What We Treat

Achilles tendon injuries are either sudden ruptures or long-term overuse problems (tendinopathy). Both can be treated effectively with physiotherapy.

1. Achilles Rupture

This is a tear in the tendon, often caused by a sudden movement like jumping or sprinting. Treatment can be:

• Non-surgical (conservative): The leg is placed in a boot to allow healing, followed by physiotherapy. NHS guidance shows this approach works just as well as surgery for most people.
• Surgical: Used in specific cases (e.g. athletes or delayed diagnosis). It involves stitching the tendon but carries risks like infection.

Rehab Timeline:

• First 6–8 weeks: Boot and crutches, limited movement.
• Weeks 8–10: Boot removed, walking begins.
• Months 3–6: Strengthening and balance exercises.
• Months 6–12: Gradual return to sport.

Most people recover well, with similar outcomes whether they have surgery or not. Full return to sport may take up to a year.

2. Achilles Tendinopathy

This is a long-term condition caused by overuse. The tendon becomes painful and stiff, especially in the morning.

Main Treatment:

• Exercise therapy: The most effective treatment. Strengthening exercises (like heel drops or calf raises) help the tendon heal.
• Manual therapy: Massage or joint mobilisation may help with pain but should be used alongside exercise.
• Shockwave therapy: May help in stubborn cases, but evidence is mixed. NICE recommends using it cautiously but there are no ill effects.
• Orthotics (insoles/heel lifts): Can reduce strain but don’t replace exercise.
• Education: Patients should stay active within pain limits. Rest alone doesn’t help.

Recovery Timeline:

• First 6 weeks: Start exercises and modify activity.
• 6–12 weeks: Most people see improvement.
• 3–6 months: Return to sport and full activity.

Key Points:

• Exercise is the core treatment for tendinopathy.
• Ruptures often heal well without surgery.
• Shockwave therapy is a second-line option.
• Patient education is vital for recovery.
• Full recovery can take months, but most people improve significantly.

Osteoarthritis (OA) is a common joint condition that causes pain, stiffness, and reduced movement, especially in the knees, hips, and hands. Although there’s no cure, physiotherapy can help people manage symptoms and stay active so you can often live an active and fulfilling life with little pain.

The main treatment recommended by NICE, the NHS, and CSP is exercise. This includes strengthening exercises, aerobic activity (like walking or cycling), and flexibility work. Exercise helps reduce pain, improve movement, and support joint health. It’s safe and effective, even if it causes some discomfort at first.

Weight management is also important. Losing even a small amount of weight can decrease overall inflammation in the body and ease pressure on joints to reduce pain.

Patient education is a key part of treatment. People with OA should understand their condition and learn how to manage it. Physiotherapists explain that OA doesn’t always get worse and that movement is good for joints. They also teach pacing (balancing activity and rest), joint protection techniques, and how to use aids like walking sticks or braces if needed.

Manual therapy (hands-on techniques like joint mobilisation or massage) can help with stiffness or pain, but it should always be used alongside exercise – not on its own.

Electrotherapy treatments like ultrasound or TENS machines are not recommended by NICE, as there’s little evidence they help in the long term – there is some building evidence that Shockwave may help. Simple heat or cold packs can be useful for short-term relief at home.

Physiotherapists tailor treatment to each person’s needs. They assess symptoms, set goals, and create personalised exercise plans. They also help patients stay motivated and adjust treatment as needed.

Useful resources include NHS websites, Versus Arthritis booklets, and the ESCAPE-pain programme – a group course combining education and exercise. The CSP also offers videos and leaflets to help patients understand OA and how to manage it.

In summary, physiotherapy for osteoarthritis focuses on helping people move more, manage their weight, understand their condition, and stay independent. With the right support, many people with OA can reduce their pain and improve their quality of life.

Wow, this is something we treat all the time and there can be numerous causes of back pain.   The key is to recognise that each case is unique and will need an individual approach for the correct advice, exercises or manual treatment.   Very rarely is back pain a serious problem and, with help, will usually resolve within 3 months.

Dizziness is a complex speciality.  It is worth thinking which of these words suits your symptoms best; unsteady, disorientated, unbalanced, light-headed or vertigo.  Vertigo is described as the sensation of motion or movement when you shouldn’t have it.

Frozen shoulder (also called adhesive capsulitis) is a condition where the shoulder becomes painful and stiff, often without a clear cause. It usually affects people over 50 and those with diabetes. Recovery can take 1 to 3 years, and some people may have a degree of lasting stiffness or discomfort.

The condition typically goes through three stages:

1. Freezing stage – pain builds up and movement becomes limited.
2. Frozen stage – stiffness is the main problem, with less pain.
3. Thawing stage – movement slowly improves and pain fades.

