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How We Treat You

Our mixed team of therapists draw on their collective clinical experience gained over many years to determine the best way to approach and tackle your problem.

This is not a “one recipe for all occasion’s” clinic.  Our profession dictates that in order to maintain your chartered status and state registration you have to keep up with the pre-requisite hours of CPD.  This means that our styles and approaches are constantly evolving to give you the best evidence based treatment options available.

Manual Therapy

Our team of very experienced physiotherapists are biased towards this hands on approach. Whilst it is not the sole modality of choice, it forms the bulk of our skills.


We use hands on pressure to varying degrees to influence the body’s connective tissue e.g. ligaments, muscles, fascia, tendons, nerves and the bony joints (the musculoskeletal system). Joints are moved by small amplitude movements or mobilisations by pushing the bones in a particular direction.


These are low grade sliding movements used to help restore normal movement in a restricted joint (both spinal and peripheral joints).  Without these small joint movements, full active movement is not possible.

If a higher grade of pressure does not lead to a solution then sometimes a manipulation may be required.  This technique often produces a “crack” noise when attempted. A physiotherapist often builds up to this level unlike other manual therapy professions, and will only choose this method if it is safe to do so (relevant history taking and consent to do so must be taken).


Our spinal specialist and Extended scope Practitioner, Nicola Shaw, is MACP trained (Musculoskeletal Association of Chartered Physiotherapists).  Contrary to popular belief, a manipulation is rarely required.


Restriction of normal movement in the body is not limited to joints in isolation. If a segment of the body has not moved normally for even a few days, the soft tissues around this local area will also be affected. This in turn will affect the larger global area that it communicates with.


It’s just like that song where everything is connected to the…    We are a dynamic system of joints, pulleys and levers. When one component is affected, it usually has a knock on effect elsewhere in the kinetic chain.  This is where experience comes into its own.


We develop (through CPD as per our chartered regulations), refine and regularly use many different techniques to achieve this restoration of normal movement.

Massage Options

Aside from bony restrictions, the physiotherapist also works with the soft tissues of the body.  This can be in the form of soft tissue release, massage, connective tissue massageSports massage, Trigger point release, deep tissue massage and cupping to suit the situation.


Massage can be used to help decrease muscle tension and muscle spasm, help improve limited movement, decrease swelling and inflammation, reduce stress, improve blood flow and therefore optimise the healing potential of the body.


People often email or call us asking for a massage to help with a problem they are experiencing.  Sometimes a few careful probing questions can reveal some of the reasons behind this request.  If we can get to the bottom of why the need keeps arising for these massages, we can often improve the short term quality of life (with less muscle tension/soreness/restriction) and make a difference to the longer path too. 


It is rare that the bony system is worked on without the connective tissue system being addressed at the same time and vice versa.  The two are implicitly linked. This is one of the reasons why manual therapies forms the largest chunk of what we do


Acupuncture now has a huge body of evidence supporting its use for the treatment of many chronic and acute conditions. Scepticism often surrounds the Eastern explanation of how it works.


This explanation of energy flow does not suit our western approach to medicine. However studies have been done using mobile brain scans to prove its efficacy.


A reflex response occurs when the skin is pierced. This reflex stimulates the release of dopamine, serotonin and cortisol. These are the body’s natural healing chemicals. The acupuncture needles are so fine that they do minimal tissue damage, thus on their removal these chemicals are in the circulation and help to facilitate healing.   


Our therapists are trained in both Chinese acupuncture – using meridians and a balance of chi as their reasoning for point selection, and western acupuncture or “Dry needling”. They are able to select the most appropriate modality for you and your condition.


These physical techniques and the chemicals released during their use can aid pain relief, help relaxation both physically through the softening of taut connective tissues and mentally through the release of dopamine, serotonin and endorphins.   These benefits make it applicable to almost any injury if deemed appropriate E.g. Low back pain, Head ache, neck pain, joint pain, sports injuries etc etc..


Taping is used by our therapists to help ease pain and facilitate normal alignment. Taping can be very effective as there are more nerve endings in the skin than any other organ in the body. The tape pulls on the skin – sending a neural signal that overrides the pre-determined signal that is facilitating the injury.


There are also occasions where tape can protect an injured joint from unwanted force whilst it starts its recovery process.


This is an excellent adjunct to the RICE practice of early injury management. P-protection, can be added to support the joint with tape- PRICE.


If you’re not sure when to see a physio, email us to ask if the joint or body part can be taped to help optimise the healing and recovery period.  Early advice and protection through taping can get you back to your preferred sport/leisure much quicker than you think is possible.



Ultrasound is used by all of our therapists. It can be used on acute or chronic ligament, tendon and muscle injuries. The therapist selects a frequency based on the depth, age and severity of your injury.


They then use a small treatment head over the area that sends painless sound waves into your tissues. These sound waves vibrate the cells and increase metabolism. This serves to increase blood supply and facilitate healing.


