Category Archives: Physiotherapy

Got the Running Bug?

Welcome to the second of my summer blogs following on from June’s blog on walking your way to fitness.
For this month’s article I’m going to up the ante a little, from walking to running.

The summer is full of running events, and Bristol, where we’re based, is full of runners jogging on the Downs and in the parks, making the most of our many green open spaces. In fact, Bristol has been named the running capital of the country!
Running is great, but, no surprise, can cause injuries. If you are a novice, make sure you build up slowly, with realistic targets – you can’t get to 10k without reaching 5k first. Suitable, supportive running shoes are vital; as are warming up, cooling down and stretching properly. If you are injured, or feel an old injury re-igniting, it’s important to stop and assess, instead of carrying on, potentially making it worse.
Here is a list of some of the most common (but not exhaustive) running-related injuries and their treatments. Physio is often very beneficial in treating running related conditions and in order to return to running as early as possible early intervention is advisable to prevent a chronic situation developing.

Shin splints
Feels like: Stiffness or pain in your shins
What it is: The strain and leg pain results from strong calves pulling repeatedly on weaker muscles near the shin. The muscles of the shin become larger with exercise and sometimes the sheath that surrounds the muscle does not stretch at the same rate putting pressure on the muscle – usually tibialis anterior – and causing pain. Running on concrete is likely to exacerbate the problem.
What to do about it: Cut back on your running for 3 to 8 weeks, depending on the severity, to give the tissues time to heal. You might need an anti-inflammatory medication, such as ibuprofen, or cold packs to reduce swelling and relieve pain. In the meantime, keep in shape by training with low-impact exercises such as swimming or cycling. You should also strengthen tibialis anterior to help prevent a recurrence, such as lifting your toes up towards your shins 20 times while standing, three times on each leg.
Physio can help to release the tight tissues, guide you with regard to appropriate stretches and acupuncture can help with symptom relief. Orthotics (insoles) are often also helpful to help unload the overactive muscles.

Trochanteric Bursitis
Feels like: Soreness on the outside of your hips
What it is: Although there are many potential causes of hip pain, it’s common for the fluid-filled sacs (bursae) that cushion the muscles on the side of the hips ,to become inflamed with repetitive stress. People with one leg slightly longer than the other may be more susceptible to this condition. Weak gluteal muscles and muscle imbalances around the pelvis can also cause more stress to the area, leading to inflammation and pain. Running without ensuring that you are engaging your gluteals well and without building your distance up slowly can predispose you to this condition.
What to do about it: Instead of running, ride a static bike, swim, or do some other non-weight-bearing activity for a few weeks. Strengthening your gluteals and other core muscles is essential. Start again gradually, building from a fast walk to a short jog before taking off on a 10k! Seek physio advice early to help release the tight overactive muscles which cause friction over the bursa and to show you how to strengthen the correct muscles.

Runner’s knee
Feels like: Throbbing either in front of your kneecap or to the side of or behind the knee.
What it is: Usually a low grade inflammation which is a result of friction between the layers of soft tissues (ligaments, tendons, muscles and fascia). This is often a result of some muscles and ligaments becoming tight – commonly the quadriceps and ilio-tibial band. This can also cause low grade inflammation behind the knee cap due to altered pressure between the knee cap and femur (patello-femoral joint). Runners with weak or imbalanced thigh muscles, weak core muscles or flat feet or high insteps, are at greater risk of runner’s knee. The knee pain may occur when you’re walking downhill, doing knee bends, or during or after sitting for a long period of time.
What to do about it: Reduce or stop running, particularly avoiding hills. Change to another type of exercise such as swimming until the symptoms subside. Seek physiotherapy early, for guidance regarding changing the muscle imbalance around your knee, thighs, calves and feet and to help release tight muscles which are causing the increased friction. Acupuncture can also help to settle symptoms. Orthotics (insoles) may be beneficial if you have particularly flat feet.

Muscle Tears
Feels like: Initially it may feel like cramp which you might try to run through or it may be sudden sharp pain which stops you in your tracks. Commonly the hamstrings (muscles behind the thigh) or gastrocnemius (calf muscle). There may be a warning from the muscle of fatigue prior to either of these sensations but not always. It may also occur with a sudden increase in speed if you’re not warmed up well or again if your muscles are fatiguing.
What it is: Tears occur in the muscle fibres and this needs time to heal.
What to do about it: Rest from running for 6-8 weeks depending on the severity of the tear. Ice x 10 minutes 4-5 times a day for the 1st few days. Taping to protect the muscle from further strain is often helpful. As the tear heals gentle stretching can begin to restore the muscle length and soft tissue release from a physiotherapist will help to ensure good structural healing of the muscle. Later rehab includes strengthening the affected muscle and also other muscles in the area which will have inevitably have weakened due to disuse. Building up and maintaining general  cardio-vascular fitness by swimming will also be helpful for a successful return to running. Initially this may only be confined upper body work to avoid re-injuring the muscle.
Seek Physio input early to help with this programme of rehabilitation.

