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Common Conditions

Here are some common conditions that you may encounter. You can compare your symptoms with those listed below. We have included general advice on these conditions, but highly recommend that you consult us to create a more specific treatment program .... we appreciate that everyone is different and has different needs!

ü      Osteoarthritis

ü      Sciatica

ü      Whiplash

ü     Runner’s Knee

ü      Achilles Tendonitis

ü      Plantar Fascitis

ü      Tennis Elbow

Osteoarthritis

Introduction:

Essentially, Osteoarthritis is the 'wear and tear' of joints that naturally occurs over time. Some people are more affected than others, depending on past activity levels e.g. running and walking place stresses on hip and knee joints, so a keen runner or walker may find osteoarthritis developing in these joints in later life. However, even a more sedentary person may suffer from arthritis, as we all have some degree of wear and tear in our joints by a certain age.

In the following example, we look at a healthy knee joint and compare it with a knee joint that has undergone arthritic changes:

          Healthy Joint                                Arthritic Joint

As the condition progresses, the cartilage cushion covering the joint surfaces begins to rub away, exposing the bone itself. Unfortunately, the body cannot replenish cartilage as well as it can with bone, so it produces more bone at the affected joint which presents as an 'outgrowth' or 'osteophyte'. Unfortunately, due to the lack of continuity in these newly-formed osteophytes, they simply irritate the joint further causing pain and swelling.

What are the signs and symptoms?

The condition can affect many joints within the body, but typically it is the weight-bearing joints that are affected i.e. hips, knees, ankles/toes. The main symptoms of Osteoarthritis include:

• Stiff joints in the morning
• Toothache-type joint pain, worsening after any sort of weight-bearing
• Occasional burning sensations within the joint with associated swelling
• Restriction of joint movement
• Joint deformities, tenderness and creaking upon movement

What puts me at risk?

Age, weight (the heavier you are, the more stress placed upon your joints), previous injuries, weak muscles and some research suggests that there could be a genetic link i.e. if other members of your family suffered from it.

What can be done about it?

Your Osteoarthritis must be diagnosed by a doctor, who may send you for X-rays. You may be prescribed pain-killing and anti-inflammatory medication. You should also be referred for Physiotherapy to improve your muscle strength and joint mobility. This is where Tailored Physiotherapy can help!

Physiotherapy and Activity:

Physiotherapy exercises can increase/maintain joint movement, increase muscle strength to cope with daily activities, prevent deformities and re-educate balance.

Exercise should be performed on a 'little yet often' basis. Too much at once can aggravate your condition. You need to do just enough to exercise your muscles, yet not so much that you induce pain at your joints. Although you may be a highly active person e.g. gardening, walking, housework etc, it does not use muscles to their full extent, so Physiotherapy exercises are very important to adhere to.

Swimming is excellent exercise for anyone suffering from Osteoarthritis. The water supports your joints, while your muscles still get the exercise they need. We can refer you for Hydrotherapy sessions as part of your treatment, that can hugely benefit your aches and pains.

Sciatica

Introduction:

Sciatica is a very generalised term for lower back pain with associated shooting pains into the buttock and leg. It is termed 'Sciatica' because these shooting pains into the leg initially follow the path of the Sciatic nerve that runs along the back of the thigh and beyond the knee. Believe it or not, Sciatica is more frequently a symptom of pain rather than a cause.

Causes of Sciatica:

There are numerous causes, but the most common are:

• Sacroili-itis - inflammation of the joint where your waist side meets the spine. This joint that becomes lax in pregnancy and can result in this condition post-natally. Other reasons for it include arthritis and trauma.

• Lumber spine facet joint - your spine has tiny joints along the back of it. They are close to the knobbly parts that you can feel when running your fingers along someone's back. These joints lie within very close proximity of the root of the Sciatic nerve, and any inflammation can irritate the nerve causing pain.

• Lumber disc pain - occasionally, Sciatica can be caused by a prolapsed disc (commonly misinterpreted as 'the slipped disc'). The spine is made up of vertebral bony segments, between each lies a fluid-filled disc. When excess pressure is placed on the spine, the disc fluid moves away and leads to uneven pressure being applied to the spinal cord, hence producing Sciatica.

A Disc Prolapse in the Lower Back

• Piriformis syndrome - Piriformis is a hip joint muscle that is pierced by the Sciatic nerve. If this muscle were to go into spasm, tighten up or undergo trauma of some sort (including heavy leg weight lifting or excessive running), it would impinge on the Sciatic nerve causing pain.

• Spondylosis - a large word simply meaning wear and tear of the spine. The disc between each bony segment of the spine slowly loses fluid as we age (one theory why we shrink as we get older). This causes the gap from which the nerves come out of the spine to narrow, and potentially get pinched on certain movements causing Sciatica.

So as you can see, many problems can underlie sciatica - the above information is only a few of them.

What are the signs and symptoms of Sciatica?

• Localised constant backache with occasional shooting pains that may progress down into the foot.
• Pins and needles in your lower limb on the affected side.
• Numbness in parts of your leg.
• In bad cases, you may notice a weakness in your affected leg.

