27 Haven Lane, Ealing, W5 2HZ

Tel: 0208 997 1555

Email: info@w5physio.co.uk

What is atraumatic shoulder instability?

February 25, 2019 by  
Filed under W5 Physio News

Whilst most shoulder dislocations are a result of trauma (an injury), some people also experience episodes of instability without having injured themselves. As physios, its important for us to work out why such instability has occurred. Here we explain a bit more about Atraumatic shoulder instability.

Basically atraumatic instability is instability of the shoulder i.e. dislocation, without a trauma. Done.

Well, not quite…

The majority of people who suffer from this will have a combination of underlying laxity in the ligaments and the joint capsule, and reduced muscle strength and control. Causes can vary from repetitive movements that create some micro trauma to the joint capsule, for example, in sports where there is a lot of throwing or overhead activity or where the joint is forced into extreme rotation, like gymnastics. This kind of activity loosens the capsular restraints.

Other causes can be our genetics, our development or some studies have even shown some psychological causes are possible.

Who is affected?

This condition is primarily seen in the younger person – those under the age of 25. As mentioned, there will be no clear history of injury but there may have been something slight that started it all off. A person may be higher on the hypermobility scale, there may be a history of subluxations or dislocations.  In someone suffering with atraumatic instability, we’d expect to see evidence of pain, particularly at the front of the shoulder and there may be fear around moving or performing tasks with the shoulder.

What can we do about it?

There are some cases that will need to be referred into a specialist shoulder unit, and some that will need surgery. However, once abnormal muscle patterning has developed, amongst other life stresses, surgery can sometimes result in a poorer outcome. But should that be the case, your physio and shoulder doctor will discuss the options with you.

The good news is, a large number of people will be able to recover and manage with physiotherapy and rehabilitation and this should be the first port of call. Having a good, structured rehabilitation programme, which factors in all muscle function, pain and any psychological factors such as fear and anxiety about moving the shoulder (1) is key. Then being consistent with your rehab is vital as some studies suggest that it takes a high level of compliance and commitment to achieve results…and most of these studies took place over 12-24 weeks, so it takes a long time and is not easy (2, 3, 4).

There are many different routes for rehabilitation to follow and many different exercises that can be done. It will depend on individual assessment as to where the focus may be. This will usually involve working on the muscles that control the scapula (shoulder blade), the muscles that act on the humerus (upper arm) and the muscles that control the shoulder joint itself.

The below are just a few examples of the sort of thing you might be doing at each stage.

Stage 1:

In this stage we are trying to reduce pain, fear and avoidance of movement and any associated anxieties which are common place and natural emotional reactions to shoulder instability. It is important in this stage to find a ‘safe zone’ which is a range where you feel comfortable to move the arm, so that we can begin to get some activation of the muscles.

To encourage this, a good place to start is with what we call ‘closed chain exercises’ where we can get some load through the arm but on a stable surface. This allows us to work on joint stability, proprioception and some co-contraction of the muscles. In this stage I would also start to introduce some isometric (static) contractions of the rotator cuff.

Here, we are not as worried about hitting specific sets and reps but working from 30-60 secs for 3-4 times is a good place to start with the focus on building confidence.

Here are some examples of the kinds of exercises we would generally recommend during Stage 1 of recovery:

1. 4 point kneeling weight shift – watch the video here.

2. 4 point Progression – watch the video here.

3.  Isometric External Rotation – watch the video here. 

Stage 2:

In Stage 2, we are aiming to introduce some weighted movement to start to build some strength and endurance. It’s best to work with pain, effort and fatigue when defining sets and reps which means work to fatigue with what you can manage. This will normally equate 3-4 sets of 12-20 repetitions as we look to build control and stability.

Here are some examples of Stage 2 exercises:

1. Side lying external rotation – watch the video here.

2. Prone external rotation – watch the video here.

3. Prone Horizontal abduction – watch the video here.

Stage 3:

During Stage 3, we’re looking to put different movements together and tap into the rest of the body’s kinetic chain.

