1. DEFINITION & ANATOMY

The Achilles tendon is the strong, fibrous cord that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). It plays a crucial role in walking, running, and jumping by helping to push off the ground. Pain in this area is commonly grouped under the term Achilles tendinopathy, which describes pain localised at the back of the heel or slightly above it. This condition typically presents as either Achilles tendonitis, an acute inflammatory irritation often reacting to a sudden increase in load, or Achilles tendinosis, a more degenerative condition related to chronic overload that causes changes in the tendon’s structure. Tendinopathy can affect the middle portion of the tendon (mid-portion) or where it attaches to the heel bone (insertional).

2. SYMPTOMS & SIGNS

• Pain located at the back of the heel or a few centimetres above it.
• Morning stiffness or significant “first-step” pain upon getting out of bed.
• Tenderness when touching the area, with possible warmth, swelling, or a noticeable thickening of the tendon.
• Pain that increases with activities that require push-off, such as hopping, running, or walking uphill.
• A crackling or grating sensation (crepitus) may be present in acute cases.
• Reduced power or a feeling of weakness in the calf muscle.
• Stiffness that eases with gentle movement but worsens after a period of heavy or sustained activity.
• For insertional tendinopathy, pain can be aggravated by shoes rubbing against the back of the heel.

3. CAUSES & RISK FACTORS

• Sudden increases in training intensity, such as adding volume, speed, or hill work too quickly.
• Repetitive overload from activities like running and jumping without adequate recovery.
• Poor strength in the calf muscles or supporting muscles around the hips.
• Limited ankle flexibility, particularly the ability to bend the foot upwards (dorsiflexion), and tight calf muscles.
• Altered foot mechanics, such as flat feet or overpronation (foot rolling inwards excessively).
• Returning to sport or activity too quickly after a layoff period.
• Certain medications (e.g., fluoroquinolone/quinolone antibiotics, statins) can increase risk.
• Higher incidence in males aged between 30 and 60.
• Regularly training on hard surfaces or using unsupportive footwear.
• Other factors like a high BMI or systemic conditions such as diabetes or inflammatory arthritis.

4. HOW PHYSIOTHERAPY HELPS

• Thorough Assessment: We evaluate your walking and running pattern (gait), foot posture, ankle mobility, and calf strength and endurance. This helps us make a precise diagnosis and rule out other issues like plantaris involvement, bursitis, or a partial tear.
• Load Management Plan: We will help you temporarily modify aggravating activities like speed work, hills, or jumping, while showing you how to maintain your general fitness safely.
• Progressive Tendon Loading: Your treatment will be built around an evidence-based exercise programme. This includes specific calf strengthening exercises (like eccentrics and heavy slow resistance), isometrics for pain relief, and a gradual progression to jumping and running drills.
• Manual Therapy: We may use hands-on techniques such as soft tissue massage and joint mobilisations to improve mobility and reduce symptoms where appropriate.
• Adjuncts: We can provide taping for support, advise on short-term heel lifts (especially for insertional cases), and may use shockwave therapy if your condition is not progressing as expected. We also offer guidance on footwear and orthoses.
• Education: A key part of recovery is understanding your condition. We will teach you how to pace your activities, warm up correctly, and monitor your symptoms using acceptable pain guidelines.

5. TIMELINE / EXPECTED RECOVERY

• Reactive/Acute Tendonitis: With early and effective load management and targeted exercises, symptoms often improve significantly within 4–6 weeks.
• Tendinosis/Chronic Tendinopathy: This condition requires a more patient approach. It typically takes 8–12 weeks or more of a consistent, progressive loading programme to see meaningful improvement, with full resolution sometimes taking several months.
• Insertional Cases: Tendinopathy at the heel bone attachment can sometimes progress more slowly than mid-portion issues.
• Your outcome is strongly predicted by how consistently you perform your exercises and manage your activity levels.

6. SELF-HELP & PREVENTION

• Temporarily reduce activities that cause significant pain, but keep moving within comfortable limits (e.g., cycling, swimming, or walking on flat ground).
• Begin gentle calf-loading exercises as advised by your physiotherapist, starting with isometrics and moving to slow, controlled calf raises.
• If your calves are tight, perform regular gastrocnemius and soleus stretches. Initially, avoid stretching that causes direct compression pain for insertional cases.
• Use temporary heel lifts or wear shoes with a slightly higher heel to reduce strain on the tendon in the early stages.
• When reintroducing activities like running, do so gradually. Be cautious with sudden increases in hills, speed work, or jumping.
• Work on strengthening your hip and foot muscles, check your footwear for signs of wear, and consider orthoses if overpronation is a factor.
• Use ice or heat for short periods for symptom relief, and prioritise your overall training load management and sleep for better recovery.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

If you feel in doubt about your diagnosis or your achilles problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

1. DEFINITION & ANATOMY

A calf strain or tear is an injury to the muscle fibres at the back of the lower leg. The calf is made up of two main muscles: the gastrocnemius and the soleus. The gastrocnemius is the larger, more superficial muscle that crosses both the knee and ankle joints; it is most active with the knee straight during explosive push-offs. The soleus is a deeper, smaller muscle that works hardest when the knee is bent, playing a key role in endurance and standing posture. Strains often happen during sudden movements like sprinting, pushing off for a tennis shot, or running uphill. Accurately identifying which muscle is injured is crucial as it guides the specific exercises needed for an effective recovery.

2. SYMPTOMS & SIGNS

• A sudden, sharp pain in the back of the lower leg, sometimes accompanied by a pulling or tearing sensation.
• Difficulty walking normally or pushing off the foot.
• Localised tenderness when pressing on the muscle belly.
• Swelling and/or bruising, which may develop over 24-48 hours.
• Stiffness and pain after periods of rest.
• Pain when performing a calf raise (standing on your tiptoes).
• Reduced power or a feeling of weakness in the calf.
• A “pop” sensation may be felt at the moment of injury.
• Gastrocnemius pain is often worse with the knee straight, while soleus pain can be more noticeable with the knee bent.
• In severe cases, a visible gap or defect may be present in the muscle, and you may have a significant limp.

3. CAUSES & RISK FACTORS

• An inadequate warm-up before exercise or sport.
• Sudden increases in running speed, distance, or intensity.
• Explosive changes of direction required in sports like football or squash.
• Underlying tightness in the calf muscles or limited ankle mobility.
• Fatigue, which can lead to poor muscle control and overload.
• A history of a previous calf strain.
• Poor strength or endurance in the calf muscles.
• Weakness in supporting muscles, such as the glutes and hamstrings.
• Poor running mechanics or wearing unsuitable footwear.
• A sudden introduction of uphill running.
• Dehydration or not allowing enough recovery time between hard sessions.

