Achilles tendon pain (tendinopathy), best advice & exercises

Achilles tendon pain

Whether you’re sporty or sendentry, male or female pain in the Achilles tendon is common problem.

If you’re suffering with a problem with your Achilles tendon then it’s likely to be tender to touch and may feel stiff, particularly in the morning. Pain during the type of exercise that involves direct impact, such as running and walking, is also common.

What is an Achilles tendinopathy? 

Your Achilles tendons are the biggest, strongest tendons in your body. They attaches your calf muscles to your heel bones, helping you to lift your heel and propel forward when walking or running.

Your Achilles tendons adapts rapidly to cope with the demands of your activites. However, pain can develop if you exceed it’s capacity to adapt and an imbalance develops between the ‘wear and repair’ processes in the tendon. We call this process tendinopathy and as physios we think about this process in two different stages, which acts as a guide to the best treatment:

  1. Reactive stage

This is the very early stages of a tendinopathy. During this stage there may be some thickening of the Achilles tendon, stiffness and pain. This stage is completely reversible and the tendon will return to a normal, pain free state again if managed appropriately.

The best advice is to reduce all activities that cause pain to a level where you can do them comfortably. Unfortunatley, for some activities you might need to stop altogether for a short period. This is to allow your symptoms to settle. During this phase, ice and taping can be helpful and your GP may recommend a course of anti-inflammatories.

Once your symptoms have settled it’s vital to build up any previously painful activites in a very structured way and a physiotherapist can help with this.

  1. Degenerative stage: 

This stage is the next step on from the reactive phase. It’s associated with persistent pain and normally more in the middle-aged population. It can happen if the reactive stage is not managed appropriately and excessive pressure has been placed upon the Achilles tendon repeatedly.

In this stage your Achilles tendon will be thickened more with nodular sections and there are physical changes in the structure of the tendon which would be seen on an ultrasound scan. These changes are not reversible but appropriate treatment to strengthen the tendon mean that it can function is a pain free way again.

What are the risk factors of developing Achilles tendinopathy? 

Excessive and sudden increases in exercise are often the cause of developing tendinopathy however there are some other risk factors linked to this issue such as  your age, your body weight, being diabetic, tightness or weakness in the calves or less optimal movement pattern causing increased pressure on the Achilles tendon.

A physiotherapist would be able to advise you of all the underlying factors that may have contributed to your symtpoms and this would be taken into account in recommending an appropriate treatment programme.

What are the best exercises for strengthening the Achilles tendon:

Isometric ‘press and hold’ exercises are recommended to relieve pain for all patients suffering from Achilles tendon pain, whether in the reactive or degenerative phases of this condition.

Depending on the severity of your symptoms, you can practice these exercises either with both legs (slightly easier) or on one leg.Isometric exercise for the achilles tendinopathy

Hold each lift for 45 seconds and repeat 5 times.

Take a break of 15 seconds in between each repetition.

Repeat up to 4 times per day.

The benefits of Shockwave therapy for Achilles tendon pain

Shockwave therapy is recommended if you are in the degenerative stage of tendinopathy. It’s a mechanical treatment applied to the tendon which kick starts the healing process again and relieves pain.


Please don’t hesitate to get in touch if you have any further questions.

The Physiofit team!

How to use a TENS machine to relieve back pain


A TENS machine - used for treatment of back pain

You might have been recommended a TENS (transcutaneous electrical nerve stimulation) mechine as part of your treatment for back pain. This helpful medical device won’t ‘cure’ your symptoms but it can provide short-term pain relief and it’s a useful alternative or addition to pain medication.

What is a TENS machine and how does it work?

A TENS machine is a small battery-powered unit which adheres to your skin via  sticky pads  called electrodes. The electrodes trasmit small electrical impulses,  creating a tingling or pins and needles sensation in your skin which distracts the nerves in the area to reduce pain signals and help relax muscle spasm. The effects can last for up to 4 hours afterwards.

How to use a TENS machine properly

Each individual TENS unit comes with an instruction manual which will explain the different settings and most include pictures to show you where to stick the the electrodes. Every brand of machine is slightly different so please do read your instruction manual.

You can choose to use either 2 or 4 electrode pads depending on how large the area of pain is that you are treating.

