An overview to treatment
We aim to restore you to your previous functional level and help you fully understand why you are having ongoing problems. This helps you manage your problem more effectively and accelerates the long term resolution of your problem. Treatment is based on a detailed examination that highlights the underlying cause(s) and we do not just treat the local area of pain with ineffective, passive treatments such as ultrasound. Our approach saves time and gets you better-often with stunning results. It’s good to see you, but we prefer a quick resolution to your problem and you can then tell your friends and family. Hallamshire Physiotherapy is different. A team you can trust and that’s why 85% of are patients are recommended by family, friends and colleagues.

• Ankle sprain
This is commonly a result of a twist of the ankle in which the ligaments are stretched resulting in pain, swelling and an inability to put weight through the leg. Repeated ankle sprains can lead to the ankle becoming ‘unstable’ as the ligaments are repeatedly damaged and the normal control of the joint is lost. Additionally, joints and nerves around the ankle and foot can be involved in combination with ligament

Treatment
In the acute (early) stage consists of ice, strapping and re-education of movement to prevent further damage and restore normal function. Early restoration of function is paramount to accelerate recovery as movement stimulates tissue repair.
Treatment for the ‘unstable’ aims at strengthening and reactivating the muscles around the ankle to compensate for the damage to the ligaments.

• Whiplash Injury
This is usually following a road traffic accident during which the neck moves forwards, and then backwards, suddenly. This can result in damage to the neck muscles, joint and even the nerves. Most ‘whiplash injuries’ resolve in time and the best advice is the keep the neck
moving and return to normal functioning as soon as possible.

Treatment
Involves neck, upper spine and shoulder exercises to maintain and increase range of movement. If stiffness persists, mobilisation of the spine will help to reduce symptoms.

• Lower Back Pain/Acute Lower Back Pain
Most episodes of low back pain (with and without symptoms spreading into the buttock are not serious and the symptoms will reduce over time). If you experience leg pain that moves into the calf and it is associated with numbness and/or weakness consult your GP as soon as possible.

The best advice is remain as active as possible and avoid long periods of rest. Take simples analgesia and keep moving. If the symptoms persist consult a physiotherapist.
Symptoms will re-occur with most forms of lower back pain and by consulting one of our physiotherapists they will fully assess your back and show you how to prevent future episodes. This will involve a combination of treatment and a home exercise programme that will correct your spinal weakness.

• Knee Pain
This is caused by many reasons and most resolve with time and if symptoms persist, physiotherapy.

• Osteoarthritis (OA)
“We do not wear out: we rust out.” The myth that joints wear out is wrong and if we use the joint sensibly it will last longer than you! Knee pain is a result of damage to the cartilage (thick discs between the two bones that reduce the stress between them).

• Ligaments
A ligament is a band of tissue that connects two bones together to provide joint stability and helps to control movement. A ligament has some elastic qualities, but if stressed beyond those limits it will be damaged (e.g. rupture or complete tear). A partial tear of a ligament will repair with the formation of scar (connective) tissue and in the case of a rupture the ligament will not repair. However, muscles around a damaged joint may compensate for a ruptured ligament, but if this is not successful, surgery may be required.

Physiotherapy following a ligament injury aims to optimise recovery and gradually increase the stresses across the ligament (damaged tissue responds to controlled movement to stimulate the healing process). If surgical repair is required, physiotherapy helps to regain the patients control around the damaged joint by strengthening muscle across the joint and regaining co-ordination of the limb before returning to previous sport or function.

• Anterior Knee Pain
This is usually a result of altered tracking of the patella (knee cap) as it runs over the anterior surface of the knee. Going down stairs or sitting with the knee flexed for long periods (sometimes called ‘movie goers knee’) can often elicit symptoms. Physiotherapy for most anterior knee pain requires that the alignment of the patella is changed by strengthening the muscles that control the tracking and by reducing the stresses on the patella using taping techniques. Additionally, it is sometimes necessary to treat the hip and foot, as abnormal movement within either of these joints can lead to altered patella tracking.

