Injuries & Conditions A - G

∑ Ankle Sprain
∑ Ankylosing Spondylitis
∑ Arthritis
∑ Avulsion Fracture
∑ Back Pain
∑ Bells Palsy Treatment
∑ Broken Wrist
∑ Bunion (Hallux Valgus)
∑ Bursitis
∑ Calf Muscle Injury
∑ Cartilage Damage
∑ Cerebral Palsy
∑ Club Foot
∑ CRPS
∑ Chondramalacia Patella
∑ Dancing Injuries
∑ Co-Ordination Disorder

∑ Diabetes
∑ Disc disorders of the back
∑ Dislocated Shoulder
∑ Elbow Pain
∑ Ergonomics
∑ Facial Palsy
∑ Fallen Arches
∑ Fibromyalgia
∑ Foot Drop
∑ Foot Pain
∑ Footballer's Ankle
∑ Fractures
∑ Frozen Shoulder
∑ Gait Dysfunction & Abnormalities
 ∑ Golfers Elbow
∑ Groin Strain

Injuries & Conditions H - L

∑ Haglund's Deformity
∑ Hamstring Injury
∑ Headaches
∑ Heart Disease
∑ Heel Pain
∑ Heel Spur
∑ Heel Stress Fracture
∑ Hip Pain /Perthes Disease
∑ Incontinence
∑ Insoles

∑ Irish Dancing Injuries

∑ Irish Dancing Test
∑ Joint Stiffness
∑ Juvenile Arthritis
∑ Knee Pain
∑ Knee Pain/Osgood Schlatters
∑ Ligament Sprains
∑ Limp
∑ Lower Back Pain
∑ Lymphoedema

Injuries & Conditions M - R

∑ Meniscal Injuries
∑ Mental Health
∑ Men’s Incontinence
∑ Metatarsal Pain
∑ Morton's Neuroma
∑ Multiple Sclerosis
 ∑ Muscle Imbalance
∑ Muscle Tears, Strains, Pulls
∑ Musculo-Skeletal Conditions
∑ Musculoskeletal/ Children
∑ Neck Pain
∑ Neck Stiffness
∑ Nerve Pain & Injury
∑ Neurological Conditions
∑ Numbness
∑ Orthotic Prescription

∑ Osteoporosis
∑ Paediatric Learning Disability
∑ Paediatric Physical Disabilities
∑ Patellar Tendinopathy (Jumper's Knee)
∑ Pins and Needles
∑ Plantar Fasciitis
∑ Post-Operative Rehabilitation
∑ Post-Pregnancy Problems
∑ Posterior Heel Pain
∑ Pulled Calf
∑ Pulled Hamstring
∑ Reflex Sympathetic Dystrophy (RSD)
∑ Repetitive Strain Injuries
∑ Respiratory Conditions in Children
∑ Rotator Cuff Injuries
∑ Runners Knee
∑ Ruptured Disc

Injuries & Conditions S - Z

∑ Sacroiliac Joint Problems

∑ Scar Tissue
∑ Sciatica
∑ Scoliosis & Children
 ∑ Shin Splints
∑ Shoulder Dislocation
∑ Shoulder Pain
∑ Shoulder Separation
∑ Soft Tissue Injuries
∑ Spinal Pain
∑ Spondylosis
∑ Sports Injuries
∑ Sports Podiatry

∑ Sprained Ankle
∑ Sprained Thumb
∑ Stiff Neck
∑ Strokes
∑ Tarsal Tunnel Syndrome
∑ Tendinopathy (Tendonitis)
∑ Tennis Elbow
∑ Tension Headaches
∑ Thigh Strain
∑ Thumb Sprain
∑ Whiplash
∑ Workplace Assessments
∑ Wrist Fracture
∑ Your Health and Physiotherapy

Ankle Sprain
With an ankle sprain there is soft tissue damage in the ankle area, caused by the ankle
twisting inwards (inversion) or outwards (eversion).

The bones in that area are on the outside of the ankle which means an injury caused by
the ankle twisting inwards happens more often. An ankle sprain causes damage to the
lateral ligaments on the outside of the ankle.
 Symptoms Of Ankle Sprain
Ankle sprains can differ in severity and so the symptoms will differ. An individual with
an ankle sprain may feel pain when they touch the area or if they turn the foot in or out.
They may have some swelling in the ankle and find it difficult to walk without feeling
pain. If the injury is really severe they might not be able to walk at all due to extreme
swelling, an excruciating pain or possible fracture/dislocation.

Ankle Sprain Treatment

Try not to put a lot of weight on the affected ankle before treatment to minimise any
further damage. (i.e. minimal walking). Depending on the severity of the ankle sprain our
Physios will use a variety of therapies and treatments to help you recover.

Often Cold therapy is used on the swollen ankle to bring down its size,
then Electrotherapy may be employed to help with repairing of the damaged ligament. As
soon as the individual can walk comfortably, our physios can begin a more dynamic
rehabilitation programme with them.

Ankylosing Spondylitis
Ankylosing spondylitis is an arthritis where the spinal joints and ligaments are
chronically inflamed causing the individual to feel pain and stiffness in their back.
Sometimes, if the arthritis is bad enough the bones can actually fuse together leaving the
patient with a rigid, inflexible spine and an Abnormal posture. It can occur in other areas
of the body (hips, knees etc.) or can sometimes affect various organs of the body however
these types of occurrences are far less common.

Symptoms
Early symptoms of ankylosing spondylitis are often similar to other conditions so this can
be a bit confusing. With ankylosing spndylitis, usually the lower spine or sacroiliac joints
become inflamed causing the individual to feel stiff and extremely sore in the lower back
and hip area. This pain will often get worse after periods of rest and eventually the pain
and stiffness may move up the body to the neck and rib cage, where the bones can fuse
together resulting in a loss of normal movement and possible breathing problems.
 Treatment
Once confirmed that ankylosing spondylitis is present, our Physios will begin treatment
to lessen the stiffness and pain for the individual. Often spinal mobilization techniques
will be employed as well as soft tissue management and exercise programmes can be
developed that help to build up strength in the core muscle groups.

Treatment also focuses on trying to avoid deformity occurring while working on

maintaining proper function and the right posture. Physiotherapy and exercise routines
are a significant part of any treatment plan for ankylosing spondylitis, alongside any
prescribed medications from your GP/consultant.

Arthritis
Arthritis is a joint disorder causing inflammation in one or more joints. It is common in
adults 65 and older, but it can affect people of all ages. Arthritis is used to describe a
range of different diseases and conditions that affect joints, the tissues that surround
joints, and other connective tissue. The most common form of the condition is
osteoarthritis which occurs when the cartilage lining the bones in the joint breaks down
due to wear and tear.

Symptoms
Where the Arthritis is quite advanced and the cartilage has degenerated a lot the bone
under the join might experience some erosion. Usually the area that is affected with
arthritis will be inflamed, swollen, painful and the joint will be stiff.

aim to reduce the inflammation in affected areas as well as focusing on strategies to

control pain and stiffness.

Treatment
Heat treatments These treatments produce heat within your body tissues. The application
can be directed towards superficial or deeper parts of the body. The most common types
of treatment used are infra-red radiation (heat lamps) and hot packs for superficial
treatments.

Electrotherapy These treatments produce electrical stimulation of your body tissues. They
may be extremely useful in the treatment of both acute and chronic arthritis, where pain,
swelling and muscle spasms are present.

Exercise: A balanced programme of rest and exercise, and careful attention to joint
posture is an important part of pain management, joint protection and maintenance of
your joint function, especially important post-surgery. Specific prescription exercise and
movement programmes can be developed.

Avulsion Fracture
With an avulsion fracture, a ligament or tendon pulls away a fragment of the bone it is
attached to but can usually heal well without surgery. Surgery is generally only needed if
there is serious tendon or ligament damage as well as the avulsion fracture and surgery
might be required to reattach the bone. Avulsion fractures can happen on a growth
plate in childhood, this sort of fracture may need surgery

Symptoms
People often feel a pop or sudden pain in their groin or hip area. Other symptoms often
include bruising, swelling, limited motion or limping. Sports which often trigger these
injury involve high impact on the hip and pelvic region such as hurdles and basketball.

Treatment
A small Avulsion Fracture is treated by icing and resting the affected area. After the
injury heals there is hardly ever problems with it but it will probably still show up on X-
ray.

Our qualified podiatrist can give you pre and post-surgery advice. For more information
on this service click here
Back Pain
Back pain can be caused by problems with either discs, joints, muscles and ligaments or
most often a combination of these. It is usually the result of acute trauma/injury or
poor postural habits and the resulting accumulation of stress on the spine. However, there
are other rarer, more serious causes of back pain that can result in progressive
inflammatory processes affecting bones and joints.

Symptoms
Back pain for many people is often experienced as a pain or discomfort located between
the lower ribs and butt with or without the addition of leg pain.

Symptoms can range from muscle ache to shooting pain, limited movement, altered
walking and difficulty standing straight. If sciatica occurs along with the back problem,
nerve pressure is experienced as pain that radiates down the leg and possibly into the
ankle or foot. Pins & needles and numbness can occur too.

Acute low back pain generally lasts for a few days to weeks and is usually as a result of
trauma or arthritis. Low back pain that persists for longer than 3 months is considered
chronic.

Treatment
As back pain is often multifactorial, our Physiotherapists are highly trained to diagnose
problems in the joints and soft tissues of the body. They will carry out a comprehensive
assessment and treatment plan to help successfully manage your particular problem.

Manual therapy such as spinal manipulation/ mobilisation and massage are often used to
alleviate symptoms and manage this condition in the acute stage. A home exercise
programme will be devised to help restore muscular strength and re-educate accurate
movement patterns. Your physiotherapist may advise other activities such as pilates or
yoga to help with the long term care of your back.

Our Chartered Physiotherapists and Certified Acupuncturists may also help to relieve
your back pain through the use of acupuncture or dry needling. For more information
please see our pages on acupuncture or dry needling .
Bells Palsy Treatment
Bell’s Palsy is in most cases a temporary disorder that affects the nerves and muscles on
one side of the face. It occurs when the nerve that controls the facial muscles is swollen,
inflamed or compressed. This disorder, which is not related to stroke, is the most
common cause of facial paralysis. However, while there may be no link between Bell’s
Palsy and stroke, any sudden weakness that occurs on one side of the face should be
checked by a doctor immediately.

Symptoms
Symptoms of Bell’s Palsy can differ from person to person and range from mild to
severe. Facial paralysis is the main symptom but due to the complex function of the facial
nerve others may be present.

Facial weakness can affect the ability to eat and drink, and the formation of normal facial
expressions may be difficult. If the face is mostly or fully paralysed, there may be
difficulty closing one eye, which can leave the eye vulnerable and exposed particularly
during sleep. Some sufferers may also experience episodes of drooling from the side of
the mouth.

Bell’s Palsy may also be accompanied by a sensitivity to sound on the affected side.
Some people experience headache and in particular may experience pain in the head just
behind the ear. This is often the first symptom of an incipient Bell’s Palsy.

Treatment
Physiotherapy can be helpful to stimulate the facial nerve, help maintain muscle tone,
strengthen the facial muscles to avoid wastage and in resensitisation of the affected
nerves. Facial massage and exercises may help with this. Acupuncture is another method
used by our Physiotherapists to treat symptoms such as muscle weakness.

Acupuncture is a safe, drug free, painless intervention in which very fine needles are
inserted at particular acupuncture points on the body to relieve the symptoms of various
physical and psychological conditions, particularly for both acute injuries and chronic
conditions resilient to other treatments.
Broken Wrist
A Broken Wrist is among the most common broken bones, usually occurring following a
fall on an outstretched hand. Risk factors for a Broken Wrist range from participation in
certain sports such as skiing or football, to bone conditions such as osteoporosis, a
condition in which bones become thinner and more fragile.

Symptoms
There are various different types of wrist fractures, named after the extent of the fracture
and where on the bone the fracture has taken place.

Symptoms of pain, swelling, deformity and an inability to use the wrist are common after
a fracture and should not be ignored. If you suspect a wrist fracture has taken place, it is
necessary to seek medical attention as soon as possible.

Treatment
Rehabilitation begins immediately while still in plaster by maintaining the range of
movement and strength in the shoulder, fingers and thumb, on the side of the affected
wrist. This prevents secondary stiffness in these areas and helps to resolve swelling in
the wrist.

Assuming that there are no complications with healing, the plaster can usually be
removed after 6 weeks and at this stage more active rehabilitation can be undertaken.
Our Physiotherapists may also performmanipulation and mobilisation to reduce
stiffness and pain.

Our Physiotherapists have extensive clinical experience treating wrist injuries and wrist
breaks for those who have acquired sporting injuries or those suffering from fragile bone
conditions such as osteoporosis. Our Chartered Physiotherapists will assess your injury
and provide appropriate treatment dependent on the level of rehab needed.
Bunion (Hallux Valgus)
A Bunion is generally considered as an enlargement of the joint at the base and side of
the big toe. Bunions are a progressive disorder, beginning with a leaning of the big toe
towards the others, gradually changing the angle of the bone and production of a
characteristic prominent bump. Hallux valgus or hallux abducto valgus (HAV) is the
name used for the deviated position of the big toe and a bunion refers to the enlargement
of that joint. Bunions can become painful, and in many cases arthritis and stiffness can
eventually develop.

Symptoms
Bunions start as the big toe begins to turn and develop a firm bump on the inside edge of
the foot, at the base of the big toe. Initially, the Bunion may not be painful but as the toe
deviates more there may be pain near the joint with redness and swelling.

The pain is most commonly due to two things – it can be from the pressure of the
footwear on the Bunion or it can be due to arthritis like pain from the pressure inside the
joint. The motion of the joint may be restricted or painful.

Bunions occur at a joint where the big toe bends during normal walking and can therefore
be extremely painful. They are vulnerable to excess pressure which can lead to the
development of a hammer toe of the second toe, corns, calluses and the change in
pressure may predispose it to an ingrown nail.

Treatment
The initial goal of treatment is simple - to relieve pressure on the bunion and to halt or
slow the progression of the joint deformity. There are a number of things that our
Podiatrists and Chartered Physiotherapists can do to help manage symptoms and improve
range of motion.

This includes;

1. Addressing of any footwear issues

2. Correction of the imbalance within the foot using an orthotic device
3. Strengthening of the lower limb to control foot motion
Unfortunately, In some cases this isn’t enough to elevate symptoms and a surgical
referral is required.

Our Chartered Physiotherapists can assess your feet using a Gait scan to determine where
the instability lies. Orthotics will play a role in slowing progression and in the prevention
of bunions developing again post-surgery. Our highly skilled Physiotherapists will also
provide a personalised fitting service of your custom orthotics.

Bursitis
We all have hundred’s of bursa throughout our bodies, the function of which is to
decrease friction between two surfaces that move in different directions. Bursa are found
at points where muscles and tendons glide over bones and without them, movement
would be painful. Bursitis is the inflammation of a bursa which comes about from
muscles or tendons pulling at the wrong time, too hard or from the wrong angle. This is
commonly seen in repetitive movements but can occur through minor impact or by a
sudden, more serious injury.

Symptoms
Our highly skilled Physiotherapists will diagnosis your bursitis on physical examination.
Findings consistent with bursitis include tenderness directly over the bursa, pain with
movement of overlying muscles and tendons & swelling of the involved area.

Pain is the main symptom associated with bursitis. However, there is a small risk that an
inflamed bursa can become infected. Signs of infection include open wounds around the
area, redness or increasing warmth of the skin, fevers, chills, and sweats. If you have any
sign of infection you should alert your doctor immediately.

Bursitis in common in adults, especially those over the age of 40. The elbow, shoulder,
hip, knee and Achilles tendon are just a few of the common areas often affected by
bursitis.
 Treatment
Our chartered Physiotherapists will provide expert advice around ways to protect the
area, including bandaging or an immobilizing brace around the joint until the
inflammation subsides. Relative rest and icing the affected area can help in the initial
stages. Depending on our diagnosis we may recommend that you see your GP to discuss
anti-inflammatory medication. Once inflammation has reduced, we can assist in ensuring
that Bursitis does not keep reoccurring.

Proper strengthening technique can help you avoid Bursitis. Our highly skilled
Physiotherapists will devise an individualised programme to address all your needs,
helping prevent the recurrence of this painful condition. Modified activity is advised until
the inflammation settles.

Calf Muscle Injury

A Calf Muscle Injury is common in sports and is sometimes known as a ‘pulled calf’.
The term ‘pulled muscle’ comes from the description of how the injury takes place.
Usually the calf muscle is loaded to quickly or lacked the required strength for the
activity and the muscle fibre is literally pulled apart. A tear in the calf muscle is referred
to as a calf strain and depending on its severity it is classified as a first, second or third
degree strain.

Symptoms
Grade 1:

Signs of injury may not be present until after the activity is over. There may be a
sensation of cramp or tightness and a slight feeling of pain when the muscles are
stretched or contracted. Mild discomfort and minimal disability.

Grade 2:

Immediate pain which is more severe than the pain of a grade one injury. It is confirmed
by pain on stretch and contraction of the muscle. A grade two strain is usually sore to
touch. Moderate discomfort with walking and limits activities such as running and
jumping.

Grade 3:

This is a very serious injury as the muscle is completely torn and there may be a large
lump of muscle above a depression where the tear is. Minimal pain but an inability to
walk will be present.

Treatment
Treatment will vary greatly depending on the grade of injury; however all require
protection through ice, compressions and optimal loading during the first 48hours to limit
bleeding and swelling.

Once ready, your physiotherapist may commence soft tissue techniques including
massage and dry needling to help align the scar tissue which forms during the healing
process. You will also be given gentle strengthening and stretching drills to further
progress this.

As you progress your physiotherapist will tailor your rehabilitation programme to include
any specific sport or functional activities that you need to return to full function.

Cartilage Damage
Cartilage damage is relatively common and often occurs due to trauma or an associated
medical condition. The most common cases of cartilage damage occur in the knee.
Cartilage covers the surfaces of joints and functions as a shock absorber and prevents
friction during movement. Unlike other tissues it has a poor blood supply which can
affect its ability to heal. If arthroscopic (key-hole) surgery is recommended, it is often
advisable to strengthen the muscles around the joint before the date of surgery, as this
will speed up the recovery time after surgery.
 Symptoms
Cartilage damage may be caused due to a sudden injury, osteoarthritis, infection, a fall or
impact, ligament tear or joint dislocation.

Symptoms include:

∑ Decreased movement
∑ Swelling
∑ Joint pain
∑ Stiffness

If the cartilage damage is severe, a piece of cartilage may have broken off and float
around in the joint space. This can cause a feeling of joint ‘locking’ or catching.
Sometimes the joint may also give way and feel unstable. The joints that are most
affected by cartilage injuries are the knee, shoulder, elbow and hip.

Treatment
Physiotherapy treatments are often provided after the surgery in order to help decrease
stiffness and pain and assist in returning the individual to complete independence and a
more active lifestyle.

Acupuncture is also of great benefit in many of these situations, to help control pain post-
surgery.

It is highly recommended that you attend Physiotherapy for rehabilitation following

keyhole surgery, a knee/ shoulder arthroscopy, after a knee or hip replacement operation
or after the insertion of metals plates or pins into various joints.

Cerebral Palsy
Cerebral Palsy is a general term used to describe a large group of disorders affecting
muscles, resulting in problems with movement and posture. Affecting about 1 in 400
children, it is usually caused by permanent non-progressive dysfunction of a part of the
brain, which fails to develop either before birth or in early childhood.
 Symptoms
The main effects of cerebral palsy are difficulty in controlling movement, posture and
balance. Sometimes other parts of the brain are also impaired resulting in sight, hearing
and learning difficulties.

Cerebral Palsy will be diagnosed at birth and will be based on the patient’s history and
any significant delay in gross and fine motor function. Physiotherapy plays an important
role in both the diagnosis and management of this condition and will for the years to
come.

Spastic Cerebral Palsy is the most common form where the muscles appear stiffer and
movements may be jerky with difficulty moving from one position to another.

Treatment
Physiotherapy plays a central role in managing this condition, often from birth. If a
problem is identified, our highly skilled Physiotherapists will assess the child and record
and monitor their development.

As part of a tailored treatment plan, they will teach the child how to control their head
movements and how to sit, roll, crawl and walk, encouraging normal motor development
and function. Their treatment will also strive to prevent and inhibit abnormal reflexes and
patterns of movement.

Physiotherapy and adaptive equipment are often the primary treatment for Cerebral Palsy.
However, medication prescribed by your GP to help manage symptoms such as spasticity
may be required.

