• Lateral ligament sprains – pain on the outside of the ankle joint often following an incident of inversion or “going over the ankle” either recently or in the past.There may be swelling and significant bruising if acute. Physiotherapy can promote the healing of the ligament decreasing pain as well as addressing any muscle strength or gait problems.
• Tendonitis – overuse injury particularly of the peroneal tendons on the outside of the ankle. This may be caused by acute or chronic overloading of the tendons. Pain is often located around the outside of the ankle which is worse during or after exercise. A thorough assessment of the biomechanics of the lower limb may indicate the reason for this overuse.
• Post fracture – Ankles can be stiff and painful following fractures. Physiotherapy can help alleviate the pain as well as increase movement and help you on your return to full fitness.

• Helping you to understand what is happening to your bones and joints with the different types of arthritis.
• Help you to manage your pain through different coping strategies as well as treatment modalities such as acupuncture and TENS
• Provide specific stretches, mobilisations and strengthening exercises as well as give you advice on general exercises that may help to improve your general fitness and wellbeing.

• Muscle strain – a common cause of calf pain often as a result of a sudden explosive activity such as jumping or sprinting. A direct blow to the calf can cause a bleed in the muscle belly resulting in local damage to the muscle
• DVT – signs and symptoms include a hot, red, swollen calf and need hospital diagnosis and treatment
• Achilles tendonitis/rupture – Repetitive strain affecting the Achilles region is a common complaint particularly seen in distance runners. Symptoms include pain in the region of the Achilles tendon, often worse after inactivity e.g. first thing in the morning or after an aggravating activity such as running.
• Cramp is commonly found in the calf muscle and can be alleviated through exercise and stretching
• Referred pain – spinal problems can refer down to the calf, often giving a more vague area of pain or ‘Shooting pain’ often described in Sciatica
• Biomechanical problems – poor foot posture can overload the calf muscles giving rise to pain and tenderness. Treatment may require referral to one of our accredited podiatrists

• Changes in Blood Pressure
• Benign Paroxysmal Positional Vertigo or BPPV
• Due to a neck problem
• Fluctuating inner ear conditions such as active Ménières disease. These cannot be treated with vestibular exercises but can often benefit from advice and coping strategies
• Damage to the balance organs of the inner ear
• Please see our link to vestibular rehabilitation.

These are fairly common in sports players and can include fractures, dislocations, tendon and ligament damage. A direct hit on the end of the pointed finger especially by a ball is often the cause.

Correct treatment will often speed up and maximise the recovery.

The most common conditions physiotherapists see in their clinics are:

• Plantarfascitis — this is acute pain and stiffness in the heel , especially when first putting the foot down in the morning.
• Metartarsalgia – this is pain underneath the foot, normally between the second and third toes.
• Tendonitis — this is inflammation of a tendon, of which there are many in the foot.

Foot problems are often of a biomechanical origin and might require made to measure insoles. If the physiotherapist believes insoles are required he/she will refer you to a podiatrist to help prevent a reoccurrence of the condition.

The symptoms are normally pain on the inside of the elbow, with early morning stiffness . The causes are normally from overuse or a change of equipment or technique. If it has been caused by your sport it is important to liase with your coach.

Treatment is very much the same for both and might include:

• Transverse friction massage
• Manipulation
• Electrotherapy
• Acupuncture
• Strengthening and stretching exercises.
• Taping or splinting.

Treatments include:

• Tailored exercise programme
• Pilates
• Acupuncture
• Mobilisations / Manipulation
• Soft tissue techniques

• Osteoarthritis of the hip will normally show up as pain and stiffness in the hip. The pain can however refer into the groin and down the front of the thigh as far as the knee. The pain and stiffness often leads to a limp, and functional difficulties, such as getting dressed.
• Trochanteric Bursitis: This is inflammation of the main hip bursa and can cause pain directly on the hip bone especially if one tries to sleep on that side.
• Hip Replacement: Post operative physiotherapy is important to optimise recovery.

The assessment as always is very important . The history and mechanics of the injury, and what affects it will help the physiotherapist make an accurate diagnosis. Below are some of the many knee problems the physiotherapist can help you with.

• Ligament Injuries – These vary on site and degree. They can be on the inside of the knee [medial] the outside [lateral] or occur internally [cruciate] . They can vary in degree from a strain to a complete rupture ,and the level of the injury will dictate if it is the physiotherapist or surgeon that carries out the first part of the treatment.
• Cartilage or Meniscal Tears – This injury is more common on the inside of the knee than the outside. Physiotherapy is normally post –operatively , unless there is a very minor tear, or if swelling reduction and muscle building is required pre-surgery.
• Tendonitis – This can be a primary cause of knee pain often at the front of the knee or as a secondary reason, normally because of a muscle imbalance and weakness caused by another often minor untreated injury.
• Osgood-Schlatters – Normally occurs in very sporty children going through growth spurts. The pain is just below the knee where the patella tendon attaches to the bone.
• Osteoarthritis – This can occur within the main weight-bearing part of the knee or behind the knee cap [patella]. Treatment will not cure the root of the problem but can provide pain relief and slow down the progression of the condition.
• Post-Surgery Knee – Whether the surgery is a fairly minor arthroscopic procedure or a total knee replacement physiotherapy will speed up and maximise your rehabilitation.

