after the accident or injury. Headaches are common after whiplash and may be due to associated muscle tension.
Other symptoms may include dizziness, tinnitus and nausea.
The severe pain usually improves within the first few weeks after the injury. Your doctor may initially prescribe painkillers and anti-inflammatories to help your symptoms. A return to active movement and normal function is advised as soon as possible.
Physiotherapy techniques such as gentle mobilisation, specific exercises and acupuncture can help to reduce pain and restore function
The shoulder is a complex but mobile joint comprised of the upper arm (humerus), shoulder blade (scapula) and collar bone (clavicle). Because it is a flexible joint, the muscles and other soft tissues around the shoulder are very important in maintaining stability and function. Problems may arise if there is damage or inflammation to any of the structures. Rotator cuff pathology, tendonitis, impingement syndrome, frozen shoulder (adhesive capsulitis), osteoarthritis and fractures or surgery can all cause pain, stiffness and reduced function. Shoulder pain can also be referred pain from the neck.
Physiotherapy plays a crucial role in diagnosing and rehabilitating shoulder problems.
Tennis elbow and golfers elbow are both painful elbow conditions that are regularly treated by physiotherapy. Golfers elbow causes pain on the inside of the elbow while tennis elbow affects the outer part of the elbow. They are usually due to overuse of the forearm muscles during tasks that include gripping or repetitive movement such as keyboard or mouse use. Symptoms may include pain, stiffness, swelling, weakness and an inability to grip. Physiotherapy treatment and advice can dramatically reduce the painful symptoms of golfers and tennis elbow. Treatment may include mobilisation of joints and soft tissues, electrotherapy or acupuncture. A progressive eccentric strengthening programme can be very effective.
Osteoarthritis of the elbow is not a common condition however this may occur secondary to elbow fractures. Osteoarthritis of the elbow may cause symptoms such as crepitus (creaking), restriction of movement and pain.
Wrist and Hand Problems
There are many conditions which can affect the wrist and hand such as trigger finger, de Quervains tenosynovitis and ligament damage. Physiotherapists are skilled in assessing these conditions to give you a diagnosis, treatment and management plan. This may include mobilisation of the joints and soft tissues, the use of resting splints, electrotherapy, stretching programme and advice on activity modification.
Osteoarthritis is common in the finger joints and at the base of the thumb.
Back Pain and Sciatica
Back pain is very common and is not usually a sign of a serious medical condition. There are many structures in the spine such as vertebrae (bones), discs, ligaments and muscles which can cause pain. Early assessment and treatment is important to promote prompt recovery and return to normal activities. Staying active and regular exercise is one of the best ways to deal with back pain. As well as treating your symptoms your physiotherapist will advise you on the most appropriate types of exercise and activity for you.
Back pain may sometimes be associated with referred pain into your leg(s). This pain may be felt anywhere in the leg from your buttock to your toes. Other symptoms of sciatica may include tingling or numbness in the leg or foot. Sciatica is due to irritation of the sciatic nerve.
If you lose bladder or bowel control, please see your doctor urgently.
Core Stability Problems
Core stability refers to the ability of the muscles in your trunk (abdominal and back muscles, pelvic floor and diaphragm) to provide stability in your body while you are moving. Weakness, tight muscles, injury or periods of inactivity may contribute to an 'imbalance' in the trunk or pelvis which can in turn lead to pain. Physiotherapists are able to effectively assess any imbalance and help you address this. Pilates is an excellent way of improving flexibility, muscle strength, and endurance and puts emphasis on spinal and pelvic alignment, breathing, coordination and balance.
Hip and Groin Pain
Hip and groin pain can have a significant impact on your daily life affecting activities like walking, going up and down stairs, putting on socks and shoes and sleep as well as limiting your exercise or sporting ability. There are a vast range of conditions affecting the hip and groin for example, osteoarthritis, femoroacetabular impingement, bursitis, adductor muscle strains and hernias.
