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Conditions Treated

Here is a list of common conditions I regularly treat at my clinic. I also include how you can recognise these conditions and some of the ways I treat them.


Back Pain

There are many forms of back pain each caused by different factors within the body. Joints, muscles, discs or nerves can all be involved. The first thing I will do is establish what factors are causing your particular back pain and then determine what can be done to alleviate pain and to treat the underlying condition.

After a thorough assessment, I will tailor a treatment plan to address the factors contributing to your back pain. Then physiotherapy will begin. The session will involve hands-on treatment like mobilising stiff joints or manipulating tight or short muscles. What I do will depend on the type of back pain you have.

For many forms of back pain, imbalance and lack of strength within the core muscles are a major factor. In these instances, treatment will focus on restoring muscle balance and strengthening core muscles as an essential part of recovery and prevention of back pain recurrence. 

In addition to this, I will advise you on how you can manage and treat your back pain yourself. You will be given simple but effective exercises and posture advice to help alleviate and prevent relapses of your injury.

I also provide acupuncture as a treatment for certain forms of back pain as research has found that acupuncture can help alleviate joint, nerve and disc pain, as well as relaxing tightened muscles.  

Foot and Ankle

Ankle and foot problems I commonly treat include ankle sprains, Achilles tendon injuries and plantar fasciitis. I also treat people who need to recover foot and ankle mobility and strength after fracture and trauma.

The reason there are so many ankle problems is that your ankle joints and feet are your link between your body and the ground. This means that your ankles and feet have to be stable and strong enough to cope with walking and running but flexible enough to adjust to uneven ground.

To be this stable, flexible and strong, the four bones of the ankle are surrounded by ligaments and tendons. These are found on the inside, outside, and front and back of the joint and they provide the extra stability you need for all movement. This in turn means a lot of possible injuries.

Acute onset ankle injuries are the most common of these problems. Often these occur on the sporting field when you go over your ankle but sometimes they are caused by simple slips and trips while walking on uneven ground. Fractures and ligament and tendon strains are the most common injuries here. 

Foot and ankle pain can also creep up over time, seemingly without cause. In these instances, factors like overloading of the foot, changes of footwear, muscle imbalance and the mechanics of the whole lower limb need to be considered as potential causes of the injury. Most heel pains, like Achilles tendinitis or plantar fasciitis, and arthritis of the ankle and foot belong to this group.

Both acute and longstanding problems can, however, often be successfully treated completely within a single treatment or a short course of physiotherapy. They require a professional assessment in order that I can create the personalised treatment plan that will best allow you to heal, regain strength and mobility, and to return to your pre-injury activity and sport. 

Headaches

Physiotherapy is highly effective treatment for headache coming from the neck (cervicogenic headache) and also useful in the treatment of tension headaches and migraine. 

Cervicogenic headaches can have many causes. Excessive strain caused by poor working postures can irritate the muscles and joints of the neck and cause a headache. The joints and muscles can also be injured by trauma like a whiplash in a car accident. In the late middle-aged to older age groups, osteoarthritis of the upper neck joints is another common cause of cervicogenic headache.

Hands-on treatment of stiff neck joints and tightened muscles, together with advice about posture, life style and neck specific exercises form an individually tailored program to achieve relief.

Physiotherapy can also assist in the management of migraine and tension-type headaches by using certain soft-tissue techniques and relaxation techniques. This may involve massages, manipulation and acupuncture. 

The current NICE guidelines for both, tension type headache and migraine, recommend acupuncture. It can reduce the frequency of headache episodes, as research reviews from 2016 have shown.

Hip Pain

The hip joint and its integration with the pelvis, lower back and lower limb make it a complex region, and injuries can present in a variety of ways. These can be a sharp pain in the front of the groin, deep buttock pain, radiating pain to the lower back and knee, aching at night, problems with sporting performance, or even resting pain when sitting or lying.

Hip pain often falls into two categories – acute and more chronic-type injuries. Acute injuries often set in quickly from a single mechanism – a slip and fall, a sporting tackle or an awkward step. They can cause pain with movement, pain turning in bed or sleeping on a particular side, and may even cause a limp.

More chronic hip injuries creep up over time. These include hip arthritis, impingement and bursitis (symptoms of biomechanical overload, weakness and muscle imbalance) and nerve-type pain such as sciatica and deep-buttock pain.

As part of your treatment, I will carry out an in-depth interview and physical assessment of your hip, considering a wide range of factors including referred pain from the low back or pelvis; the mechanics of the hip joint and lower limb; strength and balance of the surrounding muscles; gait or sporting technique; core stability, and bio-mechanical analysis.

Jaw Pain

Problems of the jaw joint and the chewing muscles can result in Temporomandibular-joint (TMJ) disorders. Common causes of TMJ problems include stress induced jaw clenching and tooth grinding; traumas to the chin or neck; and extensive dental work. 