The treatment will always include strengthening exercises. Weakness of the major muscles surrounding the knee, either due to pain, swelling or non-use can lead to reduced control of the knee joint and the possibility of other structures becoming painful.

The presentation of LBP can be extremely diverse from an ongoing ache over many years, to acute episodes where you feel unable to straighten up, to nerve referred pains such as sciatica. It is because of this variety that it is essential that a back specialist, such as your physiotherapist, fully assesses your condition to determine the appropriate course of treatment for your particular symptoms. All of our physiotherapists are highly experienced in treating LBP as it is by far the most common condition that we encounter in our clinics.

By undertaking a full physical examination your physiotherapist will be able to diagnose the likely cause of your back pain. Two of the most commonly encountered presentations are listed below:

• Disc related pain – Discs sit between each of the vertebrae throughout the spinal column, acting as shock absorbers and helping to maintain a balanced distribution of forces within the spine. Each disc consists of a gel like centre, called the nucleus, and is surrounded by an outer protective layer called the annulus (imagine a jam doughnut). Due to the often repetitive and sustained postural nature of many of our professions and hobbies the disc can be placed under repeated stress in certain positions. This can sometimes lead to a bulging of the disc, which can then press on some of the surrounding structures producing pain. If the disc happens to press on a nerve, you are likely to experience pins and needles, or numbness sometimes down to your toes.
• Facet joint pain – Each vertebra has two facet joints connecting to the level above and two to the level below. In a well conditioned back the facet joints slide and glide on each other to allow us to move normally and without pain. With LBP this can cease to be the case. One of the facets may become restricted in its ability to slide and glide, or following trauma may be impacted on the either the facet above or below, leading to LBP. The facet joints usually produce pain locally to one side, but if highly aggravated may refer pain into the leg.

Treatment for LBP: We strongly believe that a course of treatment must address not only the actual symptoms, but the cause of the problem. We frequently encounter patients who feel that their back has just ‘gone’ for no reason, but when delving into the requirements of their occupations, hobbies or family life, find clues as to why this may have happened. Initial treatment may involve manipulation or mobilisation, and exercises to restore the range of movement, and reduce the pain in your back. Following this, a consideration of lifestyle factors and a strengthening program to address the core muscles (e.g. Pilates) is often indicated. Every treatment program is individually designed to your symptoms and lifestyle demands.

It can present itself with many other symptoms such as headaches, arm pain, numbness and pins and needles. It is therefore very important to be assessed by a qualified clinician. All our physiotherapists are highly experienced and will carry out a thorough examination to make their diagnosis and then decide on the most appropriate and safe treatment.

The most common neck problems seen in the clinic are:

• Disc: A bulging disc can impinge [put pressure] on a nerve in the neck causing local neck pain . However, the local pain can be accompanied with arm pain, numbness, pins and needles or muscle weakness. The severity of the symptoms will determine the treatment chosen, or if a specialist referral is required.
• Facet Joint Pain: These are small joints on either side of the vertebral column [spine]. They can become stiff or slightly shifted out of position. This then irritates the local soft tissues, often causing neck pain. Sometimes the irritation can be so severe that the symptoms can refer into the arm like a disc problem. This condition responds very well to physiotherapy.
• Acute Torticollis: This normally occurs in teenagers, but not exclusively. The patient often wakes up with a very painful neck, unable to hold the head upright because of the pain and muscle spasm. This condition, although very painful and sometimes frightening, improves very quickly with treatment.
• Post Whiplash: This normally occurs when someone’s neck and head go rapidly forward and then back again, usually in a car accident . This affects many tissues in the neck including muscles, ligaments, joints and even neural tissue [nerves]. The symptoms are varied, but usually involve stiffness and pain. All our physiotherapists are experienced in treating this condition.
• Osteoarthritis or cervical spondylosis: This is the wear and tear one gets in the neck joints from everyday living. Like most things some people get more severe symptoms than others. The symptoms include loss of movement, and some pain. Physiotherapy will not cure the condition but can ease the symptoms by reducing the pain and maximising the movement.

Treatment for neck problems may include:

• Mobilisations / Manipulation
• Tailored exercise programme
• Electrotherapy
• Acupuncture
• Soft tissue massage
• Traction
• Postural advice

Your physiotherapist will be able to advise you on the correct set up of your work station, and educate you with regards to future prevention of posture related pain.