UK health bodies like the NHS and the Chartered Society of Physiotherapy (CSP) recommend starting with simple, non-surgical treatments. These include:

• Pain relief using paracetamol or anti-inflammatory medicines.
• Steroid injections into the shoulder joint to reduce pain and allow better movement.
• Physiotherapy, which focuses on exercises to keep the shoulder moving.

In the early painful stage, exercises should be light and not push through pain. As the shoulder becomes less painful, more stretching and strengthening exercises can be added. Physiotherapists may also use hands-on techniques like joint mobilisation to help improve movement.

Some people benefit from extra treatments like heat therapy and TENS (electrical stimulation), although evidence for these is limited.

If the shoulder doesn’t improve after a few months of physiotherapy and injections, more advanced treatments may be considered:

• Hydrodilatation – injecting fluid into the joint to stretch it.
• Manipulation under anaesthesia (MUA) – moving the shoulder while the patient is asleep.
• Arthroscopic surgery – releasing tight parts of the joint capsule.

These options are usually followed by more physiotherapy to help recovery.

Studies show that physiotherapy, injections, and surgery can all help, but no single treatment is clearly better than the others. The best approach depends on the person’s symptoms, stage of the condition, and preferences.

In summary:

• Start with pain relief and gentle exercises.
• Use steroid injections if pain is severe.
• Progress to more active physiotherapy as stiffness becomes the main issue.
• Consider specialist treatments if things don’t improve.
• Most people recover well with time and the right support.

Once a broken bone or dislocated joint has healed rehabilitation can commence. Exercises, pain relief and mobilisations will assist getting back to the normal activities of daily living.

Golfer’s elbow is a painful condition affecting the inside of the elbow, caused by overuse of the forearm muscles—often from repetitive gripping, lifting, or wrist movements. It’s common in golfers, manual workers, and anyone doing repetitive arm tasks. The problem isn’t inflammation, but wear and tear of the tendon that attaches to the elbow.

Physiotherapy is the best first treatment, backed by strong evidence. Most people (around 80–90%) recover without surgery if they follow a proper rehab plan. Recovery usually takes a few months, with noticeable improvement in 6–12 weeks.

The key parts of treatment are:

• Activity changes: Avoid or adjust movements that cause pain. Rest the elbow, but don’t stop using it completely.
• Pain relief: Ice, anti-inflammatory tablets, and elbow braces can help in the short term.
• Exercise therapy: This is the most important part. It includes:
  • Stretching the forearm muscles to improve flexibility.
  • Isometric exercises (pressing without moving) to reduce pain and keep muscles active.
  • Eccentric exercises (slow lowering movements) to rebuild the tendon.
  • Strengthening the wrist, forearm, and shoulder to support the elbow and prevent future problems.

Manual therapy (like massage or joint movements) may help with pain but only works well when combined with exercise. Other treatments like Ultrasound and Shockwave have weak evidence and again work best when combined with exercises.

Steroid injections can give fast pain relief but often don’t last. Many people feel better for a few weeks, then the pain returns. Injections may also weaken the tendon if used too often, so they’re not a long-term fix.

Surgery is rarely needed—only for severe cases that haven’t improved after 6–12 months of physio. It involves removing damaged tendon tissue and has a good success rate, but recovery still takes several months.

In short, physiotherapy is safe, effective, and should be your first choice. It treats the root cause, not just the symptoms. With patience and regular exercises, most people get back to normal activities without needing injections or surgery.

Overstretching of the tendons in the upper/inner thigh.

Some muscular tensions in the neck give rise to specific headaches.  Joint stiffness in the upper vertebral levels can also produce headaches.

Difficulty controlling the bladder or bowel.  Sometimes causing leaks.  Sometimes just needing to rush to the toilet more often than you would like.

Sometimes wear and tear behind the kneecap can cause discomfort on exercise or rest.  Occasionally foot position or changes in muscle activity can aggravate symptoms.

Sometimes pain and parasthesia (pins and needles) can refer from a back problem, Occasionally this is nerve irritation from bone, disc, joint or muscular origins.

Localised trauma to one or more ligaments in the knee causing inflammation/pain.

Tightness in the muscle often caused by overuse, tension or poor posture.

Commonly experienced as pain, pins and needles or numbness “in a line” following the route of a nerve.

This is a common cause of knee pain in active children and teenagers, especially those aged 10–15 who play sports involving running and jumping. It’s caused by irritation at the top of the shinbone where the thigh muscles attach. The condition is harmless and usually goes away on its own as the child finishes growing.

UK health bodies like NICE, the NHS, and the Chartered Society of Physiotherapy (CSP) all recommend conservative treatment—meaning no surgery or injections. The focus is on managing symptoms and helping the child stay active safely.

