Your physiotherapist has a wide variety of skills and can help you with so much more than just pain and injury. Here are a few reasons to visit your physiotherapist that can keep you healthy and pain-free, before injury strikes...

Stiffness and Inflexibility
 
Almost all of us have experienced pain and stiffness after a day of increased or unaccustomed exercise. This kind of stiffness usually wears off quickly and is referred to as DOMS (delayed onset muscles soreness). However, if you find yourself feeling stiff for more extended periods, or even most of the time – it might be time to see a physio. There are many different causes of stiffness and inflexibility. By far the most common is lack of movement. Our joints and muscles both lose flexibility if not moved through their range regularly. Muscle stiffness can feel like a tightness with a bouncy feeling of restriction, and joint stiffness can create a harder ‘blocked’ feeling when you try to move. 
 
When it comes to stiffness that evolves from lack of movement, you may not even notice that you have lost range, as it can be easy to adapt your movements to compensate. Your physiotherapist can help you to identify where you have areas of inflexibility and help you to exercise, stretch and mobilise your joints to get them back to a healthy range. Disease processes such as osteoarthritis and rheumatoid arthritis can also cause prolonged stiffness, and your physiotherapist is well equipped to help you deal with these conditions. 
 
Reduced Strength or Weakness
 
There are many possible reasons for weakness in the body, from generalised disuse, weakness in one muscle group following an injury, neurological weakness or structural weakness of joint following a ligament tear. Musculoskeletal deficiency of any kind can predispose you to future injuries and are difficult to resolve without targeted exercises. Your physio can determine the cause of your weakness and prescibe the best treatment to restore your strength. 
 
Reduced Balance
 
Keeping your balance is a complicated process and your body works hard to make sure you stay on your feet. Humans have a small base of support for our height and we use all our senses together to determine which movements we should make to stay upright, including our visual, vestibular, muscular and sensory systems. As balance is essential for walking, if one system that supports our balance begins to weaken, the others will quickly compensate, so you may not notice that your balance has worsened until you fall or trip over unexpectedly. 
 
As a general rule balance deteriorates as we get older, but this doesn't mean that falling should be an inevitable part of aging. Actively working to maintain or improve your balance can have a significant effect on your quality of life and confidence in getting around. Your physiotherapist is able to test all aspects of your balance and provide effective rehabilitation to help keep you on your feet.

Tendons, the connective tissues that join muscles to bone are known for being notoriously difficult to treat once injured. The reason for this is that often they are injured through stress or overuse, and compared to muscles they can have relatively poor blood flow, which is essential for healing. 
 
Tendons and muscles work together to move your joints and together are called a contractile unit. As muscles are exercised and gain strength, the attaching tendons are also placed under tension and adapt to this to become stronger. If the load placed on the tissues exceeds their capacity, the tendon fibres can begin to break down and become stiff and painful. 

Is my pain related to a tendon injury?
 
For an accurate diagnosis, you will need to be assessed by a physiotherapist. However, some signs that your pain might be coming from an in issue with a tendon are; 
 
· The pain is quite specific and can be felt over the tendon itself; 
· The pain is worse when under stress and improves when rested; 
· The pain improves after exercise has started, but it might be worse once you cool down; 
· The area around the tendon may feel stiff after periods of rest, particularly in the morning. 
 
How are tendon injuries treated?
 
When it comes to recovery, tendons are often treated differently to other injuries. While each tendon injury is unique and will require assessment and intervention by a physiotherapist, there are a few general approaches that usually help with all tendon injuries.  
 
Reducing your activity to a comfortable level is the first step to recovery. Complete rest can actually delay healing as the tendon simply becomes weaker and less able to cope with subsequent loads. Your physiotherapist can provide you with a targeted exercise program to aid your recovery. Eccentric exercises, which are exercises that work alongside gravity, have been shown to stimulate tendon healing and strength.
 