Achilles Tendonitis
Feels like: Soreness, pain and stiffness in the tendon connecting your calf to your heel.
What it is: It is a tendinopathy which is likely to begin with inflammation around the tendon sheath.
What to do about it: Rest from running until symptoms settle. Ice the tendon for 10 minutes 4-5 times a day in the early days. Use a heel wedge to take the strain off the tendon – especially if you are experiencing symptoms when walking. Taping can also be useful to reduce the load on the tendon.
As symptoms settle it is important to begin a programme of graded stretching and strengthening of the tendon and muscle.Strengthening other muscle groups is also important – strong core muscles and gluteals are important as always to help to relieve the strain on the calf muscles by driving the body forward from the pelvis.
Seek physiotherapy early for guidance regarding appropriate rehab. for you. Soft tissue release, acupuncture and ultrasound can also be helpful to encourage good structural healing of the tissues.

Morton’s Neuroma
Feels like: Pain in the ball of your foot.
What it is: Probably the least common of the conditions here. If tissue surrounding a nerve near the base of the toes thickens, it can cause tingling, numbness, or pain that radiates to surrounding areas. It may feel as though you’re treading on a marble. This condition, known as Morton’s neuroma, usually develops between the base of the third and fourth toes. It’s up to 10 times more common in women than men, possibly because women’s feet are structured differently and because women tend to wear narrow, high shoes or very flat ones with poor support.
What to do about it: Treatment varies from simply wearing roomier shoes to surgery, depending upon the severity of the neuroma. Physio can be helpful in order to assess and address muscle imbalances around the foot and lower limb which can help to relieve the pressure. If problems continue custom made orthotics (insoles) or pads that relieve pressure and absorb shock may be helpful. Make sure that your walking and running shoes have a spacious toe box. Ladies -limit your time in high heels, and if you need to wear them, travel in comfortable shoes and then slip on the more stylish pair later.

Above all remember that given the numbers of people running these days injuries are relatively few and correct footwear and a steady graded running programme will go a long way to keeping you on track and injury free.


Walk Your Way to Fitness

Welcome back to the blog! This summer I’d like to look at two fantastic summer pastimes – walking and running – depending on your age, level of fitness and any existing injuries you’re likely to prefer one over the other. In the first article I’ll look at walking – both the benefits and the potential for injuries – and follow up in July by taking it to the next stage, with jogging and running.

Walking is a wonderful way to achieve the recommended thirty minutes of exercise, at least five times a week – at any stage of life. It’s simple, free and easy, and has been shown to reduce the risk of chronic illnesses, such as heart disease, type 2 diabetes, asthma, stroke and some cancers. The British Heart Foundation advises people to aim to walk at least 10,000 steps a day, most days.

Before you start, however, make sure you have comfortable walking shoes or trainers, which are supportive and the right fit to avoid blisters. Make sure you’re also wearing comfortable clothes and have a backpack with snacks, water and sunscreen/waterproofs/extra layers (delete as seasonally applicable) if you’re planning to make a day of it!

To enjoy the health benefits, you’ll need to raise your heart rate to a level classed as a ‘moderate intensity aerobic activity’ – put simply, you’ll be able to talk to a friend but not sing along to your favourite song. Build up a walking plan slowly, picking up speed and distance, and make it a habit which is part of your life – walking to work or to the shops, leaving the car behind for short journeys, using the stairs instead of the lift, and so forth. Joining a walking or rambling group is a great way to keep motivated, explore new places and meet new people.

A great way to track your progress is through a pedometer or FitBit, to see how many steps you’ve walked, and with a FitBit, how high your heart rate was, how long you walked for, and how many calories you burned.

Avoiding and treating walking-related injuries

But, even with something as simple as walking, small injuries can occur, or existing conditions, if left untreated, can take the enjoyment away. Here are a few of the most common conditions, with solutions – but if any symptoms persist, physiotherapy can usually solve most of these problems quickly!

1. Plantar Fasciitis

Feels like: Tenderness on your heel or bottom of your foot

What it is: The plantar fascia is the band of tissue that runs from your heel bone to the ball of your foot. When this dual-purpose shock absorber and arch support is strained, small tears develop and the tissue stiffens as a protective response, causing foot pain.