They will also advise on the best and most appropriate adaptive equipment to help the
child’s mobility, improving independence, quality of life and maximising their learning
potential.

Club Foot
A Club Foot or congenital talipes equinovarus (CTEV) is a congenital deformity that 1 in
1,000 children are born with today. TEV is classified into 2 groups: Postural TEV or
Structural TEV. Club Foot (or CTEV) is postural. It is usually a painless defect that can
be corrected quite simply and the majority of children affected are walking by the normal
age. There are no known causes of this disorder but it is linked to genetics as twice as
many boys are affected than girls and 25% of children with club foot are related to
somebody with the same disorder.

Symptoms
Symptoms of Club Foot can be seen where the bones and joints in the foot are misaligned
resulting in the foot being turned in and down. It can happen to both feet or just one and it
makes it hard to hold the feet in the right position.

Treatment
It is important to begin treatment early on as the younger the child is, the easier it is to
correct this problem because the foot is easier to shape. Treatment is almost always non
operative with surgery only being used as a last resort.

Our Chartered Physiotherapists have the expertise to perform these non-operative

methods to correct or help the condition. They can gently manipulate the foot over a
series of visits which will help to realign the bones and move the feet into the right
position.

Complex Regional Pain Syndrome (CRPS)

Complex Regional Pain Syndrome is a complex multi-symptom pain syndrome affecting
a limb or limbs that can affect any one of any age. It usually occurs following tissue
damage to the limb, but it can also be triggered by visceral diseases, central nervous
system lesions or from unknown causes.

Symptoms
CRPS can strike at any age, but is more common between the ages of 40 and 60. It affects
both men and women, but is most frequently seen in women. Although it is more
common in the older age groups, the number of CRPS cases among adolescents and
young adults is increasing.

It often affects the hand or foot, but may also involve the knee, hip, shoulder, or other
sites. The main symptom of CRPS is severe pain, often burning in nature. The disorder
may eventually result in dystrophy (weakness or wasting) of the area. Early diagnosis and
proper treatment are very important if CRPS is to be successfully managed.

Symptoms can vary in severity and length and can be difficult to manage. Skin changes
are also common. Skin can become blotchy or red/purple, shiny and thinner. People may
also experience excessive sweating of the affected area.

Treatment
There is no single test for diagnosing CRPS. Diagnosis is a clinical one and is made
through observation of the patient’s signs and symptoms. When diagnosed and treated
within the first 3 to 6 months, there is the highest possibility of cure and treatment of
CRPS is most effective.

The most important element of treating CRPS syndrome is restoring normal movement to
the affected part. This condition is easiest to treat in its early phases. Much of the
treatment is based on a courageous effort of the patient to get the hand or foot moving
again, even if it is uncomfortable. A formal Physiotherapy exercise and
movement programme along with the use of mirror boxes and graded motor imagery
techniques are used.

It is common for both GP and Psychologist to be involved in treating the wider array of
symptoms.

Chondromalacia Patella
The knee can be affected by many different types of injuries and conditions.
Chondromalacia Patella is a general term used to describe damage to the cartilage lining
the knee cap. It can also be referred to as Patella Femoral Pain Syndrome (PFPS). It is
one of the most common causes of anterior knee pain and results from degeneration of
cartilage due to poor alignment. Physiotherapists are experts in assessing and treating the
cause of your knee pain effectively.
 Symptoms
The most common symptom is pain or discomfort around the knee. The dull, aching pain
is usually located at the front of the knee, around or behind the kneecap.

Chondromalacia Patella often have altered patella tracking toward the outer side of the
thigh bone (femur). Therefore, pain is often felt most with running, jumping, going up
and down stairs and especially when getting up from a seat after a prolonged period of
time. Unfortunately due to the increase in angle between the hip and knee in women they
are more likely to be affected.

Other symptoms include a grating noise when moving the knee and (rarely) some fluid
swelling.

Treatment
It is important that the correct diagnosis is made for all knee injuries and that treatment
commences as quickly as possible. Chondromalacia Patella has been associated with
repetitive stress, overuse and poor muscular control around the core, hip and knee.

Treatment techniques to address these issues can include specific strengthening exercises
to correct muscle imbalance, soft tissue massage, dry needling, joint mobilisation, and in
some cases the fitting of custom made orthotics (biomechanics) to correct excessive foot
pronation (which has a direct link to patellofemoral pain).

Dancing Injuries
The majority of dance related injuries are caused by overuse as opposed to any sort of
trauma. The foot/ ankle/ lower leg/ back and hip are some of the most commonly injured
sites. The type of dance style may expose the dancer to risk of certain types of injuries,
for example ballet dancers are prone to ankle sprains while urban/street dancers often
injure the knee due to attacked flexion and extension movements.
 Symptoms
Common dancers’ ailments include ankle sprains, Achilles tendinopathy, shin splints, and
low back pain. However, many other muscle strains, joint and ligament sprains, joint
pains and over training syndrome can occur.

Dancers are athletes in the degree to which they require highly skilled capabilities to
perform and train at a high level. It is important to address dance injuries correctly, as
continuation of regular practice while injured can cause far more serious injuries with
long term implications.

Treatment
Our Chartered Physiotherapists will carry out a detailed assessment to determine the type
and cause of the presenting problem. This will guide their choice of the best evidence
based treatments to manage your dance related injury.

Depending on the injury, our highly skilled Physiotherapists may prescribe various types
of treatments including strengthening programmes with additional stretching when
appropriate.

Many dancers find a sports massage and dry needling to be particularly beneficial in
helping to heal over used muscles quickly.

Developmental Coordination Disorder

Developmental Coordination Disorder (DCD), sometimes called Dyspraxia or clumsy
child syndrome, is when a person’s motor skills are impaired, resulting in movement and
co-ordination difficulties. A prevalence of 4-5% of students in mainstream primary
schools is seen and is more common amongst boys. Children with DCD experience
difficulties with posture, movement and coordination and exhibit a failure to acquire both
fine and gross motor skills such as dressing, ball games and handwriting.
 Symptoms
People with Developmental Co-ordination Disorder (DCD) are assessed in a variety of
different ways and a detailed developmental history will be taken.

As a result of DCD, the person finds it hard to learn motor skills and his or her
movements are often slow and hesitant. They may experience difficulties with dressing,
eating and ball games and they may take longer to learn such tasks as riding a bicycle.

They may also have problems with language, handwriting and organising their thoughts,
along with poor time management. Attention span and memory is often poor.

Treatment
Research has shown that without treatment the majority of people with Developmental
Co-ordination Disorder do not outgrow the condition. Physiotherapy plays a key role in
the management of this condition.

In order to improve motor skills, treatment may include exercise and movement
programmes. For example, weight bearing exercises can help to increase muscle control,
therefore improving co-ordination, while tactile (touch) activities can help to increase
sensory awareness of the limbs.

Diabetes
Diabetes mellitus is a metabolic disorder characterised by high blood sugar (glucose)
levels. The condition results from the body’s inadequate production of insulin or the
body’s altered response to insulin, or both. Diabetes causes abnormally high glucose
levels (hyperglycemia), circulatory problems, and nerve damage. Diabetes cannot be
cured, but it can often be managed with proper medical care, diet, and regular exercise.
There are two types of Diabetes and approximately 90% of all cases are Type 2.
 Symptoms
Increased urination, hunger, weight gain, fatigue, thirst, cuts and bruises that don’t
heal or have delayed healing and numbness and tingling in the hands/ feet are some of
the most common symptoms.

Type 1 Diabetes:

An autoimmune disease in which the body destroys insulin producing cells. The body
does not produce insulin and cells cannot absorb sugar needed for energy.

Type 2 Diabetes:

The body does not use insulin in the right way and can become insulin resistant. This
can develop at any age and is most commonly diagnosed in adulthood.

Treatment
Exercise and diet are two of the most important lifestyle factors for Diabetic patients.

Exercises can:

∑ Help with weight loss

∑ Lower bad cholesterol and raise good cholesterol
∑ Help maintain muscle mass and reduce fat
∑ Lower blood pressure
∑ Lower stress levels
∑ Reduce the need for insulin or drugs
∑ Reduce risk of cardiovascular disease

Regular exercise of at least 30-60 minutes, 4 times a week is recommended for diabetic
patients. Our Chartered Physiotherapists can outline a regular exercise programme for
you which will provide you with the structure you may need to start off your training.
Disc Disorders of the Back
Those suffering from Disc Disorders often feel excruciating pain and such pain is a
warning sign that should be heeded. If tackled early and quickly, pain from Disc
Disorders can normally be eliminated.

Symptoms
The pain caused by Disc Disorders of the back can be hard to ignore and are normally
alleviated from lying flat on ones back, and can exacerbated by sudden movements like
sneezing.

Sometimes this pain can be caused by a damaged nerve ending and in this case the pain
may be felt across the entirety of the nerve.

Treatment
The important thing to realize is that back pain can most often be prevented by keeping
the back muscles flexible and strong and by being careful not to bend forward either
repetitively or while carrying heavy weight.

Treatment can involve postural education (see Postural Assessment &

Dysfunction), acupuncture, exercise and movement instruction, joint manipulation and
mobilisation, massage and a variety of other techniques and modalities.

Dislocated Shoulder
A Dislocated Shoulder is a common shoulder injury in contact sports such as rugby and
martial arts. Shoulder dislocations are characterised by severe shoulder pain and hospital
treatment is required to restore normal shoulder anatomy. It is important that a shoulder
dislocation is seen quickly by a doctor who can put the joint back in place. Physiotherapy
is vital to correct any weakness and prevent the recurrence of this painful and problematic
injury.

Symptoms
Due to the damage to the structures surrounding the shoulder, there is a high chance of
recurrent dislocation. Shoulder dislocation occurs more in young men and nearly 100%
of those age 14-20 will have a recurrent dislocation. However, with our Physiotherapists’
assistance we can work on strengthening the muscle and ligament groups around the
shoulder to minimise the risk of further dislocation.

Surgery on an unstable shoulder is usually required with recurrent dislocations, however,

our highly skilled Physiotherapists can advise you on this and if required make the
necessary referral to a suitable specialist.

Treatment
Once the shoulder has been put back in place it is immobilised using a sling. The sling is
kept on for about 2 to 3 weeks, during which time it is important that the elbow, wrist and
fingers are kept moving to prevent them stiffening up.

Active rehabilitation is started as soon as possible but overhead arm movement and
sporting activity should be avoided for at least 6 weeks. Gentle range of movement
exercises under the supervision of a Chartered Physiotherapist can be started once the
sling is removed.

Our Physiotherapists will devise an evidence based rehabilitation program tailored to

your specific needs. Due to the high risk of further dislocation, Physiotherapy is vital for
successful prevention.

Elbow Pain
Elbow pain is a common complaint and usually happens after direct impact or repetitive
strenuous overuse of the muscles and tendons around the elbow joint. This can result in
two pathologies commonly known as Golfers elbow and Tennis elbow. These are
conditions where pain is experienced around the inner or outside of the elbow and may
also travel down to the rest of the forearm. Although the name would lead you to believe
that it is a problem only experienced by keen golfers and tennis players, this is not the
case.

Symptoms
Golfers Elbow can be diagnosed by a description of the pain you are experiencing. For
example if you feel pain when touching the innermost part of the elbow or if the pain
worsens when you grasp something, Golfer’s Elbow should be suspected. Pain is often
felt when carrying out everyday activities, especially when gripping (Eg. turning a
doorhandle).

Tennis Elbow is characterised by pain over the outer side of the elbow, which may
radiate down the forearm. There is pain when the Lateral Epicondyle (outermost part of
the elbow) is touched, and also if the elbow is straight and the hand is bent at the wrist.
The elbow pain is made worse by gripping activities and, in some cases, simple things
like shaking hands or squeezing objects can be extremely painful.

Treatment
Despite the pain felt with these pathologies there is often on inflammation of the tissue
and instead tends to be more one of degenerative changes in the junction between the
muscle and tendons of the forearm.

Treatment can include local massage and dry needling work coupled with joints glides to
ensure mobility. A strengthening programme will be give specifically for the forearm
muscles. Our experienced therapist will also look beyond just the elbow to ensure that
other structures; including the neck, upper back and shoulder are working optimally to
reduce the likelihood of it recurring.

Ergonomics
Work Injuries can often cause severe and debilitating symptoms such as pain, numbness
and tingling. These often lead to reduced worker productivity, lost time from work, and
temporary or permanent disability. Common causes include poor ergonomics (job set up),
repetitive, forceful, or prolonged movements or heavy lifting, pushing, pulling and
carrying of heavy objects. Others include prolonged faulty postures and exposure to
vibration or an unsafe work environment. Regular exercise has been shown to improve
health and have a positive effect on sick leave and productivity.

Facial Palsy
Bell’s Palsy or Facial Palsy is a disorder that affects nerves and muscles in the face
causing paralysis or drooping of one side of the face. Most people who experience the
condition are concerned about the unsightly unbalanced look it gives to their face but
fortunately such imbalance resolves completely in most cases.

Symptoms
Bell’s palsy can affect the ability to eat and drink, and it can be difficult to form normal
facial expressions. If the face is mostly or fully paralysed, there may be a difficulty with
closing one eye, which can leave the eye vulnerable and exposed particularly during
sleep. Some sufferers may experience episodes of drooling from the side of the mouth.

Bell’s palsy may also be accompanied by a sensitivity to sound on the affected side.
Some people experience headache and in particular may experience pain in the head just
behind the ear on the affected side. This is often the first symptom of an incipient Bell’s
palsy.

Treatment
Physiotherapy can be helpful to Bells Palsy in strengthening the facial muscles to avoid
wastage and in resensitivisation of the affected nerves. Pain relief is also something that
we can assist with.
Our physiotherapists may prescribe a number of exercises that have proven to improve
this condition. Tailored facial exercises can help to improve facial function, mainly for
people with moderate paralysis and chronic cases

Fallen Arches
Fallen arches or Pes Planus is a postural deformity where the foot appears flatter due to
collapse of the foot’s arch. This condition can be present from birth or may develop over
time. There are several factors that can contribute to the development of this condition
such as genetics, fractures, obesity, arthritis and/ or damage to tendons. Commonly,
fallen arches develop due to a weakened or injured Posterior Tibial Tendon. Several
problems can develop due to this condition and it also puts you at greater risk of
developing foot, knee and hip related problems.

Symptoms
Structural problems in your feet like fallen arches can alter your walking and running
pattern and as a result cause pain throughout your body. Clear and accurate assessment of
the mechanics of your lower limbs is key to understanding the profound effect that subtle
faults in your foot, ankle, knee and hip alignment can cause.

People who suffer from Fallen Arches often experience other conditions such as Plantar
Fasciitis, Medial Tibial Stress Syndrome (Shin Splints), and in some case knee, hip and
back pathologies

Treatment
Custom orthotics are specially designed insoles, which are made for your by prescription.
This is done by taking a digital scan of the foot standing still and while walking so that
your prescription is made to your exact specifications. The insole then correctly aligns
your foot and as a result your body. This will relieve abnormal strain of tissues and
structures which can cause pain.

For less severe mal-alignments or for sports use a wide variety of temporary insoles are
also available in our retail section of the clinic.
Fibromyalgia
Fibromyalgia, also known FM or FMS, is a chronic condition defined by widespread pain
in the muscles, ligaments and tendons of a person along with certain pressure points
across the body. This pain may then lead to sleep difficulties, headaches, irritable bowel
syndrome and muscle stiffness. It is found more commonly in women and occurs in all
age groups. However, the average age of diagnosis is 35.

Symptoms
The symptoms of Fibromyalgia are difficult to diagnose due to there being many
different causes.

Symptoms include:

∑ Chronic Muscle Pain

∑ Muscle Spasms Or Tightness
∑ Insomnia
∑ Waking Up Feeling Tired
∑ Stiffness Or Pain Upon Waking
∑ Pain From Staying In One Position For Too Long

Fibromyalgia can result in a broad range of symptoms including fatigue, psychological

problems and physical dysfunction. Diagnosis is often done through a process of
elimination, the number of painful sites, pain severity and the presence of symptoms for
at least 3 months. Our Chartered Physiotherapists can assist in the diagnosis of this
problematic condition.

Treatment
Many people know of the benefits of aerobic exercise and strengthening drills. For
sufferers of FM it is essential. Your physiotherapist will demonstrate a series of specific
stretching and graded strengthening drills to incorporate into your daily life. There is no
specific cure for FM so treatment is focused towards ongoing management.
Many sufferers of FM feel they benefit from periodic soft tissue techniques including soft
tissue massage, dry needling and acupuncture.

Foot Drop
Foot Drop is a medical term for difficulty lifting the foot at the ankle. This is a condition
caused by weakness or paralysis of the muscles involved in flexing the ankle and toes,
which causes a person to drag the toe of the shoe on the ground or slap the foot on the
floor while walking. Foot Drop is a neuromuscular disorder and can be a symptom of
nerve compression or a low back injury such as disc herniation or as a result of Multiple
Sclerosis or Parkinson’s Disease.

Symptoms
Foot Drop makes it difficult to lift the front part of your foot, so if you walk normally the
foot might drag on the floor. Often patients compensate for this by raising their thigh
when walking to help their foot clear the floor. This odd walking gait often causes those
patients to slap the involved foot onto the floor when stepping.

Foot Drop typically affects only one foot. Depending on the underlying cause, however,
it’s possible for both feet to be affected. In some cases, patients with Foot Drop
experience a numb sensation of the skin on the top of their foot and toes.

Foot Drop isn’t a disease but rather a sign of an underlying neurological, anatomical or
muscular problem. In many cases Foot Drop is temporary, although for some it is
permanent.
 Treatment
Our Chartered Physiotherapists can help you with both temporary and permanent foot
drop. The treatment used will depend on the underlying cause. If the cause can be
diagnosed and is successfully treated, Foot Drop may improve or even disappear.

If the underlying cause can’t be treated, Foot Drop may be permanent and we will guide
you through your options.

Our Physiotherapists will guide you through exercises that will strengthen your leg
muscles. These exercises will also help you maintain range of motion in your knee and
ankle, which often improves gait problems associated with foot drop.

For temporary foot drop an ankle/foot brace or AFO splint that fits into your shoe, may
be prescribed. This can help hold your foot in a normal position.

Foot Pain
Whether you're a walker, a runner or just trying to get from A to B, any foot pain can
make life difficult. There are a number of contributing factors which can cause
discomfort and pain in the foot. Foot pain can be caused by genetically inherited
conditions such as a mechanical imbalance in the foot, or developed from an injury or
inappropriate foot wear. The foot is comprised of 26 bones and is supported by ligaments,
muscle and plantar fascia. Foot pain is a common problem and there are a wide range of
possible causes.

Symptoms
There are many conditions which can cause added stress on your feet leading to pain and
discomfort such as:
Flat Feet, Arch Pain, Plantar Fasciitis , Bunions (Hallux valgus), Diabetic Foot, Diabetic
Ulcers, Rheumatoid Arthritis, Osteoarthritis, Diabetes & Foot Care, Gait Dysfunction &
Abnormalities, Haglund’s Deformity, Heel pain, Heel Spur, Heel Stress Fracture, Limp,
Metatarsal Pain, Morton’s Neuroma, Posterior Heel Pain, Runner’s knee, Shin Splints,
Sprained Ankle and Tarsal Tunnel Syndrome.

For related issues see our blog posting. Foot pain can prevent you from achieving your
sporting goals or impede your everyday mobility. Our Charted Physiotherapists can
diagnose and treatment your problematic foot pain.

Treatment
Our highly skilled Physiotherapists will carry out a thorough assessment to help identify
the cause of the foot pain and recommend ways to reduce or resolve your discomfort.

Once your foot pain has been diagnosed our Chartered Physiotherapists will use a variety
of evidence based treatments to reduce your pain and increase your function. The cause
of foot pain is often multifactorial and a variety of different treatments, such as ice,
massage, strengthening and range of motion exercises, corrective footwear and stretching
regimes, may be used.

Our podiatry service offers effective relief from foot problems such as mechanical
imbalance, corns and calluses, foot ulceration, tendonitis and recurrent ankle sprain.

Our Expertise

Footballer’s Ankle
Footballer’s ankle occurs when the soft tissue (tendons and ligaments) in the ankle get
pinched between the bones. Due to excessive kicking and bending and stretching of the
foot, the ligaments can also thicken and cause bone growth at the front of the ankle
causing pain. This is usually seen in people who have had multiple ankle sprains and
suffer from chronic pain and instability.
 Symptoms
Commonly people will describe a restricted range of motion and a pinching sensation
across the front of the ankle when completing a lunge type movement.

