Achilles tendinopathy is commonly caused by poor foot biomechanics, which may require a podiatrist to fit orthotic insoles or off the shelf insoles may be adequate. Insoles are not always required as strengthening and proprioeceptive exercises can be enough to resolve poor biomechanics. The calf muscle and proprioception (balance ability) are likely to be poor on the side with achilles tendinopathy. Treatment consists of stretches for the calf muscles, strengthening exercises, proprioceptive exercises, deep tissue massage, myofascial release, and extracorporeal shock wave therapy (ESWT). ESWT is very effective in resolving all types of tendinopathy. If you have achilles problems, book an appointment with e-physiotherapy Edinburgh.
Ankle sprains are one of the most common injuries. This can happen when the ankle turns inwards (inversion) during sport or just when walking on an uneven surface. The muscles that help to prevent inversion of the ankle can also become injured and may make you prone to recurrence of ankle injuries. Treatment with ultrasound, interferential, strapping, balance exercises, stretches, deep tissue massage, myofascial release, and joint mobilisation helps to speed up healing and prevent recurrence. If you have an ankle sprain or recurrent ankle sprains, book an appointment with e-physiotherapy Edinburgh.
Anterior knee pain is a general term for patellar tendinopathy, maltracking of the patella, and chondromalacia patella. There may be problems in the pelvis and hip that contribute to anterior knee pain, such as pelvis rotations, tight iliotibial bands (ITB), and weak hip abductor/external rotator muscles (Gluteus Medius, Gluteus Minimus, Piriformis). This needs to be addressed in conjunction with weakness of the quadriceps, especially the vastus medialis oblique (VMO). Problems with proprioception and balance will usually need to be addressed as well. Using a foam roller or acupuncture/dry needling on the ITB and myofascial release/deep tissue massage on hip and thigh muscles can help to speed your recovery. You may need an assessment with a podiatrist if you have poor foot biomechanics. Without podiatric or off the shelf insoles, you may continue to have problems with anterior knee pain. Extracorporeal shock wave therapy (ESWT) is verey helpful for resolving patellar tendinopathy (tehdinitis) along with a gradual increase in loading the knee and patellar tendon. If you have anterior knee pain, book an appointment with e-physiotherapy Edinburgh.
Dancers frequently have pain and dysfunction in many different joints. This is due to the demands placed on their body which require extremes of flexibility, control, coordination, strength and endurance. If their muscles are not strong and coordinated enough to support their joints a dancer can get pain. If a dancer’s joints are not flexible enough, they may become injured. A dancer’s pelvis may become rotated or shifted causing pain and difficulty achieving full range of movement. Physiotherapy for dancers involves improving muscle strength and coordination, muscle balance exercises, balance (proprioceptive) work, deep tissue massage, myofascial release, joint mobilisations and muscle energy techniques. Dancers usually recover quickly as they are very body aware and learn to move in a different, pain-free way faster than the average person. If you are a dancer with injuries, book an appointment with e-physiotherapy Edinburgh
De Quervain’s is an overuse injury of tendons of the thumb, specifically the extensor pollicis brevis and abductor pollicis longus.
There is usually pain with grasping and when moving the thumb away from the rest of the hand. It is common in nursing mothers from holding the head of their child for extended periods of time. It responds well to ultrasound, deep tissue massage, dry needling and altering activities that aggravate the pain. There may be stiffness in joints underneath the tendons that need to be mobilised to help prevent a recurrence of the symptoms. If you need treatment for thumb pain, book an appointment with e-physiotherapy Edinburgh.
The most common joints for dislocations or subluxations are the shoulder, the knee cap (patella) and fingers. Some disolcations are fraom trauma, usually from contact sports, and can happen to anyone. These usually require the assitance of a physiotherapist or doctor to help self reduce/relocate the joint. Other people who are hyperflexible can sublux (partially dislocate) or disolcate their joints as there isn’t enough ligamentous tension to prevent this. They are usually able to self reduce/relocate their joint and don’t need the help of a physiotherapist or doctor to do this.
In extreme cases, surgery may be required to to help stabilize the joint after traumatic or recurrent joint dislocations. This is most commonly done in the shoulder (glenohumeral) joint.