If your lower back pain is on one side, try using two electrodes. Place one pad at the top point of the pain and one pad below (about 1 inch apart). Try to place the pads on the muscle as opposed to directly onto your back bones:

Application of the TENS pads electrodes

If you have pain in the middle of your back or either side of your spine, try using 4 electrodes. Place placing one electrode either side of your spine at the top point of your pain about 1 inch out from the spine. Place the other two either side of your spine at the base of your pain, again 1 inch out from the spine:

Where to place TENS electrodes, 4 pads

The unit itself can be hooked onto a belt loop or the to of your trousers, so you can carry on with your normal activities whilst using it.


  • For pain that has started recently (acute pain) – use the ‘constant’ or ‘normal’ setting. Set the pulse rate to between 80Hz – 120Hz and a pulse width between 175uS – 200uS.
  • For pain you have had for more than a few weeks (chronic or persistent pain) – use the ‘modulation’ setting to prevent your body getting used to the stimulation, which would make the unit less effective. Set the pulse rate to between 2Hz – 10Hz and a pulse width between 175uS – 200uS.
  • Time – you can leave your machine on for 30 to 60 minutes at a time and use around 4 times a day. If you have the machine on constantly throughout the day you will find it becomes less effective.

Do not use TENS without first seeking medical advice if you have any of the following:

  • Pacemaker/heart problem
  • Epilepsy
  • Pregnancy – do not use during the first trimester. TENS can be used later in pregnancy but please consult a medical practitioner first.
  • Do not use to mask undiagnosed pain

Other precautions:

  • Do not drive, shower/bath or sleep whilst using your TENS machine.
  • Do not apply heat or ice to the area at the same time as using the TENS unit.
  • Do not place the electrode pads over broken skin, near/over your eyes, at the front/sides of your neck, over your mouth, over any numb areas of skin or on your abdomen during pregnancy.

Most people do not experience any adverse side-effects to using TENS. However very occasionally your area of pain may become more sensitive – if this occurs then stop using immediately. Some people may also experience a reaction to the electrode pads, such as itching/rash. Again, stop using immediately if this occurs.

Please don’t hesitate to get in touch if you have any further questions,

The Physiofit Team!

ACL repair, reconstruction and rehabilitation

Rugby players after ACL rehab

Not everyone who tears their anterior cruciate ligament (ACL) requires surgery to repair it.

Your decision will depend on the extent of the tear, how stable your knee feels, your lifestyle and the sports and hobbies you normally take part in.

For example, if you have fully ruptured your ACL and you normally participate in a sport which requires lots of sudden movements, like football or squash, then it’s more likely that you will require a surgery.

If you do opt to have surgery, you’ll be given post-operative instructions for your rehabilitation from your consultant which will be specific to you, so please do follow this advice even if it differs slightly from our recommendations.

Tips for recovery in the first few weeks following ACL surgery

Take your painkillers as prescribed - the first few weeks following your surgery are a critical time for regaining knee movement and strengthening your muscles. Your process will be much slower if you aren’t able to move very well because of pain.

Apply regular ice packs – a packet of frozen peas or a gel pack are ideal. Wrap your ice pack in a in a wet towel towel and place it on your knee for about 15 minutes. If you notice your skin has gone numb during this time then remove the ice pack straight away to prevent a burn. This can be repeated as often as you like to help relieve pain and also reduce excessive swelling.

Use your crutches - you are likely to be given elbow crutches prior to leaving hospital to help with your walking. Don’t be in a rush to abandon them too quickly… it’s better to be able to walk with a normal pattern of movement using your crutches for support then limp without them. As your pain starts to reduce you can gradually progress onto one crutch (held in your opposite hand).

Pace yourself – your body will need time to rest and heal after your surgery, so if your has issued you with a knee brace to protect your graft, use it at the settings advised for the length of time they recommend                                          

ACL recovery exercises  - early stage

Knee press

Quads strengthening exercise

By the end of the first week you should aim to be able to straighten your knee fully. As often as possible sit on your bed or the floor and try to straighten your knee as far as possible, hold for 5 seconds then relax. Do not push through pain. Repeat 5-10 times

Knee bends

Knee bending exercise

You should be able to bend your knee to about 70 degrees by the end of the first week, gradually increasing this in subsequent weeks. Sit on the floor or your bed with a plastic bag under your foot. Slide your foot towards you, bending your knee as far as able without pushing through pain. Hold for 5 seconds then return. Repeat 5-10 times.