Some people describe a ‘clicking’ sensation in the ankle during movement. It is also
common for the ankle to feel weaker and unable to weight bear at times. In many cases a
bony lump appears at the front of the ankle.

You may also have pain and tenderness when your ankle ligaments are pressed on as seen
in a simple ankle sprain.

Treatment
Surgery is often required to remove the bony growth from the ankle if present and
problematic.

Our Chartered Physiotherapists work with many Orthopaedic Surgeons in Dublin and
are happy to refer patients where we feel surgery may be appropriate.

However, if the growth is not significantly large, then you may benefit from a
programme of rehabilitative exercises which our expert Sports Physiotherapists can
prescribe.

Our physiotherapists will devise a specific rehabilitation program which will target
any issues of weakness, flexibility, altered postural control, balance and stiffness to
help alleviate your symptoms.
Fractures
A Fracture is a break in the bone, which is either complete or partial. Most fractures are
caused by a sudden injury that puts more pressure on the bone than it can withstand.
Fractures most often occur in the hand, wrist, ankle, collarbone and the neck of the femur
of the hip, which can be the result of a fall. This is often complicated if you have if you
have osteoporosis as an underlying pathology.
 Symptoms
The symptoms of a Fracture in vary widely depending on which bone is fractured. The
most common bone fracture is the Shin bone. This fracture often occurs as a compound
fracture, meaning the bone is protruding from the skin. Other symptoms of a bone
fracture include:

∑ Swelling or bruising over a bone.

∑ Deformity of an arm or leg.
∑ Pain in the injured area that gets worse when the area is moved or pressure is
applied.
∑ Inability to use the limb.

Not all fractures are to a person’s arm or leg. Trauma can result in skull, ribs, pelvic or
spinal fractures. An unstable fracture can cause further damage, therefore, if you suspect
a fracture seek medical attention immediately.

Treatment
Immediate medical attention is advisable if you have experienced a fracture. Moving a
broken bone can increase pain and bleeding and can cause further damage to soft tissue
structures.

Broken bones heal by themselves. However, medical treatment is needed to insure correct
alignment of the broken bone. Depending on the site and severity of the fracture,
treatment may include a splint, brace, plaster and/ or insertion of metal rods or plates.

After the bone has healed, our highly skilled Physiotherapists will plan a rehabilitation
programme taking into account your needs and lifestyle. Using specific exercises, the aim
is to reduce any swelling, regain full muscle power and joint movement and to bring back
full function.

Frozen Shoulder
Frozen Shoulder, also known as adhesive capsulitis, describes a condition in which the
shoulder is painful to move and movement is often completely restricted. Frozen
Shoulder starts as a painful shoulder in which movement is still possible, but restricted.
Over 3 to 9 months the pain reduces, whilst the stiffness gradually increases. Eventually
the pain goes but the shoulder remains stiff. People recovering from medical conditions
affecting the arm, such as stroke or mastectomy, are at a greater risk of developing
Frozen Shoulder.

Symptoms
Frozen shoulder has a very specific presentation and affects certain groups of people.

You would expect to commonly see:

∑ Shoulder pain; normally a dull,aching pain particularly at night

∑ Limited movement in multiple directions
∑ Female aged 40-65
∑ Diabetic

Frozen shoulder typically develops slowly and in three stages. The painful stage (1-3
months), the frozen stage (stiffness 3-9months) and the thawing stage (movement returns
9-18 months).

Treatment
The shoulder joint and muscles, ligaments and tendons that support the joint are all
encased in a capsule of connective tissue. Adhesive Capsulitis occurs when this capsule
becomes inflamed and thickens causing pain and restricting movement.

Physiotherapy can help to reduce the pain and stiffness and if caught early enough can
prevent full onset of Frozen Shoulder. This is usually carried out in conjunction with your
GP prescribing anti-inflammatory medication or use of a corticosteroid injection into the
shoulder.

Our highly skilled Physiotherapists will help improve movement with manual stretching
and soft tissue release. A very specific and frequent home exercise programme can also
help speed up recovery.

Gait Dysfunction & Abnormalities

Gait, limp or walking pattern is a complex activity involving most parts of the body. Our
gait varies according to our individual anatomy, our age and the speed at which we walk.
Gait abnormalities have been shown to predict functional decline in the elderly and are
often the result of multiple causes. Gait dysfunctions and abnormalities in the elderly
often result in falls and disability. Other conditions that commonly see gait abnormalities
include those with diseases such as Parkinson’s, Multiple Sclerosis and Cerebral Palsy.

Symptoms
Pain, muscle weakness, joint stiffness and nervous system diseases can result in abnormal
gait patterns. For a full list of Foot Related injuries please click here.

There are many normal age related changes that happen which have an effect on our
walking. Strength, sensory functions, balance, range of movement and flexibility all
decline as we grow older. This can result in compensatory responses and put a person at
an increased risk of falls.

An antalgic gain is related to pain, where a person avoids certain movements. Typical
features include: limited range, unable to weight bear, a limp, slower speed and shorter
steps. This type of walking pattern is often seen as a result of trauma, Osteoarthritis and
Pelvic girdle pain.

Treatment
Gait and mobility are vital for the maintenance of a person’s independence. Research has
shown that Physiotherapy interventions can improve balance and gait in the elderly and a
variety of different diseases. Therefore, it is vital that you are assessed by a trained
Physiotherapist, so that treatment can be commenced.

After assessing a person’s gait, our Chartered Physiotherapists will plan an individually
tailored rehabilitation programme which may include activities to strengthen muscles,
increase range of movement and relieve pain as well as providing walking re-education.

They will also advise and show the person how to use appropriate walking aids such as
crutches, walking sticks and walking frames.
Golfers Elbow
Despite the name, Golfers Elbow does not just affect golfers and is most often associated
with work-related activities. It is common in men and women, peaking in prevalence
between the ages of 30 and 50. Also known as medical epicondyle tendinopathy, it is an
injury to the muscles that flex your wrist and fingers and is usually associated with excess
or repetitive stress. Poor conditioning, inadequate warm up, improper technique during
lifting, hitting or throwing can contribute to Golfer’s Elbow.

Symptoms
Golfers Elbow is very easy to diagnose. It is characterised by pain over the inner elbow,
which may radiate down the forearm. There is pain when the medial epicondyle
(innermost part of the elbow) is touched. There is pain if the elbow is straight and the
hand is moved forward and back at the wrist.

The pain is made worse by gripping activities and, in some cases, simple things like
turning a door handle can cause intense pain. This elbow problem can then be very
persistent and much more difficult to treat.

Golfer’s Elbow is characterised by pain and tenderness. However, your elbow may feel
stiff and you may experience weakness in your wrist and hand with or without numbness
or tingling that radiates intoone or more fingers.

Treatment
Despite the pain felt with this pathology there is often on inflammation of the tissue and
instead tends to be more one of degenerative changes in the junction between the muscle
and tendons of the forearm.

A progressive strengthening programme using resistance bands has been shown to be the
best long term approach to Golfer’s Elbow. Dry needling Acupuncture can also be very
effective at releasing the surrounding muscles.

Correction of any muscular deficits in the neck, upper back and shoulder will also be
made to ensure a stable platform for the elbow to work off.
Groin Strain
A Groin Strain is a common injury to the muscles of the inner thigh. The groin muscles,
known medically as the “adductor muscle” group, consist of six muscles that span the
distance from the inner pelvis to the inner part of the femur (thigh bone). These muscles
pull the legs together, and also help with other movements of the hip joint. The adductor
muscles are important in sprinting and sports that involve side stepping as well as ball
sports.

Symptoms
A strain of the groin muscles will result in pain and weakness in the region. This
particularly affects a person’s ability to explosively change direction and markedly
reduces penetration and strength of the kicking action.

With a Groin Strain the muscle is forcibly stretched or contracted beyond its capabilities
and the muscle tissue becomes torn. A tear in the groin muscle is referred to as a Groin
Strain and depending on its severity it is classified as a first, second or third degree strain.

Treatment
Rest is vital during early treatment and activities that cause symptoms should be avoided.
Ice should be applied in the first 48hours to stimulate blood flow and prevent
inflammation.

The immediate treatment of a Groin muscle injury consists of the POLICE protocol –
protect, optimal loading, ice, compression and elevation. It is important that this is done
correctly and our highly skilled Physiotherapists can advise you on this.

Once ready, gentle resistance exercises and stretching are important as they help to align
the scar tissue which forms during the healing process. Our Chartered Physiotherapists
will devise a rehabilitation plan specific to your needs aimed at strengthening the
adductor muscles when healed.
Haglund’s Deformity
Haglund’s Deformity is a bony enlargement on the back of the heel. The soft tissue near
the Achilles tendon becomes irritated when the bony enlargement rubs against shoes.
This often leads to Bursitis, which is defined as inflammation of the fluid filled sac that
lies between the tendon and bone. It is also known as ‘pump bump’. The bony
enlargement coupled with hard shoes puts a lot of pressure on the back of the heel
causing pain and inflammation.

Symptoms
Haglund’s Deformity can occur in one or both feet. It is a very painful condition with
the following symptoms:

∑ A noticeable bump on the back of the heel

∑ Pain in the area where the Achilles tendon attaches to the heel
∑ Swelling in the back of the heel
∑ Redness near the inflamed tissue

Treatment
Haglund’s Deformity can be difficult to diagnose. Our Charted Physiotherapists will
carry out a detailed assessment and may refer you to your GP for an X-ray to help
determine the presence of the prominent heel bone or disease. Non-surgical treatment of
Haglund’s Deformity can resolve the pain and inflammation. However, they will not
shrink the bony protrusion.

Our highly skilled Physiotherapists will prescribe:

∑ Stretching exercises
∑ Heel lifts for patients with short calf muscles.
∑ Heel pads to cushion the heel.
∑ Orthotic devices to help control the motion of the foot
Hamstring Injury
Hamstring Injury is common in sports and is sometimes known as a ‘pulled Hamstring’.
Usually, the Hamstring muscle is forcibly stretched beyond its limits and the muscle
tissue becomes torn. Ham-string strains are one of the most common sports injuries. They
commonly occur in sports that in-volve high speed sprinting and kicking. Hamstring
injury is likely to occur during the late swing and late stance phase of running. This
injury can cause significant loss of training and competition time.

Symptoms
With a Grade one Hamstring strain, the signs may not be present until after the activity is
over. There may be a sensation of Hamstring cramp/ tightness and a slight feeling of pain
when the muscles are stretched or contracted.

With a Grade two Hamstring strain there is immediate pain which is more severe than the
pain of a grade one injury. It is confirmed by pain on stretch and contraction of the
muscle. A grade two Hamstring strain is usually sore to touch.

A Grade three Hamstring strain is a very serious injury. There is an immediate burning/
stabbing pain and the athlete is unable to walk without pain. The muscle is completely
torn and there may be a large lump of muscle tissue above a depression where the tear is.
Bruising will appear below the injury site.

Treatment
The immediate treatment of a Hamstring muscle injury consists of the POLICE protocol
– protect, optimal loading, ice, compression and elevation. It is important that this is done
cor-rectly and your Physiotherapist can advise you on this. This is aimed at reducing the
bleeding and damage within the Hamstring muscle tissue.

After the early stages have been spent resting, more active rehabilitation can be started.
Realistically, for best results this should be started as early as possible.

Gentle resistance exercises and stretching are important as they help to align the scar
tissue that forms during healing. Our skilled Physiotherapists will devise a sports specific
rehabili-tation programme tailored to your needs. We can guide you through the process
of returning to play successfully and re-duce the risk of occurrence.
Headaches
Headaches can have many different origins. Physiotherapy can be very effective in
treating those that arise from the joints in the neck being either too stiff or mobile, or the
muscles of the head, neck and shoulders that have become painful due to overuse,
weakness or poor postural habits. Headaches are commonly generated by active trigger
points (local muscle spasm) in the surrounding muscles which then radiate into the head.
It is important to identify the correct origin of your head-ache as further referral may be
needed.

Symptoms
Any of the symptoms listed below could indicate that your neck is the source of your
headache

∑ Your pain radiates from the back to the front of your head.
∑ Your headache becomes worse with prolonged sitting posture (eg sitting at the
computer)
∑ Your headache is aggravated by repetitive movements or postures.
∑ Your headache is always more severe on the same side of your head.

If headaches are as a result of a dysfunction of the vestibular system, headaches may

also be accompanied by episodes of dizziness or unsteadiness.

Treatment
Our highly skilled Physiotherapists can successfully treat cervical headaches using
specialised techniques to optimise motion of the joints in your neck and ensure the
surrounding muscles are able to do their respective jobs effectively.

These techniques include heat, joint mobilisation, soft tissue massage, postural advice,
stretching and strengthening exercises. Other techniques such as Dry needling and
acupuncture are commonly used to release trigger points and decrease pain.

Assessment of your work station may also be appropriate. We are able to provide a
review with an ergonomics specialist if required. For a host of related topics and stories
see our blog postings.
Heart Disease
According to the Irish Heart Foundation, approximately 10,000 people die annually from
cardiovascular disease. The most common form of Heart Disease is coronary artery
disease (CAD), accounting for a third of all deaths between the age of 45 and 64.
Smoking, unhealthy diet, high blood pressure and lack of exercise all contribute to Heart
Disease. Physiotherapists, working as a part of a team, develop a treatment programme,
taking into account the person’s age, lifestyle, previous history and severity of the
disease. Exercise plays a key role in tackling heart disease.

Symptoms
It occurs where the heart is damaged by the narrowing or blocking of coronary arteries
which supply the blood to the heart muscle. Insufficient blood reaches the heart leading
to chest pain (angina pectoris) and heart attacks. The narrowing of arteries is caused by
patches of cholesterol rich fatty deposits and by blood clots forming on these patches.

The most common symptom of coronary artery disease is angina. This is characterised by
discomfort, heaviness, pressure, aching, squeezing or a painful feeling in your chest.
Other symptoms of CAD include shortness of breath, palpitations, dizziness and
sweating.

If you suspect a heart attack this is a medical emergency and you should seek medical
assistance.

Treatment
Rehabilitation after a heart attack may take several months or more. The Physiotherapist
will teach relaxation techniques, breathing exercises, and exercises to gradually
strengthen leg and trunk muscles. Gradually, gentle activity such as walking is
introduced. Throughout the programme the Physiotherapist aims to rebuild the person’s
confidence, to improve exercise tolerance and to teach them to recognise signs and
symptoms of excess exercise.

Regular aerobic exercise decreases the heart rate and blood pressure at rest and during
exercise. This helps to reduce the work load on the heart and anginal symptoms may be
alleviated. Regular exercise improves muscle function and the ability to take in and
utilise oxygen better.
Heel Pain
Heel pain is one of the most common conditions to affect the foot impacting on an
estimated 1 in 10 people during their life. People who regularly exercise by jogging or
running and adults aged 40 -60 are commonly affected. As there are several potential
causes, it is important to have Heel Pain properly diagnosed. Our Chartered
Physiotherapists will be able to accurately diagnose the underlying source of your Heel
Pain so that appropriate treatment can be applied.

Symptoms
If you are unsure of the cause of your symptoms, or if you do not know the specific
treatment recommendations for your condition, we can help. Our Chartered
Physiotherapists are specifically trained in foot & ankles allowing us to offer you
expertise in the treatment of most of the causes of Heel Pain. Some signs that you should
be seen by one of our

Physiotherapists include:

∑ Inability to walk comfortably

∑ Heel Pain that occurs at night or while resting
∑ Heel Pain that persists beyond a few days
∑ Swelling or discoloration
∑ Any other unusual symptoms

Treatment
Depending on what we diagnose your condition as, we may use one of the following
treatment options, or a combination of bothOrthotics / Insoles We may recommend
either off the shelf corrective insoles or customised orthotics, which we manufacture
bespoke for you using our Gait Scan technology. We are Ireland’s largest provider of
Customised Orthotics and our Chartered Physiotherapists are specifically trained in
treatment of Heel Pain. For full details on this service, click hereAssessment and
treatment of joints and muscles surrounding the core, hip and knee will ensure you get
the best results out of your orthorics.
Heel Spur
A Heel Spur is a hook of bone that can form on the heel bone (calcaneus). Heel spurs are
caused by a build-up of calcium on the bottom of the heel bone. It is a process that occurs
over a prolonged period. The process may be triggered by a ligament or muscle strain in
the foot or by stretching the plantar fascia. Athletes that partake in running, jumping or
jogging tend to get them.

Symptoms
The Heel Spur itself is not thought to be painful. Patients who experience pain with
Plantar Fasciitis are suffering from inflammation and irritation of the plantar fascia. This
the primary cause of pain and not the Heel Spur.

Heel Spurs form in some patients who have plantar fasciitis, and tend to occur in patients
who have had the problem for a prolonged period of time. While about 70 % of patients
with plantar fasciitis have a heel spur, X-rays also show about 50 % of patients with no
symptoms of plantar fasciitis also have a heel spur.

Commonly, pain is intermittent and is often felt on standing in the morning. Over time,
pain subsides and returns after periods of rest or during activities such as walking or
jogging.

Treatment
Treatment of Heel Spurs is the same as treatment of plantar fasciitis.

To arrive at an accurate diagnosis, our foot and ankle Chartered Physiotherapists will
obtain your medical history and examine your foot. Throughout this process the highly
skilled Physiotherapist will rule out all the possible causes for your heel pain other than
plantar fasciitis.

The following treatment may be used:

∑ Orthotics/Insoles
 ∑ Inflammation reduction
∑ Mobilisation
∑ Taping and Strapping
∑ Rest

High arches, flat feet, being overweight, Diabetes, and improper shoes can increase your
risk of developing Heel Spurs.

Heel Spur
The calcaneus is the bone in the back of the foot, commonly referred to as the heel bone
and this is where the heel stress fracture occurs. This bone helps support the foot and is
important in normal walking motions. The joint on top of the calcaneus is responsible for
allowing the foot to rotate inwards and outwards. A heel stress fracture is also referred to
as a calcaneus fracture.

Symptoms
Calcaneus fractures cause significant swelling and pain of the back of the foot. Symptoms
of a calcaneus fracture include:

∑ Inability to walk
∑ Swelling of the foot
∑ Bruising of the foot
∑ Severe heel pain

Treatment
If you suspect that you have a Calcaneus fracture you will need to arrange for an
immediate X-Ray. Most calcaneus fractures are closed injuries, meaning the skin is
intact. When the skin around the calcaneus fracture is broken, this may represent an open,
also called a compound, fracture. An open fracture of the calcaneus is a surgical
emergency and you should go to A&E immediately.
All patients with a calcaneus fracture should also be examined for other high-energy
injuries. Studies have shown a large number of patients who have a calcaneus fracture
will also have fractures of the lumbar spine (10 to 15 %). Other injures commonly occur
in patients who sustain a calcaneus fracture, including injuries to the head, neck, and
other extremities.

Hip Pain /Perthes Disease

Hip pain is a common complaint that can be caused by a wide variety of problems.
Perthes Disease is a condition that affects growing children, and is characterised by a
temporary loss of blood supply to the hip. Without an adequate blood supply, the “ball”
in the socket of the hip becomes inadequate and the bone gradually breaks down. Perthes
Disease is usually seen in children between the ages of 4 and 10.

Symptoms
Children with this condition may show signs of limping and may complain of mild hip
pain. Other symptoms may develop including decreased range of motion or stiffness in
the hip joint. The child may have had these symptoms intermittently over a period of
weeks or even months. Pain may be felt in other parts of the leg, such as the groin, thigh,
or knee.

Pain may also be caused due to muscle spasm around the hip. Pain increases with
movement and is relieved by rest. In time the affected leg may become thinner due to
wasting of the thigh muscles as they are not being used as much as the other leg. The
affected leg may also appear shorter and both hips may be affected but this is uncommon.

Our Expertise
Our Physiotherapists are highly trained and qualified to provide expert care to our
patients. They are fully insured and are chartered by the Irish Society of Chartered
Physiotherapists (ISCP).
We have a team of Clinical leads who visits our Physiotherapists and clinics to ensure a
level of customer service and quality care that exceeds our competition is given to
patients every time.

Our Paediatric Physiotherapists have extensive experience in the management of a wide

variety of paediatric conditions so you know that your child is in safe hands.

Incontinence
Urinary Incontinence is the accidental or involuntary loss of urine from the bladder.
Research indicates that the frequency of Urinary Incontinence is much higher than
expected. Studies show that 2% to as much as 60% of people experience Urinary
Incontinence at some stage in their lives. Urinary Incontinence can often be associated
with increasing age, pregnancy and childbirth, menopause, pelvic pain due to childbirth,
cystitis, post-surgery, post trauma or following injury.

