Physio Solutions

Physiotherapy & Sports Injury Clinic in London

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Joint Pain

We assess and treat all manner of joint pain and dysfunction. Seeing a physiotherapist is a really good first port of call if you have a problem and many GPs also refer clients to us for a musculo-skeletal assessment and diagnosis.

We can advise you on whether physiotherapy treatment is appropriate for you. If it is, we can provide treatment and, if it is not, we can advise you on what your best next step should be e.g. seeing your GP, another Specialist such as an Orthopaedic Consultant or Rheumatologist or any other options.

Shoulder Pain

The shoulder is a very complex joint to assess and treat. In spite of huge amounts of research and specialists working in the field, there is still no one test that can tell you what structure is causing the problem. Often where the pain appears to be is not where the problem actually is.

Types of shoulder problems we treat are:

Many problems around the shoulder are related to the fine balance of the tendons known as the 'rotator cuff' which work together to maintain the stability of the joint while not compromising on the large movement available in the shoulder.

By using an array of tests and focussing on function, our experienced physiotherapists can diagnose the structure or group of structures at fault and formulate a course of treatment. This almost always includes a muscle 'rebalancing' programme to optimise shoulder function. In cases of muscle tears or underlying injury the aim is to optimise the remaining tendons' function to compensate for any loss. We liase closely with many local Shoulder Consultants in cases where investigations or intervention are required.

Knee Pain

Knee problems are often more straightforward to assess and treat than some other joints such as the shoulder and hip but there are still a large number of possible causes and an accurate assessment is vital to constructing an effective programme. A mainstay of all knee treatments is strengthening the knee muscles and identifying any biomechanical problems in the chain either above or below the knee joint that can be contributing to pressure and strain on the knee e.g. muscle imbalance or stiffness in the hip or spine.

Types of knee problems we treat are:

Joint Treatment Options

Treatment very much depends on the findings of the assessment and the possible contributing factors identified. Techniques used to treat joint pain can often include the following:

All joint treatments include assessment and treatment of the surrounding muscles where weakness or overuse is identified.

Joint Pain Case Studies (see all Case Studies)

30 year old architect with hip & low back pain

Symptoms

  • Particularly bothersome in sitting, could not cross his legs, put shoes or socks on/off etc.
  • Examination showed L5/S1 lower lumbar spine reproducing his hip pain.

Treatment

Treated with spinal mobilisations, spinal manipulation, hamstring stretches and dry needling on his hip.

Outcome

Four sessions of treatment led to a full recovery.

24 year old professional super-heavy weight boxer with shoulder pain

Symptoms & Assessment

  • Unable to effectively throw a punch
  • Attended on Thursday - needed to fight the following Saturday
  • Examination showed decreased internal rotation of the shoulder to 0
  • Diagnosis GIRD (glenohumeral internal rotation deficiency)

Treatment

  • Treatment addressed the biomechanics of his thoracic and shoulder rotation and elbow and wrist movement.
  • Treatment consisted of mobilisation of his spine and shoulder, muscle energy techniques to repower his shoulder, soft tissue work, neuromobilisation, dry needling of the back of his shoulder and scapula.
  • After an extended session on Thursday he regained 45 degree of rotation (60 on L), he was already pain free
  • After another long session on Friday he regained full flexibility of his shoulder, elbow and wrist.

Outcome

He was completely pain free during the fight on Saturday and went on to win.

His training programme was adapted after the fight to address the strength defects and muscle imbalance that had contributed to the problem.

31 year old pregnant lady with low back and pelvic pain

Symptoms & Assessment

  • 31 years old, 26 weeks pregnant
  • Pain with walking causing her to limp.

Treatment

  • She was treated with soft tissue massage, mobilisations to her lower back and acupuncture to her gluteal muscles (all in side lying). 
  • She was also advised to buy an SIJ (sacroiliac joint) belt and shown how to use it.

Outcome

After two sessions she was much better and walking again pain free.

28 year old lady amateur power lifter with hip pain

Symptoms & Assessment

Severe pain and unable to squat fully with weight above 20 kg

Examination showed decreased hip flexion and rotation, very weak gluteal muscles, and poor kinetic control. She was also extremely hypermobile (very flexible). It can take longer to regain power in comparison to normal flexibility.

Treatment & Outcome

Treatment worked on the flexibility of her hip with joint mobilisations and stretches, and a progressive strengthening program of loading in squat position with narrow shallow squats-progressing to sumo wide squats.

The physiotherapist also worked closely with the client's powerlifting trainer with regular reviews and discussions of progression and issues.