Examples may include the following:

1. Flexion with external rotation – watch the video here.

2. Lunge with resistance – watch the video here.

3. Ball rotations – watch the video here.

Stage 4:

In Stage 4, we want to add some dynamic movement, working some of what we call our ‘stretch shortening cycles’ as you start to progress back to your normal activities and/or sport.

1. Throwing and catching – watch the video here.

2. Drop and catch – watch the video here.


The general rule should be that if there is positive progress at 12 weeks, a patient should persist with the rehab programme for another 3-6 months. If at 12 weeks no progress has been made then it is probably time to explore other options.

Here’s our summary:

  1. Physio is first line of management for atraumatic instability. It’s a long process and it’s hard work. Be consistent and stick with it. You will get there.
  2. The entire process needs to be a joint decision-making process with you, your shoulder consultant and your physio.
  3. If you’re not improving, then referral on to a shoulder consultant will be necessary. Some people will need a direct referral depending on certain criteria (as discussed above).
  4. Build confidence, stability, control and then add the fun stuff.

If you’re struggling with shoulder pain, get in touch for an appointment with one of our skilled and experienced physiotherapists. We look forward to seeing you soon!


6 Top tips for a healthy Valentine’s Day

February 13, 2019 by  
Filed under W5 Physio News

It’s Valentine’s Day…cue the chocolates, wine and meals out. Although the occasional indulgence won’t hurt, if you’re keen to stick to a more healthy routine this February, there are plenty of ways to show your partner your appreciation for them, without completely neglecting your well-being in the process.

Here are our suggestions for some alternative Valentine’s activities

1. Get moving

Valentine’s Day doesn’t have to mean sitting indoors, eating or watching a rom-com. Why not try getting sweaty with your partner by heading out for a run, cycle or walk? There’s nothing more rewarding (or romantic) than feeling like you’ve both achieved a shared goal. You could even pack a picnic. After all, you’ll need to keep your strength up after burning all those calories.

2. Cook a meal together

We all know that cooking at home is the healthiest option when it comes to avoiding hidden calories, fats and sugars. This Valentine’s Day, why not plan a tasty but healthy meal in the comfort of your own kitchen? Enjoy time with your loved one as you share the food prep, before sitting down at your very own candlelit table for two. It’s the perfect way to enjoy a special evening without piling on the pounds.

3. Take a dance class

Is there a more perfect excuse to get close to your companion than in a dance class? Dance is one of the best ways to get into shape as it helps with posture and provides a workout for both body and mind. Take your Valentine in your arms and take to the dance floor – it’s one of the most popular hobbies in the UK right now.

4. Book a massage

Low lights, indulgent smells and chilled-out background music. There’s nothing more romantic than a couple’s massage as a Valentine’s treat. Even better is that a massage is a great way to take care of yourself: promoting relaxation, reducing stress and anxiety, easing aches, pains and inflammation, as well as improving sleep.

Don’t fancy leaving the house? Why not pamper your partner with a massage at home? Best of all, they’ll probably agree to repay the favour too.

5. Take a bath

Warm baths are another great way to reduce stress, ease aches and pains and create a little romance. Bring out the bubble bath, light some candles and scatter some petals for the perfect atmosphere. Your loved one will appreciate the effort and your muscles and mind will appreciate it too.

6. Climb a mountain

There are few things more rewarding than testing your body with a hike up a mountain. Better still, there are few things more romantic than the stunning view when you reach the summit. Get adventurous with your sweetheart this Valentine’s Day and create an unforgettable experience. And don’t forget the champagne and strawberries for when you arrive at the top!


For more tips on improving your health and well-being, get in touch with W5Physio. We’re experts in rehab and are here to help you reach your fitness goals.




What to expect from your first appointment at W5Physio

January 29, 2019 by  
Filed under W5 Physio News

At W5, we understand that any form of medical treatment can be daunting. And especially so if you’ve never had physio before. It’s normal to have a whole host of questions such as, will it hurt? Will I see immediate results? And, is physio the right treatment for me? Well, we’re here to help…

Your initial assessment will comprise of three parts: the subjective and objective examinations, followed by a diagnosis.