Physiotherapy helps to strengthen muscles around the unstable joint to help prevent another dislocation and has been shown to be effective in a large number of cases. Strengthening should be tried before considering surgery.
In the shoulder, physiotherapy strengthening focuses first on the rotator cuff muscles as well as the muscles that control the position of the shoulder blade (scapula). Rehabilitation progresses to learning to control the position of your arm (humerus) in the shoulder (glenohumeral) joint when you are doing every day movements and then progresses to more strenuous activites such as sports. Movements are done slowly initially and progressed to fast movements later in rehabilitation.
Manual therapy including myofascial release and acupuncture/dry needling can be helpful in reducing muscle spasm in muscles around the unstable joint. If there is swelling in the joint, electrophysical agents such as ultrasound and interferential can be uses to speed up your progress.
Dizziness can be caused by both serious or minor problems and you should consult your general practitioner if you have dizziness or vertigo. There are some forms of dizziness that physiotherapy can help such as Meniere’s disease, inner ear problems such as Benign Paroxysmal Positional Vertigo (BPPV) and stiffness in the neck. Many doctors are unaware that neck stiffness can cause dizziness. Treatment can involve Cawthorne Cooksey exercises, postural exercises, joint mobilisations, myofascial release, hold relax techniques, acupuncture and dry needling to reduce stiffness in the neck and your dizziness.
If your symptoms are more vertigo (BPPV), which is a spinning feeling rather than an unsteady feeling, the Dix Hallpike test to diagnose, and Epley Maneuover to treat, can quickly resolve these vertigo/BPPV symptoms. If you have problems with dizziness or vertigo/BPPV, book an appointment with e-physiotherapy Edinburgh.
The most common foot pain is plantar fasaciitis. The plantar fascia is located on the sole of your foot and this can become dysfunctional with changes in loading without long enough rest periods for your body to adapt to the new load. Examples of this include: increasing running distance and/or speed. Spending more time on your feet such as with a change in your occupation from a sitting based to standing or active one. Changing your shoes and having less support for your feet, including wearing heels more often. Poor foot biomechanics involving over pronation can be a cause of plantar fasciitis. Strengthening and balance exercises can help to resolve it. Off the shelf or podiatrist prescribed orthotics may also be helpful in some cases. Manual therapy and extracorporeal shock wave therapy work well to resolve plantar fasciitis.
Another tendinopathy in the foot is peroneus longus and brevis tendinopathy. This is pain on the lateral side of your foot and is usually associated with increased training, poor foot biomechanics and proprioception. Relative rest, manual therapy, gradual increase in loading and extracorporeal shock wave therapy will help to resolve your tendinopathy.
Stress fractures are most common in the metatarsal bone above your second and third toes. They are usually associated with an increase in repetitive loading, changed sport training, change in shoe supportiveness, and inefficient foot biomechanics such as over-pronation. The main treatment is to stop loading the fracture for a period of weeks and then gradually increasing the loading again.
Frozen shoulders generally occur between the ages of 40 and 60. The cause is not known but the capsule that surrounds the shoulder joint becomes inflamed, painful and gradually gets tighter. This stiffens the shoulder, hence reducing movement. As the condition continues, it becomes less painful, but the shoulder remains very stiff. It is thought that the stiffness eventually reduces, but this may take more than a year. Cortisone injections can help with the pain and stiffness in the earlier stages of frozen shoulder progression, called the freezing phase. Often do no completely resolve the problem. There are also operative procedures such as hydrodilatation/hydraulic arthrographic capsular distension/distension arthrography to loosen the shoulder joint capsule, which are more effective than a cortisone injection. Physiotherapy after these procedures is essential to improve joint range and strength. If you have a frozen shoulder, physiotherapy may not help without an injection or surgery, unless it has already moved from the painful and stiff stage and has started to loosen. If you are unsure if you have a frozen shoulder or not, book an appointment with e-physiotherapy Edinburgh.
Tension headaches are the most common type of headache. If you are getting frequent headaches, see you GP to investigate for more serious causes of your headache before seeking physiotherapy treatment. If there are no serious causes of your headache then physiotherapy often helps. Tightness in the neck muscles, especially those that attach to the base of the back of the skull (occiput) or those muscles in the front of the neck (sternocliedomastoid muscle), can cause headaches. Reduced movement in the cranial sutures (the joints between the bones of your skull) can also cause headaches. Physiotherapy treatment will usually involve a combination of joint mobilisations, myofascial release, postural exercises, relaxation, and cranial suture release. If you are having probles with headaches, book an appointment with e-physiotherapy Edinburgh.