Interferential Stimulation

Interferential is a treatment modality that we use purely for pain relief. A small oscillating electric current is passed between two or four pads on the skin. This current stimulates the nerve endings, raising the threshold of tolerance on the nerve and decreasing the pain experience (“Closing the pain gate”).


Some settings encourage endorphins to be released by the body for a longer term pain relief effect similar to that of acupuncture.  Interferential can also stimulate muscle contraction – while this has no effect on muscle strength it can facilitate the muscle pump and decrease swelling.


This is a very broad term.


As well as the physical effects of injury, “Rehab” should also factor in the mental impact. The mental well-being of the patient is paramount if the injury and its consequential behaviour are to be restored back to normal and beyond.


As physios we need to be aware of the affects that injury can have on someone’s state of mind. A person who is suddenly unable to exercise regularly, burn off some energy and unwanted chemicals/toxins/frustration and sleep well makes for a less than happy individual.


Aside from the chemical changes in your body that take place when you suddenly stop exercising, the frustration at not having that option to exercise as you would normally choose can influence a person’s mood, concentration and drive.


Early movement and relative rest

At City Physio we all try to get individuals moving as soon as possible to get back on the path to recovery and restoration of normal movement.  Complete rest is rare.  We can usually find a way of getting round the injury to incorporate some activity. Relative rest is vital to keep this healthy mental balance in check.


A balance between Stability and flexibility in the major sections of the body (shoulder girdle/pelvic girdle or core) is paramount in order to return to normal activity.  Our team’s rehab approach is centred on these 2 main features.  Some people are often in-flexible by nature, others too bendy or hypermobile. Some folk are often classified very strong and others weak.  On closer inspection you often find people have a combination of all of these things in different areas of the body.  We are all quite different and as such require thorough assessments from experienced physiotherapists to discover what each individual needs.


Home exercises will take from different elements of these areas i.e. stretching of muscles and nervous tissue or strengthening of the body’s central areas or core areas.  Experienced physiotherapists gradually put all of the pieces of this wonderful jigsaw that is the human body back together.  Once the body has the joint and soft tissue range to move normally again (early treatment phases) we move into the next phase of rehab.  



This next phase of rehabilitation focuses on form and technique.  This ensures that the body or posture is in the right position to achieve the task that is aggravating/causing the problem.   This could simply be sitting at a desk or a more complex movement pattern like throwing a ball, a dead lift in the gym or a balletic plie.


This next phase of rehab ensures that the correct muscles are firing to hold you in the right position whilst the rest of the body moves your limbs around.  A good stable base at the pelvis and shoulder girdle is essential.  This is often why folk rightly bang on about core stability so much.


You need good pelvic stability to keep a decent lower limb position with the knee in the correct place.  Repetitive movements with a poor alignment will usually result in some damage somewhere along the line.  The same can be said for the neck and shoulder region.  Poor scapula (shoulder blade) stability can overload other muscles around the neck, change the neck position and overload the soft tissues of the arm and shoulder as a result.


The well balanced body is like a well-balanced team.  Everyone has a role to play.  If someone is not “pulling their weight” then someone else has to take up the slack.  Eventually that someone or those people start to grumble or breakdown completely.  That is not to say that every injury has a weak core or poor stability at the centre of it.  As mentioned earlier, joint range of motion and flexible soft tissues are also part of this complex movement system.


Maintenance, end stage rehab and reinforcing good practice/habits

When a patient is reaching the end of the physio lead exercises and nearing return to work/sport/leisure it may be necessary for the individual to take a further leap with an allied health professional or someone in the fitness industry.


Our base in the City centre since 1989 means we have built up a good network of contacts in the local area to help the patient take this next step.  Just some of our affiliates can be seen on this page (*insert affiliates link).  The good habits, strength and flexibility gains made during the course of treatment might be maintained this way.  A shift in lifestyle choice, habits and posture is often all that is needed. Regular practice of these newly learned techniques changes the behaviour at the root cause of many problems.


Not everyone has to join a gym and start a new fitness regime.  Much of what we advise can be slotted into a patient’s regular life at home/work.

Do I Need Regular Physiotherapy Check-Ups?

The large majority of people do not come back with the same problem year after year. We do not feel that we have done our job properly if they do.  Much of course depends on whether the individual maintains the balance that was achieved at the end of the course of treatment.  Sometimes, old habits creep back or the maintenance work/exercises slip a little.   For some patients, the uncontrollable, external factors in their lifestyle may change to alter that delicate balance. 

There are a few patients that come back every few months in order to for us to help maintain the quality of movement and normal muscle tension in their skeletal system.  They view this as some kind of “service” much like you would for a well-tuned classic car/bike.  They have usually come to the conclusion that a few sessions per year to keep you healthy and functional represents better value than a few sessions per year when they are in desperate need and unable to function properly for a few weeks.  Each to their own. We are all different and have many ways of living our lives!