Stretching may aggravate your injury and should be used with caution. Assessment of any biomechanical faults or stresses that are placing undue load on the tendon is also a central component of treatment. Your physiotherapist is able to guide you with your recovery and return to sport to avoid aggravating any injury. 

Your Chair
 
The height of your chair is a good place to begin. Ideally, your feet should be flat on the floor, and if you can adjust the height of the chair, your thighs should be parallel to the floor. If your chair has armrests, they should be low enough to allow your elbows to sit comfortably between 90-110 degrees of bend and rest by the side of your body. A small cushion or rolled-up towel may be added to the back of the chair to add support to the lower back to help prevent slouching. 
 
If you are unable to adjust your chair and it is too high, you can use a footrest to allow your feet to rest comfortably. 
 
Your Desk 
 
The height of your desk should be set so that your arms can rest comfortably at the keyboard and hands, wrists and forearms can sit in a neutral position, parallel to the floor. Where possible, put everything you need within easy reach and alternate days using your mouse and phone with different hands on different days (if you can do this with your non-dominant hand!). 
 
Your Screen
 
The height of your computer should be raised so that the top of the screen is around eye level. Allowing your neck to rest in a neutral position can help to prevent neck pain and headaches. Ideally, if you can set the screen to be 20-40 inches away from your face, this will reduce strain on your eyes while reading. 
 
Some other tips
 
Being comfortable is extremely important for productivity and focus. If you are struggling with pain, your work will often suffer. Even joint stiffness and muscle tightness can disrupt your workflow, so taking the time to adjust your workstation can save you countless hours in the long run and prevent painful overuse injuries. 
 
Taking active breaks from sitting to move and stretch can help to maintain muscle and joint health, which can be compromised from being in the same posture too long. You can set a timer or make the effort to take phone calls and video meetings standing, rather than always sitting. 
 
You can speak to your physiotherapist for more personalised advice on your workplace setup. 

Have you ever woken up with a stiff and painful neck that will only turn to one side? You might have been suffering from acute wry neck, a painful condition following a typical pattern of symptoms. Most wry necks are classified as one of two different types – facet (joint) or discogenic wry neck. 

Facetogenic Wry Neck:
 
Facet joints are found on either side of the spine and allow controlled rotation and side bending of the neck. An awkward or sudden movement of the neck can cause a part of the joint capsule to strain, tear or get caught in the joint, making it feel locked. The muscles around the area can also become tight and spasm, which amplifies the pain. The pain is usually sharp and can be pinpointed quite accurately to the part of the neck causing the problem, and the pain rarely travels down into the arm. It is usually possible to find a resting position where the pain goes away completely, only having pain when turning in specific directions. The good news about facetogenic wry neck is that your physiotherapist is usually able to help you ‘unlock’ the neck quite quickly with gentle mobilisations. Most of the time, a full recovery can be expected within a week. 
 
Discogenic Wry Neck: 
 
The vertebrae of the neck are separated from each other by fibrous discs, filled with a gelatinous centre. These discs provide support, flexibility and shock absorption. When placed under pressure, these discs may bulge or tear, and the resulting swelling can cause pain and muscle spasm in the surrounding area. It is important to note that in an area as sensitive as the neck, a small amount of damage can result in a large amount of pain. 
 
The development of discogenic wry neck is usually due to a combination of factors, including neck stiffness, poor posture and biomechanics than can contribute to the disc being vulnerable prior to the injury. In these cases, it can be challenging to find a comfortable position, and it is more likely for pain or tingling to travel into the arm.
 
Treatment of discogenic wry neck is focused on reducing pain and muscle spasm with massage, taping, heat and postural education. Further treatment aims to reduce any stress that is being placed on the disc, mobilise any stiff spinal segments and correct any muscle imbalances. While the initial symptoms may settle down quite quickly, it can take up to six weeks to fully recover from discogenic wry neck. In this condition, it is also essential to address all the factors that may cause a recurrence of the issue.