4. HOW PHYSIOTHERAPY HELPS

• Assessment: We will perform a detailed examination to grade the strain (I-III), differentiate between a gastrocnemius and soleus injury, and screen for more serious issues like a complete tear or red flags for a DVT (Deep Vein Thrombosis).
• Acute Management: We guide you on a plan of relative rest, compression, and elevation. We may recommend crutches or temporary heel lifts to reduce load and manage pain, prioritising pain-modulated loading over complete rest.
• Restore Mobility: Your treatment will include gentle, pain-free range of motion exercises, soft-tissue work, and joint mobilisations where needed to restore flexibility without stressing the healing tissue.
• Strength & Loading: We will create a phased exercise programme starting with gentle isometrics, progressing to controlled calf raises (both with the knee straight for gastrocnemius and bent for soleus), and building up to heavy slow resistance, jumping, and running drills.
• Return-to-Sport Criteria: Before you return to your sport, we will ensure you meet key criteria, including symmetrical strength and endurance, and the ability to tolerate hop tests, sprints, and changes of direction.
• Education: We empower you with knowledge on how to pace your recovery, perform effective warm-ups, manage your training load, and monitor symptoms to prevent re-injury.

5. TIMELINE / EXPECTED RECOVERY

• Grade I (Mild): Recovery for everyday activities is often within 1–2 weeks. A return to sport with a full rehabilitation programme typically takes 2–4 weeks.
• Grade II (Moderate): These injuries usually require 3–6 weeks or more, depending on the demands of your activities and adherence to the rehab plan.
• Grade III (Significant Tear): A more severe tear can take 6–12 weeks or longer to heal. Some cases may require medical imaging or a specialist review.
• Following an early, structured loading programme significantly reduces the high risk of re-injury that comes with rushing back to activity too soon.

6. SELF-HELP & PREVENTION

• For the first 48–72 hours, focus on protection, relative rest, compression, and elevation. Avoid aggressive stretching if it causes sharp pain.
• Using small heel lifts in both shoes or wearing shoes with a slight heel can temporarily reduce strain on the calf in the early stages.
• Begin gentle, pain-free isometric contractions as advised. Progress to both straight-knee and bent-knee calf raises as symptoms allow.
• Gradually build your running tolerance. Start on flat surfaces and increase your distance before you increase your speed. Delay hill and sprint work until the later stages of your rehab.
• Maintain good strength in your hips and glutes and work on your ankle mobility. Always include dynamic warm-ups before sport.
• Stay well-hydrated and ensure you have adequate recovery time between hard training sessions.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

If you feel in doubt about your diagnosis or your calf problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

1. DEFINITION & ANATOMY

This section covers two related but distinct issues affecting the pelvis and inner thigh. A groin strain is an injury to the muscles of the inner thigh, most commonly the adductor muscles (especially the adductor longus) or the hip flexors. Sacroiliac (SIJ) pain refers to irritation or dysfunction of the sacroiliac joints, which are located where the base of your spine (sacrum) meets your pelvis. This pain can be related to the joint itself or the strong supporting ligaments. Both conditions can be triggered by the hormonal changes and increased load during pregnancy and postpartum, or by sporting movements like sprinting, changing direction, and kicking. A proper diagnosis is essential as the management for each differs, though strengthening the core and hip muscles is a common focus for both.

2. SYMPTOMS & SIGNS

• Groin Strain: A sharp pain in the inner thigh during activities like sprinting, cutting, or kicking; tenderness along the adductor muscles; pain when squeezing your legs together or stretching the inner thigh; possible bruising or swelling; stiffness after rest.
• SIJ Pain: One-sided low back or buttock pain that may refer into the groin; pain that worsens with prolonged standing or walking, rolling over in bed, or climbing stairs; tenderness over the back of the pelvis; pain with standing on one leg.

3. CAUSES & RISK FACTORS

• Pregnancy and the postpartum period, due to the hormone relaxin causing ligament laxity and changes in body load.
• Sudden increases in training intensity or an inadequate warm-up.
• Poor strength in the adductor muscles, hip flexors, deep core, or gluteal muscles.
• An imbalance between the inner thigh muscles (adductors) and outer hip muscles (abductors).
• Participation in sports that involve frequent cutting, kicking, or skating, such as football, hockey, and rugby.
• Poor movement control and coordination.
• A history of a previous groin strain or pelvic pain.

4. HOW PHYSIOTHERAPY HELPS

• Assessment: We perform a detailed evaluation to differentiate between an adductor strain, hip flexor issue, or SIJ-driven pain. We also screen for other potential problems like hip joint pathology or a hernia and consider any pregnancy or postpartum factors.
• Load Management: We help you modify aggravating activities and create a graded plan for your return to running, cutting, and kicking.
• Targeted Exercise: Your rehab will focus on what you need. This may include adductor strengthening (like Copenhagen progressions), core and pelvic stability exercises, and gluteal strengthening. We also address any mobility issues in the hips or spine.
• SIJ Strategies: For SIJ pain, we may recommend a temporary pelvic support belt, teach you specific motor control exercises to improve lumbopelvic stability, and use manual therapy or mobilisations where appropriate.
• Education: We provide advice on posture, optimal sleeping positions, and safe lifting techniques (especially important for perinatal clients), along with clear guidelines for monitoring your symptoms.
• Adjuncts: We may use taping or soft-tissue techniques to manage symptoms. For chronic tendon-related groin pain, shockwave therapy may be an option, but it is not a first-line treatment.

5. TIMELINE / EXPECTED RECOVERY

• Mild Groin Strains: With a proper rehab programme, a return to light sport is often possible within 2–4 weeks.
• Moderate Groin Strains: These typically require 4–8 weeks or more, depending on the demands of your sport.
• SIJ Pain: Symptoms often improve significantly within 4–6 weeks with targeted exercise and load management. Perinatal cases can fluctuate but respond well to tailored support and strengthening.
• Chronic or recurrent cases may require a longer, more progressive programme lasting 8–12 weeks or more.

6. SELF-HELP & PREVENTION

• In the early phase, reduce high-impact activities like sprinting and deep lunges, but stay active with comfortable movements like walking or cycling.
• Begin gentle range-of-motion and pain-free isometric exercises, such as adductor squeezes or core activation, before progressing to controlled strengthening.
• Always warm up thoroughly, including adductor-specific drills, before sports involving kicking or changing direction.
• For SIJ discomfort, you can try a pelvic support belt, practise “log-rolling” to get in and out of bed, and avoid prolonged standing on one leg in the early stages.
• Focus on building well-rounded hip and core strength, address any asymmetries, and prioritise sleep and recovery.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

If you feel in doubt about your diagnosis or your groin problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

1. DEFINITION & ANATOMY

A hamstring injury is a strain or tear affecting the group of three muscles at the back of the thigh (biceps femoris, semitendinosus, and semimembranosus). These injuries typically occur via one of two common mechanisms: high-speed running, where the muscle is rapidly overloaded as the leg swings forward, or a stretch-type injury from movements like kicking, high-stepping, or doing the splits. In some cases, the injury can involve the proximal hamstring tendon, which attaches the muscles high up on the “sit bone” (ischial tuberosity). A correct diagnosis of the grade and mechanism of injury is essential for guiding an effective rehabilitation plan.