Hip osteoarthritis is characterised by degenerative change in the cartilage covering the hip joint. This degeneration may be caused by ageing, overuse injury, being overweight, previous trauma, leg length discrepancies, genetics or poor core stability. Osteoarthritis can cause symptoms such as pain in the front of the hip, buttock, thigh and groin as well as stiffness and weakness. Your Physiotherapist can help you address the cause as well as providing treatment and advice on improving mobility and strength of the hip and core stability
Femoroacetabular Impingement (FAI)
FAI is a hip condition where there is a mismatch between the shape of the acetabulum (hip joint socket) and femoral head (ball of the ball and socket joint). The result is an increase in friction causing pain, inflammation and decreased range of movement in the hip joint. Your physiotherapist will assess your hip joint including looking at range of movement, strength and impingement tests. Physiotherapy aims to mobilise the hip joint to stretch any tight structures, strengthen the muscles, to improve core stability and improve function. The pain from FAI is relatively self-limiting but if your symptoms remain unchanged then a referral to an orthopaedic consultant may be an option.
Bursitis is an inflammation of the bursa. A bursa is a small fluid filled sac which acts as a cushion between structures. In the hip the trochanteric bursa sits between the greater trochanter (bone) and the iliotibial band (thick band of fascia - fibrous tissue). The bursa can become inflamed by either a direct trauma or by repetitive friction. Symptoms include pain on the outside of the thigh aggravated by activity and difficulty lying on that side at night.
Adductor muscle strain or groin strain
The group of muscles on the inside of the thigh are called the adductors. The main function of the adductors is to pull the legs together (adduct). During normal walking they pull the swinging leg inwards to maintain balance.
An adductor muscle strain is often felt as a sharp pain on the inside of the thigh during exercise with associated bruising, swelling and tightness within 1-2 days of the initial injury.
Treatment involves an initial period of rest, gentle stretching, ice or heat and advice on return to activity. The physiotherapist will thoroughly assess the injury and give you guidance on the most appropriate treatment depending on factors such as the severity of the strain in order to aid your return to activity.
See also strains and sprains
Knee Ligament Injuries
There are various ligaments around the knee which have a significant role and importance in knee joint stability.
Medial Collateral Ligament (MCL)
The MCL stabilizes the inside of the knee and resists forces that open up the inside of the knee especially when the knee is in full extension (fully straight). The MCL is commonly injured in contact injuries with the contact against the knee or lower leg. It can also be injured by inwardly twisting the knee with the foot planted on the floor.
Lateral Collateral Ligament (LCL)
The LCL stabilizes the outside of the knee and resists forces that open up the outside of the knee. It also resists rotational forces with the knee flexed (bent). The LCL is less commonly injured than the MCL. As with the MCL the injury may either be contact or non contact
Anterior Cruciate Ligament Injury (ACL)
The anterior cruciate ligament is inside the knee joint between the tibia (shin bone) and femur (thigh bone). It prevents anterior (forwards) displacement of the tibia and also gives some rotational stability.
Injury occurs most commonly when the knee is flexed (bent) and the tibia is rotated in either direction as the foot is planted on the floor.
Posterior Cruciate Ligament Injury (PCL)
The PCL is also situated within the knee joint between the tibia and femur. The PCL prevents excessive posterior (backwards) movement of the tibia and also helps with side to side and rotational stability of the knee. It is less commonly injured than the ACL.
Ligament injuries are graded between grade I (minor strain) to grade IV (large tear). By undertaking a thorough history and a full examination of the knee the physiotherapist is able to assess the degree of damage to these stabilising ligaments. An MRI scan may also be carried out to establish which ligament or ligaments are injured. Physiotherapy treatment is guided by the degree of the strain/tear and is aimed at regaining stability. The physiotherapist will advise on an individualised rehabilitation schedule to suit your sporting and daily activity levels. If the injury is severe a referral to an orthopaedic specialist may be required.
