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Physiotherapy - What We Treat

Our physio team treat a broad spectrum of ailments and injury's, from headaches to knee pain.

Here is a comprehensive list of what we can help you with.

Headaches

Once other potential pathological/medical causes of headache have been ruled out, physios are well placed to help with the mechanical causes of headache. Mechanical causes of headache are frequently generated by adverse muscle tension resulting from repeated unhelpful postures at work or during leisure time. The joints in the neck also lose their natural mobility as a result of frequently adopted poor postures and body alignment.

 

Treatment for Headaches is centred on analysing posture and adjusting the environment to assist. This can be the position of your chair, desk, monitor if you work in an office, or your machinery or equipment at work. It could even be a result of your position or form in the gym.

 

Your standing, sitting, sleeping and running posture can all contribute to adverse forces on the spine and its connective tissues that hold us together.

 

Our team will identify areas of possible tension, weakness, lack or excessive length of tissues and stiffness in the muscles, bone and connective tissue system. We will then use the wide variety of evidence based techniques available to the experienced therapist to tackle these.

 

Techniques may include soft tissue release techniques, joint mobilisations or manipulations, dry needling/acupuncture, home stretching and core stabilisation/strengthening exercises.

 

Our aim is to finish the course of treatment knowing the cause of a problem and put in place a suitable strategy to prevent the problem from recurring. Empowering the patient to tackle the problem independently using the tools demonstrated should it recur is our shared aim.

 

Patients may of course require the occasional refresher or brief top up of manual therapy or acupuncture to kick start the healing period once again should a “blip” occur in the future.

Jaw Pain

(Problems in the Temporomandibular joint TMJ) (Temporomandibular joint disorder)

 

Jaw pain can be very limiting and therefore very frustrating. It commonly stems from 3 causes that are often very closely linked. Most referrals come from the dentist where the client has been treated for problems with the cartilage in the joint, but we also see a lot of self-referers.

 

Quite often the Dentist will provide a night splint to try to calm their symptoms down. This is usually secondary to some form of trauma aggravating the joint and leading to inflammation of the cartilage.

 

In addition to this and sometimes independent from it the pain can arise from the musculature around the joint. This is often stress related. The muscles develop knots and tighten up restricting the ability to open the mouth and specifically chew.

 

The third cause can actually be the neck. The upper cervical vertebrae can become very stiff and radiate/refer pain round to the side of the face. This again is often a result of stress but it can also occur from poor postural alignment or trauma.

 

Management of TMJ pain consists of evidence based treatment to all three areas as they are so intrinsically linked.

 

Treatment usually starts with acupuncture into the muscles of the jaw and meridians in the neck. This serves to calm any muscle spasm and get helpful chemicals such as dopamine and serotonin floating around the area.

 

We then use ultrasound. This sends sound waves into the joint at such a frequency that the cells oscillate and increase metabolism. Again this then promotes blood flow to help calm inflammation of the cartilage. Finally we mobilise the neck, using gentle manual techniques to alleviate stiffness and calm muscle spasm.

 

Essential to the management of TMJ pain are exercises to promote the stability of the joint and the postural alignment of the neck. It is also essential to establish what is causing the stress or aggravating the joint so that we can minimise the chance of the condition returning.

Neck Pain

Quite literally a pain in the neck. Those qualified to comment have rated some of these worse than childbirth pains! By far the biggest cause of neck pain in this clinic is the time spent sitting in front of a screen.

 

The team here are skilled to assess your work set up/position and the posture you adopt on it.  We can then address the effects these postures have had on the skeletal system of the spine.  It is important to note the effects on both the lower back, mid back and neck/shoulders in this scenario as often the whole spine is compensating for imbalances and problems somewhere else in the chain. 

 

Our team will identify areas of possible tension, weakness, lack or excessive length of tissues and stiffness in the muscles, bone and connective tissue system. We will then use the wide variety of evidence based techniques available to the experienced therapist to tackle these.

 

Treatment techniques may include soft tissue release techniques, joint mobilisations or manipulations, dry needling/acupuncture, home stretching and core stabilisation/strengthening exercises.

Whiplash (Whiplash Affected Disorder) 

Whiplash is another common problem in our busy city centre clinic. This can be very mild or major with very differing symptoms depending on the speed of impact, underlying health and age of the neck/back, position the body was in at the point of impact and even the behaviour/way that the individual perceives and copes with the injury.