What to do about it: At the first sign of stiffness in the bottom of your foot, loosen up the tissue by doing this stretch: Sit with the ankle of the injured foot across the opposite thigh. Pull your toes towards the shin with your hand until you feel a stretch in arch of your foot. Run your opposite hand along sole of foot; you should feel a taut band of tissue. Do 10 stretches, holding each for 10 seconds,relaxing the stretch for a few seconds between each one. Then stand and massage your foot by rolling the bottom of your foot over a golf ball or full water bottle. Wear shoes with an arch support, and avoid hard (concrete) surfaces – stick to paths and grass where possible when walking until your symptoms have settled.

2. Ingrown toenail

Feels like: Soreness or swelling on the sides of your toes most commonly the big toe.

What it is: Toe pain can develop when the corners or sides of your toenails grow sideways rather than forward, putting pressure on surrounding soft tissues and even growing into the skin.

What to do about it: Leave wiggle room in your shoes. You may need to go up a half size when you buy trainers, because your feet tend to swell during exercise. Use toenail clippers (not fingernail clippers or scissors) to cut straight across instead of rounding the corners when you give yourself a pedicure.

3. Bunion

Feels like: Pain on the side of your big toe

What it is: A bunion develops when the bones in the joint on the outer side of the big become misaligned, forming a painful swelling. Walkers with flat feet, high arches or stiff ankles may be more prone to develop bunions.

What to do about it: Wear shoes that are wider – especially in the toe box. Stretch your ankle and calf muscles before and after walking. Place your feet in cool water after walking to help reduce any inflammation. Gently stretch your toes whilst in the cool water.

4. Achilles tendinitis

Feels like: Pain in the back of your heel and lower calf

What it is: The Achilles tendon, which connects your calf muscle to your heel, can be irritated by walking too much, especially if you don’t build up to it. Repeated flexing of the foot when walking up and down steep hills or on uneven terrain can also strain the tendon, triggering lower leg pain.

What to do about it: For mild cases, reduce your mileage or substitute non-weight-bearing activities such as swimming or upper-body strength training, so long as these don’t aggravate the symptoms. Avoid walking uphill, because this increases the stretch on the tendon, irritating it and making it weaker. Regular calf stretches may help prevent Achilles tendinitis, but in severe cases, limit or stop walking and place cold packs on the injured area for 10 minutes, 3 to 4 times a day, to reduce inflammation and discomfort.At this stage it is prudent to seek some physiotherapy input. When you return to walking, begin on flat surfaces and gradually increase your distance and speed and then introduce gradients.

5. Lumbar strain

Feels like: Ache in your mid to lower back

What it is: Occasionally when beginning a walking programme people experience back ache. Usually because muscles around the back are doing activity that they are not used to and often because the abdominal and gluteal (bottom) muscles are not engaging consistently.

What to do about it: For general back fitness, keep the abdominal and gluteals muscles strong. While you walk, engage your abs by pulling your belly button toward your spine as if you were trying to flatten your tummy to zip up tight jeans and gently squeeze your bottom muscles. Do this for 30 seconds every 5 minutes whilst walking and it will soon become a habit for these muscles to engage gently all the time. Stretch out your back, hamstrings and hip flexors before and after walking to help distribute the load evenly between your back and legs.

Nordic walking and Pilates are two great ways of maintaining the fitness of these ‘core’ muscles and your back – provided you begin at the right level for you.


Winter Sports Injuries


Winter sports – the thrills, and unfortunately the spills…

For those of us who love to ski or snowboard, there’s little to match the thrill of flying down a shimmering white piste, with clear blue skies above, pine trees and mountain peaks offering up a feast for the eyes, and barely a sound bar the swish of skis slicing through powder.

However, for those of us who love our winter sports but only get to do them once a year at most, it’s also a time when we suddenly make extreme physical demands on a body unused to this type of exercise, and rusty skills can make us more likely to come a cropper. So here are a few tips on how to avoid injury, and if you are injured, how to minimise the damage and heal soonest.

Taking care of your body – before, during and after 

  • Preparation is key

Spend some time at the gym. Most gyms run ski-fit courses, and these will get the quads and other key muscle groups primed for action. Attaining a higher level of general fitness will put you in a far better position to enjoy an injury-free holiday, while it’s also important to take into account any existing injuries, and their healing time, before heading off.

A good pre-ski programme at the gym will prepare you over 6-8 weeks, while if, for example, you have had knee surgery, you should take your doctor’s advice on when it will be ready for the challenge of winter sports. 