Keeping active can be challenging. For many people, going out for a run or taking time to perform a full workout can be daunting, especially if this is not a part of their usual routine. 
 
There are a few quick and easy ways to add some movement to your day, starting with something as simple as boiling the kettle. As the average kettle takes 2-3 minutes to boil, challenge yourself to see if you can complete these three exercises while waiting for your cup of tea or coffee. You can focus on one each day, or work through a different one each time. 

1. Challenge your balance. 
 
Standing on one leg is something many of us assume we can do, yet rarely take the time to check. This is an essential skill that can deteriorate without being noticed until everyday activities, such as getting dressed, are impacted. Being able to stand on one leg is important for putting on shoes, trousers and reduced balance can be a risk factor for falls. 
 
Start by seeing if you can stand on one leg with your eyes open for the entire time the kettle is boiling. Test both legs, making sure you are close to a bench that you can use to support yourself. To increase the difficulty, try balancing with your eyes closed, then progress to balancing on your tiptoes. If you can balance on your tiptoes, with your eyes closed, then you can ask your physio for more suggestions.
 
2. Heel Raises
 
Start by keeping your knees slightly bent and lift both heels off the ground at the same time. You can begin with repetitions of 5, have a quick rest then repeat. Challenge yourself to increase the speed of your heel raises and see how many you can fit into your waiting time. As you bend your knees, aim to keep your knees over your second toe. If you feel this is a little too easy, you can progress to single-leg heel raises, which will also improve your balance!
 
You can start a daily competition with the people in your household to see who can complete the most repetitions in a set time period.
 
3. Squats
 
Squats are a great exercise to keep your large muscles working. You can start with 5 shallow squats, aiming to slowly increase your number and progressively squat to a lower position. As with heel raises, when you start to find squats to be less of a challenge, you can move to single-leg squats. 
 
Don’t hesitate to ask one of our physios for tips on how else you can stay active at home or in the office. 

Nothing can ruin your enthusiasm for a new workout program faster than the pain and stiffness that sneaks up on you the day after. This delayed reaction from your muscles, known as DOMS (delayed onset muscle soreness), has affected almost all of us at one time or another. While there is no sure-fire cure or prevention for DOMS, here are a few tips to help reduce your symptoms next time you hit the gym

Understand what it is
DOMS is thought to be a result of micro tears in muscle tissue during eccentric exercises in particular. While DOMS is not a sign of a serious injury and usually goes away on its own within 48 hours, it can be very uncomfortable and a deterrent to continue exercising. It can also leave you at a higher risk of injury, and for athletes who are competing in a tournament and need to recover quickly, DOMS can be particularly problematic. 
 
Warm-up and cool-down
By taking the time to let your muscles warm-up, your muscles can operate at optimum flexibility, reducing the tension on muscle tissue during exercise. A cool-down encourages effective blood flow to muscles after exercise, so that any waste products such as lactic acid and calcium can flow back into the bloodstream rather than staying in the muscle tissues. 
 
Get a massage or use a foam roller
By massaging tight and sensitive muscles, you can improve blood flow, promote tissue healing and reduce pain. Both massage and foam rolling can help to relax tight muscles and enhance tissue recovery in the first 24-48 hours after exercise.
 
Stay hydrated
Keeping hydrated allows your body to remove waste, stay flexible, and help tissues heal optimally. The trick is to maintain hydration throughout your day, not just when it's time to exercise. It's also essential not to wait until you are thirsty, as you could already be dehydrated at this point. 
 
Other ideas includes gentle exercise such as 20 minutes on a stationary bike, and mild stretching. If you are particularly brave, ice baths have recently been shown to have mild benefits in pain reduction following intense exercise.

What Are They?
 
Trigger points are what are often thought of as muscle "knots" and can feel like painful, hard lumps located in your muscles. These points can both be painful to touch and refer pain to surrounding areas. It is thought that trigger points form when a portion of muscle contracts abnormally, compressing the blood supply to this area, which in turn causes this part of the muscle to become extra sensitive.  Trigger points are a common source of pain around the neck, shoulders, hips and lower back. 