An anterior cruciate ligament repair is a surgical procedure usually carried out as a result of a rupture to the ligament caused by injury. The ACL is situated between the tibia and femur within the knee joint. The injury is often a non-contact injury, for example deceleration with sudden stopping or jumping or turning. A 'pop' is often felt or heard. Swelling develops over the following few hours.
A contact injury usually results in multi ligament injury.
An ACL reconstruction is carried out to replace the torn ligament usually using part of your own hamstring tendon.
Following the surgery physiotherapy is aimed at reducing swelling, restoring movement and strengthening the muscles around the knee and trunk in order to regain full function, weight bearing and mobility. Physiotherapy lasts for between 6 and 10 weeks. You will be advised on a self management programme including gym exercise when appropriate. Active return to sport is usually around 6-12 months after the surgery. Physiotherapy is key to achieving your functional goals.
Knee Meniscus Injuries
The menisci (cartilage) in the knee joint sit between the femur (thigh) and tibia (shin). The menisci are integral to knee joint health. Their function includes transmitting loads across the knee joint, providing stability to the knee, shock absorption and joint lubrication and nutrition.
There are two menisci in each knee - the medial meniscus (inner side of the knee) and lateral meniscus (outer side of the knee). Each meniscus can be divided into portions to classify an injury. This can be done either based on the location of the meniscus within the knee or by how the blood is supplied to the meniscus. The blood supply classification is useful in determining how well an injury will heal (good blood supply is essential for healing).
Injuries to a meniscus are usually the result of a high force trauma. Sometimes low force trauma injuries occur, however this is more likely to happen in a meniscus that already has undergone some degenerative change. During the injury a popping sensation may be felt.
Symptoms of a meniscal tear include pain, swelling, inability to fully straighten the knee, loss of movement, locking, catching, the knee giving way and weakness.
MRI scans can confirm the presence of a meniscal tear.
Surgical techniques focus on preservation of the cartilage and repair if possible. This is usually done through an arthroscopy keyhole surgery. Not all meniscal injuries require surgery.
Recovery after the surgery is highly dependent on the specific procedure used. In general if the damaged cartilage is removed the recovery time is quicker than if the cartilage is repaired - healing time for a repair is longer.
Physiotherapy is an important part of the post-surgery rehabilitation and is aimed at regaining movement, strength, function, balance and stability.
Foot and Ankle Pain and Sprains
The foot and ankle are made up of a complex structure of bones supported by ligaments, tendons and muscles. While foot and ankle injuries are common in sports people they may also be sustained during relatively minor trips or falls or through repetitive action. Sprains, tendinitis, bursitis and plantar fasciitis are all conditions which can be treated with physiotherapy as well as rehabilitation following fractures, surgery or periods of immobilisation.
Most fractures need a period of immobilisation to allow the bones to heal. However side effects from this include stiffness, loss of muscle strength, pain, loss of co-ordination or balance, decrease in physical activity levels and over use of the uninjured limb or joints. Physiotherapy is aimed at addressing your specific limitations to regain movement and function as soon as possible.
Osteoarthritis (OA) is a degenerative condition which is characterised by loss of joint cartilage. Subsequently as a response to the increased mechanical stress there is an increase in local bone formation around the joint. These bony formations are known as osteophytes or spurs.Other soft tissues around the area may also be involved such as the synovium, ligaments and muscles.
Symptoms may include joint pain, tenderness, stiffness, locking and swelling. The joints most commonly affected are the knees, hips, back and neck, big toes and hands.
In some cases joint replacement may be appropriate.
There are a variety of causes of osteoarthritis including developmental, hereditary, metabolic and traumatic reasons.
Treatment will involve a combination of exercise, lifestyle modification, analgesics and weight management. The National Institute of Health and Clinical Excellence (NICE) recommends exercise as the principal treatment for osteoarthritis which helps relieve pain, maintain function and improve joint mobility. Physiotherapy can provide effective treatment for the symptoms of osteoarthritis. Exercises will be individualised for your condition and may involve a combination of strengthening, stabilising and mobility. Low impact regular exercise will benefit overall fitness and weight management. Other physiotherapy techniques may be used to relieve the pain for example acupuncture, TENS or electrotherapy.