2. SYMPTOMS & SIGNS

• A sudden, sharp pain felt in the back of the thigh.
• A distinct pulling or tearing sensation at the time of injury.
• Difficulty running, accelerating, or even walking normally.
• Tenderness when pressing along the length of the muscle or tendon.
• Bruising and/or swelling appearing on the back of the thigh, sometimes tracking down towards the knee.
• Stiffness and discomfort after periods of rest.
• Pain when performing a straight-leg raise or attempting to stretch the hamstring.
• Pain when resisting knee bending (flexion) or pushing the leg backwards (hip extension).
• Reduced sprint speed or a feeling of lost power.
• For proximal injuries near the sit bone, symptoms can include a deep buttock pain and significant discomfort when sitting.

3. CAUSES & RISK FACTORS

• Having a previous hamstring injury is the single biggest risk factor.
• An inadequate warm-up before intense activity.
• Rapid increases in training volume or speed work.
• Poor hamstring strength, especially eccentric strength (the muscle’s ability to lengthen under control).
• A strength imbalance where the quadriceps are much stronger than the hamstrings.
• Reduced hamstring flexibility or limited hip mobility.
• Weakness in the supporting gluteal and core muscles.
• Poor running or sprinting mechanics.
• General fatigue or inadequate recovery between training sessions.

4. HOW PHYSIOTHERAPY HELPS

• Assessment: We perform a thorough evaluation to grade the strain (I-III), identify the mechanism (sprint vs. stretch), and locate the exact site of injury. We also screen for more significant issues like proximal tendon involvement or a potential avulsion injury.
• Acute Care: We guide you on a plan of relative rest and pain-modulated loading, using compression to manage swelling. We advise on crutch use if needed and educate you on why aggressive stretching should be avoided in the early stages.
• Progressive Loading: Your recovery will be built around a phased exercise programme. This starts with gentle isometrics and progresses to eccentric strengthening (like Nordic curls and Romanian deadlifts) and lumbopelvic control exercises, building a robust foundation for your return to activity.
• Running Rehabilitation: We provide a structured, criteria-based return-to-running plan. This involves specific drills, building up stride length and speed, and safely reintroducing acceleration, deceleration, and changes of direction.
• Mobility & Adjuncts: We use gentle neural and soft-tissue techniques to restore pain-free movement without provoking symptoms. Manual therapy and taping may be used as needed to support your recovery.
• Education: A key part of our role is to teach you about load management, effective warm-up strategies, and how to recognise muscle soreness vs. pain, empowering you to prevent a recurrence.

5. TIMELINE / EXPECTED RECOVERY

• Grade I (Mild): Daily function often returns within 1–3 weeks. A return to running and sport typically takes 2–4 weeks or more with consistent rehab adherence.
• Grade II (Moderate): Recovery usually takes 4–8 weeks, though this can be longer depending on the demands of your sport and the specific injury location (stretch-type injuries can be slower).
• Grade III (Severe) / Suspected Avulsion: These injuries require 8–12 weeks or more. Some cases may need medical imaging and a specialist review.
• Following an early, criteria-based rehabilitation programme is the most effective way to reduce the high risk of re-injury.

6. SELF-HELP & PREVENTION

• In the first 48–72 hours, focus on protection, relative rest, and compression. Avoid aggressive stretching, especially if the injury occurred during a stretch.
• Begin gentle, pain-free isometric contractions as advised. Progress to eccentric strengthening exercises (like Nordics, sliders, and RDLs) alongside your glute and core work.
• Reintroduce running gradually, following a walk-jog plan before moving to strides and faster speeds. Avoid maximal sprinting until the final stages of your rehabilitation.
• Always warm up thoroughly before sport, including hamstring-specific preparation drills, and maintain good hip mobility.
• Pay attention to your overall training loads, recovery, and sleep to prevent fatigue-related injuries.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

If you feel in doubt about your diagnosis or your groin problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

1. Definition & Anatomy

Patellofemoral pain (PFJ pain) refers to discomfort around or beneath the kneecap (patella). It often occurs due to how the patella moves (or “tracks”) within the femoral groove during activities like walking, running, or squatting. The condition can involve irritation of the cartilage under the kneecap, leading to pain and inflammation.

2. Symptoms & Signs

• Pain when squatting, climbing stairs, or sitting for long periods (commonly called the “theatre sign”).
• Clicking or grinding sensations under the kneecap.
• Swelling, aching, or stiffness in the knee.

3. Causes & Risk Factors

• Overuse or repetitive stress: Activities like running or jumping can overload the knee.
• Poor hip/core strength: Weakness in these areas can lead to poor knee alignment.
• Flat or overpronated feet: This can alter biomechanics and increase strain on the knee.
• Muscle imbalances: An imbalance between the vastus medialis and lateralis muscles can affect patella tracking.
• Sudden increases in activity: Rapidly increasing running distance or intensity can trigger symptoms.

4. How Physiotherapy Helps

• Assessment: A physiotherapist will evaluate your gait, hip and foot biomechanics, strength, and flexibility.
• Treatment Plan: This may include manual therapy, taping, and exercise therapy to improve strength and stability.
• Load Management: Temporary modifications to activities to reduce strain on the knee.
• Modalities: Techniques like ultrasound or other clinic-specific treatments may be used to reduce pain and inflammation.

5. Timeline / Expected Recovery

• Mild cases: With consistent physiotherapy and adherence to exercises, improvement is often seen within 4-6 weeks.
• Severe or long-standing cases: Recovery may take several months, especially if cartilage damage is involved.

6. Self-Help & Prevention

• Strengthen key muscles: Focus on hips, quads, and glutes.
• Stretch tight areas: Pay attention to the IT band, hamstrings, and calves.
• Wear proper footwear: Consider orthotics if needed.
• Avoid rapid increases in activity: Gradually build up running or stair-climbing.
• Use ice and rest during flare-ups to manage pain.

7. When to See a Physio or Specialist

If you feel in doubt about your diagnosis or your knee problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

Don’t let knee pain hold you back. If you’ve been experiencing symptoms for more than 3-6 weeks or your pain is getting worse, book an appointment with one of our physiotherapists today. Let us help you get back to doing what you love, pain-free.

1. DEFINITION & ANATOMY

The forefoot is a complex area responsible for absorbing shock and propelling you forward. It contains five long bones called metatarsals, which connect your midfoot to your toes at the metatarsophalangeal (MTP) joints—commonly known as the ball of your foot. Supporting these joints are crucial structures like the tough plantar plate ligaments underneath, collateral ligaments on the sides, and small intrinsic foot muscles. Under the first MTP joint (the big toe) are two small, pea-sized sesamoid bones that act like pulleys for the tendons. The entire system relies on the powerful calf complex for control and power.

Forefoot pain can arise from several issues, including:

• Acute Fractures: A break in a metatarsal bone, usually from direct trauma.
• Stress Fractures: A small crack in the bone caused by repetitive overuse and overload.
• Metatarsalgia: A general term for pain and inflammation in the ball of the foot.
• Plantar Plate Sprain/Tear: Injury to the thick ligament under an MTP joint, often causing the toe to sit slightly elevated.
• Turf Toe: A sprain of the first MTP joint caused by hyperextension of the big toe.
• Capsulitis: Inflammation of the joint capsule surrounding an MTP joint.
• Morton’s Neuroma: While not a true metatarsal injury, this thickening of nerve tissue between the metatarsals can cause similar symptoms and must be differentiated.