Quadriceps strengthening- straight leg raise

Straight leg raise exercise

Lie on your back of sit up supported with your legs out straight in front of you. Tighten your thigh muscles then lift your whole leg, keeping your knee stays straight. Hold for 5 -10 seconds the relax. Repeat 5-10 times.

Hip strengthening

Gluten strengthening exercise

 1. Lie on your good side with back to a wall. Bend your good leg underneath you and keep your operated leg straight. Place your heel on the wall behind you and slide it up the wall. Hold for 5-10 seconds the relax. Repeat 5-10 times.

Hip strengthening exercise

2. Lie on your front over a couple of pillows. Bend your knee as far as is comfortable and lift your leg slightly, without arching your lower back. Hold for 10 seconds then relax. Repeat 5-10 times.

The majority of people are able to get back to all their usual activities and sports over a period of 3–9 months. An experienced physiotherapist will be able to support your recovery from ACL surgery with a structured rehab programme focusing on mobility, balance, control, strength and sports specific drills to ensure the long term success of your surgery.

Please don’t hesitate to get in touch if you have any questions at all,

The Physiofit Team!

Patellar Instability - symptoms, causes & best treatment

Article about patellar dislocation

What is patellar instability?

Your patella (knee cap) is a small triangular bone that sits in a groove at the bottom end of your thigh bone (femer). As you bend and straighten your knee, your patella slides up and down in this groove, controlled by ligaments and muscles.

If your patella doesn’t stay fully in the groove, either during movement or when you are resting, this is called patellar instability.

What are the main symptoms?

If you have patellar instability it’s likely that you will have some pain around the front of your knee and possibly swelling. Your knee might also feel weak or loose and you might feel like you don’t trust it fully to support you.

The symptoms range from minor laxity, where the knee cap moves slightly out of the groove causing a distinctive clunking sensation (patellar maltracking), to dislocation of your knee cap altogether. Dislocation can be momentary, where the patella relocates itself or it may dislocate and stay out until it is manipulated back into position.

Unfortunately, the more times your knee cap dislocates, the more stretched and lax the supporting ligaments become, making the chances of another dislocation higher over time. This is why it’s so important to not ignore your symptoms and to complete an effective rehab programme to strengthen the muscles that stabilise your knee cap.

Why does your knee cap dislocate?

There are two main types of patellar instability, the first is caused by a direct injury to the ligaments around your knee cap. This tends to be a sporting injury where the knee cap has received a blow on the side, causing it to move sideways either fully or partially (subluxation) out of its groove. This will lead to some ligament damage and laxity.

The second type of instability is due to an underlying structural issue that predisposes you to excessive movement of your kneecap in its groove. You might have a shallower groove in your thigh bone or your knee cap might be very small or located very high up in front of your knee (patella alta). If your thigh muscles are weak or you have hypermobility syndrome, where your ligaments are naturally quite lax, these are also common causes.

Best treatment for patellar instability

If you have experienced a dislocation, your knee will likely swell for a few days and feel stiff and painful. Depending on the severity of the dislocation some people are issued with a knee brace. The length of time this is worn for varies from person to person and will be decided by a consultant.

In the early stages after a dislocation you will need to rest your knee and allow it to heal. Pace your activites and avoid things that cause pain. Take any medication which is prescribed for pain relief or to reduce swelling and apply an ice pack regularly for up to 20 minutes, three times per day.

If walking is uncomfortable try using a walking stick or hiking pole for a few days, holding it the opposite side to your affected knee.

Early stage exercises for patellar instability

Knee bends

Exercise for patellar instability

Sit in a chair or lie odwn on your back with your leg straight. Bend your knee as far as comfortable.. Repeat 5-10 times. Do not push through pain.

Knee press

Quadriceps strengthening for patella dislocation rehab

Press the back of your knee into the floor and hold for 5 seconds then relax. Repeat 5-10 times.

A physiotherapist will be able to guide you through arehab programme of exercises to restore movement, strength and control around your knee.

Some people do require surgery following patellar dislocation but this is normally only considered if you have not been successful following an appropriate programme of strength and conditioning exercises for at least 3 months.

Don’t hesitate to get in touch if you have any questions,

The Physiofit Team!

Urinary incontinence in men and women - causes & treatment

Couple on a beach - incontinence

Whether you are male or female, young or old, about a quarter of the population will experience an issue with incontinence at some point in their life.