The most commonly replaced joints are the hip and knee, however many other joints may be replaced for example the shoulder, elbow and ankle. The joint may need to be replaced as a result of osteoarthritis, rheumatoid arthritis, following fractures or injuries or bone disease.
Physiotherapy is extremely important in the overall outcome of any joint replacement surgery. Physiotherapy may be started prior to the surgery to build up muscle strength or increase flexibility.
During a hip replacement the damaged hip joint is replaced with prosthetic implants. This is usually carried out to relieve pain or after a fracture. A total hip replacement (THR) replaces both the femoral head (ball of the ball and socket joint) and the acetabulum (cup of the ball and socket joint). A hemiarthroplasty generally only replaces the femoral head (ball of the ball and socket).
The aims of physiotherapy following hip replacement are to prevent contractures (stiffening), improve range of movement at the joint, to strengthen the muscles, advice on appropriate walking aids and gait re-education as well as giving appropriate exercises and functional goals.
Hip replacement surgery is one of the most successful joint surgeries performed with the prosthesis lasting at least 15 years in 95% of patients. Long term results have been improving dramatically with new devices and techniques and look likely to continue to improve.
Knee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. It is most commonly performed for osteoarthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk.
Knee replacement surgery can be performed as a partial or a total knee replacement. In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow movement and function of the knee.
Following the operation there is typically substantial postoperative pain. Physiotherapy concentrates on relieving the pain, improving movement and regaining function. The recovery period is at least 6 weeks and may be much longer.
Sport and regular exercise are good for your health but can sometimes result in injuries. The typical symptoms from a sports injury are pain, swelling and restricted movements. Affected tissues can include muscles, ligaments, tendons or cartilage.
Sports injuries are often the result of overtraining but could also be caused by an accident, not warming up or using inadequate equipment or poor technique
If you have suffered a sports injury it is important to allow your body time to recover. Continuing to exercise while you're injured may cause further damage and delay healing.
Sports injuries can often be treated at home with rest and over-the-counter painkillers but you would also benefit from physiotherapy. Your physiotherapist will diagnose the problem and give you advice on appropriate exercise and return to activity as well as treating the condition to help speed the recovery process
See also strains and sprains
Strains and Sprains
A strain is an injury to a muscle or tendon and is often known as a pulled muscle. If the muscle or tendon is overstretched some of the muscle fibres may tear, for example a pulled hamstring while running.
Symptoms of a strain may include pain, stiffness, discoloration of the skin over the muscle or bruising. Muscle tears are graded according to the severity of the injury - Grade 1 usually involves a sensation of cramp or tightness and a slight feeling of pain in the injured area. Grade 2 causes immediate pain. There will be pain on stretching or contracting the muscle. There may be some swelling around the area. Grade 3 strains cause immediate pain, often burning or stabbing in nature, and it is difficult to move the affected limb. The muscle is completely torn. You may be able to feel a ridge of muscle tissue directly above a depressed area. The depression is where the tear is. With grade 2 or 3 injuries a large area of bruising may appear below the injury site caused by bleeding within the tissues.
Physiotherapy is an important part of the recovery process and is aimed at restoring function to the injured area. Electrotherapy may be used to help the healing process and acupuncture can be helpful in relieving pain and promoting the muscle healing. Following the initial acute stage your physiotherapist will guide you through a strengthening programme to regain full function.
A sprain is an injury to the ligament. Ligaments are tough fibrous tissue connecting bone to bone. If the ligament is stretched beyond its normal capacity some of the ligament fibres may tear. Ligament injuries are classified by the proportion of the ligament that is torn � first degree involves a few fibres, second degree involves a third of the ligament to almost all the ligament and a third degree sprain is a complete tear of the ligament. A common example of a ligament sprain is twisting the foot inwards causing a sprain of the ankle ligament.