2. SYMPTOMS & SIGNS

• Localised pain under the ball of the foot or along the shaft of one of the metatarsal bones.
• Swelling and bruising, especially after an acute injury like a stamp on the foot.
• Sharp pain during the push-off phase of walking, running, or sprinting.
• A general ache that develops after prolonged walking or standing.
• Stiffness in the MTP joints, particularly in the morning.
• Pain that is noticeably worse in narrow-toed or high-heeled shoes.
• Tenderness when you press on a specific metatarsal head or along the bone’s shaft.
• Pain when the forefoot is squeezed from side to side.
• Reduced ability to perform a single-leg calf raise due to pain.
• An altered or limping (antalgic) gait to avoid putting pressure on the forefoot.
• Pain when hopping on the affected foot.
• Stress fracture red flags: Pin-point tenderness on the bone, pain at night, and pain that worsens over time, even with rest.

3. CAUSES & RISK FACTORS

• Direct Trauma: A sudden blow, such as dropping something on the foot or a misstep off a curb.
• Sudden Spikes in Training: Rapidly increasing running distance, intensity, or frequency.
• Changes in Surface or Footwear: Switching from soft to hard running surfaces or wearing new or unsupportive shoes.
• Biomechanical Factors: Foot shapes or movement patterns like overpronation (flat feet), over-supination (high arches), or having a second toe that is longer than the big toe.
• Weak Muscles: Poor strength or endurance in the small intrinsic foot muscles and the larger calf muscles.
• Limited Ankle Mobility: Restricted ankle dorsiflexion (bending the ankle up) can force the forefoot to take more load.
• Hallux Rigidus: A stiff big toe joint that alters push-off mechanics.
• Inappropriate Footwear: Regularly wearing high-heeled or narrow, pointed shoes that compress the forefoot.
• Low Energy Availability / RED-S: Inadequate nutrition can compromise bone health.
• Vitamin D Deficiency: Important for bone density and health.
• Occupations: Jobs that require prolonged standing or walking on hard surfaces.

4. HOW PHYSIOTHERAPY HELPS

• Assessment: We start with a detailed history to understand your training loads and screen for stress fracture red flags. A physical examination will include palpation, special tests (like the tuning fork, hop, or fulcrum tests), and a thorough gait and footwear analysis. If a fracture or neuroma is suspected, we can help facilitate a referral for imaging.
• Manual Therapy: We use hands-on techniques to improve MTP joint mobility and perform soft-tissue release for tight structures like the plantar fascia, calf muscles, and peroneals to unload the forefoot. Taping can also be used to offload an irritated plantar plate or sesamoid bones.
• Exercise Therapy: You will receive a carefully graded loading programme. This begins with strengthening the intrinsic foot muscles (e.g., short-foot exercises, toe yoga) and progresses to building endurance in the calf complex. We will also address foot and ankle mobility and restore your balance. For runners, we will guide you through a specific return-to-running plan using hopping and plyometric progressions.
• Education & Habit Change: We will teach you the difference between relative rest and complete rest, and help you manage your training loads to prevent recurrence. We provide expert advice on footwear, recommending shoes with a roomy toe box, adequate cushioning, or rocker soles. We can also advise on in-shoe padding or off-the-shelf orthoses where appropriate.
• Adjuncts: We provide guidance on using ice or heat, and may recommend temporary use of a stiff carbon plate or steel shank insert for conditions like turf toe to limit painful movement. If a vitamin D deficiency or significant fracture is suspected, we will liaise with your GP.

5. TIMELINE / EXPECTED RECOVERY

• Plantar Plate Sprains/Capsulitis: These soft tissue injuries can take 4–8 weeks, or longer, to fully settle, depending on their severity and how well load is managed.
• Bone Stress Injuries: Uncomplicated stress reactions often improve within 6–8 weeks. Confirmed stress fractures typically require 6–12 weeks or more to heal, depending on the location and severity.
• Acute Fractures: Recovery will follow the timelines set by your orthopaedic consultant, which often involves a period of immobilisation in a boot.
• Early intervention is key. Symptoms almost always improve faster when aggravating loads are identified and managed early in the process.

6. SELF-HELP & PREVENTION

• During a Flare-up: Reduce high-impact activities like running and switch to cross-training like cycling or swimming. Avoid hills and sprinting. Consider using an over-the-counter metatarsal pad or a more cushioned insole. Apply ice for 10–15 minutes after activity to manage pain and swelling.
• Gentle Movement: Perform pain-free big toe mobility exercises and gentle intrinsic muscle activation (like trying to dome the arch of your foot).
• Build a Routine: When returning to running, use a gradual walk-jog progression. Focus on strengthening your calves and intrinsic foot muscles 2–3 times per week. Rotate your shoes regularly and check that the midsole cushioning hasn’t worn out.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

If you feel in doubt about your diagnosis or your metatarsal problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

Book your slot today to find out more.

Posterior Ankle Pain / Heel Pain / Fat Pad

1. DEFINITION & ANATOMY

Pain at the back of the ankle and heel can arise from several different structures. The anatomy in this area is complex, involving the large calcaneus (heel bone) which acts as the attachment point for the powerful Achilles tendon. Between the tendon and bone sits the retrocalcaneal bursa, a small fluid-filled sac that reduces friction, with another bursa (superficial calcaneal) located between the tendon and the skin. Kager’s fat pad sits just in front of the Achilles, while the plantar fat pad provides crucial cushioning directly under the heel bone. Deeper within the ankle, the posaterior part of the talus bone and tendons like the tibialis posterior and flexor hallucis longus (FHL) can also be sources of pain.

Common conditions we treat include:

• Achilles Tendinopathy: Irritation and degeneration of the Achilles tendon, either in its mid-portion (2-6cm above the heel) or at its insertion point on the heel bone (insertional).
• Retrocalcaneal Bursitis: Inflammation of the bursa located between the Achilles tendon and the heel bone.
• Haglund’s Deformity: A bony enlargement on the back of the heel bone that can irritate the bursa and Achilles tendon.
• Heel Fat Pad Irritation: Bruising or irritation of the shock-absorbing fat pad under the heel, which must be differentiated from plantar fasciitis.
• Posterior Ankle Impingement: When soft tissues or a small extra bone (Os Trigonum) get pinched at the back of the ankle joint during pointing of the foot.
• FHL or Tibialis Posterior Tendinopathy: Irritation of tendons that run deep behind the ankle, common in dancers, runners, or people with flat feet.