Hip pain can be caused by a number of problems. Often weakness in the hip extensor (Gluteus Maximus) muscles or hip abductors (Gluteus Minimus) and external rotators (Piriformis) can cause hip pain. Degenerative changes in the hip joint itself will also cause hip pain, as will an unbalanced pelvis. Persistent hip pain that does not respond to physiotherapy should be seen by an orthopaedic surgeon for an opinion. There may be an internal hip joint problem that can be corrected surgically. Physiotherapy treatment will depend on what is causing the problem but may include muscle energy techniques on the pelvis, myofascial release, strengthening exercises, and proprioceptive exercises. If you are having hip pain, book an appointment with e-physiotherapy Edinburgh.
The Iliotibial Band (ITB) is a broad band of connective tissue down the outside of the thigh. The Tensor Fascia Latae muscle attaches to the ITB helping to tighten the ITB and stabilise the knee during walking and running.If you have poor foot biomechanics, weak hip abductor muscles, torsion of your pelvis, poor proprioceptive control, or you increase your activity levels too quickly, you may develop pain in the ITB. It is a common problem in runners who are increasing the distance they run too quickly. Treatment with a physiotherapist will usually involve deep tissue massage of the ITB, strengthening of the hip abductor muscles, muscle energy techniques to balance the pelvis, proprioceptive (balance) exercises and assessment of your foot biomechanics to see if you need referral to a podiatrist for orthotic insoles. If you have ITB syndrome, book an appointment with e-physiotherapy Edinburgh.
Muscle tears can happen spontaneously, due to trauma or sport and leisure activites. The most common area for Spontaneous muscle tears is in the shoulder rotator cuff, especially as people get older. Calm muscle (gastrocnemius and soleus) tears are commonly caused during sports such as running or athletics. They can even happen with walking, more specifically hill walking where there is increased load on the calf muscle as you go up hill.
If you have a large muscle tear, the muscle will swell and bruise quickly. In the more extremem examples in minutes. Less severe muscle tears may swell and bruise overmnight and less severe tears may not visibly swell or bruise. IOt is important to remember that a mild deep muscle tear may only show bruising a week after the injury as the blood makes its way more superficially.
If you think you have torn a muscle, it is best to be assessed by a physiotherapist. The right treatment early can speed your recovery and have you back to your leisure and sporting activities. Larger tears may need a consultant opinion about a repair and this is especially true with shoulder rotator cuff tears. Calf tears may be more comfortable with a compression bandage and using crutches to reduce the load on the calf initially. Physiotherapists can use ultrasound, laser and interferential treatments to speed up your recovery by helping to reduce pain and swelling. Manual therapy a week or two after a muscle tear can help your muscle recover with more strength and flexibility. Progressive balance and strengthening exercises are needed to help prevent a recurrence and to improve the quality of the tear healing.
Weakness can occur in muscles after injury or gradually from postural & movement habits. Common muscles affected by weakness are:
- Deep neck flexors (Longus Capitis & Longus Colli)
- Shoulder rotator cuff muscles (Infraspinatus, Supraspinatus, Subscapularis), Scapula muscles (Serratus Anterior
- Spinal core muscles (Transversus Abdominis & Lumbar Multifidus)
- Hip abductors (Gluteus Minimus & Medius), Hip external rotators (Piriformis), Hip extensors (Gluteus Maximus)
- Ankle invertors and evertors (Peroneus Longus / Brevis / Tertius & Tibialis Posterior)
Strengthening these weak muscles can be done in isolation or with more complex movements, depending on an analysis by your physiotherapist. Deep neck flexors and spinal core muscles are commonly activated in isolation initially and then progressed to being activated with other muscles and while during more complex movements, such as during sport. Fot this to be effective, the use of these muscles needs to carry over to your everyday activities or sporting activites that have been giving you pain.