What is urinary incontinence?

Urinary incontinence is classified according to the type of symptoms experienced by each individual, such as:

  1. Stress incontinence: leaking of urine when you cough, sneeze or on physical exertion such as jumping or lifting something heavy.
  2. Urge incontinence: a sudden urge to pass urine and not being able to hold on for very long. With this type of incontinence, it’s likely that you will be going to the toilet frequently and you may experience some leakage after you’ve just emptied your bladder (dribbling).
  3. Overflow incontinence: being unable to empty your bladder fully and experiencing a mixture of the features of both stress and urge incontinence.

What causes urinary incontinence?

Urinary incontinence is sometimes due to  weakness of the pelvic floor muscles. However, for some people strength isn’t the issue at all and the problem is due to difficulty coordinating their pelvic floor muscles to tighten effectively when needed.

Pregnancy or excessive weight gain, abdominal surgery or child birth may result in an increased pressure on your pelvic floor which is a common cause of stress incontinence.

Excessive alcohol or caffeine intake, poor fluid intake, constipation, urinary tract infections (cystitis) or the side effects caused by medication such as hormone replacement therapy (HRT), diuretics and some antidepressants have all been linked to urge incontinence.

How is urinary incontinence treated?

First of all, it’s important to determine the underlying cause of your incontinence. Seeing your GP or a physiotherapist specialising in pelvic health will be able to assess your condition fully and advise.

You can expect to be asked questions about your lifestyle and bladder habits, including how often you drink, what you drink, how frequently you use the toilet and how much urine you normaly pass. So it’s worth thinking about this beforehand and perhaps keeping a record for a few days to take with you to your first appointment.

Your physical assessment may include an internal examination to assess the strength and condition of your pelvic floor muscles. This will help to guide the treatment approach.

Everyone is different, therefore the treatment of urinary incontinence will vary from person to person and you will get better results if your treatment is tailored to your own individual needs.

Although this condition is more common in women, we also see a number of men with urinary incontinence. The important thing is to recognise that although these symptoms are common, they aren't normal and can happen at any age. The key is to seek treatment as early as possible.

If you have any questions at all or you’d like to discuss your condition, please don’t hesitate to give us a call.

The Physiofit team!

Pelvic floor weakness - symptoms, causes & exercises

Pelvic floor weakness

Problems with the muscles of your pelvic floor are so common that many of us accept this as normal, especially as we get older or after having a baby. However, pelvic floor problems are not inevitable and up to 80% of women suffering with issues like incontinence, prolapse or an overactive bladder can be successfully treated by a women’s health physiotherapist.

How to tell if you have a problem with your pelvic floor – signs and symptoms

The pelvic floor muscles blend together to form a hammock that runs from your tailbone to your pubic bone. They are supported by strong ligaments that help your pelvic floor muscles hold your internal organs in place and allow us to move around, walk, run and jump without unwanted urine leakage.

The most common signs that you might have a problem with your pelvic floor include:

  • The sudden need to go to the toilet and sometimes not making there in time
  • Feeling like you always need to go to the toilet and going very frequently
  • Leaking when you cough, sneeze or physically exert yourself
  • A feeling of heaviness in your vagina or rectum
  • Vaginal pain
  • Lack of sensation or pain during or after having sex

Why do pelvic floor problems develop –  causes

Having a healthy pelvic floor means that your pelvic muscles are able to work well together, tighten sufficiently and release, so you can easily control or empty the bladder and bowel at the appropriate time.

Weak, over-stretched, slow-working, tight or damaged pelvic muscles are likely to result in some of the signs and symptoms above. These conditions can develop during to pregnancy or after childbirth, if you have a job that involves heavy lifting or you take part in a type of high impact exercise or if you have chronic constipation and need to strain to empty your bowels. Menopause can also lead to problems with your pelvic floor due to the hormonal changes affecting women.

Exercises to strengthen your pelvic floor

Like any other muscle in your body, you are able to retrain your pelvic floor muscles with the right exercise programme.

Strengthening exercises may be recommended to you as part of this programme. Here’s how to find and tighten these muscles correctly. A good position to feel the pelvic floor muscles working is in high kneeling:Kneeling for pelvic floor exercises

Breathe out and imagine you are drawing a marble up your back passage to gently lift your pelvic floor and draw it upwards towards your pubic bone. You should feel a slight lift and tightening sensation. Hold for a moment and then relax as you breathe in and imagine your sitting bones melting into your heels.