2. SYMPTOMS & SIGNS

• Pain Location: Can be specific to the back of the heel (insertional/bursitis), higher up the tendon (mid-portion), deep inside the ankle when pointing the toes (impingement), or directly under the centre of the heel (fat pad).
• Morning Stiffness: Significant pain and stiffness upon taking the first few steps in the morning, which often eases as you warm up.
• Warm-up Effect: Pain that lessens during the initial part of an activity but returns afterwards, often worse the next day.
• Swelling or Thickening: A noticeable lump or thickening in the mid-portion of the Achilles tendon or swelling around the insertion.
• Pain with Activity: Symptoms are typically aggravated by uphill running, sprinting, jumping, or pointing the toes.
• Pain on Heel Strike: A deep, bruise-like pain directly under the heel when walking, characteristic of fat pad irritation.
• Crepitus or Snapping: A clicking or snapping sensation at the back of the ankle, sometimes associated with FHL tendinopathy.
• Red Flags: Following a trauma (like a forced pointing of the foot), persistent deep posterior pain could indicate a fracture of the posterior talar process.

3. CAUSES & RISK FACTORS

• Sudden Spikes in Training: Rapidly increasing running distance, speed, or introducing hill repetitions.
• Biomechanical Factors: Tight calf muscles, limited ankle dorsiflexion (bending the ankle up), overpronation (flat feet) which loads the tibialis posterior, or high-arched (cavus) feet.
• Poor Footwear: Shoes with a rigid, rubbing heel counter can irritate the bursa and Achilles insertion. Switching abruptly from high heels to flat shoes can also overload the tendon.
• Haglund’s Deformity: A pre-existing bony prominence on the heel.
• Hard Surfaces: Regularly running or walking on unforgiving surfaces.
• Previous Ankle Sprain: An old injury can alter mechanics and increase load on surrounding structures.
• Specific Sports: Activities requiring repeated pointing of the foot and ankle, such as ballet, gymnastics, or football (kicking).
• Systemic Factors: Certain medical conditions or medications (like fluoroquinolone antibiotics) can increase the risk of tendon problems.

4. HOW PHYSIOTHERAPY HELPS

• Assessment: We start with a detailed history to identify changes in your training load. A physical examination will involve mapping the precise location of your pain through palpation, assessing calf flexibility, ankle range of motion, and testing your strength with tasks like single-leg heel raises and hopping. We will differentiate between fat pad pain and plantar fasciitis and assess the function of tendons like tibialis posterior and FHL. We also analyse your footwear. If a fracture is suspected, we can refer you for imaging.
• Manual Therapy: We use hands-on techniques like ankle and subtalar joint mobilisations and soft-tissue release for the calf, Achilles, and other tight structures. We may also use taping to offload the fat pad or Achilles tendon.
• Exercise Therapy: This is the cornerstone of recovery. You will receive a graded loading programme, often starting with isometric holds for pain relief. This progresses to specific calf raise variations (both bent and straight knee) and, for insertional issues, modifications to avoid painful end-range positions initially. We also target other relevant muscles (e.g., tibialis posterior, foot intrinsics) and guide you through a safe return to running and sport with plyometric drills.
• Education & Habit Change: We will teach you how to manage your activity levels to allow for healing. We’ll provide advice on avoiding direct compression on the tendon, modifying footwear (e.g., finding shoes with a softer heel counter or using a small heel lift), and using ice or heat appropriately.
• Adjuncts: For chronic tendinopathies, shockwave therapy can be an effective treatment option. We can also advise on orthoses for issues like tibialis posterior dysfunction and liaise with your GP regarding imaging or medication.

5. TIMELINE / EXPECTED RECOVERY

• Mid-Portion Achilles Tendinopathy: These often require a consistent loading programme over 8–12 weeks or more.
• Insertional Achilles Tendinopathy: Can be more stubborn and often takes 12+ weeks to resolve fully.
• Bursitis & Fat Pad Irritation: With appropriate load management and footwear changes, these can settle within 2–6 weeks.
• Posterior Impingement: Conservative management can be effective over 4–8 weeks, though some persistent cases may require specialist surgical review.
• FHL/Tibialis Posterior Tendinopathy: Typically requires a 6–12 week progressive strengthening programme.

6. SELF-HELP & PREVENTION

• During a Flare-up: Reduce or stop aggravating activities like hill running and sprinting. Avoid shoes with a hard, rigid heel counter. A gel heel cup or temporary heel lift can provide short-term relief. Apply ice for 15 minutes after activity.
• Gentle Movement: Perform gentle calf mobility exercises and pain-free isometric heel raises (e.g., holding a calf raise position for 30-45 seconds).
• Build a Routine: As symptoms settle, gradually reintroduce walk-run intervals. To prevent recurrence, incorporate calf strengthening 2–3 times per week, work on your balance, and rotate your footwear regularly.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

If you feel in doubt about your diagnosis or your posterior ankle problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

Book an appointment today for expert advice on ankle pain.

1. DEFINITION & ANATOMY

Posterior knee pain refers to any discomfort felt at the back of the knee, in an area known as the popliteal fossa. This is a busy anatomical region where the thigh bone (femur) meets the shin bone (tibia). It is stabilised by ligaments like the Posterior Cruciate Ligament (PCL) and contains the back portions (posterior horns) of the shock-absorbing menisci.

Many important structures run through or attach here, including the hamstring muscles (semimembranosus, biceps femoris), the calf muscles (gastrocnemius), and the smaller popliteus and plantaris muscles. These are surrounded by bursae (fluid-filled sacs) that reduce friction, most notably the one that can swell to form a Baker’s Cyst. Crucial arteries, veins, and nerves also pass through this space. Pain can also be referred to the back of the knee from the lower back or hip.

2. SYMPTOMS & SIGNS

• A dull ache or sharp pain located at the back of the knee.
• Stiffness after periods of sitting, which improves with movement.
• Pain that is triggered by deep knee bends, walking down stairs, running (especially uphill), or pushing off.
• Tenderness when pressing on the hamstring or calf muscle insertions, or deep within the back of the knee.
• A feeling of fullness, swelling, or a palpable lump behind the knee (often a Baker’s Cyst).
• Catching, clicking, or a feeling of instability.
• Difficulty fully straightening the knee (reduced terminal extension).
• Pain when resisting a knee bend (resisted flexion) or performing a calf raise.
• Pain when stretching the hamstring muscles.
• Red Flags: Sudden, significant calf swelling, redness, and warmth (suspicion of a DVT, which requires immediate medical attention); severe pain and swelling after trauma with an inability to bear weight; or true locking of the knee.

3. CAUSES & RISK FACTORS

• Overuse: Sudden increases in running distance, introducing hill work, or a spike in training load.
• Hamstring or Calf Tendinopathy: Irritation of the tendons where they attach at the back of the knee.
• Popliteus Strain: Injury to the small muscle that helps “unlock” the knee from a straight position.
• Meniscal Tears: A tear in the posterior horn of the meniscus can refer pain to the back of the knee.
• PCL Sprain: Injury to the Posterior Cruciate Ligament, often from a direct blow to the front of the shin (a “dashboard injury”) or from hyperflexion of the knee.
• Baker’s Cyst: Swelling of a bursa at the back of the knee, which is almost always a secondary sign of an underlying issue within the knee joint, such as arthritis or a meniscal tear.
• Biomechanical Factors: Poor hip and gluteal strength, limited ankle flexibility, or running with an over-striding gait.
• Previous Knee Injury: An old injury can alter mechanics and overload posterior structures.
• Occupations: Jobs that involve repetitive kneeling or squatting.
• Age-related degeneration (osteoarthritis) or inflammatory conditions.