Since completing the postgraduate jaw treatment training with CRAFTA (crafta.org) in 2010, I have gained extensive experience of helping people with jaw joint problems, facial pain and tightness in chewing muscles. 

Depending on the patient’s individual injury, I use hands-on techniques like jaw joint mobilisation, muscle releases of chewing muscles, trigger point massage and acupuncture. These treatments help in the regaining of muscle balance and the lessening of tension in the jaw region and are complemented by an exercise program I will tailor for you to help in your continued recovery.

Knee Injuries

Knee injuries can result from one traumatic incident like a twist or fall, or they may progressively build up as a result of something less obvious like muscle imbalance or using inappropriate shoes or trainers (a frequently overlooked cause of injuries for which I do a bio-mechanic assessment and give footwear advice).

The first thing I will do is establish what caused your knee injury. Then I will screen neighbouring joints and muscles as problems with these can lead to knee injuries. Dropped arches, weakness in the buttock muscles or shortened hip muscles are all common causes of knee pain.

Next, I will create a treatment plan and begin treatment. This will involve hands-on treatment, usually joint manipulation and release of muscles but the treatment will vary to suit your specific knee injury.  

Re-creating a good muscle balance in your legs is crucial for the recovery of all knee injuries, from sports injuries and strains, to post-surgery and osteoarthritis. To aid your recovery, I will teach you strengthening exercises and stretching techniques, and will tailor a compact home exercise program to help you with this.

Neck Pain

Neck pain is a common and disabling condition, often combined with shoulder and arm pain. The origin of the injury can be obvious like a recent sports injury or whiplash trauma. Often, though, the cause is less straightforward, like poor posture when using screens or phones, an old injury, or arthritis of the neck joints themselves. 

My initial assessment will involve looking for what precisely is causing your pain. The source of the injury can be in muscles, joints, discs or nerves, or in a combination of two or more of these.

After the cause of the neck pain is established, I will create an individual treatment plan for you and begin treatment within the first session. What I do will vary according to the result of the examination and the severity of your injury. The treatment may include manipulation of stiff joints, gentle mobilisation to soothe irritated joints and discs or release tension and spasms in the muscles of the neck, or acupuncture to treat muscle spasm or alleviate nerve, joint and disc pain. 

 I will also, of course, advise you on how you can manage and treat your back pain yourself and give you simple but effective exercises and advice on how best to alleviate and prevent relapses of your neck pain. 

Osteoarthritis

Osteoarthritis can seem like the end of many of the activities you enjoy but it need not be. A tailored program of simple but effective exercises and manual treatment combined with the development of new habits can help alleviate joint stiffness, improve life quality, and let you to keep doing the things you like doing.

Although Osteoarthritis commonly affects the weight-supporting joints, like the hips and knees, it can affect any joint in the body, from your shoulder and spine through to your fingers and toes. Initially, I will examine you to assess how your arthritis is affecting you and how it can be best treated to reduce pain, maintain mobility and slow the condition’s progress. 

After assessment, I will develop a plan for you. This will involve hands-on treatment, like massage and manipulation, to lessen muscle tightness and joint stiffness. Partly this will aim to reduce pain but it is also designed to keep the joint working as well as it can.

To maintain good strength in the surrounding muscles is crucial to ensure that your ‘muscular brace’ is stabilising the arthritic joint. This not only helps to reduce pain but also slows down the progress of the arthritis in the joint. 

I will also develop a home exercises programme for you that is adjusted to the severity of your arthritis and focuses on your situation and your goals. I will walk you through each exercise and answer any question to make sure you are clear about what you are doing and why. 

In cases where you have decided with your Orthopaedic Consultant that you need joint replacement surgery, I offer pre-surgery physiotherapy. This is a good way of putting you in the best possible position for a speedy recovery as it strengthens relevant muscles and maintains mobility. This means you can begin using the affected limb more quickly post-surgery and helps avoid the muscle loss often seen after joint replacement.

Rehabilitation after Surgery

Following surgery and trauma, physiotherapy helps to regain strength and mobility as soon as possible so you can return to your active life style. 

I worked in post-surgery rehabilitation for many years and have a lot of experience in deciding when to begin with each step in post-surgery recovery. This is important part of recovery as early mobilisation of joints and the surrounding soft tissue is a major part of lessening scarring, reducing pain, preventing joint stiffness and regaining good muscle function.

I will also individually tailor a programme of stretching and strengthening exercises for you. This programme will take into account your pain levels and what you want to achieve through your recovery. This will help accelerate your recovery and let you return to your normal life and to your sports and day-to-day activities as quickly as possible.

Sciatica

Sciatica is pain running along the sciatic nerve in the buttock and the leg. The pain comes from irritation or compression of the nerve or, in many instances, as a side-effect of a lower back injury like a bulging disc, joint inflammation or arthritis.