What puts me at risk?

Risk factors to Sciatica include age, weight, poor emotional status, depression, sedentary lifestyles, occupation e.g. if you lift heavy loads or bend in awkward positions .... or even just sit at a desk! Research also suggests that genetics may also play a part too.

What should I look out for?

Any form of sciatica is a nasty experience. You should always go to your GP first. Symptoms like pins and needles (particularly in the groin), change in bladder/bowel habits, erectile dysfunction and numbness are all important and should be mentioned to your GP.

What can be done about it?

It is important to get Sciatica properly diagnosed so your GP may refer you for an X-ray or another type of scan. You may be prescribed pain-killing and anti-inflammatory medication and referred for Physiotherapy.

Physiotherapy:

Sciatica causes are very diverse and Physiotherapy works to ensure that the cause does not happen again. Therefore one person's Physiotherapy may be different to another's. Sometimes, your Physiotherapy may involve manipulation, stretching and strengthening exercises. You will receive lifestyle advice as to how to manage your condition to ensure goes away and stays away.

Whiplash

Introduction:

This sort of injury can be anything from very mild to extremely severe. A whiplash injury is commonly associated with road traffic accidents, but it can occur with other causes e.g. roller coaster rides.

What causes the pain?

It is the whipping action of the head being forced one way then another that causes the pain. Why don't rock and roll 'head bangers' and footballers heading a ball get whiplash? When a head action is intended, the neck muscles fix to protect the structures beneath them, so no injury occurs. However, in road traffic accidents, the force from the car behind is a shock, so the muscles are not 'on guard' to protect the neck.

This results in injury to the neck's ligaments, nerves, bony structures, spinal discs and tendons. Injury could cause bleeding into the structures, which is followed by inflammation and pain .... and neck stiffness/tightening in the longer-term.

What are the signs and symptoms?

• Very mild pain immediately after initial injury.
• Extreme pain approximately 12-24 hours later.
• Neck stiffness that worsens before it gets better. Usually very bad in the mornings.
• A hot feeling around your neck and head.
• In extreme cases, you may experience blurred vision, headaches, shoulder pain, pins and needles in the arms and even lower back pain.

What are the risk factors?

People who drive as an occupation are at higher risk of accidents in the first place. Poor neck/shoulder posture around your neck and shoulders can also affect how well you recover from the injury. Also, individuals who are underweight with very little muscle mass (thin, slender necks) are at higher risk.

What can be done about it?

Whiplash can be minimised if your car's head-rest is at the correct level - i.e. at the same level  as your head so that any 'whipping back' will be minimised as your head will stop at the head-rest. Furthermore, ensuring that your head rest is well cushioned can also help.

If you have been involved in a car accident and worry you may have incurred whiplash, you should see your GP for pain-killing and anti-inflammatory medication. Remember, whiplash can take up to a day to develop.

Physiotherapy:

It is natural with neck pain to want to 'guard' the neck, i.e. not move it. However, this is the worst thing to do as, like any joint in the body, not moving it causes it to stiffen further. During this painful period, it is important to keep your neck gently moving to prevent this stiffening - as it is the stiffening that usually causes long-term problems rather than the initial trauma itself!

We can offer some gentle neck stretches and mobilisations, along with some thermal treatment for the initial injury and associated stiffness afterwards too.

Remember, whiplash does not have to be a big deal .... but if left, you could be suffering for moths or years afterwards.

Runner's Knee

Introduction:

Runner's Knee presents as pain behind your knee cap and the most commonly affected group of individuals are .... runners!

What causes the pain?

In a normal knee, the knee cap slides smoothly up and down within a groove. In Runner's Knee, the knee cap is pulled out of this natural groove, causing 'cartilage grinding' and pain. Also, the knee cap's tendon can become inflamed, causing further complications. Runner's Knee arises for a number of reasons, including a muscle imbalance between your hamstrings, calf muscle and quads, poor footwear, flattened foot arches, wide hips and frequently dislocating knee caps.

What are the signs and symptoms?

• Pain behind the knee cap.
• Pain at the bottom of the knee cap especially after running.
• Pain during prolonged sitting periods with knees bent.
• Hamstring strains, regular cramps and tightness.

What are the risk factors?

• People who run long distances.
• Flattened foot arches.
• Knocked knees.
• Women with wide hips.
• Increasing age.
• Obesity combined with weak muscles.

What can be done about it?

Runner's Knee is not usually a serious condition. In some cases, it can resolve on its own follow a good rest periods. Heat packs can be very beneficial for pain relief as can medication. In more severe cases, your GP may decide to take an X-ray.

Physiotherapy:

A detailed Physiotherapy Assessment from us can determine the underlying cause of your pain, whether it be a muscle imbalance or poor footwear. We can help to stretch out your tight muscles and strengthen those identified as weak. Advice with regards to foot orthoses can be given and electrotherapy can help to promote healing of the condition.

Achilles Tendonitis

Achilles Tendonitis is a painful debilitating condition of the tendon that runs down the back of our ankles to the heel. This tendon enables us to go onto tiptoes and to walk/run. When the tendon inflames, walking, running and other simple activities become very painful. Achilles Tendonitis is more common in athletes and very sedentary individuals. Those that fall in between these extremes tend to be less commonly affected.