4. HOW PHYSIOTHERAPY HELPS

• Assessment: We conduct a thorough assessment to determine the source of your pain. This includes a detailed history, specific palpation, and clinical tests for the ligaments (e.g., Posterior Drawer test for the PCL) and menisci (e.g., McMurray’s test). We will assess your muscle strength, joint range of motion, balance, and analyse your gait or running pattern. Crucially, we will screen for any red flags and can liaise with your GP for imaging if necessary.
• Manual Therapy: We use hands-on techniques like knee joint mobilisations to improve movement, and soft-tissue release for tight hamstrings, calf muscles, or the popliteus. In some cases, gentle neural mobilisations can help if nerve tension is a factor.
• Exercise Therapy: You will receive a graded exercise programme tailored to your specific diagnosis. This may include isometric exercises for pain relief, progressing to a loading plan for the hamstrings and calves (e.g., bridges, eccentric exercises, Nordic curls). We will also focus on strengthening the quadriceps and improving hip/gluteal control and ankle mobility. Restoring full knee extension and a progressive return-to-sport plan are key components.
• Education & Habit Change: Understanding how to manage your activities is vital. We provide education on load management, the importance of gradual progression, correct warm-up and cool-down procedures, and footwear advice. For runners, we can provide cues to adjust cadence to reduce over-striding.
• Adjuncts: We may use taping or a brace for short-term support, and provide guidance on using heat or ice. For large, symptomatic Baker’s Cysts, we can advise on management options and liaise with your GP.

5. TIMELINE / EXPECTED RECOVERY

• Mild Muscular or Tendinous Strains: These often respond well to physiotherapy within 2–6 weeks.
• Hamstring or Calf Tendinopathy: These can be more persistent and may require a dedicated loading programme for 6–12 weeks or more.
• Meniscal Irritation: Recovery is variable, but a 6–12 week period of targeted rehabilitation can often be very effective.
• PCL Sprains (Grade I-II): These ligament injuries typically require a structured rehabilitation plan over 6–12 weeks to restore stability and strength.
• Baker’s Cyst: The cyst itself will resolve once the underlying cause within the knee is successfully treated.

6. SELF-HELP & PREVENTION

• During a Flare-up: Modify your activity. Reduce hill work and deep squats, and switch to lower-impact activities like cycling on the flat or swimming. Apply ice for 10–15 minutes to manage pain and swelling.
• Gentle Movement: Perform pain-free range of motion exercises like heel slides. Gentle isometric holds for your quads, hamstrings, and calves can help maintain muscle activation without aggravating the knee.
• Build a Routine: To prevent recurrence, incorporate a regular strengthening programme for your hips, glutes, and hamstrings 2–3 times per week. Maintain good mobility in your hips and ankles. When returning to running, do so gradually.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

If you feel in doubt about your diagnosis or your posterior knee problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

Knee pain is one of the most common complaints we help in clinic. Book to see us today.

1. DEFINITION & ANATOMY

Shin splints, known clinically as Medial Tibial Stress Syndrome (MTSS), is an overuse injury characterised by exercise-induced pain along the inner border of the shin bone (tibia). It’s not an injury to a single muscle, but rather a stress reaction at the interface where muscles and fascia attach to the bone’s sensitive outer layer, the periosteum.

Key structures involved include the tibia itself, and the deep posterior compartment muscles that run alongside it, such as the tibialis posterior, soleus, and flexor digitorum longus. The entire calf complex and the small intrinsic muscles of the foot also play a crucial role in absorbing load. MTSS is essentially a bone-loading injury, representing a point on a spectrum that, if ignored, can progress to a more serious tibial stress fracture. It’s important to differentiate it from a stress fracture (more localised pain) and Chronic Exertional Compartment Syndrome (CECS), which involves pressure build-up and neurological symptoms.

2. SYMPTOMS & SIGNS

• A gradual onset of a dull, aching pain along the inner, lower two-thirds of the shin bone, felt during and after exercise.
• Tenderness to touch over a broad area (usually more than 5cm) along the medial border of the tibia.
• Morning stiffness or pain with the first few steps of the day.
• A typical pain pattern during a run: pain may appear at the start, ease off as you warm up, then return with greater intensity later in the run or afterwards.
• Pain that is worse when running on hard surfaces or hills.
• You may feel lumpy or thickened areas along the bone where the pain is most intense.
• Pain when hopping on the affected leg.
• Stress Fracture Red Flags: Very localised, focal point tenderness (an area you can cover with one fingertip); pain that occurs at night or at rest; and a positive hop test that produces sharp, immediate pain.
• CECS Clues: Symptoms that include a feeling of intense tightness, cramping, tingling, or numbness that builds predictably during a run and resolves quickly with rest.

3. CAUSES & RISK FACTORS

• Rapid Training Spikes: The most common cause is doing “too much, too soon”—suddenly increasing running mileage, intensity, or introducing hill work.
• Changes in Surface or Footwear: Switching from soft to hard running surfaces or wearing worn-out or inappropriate shoes.
• Biomechanical Factors: Foot mechanics like overpronation (flat feet) or having very high, rigid arches (pes cavus).
• Muscle Imbalances: Tightness or weakness in the calf and soleus muscles, or poor strength in the hip abductor (gluteal) muscles.
• Running Gait: A low running cadence (fewer steps per minute) or over-striding can increase impact forces on the tibia.
• Limited Ankle Dorsiflexion: Restricted ability to bend the ankle upwards can alter running mechanics.
• Low Energy Availability / RED-S: Inadequate nutrition relative to training demands, which can compromise bone health.
• Vitamin D deficiency and low bone mineral density.
• A previous history of MTSS.

4. HOW PHYSIOTHERAPY HELPS

• Assessment: We perform a thorough assessment, starting with a detailed history of your training load. We will map the tender area via palpation and use tests like the hop test to help rule out a stress fracture. We assess calf and soleus strength and length, single-leg control, and perform a running gait analysis to identify factors like low step rate or foot crossover. If a stress fracture or CECS is suspected, we can facilitate a referral to your GP or a specialist.
• Manual Therapy: We may use soft-tissue techniques for the calf, soleus, and tibialis posterior muscles to reduce tension, along with gentle techniques to desensitise the tibial periosteum. Mobilisations for the ankle and foot can also help improve mechanics. Taping can be used to temporarily support the arch or offload the tibia.
• Exercise Therapy: This is the key to long-term success. We will create a graded loading programme starting with pain-free activity. This will include specific calf strengthening, with an emphasis on the soleus muscle (e.g., bent-knee calf raises), and progressing to heavy slow resistance. We will also address foot intrinsic strength, hip and gluteal control, and balance. As you improve, we will guide you through a structured return-to-run plan.
• Education & Habit Change: We will teach you crucial load management principles, such as the “10% rule” for safe training progression. You will receive guidance on footwear, the benefits of shoe rotation, and how to manage different running surfaces. We may recommend a temporary increase in your running cadence (steps per minute) by 5–10% to reduce impact forces.
• Adjuncts: We will provide advice on using ice post-run, shock-absorbing insoles, and can liaise with your GP regarding bone health concerns like Vitamin D levels if indicated.