Symptoms
During pregnancy your pelvic floor muscles have to endure an added strain. They have to
support the weight of your growing uterus, and cope with the changes caused by
pregnancy hormones. A quick increase in pressure on the stomach area, which can easily
occur by something as simple as coughing, can be too much for these muscles to hold
back the flow of urine and a few drops might escape. This is referred to as Stress
Incontinence.

Urgency Incontinence is often referred to as an overactive bladder. You experience an

urgent need for the toilet and may not make it there in time.

Treatment
Our Women’s Health Physiotherapist can help to overcome these difficulties by teaching
you to strengthen the pelvic floor muscles. A personalised treatment plan, involving
exercises and lifestyle recommendations will be given to you.
Our Physiotherapists can also prescribe a home based device to use as part of your
treatment plan – INNOVO. INNOVO has been developed to treat the root cause of
bladder weakness and not just the symptoms. To learn more, please click here.

Our highly skilled Women’s Health Physiotherapist will carry out a detailed assessment
to identify your problem and the underlying cause. They will do this by analysing your
symptoms, assessing your pelvic floor muscles and identify any lifestyle habits that may
contribute to your incontinence. They may utilise Biofeedback to for pelvic floor re-
education.

Insoles
The field of biomechanics applies principles of mechanics to study the structure and
function of biological systems. The basis of biomechanical analysis is the determination
of how forces generated within the body, or how forces applied to the body, influence the
way that we move. Structural problems in your feet can alter your walking pattern,
running pattern & cause pain throughout your body. Clear & accurate assessment of the
mechanics of your lower limbs is key to understanding the profound effect that subtle
faults in your foot, ankle, knee & hip alignment can cause.

Assessment
Your foot is in contact with the ground for about 0.8 of a second when walking and about
0.25 seconds when running. No practitioner (no matter how well trained) can provide a
100% accurate analysis of foot function with the naked eye in a quarter of a second!

Through our combination of a skilled Biomechanical Assessment & a computerised Gait

Scan, foot problems can easily be diagnosed by our expert Physiotherapists.

Gait scan involves thousands of tiny sensors which capture the distribution of pressure
throughout the sole of your foot each step you take. We can then display foot pressure
distribution on the screen giving a very accurate visual representation of the pressures
under your feet.
 Treatment
Orthotics are specially designed insoles, which are made for you by prescription. This is
done by taking a plaster cast of the foot in its neutral position and is then sent to a
laboratory, with your prescription to be made to your exact specifications. The insole
then correctly aligns your foot and as a result your body. This will relieve abnormal strain
of tissues and structures which can cause pain. For less severe mal-alignments or for
sports use a wide variety of “off the shelf” insoles are also available. These can be
purchased from our Shop and our Chartered Physiotherapists will advise you on the best
insole to manage and resolve your specific problem.

Irish Dancing Injuries

The majority of dance related injuries are caused by overuse as opposed to any sort of
trauma. The foot/ ankle/ lower leg/ back and hip are some of the most commonly injured
sites. The most commonly seen Irish Dancing injuries are listed below in the symptoms
section but many other injuries from dancing do occur and are easily treatable with focus
on the specific dance techniques, flexibility and strength.

Symptoms
Plantar Fasciitis - This is a painful injury that occurs when the tissue supporting the arch of
the foot is overused and becomes inflamed.

Bunions - This is a small deformation of the bone around the big toe area. For dancers it is
usually caused by wearing ill-fitting dance shoes.

Shin Splints – It is a painful condition caused by slight tears of the tissue that connect the
muscle to the tibia/shin bone. In dancing these tears are caused by over exertion of the
lower limbs by landing jumps on hard surfaces, landing improperly and inflexibility.
Achilles Tendinopathy – This refers to a painful condition when the Achilles tendon has
become irritated and degenerative.

Treatment
Depending on the injury, our highly skilled Physiotherapists may prescribe various types
of treatments including stretching and strengthening drills to ensure the core, hip, knee
and ankle joints are all working in unison to keep the foot in an optimal position.

Orthotics can be used to help support the foot, particularly during non-dancing periods
when it is out of the dancing shoes to enable adequate resting of the surrounding joints
and muscles.

Many dancers find a sports massage to be particularly beneficial in helping to heal over
used muscles quickly.

Irish Dancing Injuries

The majority of dance related injuries are caused by overuse as opposed to any sort of
trauma. The foot/ ankle/ lower leg/ back and hip are some of the most commonly injured
sites. The most commonly seen Irish Dancing injuries are listed below in the symptoms
section but many other injuries from dancing do occur and are easily treatable with focus
on the specific dance techniques, flexibility and strength.

Symptoms
Plantar Fasciitis - This is a painful injury that occurs when the tissue supporting the arch of
the foot is overused and becomes inflamed.

Bunions - This is a small deformation of the bone around the big toe area. For dancers it is
usually caused by wearing ill-fitting dance shoes.

Shin Splints – It is a painful condition caused by slight tears of the tissue that connect the
muscle to the tibia/shin bone. In dancing these tears are caused by over exertion of the
lower limbs by landing jumps on hard surfaces, landing improperly and inflexibility.
Achilles Tendinopathy – This refers to a painful condition when the Achilles tendon has
become irritated and degenerative.

Treatment
Depending on the injury, our highly skilled Physiotherapists may prescribe various types
of treatments including stretching and strengthening drills to ensure the core, hip, knee
and ankle joints are all working in unison to keep the foot in an optimal position.

Orthotics can be used to help support the foot, particularly during non-dancing periods
when it is out of the dancing shoes to enable adequate resting of the surrounding joints
and muscles.

Many dancers find a sports massage to be particularly beneficial in helping to heal over
used muscles quickly.

Joint Stiffness
Most people will not feel like exercising when their joints are painful, inflamed or stiff.
However, an appropriate and regular exercise program can help reduce stiffness and pain,
increase flexibility, improve endurance, develop muscle strength, improve sleep and keep
bone and cartilage healthy. Joint Stiffness can be caused by injury or disease and is a
common symptom in arthritic conditions. It can often be one of the earliest symptoms of
arthritis.

Symptoms
Joint stiffness is gradual loss in flexibility of a joint or a reduction in the range of
motions.

Joint stiffness occurs mainly due to arthritis or following an injury to a joint which is
accompanied by muscle spasm.
Joint stiffness last less than 30 minutes would tend to be associated more so with
Osteoarthritis. While that lasting more than 30 minutes is found in inflammatory arthritis
such as Rheumatoid Arthritis or the family of spondyloarthropathies.

Although joint stiffness may not appear to be life threatening it can be painful and limit
your independence. It is important that you seek advice and assessment from a qualified
health care professional such as your GP or one of our highly trained Physiotherapists.

Treatment
This will include:

∑ Range-of-motion exercises
∑ Strengthening exercises
∑ Aerobic exercise

Our Chartered Physiotherapists will also carry out a thorough assessment to determine
the causes of your joint stiffness to help tackle this problem. They utilise manual joint
mobilisations if they feel this treatment approach may help and is not contraindicated.

Your GP may also prescribe disease modifying drugs if your joint stiffness is disease
related and they may help to slow down disease progression and improve symptoms.

Our Expertise

Juvenile Arthritis
Juvenile Arthritis is an umbrella term that describes conditions that can develop in
children ages 16 and younger. Unlike typical arthritis, Juvenile Arthritis can involve the
eyes, skin and gastrointestinal tract. The most common type of Juvenile Arthritis is
Juvenile Idiopathic Arthritis (JIA). To be diagnoses with this condition a child must be
younger than 16 and have initial swelling in one or more joints for at least six weeks.
 Symptoms
Juvenile arthritis (JA) refers to any form of arthritis or an arthritis-related condition
that develops in children or teenagers who are less than 16 years of age.

Symptoms include:

∑ Pain, swelling, tenderness and stiffness of joints, causing limited range of

motion
∑ Joint contracture
∑ Damage to joint cartilage and bone leading to joint deformity and impaired use
of the joint
∑ Altered growth of bone and joints leading to short stature
∑ Frequent fevers accompanied by malaise or fatigue
∑ Eye problems
∑ Rashes

Treatment
Our Physiotherapists are highly skilled in the assessment and management of arthritis.
They can show your child with arthritis different stretches and range-of-motion exercises
that will reduce their pain when performing certain activities helping them to stay active.
These exercises will make sure their joints stay flexible, reducing the risk of degenerative
arthritis.

We will also teach your child strengthening exercises to help build up muscle and
endurance. Your child will need to perform a range of these exercises daily to make daily
activities easier to perform and helping to maintain their independence. Certain
techniques and treatments can also be performed by our Physiotherapists to minimise any
joint damage or swelling that often occurs as a result of juvenile arthritis.
Knee Pain
There are many types of knee injuries and conditions, which can be treated successfully
by Physiotherapy. These range from ligament and cartilage problems to tendon and
muscular strains. Knee pain can also be due to overuse injuries, sudden injuries or
conditions such as arthritis, gout or infections. Our Physiotherapists are experts in
assessing the cause of knee pain and treating the problem effectively.

Symptoms
Ligament sprains or tears –

Ligaments provide stability to the knee by providing extra support. When a ligament
is over-stretched the ligament fibres can be damaged, resulting in pain, swelling and
in many cases, joint instability.

Cartilage tears (Meniscal tears) –

The cartilage acts as a shock absorber in the knee and can be damaged over a
prolonged period as a result of natural wear and tear or when the knee is injured.

Knee-Cap Pain (Patellofemoral Pain / CMP Condramalacia Patella) –

Abnormal movement of the patella can be caused by; muscle imbalance, a shallow
groove in the femur, soft tissue tightness and pronated (flat) feet. Pain generally
develops over a period of time. And tends to be aggravated by any bent knee
activities.

Treatment
It is important that the correct diagnosis is made for all knee injuries and that treatment
commences as quickly as possible.

Treatment techniques can include specific strengthening exercises to correct a muscle

imbalance, soft tissue massage, joint mobilisation, and the fitting of custom made
orthotics (biomechanics) to correct excessive foot pronation. This has a direct link to
patellofemoral pain and a full biomechanical assessment can be performed by our skilled
Physiotherapists to determine the imbalance in your foot.

Acupuncture has also been proven as an effective way to relieve knee pain. One of our
highly skilled Acupuncturists can help to relieve symptoms and work in tandem with
your team of Physiotherapists.

Knee Pain/Osgood Schlatters

Osgood Schlatter’s Disease (OSD) is far less frightful than its name suggests. Rather than
being a disease, it is better described as an overuse injury and is a common cause of knee
pain in active children. OSD is an inflammation of the bone at the top of the shin (tibia)
where the tendon from the kneecap (patella) attaches. OSD affects children during high
growth periods due to the soft ends of growing bones being unable to contend with the
rate of change.

Symptoms
Swelling or tenderness is felt at the front top of your shin bone, over the bump where the
patellar tendon inserts into the tibia. The pain usually worsens with exercise, is relieved
by rest and causes you to limp after exercise.

Children increase their risk of developing OSD if they play sport that involves running,
twisting, and jumping such as basketball, football, figure skating and gymnastics. Your
child may experience muscle tightness around the knee in the hamstrings and quadriceps.

Treatment
First of all, it is important to ensure that OSD is the actual diagnosis. Our highly skilled
Physiotherapists will carry out a detailed assessment to diagnose your child’s knee pain.
As slowing down the rate at which your child is growing is not really an option, ensuing
the control of the hip, knee and ankle joints is imperative for reducing the overall stress
on the bony insertion. Use of ice for pain relief and soft tissue massage – including
trigger point release work – is recommended. Advice on activity modification may also
be needed.

Ligament Sprains
Soft tissue injuries are injuries related to the soft tissues of the body (muscle, tendon,
ligament and nerve). Specific diagnosis can be made by our Physiotherapists to determine
what structure is involved and how advanced or severe the sprain, strain or tear is. This is
an area of expertise for physiotherapists and encompasses the whole body.

Once a diagnosis is made, specific treatment advice can be given. When it comes to
treating ligament sprains, our team of Physiotherapists are highly experienced, so you can
be assured you are receiving a first class service.

Symptoms
A Ligament Strain is caused by a traumatic stress being placed on the joint which can
strain or in some cases completely tear the ligament. The location of your tear will vary
on the sports you play and the direction of the force. For example, square or tennis
players may experience a high incidence of hand sprain.

Depending on the degree of damaged symptoms such as bruising, pain, swelling and
reduced movement will be seen. In some cases small fractures, known as an avulsion
fracture may occur. This requires an x-ray to confirm and may result in an adjustment to
your treatment plan.

Treatment
Protect, Optimally load, Ice, Compression and Elevation will become your new mantra!
While protecting the injury from further damage, ice should be applied, ensuring to apply
for no greater than 20 minutes. It is important to not apply ice directly to the skin as this
may result in a burn.
A bandage should be applied to help limit and reduce swelling while providing a
protective function for the joint. The injury should be elevated above waist height, for at
least as long as you are icing it which will further help reduce swelling.

Treatment will then depend on the grade and severity of the injury. As soon as the
individual is ready and comfortably, our physiotherapists will begin a specific hands on
rehabilitation program tailored to your needs.

Limp
Differences in limb length can be due to many causes and their management is related to
the predicted limb length discrepancy at skeletal maturity. Predicted leg length
discrepancies of 2-5 cm at skeletal maturity can be managed with a shoe raise or a
shortening procedure such as surgical closure of a relevant growth plate (epiphysiodesis)
at an appropriate time to achieve limb length equality at cessation of growth. Injuries
such as bone fractures, sprains and strains are common causes of a limp.

Symptoms
A limp refers to any type of difficulty found when walking.

If you notice you favour using one leg over another, then you may a have a slight limp. A
limp is often due to disease or damage and should be assess by a trained health care
professional.

Our highly skilled Physiotherapists are trained to assess, diagnose and treat conditions
that may result in a person experiencing a limp.

Treatment
Our Chartered Physiotherapists can assess discrepancies, which can often be corrected
with athletic conditioning and stretching programs, or by wearing arch supports, heel lifts
or orthotic devices.

Whilst in some cases, certain limb length discrepancies are beyond the scope of the
Paediatric Physiotherapists, our podiatrist can advise you on the best course of action
after having an assessment.
For a full list of Foot Related injuries please click here

Back Pain
Back pain can be caused by problems with either discs, joints, muscles and ligaments or
most often a combination of these. It is usually the result of acute trauma/injury or
poor postural habits and the resulting accumulation of stress on the spine. However, there
are other rarer, more serious causes of back pain that can result in progressive
inflammatory processes affecting bones and joints.

Symptoms
Back pain for many people is often experienced as a pain or discomfort located between
the lower ribs and butt with or without the addition of leg pain.

Symptoms can range from muscle ache to shooting pain, limited movement, altered
walking and difficulty standing straight. If sciatica occurs along with the back problem,
nerve pressure is experienced as pain that radiates down the leg and possibly into the
ankle or foot. Pins & needles and numbness can occur too.

Acute low back pain generally lasts for a few days to weeks and is usually as a result of
trauma or arthritis. Low back pain that persists for longer than 3 months is considered
chronic.

Treatment
As back pain is often multifactorial, our Physiotherapists are highly trained to diagnose
problems in the joints and soft tissues of the body. They will carry out a comprehensive
assessment and treatment plan to help successfully manage your particular problem.

Manual therapy such as spinal manipulation/ mobilisation and massage are often used to
alleviate symptoms and manage this condition in the acute stage. A home exercise
programme will be devised to help restore muscular strength and re-educate accurate
movement patterns. Your physiotherapist may advise other activities such as pilates or
yoga to help with the long term care of your back.
Our Chartered Physiotherapists and Certified Acupuncturists may also help to relieve
your back pain through the use of acupuncture or dry needling. For more information
please see our pages on acupuncture or dry needling .

Lymphoedema
Lymphoedema is a chronic condition for which there is no cure. However, it can be
controlled with early intervention. When the lymphatic system is blocked or damaged,
lymph fluid accumulates in tissue causing long term swelling of parts of the body:
lymphoedema. Individuals affected by lymphoedema seeking treatment should be seen
by a specialist Physiotherapist – ie, a practitioner with an appropriate postgraduate
qualification (complex de-congestive therapy [CDT]/manual lymphatic drainage [MLD]
certificated. It is important to recognise the early signs of this condition.

Symptoms
Lymphoedema most often affects the limb, but can also occur in the face, neck and
abdomen, genitals and internal organs.

Early signs:

∑ Swelling
∑ A feeling of heaviness
∑ Soreness in affected area
∑ Skin changes
∑ Clothing or jewellery may feel tighter

Treatment
Unfortunately Lymphoedema cannot be prevented or cured entirely; Physiotherapy
however can help to lessen the uncomfortable effects of lymphoedema.
Physiotherapists manage the condition primarily using manual lymphatic drainage –
draining lymph fluid from tissues – as well as deploying multi-layer bandaging, skin care
and exercises. In some cases positioning may be used by the Physiotherapist.

They will also advise on the use of special sleeves or support stockings and give more
general advice to avoid aggravating the condition. Machines are also available for
purchase. They are specialized and expensive and one of our highly skilled
Physiotherapists can advise on the correct one for you.

Meniscal Injuries
A Meniscus tear describes a tear in the shock-absorbing cartilage (meniscus) of the knee.
The meniscus is a C-shaped fibrous piece of cartilage, which is found in certain joints and
forms a buffer between the bones to protect the joint surface. The meniscus also serves as
a shock-absorption system, assists in lubricating the joint, and limits the joint flexion and
extension. Unlike other tissues it does not have its own blood supply which can affect its
ability to heal.

Symptoms
A twisting mechanism or over-flexing the joint most commonly causes Meniscal tears. It
is a common injury in sports that require rapid, forceful changes of direction (i.e.:
football, basketball etc). Commonly swelling in and around the knee joint starts to
accumulate between 2-6 hours post injury.

Walking, squatting, and twisting motions can all be painful. If the meniscal damage is
severe, a piece of cartilage may have broken off and have become loose. This can cause a
feeling of joint ‘locking’ or catching.

Treatment
The goal of treatment is to reduce symptoms and protect the joint from further injury
while it heals. Initial management will include the POLICE protocol – protect, Optimal
loading, ice, compression and elevation. It is important that this is done correctly and our
Physiotherapists can advise you on this. This is aimed at reducing the bleeding and
secondary tissue damage.

Depending on the severity of injury crutches may be needed in the initial stages. Your
physiotherapist will give you drills to restore normal range of motion, strength and
proprioception around the knee. A progressive exercise programme will be put in place to
help return you to your work or sporting endeavours.

Your GP may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs).

Mental Health
Mental health problems affect one in four of us at some time in our lives. Depression,
post traumatic stress disorder, anxiety and other problems can be triggered by personal
and lifestyle pressures, such as bereavement, relationship breakdown, or job loss. They
can also be the result of drug or alcohol dependency, illness or long term physical
disability.

Symptoms
Mental Health refers to how you are thinking, feelings and behaviour reflect how we are
in the world. Some aspects of ‘Good’ Mental health include balanced thinking, healthy
emotional experience, coping with stress and managing setbacks well. It involves
engaging and enjoying various aspects of life while being resilient through difficult
times.

In contrast mental health problems can be defined as the experiencing of distressing

psychological symptoms to the extent that normal functioning is seriously impaired.
Mental health difficulties can have a detrimental impact on a person’s life affecting their
work, leisure, relationships and self-esteem.

Treatment
Physiotherapy has an important role to play in helping those with mental health problems.
Research shows that regular exercise affects mood and increases self-esteem. Our
Physios are able to assess people and devise a safe, enjoyable exercise and
movement programme tailored to their needs, which will help to build their mental and
physical well being.

They can also alleviate back pain and other physical symptoms which often accompany
mental health problems by teaching relaxation techniques or by using massage and other
touch related therapies.

Men’s Incontinence
Urinary Incontinence is the accidental or involuntary loss of urine from the bladder.
Research indicates that the frequency of Urinary Incontinence is much higher than
expected. Studies show that 2% to as much as 60% of people experience Urinary
Incontinence at some stage in their lives. It is very common for men to experience
Urinary Incontinence. Urinary Incontinence can often be associated with increasing age,
cystitis, post-surgery, post trauma or following injury.

Symptoms
If you suffer from incontinence, you probably have two or more of the following
symptoms:

∑ Involuntary loss of urine or a continuous leakage of urine from the bladder.

