Some of the more specific conditions that we have developed specialist experience in over the years are the following:
RSI (Repetitive Strain Injury) and work-related problems
Work-related problems and soft-tissue overuse issues, such as upper limb tendonitis, can cause considerable stress and anxiety and are often seen as quite difficult to treat and manage effectively. We have been involved with individuals with these types of problems over a long period of time and can offer help in the following ways:
- Provision of assessment and treatment programmes
- Advice on management of symptoms at home and/or at work to optimise recovery
- Liaise with Occupational Health departments and provide guidelines and advice on back-to-work programmes and workplace adaptations.
- Provide work-station assessments and advice where appropriate
- Liaise with GPs and other Specialists to provide a multidisciplinary programme of care
Many clients that we see are actually slightly more flexible in their joints and soft tissue than the norm and this can be a contributory factor to the symptoms that they present with. Some clients are very aware of this but many are not and it can often be the missing piece of the puzzle to explain a pattern of slightly unusual and/or recurrent symptoms.
Depending on the levels of flexibility, treatment programmes may have to be adapted or in some cases completely changed to be appropriate for clients with this condition.
We do look out for hypermobility conditions when assessing new clients and can advise and treat them accordingly.
The Injured Musician
This is a specialist area that we have developed experience in and there is an overlap with hypermobility and overuse-related injuries and the type of injuries that musicians are more susceptible to.
Sometimes it can be a matter of the posture adopted whilst playing, the size and positioning of the instrument, practicing methods and techniques and other, often non-musical related factors. We generally assess the client whilst playing their instrument (where feasible!) as well as providing the full physical assessment.
We have treated a wide range of musicians over the years, from drummers in West End hit musicals to professional lead instrumentalists in national orchestras.
Pregnancy-related spinal and pelvic pain
Back pain is commonly experienced by women during pregnancy and can be dismissed as trivial or inevitable. It can however have a major impact on women's lives during and beyond the childbearing year. Our physiotherapists have considerable experience in assessing and treating this condition and can provide treatment and help with symptoms and advise on management techniques to get you through this sometimes difficult time.
Other types of spinal pain and mechanical symptoms can also surface during this time due to changes in body size, weight and posture and/or changes in activity and exercise habits.
Treatment very much depends on the findings of the assessment but can include the following:
- vertebral joint mobilisation (a more gentle form of manipulation)
- soft tissue massage (see more on Massage Therapy)
- trigger point therapy
- acupuncture or dry needling (the western medicine version of chinese acupuncture) - some of our physiotherapists have specialist qualifications in using acupuncture in pregnancy
- neural gliding techniques
- taping techniques to protect joints, correct posture or give feedback
- posture correction
- advice on ways to change movements and habits to reduce or eliminate the pain such as during work or home activities
- exercise programmes to mobilise the spine.
- provision of pelvic braces and other supports where necessary and advice on their use.
Children & Teenagers
We do not have specialist paediatric physiotherapists per se but we can assess and treat children from age 9/10 years and upwards presenting with sports injuries and/or mechanical pain. We can liaise with GPs where necessary if further investigations are required and have a network of trusted paediatric specialists to refer on to if required.
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.
- 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.
After two sessions she was much better and walking again pain free.
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.
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.
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.
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.
Worked on soft tissue work around the shoulder, spinal joint mobilisations and a home programme of stretches and strengthening exercises.
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.
Client was shown a range of stretches for the upper limb and some hand strengthening exercises. Her Pilates class was covering shoulder girdle strengthening.
Reviewed after 3 weeks when all was much better and hand muscle strength tests were improved.
She did not require any further treatment.
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.
She attended for 4 sessions of one-to-one Clinical Pilates.
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.