Your pelvic floor muscles need to be able to tighten quickly in case you sneeze and be able to hold to allow you to get to the toilet, so it’s important to practice both ways with short, quick lifts (be sure to relax fully after each one) and long, slow holds.

For some women the strength of their pelvic floor muscles is actually okay but the inability to coordinate them to work together effectively can be a problem. So if you are still experiencing symptoms after 6-8 weeks training it is worth having a pelvic examination with a specialist women’s health physiotherapist because, like any other exercise programme, pelvic floor exercises are most effective when they are tailored specifically to the individual.

Don't hesitate to get in touch if you have any questions.

The Physiofit Team!

Neck pain due to a ‘trapped nerve’ - exercises and advice

Patient with neck pain

The phrase ‘trapped nerve’ conjures up quite an unpleasant picture and it isn’t really a great way to explain what’s actually happening in your body when you get nerve pain.

It’s also quite commonly blamed for lots of different types of neck pain, regardless of the underlying cause. In fact, if you don’t have any symptoms in your arms or hands like pain, pins and needles, tingling, numbness or weakness  then it’s unlikely that you have a problem with one of the nerves in your neck at all.

Even though the sharp ‘zing’ of pain when you move your neck may remind you of a nerve, if your symptoms are only felt in your neck, they’re more likely to be coming from the joints or muscles.

What is a trapped nerve?

Nerves travel out in bundles from your spinal cord through tunnels formed by the bones of your spine (vertebrae). A true ‘trapped nerve’ occurs when one of your nerves is compressed by an extra bit of bone growing (osteophyte) which narrows the nerve tunnel. It can also occur if you have injured one of your discs and part of the disc is pressing directly onto the nerve.

When a nerve is truly compressed, there is always a predictable pattern of numbness or loss of feeling in the skin, a loss of strength in your arm or hand and your reflexes will be absent or reduced when they are tested.

It’s not actually that common and if you are experiencing symptoms down your arms spreading from your neck then you are far more likely to have a form of nerve irritation, rather than a trapped nerve.

Nerve irritation and neck pain

Your nerves can become inflamed like any of the soft tissues in your body. This can happen suddenly after an accident, like a whiplash injury or can develop gradually due to accumulative strain.

When you move your neck and shoulders to reach for something or look around, the nerves around your neck stretch and move too. This is entirely normal and you won’t experience any symptoms unless you stretch a nerve beyond 5% of its original length.

When a nerve is inflamed or irritated it becomes more sensitive to stretch. This means that it will start hurt from just a 3% stretch, which is well within the range it should actually be able to tolerate. Put simply, your nerve still has the capability of moving and stretching as it should, but it has become more sensitive and thinks that you are stretching it too much, even when you’re not. This is why you may suddenly find that everyday arm movement causes pain or pins and needles.

How to reduce nerve irritation and sensitivity

Even if you are experiencing numbness or some weakness in your arm, this can often be treated and resolved with physiotherapy, so try not to panic.

Controlling your pain is important to enable you to move your neck and shoulders, which helps your nerves to settle and become less sensitive again. Try over-the-counter pain control first. If this does not help, then discuss trying some neuropathic pain control medication with your GP. Try propping your arm on some pillows while you are sitting and use a wheat pack or hot water bottle to apply some heat to relax tight muscles around your neck for up to 10 minutes.

We recommend these exercises but be aware that nerves prefer gentle continuous movement, so don’t hold these positions, just move into them and then back out of them again. Don’t push into pain, just move within a comfortable range that doesn’t increase your neck or arm symptoms. Start by rolling your shoulders back 5 - 10 times:

Neck bend

Neck exercise for trapped nerves

Sitting, take your chin down towards your chest. Return. Repeat 5-10 times

Neck turn

neck stretch into rotation for nerve pain

Sitting, turn your head to look over your shoulder. Return. Repeat 5-10 times in both directions.

If you have any concerns please don’t hesitate to get in touch,

The Physiofit team!

Rotator cuff tear - diagnosis & treatment

shoulder painIt’s understandably worrying to be told that you have a tear in one of your shoulder muscles (the rotator cuff).

However, rotator cuff tears are incredibly common with nearly a quarter of the general population having one and only one third of these actually experiencing any pain as a result.