This short article has been written to put you at ease and provides an insight into exactly what you can expect from your first physiotherapy appointment with us.

The subjective examination

As physiotherapists, we work within a biopsychosocial model…wow! Are you blinded by technobabble yet? Whatwe basically mean is “listening to you about your complaint” – something we call the “subjective examination.”

The first part of your initial appointment will involve us collecting a lot of information from you about what’s wrong and, more importantly, how it’s affecting you so that we can work out how to help.

During this subjective examination, we’ll ask questions that aim to rule out things like chronic pain (pain that’s been present for a long time, comes from the central nervous system and may be better treated by a specialists such as a psychologist); or, things like tumours, that unfortunately won’t benefit from physiotherapy either.

It’s really important we ask you lots of questions to gather as much information as possible. We’ll likely ask you what you think is going on and whether you have any thoughts on how we can help you to get yourself better.

It’s all part of us building a partnership where you’re in the driving seat and we’re simply helping you to your destination of feeling better. And we appreciate that the journey to recovery will look different for every individual.

The objective examination

The next stage is the objective examination. Based upon the information you provided us in the subjective, we probably have an idea of what the complaint could be.

This part of your appointment helps us to test some of our thoughts around what we think the problem is.

This is the “hands on” part of your session where your physiotherapist will use gentle movements and/or manual therapy techniques to confirm your complaint, and to help the pain and restore some movement, should you be having mobility issues.

We’ll ask you to show us where it hurts and when it feels better through guiding you through a series of movements such as bending, stretching and twisting. We’ll carry out a full assessment, palpitating muscles and checking joints for stiffness or laxity.

The objective is also the part of the examination where we use our neurological testing skills. This means testing your reflexes, muscle strength and sensation. A thorough neurological exam helps to “rule in” problems of the nervous system and can help your physiotherapist decide whether you need an x-ray or scan.

The diagnosis

Once we’ve carried out both the subjective and objective examinations we can reach a diagnosis and discuss what we can do to help. We’ll estimate how much treatment is required and how long it will take to reach the goals agreed with you.

By the end of your first session, you’ll understand:

  • What’s wrong
  • What to do about it
  • An approximate recovery time
  • And, how to prevent problems coming back.

Do you think you or someone you know could benefit from physiotherapy? Why not get in touch to arrange an initial appointment. Our team of professional and friendly staff will use their experience and knowledge to put you at ease and ensure you’re feeling better as soon as possible.




Physiotherapist vacancy

January 8, 2019 by  
Filed under W5 Physio News

Are you a physiotherapist with at least 5 years’ experience?  Would you like to join an established practice in Ealing Broadway?

If you’re positive, highly-skilled, self-motivated and people-focused, we want to hear from you. The successful candidate will join an enthusiastic team of like-minded professionals and receive clinical support and structured CPD and in-service training. External CPD courses and training will be paid for in keeping with the candidate’s learning objectives and career direction.

Please send your CV plus a covering letter to Mrs L O’Leary, Practice Manager, W5Physio Ltd, 27 Haven Lane, Ealing, W5 2HZ, or alternatively apply here. 


Preparing for winter sports

November 30, 2018 by  
Filed under W5 Physio News

It’s that time of the year again when you start getting excited about your upcoming snowsport holidays.

Accommodation and flights have been booked, transfers organised and equipment hire sorted. But amongst all of this planning, one of the most important aspects often gets overlooked…are you physically ready for your trip? Afterall, skiing and snowboarding are sports!

If you’re as crazy about snow sports as some of us at W5Physio are, then you’ll be out on the first lift most days, only to return as the pistes close. With this in mind, it’s important that your body is prepared for this continuous exertion of throwing yourself down a mountain, with nothing but a sliver of wood strapped to your feet.

Here are our exercise tips for getting you in shape for your next snow sports holiday.

Your fitness goal

One of our physios, Taryn, shares the moto, “exercising your body should be the same as cleaning your teeth.” You wouldn’t only brush once a week, would you?

The NHS website advises:

‘…to stay healthy, adults aged 19 to 64 should try to be active daily and should do at least 150 minutes of moderate aerobic activity such as cycling or brisk walking every week. Plus, strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms).”