  • Heading for the slopes

Warming up each day before setting out for the cable car or ski lift will minimise the risk of injury and muscle strain – simple bending, stretching, loosening the shoulders and priming the thigh muscles will all help. Wear plenty of warm, breathable layers for insulation and remember to take plenty of water to stay hydrated.

Don’t push yourself to do “one last run” when you’re already tired. This is when accidents often happen.

  • On kit, nerves, alcohol and lifts

Firstly,check your equipment – if it’s hired, make sure it’s right for you, as injuries are staggeringly, 800% more likely to occur with hired equipment. If your own boots are 15 years old, it will almost certainly be worth replacing them or at least changing the foot beds.

If you are a nervous skier, invest in a one-to-one lesson and learn some relaxation techniques – falling on a tense body is likely to cause more injury than a more relaxed one.

Alcohol will also seriously undermine your capacities, so as enticing as it may seem, you’ll do better to leave the glühwein until you’ve safely reached base at the end of the day.

Be careful getting off chair and drag lifts, especially if travelling with someone of an incompatible weight or skill level – the vast majority of knee injuries happen here, as one skier or boarder accidentally bumps another out of the way, leading to a twist or fall on dismounting.

Finally, make sure you wear a helmet and goggles, test your bindings and know your limits.

  • If you are injured… 

Some of the most common skiing and snow-boarding injuries are as follows:

  • Errant skis and bad falls can cause knee injuries, particularly to the anterior cruciate ligament (ACL).
  • Using your arms to break a fall can cause injuries to the rotator cuff or shoulder dislocations, while skiers often injure thumbs due to holding ski-poles during an accident.
  • Collisions can result in head injuries like concussions as well as bruising, pulled muscles and ligament tears.

Sledging is especially dangerous lying on your stomach heading face first, as collisions are the most common type of injury, whether with a rock, tree or another sledger, so it’s advisable to sit upright facing forward and use a sledge with steering controls – and to sledge on a clear, obstacle-free hill.

In all cases, it is vital to seek immediate help and follow the P.R.I.C.E. recovery protocol if injured: Protection (such as strapping up the injury immediately to immobilise it).

Rest with the limb elevated and supported comfortably.

Ice – to reduce swelling and bruising.

Do also see a doctor and invest in physio at your resort, and follow their advice in the days and weeks that follow, with a follow-up visit to your own GP and/or physio on your return.


A right pain in the neck (or shoulders, or back)

back pain

If you work for a large company, you will probably have had some basic training about avoiding back, shoulder and neck pain, related headaches, and repetitive strain injuries (RSIs). This probably included diagrams or videos around good posture and chair/desk position (if sitting at a computer for much of the day), or how to lift and carry or operate machinery safely (if engaged in more manual work).

However, you may well have glanced at the information once or twice during your induction and then quietly forgotten about it, and if you work for a smaller company, or are self-employed, not really thought about it much at all.

Sounding familiar? Then this article is for you!

A complex joint

The shoulder consists of several joints, connected by various ligaments, tendons and muscles. Its’ large range of movement is what enables us to do so much with our arms – and this is also the reason so many of us experience shoulder pain, as well as related neck and back pain.

Chronic pain in the neck and shoulder area tend to stem from prolonged, repetitive or awkward movements, which put strain on the muscles and tendons in the upper body. Activities which cause this kind of pain or RSI injury can include use of industrial machinery, using a computer mouse, swiping items at the supermarket for long periods, overhead activities such as painting and plastering or carrying and lifting heavy loads.

Neck pain and headaches are often linked to desk-based work: craning sideways at a computer screen, having a desk or chair position which puts strain on the neck, cradling a phone between the neck and shoulder, or spending long periods hunched over mobile phones and tablets.

Relieving the strain

The good news is, there is a lot you can do to avoid putting strain on your neck, back and shoulders. All sedentary workers should get up and take a break from sitting for ten minutes every couple of hours. Simply by making phone calls in  standing, going to make a drink,  doing some filing, discussing projects with colleagues or other work away from the desk will make a big difference.  A 30 second micro-break, to do some stretches and  have a quick walk around the office every half hour, is really important to boost the circulation. Movement refreshes the brain as well as the muscles, so the boss shouldn’t complain!

When sitting at your desk, bear in mind that your:

  • feet should be firmly planted and flat on the floor or on a stable footrest;
  • Knees should be slightly lower than your hips;
  • elbows should be supported and close to your body;
  • wrists and hands should be in line with your forearms;
  • lower back (the lumbar region) should be supported;
  • shoulders should be relaxed;

Finally, check your work station is set up correctly, with everything within easy reach, your screen at arms’ length and the top of the screen just below eye level, centred in front of you.