∑ A frequent and urgent need to urinate.
∑ A feeling that your bladder is constantly full or that it isn’t empty after urinating.
∑ Difficulty urinating even if you have the urge.
∑ Releases of urine triggered by movement or by coughing, sneezing, or laughing.
∑ The need to get up repeatedly at night to urinate
∑ A start-and-stop stream during urination.
 Treatment
Chartered Physiotherapists have a central role in treating incontinence. After a detailed
assessment, our Men’s Health Physiotherapist may teach you exercises to strengthen the
muscles that hold urine in the bladder, along with other techniques to retrain the bladder,
lifestyle changes and advice to promote and maintain continence. You may also be asked
to maintain a voiding diary and give details of your general medical history.

If the muscle strengthening exercises are proving ineffective for you, Biofeedback and
Electrotherapy may be used to help activate and stimulate the muscles.

Our Physiotherapists can also prescribe a home based device to use as part of your
treatment plan – INNOVO. INNOVO has been developed to treat the root cause of
bladder weakness and not just the symptoms. To learn more, please click here.

Metatarsal Pain
People with metatarsalgia suffer from intense ball-of-foot or metatarsal pain. The five
metatarsal bones act as a shock absorber and if forces are unevenly distributed may
become irritated causing pain. This condition is often due to a number of causative
factors such as: intense training or activity, foot deformities, foot imbalance, excessive
weight, poor foot wear, stress fractures and Morton’s neuroma.

Symptoms
For people who suffer with metatarsal pain, the main symptom is pain in the ball of the
foot. Metatarsal pain is most pronounced when walking or engaging in sports.

Other symptoms can include sharp, burning, aching pain in the ball of your foot, usually
affecting the second toe. Pain gets worse on standing, running, flexing feet, or walking
especially barefoot. Normally symptoms develop over a few months and improve with
rest. People often express a feeling of having a stone or pebble in their shoe and may
experience tingling or numbness into the toes.

Some people may also experience discomfort when simply wearing shoes.
 Treatment
If left untreated, metatarsal pain can lead to other more serious foot and lower body joint
problems, so it is important to consult a podiatrist or physiotherapist.

Treating metatarsal pain depends on the cause, but simple additions such as metatarsal
pads to your shoes that help spread the weight will help ease the pain. In
addition, orthotics will spread your weight more equally across the bottom of the foot and
provide stability to the arch, relieving metatarsal pain.

Our Chartered Physiotherapists can assess your foot to determine which form of
treatment would be most suitable for you. Good foot wear which suit your needs and a
personalised stretching program can also help.

Morton’s Neuroma
Morton’s Neuroma is a painful condition that affects the ball of your foot, most
commonly the area between your third and fourth toes. Morton’s neuroma may feel as if
you are standing on a pebble in your shoe or on a fold in your sock. A neuroma is the
thickening of a local nerve nerve as a result of compression and irritation.

Symptoms
Usually there is no particular obvious symptom of this condition, such as a lump but
instead you may experience:

∑ A feeling as if you’re standing on a pebble in your shoe

∑ Pain in the ball of your foot that may radiate into your toes
∑ Tingling, burning or numbness in your toes

At first symptoms may only be felt wearing narrow toed shoes. Symptoms may go away
temporarily with massage, removal of shoes and/ or reduced activity but over time
symptoms will become progressively worse and may persist for days or weeks. As the
neuroma becomes bigger temporary changes in the nerve can become permanent.
Therefore early treatment is vital.
 Treatment
Our Podiatrist or Chartered Physiotherapists will assess your condition and provide you
with the correct treatment depending on the severity of your symptoms.

Treatments often include:

* address footwear issues

* correct biomechanical issues and make the forefoot stable

* refer for steroid injection

* surgical removal Orthotics devices and arch supports for your shoes can help reduce
pressure on the nerve.

Our podiatrist will work closely with our physio’s who specialise in biomechanics, and
determine whether you need custom made orthotic devices or over the counter insole,
which we have available in our clinics. For full details on this service click here.

Multiple Sclerosis
MS is thought to be an autoimmune disease where the nerve cells that transport messages
between your brain and body are damaged. A gap then develops along the message path,
disrupting the flow of the messages travelling to and from the brain and body. As a result
the message is either distorted in some way or completely lost affecting the individual’s
health and lifestyle in different ways.

Symptoms
No two people are the same and likewise the condition affects each individual differently.
The symptoms that arise depend on which particular nerve cells have been damaged
therefore a wide range of symptoms occur and tend to differ greatly from one patient to
the next. Some of the more common symptoms that can develop include fatigue, sensory
disturbance (vision problems), muscle weakness and lack of balance and co-ordination.
 Treatment
Physiotherapy on its own or in conjunction with appropriate medication can help people
with MS to live a more comfortable and active life by helping to lessen the effects of the
condition through exercise. A Chartered Physiotherapist can assess the physical
difficulties you are having and be able to help restore more normal movement by setting
you an exercise regime designed specifically for you.

The suggested exercise plan can help you to: Coordinate movements, Control movements
to reduce muscle spasms, Strengthen muscles, Improve coordination, Reduce stiffness by
keeping joints mobile, Address Balance issues and retrain Balance, Assist in Preventing
falls.

Muscle Imbalance
Movement and physical function requires a balance between muscle tone, strength and
length. The relationship between these three muscle characteristics around a joint is
known as muscle balance. Repeated movements in one direction or sustained postures
can quickly set up a muscle imbalance that can ultimately lead to the dysfunction of a
joint.

Symptoms
A lot of musculoskeletal pain conditions are caused by muscle imbalance of opposing
muscles in the front and back of the body. This can be seen commonly in the hips,
shoulder and lumbar spine.

These imbalances occur in many activities of life, from simple poor posture sitting at the
desk or sleeping at night, through to repeated movements without working the opposing
muscle group. So even when we are doing the correct thing getting out exercising we can
be slowly developing a muscle imbalance if the programme isn’t well rounded.
 Treatment
Our highly skilled Physiotherapists will work with patients to prescribe an exercise
rehabilitation programme to address muscle imbalance.

By addressing issues like posture, our Chartered Physiotherapists can help ensure that
your muscle balance can return to normal and prevent future injury.

Our Physiotherapists will carry out a detailed assessment of your posture and
musculoskeletal system. They will identify any imbalances in strength, flexibility or tone
and devise a personalised treatment plan to address these issues.

Muscle Tears, Strains, Pulls

Soft tissue injuries are injuries related to the soft tissues of the body (muscle, tendon,
ligament and nerve). A muscle tear, strain or pull refers to damage to a muscle or its
attaching tendons. This can be caused by sudden pressure or tension being put on a
muscle group causing it to overstretch or tear.

Symptoms
Muscle strains are graded depending on their severity:

Grade 1 strain - the signs may not be present until after the activity is over. There may be a
sensation of muscle cramp/tightness and a slight feeling of pain when the muscles are
stretched or contracted.

Grade 2 strain - immediate pain which is more severe than that of grade 1. It is confirmed
by pain on stretch and contraction of the muscle and is usually sore to touch.

Grade 3 strain - a very serious injury. There is an immediate burning/ stabbing pain and
the athlete is unable to walk without pain. The muscle is completely torn and there may
be a large lump of muscle tissue above a depression where the tear is. Bruising will
appear below the injury site.
 Treatment
The immediate treatment of a muscle injury consists of the POLICE protocol – protect,
optimal loading, ice, compression and elevation. It is important that this is done correctly
and your Physiotherapist can advise you on this. This is aimed at reducing the bleeding
and damage within the muscle tissue.

After the early stages have been spent resting, more active rehabilitation can be started.
Realistically, for best results this should be started as early as 48 hrs post injury.

Gentle resistance exercises and stretching are important as they help to align the scar tis-
sue that forms during healing. Our skilled Physiotherapists will devise a sports specific
rehabili-tation programme tailored to your needs. We can guide you through the process
of returning to play successfully and reduce the risk of occurrence.
Musculo-Skeletal Conditions
The musculoskeletal system consists of the human skeleton, made by bones attached to
other bones with joints, and skeletal muscle attached to the skeleton by tendons. There
are 5 basic tissues comprising the musculoskeletal system: bones, ligaments (attaching
bone to bone), cartilage (protective gel-like substance lining the joints and intervertebral
discs), skeletal muscles and tendons (attaching muscle to bone). So when we refer to
musculoskeletal conditions we are referring to a broad range of conditions encompassing
almost all of the joints, back or muscular pain.

Symptoms
Many musculoskeletal conditions can cause symptoms of pain (ache, sharp, shooting,
darting, soreness) or swelling or tenderness in the area. However there are other
symptoms which are also connected with these such as sleep disturbance, fatigue, lack of
energy or lethargy, anxiety and stress.

Musculoskeletal conditions vary in severity. Pain and discomfort secondary to these

conditions can interfere with daily activities and potentially limit a person’s
independence. They are extremely common and the risk of developing one increases with
age.
Musculoskeletal conditions have a range of causes such as age, occupation, activity level,
lifestyle, sport and comorbidities. Low back pain is one of the most common
musculoskeletal conditions.

Treatment
Acupuncture has been proven as an effective form of treatment for a range of
musculoskeletal conditions. Pain, stiffness, swelling and soreness, in muscles and joints
can lead to an obstruction of energy (Qi/Chi), causing problems to the normal function of
the whole body. An acupuncturist can restore these disturbances by inserting fine needles
into specific points to relieve pain and reduce inflammation.

Acupuncture is recommended in the National Institute for Health & Clinical Excellence
(NICE) guidelines for back pain treatment. Acupuncture attempts to treat the body as a
“whole” and not just the localised symptoms.

Our highly skilled Chartered Physiotherapists may refer you to one of our clinical
Acupuncturists.

Musculoskeletal and Sports Injuries in

Children
Children can experience the same Musculoskeletal Injuries as adults and as their
skeletons are still growing and their bones are more porous than adults injuries can
happen more easily.

Symptoms
Sports Injuries may be hard to avoid with active children, and can range from minor cuts
and bruises, to more serious sprains, fractures and broken bones. Injuries can occur for a
number of reasons, including not wearing correct protective sports equipment, not
warming up correctly or from dehydration. Below are some of the most common types of
sports injuries in children: Sprains and Strains - A sprain is an injury to a ligament–a
stretching or a tearing. One or more ligaments can be injured during a sprain. A ligament
is a band of tough, fibrous tissue that connects two or more bones at a joint and prevents
excessive movement of the joint. Ankle sprains are among the most common injury
treated by our Physios and often occur during sports or recreational activities. A strain is
an injury to either a muscle or a tendon. A muscle is a tissue composed of bundles of
specialized cells that, when stimulated by nerve impulses, contract and produce
movement. A tendon is a tough, fibrous cord of tissue that connects muscle to bone.

Growth Plate Injuries - In some sports accidents and injuries, the growth plate may be
injured. The growth plate is the area of developing tissues at the end of the long bones in
growing children and adolescents. When growth is complete, sometime during
adolescence, the growth plate is replaced by solid bone. The long bones in the body are
the long bones of the fingers, the outer bone of the forearm, the collarbone, the hip, the
bone of the upper leg, the lower leg bones, the ankle, and the foot. If any of these areas
become injured, seek professional help from a doctor who specializes in bone injuries in
children and adolescents (your GP will be able to advise).

Treatment
All of our Physios have training in the assessment and diagnosis of musculoskeletal
injuries. They employ the most advanced techniques and their results are sometimes
instantaneous. Apart from providing rapid pain relief, there are a number of other
important ways that our Physiotherapists can help with injuries in children. These
include:

Identifying exactly what’s wrong with your child’s back, neck or other areas of the body
because they’re trained to diagnose the specific causes of body pain. Teaching your child
exercises that will help with the injury. Identifying the factors that led to the injury in the
first place, our Physios can advise on how to avoid musculoskeletal injuries in the future.

Possessing advanced skills including pain management, our Physios offer a broad range
of treatment options. As a result, they are in the best position to improve your child’s
overall strength, mobility and co-ordination.

Neck Pain
Understanding what condition you have and what you can do to help reduce your
symptoms is half the battle. Although acuteneck pain can be very debilitating affecting
activities of daily living, most people will see an improvement in 1-2weeks and the
majority of people experience no pain in 8-10weeks. We will provide you with advice
and education on exercises for neck pain aimed at reducing the likelihood of it recurring
while giving you tips on how best to reduce pain on a day to day basis.
 Symptoms
Neck Pain can often be associated with neck stiffness, pins and needles in the arm,
shoulder stiffness and related pain in the shoulder blade, head, arm, wrist and hand. It can
be caused by a sprained ligament, pressure on a disc or a muscle strain or spasm. Neck
pain can also be a result of poor postural habits at work, whiplash post road traffic
accident, strains while playing sports or stress related incidents in one’s life.

Osteoarthritis, which causes narrowing of the space between vertebrae and the growth of
bone spurs on vertebrae as a result of increased pressure, can cause pain in the neck or
arm if the nerve has been compressed.

Treatment
All of our Chartered Physiotherapists have training in the assessment and diagnosis of
musculoskeletal injuries. They employ the most advanced evidence based techniques and
their results are sometimes instantaneous.

Apart from providing rapid pain relief, there are a number of other important ways that
our Physiotherapists can help with neck pain.

Our Physiotherapists offer a broad range of treatment options such as massage, soft tissue
release, trigger point therapy, exercise prescription and joint mobilisation. As a result,
they are in the best position to improve your overall strength, flexibility and range of
movement, addressing any limitations you may have which may be contributing to your
neck pain.

Neck Stiffness
Neck Stiffness is extremely common and is usually caused by injury to the soft tissue
structures of the neck, such as muscle, tendon, ligament or joint. Muscle spasm in the
neck, leading to a stiff neck, is usually a protective mechanism which is secondary to an
underlying neck problem. This is referred to as ‘Acute Torticollis’ or ‘Wry Neck’.
 Symptoms
A stiff neck is an extremely common symptom, which may be caused by a variety of
neck conditions. The symptoms of neck pain and stiffness, which decreases neck
movement, can be secondary to several problems, such as a disc prolapse (slipped disc), a
facet joint problem, an undiagnosed cervical fracture (broken neck), or another neck
problem.

In most cases of Wry Neck, the person wakes up with the painful stiff neck, although
occasionally the neck may become stuck following a sudden movement. The head will be
held to one side and the neck is too painful to move. Attempting to move the neck will
usually make the neck pain worse. In some cases, the pain will radiate up the neck or
down to the shoulder area. There may be painful spasm in the neck muscles.

Treatment
Stiff neck can be effectively treated by one of our Physios, who will first determine the
cause of the problem.

Dependent on the cause of the problem, likely treatment will include gentle massage and
mobilisations (see Manipulation and Mobilisation) which involves the Physiotherapist
gently applying pressure to each vertebra in the neck in order to loosen them and allow a
greater range of movement.

Another helpful treatment is the use of a heat therapy, to relax the muscles that had
previously been in spasm.Gentle stretching exercises (see exercise and movement) may
also be introduced to patient treatment to alleviate muscle spasm in the neck.
Nerve Pain & Injury
Nerve Pain or Injury is a broad definition for conditions affecting the arms, legs and face
including: Sciatica, pins and needles, numbness, pain and possible weakness. Nerves are
fragile structures that can be damaged through pressure, stretching and laceration.

Symptoms
Symptoms of Nerve Pain and Injury may include:
 ∑ Pain
∑ Sensitivity
∑ Numbness
∑ Tingling or prickling
∑ Burning
∑ Pins and needles
∑ Weakness

Nerve injury can be classified into three types:

Neuropraxia– blockage of nerve conduction but the nerve is intact. Spontaneous

recovery in 4-6 weeks.

Axonotmesis– internal structures of the nerve are damaged, with no or partial damage
to the outer part.

Neurotmesis– rupture of the nerve. The most severe type of nerve injury with no
chance of spontaneous recovery.

Treatment
Treatment by our highly skilled Chartered Physiotherapists can relieve nerve root
compression caused by fibrous scar tissue following a disc prolapse and can treat
conditions related to compression of the sciatic nerve by other structures.

Our Physiotherapists also aim to prevent further episodes of sciatic pain through teaching
correct postural techniques, and exercises to correct any muscle imbalance in the spine.

Other Common nerves injuries include Brachial plexus injury and Foot drop. Depending
on the severity of the nerve damage, the nerve may experience some recovery or in the
case of a laceration injury, a permanent disability may result. Nerves grow about an inch
per month in adults. Nerve compression is common in the cervical and lumber spine.
Neurological Conditions
The nervous system is highly complex, and includes the brain, spinal cord and nerves to
the face, body arms and legs. Damage to the nervous system from either injury or disease
can lead to difficulty in controlling movement. Sensation may also be affected, and
problems with speech, vision, swallowing, speaking and bowel and bladder control may
also present. Mood, ability to concentrate and memory can also be affected. There are
more than 600 neurologic diseases such as Parkinson’s, Alzheimer’s, Muscular
Dystrophy, Huntington’s disease and many more.

Symptoms
Most people will present with a combination of symptoms depending on the type of
condition they are suffering from. Below is a list of possible symptoms (this list is not
exhaustive):

∑ Functional limb weakness

∑ Blackout/ attacks
∑ Sensory symptoms
∑ Pain
∑ Tiredness/ fatigue
∑ Sleep problems
∑ Poor memory/ cognition
∑ Dissociation
∑ Worry/ panic
∑ Dizziness
∑ Headaches
∑ Low mood
∑ Facial spasm
∑ Visual symptoms
∑ Problems walking
∑ Slurred speech
∑ Swallow problems
∑ Word finding difficulties
∑ Bladder problems
∑ Bowel problems
∑ Functional jerks and twitches
 Treatment
Following a full individual assessment, our highly skilled Physiotherapists will suggest a
treatment and management plan to target your specific needs. Treatment may involve
stretches, exercises, and regular standing or walking.

As most neurological conditions are often progressive in nature, our Chartered

Physiotherapists can also offer advice on problems which occur at any stage of the
condition.

Physical fitness and stamina are often major contributors to loss of independence and
disability. Physiotherapy treatments are aimed at improving strength, endurance and
flexibility.
Numbness
Numbness or lack of sensation is generally caused by pressure on a nerve but there are
many other possible reasons for this problem. Once pressure is taken off the nerve,
functioning normally resumes. Nerves can also be pinched by bones and other tissue and
if severe it is a medical emergency. The occasional bout of numbness is a harmless event.
However, chronic numbness can be symptomatic of some other underlying disorders such
as Diabetes, Multiple Sclerosis, Migraines etc. So if you are experiencing this sensation
frequently it would be wise to get it checked out soon.

Symptoms
Numbness, tingling and pins and needles are abnormal sensations that may occur
anywhere in the body. They are often felt in fingers, hands, feet, arms and legs. There are
several different causes for experiencing such abnormal sensations. Injury to a nerve in
your neck may cause feelings of numbness anywhere along your arm or hand, whereas,
an injury in the lower back region can cause numbness or tingling in your legs.

Other causes of numbness are:

∑ Herniated disc
∑ Pressure on peripheral nerves
∑ Shingles
 ∑ Lack of blood supply
∑ Lack of Vitamin D
∑ Abnormal levels of calcium, potassium or sodium in your body
∑ Radiation therapy
∑ Stroke
∑ Underactive thyroid
∑ Carpel Tunnel Syndrome

Treatment
Treatment depends on the cause of your numbness. Our team of highly skilled
Physiotherapists will examine you, carrying out a detailed assessment to determine the
cause of your symptoms.

Diagnosis of a nerve injury is made by taking a detailed history and carrying out a
comprehensive objective examination. Depending on the findings, our physiotherapists
may recommend Electromyography (EMG), a nerve conduction test to confirm the
presence of a pinched nerve and to determine the extent of the nerve injury.

A nerve pinched by bone or some other tissue will need Physiotherapy treatment to allow
full nerve functioning to resume. Nerve compressions can be extremely problematic if
left untreated. It is therefore vital that you seek advice from a trained medical
professional as early intervention is key to full return of function.
Orthotic Prescription
Orthotics also known as ‘foot orthoses’ are supports that are custom made to suit your
needs. They are designed to fit your feet with a view to helping rectify the balancing and
biomechanical inadequacies of your feet and legs. Orthotics are made from scans of your
feet and aim to correct biomechanics which will alleviate your symptoms. The basis of
biomechanical analysis is the determination of how forces generated within the body, or
how forces applied to the body, influence the way we move.

Symptoms
There are a range of issues that Orthotics can be used to treat.

Some more common pathologies that could flag the need for orthotics are:
 ∑ Shin Splints
∑ Plantar Fasciitis
∑ Achilles Tendonitis
∑ Severs Disease
∑ Pain In Muscles In Lower Leg
∑ Knee, Ankle or Hip Pain

Treatment
Our Physiotherapists will complete a full biomechanical assessment and Gait Scan to
accurately determine the cause of your symptoms. Depending on the results, corrective
insoles or customised orthotics may be prescribed, which we manufacture bespoke for
you using our Gait Scan technology.