• Tennis Elbow Pain
This is pain in the lateral (outer) aspect of the elbow. You don’t have to play tennis to have this problem and many structures both within (ligament, muscle and joint) and outside the elbow (neck, thorax and shoulder) can cause symptoms. Treatment is based on a full assessment of those factors that are contributing to the problem. Many ‘Tennis elbow’ problems are caused by repetitive activities, for example, inputting data on a computer or gardening and pulling out too many weeds over a short period of time! Other sports such as climbing, cricket or even tennis, can cause symptoms, especially if activity levels are increased rapidly without a graded exercise programme.

Common treatments for tennis elbow are to mobilise the elbow joint, begin strengthening exercises of the muscles that lift your fingers/wrist up (extensor muscles) and reduce the stress across the elbow by reintroduction of the correct use of the whole upper limb in specific activities.

• Achilles Tendonitis
This is not an inflammation (‘tendinosis’ is a better term to describe this condition) of the long tendon that connects the calf to the posterior foot, but research suggests that the pain originates from degeneration of or microtrauma to the tendon over several years. Symptoms are experienced during exercise, but also after periods of rest (e.g. getting out of bed or after driving). Local treatment might be necessary, but part of a physiotherapy assessment should identify those factors that are causing the increased stress on the tendon. For example, running on the toes for prolonged periods, increasing training too rapidly, weakness in the calf muscle producing increased stress on the Achilles tendon or poor hip control that prevents the upper part of the leg generating sufficient forces during walking or running (thus increasing the stress on the Achilles tendon as it tries to compensate for this weakness around the hip).

Treatment aims to reduce the stress on the Achilles tendon by correcting faulty gait or running actions and by strengthening weakened muscles (both in the lower leg and hip/pelvis). Interestingly, as the person’s tendon recovers it is not uncommon to find that their running improves as optimising running will reduce injuries and increase efficiency in running.

• Shoulder Pain
There are many different problems within the shoulder that can cause pain. These are the most common:

Instability:
The shoulder has a wide range of movement and requires the joint to have sufficient movement at allow normal shoulder function. The downside to this flexible joint is that following trauma or after repeated shoulder movements (e.g. prolonged swimming, throwing a javelin or just poor posture for many years), it is possible to lose the control of shoulder movement and a catching pain on certain activities may be elicited. The shoulder still has its normal range of movement, but the patient complains of a ‘catching’ pain and /or ‘clicking’ in the shoulder. This abnormal movement of the shoulder can produce structural damage to the joint and if conservative treatment fails, surgery may be indicated.

Treatment is aimed at restoring the correct shoulder control around the joint (and surrounding joints) and addressing weakness of specific muscles within the shoulder that provides dynamic stability to the joint. Re-educating correct upper limb function is also important to prevent future problems and help the person manage their problem more effectively. Success is judged by returning you to your normal functional state, be that climbing to international standard or just being able to reach for objects ion a top shelf.

Impingement:
This is usually catching of a shoulder tendon or muscle as it passes through a narrow opening within the shoulder joint. The problem may be the result of trauma or, more commonly, repeated stress on the shoulder following poor posture in which the shoulder moves forward (or protracted) when sitting at a computer or desk. Symptoms are experienced as the arm is moved away from the body (abduction) and often worse at 80 to 100 degrees of movement (an ‘arc’ of pain).

Treatment restores the normal control of the shoulder and prevents the tendon ‘impinging’ on specific structures within the shoulder. This may include mobilising stiff joints, strengthening weakened muscles and re-educating faulty movement patterns in symptomatic directions.

Stiff shoulder:
Shoulders become stiff for many reasons and it is important to exclude the neck or thorax as a source of the problem. ‘Frozen shoulder’ is caused by tightening of the sac surrounding the shoulder (or capsule) and this condition is hard to manage and people can have symptoms for years. Fortunately, most stiff shoulder problems (including many diagnosed incorrectly as ‘frozen shoulder’) are easily treated by mobilising the shoulder and home stretching exercises. Incorrect shoulder movement during a specific activity, e.g. lifting at work or playing a specific racquet sport can cause structures in the shoulder to tighten and produce symptoms. Pain is usually encountered at the end of the available range, for example reaching to a high shelf or using a hairdryer.