Stress activates your sympathetic nervous system, this is the where we can move into "fight, flight or freeze" mode. The sympathetic nervous system is responsible for keeping us safe when we are in danger, however it can be activated for prolonged periods and many of us lack the skills to return control to our parasympathetic nervous system, which is responsible for helping us to "rest and digest".

How would this affect pain?

During this state muscles become tense and ready for action, the nervous system is extra sensitive to stimulus, blood pressure is raised and we are more likely to notice and have negative thoughts. Tense muscles can become tired and sore or put extra stress on other structures, causing pain and irritation. Often when in a stressed state our breathing becomes shallow and rapid, even when not really exerting ourselves, such as while sitting in an office.

Use your breathing to recover.

An effective way to help your body return control to the parasympathetic nervous system is to consciously change your breathing. One method is to hold your breath for as long as you can, once you relieve your breath your body senses that a threat has passed and can return to a more relaxed state.
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Another commonly used technique is box breathing. To do this, breathe in for four seconds, hold for four, breathe out for four, hold again for four and repeat. Do this for a few minutes until you start to feel more relaxed and calm.

Show your body that you are safe.

Other activities that can help your body to relax include yoga, going for a swim or having a shower, or doing some intense exercise where your heart rate is raised.

Speak to your physiotherapist for more information on this topic and tips to help you relax during the day.

Essentially, the ankle consists of three bones, the tibia, fibula and talus, all held together by thick fibrous ligaments. The bottom parts of the tibia and fibula (shin bones) join together and surround the talus in such a way that it is able to rock forwards and back while providing stability and restricting the side-to-side movements.
The ligaments holding the tibia and fibula together are large and thick, forming a syndesmosis. An injury to this area is known as a high ankle sprain.

What are they?
 
The hamstrings are a large group of muscles located at the back of the thigh. Their job is to bend the knee, extend the hip backwards and stabilise the leg. The muscles can be injured at any point along their length but are most vulnerable where the tendon and muscle fibres join together. This is a common injury for players of all sports that involve running, and particularly those that involve quick movements and kicking. 

What are the causes?
 
As the hamstrings cross two large joints (the hip and the knee), they need to perform complicated movements, often activating suddenly and with great force. They are often stretched during a fall, a powerful kick of a ball or a sudden take-off. Factors that increase the chance of a tear include poor flexibility, strength or neural mobility. Other factors that contribute to hamstring injuries are muscle imbalances, abnormal lower limb biomechanics, fatigue, and inadequate warm-up. The biggest predictor of a future hamstring tear though, is a previous hamstring injury.
 
What are the symptoms?
 
The most common symptom of a strained or torn hamstring is a sharp pain at the back of the thigh, often immediately after intense activity. There may also be swelling, bruising, difficulty walking and pain with knee movements.
 
Your physiotherapist can confirm that the pain is due to injured hamstrings rather than any other issues, and tell you how bad the strain or tear is. Although not usually required, diagnosis can be confirmed by having an MRI or ultrasound scan.
 
How can physiotherapy help?
 
Once a diagnosis has been made, the first step is to follow the R.I.C.E protocol (Rest, Ice, Compression, Elevation). During the first 48 hours, you should apply ice for 20 minutes every one to two hours to reduce swelling and bruising. Consultation with your physio will include advice about your recovery, and when it is appropriate to return to sport. Your physiotherapist has many techniques that can promote healing and reduce scar tissue formation, which may include ultrasound, deep tissue therapy, electrotherapy and dry needling.
 
Crucially, they will also prescribe you an exercise program to return strength, flexibility and control to your muscles, getting you back to your sport quickly and safely. Due to the high chance of recurrence, rehabilitation is very important and usually takes 6-12 weeks. If the muscle is completely torn, surgery may be required before rehabilitation can start. Your physiotherapist will work with you to help you set goals to get you back to your favourite activities as soon as possible.

What is Ankylosing Spondylitis?
 
Ankylosing Spondylitis (AS) is a type of inflammatory, autoimmune arthritis that primarily affects the spine. It is characterised by intermittent pain and progressive stiffness due to the inflammation and eventual hardening of the ligaments that surround the spine. The classic early symptoms of AS are pain and stiffness of the sacroiliac joints, the joints connecting the pelvic bones to the sacrum in the lower back. In the more severe, final stages of the disease, the entire spine can become fused and rigid, often in a flexed, forward posture.
 
As this is an inflammatory disorder, many other systems and joints can also affected. A significant number of people with AS also suffer from irritable bowel syndrome and inflammation of the eye.

What causes it?
 