Custom orthotic devices that fit into your shoe help correct the underlying structural
abnormalities causing your problem. We are Ireland’s largest provider of Customised
Orthotics and our team are specifically trained in orthotic prescription. For full details on
this service, click here.

Most foot orthosis will last 5 to 10 years and may need to be changed if outgrown or
weakened.
Osteoporosis
Osteoporosis is a silent condition, with little or no symptoms until a fracture occurs.
Although osteoporosis can affect the whole skeleton, the most common areas to break are
the wrist, spine and hip. A small percentage of people can have back or hip pain, prior to
a fracture. As the condition develops, it may cause dull pain in the bones or muscles,
particularly low back pain or neck pain. Subsequently, sharp pains may come on. The
pain may be made worse by activity that puts weight on the area and may be
accompanied by tenderness. Other symptoms include a loss of height (greater than 2cm)
or a development of a hump on the back or change in body shape.

Symptoms
Osteoporosis is a silent condition, with little or no symptoms until a fracture occurs.
Although osteoporosis can affect the whole skeleton, the most common areas to break are
the wrist, spine and hip. A small percentage of people can have back or hip pain, prior to
a fracture. As the condition develops, it may cause dull pain in the bones or muscles,
particularly low back pain or neck pain. Subsequently, sharp pains may come on. The
pain may be made worse by activity that puts weight on the area and may be
accompanied by tenderness.

Other symptoms include a loss of height (greater than 2cm) or a development of a hump
on the back or change in body shape.

Treatment
The number of osteoporosis sufferers is on the rise, with more women than men affected
because their bones are smaller and because menopause lowers oestrogen levels, which is
essential for healthy bones.

Women in Ireland, especially those over 60 years of age, are at a greater risk of getting a
fracture because of osteoporosis than having breast cancer and cardiovascular disease put
together.

Other factors that may contribute to bone loss include inadequate intake of calcium and
vitamin D in older men and women, lack of weight-bearing exercise, and other age-
related hormonal changes. Physiotherapy is proven to help prevent and manage this
problematic condition.

Paediatric Learning Disabilities

Our Paediatric physiotherapists have training and experience which
make them specialists in children’s conditions and their management. They deliver
assessment, treatment, advice and education to parents and other carers, thereby enabling
them better to understand the needs of the child and participate in therapy.

Paediatric Physical Disabilities

Approximately 6% of all children in Ireland live with a disability, 62% of which are
boys. There are various conditions related to children that result in physical impairments.
Cerebral palsy, Spina Bifida, developmental delay, and Torticollis are among some of the
conditions where Physiotherapy plays a key role in their successful management. Our
Paediatric Physical Disability programme offers assessment, treatment, advice and
education to parents and other carers on how best to help children with Physical
Disabilities. Paediatric Physiotherapy promotes a child’s independence.

Symptoms
Torticollis (Wry Neck)

- This is where a child’s neck is twisted so that their head is tilted one way and they strain
to look in the opposite direction.

Spina Bifida

- Children with Spina Bifida usually have lower muscle strength because the nerves that
supply the muscles in their body are damaged.

Cerebral Palsy

Cerebral Palsy is a motor condition that causes difficulty in controlling movement,

posture and balance.

Developmental Delay

This is where a child does not reach their developmental milestones at expected times.
Delay can occur in one or many areas such as: gross or fine motor movement, language,
social, or thinking skills.

Treatment
For Torticollis our Chartered Physiotherapists can show parents or careers correct
positioning and teach them exercises and activities for children to perform daily that will
help them to gain movement they are lacking and minimise the effects of the condition.

For Spina Bifida and Cerebral Palsy our highly skilled Physiotherapists can help to
improve your child’s muscle function and strength as well as helping to develop normal
movement patterns to improve mobility.
Cranio Sacral Therapy may also be used to relieve tightness in your child’s muscles. For
all of the disabilities mentioned in the symptoms section, a home exercise program will
normally be provided to ensure ongoing intervention by the parents at home and to
optimise the child’s overall development.

Patellar Tendinopathy (Jumper’s Knee)

Jumper’s Knee is the common term for Patella Tendinopathy. Typically knee pain comes
on gradually if running, jumping and landing activities are practised too much, because
the strain on the Patella Tendon becomes too great and microscopic damage develops in
the tissue that makes up the tendon. Early recognition by a doctor or Chartered
Physiotherapist is important as the outcome is better if treatment is initiated early.

Symptoms
The greatest amount of stress is put through the Patella Tendon during jumping and, just
as importantly, during landing. Apart from sporting overuse, this condition is also
associated with ageing. As we get older, our ability to regenerate damaged tissue
decreases and the quality of the tendon deteriorates. Jumper’s knee usually comes on
gradually. There is pain in the tendon which is worsened by activity. It will feel tender to
touch just below the knee cap. Pain and tightness is often experienced when bending,
squatting, or straightening the leg and stiffness first thing in the morning is common.

Factors that increase your chance of developing this:

∑ Being physically active

∑ Increase in training
∑ Changing sport
∑ Hard training surface
∑ Muscle weakness

Treatment
As the tendon is healing, our highly skilled Physiotherapists may gently mobilise the soft
tissue by providing gentle stress, to help the tendon to adapt and gain tensile strength.
Recovery is optimised by using a programme that uses what is called ‘eccentric muscle
work’. Eccentric muscle work refers to a muscle that is lengthening while contracting – a
contraction that occurs during movements such as landing and decelerating.

Maximal tension is generated in the muscle during the eccentric contraction and this
causes the tendon to adapt and get stronger. Our highly trained Sport Physiotherapists can
guide you through this rehabilitation process, tailoring your treatment to both your needs
and your sport.

Pins and Needles

Pins and Needles’ (paraesthesia) is a sensation of uncomfortable tingling or prickling,
usually felt in the hands or feet but can affect any part of the body. The affected area is
sometimes said to have ‘fallen asleep’. A common cause is leaning or lying awkwardly
on a limb, which either presses against the nerves or reduces the blood supply to the local
area. Changing position quickly restores normal feeling. Any numbness is soon replaced
by the tingling and prickling sensation, as the nerves start sending messages again to the
brain and spinal cord. In some cases, pins and needles are caused by nerve damage or
certain disorders of the central nervous system.

Symptoms
Pins and needles is an abnormal sensation that may occur anywhere in the body. It is
often felt in fingers, hands, feet, arms and legs. There are several different causes for
experiencing such an abnormal sensation. Injury to a nerve in your neck may cause Pins
and Needles anywhere along your arm or hand, whereas, an injury in the lower back
region can cause them in your legs.

Treatment
The occasional bout of pins and needles is a harmless event. However, chronic pins and
needles can be symptomatic of some other underlying disorder.

Treatment depends on the cause of your Pins and Needles. Our team of highly skilled
Physiotherapists will examine you, carrying out a detailed assessment to determine the
cause of your symptoms. Diagnosis of a nerve injury is made by taking a detailed history
and carrying out a comprehensive objective examination.

A nerve pinched by bone or some other tissue will need Physiotherapy treatment to allow
full nerve functioning to resume. Nerve compressions can be extremely problematic if
left untreated. It is therefore vital that you seek advice from a trained medical
professional as early intervention is key to full return of function.

Plantar Fasciitis
The Plantar Fascia is a very thick band of tissue that connects the heel bone to the toes.
This band of tissue under tension helps maintain the integrity of the main arch of the foot.
Plantar Fasciitis is a common foot condition that causes heel pain and pain in the sole of
the foot – it is often sore first thing in the morning or on standing after periods of
inactivity. Often this pain can be very severe but the good news is that it is treatable by
our Physios who have had specific training in the treatment of this condition.

Symptoms
The symptoms of plantar fasciitis are:

∑ Foot pain over the inside/bottom of the heel

∑ Pain often radiates down the inside of the sole of the foot
∑ Pain that is usually worse in the mornings
∑ Pain that increases over a period of months

People with Plantar Fasciitis often describe the pain as worse when they get up in the
morning or after they've been sitting for long periods of time. After a few minutes of
walking the pain decreases, because walking stretches the fascia. For some people the
pain subsides but returns after spending long periods of time on their feet. If pain is
present on touching the affected area, and/or on stretching the Plantar Fascia, then it is
likely that you have Plantar Fasciitis.

Treatment
The treatment of Plantar Fasciitis depends on both the cause and the symptoms being
experienced by our patients. To arrive at an accurate diagnosis, our foot and ankle
Chartered Physiotherapists will obtain your medical history and examine your foot.
Throughout this process the physio will rule out all the possible causes for your heel pain
other than plantar fasciitis. The following treatment may be used:

Orthotics / Insoles - Where there are biomechanical cause to Plantar Fasciitis, our Physios
will complete a full biomechanical assessment and Gait Scan to accurately determine the
aetiology. Depending on the results, we may prescribe either off the shelf
corrective insoles or customised orthotics, which we manufacture bespoke for you using
our Gait Scan technology. Custom orthotic devices that fit into your shoe help correct the
underlying structural abnormalities causing the plantar fasciitis. We are Ireland’s largest
provider of Customised Orthotics and our team are specifically trained in treatment of
Plantar Fasciitis. For full details on this service, click here.

Post-Operative Rehabilitation
Our expert physiotherapists can help you or your loved one get back to 100% after an
operation.

Treatment
It is highly recommended that you attend Physiotherapy for rehabilitation following
keyhole surgery or arthoscopy on knees and shoulders or after a knee or hip replacement
operation or after operations to insert metals plates or pins into various joints. Using a
range of exercises, our Physios will help you to regain muscle strength and movement so
that you can function as normally as soon as possible.

They will also teach you how to use crutches or supports, and will ensure that you can
carry out basic movements such as standing up, sitting down and going up and down
stairs. You should continue to see the Physiotherapist until you have optimum function
from the new joint. Our Physios work with many Orthopaedic Surgeons in Dublin and
are happy to refer patients where we feel surgery is appropriate.
 Symptoms
Pelvic Pain and pubic symphisis discomfort directly relate to the process of the baby
passing through the bony pelvis. Relaxation of the ligaments to allow the baby to pass
through leads to decreased stability of the joint. Then comes the stretching of joint as the
baby passes through. This can lead to pain around the joints of the pelvis following the
birth process.

Low Back Pain can be traced back to two major causes. One is the aforementioned
‘loose’ ligaments effect causing instability in the region. The other is the obvious increase
in weight in the abdominal region. In particular the increased weight dragging forwards
combined with the lack of ligament support due to release of Relaxin causes low back
pain, often with symptoms referring into the bottom or legs.

Treatment
Our Physios can ascertain which structures are involved and use a combination of
treatment and rehabilitation to alleviate your symptoms.

There are a number of different techniques that our specialist will use to treat you but in
most cases there will be a factor of personalisation for the symptoms that you are
suffering from.

Posterior Heel Pain

When a Physiotherapist talks about posterior heel pain, he or she is referring to pain
behind the heel, not below it. Posterior Heel pain is not actually a condition but rather a
symptom of a condition. There are three main possible causes of such pain: Achilles
Tendinopathy, Retrocalcaneal Bursitis and Haglund’s Deformity, all of which may
coexist together as a triad of conditions. If you have pain underneath the heel, on the
bottom of the foot please go to our Heel Pain section which explains the likely causes and
treatment options.
 Symptoms
∑ Achilles tendinopathy is a condition of degeneration of the large tendon in the
back of the ankle.
∑ Bursitis, there are several bursa behind the heel bone that protect this area of
contact. Often these bursa can become irritated. For full details on this condition,
click here
∑ Haglund’s Deformity (“Pump Bump”): a bony enlargement of the upper/back
portion of the heel. This enlarged bone rubs on the Achilles Tendon, just above its
attachment to the heel causing inflammation and pain. For full details on this
condition, click here

Treatment
Diagnosis of the cause of posterior heel pain can be difficult as it is not uncommon for
these diagnoses to coexist. For example, a patient with a bony spur of the calcaneus may
have bursitis in that area as well. Because of this, all of these diagnoses must be
considered for effective treatment of posterior heel pain.

Our onsite Physiotherapists Podiatrist can assess your condition through gait analysis.
Posterior Heel pain is not actually a condition but rather a symptom of one of the
aforementioned conditions so for further information please go to those sections.

Often the cause of posterior heel pain is a biomechanical problem of the foot or
exacerbated by mechanical faults at the knee, hip and back.

Pulled Calf
A Calf Muscle Injury is common in sports and is sometimes known as a ‘pulled calf’.
The term ‘pulled muscle’ comes from the description of how the injury takes place.
Usually the calf muscle is forcibly stretched beyond its limits and the muscle tissue
becomes torn. A tear in the calf muscle is referred to as a calf strain and may involve one
or two of the muscles that make up the calf. Calf strains usually occur at the junction
between the muscle and tendon and it is classified depending on its severity (Grade 1 –
Grade 3).
 Symptoms
Grade 1:

Signs of injury may not be present until after the activity is over. There may be a
sensation of cramp or tightness and a slight feeling of pain when the muscles are
stretched or contracted. Mild discomfort and minimal disability.

Grade 2:

Immediate pain which is more severe than the pain of a grade one injury. It is confirmed
by pain on stretch and contraction of the muscle. A grade two strain is usually sore to
touch. Moderate discomfort with walking and limits activities such as running and
jumping.

Grade 3:

This is a very serious injury as the muscle is completely torn and there may be a large
lump of muscle above a depression where the tear is. Minimal pain but an inability to
walk will be present.

Treatment
The immediate treatment of a calf strain consists of the POLICE protocol – Protection,
Optimal loading, Ice, Compression and Elevation.

Once ready, gentle resistance exercises and stretching are important as they help to align
the scar tissue which forms during the healing process. This will enhance the strength of
the healing calf.

At first, gentle resistance is provided by our Chartered Physiotherapists, but as the muscle
gets stronger resistance bands can provide more of a challenge. The sets and repetitions
are gradually increased and Core strengthening will be introduced. Our highly skilled
Physiotherapists will devise a rehabilitation plan specific to your needs.
Pulled Hamstring
Hamstring Injury is common in sports and is sometimes known as a ‘pulled Hamstring’.
The term ‘pulled muscle’ comes from the description of how the injury takes place.
Usually, the Hamstring muscle is forcibly stretched beyond its limits and the muscle
tissue becomes torn. Hamstring strains are one of the most common sports injuries. They
commonly occur in sports that involve high speed sprinting and kicking. Hamstring
injury is likely to occur during the late swing and late stance phase of running. This
injury can cause significant loss of training and competition time.

Symptoms
With a Grade one Hamstring strain, the signs may not be present until after the activity is
over. There may be a sensation of Hamstring cramp/ tightness and a slight feeling of pain
when the muscles are stretched or contracted.

With a Grade two Hamstring strain there is immediate pain which is more severe than the
pain of a grade one injury. It is confirmed by pain on stretch and contraction of the
muscle. A grade two Hamstring strain is usually sore to touch.

A Grade three Hamstring strain is a very serious injury. There is an immediate burning/
stabbing pain and the athlete is unable to walk without pain. The muscle is completely
torn and there may be a large lump of muscle tissue above a depression where the tear is.
Bruising will appear below the injury site.

Treatment
The immediate treatment of a hamstring strain consists of the POLICE protocol –
Protection, Optimal loading, Ice, Compression and Elevation.

Once ready, gentle resistance exercises and stretching are important as they help to align
the scar tissue which forms during the healing process. This will enhance the strength of
the healing hamstring.
Our skilled Physiotherapists will devise a sports specific rehabilitation programme
tailored to your needs. We can guide you through the process of returning to play
successfully and reduce the risk of occurrence.

Reflex Sympathetic Dystrophy (RSD)

Reflex Sympathetic Dystrophy syndrome (RSD) is a complex multi-symptom pain
syndrome affecting a limb or limbs that can affect any one of any age. It usually occurs
following tissue damage to the limb, but it can also be triggered by visceral diseases,
central nervous system lesions or from unknown causes.

Symptoms
RSD can strike at any age, but is more common between the ages of 40 and 60. It affects
both men and women, but is most frequently seen in women. Although it is more
common in the older age groups, the number of RSD cases among adolescents and young
adults is increasing.

It often affects the hand or foot, but may also involve the knee, hip, shoulder, or other
sites. The main symptom of RSD is severe pain, often burning in nature.

The disorder may eventually result in dystrophy (weakness or wasting) of the area. Early
diagnosis and proper treatment are very important if RSD is to be successfully managed.

Treatment
There is no single test for diagnosing RSD. Diagnosis is a clinical one and is made
through observation of the patient’s signs and symptoms. When diagnosed and treated
within the first 3 to 6 months, there is the highest possibility of cure and treatment of
RSD is most effective.

The most important element of treating RSD syndrome is restoring normal movement to
the affected part. This condition is easiest to treat in its early phases. Much of the
treatment is based on a courageous effort of the patient to get the hand or foot moving
again, even if it is uncomfortable. A formal Physiotherapy exercise and
movement programme and other treatments may help maintain flexibility and strength.
A TENS (Transcutaneous Electrical Nerve Stimulator) unit (see Electrotherapy) or
biofeedback may be tried. A TENS unit is a small, battery-operated device which relieves
pain by blocking nerve impulses. Biofeedback is a technique which can help control pain,
blood flow, and skin temperature.

Repetitive Strain Injuries

Repetitive Strain injuries is caused by repetitive movement leading to muscular pains or
problems with nerves, ligaments and joints to the upper and lower limbs. Usually work-
related, the incidence of RSI has risen dramatically with the use of word processors and
other automated equipment, which need only a limited range of movement.

Symptoms
RSI is an umbrella term that includes many different types of overuse/ over load injury and depending on the
activities you perform can affect tendon, muscle and nerve structures in any region of the body.
The most commonly recognised repetitive strain injuries are at the elbow, wrist and hand and include tennis
elbow, golfer’s elbow, carpal tunnel syndrome and iphone hand.

Treatment
Many groups of working people can be affected, including computer operators, typists,
musicians, shop staff and factory workers. Our Physios are trained and experienced in
treating muscle, nerve, joint and ligament complaints. After assessing the affected
person’s posture, workplace, lifestyle and work patterns, they will devise a treatment
programme.

This may include stretching exercises, mobilisation and electrotherapy, such as ultrasound, to
speed up the healing process. If treatment is delayed, RSI can take longer to clear up. Our
Physios can also give preventive advice.

RSI can also occur frequently in sports; some examples include Achilles Tendonitis
or Tennis Elbow. Please click here for other soft tissue injuries.
Respiratory Conditions in Children
We provide physiotherapy programmes for those who suffer from respiratory conditions.

Treatment
Many groups of working people can be affected, including computer operators, typists,
musicians, shop staff and factory workers. Our Physios are trained and experienced in
treating muscle, nerve, joint and ligament complaints. After assessing the affected
person’s posture, workplace, lifestyle and work patterns, they will devise a treatment
programme.

This may include stretching exercises, mobilisation and electrotherapy, such as ultrasound, to
speed up the healing process. If treatment is delayed, RSI can take longer to clear up. Our
Physios can also give preventive advice.

RSI can also occur frequently in sports; some examples include Achilles Tendonitis
or Tennis Elbow. Please click here for other soft tissue injuries.

Our Expertise
Our physiotherapists are highly trained and qualified to provide expert care to our
patients. They are fully insured and are chartered by the Irish Society of Chartered
Physiotherapists (ISCP).

We have team of Clinical leads who visits our physios and clinics to ensure a level of
customer service and quality care that exceeds our competition is given to patients every
time.

Rotator Cuff Injuries

The shoulder joint is an extremely flexible joint which allows us to move the arm in all
directions. This wide range of joint movement however means the shoulder is very
susceptible to injury.
 Symptoms
The primary symptom is a sudden onset of pain in the shoulder, especially when
movement is involved. If you for example have trouble lifting your arm, then your rotator
cuff may be injured. You may have difficulty doing sports like swimming and
basketball.

Treatment
Our Physios are trained to accurately assess the shoulder and to treat your pain effectively
with both hands-on techniques and a carefully designed home strengthening and
stretching programme. Ultrasound, electrical stimulation, laser and heat may also be used
to enhance healing and provide some pain relief.

Shoulder problems are best treated early to prevent them becoming chronic, however
longstanding problems can also be treated effectively by accurate diagnosis and
treatment.

Runners Knee
Runners Knee is a painful overuse knee injury that affects the outer part of the knee. It is
fairly common in runners and cyclists. It is reported to affect 2-10% of all runners, while
around a quarter of all knee injuries in cyclists are diagnosed as Runners Knee.