 

A wide range of mechanical symptoms can be present in the individual with WAD.  All of our clinicians at this clinic have 10-20 years’ experience in this field. As with any serious problem, experience is considered an invaluable asset.

 

Other challenging neck pains also occur with the hypermobile (bendy) population. We encounter a lot of this within the professional and student ballet dancers as well as the more robust and restricted Rugby playing population. Our approach is similar but you can’t apply a single recipe to each individual.

 

We are all quite unique and need an approach that reflects this.

Upper back, Rib & Chest pain – Thoracic pain

Often mislead by the brain cells that think you’re having some kind of cardiac event, people with this type of pain often come to us having had these primary fears allayed by other medical professionals first.

 

Pain on deep inspiration/coughing/sneezing, twisting movements, bending forward, pain sitting at the desk at work, can all be triggers and all difficult to endure. 

 

A thorough well taken history to look into the potential causes of these problems is imperative (as with all spinal pains) and should lead your clinician to the treatment techniques available to him/her and the corrective postures and  exercises to restore normal movement in the restricted areas.

 

The rib cage does a wonderful job of protecting our vital organs, but it does make for a rather rigid section of the body. This rigidity can easily go beyond the norm and start to affect individual joints around the rib cage/sternum and the connections with the spine as well as the junctions of the spine immediately above and below this more rigid zone.

 

If the more mobile sections above and below the thoracic spine start to become influenced by increasing rigidity we have a problem. Sooner or later this problem will manifest itself in the form of pain, restriction, dysfunction, or all 3!

 

A loss of normal movement and rotation in the spine can quickly affect the way the body should move. Apply this problem to a golf swing, a contemporary dance sequence or clearing out the loft for example and things begin to snowball.

 

Treatment techniques may include soft tissue release techniques, joint mobilisations or manipulations, dry needling/acupuncture, home stretching and core stabilisation/strengthening exercises. Some strength building exercises may be required to improve your posture and alignment to prevent recurrence.  Our rehabilitation uses many exercises and techniques from allied principles such as Pilates and Yoga. 3 of our 4 staff here are keen Yogis. We also have a high level of experience of Pilates and gym based strength and conditioning.

Mechanical Low back Pain

Probably our most commonly seen problem in clinic.

 

Almost 31 million days of work were lost last year due to back, neck and muscle problems, according to the Office for National Statistics (ONS).

 

Our 2 City centre clinic locations mean that the bulk of our clients are working long hours sat at a desk. The personality type of some of these driven workers also means that they are the ultimate weekend or evening warrior.  A spine that has just spent 10 hours or more per day slumped in front of a screen (intermittently banging your head on the desk in frustration) may not adjust well to being propelled across gym studios, hard road  surfaces, pedalling for 100 mile rides or smashing into other people in contact sporting environments.

 

A discussion with a physiotherapist regarding work related set ups, footwear, sleep positions/mattress types and what your body is put through as part of your leisure choice is imperative. Getting an idea of how you look after/abuse/heal your body helps to formulate the solution.

 

The back or lumbar spine is considered the engine room of the body or the core. Without a good stable base/platform that moves normally, the legs cannot give you the full output they should. If the building blocks of the spine are not well stacked on top of each other in the natural way, adverse tension and stress is created in different parts of the body much like a building that is not well designed or looked after.  We don’t want to resemble a large game of Jenga just before that last …brick ...goes ...on.

 

A healthy balance of strength, flexibility and movement control is the ultimate aim. It’s harder than it sounds when much of our day is spent sat down or stood up in unhealthy quantities.  That magic word “balance” also applies to the body and what you do to it. 

 

Negative forces need to be countered by positive ones.  If the see-saw of forces remains on the negative for too long, the environment begins to change and problems start to develop.

 

Physiotherapy should focus not just on the diagnosis and the local structures of the body that are unhappy. The hard part of our job and ultimately that of the patient is to determine why the problem has arisen and what needs to change to help achieve a solution i.e. how to re-balance that see-saw.

 

We have Nicola Shaw- an Extended Scope Practionner in the NHS in spinal problems, and gym based Bob Johnson, a keen core stability biased rehab specialist. 

 

Treatment is evidence based and could include postural advice, joint and soft tissue mobilisations, perhaps spinal manipulations if indicated, dry needling/acupuncture techniques, passive stretches, strength and conditioning exercises.  Typically, an average course of physiotherapy lasts about 6 sessions.