The cause of Ankylosing Spondylitis is not clear, however there are markers and predisposing factors that may contribute to the development of the condition. Genetics, chronic stress and frequent gastrointestinal infections are among the predisposing factors. Men are affected more often than women and symptoms usually begin between the ages of 17 and 45 years.
 
What are the signs and symptoms?
 
Intermittent back pain and progressive stiffness are the two most common symptoms of Ankylosing Spondylitis. Other tendons and ligaments may be affected, including those in the hands, feet and ribs. Symptoms tend to be worse following periods of rest, particularly first thing in the morning and improve following periods of activity. It is common for people to experience “flare-ups” and “remissions” of symptoms.
 
Some people with AS may experience mild discomfort in the spine from time to time, while others may experience severe and debilitating symptoms at frequent intervals with minimal time in remission. Long term issues with AS include breathing difficulties due to thoracic and rib cage stiffness and severe spinal pain and immobility. Medical treatment focuses on reducing inflammation and slowing the disease process.
 
How can physiotherapy help?
 
Physiotherapy treatment aims to manage pain during flare-ups and maintain optimal posture as the disease progresses. Your physiotherapist will assess your spinal movement and posture as well as strength. If your hands, feet, hips or shoulders are affected, they will also provide you with specific exercises to help maintain mobility and strength in those joints. Many studies have proven the positive benefits of exercise for those with Ankylosing Spondylitis, such as improved rib cage expansion when breathing, and improved posture of the upper back and neck.

1. Exercise improves energy levels.  
Improving your fitness means your body is capable of achieving more for the same energy expenditure. While doing exercise can make you tired in the short term, regular improvements to your fitness will help you get more out of your body each day, with seemingly less effort.
 
2. Exercise can help to reduce stress. 
If you are stuck in a state of stress or anxiety, exercise can help you move out of it into a calmer and more relaxed state, improving your mood, concentration and sleep. There are now many studies to support this.
 
3. Exercise and hobbies can help you build connections and community.  
Making new friends as an adult can be surprisingly difficult and the importance of connection and community is being recognised more and more as being essential for overall wellbeing. Being part of a team, group or club is a great way to build confidence and meet friends as well as keeping active. 
 
4. Exercise keeps your muscles, tendons, joints and bones healthy. 
Our bodies are often compared to machinery or car parts. However, there are some crucial differences between our bodies and machines, including the fact that our bodies respond to exercise by becoming stronger and healthier, rather than being worn out. As an example, one of the best ways to prevent osteoporosis is through regular high impact activity, which stimulates bone growth. 
 
5. Exercise can help to reduce injuries. 
Similar to the previous point, tissues that are used regularly are stronger, more elastic and are less likely to tear or break when under stress. Regular exercise is the best way to keep your body in a healthy state and prevent injuries.
 
Finding the right exercise for you can be tricky, your physiotherapist can help you with suggestions based on your ability and skillset if you need some help. 

What is Carpal Tunnel Syndrome?
 
The carpal tunnel is a small space where the wrist meets the base of the hand. This space is covered by a thick ligament and creates a small tunnel where various nerves, arteries and tendons pass through from the forearm into the hand. If anything causes this space to be reduced, these structures can become compressed or damaged, particularly the median nerve. This condition is referred to as Carpal Tunnel Syndrome. 

What are the symptoms?
 
The hallmark symptoms of carpal tunnel syndrome are pain, tingling or numbness in the hand, usually following a typical pattern over the thumb, index and middle finger. There can also be a reduction in grip strength and wasting of the thumb muscles. Symptoms are usually worse on waking or with repetitive hand movements. Patients might also report difficulty holding items, writing or doing up their buttons.
 
How does it happen?
 
Carpal tunnel syndrome can be caused by anything that reduces the space in the carpal tunnel, including arthritis, the growth of a cyst or compression from everyday activities. The median nerve is particularly vulnerable to compression and is of the most concern as prolonged compression can cause nerve damage and permanent weakness of the hand. 
 
How is it treated?
 
There are a few different treatment options for carpal tunnel syndrome. Non-surgical treatment is recommended first, which could include physiotherapy, wearing a splint, cortisone or plasma rich platelet injections to promote nerve healing. The effectiveness of physiotherapy will depend on the cause of your syndrome. If the space of the tunnel has been reduced permanently, such as with arthritis, then surgery is likely to be the most effective treatment. Carpal tunnel surgery is an operation to widen and release the carpal tunnel allowing decompression. This is a common procedure but is not without risks or complications and requires a period of time off work for recovery.
 
For non-surgical cases, altered biomechanics of the arm, the mobility of the median nerve and muscle tightness may all be contributing to symptoms. In this case, physiotherapy can be highly effective, along with a period of rest, possibly splinting and a change in your daily activities.