Strengthening should always include functional strengthening. This simply means strengthening muscles in the body positions that you get your pain or dysfunction in. So if you get pain while bending forwards, you need to practice activating muscles that have been weak while bending. If you have issues with pain during running, your rehabilitation/strengthening needs to be in standing and usually on one leg. This is to improve your proprioception, balance and strength. The exercises need to be progressed from simple, so you can learn to use the muscles that have been weak, to more complex or with a heavier load. A heavier load may be achieves by using a weight, standing on un unstable surface or loading your leg more quickly, such as hopping. Maintaining this improved strength and control can help to prevent reinjury too.
If you are having problems with weakness in any part of your body, a physiotherapist can help to resolve this and get you back to full function and sport. This will take time, the same as if you are strengthening in the gym. Usually it can take a few months for your strength to be adequate to return to your activites and sports without pain.
Neck pain is the most common problem treated at e-physiotherapy Edinburgh. Clients who use a computer for long periods and do not exercise regularly are more likely to get neck pain. A review of your workstation set up is essential to have long term relief of your neck pain as a poorly set up workstation will not allow you to sit with good posture, resulting in strain on your neck. Physiotherapy is very successful at resolving neck pain if you also improve your posture and increase your general exercise levels. Manual therapy including joint mobilisations, myofascial release, deep tissue massage and manual traction are used to reduce tension in neck muscles and joints. Relaxation and postural exercises are also necessary to resolve neck pain. If you are having problems with neck pain, book an appointment with e-physiotherapy Edinburgh.
A full assessment by a physiotherapist is needed to determine the cause of and best treatment for low back pain. However, most low back pain is due to poor sitting posture and lifestyle issues. Sitting for long periods, frequent bending and not enough general exercise can be enough to cause low back pain. This may eventually cause a lumbar disc to protrude and in extreme cases may put pressure onto the nerves as they leave the spine causing leg pain, numbness, a sensation of pins and needles, and weakness in the legs. Physiotherapy can help even in these situations, but it is best to get advice and treatment quickly to help prevent this happening in the first place.
Another common cause of low back pain, especially after abdominal surgery and in postnatal women, is poor strength in spinal and abdominal core muscles. The deepest muscles of the abdomen and spine, the transversus abdominis and multifidus respectively, are responsible for creating a stable foundation on which the other muscles of the trunk create movement. If the foundation is not stable, the joints of the spine and pelvis can become painful. This is an area I conducted research into to obtain a master’s degree in physical therapy. By increasing awareness and activation of the transversus abdominis and multifidus with individual tuition from a physiotherapist followed by a carefully controlled progression of exercises, the core’s stability can be improved and pain resolved. Even after years of problems. If you are having low back pain, book an appointment with e-physiotherapy Edinburgh.
The most common overuse injuries are wrist and elbow pain such as carpal tunnel syndrome and tennis or golfers elbow (lateral epicondylitis and medial epicondylitis). This is often related to long periods sitting at a computer and using the mouse and keyboard. Tension in the neck and shoulders may also contribute to arm symptoms. There are a number of adaptive devices that can be useful if you have an overuse injury, such as an upright mouse, wrist rests, tennis elbow supports, ergonomic keyboards, and adjustable height desks. Some of these are more useful than others, and an assessment with a physiotherapist can help to decide which are worth purchasing for your condition. Manual therapy and dry needling / acupuncture are very useful in treating overuse injuries in conjunction with rest breaks and strengthening esercises. If you have epicondylitis, extracorporeal shock wave therapy is very liekly to help your pain. There is very little evidence that poor posture causes these issues, but it is thought that if you have poor postural habits and you have developed pain, altering your posture may help to unload the already overworked tissues and help you recover.
Patellar tendinopathy is degenerative change in the tendon below your knee cap. It was previously called patellar tendinitis, but as it is not an inflammatory problem of the tendon, it was renamed. Overuse of the quadriceps muscles in sports that require a lot of running and jumping, causes the tendons and muscles develop small tears. This is a normal part of developing strength for the new activity or increased intensity of current activities you are undertaking. The problem starts when there is inadequate rest periods before increasing activity levels. The small tears do not heal fully and gradually get larger and more painful. Rest from the aggravating activity is required to allow normal healing to take place. When returning to activity again, a very gradual increase is required to prevent the symptoms returning.