 

We also have strong links with local Yoga and Pilates companies. Our aim as physiotherapists is to provide you with the awareness to recognise when the balance in your lifestyle is starting to alter and create the beginnings of an early musculoskeletal problem.

 

We aim to equip you with enough skills to head the problem off early before it gets hold and causes further dysfunction and difficulties. We are always here to top up and refresh these home exercises or lend a physical hand to help get things moving in the right direction via a one off or intermittent MOT/Service for the body. We do this for our cars and some people come for ½ yearly check-ups to ensure that all is functioning as it should.

Upper Limb Problems (Shoulder, Elbow, Wrist & Hand)

Shoulder problems are a common occurrence in the City Centre based population we see. From gym related shoulder impingements to tears of the rotator cuff and the labrum as a result of overhead throwing and contact sports we get a good cross section.

 

The shoulder is a notoriously tricky joint. It needs to move through a wide variety of angles yet provide us with the stability to weight bear and the explosive power to launch things from our hands. This does not always work out so well!

 

Rehabilitation techniques often start by looking at the quality of movement control of the shoulder blade (Scapula). Poor control and movement of the scapula can cause injuries in itself. The timing and quality of the movement in relation to how the arm moves often goes out of synch following injury in the neck/upper arm.

 

Even the core of the body (lower back/centre) has an influence on how the shoulder and upper limb performs.  A small shoulder niggle with no obvious cause can often open a larger “Can of worms” that traces its way back to a wider global problem involving larger areas of the body.

 

Once this is detected, the benefits to the individual are wider than just improving the original niggle.  Often the body’s niggle is an early sign that a larger system is not coping well. Another reason why we shouldn’t ignore niggles! A good rehabilitation progamme doesn’t necessarily mean stopping the training or sport you love doing, usually it just means rebalancing the exercises you are doing in your training to facilitate recovery.

 

Tennis and golfer’s elbow is a good example of the scenario above. Incorrect techniques or postures whilst performing a repetitive task, historically a back hand tennis shot or golf swing, can contribute to these overuse injuries. We seldom find that the people receiving these injuries ever play the sports mentioned, but the biomechanical fault/cause is true for most of the overuse injuries we see. 

 

Treatment is aimed at calming down the initial inflammation and then restoring length and strength to both the local muscle system and the supporting global system further up the chain. If technique is an issue, conversations with the client’s coach, parent, teacher, personal trainer etc. often occur to ensure everyone is focused on correction of the cause.

Hip, Groin and Buttock Pain

The potential structures involved in these injuries is mind boggling to the newly qualified physiotherapist.  In reality, there are often quite a few of the structures that are affected and indeed contribute to injuries in this area.

 

Poor quality (too much or too little) movement in the lumbar spine, slipped or rotated Sacro-Iliac joints (SIJ), hip joint impingements and femoral head asymmetries, hip joint deterioration (less common in our typical age range of 16-55), groin strains and tendonitis/tendonosis and sportsman’s hernia’s/gilmores groin are all seen regularly in the clinic. 

 

Pelvic girdle pain/SPD and other pregnancy related problems are attended to by our women’s health specialist.

 

Our primarily young and sporty population require accurate diagnosis and structured rehabilitation to take into consideration this crucial area that is the engine room of our body.

 

Core strength is a term that is often too easily applied to many injuries. Often it is true, but a simple recipe for an individual with pain in this zone is not appropriate.

 

Following a list of exercises from a sheet to get stronger may help some folk, but individual assessment, diagnosis, treatment and bespoke rehabilitation will shape your return to the healthy state you’re searching for. With the right attention and compliance from the individual, a course of treatment should result in a better outcome than pre-injury levels of performance.

 

Injury can often reveal a valuable flaw in a person’s technique or biomechanics/movement.  Improve this feature and you may come back either stronger, more flexible, more controlled or ultimately more skilful than before.

Knee Pain

We regularly see fresh ACL traumas both pre and post-surgical repair, meniscal tears, ligament injuries, patellar tendonosis problems, patella-femoral (knee cap) tracking issues, ITB friction or runner’s knee problems among a long list of potential injuries that this unfortunate weak link in the biomechanical chain receives.   A fixed stable base at the foot and solid platform above the knee somewhat leaves the knee a little unprotected in the natural sporting environment.  Considering it only moves largely in 2 directions, it’s no wonder it gets clobbered a lot in sport. 