Bear in mind that fatigue sets in through the day, so we tend to slouch, losing our good posture and increasing strain on the body. Taking a break really helps. In the longer term, counteracting hours spent at the desk with stretching and strengthening exercises such as Pilates, yoga or tai chi is also very beneficial. Some cardio-vascular exercise is also essential – a 10 minute brisk walk at lunch time and 30 minutes walking several times week keeps you fit and has the added bonus of burning off a few calories.

Neck, shoulder, back and RSI pain is cumulative but effectively helped by physio

These types of injuries have a habit of creeping up on us, and sometimes need a helping hand to send them on their way, along with some changes in lifestyle and habit. Habits are often not corrected overnight, and it can take some time to repair the stresses and strains which have built up over the years.

Physio is especially effective in cases of desk related tightness and pain, repetitive strain injuries and injuries caused by lifting or carrying. If you are finding it increasingly uncomfortable to do your job effectively, and would like some help, please get in touch!


Stay Sport Fit This Summer

sports injury

The summer is finally with us, and with it comes all the sports that many of us love to both watch and play, whatever our level of ability. Wimbledon, Test Cricket, the US and British Golf Opens… the evenings are light, the weather is warm, and full of enthusiasm we head out to the nearest court, course or pitch.

But even people who exercise and train regularly can be prone to injuries, and the likelihood is greatly increased if you suddenly throw yourself into a sport without having got your body used to the idea. Golfers and tennis players can fall victim to elbow problems. While in cricket bowlers will be more likely to experience lower back, shoulder or knee pain, and batsmen or women can get hamstring injuries, caused by the sudden need to sprint from a standing start.

This article is a quick guide to identifying the symptoms, and how to treat them before they get worse.

Tennis elbow, or pain in the outside elbow area

Clinically known as lateral epicondylitis, tennis elbow often occurs after overuse of the muscles and tendons of the forearm, near the elbow joint.
You may notice pain:

  • on the outside of your upper forearm, just below the bend of your elbow
  • when lifting objects such as a kettle
  • when bending or fully extending your arm
  • when gripping small objects, such as a pen
  • when twisting your forearm, such as turning a door handle or opening a jar

Physio can provide fast relief, especially when followed by simple extension exercises which you can practice anytime, anywhere, to strengthen the muscles and stretch out scar tissue. Bags of frozen peas will relieve pain and swelling in the meantime, and of course it’s important to stop the activity which has caused the strain so the tendon can heal.

Golfer’s elbow – pain in the inner elbow

Golfer’s elbow is the opposite – pain along the inside elbow area, but it is the same kind of injury, involving an inflamed tendon. It is most commonly caused by overuse of muscles in the forearm that flex (curl inwards) the wrist and fingers. Sports such as golf or other activities which involve repeated gripping or flexion of the wrist and fingers and overuse of the tendons can cause degeneration in the form of microscopic tears. This then causes the symptoms of golfer’s elbow, for which, similarly, physio, simple exercises and bags of frozen peas provide fast relief, while the exercises will strengthen the muscles around the tendon, so they take more of the strain, and help stretch out the tendon to alleviate the impact of swelling and scar tissue.

Cricket injuries

Cricket, that seemingly most gentle of sports, involving long periods of standing around with a tea break in the middle, actually puts a surprising amount of strain on the body. Bowlers often fall prey to muscle sprains through one side of their body from their shoulders down to their knees, due to the one-sided action required of them, while batsmen are most likely to strain their hamstrings from the impact of a sudden sprint.

Warming up properly is especially important for cricketers, and as with golf and tennis elbows, ice packs will reduce swelling while physio and deep tissue massage will start to repair damaged muscles.

Tips for avoiding sports injuries

However, we would all rather stay healthy and avoid injuries all together. Here are my top six tips for a happy summer of sport:

  1. Over-use injuries are preventable. If you haven’t played all winter, do some ‘pre-training’, working the relevant muscle groups in the weeks before the season starts.
  2. Warm up properly, focussing on the actions and parts of the body which may be most affected.
  3. Wear protective clothing as needed – whether it’s a cricket helmet or a support band.
  4. Quit while you’re ahead – muscle fatigue takes away your protective mechanisms and increases your risk of injuries. After all, you can always come out to play again next weekend, if you don’t get injured today.
  5. Drink plenty of water.
  6. Stretch and cool down afterwards – it will protect the muscles for next time.

And finally, if you do find yourself with an injury for which ice packs and painkillers don’t do the job or it’s not getting better – please do call. Physio is very effective for all these sports injuries, and you can speed up recovery and get back out there far quicker if you treat your injury properly!