The progressive loading program was continued for 6 months until the client was able to beat her personal best in full squat position.

10 year old boy with heel pain

Symptoms & Assessment

  • 10 year-old schoolboy playing a minimal amount of sport at school
  • Pain and moderately sized swelling/lump over the back of the right heel
  • Had started to spread up into the calf and down into the sole of his foot. 
  • Aggravated by playing football, running and walking.
  • His GP had X-rayed the foot to clear a bony tumour, and then referred him to the clinic, with Sever’s Disease as the suspected condition (common condition causing heel pain during growth spurts in children)
  • On assessment walking with a limp and turning his foot out to the side to avoid putting a full stretch on his calf
  • Also stiff big toe (possibly from kicking a heavy piece of furniture a couple of months before), a tight sole of the foot and tight calf on that side.
  • Lower ankle joint also stiff and absorbing less impact as a result.  His football boots were found to be slightly tight due to a recent growth spurt.

Treatment

Self management strategies with some in-clinic treatments.

  • Home: Ice, Anti inflammatory gel, no tight footwear for school (and none at all at home), new football boots, home stretches for the calf and foot
  • Clinic: Soft tissue release to sole of foot, tight toe tendons and calf
  • Joint mobilisations for heel and big toe joint
  • Progressive calf loading exercises.

Outcome

After the first week, his symptoms had reduced by 50% and he was re-treated as before. 

Then another week of self-management, during which he restarted playing football.  Reviewed at the 2 week period with no symptoms and a much smaller heel lump.  Some stiffness remained in the calf and the forefoot, so these were re-treated and he was then sent away with an ongoing plan and to call a week later with an update.

A week later, there were no pains on playing football, running and other strenuous activities and the lump was almost non-existent.  He was then discharged with an ongoing set of stretches to do, bearing in mind his current growth patterns. 

He remained pain-free at the 6 week stage.

71 year old retired solicitor referred following hip replacement

Symptoms & Assessment

Referred by their orthopaedic consultant 4 weeks following a total hip replacement.

  • Physiotherapy was recommended to strengthen his hip abductor muscles and to help correct his gait after a prolonged period of limping.
  • Some issues also with ankle swelling and difficulty putting on socks. 
  • Goal:  to get back to walking without a limp and without a stick and be back to full normal activities.

Treatment

Consisted of a progressive exercise programme to strengthen his hip muscles, some soft tissue work over the operation scar to improve scar mobility.

Some gentle joint mobilisations to help achieve sufficient hip flexion to put on socks comfortably.

Advice given on management of the ankle swelling.

Outcome

Attended for 4 sessions in total, back to full normal function with reduced swelling left ankle and able to complete a two hour walk with no ill-effects.

63 year old primary school teacher with foot pain

Symptoms & assessment

  • 63 year old teacher - on her feet a lot
  • Regular gym and running (up to 5 kms)
  • 4 month history of right forefoot pain and swelling
  • Keen to have check-up, diagnosis and advice on exercises to fix it
  • Assessment showed moderate swelling in the web space between the 1st and 2nd toes, marked stiffness of the right 1st toe and also right hip into internal rotation and stiffness of the mid-spine. Slight swelling of both knees were also noticed even though client had no knee symptoms.
  • Diagnosis: biomechanical contribution to overloading onto big toe -possible early degenerative changes at big toe and also knees (family history).

Treatment

  • Aimed at improving the mobility of the mid-spine, hip and big toe along with a strengthening programme for the muscles around the hip. Strengthening exercises were also shown for the knees to lessen loading on the joints
  • Client worked on the home exercise programme and attended for a few sessions of joint mobilisation and soft tissue release for the toe.

Outcome

Swelling resolved in knees and toe. Residual but improving toe stiffness. Back to normal exercise routine.

51 year old professional violinist musician with shoulder and neck pain

Symptoms & Assessment

  • Pain in right shoulder following doing lunges in the gym with a 2kg weight
  • Now affecting playing her instrument, interrupting her sleep and getting worse.
  • Unable to do her usual exercise which was swimming due to the pain.
  • On examination, pain with shoulder movements above shoulder level and also with neck movements on palpation. Stiffness of the neck and upper spine, tenderness of the rotator cuff muscles of the shoulder.

Diagnosis: Rotator cuff strain of the shoulder aggravating early degenerative changes in the neck.

Treatment

Worked on soft tissue work around the shoulder, spinal joint mobilisations and a home programme of stretches and strengthening exercises.

Outcome

Pain started to improve following the 2nd treatment session and by treatment no. 5 the main problem was neck stiffness after playing.