5. TIMELINE / EXPECTED RECOVERY

• Mild MTSS: With prompt and effective load modification, symptoms often improve significantly within 3–6 weeks.
• Moderate Cases: These may require a more structured rehabilitation plan over 6–10 weeks.
• Severe or Recurrent Cases: Long-standing issues can take 10–12 weeks or longer to resolve, requiring consistent adherence to a strength and conditioning plan.
• Early management is crucial. The sooner you address the contributing factors, the faster your recovery will be.

6. SELF-HELP & PREVENTION

• During a Flare-up: Reduce or replace high-impact activity. Switch to cross-training like cycling, swimming, or using the elliptical. Avoid running on hills or heavily cambered roads.
• Symptom Management: Apply ice for 10–15 minutes after activity. Gentle calf and soleus stretches may be helpful if they are pain-free. Compression sleeves can sometimes provide symptomatic relief.
• Build a Routine: To prevent recurrence, build a consistent strengthening routine for your calves, soleus, hips, and glutes 2–3 times per week. When you return to running, do so gradually and pay attention to your cadence.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

If you feel in doubt about your diagnosis or your shin splint problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

If you suspect shin splints, make an appointment with us.

1. DEFINITION & ANATOMY

Pain in the thigh is common among active individuals and can arise from either a muscle strain or an overuse condition like Iliotibial Band (ITB) Syndrome.

• Thigh Strains: These are acute injuries involving the tearing of muscle fibres. They are graded based on severity:
  • Grade I: A mild strain with minor tearing of muscle fibres.
  • Grade II: A moderate tear involving a significant portion of the muscle.
  • Grade III: A complete rupture of the muscle.
    This can happen to any of the major muscle groups in the thigh: the hamstrings (at the back), the quadriceps (at the front), or the adductors (on the inside).
• Iliotibial Band (ITB) Syndrome: This is an overuse condition, not a muscle strain. It causes pain on the outside of the knee. The ITB is a thick band of connective tissue that runs from the side of your hip down to just below your knee. ITB syndrome occurs when this band becomes irritated, often due to friction or compression as it passes over the bony prominence on the outer side of the femur (lateral femoral epicondyle) when the knee repeatedly bends and straightens.

2. SYMPTOMS & SIGNS

• Thigh Strains:
  • A sudden, sharp pain in the front, back, or inside of the thigh during an activity like sprinting or kicking.
  • A “popping” or tearing sensation at the time of injury.
  • Pain when stretching the affected muscle or using it against resistance.
  • Swelling and bruising (which may appear a day or two after the injury).
  • In a Grade III tear, there may be a palpable gap in the muscle and a significant loss of function.
• ITB Syndrome:
  • A sharp or burning pain on the outer side of the knee.
  • Pain that typically starts after a certain period of running and worsens as the run continues, forcing you to stop.
  • The pain often subsides with rest but returns with the next run.
  • Tenderness when pressing on the outer side of the knee.
  • Pain may be worse when running downhill or descending stairs.
• Red Flags: An inability to walk or bear weight after an injury, a visible deformity, or a large, palpable gap in the muscle may indicate a complete rupture and warrants urgent assessment. Deep, localised bone pain could suggest a stress fracture.

3. CAUSES & RISK FACTORS

• Thigh Strains:
  • Sudden Acceleration/Deceleration: Activities like sprinting, jumping, or kicking place high demands on the thigh muscles.
  • Inadequate Warm-up: Cold muscles are less flexible and more prone to tearing.
  • Muscle Fatigue: Over-tired muscles are less able to absorb shock and are more susceptible to injury.
  • Muscle Imbalances: For example, significantly stronger quadriceps compared to hamstrings can increase the risk of a hamstring strain.
  • Previous Injury: A prior strain can leave scar tissue, making the muscle more vulnerable to re-injury.
• ITB Syndrome:
  • Rapid Increase in Training Volume: A sudden spike in running mileage is a classic cause.
  • Running Technique: An over-striding gait or a “crossover” running pattern (where feet land across the body’s midline) can increase strain on the ITB.
  • Weakness in Hip Muscles: Weakness in the gluteal muscles (particularly gluteus medius) can lead to poor pelvic control and increased tension through the ITB.
  • Excessive Downhill Running.

4. HOW PHYSIOTHERAPY HELPS

• Assessment: A precise diagnosis is vital. For thigh strains, we conduct a thorough physical examination to grade the injury, identify the exact muscle involved, and test your strength and flexibility. For ITB syndrome, we assess your pain patterns and perform specific clinical tests. A key part of our assessment is a biomechanical analysis, including observing your walking and running gait, to identify underlying causes like muscle weakness or poor technique.
• Manual Therapy: In the early stages, we use techniques like soft-tissue massage to the surrounding areas to manage pain and swelling. As you recover, we can use more specific techniques to improve tissue mobility.
• Exercise Therapy: This is the foundation of recovery and prevention. You will receive a structured, progressive rehabilitation programme:
  • For Strains: We start with gentle isometric holds for pain relief, progressing to strengthening exercises (eccentrics and heavy slow resistance), and finally reintroducing dynamic, sport-specific movements like hopping, plyometrics, and a guided return-to-running plan.
  • For ITB Syndrome: The focus is on strengthening the hip and gluteal muscles to improve control and reduce strain on the ITB, alongside load management.
• Education & Load Management: We teach you how to modify your training to allow the tissue to heal without becoming deconditioned. We will guide you on how to structure a safe and gradual return to your sport.
• Adjuncts: We may use taping techniques to offload injured tissue. For chronic tendinopathies that sometimes accompany muscle strains, shockwave therapy can be an effective treatment option. If a complete rupture is suspected, we will refer you for an urgent scan.

5. TIMELINE / EXPECTED RECOVERY

• Grade I Strain: Typically requires 2–4 weeks of rehabilitation before a return to sport.
• Grade II Strain: Often takes 4–8 weeks, requiring a more comprehensive strengthening programme.
• Grade III Strain / Rupture: These are significant injuries. A complete rupture can take 3–6 months or longer to fully rehabilitate, and sometimes requires surgical review.
• ITB Syndrome: With appropriate load management and a targeted strengthening programme, symptoms often improve significantly within 4–8 weeks.