 

Finding the cause of the injury with no obvious traumatic cause is the biggest challenge.  A detailed history and examination of the joints and their quality of movement is essential to piece together the reasons for the injury.  This is particularly the case for tendonosis, patella-femoral and ITB problems.

 

The long haul and commitment required for the longer rehabilitation scenarios should not be under estimated.  Leg fractures, ACL repairs and ligament ruptures all require months of diligent rehabilitation.

 

One of our clinics is based in a gym with the option of hydrotherapy and a fitness studio if required. 

 

If the patient’s problem requires further investigations like an MRI scan/X –ray etc, we have built up a good network of specialists since we started in the City Centre in 1998.

Shin & Calf Pain

The runner’s and dancer’s scourge…

 

Also labelled as calf tears, calf strains, shin splints, peroneal tendonosis, tib posterior tendonosis, achilles tendonosis, achilles rupture or stress fracture.

 

Often these injuries occur in sport as result of an over-used/under prepared reaction of the muscles and connective soft tissues of the lower leg team.

 

A post training stiffness or DOMS (delayed onset muscle stiffness) is not uncommon if it’s been a slightly harder than usual sporting session. This will commonly peak on day 2 after an overcooked session.  But soreness that begins during the session or comes on overnight and remains during the days to follow should not be ignored.

 

Inflammatory problems are often worse first thing in the morning and then ease once the blood gets circulating again around the area. One sided/asymmetrical soreness is also an indication that things are a little out of synch.

 

The cause behind these problems is again the most important thing to gain out of the first session with a physiotherapist. Training schedules, footwear, sporting surfaces, muscle length and relative strength are all part of the detailed forensic like questioning required to get to the reasons why you have this problem. The solution of course targets these reasons. As mentioned in earlier sections, often the cause is part of a wider problem that stems from a zone much further away from the actual injury.

 

The convenience of running means that it’s a sport that appeals to many of our clients. As a result we are well versed in dealing with these types of injuries.

 

Nick, our physio manager is also a keen runner himself. Even more so having undergone the rehabilitation necessary to recover from a total rupture and subsequent surgical repair of his Achilles tendon in 2015.

Ankle & Foot Pain

The foot is a wonderful piece of natural design and engineering. This complex structure comprises of 26 bones, 33 joint and 100’s of muscles, ligaments and tendons. It provides a strong and stable platform for us to propel ourselves forward, conforms to uneven surfaces/shapes,  absorbs huge loads and force as we run/jump/walk and relatively speaking, stands up pretty well to the task considering.  A glance at the foot of a ballet dancer, a long distance runner or a footballer will reveal just some of the stress we put them under. It is not a pretty sight on the whole!

 

Sprained ankle, plantar fasciitis, Morton’s neuroma, metatarsal stress fractures, hallux valgus and bunion related problems, calcaneal fractures, degenerative / early OA big toe, TA tendinopathy, post tibial tendon dysfunction, ankle impingements are just some of the long list of things that can go awry in this region.

 

Natural shock absorption provided by the musculature, bones and connective tissue of the foot is a feature that varies greatly from person to person.  Feet come in a variety of shapes and sizes clearly vary widely on this planet, so too does the size of the 3 arches of the foot (2 long and 1 transverse). 

 

Genetic luck of the draw, occupation, cultural influences, footwear choice and level of impact all affect how the foot develops and behaves. This wide diversity of factors will determine the nature of the forces that are transmitted further up the mechanical chain into the lower leg, knee, hip and back.

 

Foot position during walking, running and dance poses will affect the knee position and therefore hip position and low back tension. The same flow of energy can work down the chain the other way. The whole leg is a kinetic chain that works together to transmit that huge level of ground reaction force that is absorbed by the foot and transmits this upwards.

 

These forces are then converted into energy that drive that moves us through the air forwards/upwards/sideways etc.

 

It is an impressive system that works together…. So when it goes a bit wrong, it can affect all parts of that mechanism. Fascinating stuff for the enthusiastic physio… Highly annoying for the injured client! Although an understanding of how it fits together does help focus the mind on the rehab that is necessary to fix it.

 

See also: our section on Orthotics and Insoles

Call us on: 0844 257 0122
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