Symptoms of a sprain may include pain, swelling, bruising and a decreased ability to move the affected limb or joint
A sprain is diagnosed by history of the injury and through a full examination. X-rays do not show ligaments but may be taken to exclude injury to the bone. MRI scans will show ligament damage.
Physiotherapy is important in the management of sprains. Prolonged immobilisation delays the healing of a sprain and will cause muscle weakness and stiffness in the joint. Physiotherapy will involve assessment of the injury to give a specific diagnosis, treatment to increase the range of motion and progressive muscle strengthening. Sometimes the joint may need to be supported by taping or bracing to allow healing and recovery.
In cases of complete tear bracing or sometimes surgery are needed.
Osteoporosis is a condition that affects the bones. Each bone is made up of a thick outer layer and strong internal �struts�. With osteoporosis the inner struts become thin causing the bone structure to weaken and become more likely to fracture.
Having osteoporosis does not mean that your bones will break but that you have a greater risk of fracture.
The thinning of the struts does not cause pain therefore you may be unaware that you have osteoporosis until there is a fracture.
The wrist, hip and spine are most commonly affected by osteoporotic fractures. The role of the physiotherapist is to encourage physical activity and teach exercises which can in turn help maintain bone strength. Treatment is also advised to aid recovery from a fracture.A healthy balanced diet which provides the recommended amounts of calcium and vitamin D is recommended.
Work Related or Repetitive Injury
Upper limb pain caused by overuse or work has many names in the UK including upper limb disorder (ULD), work related upper limb disorder (WRULD) or repetitive strain injury (RSI).
It covers symptoms experienced in the head, neck, shoulder, arm, forearm, elbow, wrist, fingers and thumb. Symptoms may include pains, ache, stiffness, weakness, tingling and numbness usually on one side but could also affect both sides.
Upper limb disorder symptoms can be due to a variety of activities, for example poor sitting posture while working on a computer, a manual job where heavy loads or repetitive actions are involved or by smaller fine movements as in the hand.
Making changes to your way of working can considerably improve symptoms. Try to avoid repeated actions and uncomfortable or sustained positions and decrease the use of force. Your physiotherapist will be able to assess and treat your symptoms as well as identifying your risk factors and guiding you and your employer on how you can make the appropriate changes.
Rehabilitation after Surgery
There are a whole range of surgical conditions after which physiotherapy is beneficial, if not essential. The most common types of surgery which require physiotherapy are orthopaedic procedures such as joint replacement or ligament repair.
If you are unsure whether physiotherapy is required please discuss this with your consultant or speak to one of the physiotherapists
Chemical, structural or electrical changes in the brain, spinal cord or nerves can result in a neurological condition. Conditions such as Parkinsons Disease, stroke and multiple sclerosis are examples of neurological conditions. Assessment and treatment of neurological conditions by a specialist neurological physiotherapist may help to maximise recovery or prevent deterioration.
Urinary incontinence in women is not inevitable. Urinary Incontinence (UI) is 'the complaint of any involuntary loss of urine'. Assessment is carried out by a specialist womens' health physiotherapist and treatment is aimed at training and strengthening the pelvic floor to improve or manage this distressing condition.
Antenatal and postnatal female health
Due to postural changes, hormonal changes and weight gain problems during and after pregnancy are very common. These may include muscle or joint pains, problems with the lower back and pelvis including the pubic symphysis, hip pains and bladder symptoms. Physiotherapy is aimed at maintaining joint mobility, managing or preventing pain and strengthening muscles as well as continence promotion. Antenatal and postnatal physiotherapy appointments are with a specialist womens' health physiotherapist
Massage during pregnancy can help relieve symptoms such as swelling and muscle aches and pains by increasing blood flow and encouraging lymphatic drainage while reducing fatigue and tension. Massage in pregnancy is carried out by a qualified massage therapist
To book an appointment, make an enquiry or contact us for further information, please call us on
020 8893 8676 or email us at firstname.lastname@example.org
T: 020 8893 8676