In reality, most of the population don’t manage this but it’s certainly a goal to work towards.

When and how to start training

Training should start at least three months before your holiday and you should do two to three strength sessions and cardio workouts a week. This also depends on your base level of fitness, so if you’re fitter, try for four to five times a week. Cardio exercise includes swimming, running, cycling, rowing or using the cross trainer. It can be any activity that raises your heart rate.

Interval training – that’s going faster and then slower for short bursts – is particularly good as it imitates the stop-start nature of snowboarding.

The muscles that are most important during snowboarding are your core muscles (abdominal and back muscles), foot and calf muscles and your upper leg and hip muscles. It’s important to work all of these areas in your training, and of course if you have any specific weak areas, then these should be focused on. Or, if you have any ongoing or current injuries these should also be assessed by a physiotherapist so the right treatment programme can be followed.

Here at W5Physio we pride ourselves in tailoring exercise programmes and rehab to your goals and needs.

Your snow sports exercise plan

When starting any exercise session you should always warm up the muscles you’re planning on working. Start with five minutes of walking/cycling, or even simply stepping up and down the bottom step of your stairs at home. Follow this with around five minutes of dynamic stretches (taking muscles to end range but not holding for a stretch).  See this video for some examples.

Below, our very own physiotherapist and snow sports enthusiast, Taryn,  will share her own current snow sport programme. It works well when performed in a HIIT (High-Intensity-Interval-Training) of 20 seconds in the beginning,  building up to 45 seconds, and in sets of four to six. Alternatively, try eight reps to start with and work up to 15-20 reps, doing four sets.

  1. Press ups with a high low plank – try keep your body still and don’t rock.

Do eight press ups and then four high low planks with each arm or alternate for 20-45sec

Watch the plank video here

  1. Slide lunges with or without a weight – keep your chest up. Either take one shoe off or place a towel under one foot to help you press and slide one leg out into a side lunge.Introduce a weight as you get stronger. Repeat both sides.

Watch the side lunges video here

  1. Squats and woodchop squats – keep your chest up and start with a light weight, progressing to slightly heavier weights. Be careful not to through the weight over your shoulder during the woodchop.

Watch the woodchop squats video here

  1. Physio ball bent leg jack knife – don’t let your back collapse when your legs are straight. Progress to a straight leg jack knife when you’re stronger.

Watch the bent leg jack knife video here

  1. Squat jumps – Begin without a weight, but introduce one when you’re ready. Progress further by jumping onto a step, and finally, by adding a twist (for the jumps I never land)

Watch the squat jumps video here

  1. Medicine ball get up – push the weight forward as you get up and try keep your feet still as you plant them and reach for ceiling when standing. Try this version first but if you have  had any recent lower back pain, do the easier version instead.

Watch the medicine ball get up video here

One extra exercise I’d add, if you have access to a leg press machine, is doing calf raises in a straight and bent knee position with a weight you find difficult but manageable to lift.

Our final tips

Our final tips would be to make sure all your equipment is in safe working order and to maybe buy some buttock padding and wrist guards, particularly if you’re prone to falling. Also remember wear a helmet. Get enough sleep and drink plenty of water leading up to  and during your holiday.

Finally, take a moment at the top of the mountain to enjoy the view, then take pride in how strong you feel when skiing or boarding down.


W5Physio are leading London physiotherapists. If you’d like any personal advice on preparing for an upcoming sporting event, or preventing injury, don’t hesitate to give us a call to arrange a session with one of our experienced physios.







Full-time Physiotherapist Position Available

November 1, 2018 by  
Filed under W5 Physio News




We have an exciting opportunity for a positive, highly skilled and people-focused self-employed Physiotherapist to join our great team.  The role is 30 hours a week in our busy, established practice in Ealing Broadway, London.

The ideal candidate will have at least 5 years of neuromusculoskeletal experience, and excellent skills in the assessment, diagnosis and treatment of all neuromusculoskeletal conditions.  The candidate will be highly self-motivated, enthusiastic, positive and want to work as part of a successful team to build their caseload and relationships with existing referrers.