Most frequently the neck is involved resulting in what is commonly termed whiplash or whiplash associated disorder (WAD). In the majority of cases symptoms are due to damage to the soft tissue structures rather than the discs, facet joints or nerves. These injuries, although extremely sore and debilitating initially, are not generally serious and most people will make a full recovery.

All of our physiotherapists are highly experienced in treating WAD and musculoskeletal injuries resulting from road traffic accidents, and following a thorough assessment a treatment program will be developed to maximise your recovery.

Treatment for whiplash associated disorders may include:

• Home exercise programme
• Electrotherapy
• Acupuncture
• Mobilisations / Manipulation
• Soft tissue techniques

It is a controversial area with some schools of thought considering it a significant source of pain around the lower back and buttock area, whilst others feel it has little contribution to pain in this area. This difference of opinion is due to the SIJ being a very secure joint that has a very small amount of available movement. Pain is usually felt on one side and locally to the base of the spine and buttock area. It can commonly coexist with LBP or hip problems, and patients often complain of pain when getting in or out of the car, turning over in bed or standing on one leg. Pain attributable to the SIJ is often seen during pregnancy.

SIJ pain is usually due to a directional stiffness at the joint, or instability due to poor muscle control. A thorough assessment by your physiotherapist will determine whether the SIJ, lumbar spine, hip joint or a combination of these are the reason for your symptoms.

True sciatica is due to an irritation of this nerve either mechanically (e.g. disc bulge) or chemically (inflammatory changes) and is often experienced as sudden shooting pains into the back of the leg or calf. Successful elimination of the pain is dependent on identifying the cause of the nerve irritation and looking to eliminate this.

Treatments for Sciatica may include:

• Exercise programme
• Neural mobilisations
• Electrotherapy
• Acupuncture
• Mobilisations
• Manipulation

• Inflammation – often where the muscle or fascia inserts onto the bone
• Compartment syndrome. There are groups of muscles in the shin region which are surrounded by a fascia. When you increase your exercise and build up muscle density in this region it can result in pain and inflammation as the fascia does not have time to expand
• Bone stress – varying from strain up to stress fracture

Treatments offered for shin pain may include:

• Tailored exercise programme
• Acupuncture
• Mobilisations / Manipulation
• Soft Tissue Techniques
• Biomechanical assessment – often it is beneficial to bring your running trainers with you to the assessment

• Referral from the neck
• Rotator cuff pathology. The rotator cuff comprises of 4 muscles that work to maintain the position of the humerous in the shoulder joint. They are at risk of tendonopathy, impingement or possible tear.
• Shoulder joint dislocation
• AC joint dislocation/subluxation – commonly as a result of a fall onto a out-stretched hand or onto the shoulder e.g. during a rugby match
• Frozen Shoulder or Adhesive Capsulitis
• Bursitis
• Post-surgery – The Physiotherapy Partners commonly deal with rehabilitation after shoulder operations and can help you

• The common site of the pain is normally at this point but it can also be slightly lower down in the forearm.
• The symptoms are normally pain on the outside of the elbow aggravated by gripping and lifting, and early morning stiffness.
• It can be caused by tennis or other racquet sports, or a sudden increase in another activity such as pruning. If it is caused by increased tennis or increased practice particularly of a new stroke it should be mentioned to your coach. A change of racquet, one that is heavier or has a thicker grip can sometimes be the trigger of this condition.

• Referred pain – either from a lower back problem or from the hip joint
• Muscle injury – the quadriceps muscle group at the front of the thigh are a common site for contusions, particularly in contact sports such as football.
• Tendonitis – an overuse injury affecting the tendon
• ITB syndrome
• Stress fracture of the femur
• Bursitis – inflammation of one of the fluid filled sacs around the hip joint that can give pain around the hip joint sometimes radiating down the thigh and leg.
• It is often painful when you lie on the affected hip.

Treatments for thigh pain include:

• Tailored Exercise programme
• Pilates
• Acupuncture
• Mobilisations
• Manipulation
• Soft Tissue Techniques

Treatment may include:

• Electrotherapy
• Mobilisations
• Manipulation
• Postural advice

The overuse injuries are often in the news, with RSI [repetitive stress injury ] often caused by the overuse, or poor postures adopted at computers, especially laptops. There were however many examples of RSI in the past with conditions such as Gamekeepers thumb.

• Post fracture stiffness and pain – This occurs due to the wrist having to be immobilised in plaster for up to six weeks. The patient is normally an elderly lady who has fallen onto her outstretched arm.
• Dislocation – This will often occur in sportsmen, especially racquet players who put their hand out to prevent a fall or when running into the court wall . This can result in a fracture of one of the small bones in the wrist or a dislocation.
• Tendonitis – It is usually a slow onset of pain in the wrist with increasing pain and disability. It is often seen in people with highly repetitive jobs working in a poor biomechanical position such as computer or checkout operators . Where possible it is important to have a workstation assessment to try to prevent reoccurrence of the condition once cured by physiotherapy.