The initial assessment will involve identifying the root cause of the sciatic pain. The history and your description of the pain will give important clues, particularly sensation of tingling, numbness or weakness in the leg can be indicators of the severity of the injury and must be taken into consideration.

Based on the outcome of the assessment, a treatment plan is made. Most often, treatment starts with gentle hands-on treatment aiming to relieve pain and to calm down inflammation of the nerve. Advise on gentle exercises will enable you to look after your injury at home. 

As the pain is easing, rehabilitation will be the focus of treatment: I will use joint manipulation and releases for taught muscles where necessary. Tailoring a home exercises to target weak core muscles, poor posture and stiff joints and muscles is essential to speed up recovery and to prevent relapses.

Shoulder Pain

The shoulder is the joint in the human body that moves most freely. Therefore, it relies heavily on the surrounding muscles and ligaments to stabilise it. This means shoulder injuries need careful assessment, diagnosis and treatment.

Before treatment, I will physically assess you. This will involve examining both the shoulder and its surrounding structures like the rotator cuff muscles, the neck, the collarbone and the shoulder blade. 

After examining you to identify the source of the pain, I will tailor a treatment plan consisting of hands-on treatment designed to reduce pain, relax seized up muscles and improve shoulder mobility. I will begin treatment during the first session.

Additionally, I will give you advice on self-care and exercises so you to continue your recovery beyond the session. I will talk you through and demonstrate these exercises which are simple and quick but an important part of strengthening the stabilising muscles of the shoulder joint. These exercises will also address muscle stiffness, muscle weakness and imbalance.

Sports Injuries

Whilst some sports injuries are caused by a single trauma like a fall or impact, the origin of many sports injuries is not so immediate. The symptoms often come on slowly or are delayed. The causes are often poor technique, muscle imbalance, overly intensive training or not warming up. It is not always easy to see the link between a sports injury and its cause.

With running, injuries are often down to using the wrong shoes. This causes a domino effect in which unsupported arches lead to poor alignment of the knee which, in turn, leads to hip and lower back injuries. 

Upper limb injuries can occur when starting a new technique the body is not used too, like a new exercise in the gym or altering your way of striking the ball in racket sports or golf.

To ensure a speedy recovery and to prevent relapses, the underlying cause must identified and addressed as well as the injury being treated. I will make sure this is so by conducting a thorough assessment and tailoring your treatment to your particular needs.

In the first session, I will also begin hands-on treatment and give advice and exercises. This treatment will not only focus on the healing of the injured tissue but also work towards the rehabilitation of the affected area. 

Additionally, I will aim to maximise fitness retention as maintaining fitness during an injury helps you get back into your sport as close as possible to the level you were performing in before the injury. Maintaining fitness also helps prevent re-injury. 

Tennis Elbow

Tennis and golfer’s elbow are the most common repetitive strain injuries (RSIs) I see in my clinic. Tennis elbow occurs at the outer elbow where the tendons that extend our wrist and fingers attach to the bone. Golfer’s elbow is the equivalent injury to the hand tendon that bends muscles on the inside of the elbow. 

Both these injuries usually occur as a result of repetitive actions and prolonged gripping. This is why these conditions are linked to tennis and golf. The injuries I more often see today, though, are caused by excessive use of the computer or phone (mouse use, typing and scrolling are repetitive activities that cause strains and tension in the forearm muscles and tendons) or domestic activities like painting and gardening. Poor forearm strength and posture often play a part in the injuries as well.

A physical assessment is needed to analyse the injury and to rule out referred pain from the neck or a problem with the elbow joint itself. The starting point of the treatment, as for all RSIs, is advice on adjustment of the work and sport technique and on temporary relative rest for the affected area by avoiding aggravating activities. 

The treatment will depend on your particular injury, but usually I will use soft tissue release and friction massage of the forearm muscles and tendons, joint mobilisations, acupuncture and kinesio tape to speed your recovery. I will also show you specific eccentric strengthening exercises as these are essential when stimulating the body to restore tissue in damaged tendons.

Vertigo and Dizziness

I have a special interest in vestibular rehabilitation, the treatment of vertigo and conditions of the balance system. This includes BPPV (benign paroxysmal positional vertigo), labyrinthitis, vestibular neuritis and migraine associated vertigo.

Since completion of postgraduate training in this treatment with CRAFTA (www.crafta.org) in 2010, I have had extensive experience in helping patients through the process of recovering of vertigo and balance disorders.

I am qualified to carry out the Epley manoeuvre for BPPV which aims to release the dislodged crystals in the inner ear which cause the severe vertigo, nausea and imbalance. It is often effective carried out a single time. 

For other conditions, vestibular rehabilitation therapy uses specific head, body, and eye exercises designed to retrain the brain to recognize and process signals from the inner ear and coordinate them with information coming from our eyes, feet and spine. 

The choice and form of the exercises will differ from person to person but will always aim to reduce the dizziness, danger of falls and therefore enable the patient to return to an active and social life.