Key Treatment Recommendations:

• Rest and Activity Modification: Children should reduce or pause activities that cause pain, like jumping or kneeling. They don’t need to stop all sport—gentle activity is fine if it doesn’t make the pain worse. Pain should guide how much they do.
• Ice and Pain Relief: Applying ice to the sore area for 10–15 minutes after exercise can help. Over-the-counter painkillers like paracetamol or ibuprofen may be used if needed.
• Stretching Exercises: Tight thigh muscles (especially the quadriceps and hamstrings) can make the pain worse. Daily gentle stretches help reduce strain on the knee. These should be done when the pain isn’t too bad.
• Strengthening Exercises: Building strength in the thigh and hip muscles helps support the knee. Exercises start gently and progress as pain allows. Examples include wall sits, bridges, and step-ups.
• Manual Therapy and Supports: Massage or taping to ease discomfort. Patellar straps or knee sleeves may help during sport, but they’re optional and don’t treat the root cause.
• Avoid Immobilisation and Injections: Braces or casts are rarely needed and can weaken the leg. Steroid injections are not recommended for children with OSD.

What to Expect:

• Most children recover fully with time and proper care.
• Symptoms can last from a few months to up to two years but usually improve gradually.
• The bony bump below the knee may remain but is usually painless in adulthood.
• Surgery is only considered in rare cases after growth has finished.

Bottom Line:

Osgood-Schlatter Disease is a temporary condition that responds well to rest, stretching, strengthening, and symptom relief. UK guidelines strongly support physiotherapy and self-management. With the right approach, most children can stay active and recover without long-term problems.

Bladder or bowel incontinence, pelvic pain, pain with intercourse, pelvic organ prolapse which can feel achy or painful but sometimes just feels “different down there”.

This is a common cause of heel pain, especially in people aged 40–60 or those who spend a lot of time on their feet. It happens when the thick band of tissue under your foot (the plantar fascia) becomes irritated or damaged, usually due to overuse, tight calf muscles, poor footwear, or changes in activity.

The pain is often worst first thing in the morning or after sitting for a while, and it tends to ease as you move around. It can come on gradually and last for weeks or months if not treated.

Physiotherapy is the main treatment, and most people recover without needing injections or surgery. Around 90% of cases improve with simple, non-invasive care.

Treatment includes:

• Stretching: Daily stretches for the calf muscles and the sole of the foot help reduce tension on the heel. A key stretch is pulling your toes back towards your shin to stretch the arch. Doing this before your first steps in the morning can ease pain.
• Strengthening: Exercises to build up the muscles in your foot and lower leg improve support and reduce strain. These include towel scrunches with your toes, heel raises, and resistance band exercises.
• Footwear and supports: Wearing cushioned, supportive shoes (even indoors) helps. Gel heel pads or arch supports can reduce pressure. Night splints, which keep your foot stretched while you sleep, may help with morning pain.
• Pain relief: Ice packs, rolling your foot over a frozen bottle, or short-term use of painkillers like ibuprofen can ease discomfort. Taping the foot or using a heel lift may also help.
• Manual therapy: A physiotherapist may use massage or joint mobilisation to reduce stiffness and improve movement.
• Shockwave therapy: If symptoms persist after a few months, this treatment may be offered. It uses sound waves to stimulate healing and is often effective in stubborn cases.
• Surgery: Very rarely needed – only considered if nothing else works after 12+ months.

Recovery usually takes a few months, but some cases can last up to a year. Most people see improvement within 6–10 weeks if they stick to their exercises and wear proper footwear. Recurrence can happen, especially if you stop stretching or wear unsupportive shoes again, but it’s usually manageable.

A specific exercised based programme to help you get back to full function after your operation.

Muscles that support our body rather than move it can fatigue if overworked or used in an abnormal position.  They often feel stiff and sore.

Pain overlying or between the ribs.  It may radiate around the chest wall.

A group of 4 muscles around the shoulder make up the rotator cuff, dysfunction or injury to any of these muscles can cause shoulder pain and is referred to as a rotator cuff problem.

Very occasionally, pelvic joint can be come strained or stiffen, often associated with hormonal changes in pregnancy.

Pain specific to the back/outer aspect of the leg, sometimes as far as the ankle/foot.

See ‘Frozen Shoulder’.

Misleading disused terminology now described as disc bulge or prolapse.  Common finding on MRI scans often without symptoms but occasionally touching on nerves to create pain.

Overstretching or occasional tearing of muscles

Leaking urine when jumping, running, lifting, coughing or sneezing.

Misleading disused terminology now as most are not inflammatory.  Should be called tendinopathy and refers to painful, sometimes swollen areas within any tendon.

An overuse injury causing pain in the outside of the elbow.

Term often used to describe when nerves have become irritated by tension in the tissues around them causing pain, pins and needles or numbness along the path of the nerve.  Only very occasionally is the nerve actually trapped.

Symptoms following an incident where the head or body has jerked violently, occasionally, there is soft muscular tissue injury, but usually a muscular spasm reaction that stiffens movement and causes discomfort.