What Causes Trigger Points?
 
Many factors can cause trigger points to develop. Repetitive stress, injuries, overuse and excessive loads are common examples. Inflammation, stress, nutritional deficiencies and prolonged unhealthy postures may also contribute to the formation of these painful areas. Generally speaking, muscular overload, where the demands placed on the muscle mean that the fibres are unable to function optimally, is thought to be the primary cause of trigger points. This is why you might notice trigger points in weaker muscles or after starting a new training program.

Signs and Symptoms

Pain caused by trigger points can often be mistaken for joint or nerve-related pain as it can be felt in a different location to the site of the trigger point. Trigger points feel like hard lumps in the muscles and may cause tightness, heaviness, aching pain and general discomfort. They can cause the length of the affected tissues to shorten, which may be why trigger points can increase the symptoms of arthritis, tennis elbow, tendonitis and bursitis.

How Can Physiotherapy Help?

Your physiotherapist will first assess and diagnose whether trigger points are contributing to your pain. If they feel that treatment will be beneficial, there are a variety of techniques that can help, including dry needling, manual therapy, electrical stimulation, mechanical vibration, stretching and strengthening exercises. While these techniques may be effective in treating trigger points, it is important to address any biomechanical faults that contribute to their development so they don't keep recurring.
 
Your physiotherapist is able to identify causative factors such as poor training technique, posture and biomechanics and will prescribe an exercise program to address any muscle weaknesses and imbalances.  If you have any questions about how trigger points might be affecting you, don’t hesitate to ask your physiotherapist. 

Referred pain is one of the most complicated processes in the human body. You may have experienced this if you ever saw a physiotherapist for pain in one part of your body, and they started to treat an entirely different area.  The complexity of pain is one of the reason's why physiotherapists conduct such a thorough interview with you and physical examination before being able to determine the exact source of your pain.

Why is pain so complicated?
 
Unfortunately, we still don't understand everything about the way pain is processed.  Usually, when an injury or damage occurs to body tissues, a signal is sent to the brain, which begins to interpret this signal and creates the sensation of pain. Pain is thought to be a warning signal to let you know to avoid danger and pay attention to the injured body part. Occasionally this system goes a little haywire, and pain signals are sent when there is no damage or the location of the pain is misdirected.
 
Referred pain is the term used when pain is felt at a different location to the source of the problem that is sending the pain signal. There are many kinds of referred pain, and some are easier to explain than others.
 
What are the different types of referred pain?
 
In some cases, if it is a nerve that is sending the pain signal, then pain can be felt all along the length of the nerve. This may be described as a sharp burning pain along the skin. One of the most common examples of this is "sciatica", where the large nerve that runs down the back of the leg is irritated around the lower back or buttock. The source of the pain signal is near the spine. However, that pain follows a distinctive pattern down the leg. In other cases, it is the muscles and not the nerves that are referring pain elsewhere. Muscular trigger points are taut bands that develop within muscle tissue that is undergoing abnormal stress. Poor posture, lack of movement, and overuse can cause muscles to develop areas of dysfunction. These trigger points can cause pain that radiates out in distinctive patterns. Trigger points are diagnosed as the source of pain if symptoms are reproduced when a therapist presses on a specific point.
 
If that wasn't confusing enough, we know that our internal organs can also refer pain.  Pain referred by internal organs may be described as a deep ache, and usually not influenced by movements of the limbs or back. Organs often distribute pain in patterns that are very obscure and sometimes don't even create any pain at their own  location. For example, kidney pain can feel like lower back pain. 
 
There are many other fascinating aspects to pain and understanding how it works is an important part of managing your symptoms. To understand how referred pain may be affecting you, talk to your physiotherapist who can help with any questions. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.