What causes the pain?

The condition can be triggered by a change in activity levels e.g. a previously sedentary person who starts running and goes straight in to running 10 miles daily, would be very susceptible - training up to such distances is important.

Tendonitis in the Achilles can also be caused by a single episode of extreme stress e.g. a partial microscopic tear. The mechanism of injury usually involves some sort of sudden start or push off at the ankle. The tendon's vulnerability depends on the flexibility of the individual's calf muscle.

What are the signs and symptoms?

• Pain in the area of the tendon and calf muscle.
• Pain worse with activities such as running or moving your ankles up/down.
• Limping can cause further knee, hip or back pain.
• Pain can spread from the Achilles tendon to the plantar fascia (see below).

What are the risk factors?

• Age - younger/middle aged people partaking in sports involving repetitive jumping and landing (e.g. basketball), and elderly people with sedentary lifestyles or arthritic problems.
• High heels - women who alternate between high heels and flat shoes.
• Flattened foot arches.
• Body type and male gender.
• Physical fitness and training methods.
• Running on hard, unforgiving surfaces.

• Pre-existing gout, systemic lupus erythematosus, rheumatoid arthritis, diabetes mellitus, hyperparathyroidism.

• Smoking.

• Previous steroid injections in/around the tendon.

What can be done about it?

Your GP may prescribe pain-killing and anti-inflammatory medication, and refer you for an ultrasound scan to see the severity of your condition. You should also be referred for Physiotherapy treatment.

Physiotherapy:

Physiotherapy treatment will take into account the risk factors for your condition and the causes of it. We look at footwear, foot posture, activities/sports and a lot more. Our treatment may include friction massage, ultrasound therapy, superficial massage, thermal therapy and stretching/active exercises.

Plantar Fascitis

Introduction:

This condition is one of the most common reasons for heel pain - inflammation of the Plantar Fascia (thick flat band of ligament connecting the underside of your heel to your toes). The Plantar Fascia helps to maintain the foot's natural arch, so naturally flat foot arches can stress the Plantar Fascia, leading to inflammation and pain.

What causes the pain?

The pain is usually caused by microscopic tissue tears, occurring from a number of possible ways. Commonly, there is a muscle imbalance within the foot. Also tight calf muscles, shortened Achilles Tendons, flattened foot arches, very high foot arches, poor footwear and repetitive activities such as running on hard surfaces, can cause Plantar Fascitis.

What are the signs and symptoms?

• Worsening heel pain that is stiff in the morning and progressive as the day goes on.
• Pain that increases when going onto tiptoes e.g. climbing stairs.
• Localised pain on the underside of your heel.
• Pain worse when standing on affected leg only.

What are the risk factors?

• Previous episode of the condition.
• Flat feet/very high foot arches.
• Obesity.
• Age.
• Leg length discrepancy e.g. from previous leg fractures.

What can be done about it?

Your GP may prescribe pain-killing and anti-inflammatory medication. Investigations may include X-rays, other scans or blood tests. You should also be referred to have Physiotherapy.

Physiotherapy:

Treatment of Plantar Fascitis involves diagnosis of the underlying cause and the addressing of it to ensure long-term relief and prevention of recurrence. Ultrasound, specific exercises/stretches along with heat-therapy can heal the problem, enabling you to return to normal as soon as possible.

Tennis Elbow

Introduction:

Tennis elbow (or lateral epicondylitis) is one of many repetitive strain injuries. The condition affects the outer part of your elbow, where the tendon becomes tender and painful. It commonly affects those who regularly partake in any activities involving gripping e.g. raquet sports, DIY, caring.

What causes the pain?

Often the underlying cause is weakness in the upper forearm muscles (these extend your wrist, control your fingers and perform a grip). These muscles are attached to the elbow by a tendon that can become inflamed, causing pain. Microscopically, tiny tears and bleeds can occur within the tendon that may lead to calcification of the tendon itself, which can affect the nerve supply to the rest of the forearm (leading to muscle weakness and odd sensations).

Site of Pain

What are the signs and symptoms:

• Recurring pain on the outside of your elbow, occasionally moving to your forearm.

• Pain caused by lifting, bending, gripping or even picking up light objects such as a toothbrush or coffee cup.

• Difficulty fully straightening your elbow.

• Tender to touch the outside bony aspect of your elbow.

What are the risk factors?

• Age.

• Occupation involving heavy lifting/gripping/typing etc.

• Hobby involving heavy lifting/gripping/typing etc.

What can be done about it?

Your GP may prescribe pain-killers or anti-inflammatory medication. You should also be referred for Physiotherapy.

Physiotherapy:

The most important advice is to rest the elbow and temporarily stop the activity that aggravates it. Lifestyle advice is key to enabling you to continue with your day-to-day life whilst protecting your tendon as much as possible.

We can help you to manage your condition by advising you about protecting your tendon, teaching you specific stretches/exercises to do at home or at work, and offering you friction massage, ultrasound, heat therapy or all of these in any combination as treatment.