Poor foot biomechanics, poor proprioception (balance), weakness in the vastus medialis oblique (VMO) muscle, weakness in the hip muscles, tightness in the iliotibial band (ITB) and rectus femoris, and pelvic rotations all contribute to developing patellar tendinopathy. Physiotherapy to deal with patellar tendinopathy includes advice on training and rest periods, deep tissue massage, myofascial release, dry needling, strengthening and stretching muscles of the ankle, knee, hip and pelvis, proprioceptive exercises, and muscle energy techniques for the pelvis. If you have patellar tendinopathy, book an appointment with e-physiotherapy Edinburgh.
The pelvis has a small amount of movement between the base of the spine (sacrum) and the pelvis (ilium). This is called the sacroiliac joint. A large number of muscles attach to the pelvis from both the legs and torso and can influence the position that the pelvis rests in. Restrictions in these muscles can cause the pelvis to twist or shift up or down a small amount. This may be felt as pain in the thighs, hips, pelvis, lower back or mid back. It can have a marked effect on the bio-mechanics of the whole body. Trauma such as a fall or child birth may initiate symptoms, but more often there is no obvious cause and the symptoms start gradually. If you think you are having problems with an imbalance in your sacroiliac joints and pelvis then book an appointment with e-physiotherapy Edinburgh.
Plantar fasciitis is most commonly felt near the heel on the underside of your foot. It usually starts gradually for no obvious reason but is associated with poor foot biomechanics. You may need to see a podiatrist for specially made orthotic insoles to help correct your foot mechanics. Physiotherapy can help with strengthening exercises, balance exercises, myofascial release and joint mobilisations. If you have plantar fasciitis, book an appointment with e-physiotherapy Edinburgh.
Sciatica is simply pain in the areas that the sciatic nerve innervates, generally the back of the leg. It does not give a diagnosis of the cause of this pain, it is simply a description of the symptoms. Common causes of sciatica are disc protrusions in the lower back, irritation to the sciatic nerve anywhere along its path, tightness in the piriformis and other hip muscles that rotate the hip joint, pelvic muscle imbalances, and degenerative changes in the spine or hip. Sciatica generally takes longer to resolve than simple low back pain and treatment should start early for a better outcome. If you are have sciatica, book an appointment with e-physiotherapy Edinburgh.
Shin splints is a non-specific diagnosis for several problems in the lower leg which are common in runners and other running based sports. Medial tibial stress syndrome, anterior compartment syndrome, medial tibial stress fractures and tibialis anterior tendinitis (tendinopathy) are common medical diagnoses associated with shin splints. Assessment with a physiotherapist and often a podiatrist is needed for a differential diagnosis.Treatment involves reducing activity levels, deep tissue massage, proprioceptive (balance) exercises, dry needling/acupuncture, stretching and podiatry orthotic insoles. If you have shin splints, book an appointment with e-physiotherapy Edinburgh.
Rotator cuff muscles of the shoulder can become injured with gym training, throwing and racquet based sports. Degenerative rotator cuff tears may also occur as you get older with no specific injury. The rotator cuff is important for the stability of the glenohumeral (shoulder) joint. An injured rotator cuff can be painful by itself and can lead to other problems with your shoulder such as impingement, instability and over time a frozen shoulder. Myofascial release, deep tissue massage, hold relax stretches, joint mobilisations, strengthening, stretching, and postural exercises are used to help resolve rotator cuff injuries. It may take some time to get over a rotator cuff injury as the muscles need to gradually strengthen over a period of months. If you think you have problems with your rotator cuff, book an appointment with e-physiotherapy Edinburgh.
Shoulder impingement means that one or more of the tendons in your shoulder get pinched by incorrect movement of the shoulder complex. If the scapula (shoulder blade) does not rotate correctly as you lift your arm, tendons such as the biceps, infraspinatus or supraspinatus can become trapped between the scapula and the head of the humerus (the arm bone). This usually results in pain in the middle of your shoulder range as you lift the arm. The pain is usually felt in the upper arm, but treatment is aimed at improving the movement of the scapula with strengthening and coordination exercises, postural exercises, myofascial release, deep tissue massage and joint mobilisations. If you are having problems with shoulder impingement, book an appointment with e-physiotherapy Edinburgh.