6. SELF-HELP & PREVENTION

• During a Flare-up: For an acute strain, follow the PEACE & LOVE principle (Protection, Elevation, Avoid Anti-inflammatories, Compression, Education & Load, Optimism, Vascularisation, Exercise). For ITB syndrome, temporarily reduce running volume to a level that does not provoke pain.
• Gentle Movement: For strains, start gentle, pain-free mobility and isometric exercises as soon as possible. For ITB syndrome, focus on gluteal activation exercises.
• Build a Routine: To prevent recurrence, incorporate regular strengthening for the hamstrings, glutes, and quadriceps into your weekly routine. Always warm up thoroughly before sport and avoid sudden, dramatic increases in training intensity or volume.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

If you feel in doubt about your diagnosis or your thigh problem is not resolving book a physiotherapy assessment with one of our physiotherapists.

A complete rupture can sometimes take between nine and 12 months to heal, so don’t put off an appointment for thigh strains and ITB issues. Book to come and see us ASAP.

1. DEFINITION & AREAS WE SUPPORT

Women’s Health Physiotherapy is a specialist area dedicated to supporting women through all stages of life, from pregnancy and the postnatal period to perimenopause, menopause, and beyond. It focuses on the assessment, treatment, and management of conditions related to the pelvic floor, abdomen, and musculoskeletal system.

Many women experience issues like pelvic floor weakness, abdominal separation, or bladder and bowel problems, particularly after childbirth or during hormonal changes. These conditions are common, but they are not something you have to live with. Specialist physiotherapy provides the knowledge, targeted treatment, and correct exercises to restore function, reduce pain, and empower you to live an active, confident life.

We’re lucky enough to have a dedicated Women’s Health Physiotherapist at W5Physio. Learn more about Vicky here. The support she provides includes:

• Pregnancy & Postnatal Recovery: Preparing for birth, recovering from delivery (vaginal or c-section), treating Diastasis Recti (tummy gap), and safely returning to exercise. We are also certified providers of the Mummy MOT.
• Pelvic Floor Dysfunction: Addressing weakness, overactivity (tension), pain, and symptoms of Pelvic Organ Prolapse.
• Bladder & Bowel Health: Managing incontinence (stress and urge), urgency, frequency, constipation, and issues with emptying.
• Menopause Transition: Supporting the body through perimenopause and menopause, addressing issues like vaginal dryness, joint pain, and changes to pelvic health.
• Sexual Dysfunction: Helping with pain during intercourse (dyspareunia) and other intimacy-related issues.

2. COMMON SYMPTOMS & SIGNS

You may benefit from seeing a Women’s Health physiotherapist if you experience any of the following:

• Bladder Leakage: Leaking urine when you cough, sneeze, laugh, jump, or run (stress incontinence).
• Urgency: A sudden, desperate need to go to the toilet, which can sometimes result in leakage (urge incontinence).
• Pelvic Heaviness or Dragging: A sensation of something “coming down” inside the vagina, which can be a sign of Pelvic Organ Prolapse.
• Tummy Gap or “Doming”: A visible gap or bulging along the midline of your abdomen, known as Diastasis Recti.
• Pelvic or Lower Back Pain: Persistent pain in the pelvis, hips, or lower back that hasn’t responded to other treatments.
• Painful Sex: Discomfort or pain during or after intercourse.
• Bowel Issues: Difficulty with constipation, straining, or a feeling of incomplete emptying.
• Menopause-related Symptoms: New or worsening joint aches, vaginal dryness, or changes in your bladder habits.

3. CAUSES & RISK FACTORS

These conditions can develop for many reasons and are influenced by hormonal changes and physical stresses throughout a woman’s life.

• Pregnancy and Childbirth: The weight of the growing baby and the process of delivery place significant strain on the pelvic floor and abdominal muscles.
• Menopause: The decline in oestrogen during perimenopause and menopause can affect muscle mass, tissue elasticity, and joint health, impacting the pelvic floor and contributing to bladder symptoms.
• High-Impact Exercise: Repetitive jarring activities like running can place stress on the pelvic floor if it isn’t functioning optimally.
• Chronic Straining: Long-term constipation or persistent coughing can weaken the pelvic floor over time.
• Poor Posture and Lifting Technique: Incorrect mechanics can increase pressure on the abdomen and pelvic floor.
• Previous Surgery: Gynaecological or abdominal surgery can affect pelvic floor and core function.

4. HOW PHYSIOTHERAPY HELPS

So much can be achieved through correct knowledge, treatment, and exercise. Our approach is sensitive, confidential, and tailored to you.

• Specialist Assessment: We start with a detailed conversation about your symptoms, history, and goals. This may include a comprehensive pelvic health assessment, which can involve an internal pelvic floor examination. This is the gold standard for accurately assessing muscle strength, tone, and coordination, but it is only ever performed with your informed consent and utmost comfort. We are also official providers of the Mummy MOT, a detailed postnatal check-up.
• Education and Lifestyle Strategies: We empower you with knowledge about your body. We provide practical advice on bladder and bowel habits, fluid intake, diet, and strategies to manage your symptoms in daily life.
• Pelvic Floor Muscle Training: We teach you how to correctly contract, relax, and coordinate your pelvic floor muscles. It’s not just about squeezing; it’s about restoring optimal function, whether the issue is weakness or over-tension.
• Core Rehabilitation: We guide you through a safe and progressive exercise programme to address Diastasis Recti and rebuild your core strength from the inside out.
• Manual Therapy: We may use hands-on techniques to release tight muscles in the pelvis, back, and hips that may be contributing to your pain.
• Return to Exercise Guidance: We provide a structured plan to help you safely return to the activities you love, whether it’s running, weightlifting, or yoga, without aggravating your symptoms.
• Collaboration: We work closely with your GP, gynaecologist, or other specialists and can provide onward referrals when necessary.

5. TIMELINE / EXPECTED RECOVERY

• Recovery is highly individual. For postnatal recovery or managing incontinence, many women notice significant improvements within 6-12 weeks of starting a consistent, targeted programme.
• More chronic or complex conditions, such as pelvic pain or prolapse management, may require a longer-term approach over 3-6 months to build strength and change habits.
• The key is consistency. Our goal is to give you the tools and confidence to manage your health for the long term.

6. SELF-HELP & PREVENTION

• Mindful Movement: Pay attention to your posture and learn how to lift correctly, using your legs and engaging your core to avoid straining.
• Bowel Health: Avoid straining on the toilet. A healthy diet rich in fibre and adequate fluid intake are crucial for preventing constipation.
• Learn to Relax Your Pelvic Floor: Your pelvic floor needs to relax just as much as it needs to contract. Practice diaphragmatic (belly) breathing to help release tension.
• Be Patient Postnatally: Allow your body time to heal after birth. Avoid high-impact exercise until you have rebuilt your core and pelvic floor foundations.

7. WHEN TO SEE A PHYSIO OR SPECIALIST

These conditions should not be something you just “put up with” because you have had a baby or are going through menopause. It’s time to book an appointment if:

• You leak urine or faeces, no matter how small the amount.
• You feel a sense of heaviness or a bulge in your vagina.
• You have pain in your pelvis, lower back, or during sex.
• You have had a baby and want a comprehensive check-up (Mummy MOT) to guide your recovery.
• You are entering perimenopause or menopause and want to proactively manage your pelvic and musculoskeletal health.

Learn more about the Mummy MOT here. Or, book in today for the health check you deserve.