Taping techniques to improve postural awareness while playing were helpful in improving the spinal stiffness and patient was given a revised gym programme to build up her shoulder and core strength.

No further problems with the shoulder.

58 year old amateur musician with hand pain

Symptoms & Assessment

  • 58-year old pianist with pain in both thumbs and 'sensitivity' of the left hand
  • main exercise is walking, Pilates and Alexander technique
  • keen to learn techniques to improve thumbs
  • On examination, imbalance of shoulder girdle muscles causing overuse of upper trapezius muscles, weakness of lower trapezius postural holding muscles and ultimately overloading of hands and arms whilst playing.
  • some altered neurodynamics in left hand.

Treatment

Client was shown a range of stretches for the upper limb and some hand strengthening exercises. Her Pilates class was covering shoulder girdle strengthening.

Outcome

Reviewed after 3 weeks when all was much better and hand muscle strength tests were improved.

She did not require any further treatment.

33 year old, right handed cyclist seen following shoulder surgery

Symptoms & Assessment

  • cycling injury causing collar bone joint disruption, surgically repaired.
  • advice given by surgeon to mobilise below shoulder level and avoid lifting and loading for 6 weeks.
  • seen at 7 weeks for rehabilitation and to 'top up' his NHS physiotherapy.
  • treatment aims were to restore full mobility and get him back to full function
  • on examination, main movement restriction was overhead and crossing the arm across the body with a tendency to overuse the chest muscles.

Treatment

Mainly exercise programme to regain full movement and early strengthening within the limits of pain.

Lots of work on improving the shoulder girdle strength and stability to counteract the dominant chest muscles.

Outcome

Attended for 5 sessions in total until back to full function and normal exercise.

70 year old woman with chronic lower back/leg pain due to arthritis

Symptoms & Assessment

A 70-year old woman with chronic lower back and leg pain due to degenerative changes (arthritis) in her spine attended for treatment.

Treatment

She was recommended to try Clinical Pilates in a bid to try and avoid surgery.

She completed a 6-week programme of Clinical Pilates and then continued with a tailor-made home exercise programme.

 

Outcome

She became pain-free and reported that her mobility had improved significantly.

36 year old woman with middle/low back pain after childbirth

Symptoms & Assessment

A 36-year-old woman developed middle and low back pain following the birth of her first child.

Treatment

She attended for 4 sessions of one-to-one Clinical Pilates.

Outcome

She noticed such a profound change in her back pain that she decided to enrol in a local Pilates group class for the ongoing benefits that she felt it gave her.

Clinic note: Post-pregnancy low back pain is very common due to weakness developing in the core abdominal muscles during pregnancy. This is compounded by an increase in lifting and ‘leaning over’ type activities once the baby arrives. It is generally safe to start Pilates after 6 weeks.

43 year old with neck/back pain after long periods in front of computer

Symptoms & Assessment

A 43-year-old man presented with longstanding neck and upper back pain which he felt was related to long hours spent sitting at a computer for his work.

Assessment showed weakness of his neck and upper back muscles.

Treatment

He enrolled on a 6-week Clinical Pilates course carried out on a one-to-one basis here at the clinic.

The main focus was to strengthen the body’s natural corset muscles to help support the neck and back during prolonged hours sitting at a desk.

Outcome

The results were fantastic and he now has very little pain and an ongoing home-maintenance exercise plan.

26 year old office worker with migraines, neck and shoulder pain

Symptoms & Assessment

  • Persistent headaches in particular after long hours of working at the computer
  • Neck and shoulder pain particularly bothersome when sitting at the desk over a long period of time

Treatment

She was treated with a combination of soft and deep tissue massage and mobilisations to her shoulders in side-lying position.  She was also advised to take regular breaks when working on the computer and engage in regular yoga practice to monitor stress levels

Outcome

This client is finding a regular massage session helpful and feels better after every session. She is now able to manage her work related stresses and experiences fewer spells of migraines than before. 

29 year-old runner with knee pain

Symptoms & Assessment

A keen runner who was preparing for the marathon attended the clinic complaining of knee pain following increasing his running distance.

On examination, the source of the pain was found to be under the kneecap. Tightness of the thigh muscles and poor leg control were also identified as possible contributing factors.

Treatment and Outcome

During the appointment, the client was treated with soft tissue release and stretches. He was given home exercises to help improve his leg control while running. He was also advised on how much running load he could undertake on the following days and how he could optimise his training in preparation for the event.

Taking everything on board, he successfully completed the marathon he was scheduled for and was planning to continue his stretches and home exercises to prevent recurrence.

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