Shoulder instability includes dislocations as well as subluxations. A dislocation is when the shoulder joint completely separates, a subluxation is when it partially comes out of its socket. Dislocations can be due to trauma, such as a skiing accident and falling onto the shoulder. This trauma forces the shoulder out of its socket when it did not have underlying instability. In this form of dislocation the most common place the the shoulder dislocates is towards the front of the shoulder. Once the shoulder has been put back in place (reduced) it will need physiotherapy to improve the muscle strength around the joint. Without this strengthening it can dislocate or give you pain with activity.
A shoulder can dislocate without trauma, which is generally associated with too much flexibility (hyperflexibility) in your joints. These type of shoulders need intensive physiotherapy strengthening to help reduce the occurrence of dislocations.Surgery may also be suggested if the shoulder continues to dislocate frequently.
Shoulders may also be unstable but not sublux or dislocate. This form of shoulder instability is much more subtle and may only present a problem when playing particular sports that put a lot of strain on the shoulder such as throwing sports or swimming. Once again, physiotherapy involving strengthening and also myofascial release are useful in returning your shoulder to full function. If you are having problems with shoulder instability, book an appointment with e-physiotherapy Edinburgh.
Lateral or medial epicondylitis (tennis and golfer’s elbow respectively) are generally caused by an increase in intensity or frequency of movements that use wrist and elbow. Often excessive mouse and keyboard use can initiate the problem and a full workstation assessment is needed to optimise the layout of your desk. An increase in racquet sports or gym training can also start epicondylitis. Generally there is pain over the inside or outside of the elbow and along the forearm, which is made worse with extending or flexing the wrist under load. To resolve epicondylitis, you will need to rest from the activity that is aggravating the problem, or modify it to reduce the load on the forearm muscles. Deep tissue massage, myofascial release, dry needling, extracorporeal shock wave therapy (ESWT), stretches and strengthening exercises are the treatments most commonly used. Your GP may also be able to inject the painful area with cortisone to help reduce the pain. This works well in conjunction with physiotherapy. Returning to the activities that aggravate the problem needs to be gradual or the symptoms can start again. If you are having problems with tennis or golfers elbow, book an appointment with e-physiotherapy Edinburgh.
Pain, clicking and/or limited movement of the jaw is a common problem but it is generally poorly treated by physiotherapists, general practitioners and dentists. Stress, grinding your teeth at night, clenching your teeth during the day, orthodontic work and poor posture can lead to problems in the jaw. Physiotherapy, in conjunction with a specific dental appliance/splint, can help to control or resolve the pain. Stress reduction, postural exercises, TMJ exercises, myofascial release and dry needling / acupuncture of muscles that move the jaw are all part of what the physiotherapist will do with you. Craniosacral therapy can be useful in some clients, especially those with stress and anxiety. If you are having problems with your jaw, book an appointment with e-physiotherapy Edinburgh.
Voice disorders can be caused by tension in the muscles above, below or on the larynx. Overuse of the voice by singers or people who use their voice for long periods, such as teachers, salespersons or customer service agents, can cause imbalance in these muscles leading to hoarseness, loss of vocal range, pain or breathing difficulties. Manual physiotherapy, often called laryngeal massage or vocal massage, can help to improve vocal quality and range, reduce pain and ease breathing difficulties.
There can be other causes of vocal problems, so it is important to get this checked with a ear nose and throat specialist or speech and language therapist to exclude these. If you have problems with your voice, book an appointment for a vocal assessment and laryngeal massage with e-physiotherapy Edinburgh.
Wrist pain can occur from excessive mouse and keyboard work or with sports such as golf or racquet sports. The common problems are tendinopathy (tendinitis) and reduced movement in the small bones of the wrist (carpal bones). It is important to remember that wrist pain can often be referred from your neck or shoulder. For this reason your first physiotherapy assessment will assess these areas as well as the wrist. If treatment of the wrist is required it will usually involve mobilising the carpal bones and myofascial release or deep tissue massage of muscles and tendons. Resting from activities that aggravate the problem is usually necessary and if the problem is from mouse or keyboard work, a full workstation assessment will be needed. If you need treatment for your wrist problem, book an appointment with e-physiotherapy Edinburgh.