Symptoms
Typically there is pain located on the outer side of the knee joint. This pain may radiate
up the thigh or down the outer side of the shin and is exacerbated by running or cycling
activities.
Usually, the pain from Runner’s Knee is only present during activity and settles when the
person rests.

However, in some cases it can also be extremely uncomfortable going up or down stairs.

Treatment
Virtually all cases of Runner’s Knee respond well to Physiotherapy treatment. The aims
of treatment are to resolve the localised inflammatory response and identify and address
any underlying postural and body alignment issues that may be contributing to the
problem.Leg length differences, a knock kneed posture or a foot position where the arch
of the foot lowers during running can all contribute to Runner’s Knee.

Our Physios will check for these things during the physical assessment and will give
specific advice to correct these problems before the person returns to activity, in order to
prevent a recurrence of Runner’s Knee. In mild cases of Runners Knee a knee strap can
relieve symptoms very effectively during running. We have these available for purchase
in the retail section of our clinic. It is important that the appropriate support is used and
we can advise you on this.

Ruptured Disc
Ruptured discs are most often the result of a gradual, aging-related wear and tear called
degeneration of the disc. As you age, your spinal discs lose some of their water content,
making them less flexible and more prone to rupturing. Many causes of ruptured disc
stems from people using their back muscles instead of leg and thigh muscles to lift heavy
objects. Twisting and turning while lifted can also be the cause for a ruptured disc.

Although less frequent, a fall or blow to the back can also cause a herniated disc. A
herniated disc is another cause of back pain, sometimes called a slipped disc or a ruptured
disc.

As the spinal disc becomes less elastic, it can rupture. When the disc ruptures, a portion
of the spinal disc pushes outside its normal boundary, known as a herniated disc. This can
irritate the nerve and result in pain, numbness or weakness in your back, leg or arm.
 Symptoms
You can have a herniated disc without knowing it, as herniated discs sometimes show up
on spinal images of people who have no symptoms of a disc problem, however, some
herniated discs can be painful. The most common signs and symptoms of a herniated disc
are pain, numbness and weakness in your lower back and leg, or in your neck, shoulder
and arm. Some people often experience sciatica, a pain that starts in the buttock and
extends down the back or side of one leg. Low back pain or leg pain that worsens when
you sit.

Treatment
A herniated disc generally gets better with conservative treatment. Surgery for a
herniated disc usually isn’t necessary. Treatment of a herniated disc depends on a number
of factors such as age of the patient, activity levels of the patient and symptoms
experienced. Our Chartered Physiotherapists can provide personalised lumbar
stabilisation exercises, which will not directly affect the disc, but they can stabilise the
lumbar spine muscles.

This has an effect of decreasing the load experienced by the disc and vertebrae. Stronger,
well balanced muscles help control the lumbar spine and minimize the risk or injury to
the nerves and the disc. Our Physios not only advise you on how to exercise safely but
also on what types of exercise are suitable for your age and condition.

Sacroiliac Joint Problems

Sacroiliac joint problems (SIJ) are one of the most common generators of pain in the
lower back region. The joint does not have much motion and transmits forces from the
upper body to the pelvis, hips and legs. It is also commonly affected by inflammatory
conditions such as gout, rheumatoid arthritis, psoriasis and anklylosing spondylitis.

Symptoms
∑ Stiffness in the hips, pelvis and back
 ∑ Radiating burning pain into the leg.
∑ Tends to be on one side
∑ Pain greater during walking and standing v’s sitting
∑ Pain rolling over at night
∑ Sleeping on side can often be painful

Treatment
Treatment can involve postural education (see Postural Assessment &
Dysfunction), acupuncture, exercise and movement instruction, joint manipulation and
mobilisation, massage and a variety of other techniques and modalities.

Exercise may also be used to increase general fitness or to strengthen muscles which
support the spine and SIJ. If you are prone to back pain, our Physiotherapists can also
offer preventive advice to assist in reducing recurrence and empowering you through
self-management of your condition.

Our highly skilled Physiotherapists are trained to diagnose problems in the surrounding
joints and soft tissues of the SIJ and will work to correct these underlying faults as well
as the specific pathology of the SIJ.

Scar Tissue
Soft tissue injuries are injuries related to the Scar Tissues of the body (muscle, tendon,
ligament and nerve). Scar tissue forms to replace normal tissue that has been damaged
due to injury. Skin scars are easier understood due to their visibility. Soft tissue scaring
and its specific diagnosis can be made by our team of highly skilled Physiotherapists.
They will determine what structure is involved and how advanced or severe the sprain,
strain or tear is which will help guide your treatment and hopefully speed up recovery.

Types Of Skin Scars

∑ Atrophic Scars - sunken down into skin. Often seen with acne scars or with wounds
where skin or muscle has been removed.
∑ Hypertrophic Scars - Usually red, purple and slightly raised above the skin. They
generally fade and flatten over time.
 ∑ Contracture Scars - Often happen due to burns and pull the skin in towards the injury
site.
∑ Keloid Scars - Elevated, red or dark scars that form when the body produces too
much collagen in the scar.
∑ Stretch Scars

Soft Tissue Scarring

‘Scar tissue’ is commonly described as the formation of weak tissue at the site of injury.
Scar tissue forms two different ways.

1. If a muscle, tendon or ligament is torn or damaged, the body creates scar tissue to bind
the torn pieces together.

2. The most common way for scar tissue to form is by soft tissue not receiving enough
oxygen (hypoxia). Poor posture, repetitive actions, sustained pressure (sitting) all result in
increased muscle tension. Increased muscle tension can result in reduced blood supply
which means less oxygen. Hypoxia leads to the formation of scar tissue which can affect
muscle length, strength and pain.

Sciatica
Sciatica is a specific pain that originates from the sciatic nerves which each run from one
side of the pelvis through the hip and buttocks and down the leg. The Sciatic nerve forms
what is effectively an electrical cable to and from the brain. Sciatica is a condition where
pain, weakness or altered sensation can be experienced in the buttock, hamstring, calf or
foot but it stems from the spine, via the Sciatic nerve. The most common cause of
Sciatica is compression of the nerve due to a herniated disc.

Symptoms
Common symptoms:

∑ Pain along the back of the leg

∑ Burning or tingling along the leg
 ∑ Weakness or numbness
∑ Constant pain on one side of the buttocks
∑ Shooting pain aggravated by standing and prolonged sitting

Sciatica may be triggered by very small, normal movements like bending over to one side
to pick something up, as well from suffering a trauma like falling off a ladder and landing
on your back. It usually affects only one side of the pelvis and leg. Pain extending from
the lower back along the back of the leg is a common symptom of sciatica.

Treatment
Physiotherapy is very effective in the treatment of Sciatica. Treatment by our team of
highly skilled Physiotherapists can relieve nerve root compression caused by fibrous scar
tissue following a disc prolapse and can treat conditions related to compression of the
sciatic nerve by other structures also.

Our Physiotherapists also aim to prevent further episodes of sciatic pain through teaching
correct postural techniques, and exercises to correct any muscle imbalance in the spine.

In most cases Sciatica can be managed conservatively. Exercise prescription from a fully
qualified Physiotherapist has been shown to play a key role in the successful management
of this troublesome condition.

Scoliosis & Children

Scoliosis in a growing child is always abnormal and has the potential to cause
considerable disability and must be taken seriously. Scoliosis may not be the primary
defect nor always require treatment. Minor asymmetry is common in children and may
lead to unnecessary treatment and concern but a curve of more than 15º is of greater
concern because there is potential for progression with growth. Scoliosis is more
common among girls and children over the age of the. However, it can be seen at any
age.
 Symptoms
Scoliosis is a disorder which causes an abnormal curve in the spine. It may be defined
simply as any lateral tilt, curve, deviation or rotation of one or more vertebral segments
of the spine from the normal straight position. In most cases the cause is unknown. More
than 80% of people with scoliosis have idiopathic scoliosis. There are three main types:

∑ Functional – the spine is normal but a curve develops due to an abnormality

somewhere else in the body.
∑ Neuromuscular – caused by a problem when the bones of the spine are formed. This
type is often much more severe.
∑ Degenerative – This occurs in older adults and is caused by changes in the spine due
to arthritis.

Treatment
Early postural control with bracing, seating systems and night time positioning is
important to delay or prevent progression of the curve.

Our Chartered Physiotherapists may also advise personalised exercise programmes in

conjunction with bracing to increase postural awareness, and muscle tone as well as
encourage trunk mobility.

Bracing is commonly used for progressive curves and is normally prescribed in

consultation with an orthopaedic consultant.

If you have any concerns regarding your child’s posture or potential scoliosis, please
contact one of our highly skilled specialist Paediatric Physiotherapists today.

Shin Splints
This is a common term for shin pain that is often experienced during running. It can be a
misleading term and most sports medicine professionals try to avoid using it. This is
because shin pain and ‘Shin Splints’ can be due to several different conditions. Medial
Tibial Traction Periostitis (MTTP) is the medical term used to describe Shin Splints. It is
an inflammatory condition of the front part of the shin bone called the tibia.
 Symptoms
People suffering from MTTP will feel pain on the inner border of the shin (medial Tibial
border) during and following exercise. It is important to distinguish MTTP from other
causes of shin pain (‘Shin Splints’) such as Compartment Syndrome or a Tibial Stress
Fracture.

MTTP typically presents with pain (dull ache) and palpable tenderness along the inside of
the lower leg. At the beginning, you may experience pain early in running, which is
relieved with continued activity. As the condition progresses pain may be present
throughout the activity.

Treatment
The pain experience with MTTP is caused by excessive pressure on the lower leg
muscles. Running a lot on hard surfaces or increasing your training load too quickly is a
common issue.

For the immediate treatment of symptoms Cold therapy is a very effective form of pain
relief. Most patients respond well to non-operative treatment. This involves rest,
strengthening and stretching exercises, followed by a gradual return to running after
symptoms subside.

In order to help prevent recurrence of the condition, a bio-mechanical analysis (an

analysis of posture at rest and during walking and running) with our Physios should be
undertaken. This will pick up any factors that may be making a person susceptible to
MTTP, so that they can be corrected before a return to activity.

Shoulder Dislocation
A Dislocated Shoulder is a common shoulder injury in contact sports such as rugby and
martial arts. Shoulder dislocations are characterised by severe shoulder pain and hospital
treatment is required to restore normal shoulder anatomy. It is important that a shoulder
dislocation is seen quickly by a doctor who can put the joint back in place. Physiotherapy
is vital to correct any weakness and prevent the recurrence of this painful and problematic
injury.
 Symptoms
Due to the damage to the structures surrounding the shoulder, there is a high chance of
recurrent dislocation. Shoulder dislocation occurs more in young men and nearly 100%
of those age 14-20 will have a recurrent dislocation. However, with our Physiotherapists’
assistance we can work on strengthening the muscle and ligament groups around the
shoulder to minimise the risk of further dislocation.

Surgery on an unstable shoulder is usually required with recurrent dislocations, however,

our highly skilled Physiotherapists can advise you on this and if required make the
necessary referral to a suitable specialist.

Treatment
Once the shoulder has been put back in place it is immobilised using a sling. The sling is
kept on for about 2 to 3 weeks, during which time it is important that the elbow, wrist and
fingers are kept moving to prevent them stiffening up.

Active rehabilitation is started as soon as possible but overhead arm movement and
sporting activity should be avoided for at least 6 weeks. Gentle range of movement
exercises under the supervision of a Chartered Physiotherapist can be started once the
sling is removed.

Our Physiotherapists will devise an evidence based rehabilitation program tailored to

your specific needs. Due to the high risk of further dislocation, Physiotherapy is vital for
successful prevention.

Shoulder Pain
The shoulder joint is an extremely flexible joint which allows us to move the arm in all
directions. This wide range of joint movement however means the shoulder is very
susceptible to injury. Many shoulder problems are caused by the breakdown of soft tissue
through either repeated use or sudden over load.
 Symptoms
Shoulder pain may be felt in one small spot, in a larger area, or down the arm. There are
various causes of should pain and discomfort.

Dislocated Shoulder

- A Dislocated Shoulder is a common shoulder injury in contact sports. Shoulder

dislocations are characterised by severe shoulder pain and hospital treatment is required
to restore normal shoulder anatomy.

Arthritis

- This generally occurs due to wear and tear and affects both the bony and muscular
structures of the shoulder.

Rotator Cuff Tear

- The primary symptom of a Rotator Cuff injury is a sudden onset of pain in the shoulder,
especially when movement is involved eg. lifting your arm.

Treatment
Our highly skilled team of Physiotherapists are trained to accurately assess the shoulder
and to treat your pain effectively with both hands-on techniques and a carefully designed
home strengthening and stretching programme.

Acupuncture and heat may also be used to enhance healing and provide some pain relief.
Shoulder problems are best treated early to prevent them becoming chronic; however
longstanding problems can also be treated effectively by accurate diagnosis and
treatment.

Acute Shoulder injuries should be treated immediately by following the principles

of POLICE:

∑ Protect
∑ Optimally Load
∑ Ice
∑ Compression
∑ Elevate
Shoulder Dislocation
A Dislocated Shoulder is a common shoulder injury in contact sports such as rugby and
martial arts. Shoulder dislocations are characterised by severe shoulder pain and hospital
treatment is required to restore normal shoulder anatomy. It is important that a shoulder
dislocation is seen quickly by a doctor who can put the joint back in place. Physiotherapy
is vital to correct any weakness and prevent the recurrence of this painful and problematic
injury.

Symptoms
Due to the damage to the structures surrounding the shoulder, there is a high chance of
recurrent dislocation. Shoulder dislocation occurs more in young men and nearly 100%
of those age 14-20 will have a recurrent dislocation. However, with our Physiotherapists’
assistance we can work on strengthening the muscle and ligament groups around the
shoulder to minimise the risk of further dislocation.

Surgery on an unstable shoulder is usually required with recurrent dislocations, however,

our highly skilled Physiotherapists can advise you on this and if required make the
necessary referral to a suitable specialist.

Treatment
Once the shoulder has been put back in place it is immobilised using a sling. The sling is
kept on for about 2 to 3 weeks, during which time it is important that the elbow, wrist and
fingers are kept moving to prevent them stiffening up.

Active rehabilitation is started as soon as possible but overhead arm movement and
sporting activity should be avoided for at least 6 weeks. Gentle range of movement
exercises under the supervision of a Chartered Physiotherapist can be started once the
sling is removed.

Our Physiotherapists will devise an evidence based rehabilitation program tailored to

your specific needs. Due to the high risk of further dislocation, Physiotherapy is vital for
successful prevention.
Soft Tissue Injuries
Soft tissue injuries are injuries related to the soft tissues of the body (muscle, tendon,
ligament and nerve). The most common soft tissue injuries consist of sprains, strains,
contusions, tendinopathies, bursitis and stress injuries. Soft tissue injuries are common in
sport but can also happen due to repetitive use and falls. All soft tissue injuries need to be
treated appropriately. Our Chartered Physiotherapists can help assess and treat your soft
tissue injury.

Symptoms
Soft tissue injuries are commonly categorised depending on the time frame since
injury and the healing processes that are occurring at that time.

Acute (Protection Phase)

- Pain, bleeding and swelling is at its worst in this phase. Your body's aim at this point
is to protect your injury from further damage.

Sub-Acute (Repair Phase)

- A soft tissue injury is termed as sub-acute when the initial acute phase makes a
transition to repairing the injured tissues.

Late Stage (Remodelling Phase)

- At six weeks post-soft tissue injury your healing tissue is reasonably mature but as
you stretch, strength and stress your new scar tissue it often finds that it is not strong
enough to cope with your increasing physical demand.

Treatment
Treatment depends on the grade and severity of the injury. In the early stages try not to
put a lot of weight on the affected area before commencing treatment to minimise any
further damage. (i.e. minimal walking).
Cold therapy is often used to decrease swelling in the acute stage. Following this,
Electrotherapy may be employed to help repair damaged ligaments.

Joint stiffness is common post joint and soft tissue injuries. Our highly skilled
Physiotherapists will help you regain full range of movement through skilled hands on
techniques and will provide you with a research based personal exercises program to help
you self-manage your injury successfully. Our team of Physiotherapist will provide a
safe, quick and effective solution to your problem.

Spinal Pain
Sixty percent of adults suffer from back pain every year, and half become chronic
sufferers. Back pain can be caused by problems with discs, joints, muscles and ligaments.
Back pain is most often the result of acute trauma / injury, poor postural habits and the
accumulation of physical stress on the spine but there are other causes of back pain such
as inflammation, and rarer, more serious problems such as progressive diseases affecting
bones and joints.

Symptoms
A back problem, in turn can cause sciatica in which nerve pressure is experienced as
pain in the leg, ankle or foot. Pins and needles and numbness are also common.
Sciatica may be triggered by very small, normal movements like bending over to one
side at a bad angle to pick something up, as well from suffering a trauma. Sciatica can
also be caused by a stretch type injury as well as a gradual onset for no apparent
reason. It usually affects only one side of the pelvis and leg. Pain extending from the
lower back along the back of the leg is a common symptom of sciatica. Our Chartered
Physiotherapists are trained to diagnose problems in the joints and soft tissues of the
body and will carry out a comprehensive assessment and treatment plan for your
particular problem.

Treatment
Physiotherapy is very effective in the treatment of Sciatica and back related pain.
Treatment by our team of highly skilled Physiotherapists can relieve nerve root
compression caused by fibrous scar tissue following a disc prolapse and can treat
conditions related to compression of the sciatic nerve by other structures also.

Our Physiotherapists also aim to prevent further episodes of back and/or sciatic pain
through teaching correct postural techniques, and exercises to correct any muscle
imbalance in the spine.

Exercise prescription from a fully qualified Physiotherapist has been shown to play a key
role in the successful management of back related problems when prescribed from a fully
trained professional.

Spondylosis
Spondylosis is a type of Osteoarthritis of the spine. When the low back area is affected, it
is known as “lumbar spondylosis” and when affecting the neck area, it is known as
“cervical spondylosis”. It is thought to be mainly a problem of “wear and tear” and
ageing. When it occurs in the younger age groups, it is usually associated with injury or
previous damage to the joint. Certain occupations may also make a person more prone to
the condition.

Symptoms
Often people with clinical signs of spondylosis on x-ray do not suffer from symptoms.
27% - 37% of people with lumbar spine spondylosis do not experience symptoms. In
some cases, spondylosis can cause back pain and neck pain due to compression or
pinching of nerves in the area. Bulging intervertebral discs and bone spurs can cause
nerve compression due to narrowing of the holes in which the nerves exit (foraminal
stenosis). Symptom location depends on where your spine is affected by this condition.
Common symptoms are:

∑ Pain that comes and goes

∑ Morning stiffness
∑ Tenderness
∑ Weakness, numbness or tingling.
∑ Bowel or bladder problems (This is rare but if experienced you should go straight
to hospital).
 Treatment
Conservative treatment is successful 75% of the time. Many patients find their pain and
other symptoms can be effectively treated without surgery.

During the acute phase, anti-inflammatory agents, analgesics, and muscle relaxants may
be prescribed for a short period of time.

In Physiotherapy, heat therapy, manipulation and mobilisation and other modalities may
be incorporated into the treatment plan to control muscle spasm and pain. Strengthening
exercises for the lumbar and abdominal will be given as part of a long term management
plan.

Sports Injuries
Sports Injuries not properly treated can lead to ongoing problems which can affect your
sporting performance or future health! Sports injuries, whether they are recent or old
injuries continuing to cause problems, need professional assessment and management to
ensure no unnecessary complications arise. Our team of highly skilled Sports
Physiotherapists can help diagnose, treat and prevent injuries, helping you perform at
your very best.

Treatment
The most common sports injuries:

∑ Ankle sprain
∑ Groin Pull
∑ Hamstring Strain
∑ Shin Splints
∑ ACL tear
∑ Tennis Elbow (epicondylitis)

Injuries left to heal themselves can lead to long term residual problems due to, soft tissue
adhesions and tightness, joint stiffness, muscle imbalance and a deficiency in the return
of normal muscle strength.
Our Chartered Sports Physiotherapist are just as happy treating elite athletes as well as
once a month 5 aside football players!! Our experienced staff will accurately assess your
problem and provide you with the rehabilitation that you need in order to return to your
sport as soon as possible.

Early recovery and active rehabilitation are important goals in the treatment of sports
injuries; our clinic is equipped with the appropriate tools to help you achieve these goals.
Each treatment plan will not only be tailored to your needs but the specific sports you
play, helping you to return to your best and prevent future injuries.