The successful candidate will receive clinical support, fortnightly structured CPD and in-service training.  External CPD courses and training will be paid for in keeping with the candidates learning objectives and career direction.

Please send your CV plus a covering letter to accounts@w5physio.co.uk or post to Mrs L O’Leary, Practice Manager, W5Physio Ltd, 27 Haven Lane, Ealing, W5 2HZ.

There’s No Time Like Mo Time @ W5 Physio

November 17, 2017 by  
Filed under W5 Physio News

Its that time of year again, where the good fellows at W5 Physio grow a mustache to raise money for the Movember Foundation.

‘We’re the only charity tackling men’s health on a global scale, year round. We’re addressing some of the biggest health issues faced by men: prostate cancer, testicular cancer, and mental health and suicide prevention.

We know what works for men, and how to find and fund the most innovative research to have both a global and local impact. We’re independent of government funding, so we can challenge the status quo and invest quicker in what works. In 13 years we’ve funded more than 1,200 men’s health projects around the world. By 2030 we’ll reduce the number of men dying prematurely by 25%’ (https://uk.movember.com/about/foundation)

If you wish to donate to this worthy cause, please click the link here.

Yours in mustachely styliness,

W5 Physio

Christmas Opening Hours

December 24, 2015 by  
Filed under W5 Physio News

Merry Christmas everyone!

We are closed today (Thursday 24th December) for 4 days, before opening again Monday 28th in the lead up to New Year. Here are our opening hours over the festive period –

Thursday 24th – Closed

Christmas Day – Closed

Boxing Day – Closed

Monday 28th – Open 10am to 9pm

Tuesday 29th – Open 8am – 9pm

Wednesday 30th – Open 8am – 1pm

New Years Eve – Closed

New Years Day – Closed

Friday 2nd – Closed

Saturday 3rd – Closed

Monday 4th – Open 8am – 9pm and normal hours resume.


From all of us at W5 Physio, have a happy, safe and joyful christmas and New Year!

Full-time Physio Position at W5 Physio

October 19, 2015 by  
Filed under W5 Physio News


We have an exciting opportunity for a positive, highly skilled and people-focused self-employed Physiotherapist to join our great team.  The role is 34hrs a week.

We are a busy dynamic established practice based in Ealing Broadway, London.

The practice has 3 treatment rooms and is supported by a strong administration team. We are a dynamic team of 5 great physios.

The ideal candidate will have at least 5years of neuromusculoskeletal experience, and excellent skills in the assessment, diagnosis and treatment of all neuromusculoskeletal conditions.  The candidate will be highly self-motivated, enthusiastic, positive and want to work as part of a successful team to build their caseload and relationships with existing referrers.

The candidate will receive clinical support, fortnightly structured CPD and in-service training.  External CPD courses and training will be paid for in keeping with the candidates learning objectives and career direction.  Excellent remuneration of between £45K-£50K depending on experience and caseload.

Please send your CV plus a covering letter to accounts@w5physio.co.uk or post to W5Physio, 27 Haven Lane, Ealing, W5 2HZ.

W5 Physio Goes Pink For The Breast Cancer Campaign

January 7, 2015 by  
Filed under W5 Physio News

W5 Physio has turned a striking shade of pink for the whole of January in support of Breast Cancer Campaign. All physio staff are wearing specially branded shirts in breast cancer pink for the month to raise money for a brilliant cause.

in-aid-of-breast-cancer-campaignTaryn, Stewart and Vicky looking stunning!

Breast Cancer Campaign was established in 1988 with the aim of researching the cure for breast cancer. The charity aims to be the leading specialist in breast cancer research across the UK and Ireland, making a significant impact on breast cancer for the benefit of patients. As of September 2014, Breast Cancer Campaign has invested nearly £14 million in 82 research projects across the UK and Ireland, all with a goal of ‘overcoming and outliving the disease in our lifetime’. Read more on the campaign at www.breastcancercampaign.org

The clinic has been covered in pink stars – for 50p, anyone can guess the number of stars to win a free treatment!

We hope to see you soon,

The W5 Physio Team

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