Sports Podiatry
Sports Podiatry is the treatment of foot, ankle, leg and knee injuries by altering lower
limb function using a variety of methods, including insoles, footwear and exercises. Our
sports podiatrist will analyse the way an individuals’ foot strikes the ground and evaluate
its impact on the other joints. Through biomechanical assessment and testing they can
determine if your leg alignment and stability are sufficient for performing particular sport
and if there are any mechanical reasons contributing to your injury.

Symptoms
You should see a podiatrist if you have repeated lower limb injuries, as it may to be
caused by a mechanical problem or imbalance in the body.

A sports podiatrist is also important for either recreational or elite level athletes who want
to avoid injury & maximise their performance. A Sports Podiatrist will often work
closely with a sports physiotherapist as many leg and foot problems are secondary to
problems in the lower back & pelvis.

Sports podiatrists specialise in the diagnosis and management of foot and lower leg
disorders with a particular focus on injuries associated with foot and lower limb function.

Common sports podiatry injuries are Knee Pain, Shin splints & Achilles tendon.
 Treatment
Our highly skilled team of Sports podiatrists will provide walking and running
assessments to investigate posture and lower limb function which may include a
Biomechanical and computerised Gait Analysis.

They will assess the mechanical causes of your lower limb pain. Prescription orthotics or
corrective foot orthoses for lower limb alignment may be used as part of your treatment
plan. Your sports podiatrist may also prescribe appropriate stretching and strengthening
training programs.

They will give you advice and modify your running shoes, football boots and other
sporting footwear. A Sports Podiatrist can determine via biomechanical assessment and
specific testing whether your leg alignment and leg stability is normal and is sufficient for
performing in your particular sport.

Sprained Ankle
A sprained ankle is a soft tissue injury caused by the ankle twisting inwards (inversion)
or outwards (eversion). Inversion ankle sprains account for 85% of all sprains, as the
ligaments on the outside of the ankle are weaker and more prone to injury than those on
the inside. Recurrent sprains can lead to chronic pain or instability so it is vital that you
seek advice from a chartered physiotherapist.

Symptoms
Following a sprained ankle, individuals may feel pain when the injured area is touched or
when the foot is turned in or out. They may also experience swelling and find it difficult
to walk, with potential bruising. Symptoms will differ from mild to severe depending on
the grade. If the injury is really severe they may not be able to walk at all due to a
possible fracture/dislocation.

Most people will experience a decrease in pain and an improvement in function over a
two week period. However, once the initial symptoms of pain and swelling have reduced,
people often experience weakness, altered balance and stiffness. Research shows that
individuals who suffer an ankle sprain are more likely to reinjure the same ankle again
for up to two years.

Treatment
Treatment depends on the grade and severity of the injury. In the early stages try not to
put a lot of weight on the affected ankle before commencing treatment to minimise any
further damage. (i.e. minimal walking).

Use of the POLICE protocol is used in the early stages to limit swelling and bleeding –
Protection, Optimal loading, Ice, Compression and Elevation. As soon as the individual
can weight bear comfortably, our physiotherapists will begin more hands on therapies
along with a more dynamic neuromuscular rehabilitation program. This will target any
problems with weakness, altered postural control, balance problems and stiffness that our
physiotherapists identify through their ongoing detailed assessments.

Stiff Neck
A Stiff Neck is an extremely common symptom, which may be caused by a variety of
neck conditions. Most episodes of neck pain are related to soft tissue injuries, strains or
sprains. Neck stiffness can be a symptom of an underlying disorder of the cervical spine.
Disc herniation or cervical spondylosis can lead to a stiff neck and physiotherapy can
help relieve your symptoms.

Symptoms
The symptoms of neck pain and stiffness can be secondary to several problems, such as a
disc prolapse (slipped disc), a facet joint problem, or more seriously - an undiagnosed
cervical fracture (broken neck).

Muscle spasm in the neck, leading to a stiff neck, is usually a protective mechanism
which is secondary to an underlying neck problem. This is referred to as ‘Acute
Torticollis’ or ‘Wry Neck’.
In most cases of Wry Neck, the person wakes up with the painful stiff neck, although
occasionally the neck may become stuck following a sudden movement. The head will be
held to one side and the neck is too painful to move. The pain may radiate up the neck or
down to the shoulder area. There may be painful spasm in the neck muscles.

Treatment
Stiff neck can be effectively treated by one of our highly skilled Physiotherapists, who
will first determine the cause of the problem. Dependent on the cause of the problem,
likely treatment will include gentle massage and mobilisations (see Manipulation and
Mobilisation) along with the use of heat.

This involves the Physiotherapist applying heat to the neck then gently applying pressure
to each vertebra in the neck in order to loosen them and allow a greater range of
movement.

Another helpful treatment is the use of a heat therapy, to relax the muscles that had
previously been in spasm. Gentle stretching exercises (see exercise and movement) may
also be introduced to patient treatment to alleviate muscle spasm in the neck.
Strokes
A stroke occurs when the normal blood flow to the brain is suddenly interrupted or
blocked. This can be due to bleeding or haemorrhage from a blood vessel, or a clot in a
blood vessel. Stroke is the third leading cause of death worldwide. 80% of strokes are
classified as ischemic, meaning blood supply to a part of the brain is cut off due to a clot
or blockage resulting in death of the brain tissue.

Symptoms
The result of a Stroke is loss of function in the affected part of the brain. The person may
have difficulty controlling movement on one side of the body, affecting the head, arm,
leg and face. Speech, vision, swallowing, bowel and bladder can also be affected. The
person’s emotions, ability to concentrate and memory may also change.

It is vital that you recognise the signs of a stroke early and seek medical attend. New
treatments if administered in a certain space of time from the onset of symptoms can
result in little or no deficits but early intervention is the key.
Remember FAST

∑ Face drop
∑ Arm weakness
∑ Speech Difficulty
∑ Time to call 112 or 999

Treatment
Once a patient has been hospitalised and is medically stable, rehabilitation will
commence.

Physiotherapy plays an important role in stroke rehabilitation. After a detailed

assessment, our highly skilled Physiotherapists will plan rehabilitation programme taking
into account your lifestyle and home environment. Treatment may include guided
movements of limbs, and relearning how to sit, stand, walk and other everyday activities.
A falls screen may also be of benefit.

Advice will also be given to carers on how to help. Depression is common post stroke
and It may be suggested that you visit our psychologists at Spectrum Therapy.
Tendinopathy (Tendonitis)
Soft tissue injuries are injuries related to the soft tissues of the body (muscle, tendon,
ligament and nerve). Tendinopathy is a broad term used to describe painful conditions
occurring in and around tendons due to overuse. The heel and elbow are common sites
for tendon injuries Achilles tendinopathy and Tennis Elbow. Tendons connect muscle to
bone and most injuries occur near joints. Anyone can experience a tendon injury but
repetitive actions are more likely to damage a tendon.

Symptoms
A tendon injury may happen suddenly or over time. Tendinopathy usually results in pain,
stiffness and a reduction in strength. Symptoms include:

∑ Pain may get worse as you use the tendon

∑ Morning stiffness and pain
∑ The area may be tender, red or swollen
In the beginning of an evolving tendinopathy, pain may be present in the early stages of
activity and then disappear during the activity, only to reappear once the activity has been
cessed. Patients are able to localise the pain and often report a ‘sharp’ pain at the
beginning and a ‘dull ache’ after a few weeks of the tendinopathy being present.

Treatment
Our Chartered Physiotherapists will carry out a comprehensive assessment to determine
the presence of a tendinopathy and develop a treatment plan tailored to your needs.

Initial treatment of a tendinopathy usually involves rest, pain management, maintain

normal movement with gentle range of motion exercises and gradual return to normal
activities. Ice should be applied in the acute stages and avoid smoking as it delays tissue
healing.

Our highly skilled Physiotherapists can advise you on appropriate rest and help relieve
your pain which a variety of manual techniques.

Our Certified Acupuncturists may also use acupuncture or dry needling to treat such
musculoskeletal conditions. For more information please see here.
Tennis Elbow
Tennis Elbow (Lateral Extensor Tendinopathy) is a common cause of elbow pain. It is
characterised by pain over the outer side of the elbow, which may radiate down the
forearm. Tennis Elbow is equally common in men and women, peaking in prevalence
between the ages of 30 and 50. Despite the name, Tennis Elbow does not just affect
tennis players and is most often associated with work-related activities such as painting,
meat cutting and weaving.

Symptoms
Tennis Elbow is the result of chronic overloading of the extensor tendons of the forearm
as they attach to the humerus (upper arm) bone, just above the elbow joint. Typically this
results in a slow accumulation of degenerative tissue. It is caused by prolonged gripping
activities such as hammering, driving screws, weight lifting, playing certain musical
instruments, canoeing, digging in the garden, driving and, of course, racquet sports.
Tennis elbow pain is made worse by gripping activities and, in some cases, simple things
like turning a door handle can cause intense pain.

Commonly people can have associated cervical (neck) and shoulder dysfunctions

Treatment
Once the diagnosis has been confirmed as tennis elbow your physiotherapist will look to
carry out treatments to restore the normal joint motion of the elbow, release any muscle
tightness with massage or dry needling. They will then give you a strengthening
programme to help restore the normal tendon make-up.

Sometimes tennis elbow is slow to respond to treatment and referral onto a sports
specialist is required for injections.

Your physiotherapist will also give you advise on ways to modify daily activities that
may be contributing to the overloading of the tendon
Tension Headaches
A Tension Headache is caused by a tightening of the muscles in the upper back, neck and
head, and is the most common of all the various headache types. Many people cite stress
as an important headache trigger. Feelings of stress or anxiety instruct the nervous system
to initiate the ‘fight or flight’ response, which is characterised by shallow breathing,
increased blood pressure and heart rate, and increased muscle tension. Physiotherapy can
help manage and reduce the intensity and frequency of headaches.

Symptoms
It is estimated that 50% of people experience tension type headaches. They are more
common in women than men and are often seen in teenagers. Symptoms include a
constant ache that affects both sides of the head, stiffness in the muscles surrounding the
neck and/ or shoulders and often people report a pressure behind the eyes. The exact
cause of tension type headaches isn’t clear but certain triggers have been identified.

∑ Stress
∑ Anxiety
∑ Poor posture
∑ Dehydration
 ∑ Lack of sleep
∑ Noise
∑ Bright sunlight

Treatment
Physiotherapists can successfully treat headaches using specialised techniques to
decrease stiffness and inflammation in the spinal joints of your neck. These techniques
include heat, joint mobilisation (a safe and gentle form of manipulation), soft tissue
massage, stretching and strengthening exercises to improve muscular imbalance, and
postural assessment and dysfunction correction.

Acupuncture may also help to relieve your symptoms. Our specialist Acupuncturists can
advise and treat this problematic condition.

For a host of related topics and stories see our blog postings.

Thigh Strain
A Thigh muscle strain is quite common in sports like football, where kicking is
repeatedly practiced. A Thigh muscle strain refers to a tear in the Quadriceps muscle
group. Usually, the muscle is forcibly stretched beyond its limits and the muscle tissue
becomes torn. A tear in a Thigh muscle is referred to as a Thigh strain and depending on
its severity it is classified as a first, second or third degree strain.

Symptoms
With a Grade one Thigh strain, the signs may not be present until after the activity is
over. There may be a sensation of thigh cramp/ tightness and a slight feeling of pain
when the muscles are stretched or contracted.

With a Grade two Thigh strain there is immediate pain which is more severe than a grade
one injury. It is confirmed by pain on stretch and muscle contraction. A grade two thigh
strain is usually sore to touch.
A Grade three Thigh strain is a very serious injury. There is an immediate burning/
stabbing pain and the athlete is unable to walk without pain. The muscle is completely
torn and there may be a large lump of muscle tissue above a depression. Bruising will
appear below the injury site.

Treatment
The immediate treatment of a Quadriceps muscle injury consists of the POLICE protocol
– protect, Optimal Load, Rest, Ice, Compression and Elevation. It is important that this is
done correctly and your Physiotherapist can advise you on this. This is aimed at reducing
the bleeding and damage within the quadriceps muscle tissue.

After the early stages have been spent resting, more active rehabilitation can be started.
Realistically, for best results this should be started as early as possible.

Gentle resistance exercises and stretching are important as they help to align the scar tis-
sue that forms during healing. Our skilled Physiotherapists will devise a sports specific
rehabilitation programme tailored to your needs. We can guide you through the process
of returning to play successfully and reduce the risk of occurrence.

Our Expertise
Our Sports Physiotherapists have extensive clinical experience diagnosing and treating
thigh injuries. Following detailed clinical assessment, they will devise a rehabilitation
program tailored to your needs. They will be able to assess and advise your
Biomechanics, sporting technique and muscle coordination.

Initially, our chartered physiotherapists will carry out a thorough assessment to determine
the grade of your strain, helping them to select the most appropriate treatment to help you
recover.

They will use a variety of evidence based therapies and treatments to help reduce your
pain, improve your swelling and get you back on your feet as quickly as possible.

Thumb Sprain
A Sprained Thumb is often referred to as Skier’s Thumb, due to the prevalence of this
injury during skiing. It is a common cause of thumb pain. Skier’s Thumb refers to
damage to the Ulnar Collateral Ligament at the base of the thumb. It is important to note
that this injury is not exclusive to skiers and can occur to anyone where there is sufficient
force applied to the thumb that takes it in a direction furthest away from the hand.

Symptoms
In severe Sprained Thumb injuries there is often immediate thumb swelling and bruising
may develop in a few days. In more chronic cases of Sprained Thumb that have not been
diagnosed early, then there may be a persistent thickening of the joint with chronic thumb
swelling. The joint between the metacarpal (long bone) and thumb bone will feel lax and
unstable.

The ability to pinch grip small objects between the thumb and the index finger is often
severely impaired because of the resultant instability in the MCP joint. The Ulnar
Collateral ligament of the thumb may be partially or completely torn. One of our
physiotherapists will apply various tests and movements to help determine the extent of
your thumb sprain and the stability of the joint.

Treatment
Diagnosis is made by physical examination by our Physios. During the immediate period
following damage to the Ulnar Collateral Ligament of the thumb, cold therapy applied by
Physiotherapists is the best treatments. With a Physio rehab programme, sprains tend to
resolve in around four to six weeks.

For complete ruptures of the ligament early referral onto an Orthopaedic Surgeon is
required.

Friction and mobilisation work can be commenced early in the rehabilitation. Mobility of
the Thumb, strength and dexterity can be improved by using hand therapy balls and
therapeutic putty. Your Physiotherapist will advise you on the most appropriate rehab
tools and when it is safe to return to full hand function.
Whiplash
Whiplash is an injury to the neck that usually occurs in a motor vehicle accident. It
affects the soft tissue (neck muscles) but can also involve the spinal joints and ligaments,
nerve roots, the jaw joints, and the upper, mid and low back. It is an injury resulting from
a sudden extension and flexion of the neck. Average recovery time for a whiplash injury
is a few weeks but may be longer depending on the speed and the position of the head
during injury.

Symptoms
The common symptoms of Whiplash include:

∑ Neck pain and stiffness

∑ Neck swelling
∑ Tenderness
∑ Reduced movement
∑ Headaches

The symptoms of Whiplash often take a while to develop and may not appear
immediately. It may take as long as 72 hours for symptoms to appear.

Other associated symptoms:

∑ Dizziness
∑ Anxiety
∑ Low back pain
∑ Muscle spasms
∑ Numbness or pins and needles
∑ Fatigue

Treatment
Our Physiotherapy treatment will emphasize early return to usual activity and promotion
of body movement. The most important principle is to prevent the condition from
becoming chronic. Our highly skilled Physiotherapists offer a Specialized Treatment
Program for whiplash.

This includes a variety of Physiotherapy treatments, acupuncture, massage therapy,

exercise instruction and education.

Considerable pain may be experienced when moving your neck, but keeping your neck
mobile from an early stage will help to improve its functionality and speed up your
recovery.
Resting your neck and keeping it still is likely to prolong your symptoms and delay your
recovery. Any pain that you experience when moving your neck is normal and will not
cause further damage
Workplace Assessments
Work Injuries can often cause severe and debilitating symptoms such as pain, numbness
and tingling. These often lead to reduced worker productivity, lost time from work, and
temporary or permanent disability. Common causes include poor ergonomics (job set up),
repetitive, forceful, or prolonged movements or heavy lifting, pushing, pulling and
carrying of heavy objects. We offer a full Work Place Assessment, which is carried out
by physiotherapists specially trained in occupational health, ergonomics and health and
safety.

Principles Of Ergonomics
Keep work close to the body. If work is too far from the body, the arms will be
outstretched and you will need to bend at the hips putting pressure on your lower
back.

Avoid:

- bending forward. The upper body of an average adult is 40kg. The greater the trunk
bends forward the more work muscles have to do to stabilise and support the back.

- combined bending and twisting movements of the trunk. This causes undesirable
stress on the back. It is important to stand up and walk around regularly if you are in a
seated position for a prolong time. If you carry out repetitive movements, alternate
activities regularly to reduce the risk of injury.

Symptoms
Common causes of work related injuries include poor ergonomics (job set up), repetitive,
forceful, or prolonged movements or heavy lifting, pushing, pulling and carrying of
heavy objects. Others include prolonged faulty postures and exposure to vibration or an
unsafe work environment.

Wrist Fracture
A Broken Wrist is among the most common broken bones, usually occurring following a
fall on an outstretched hand. It generally takes approximately six to eight weeks to heal in
adults and less time in children. The radius is the large bone at the wrist that is usually
broken in the case of a wrist fracture. The scaphoid and ulna are two other bones that are
near the wrist and may also be involved.

Symptoms

There are various different types of wrist fractures, named after the extent of the fracture
and where on the bone the fracture has taken place.

A Colles’ fracture involves the radius bone and is often described as ‘a dinner fork’
deformity due to the shape of wrist following the fracture. A Smith’s fracture is the
opposite of a Colles’ fracture and is often the result of a fall on a bent wrist. Both of these
fractures are extra articular, meaning the wrist joint is not involved.

Symptoms of pain, swelling, deformity and an inability to use the wrist are common after
a fracture and should not be ignored. If you suspect a wrist fracture has taken place, it is
necessary to seek medical attention as soon as possible.

Treatment
Rehabilitation begins immediately while still in plaster by maintaining the range of
movement in the shoulder, fingers and thumb, on the side of the affected wrist. This
prevents secondary stiffness in these areas and helps to resolve swelling in the wrist.

Assuming that there are no complications with healing, the plaster can usually be
removed after 6 weeks and at this stage more active rehabilitation can be undertaken. Our
Physiotherapists may also perform manipulation and mobilisation to reduce stiffness and
pain.

Your Health and Physiotherapy

With their detailed knowledge of human anatomy and movement, our highly skilled
Physiotherapists can help you to solve all kinds of problems during and after illness or
injury, as well as offering preventative advice. Smoking, unhealthy diet, high blood
pressure and lack of exercise all contribute to Heart Disease. Physiotherapists, working as
a part of a team, can develop a treatment programmes, taking into account your age,
lifestyle and previous history.
Mental health problems affect one in four of us at some time in our lives. Depression,
post-traumatic stress disorder, anxiety and other problems can be triggered by personal
and lifestyle pressures, such as bereavement, relationship breakdown, or job loss. They
can also be the result of drug or alcohol dependency, illness or long term physical
disability. Mental Well-being is often about how well a person functions successfully
while feeling capable and competent. Sleeping well, eating well, exercise, having a
positive outlook and good social support characterise mental well-being.

Physiotherapy has an important role to play in helping those with mental health problems.
Research shows that regular exercise affects mood and increases self-esteem. Our highly
skilled Physiotherapists are able to assess people and devise a safe, enjoyable exercise
and movement programme tailored to their needs, which will help to build their mental
and physical well-being. Physiotherapy can also alleviate back pain and other physical
symptoms which often accompany mental health problems by teaching relaxation
techniques or by using massage and other touch related therapies.

Exercise plays a key role in tackling mental health related issues and heart disease.
Rehabilitation after a heart attack may take several months or more. Our Chartered
Physiotherapists will teach relaxation techniques, breathing exercises, and exercises to
gradually strengthen leg and trunk muscles. Regular aerobic exercise decreases the heart
rate and blood pressure at rest and during exercise. This helps to reduce the work load on
the heart and anginal symptoms may be alleviated. Regular exercise improves muscle
function and the ability to take in and utilise oxygen better.

Physiotherapists are trained health care professionals with a wealth of experience in the
diagnosis and treatment of sports injuries and neurological and respiratory conditions.
Our team of Physiotherapists are all university trained and fully insured so you know that
you are in safe hands. If you have a concern about your health or have sustained an injury
consult one of our skilled physiotherapists today.

THANK YOU

DR. MAHESH SAHU ( PT)

B.P.T. M.P.T. (NEURO)