Simply put, having rotator cuff tear without any pain is twice a common as having a tear which causes pain. In fact, the majority of people might not even realise they have one.

What can cause a torn rotator cuff?

You can develop a tear through two main routes. The first is through sudden injury, like a fall or an awkward tackle. The second, and most common cause, is more gradual and happens as a result of accumulative strain in one part of the cuff as it ages along with the rest of your body.

How do you know if you have a rotator cuff tear?

One of the main symptoms is weakness, the extent of which depends on how big the tear is.

If you have a small tear you may struggle with twisting movements of the shoulder. You can test for it like this:

Test for muscles of the rotator cuff

Face a mirror and keeping your elbows bent, move your hands out to the sides. If there is a loss of movement on one side, use your other hand to see if you can move your arm a bit further outwards. If you can achieve a bit more movement with the help from your other arm but you can’t hold it out there on its own, then it’s possible that you have a muscle tear.

Bigger tears lead to difficulty with lifting your arm upwards or out to the side. An ultrasound scan is the most accurate way to determine the size of a tear.

What’s the best treatment?

If your shoulder is painful then in the early stages, you should avoid all activities which aggravate your symptoms. Take medication as often as you need to control your pain and allow your symptoms to settle as quickly as possible.

If your tear happened after an injury or you have a large tear, then you may be offered surgery but physiotherapy treatment is usually very successful if you have a small or medium sized tear.

How long will it take to heal and what are the best exercises?

An experienced physiotherapist will be able to guide you through a safe, effective rehabilitation programme. Initially this is likely to focus on restoring the normal movement in your shoulder joint. The next step is to make sure that the muscles around your shoulder blade are not only strong but that they’re working properly with the other muscles around your shoulder to produce smooth and well- coordinated shoulder movement. A strengthening programme can then be introduced gradually to restore power, speed and precision.

There’s no set time frame for recovery from a rotator cuff tear and your progress should be monitored carefully. Pushing yourself too hard, too soon has the potential to make the tear worse.

If you suspect you might have a rotator cuff tear or you have any questions at all, please don’t hesitate to get in touch,

The Physiofit Team!

What are the best exercises to improve balance?

Elderly man

Many adults find that their balance deteriorates as they get older and they become fearful of falling.

The body systems that contribute to balance and mobility do change with age, but growing older doesn’t necessary mean becoming weaker or less able to do things that require good balance.

There are lots of things that contribute to your ability to balance when you are on your feet and moving around. We are provided with constant information about the environment and our movements from our eyesight, the balance mechanism in our inner ear and the system that tells us where we are in relation to other objects (somatosensory system).

Ageing can affect how well those systems work independently but can also impact on how well these systems interact with each other. For example, a 67-year-old man who usually runs twice a week finds that since his cataract has worsened he has become unsteady on his feet. He is strong, fit and mobile but not being able to see clearly has impacted on his balance as the visual information is less accurate and therefore his brain has to rely on the other two systems to maintain balance. It’s like standing with your eyes closed … try it for yourself and you’ll see how much harder it it!

Feeling unsteady on your feet can really knock your confidence and you may find yourself avoiding activities that feel more challenging. Unfortunately, this can make the problem worse as you may then also lose some strength and flexibility, which are also factors which contribute to your ability to balance. It’s a vicious cycle.

Muscle weakness is a common factor contributing to lose of balance, so here are a few examples of the kind of exercises that might be recommended to you.

When you first start, use a chair or bannister for support and as you get stronger and more confident you can gradually reduce the support you need for each exercise. Repeat each exercise 8 - 10 times.

Leg liftStrengthening exercise for balance

Keep your knee straight and lift your leg on the side, keeping your toes pointing forwards.

High knee marching

Balance and strengthening exercise

Bend your knee and lift your thigh towards your chest, lower again and repeat with your other leg. Repeat

Heel and toe raisers
Rocking exercises to improve balance

First push up onto tiptoes, lifting your heels up off the floor. Lower again and lift your toes up off the floor.

Sit to stand

stand up from sitting for strength

Perch on the edge of a chair. Lean forwards bending your hips until your nose is over your toes. Push through your heels to stand up. Lower again slowly, bending at the hips and pushing your bottom back behind you.

Tips: Initially you can use your arms to help but as you get stronger try to stand up without using your hands.

Take home message …

There are lots of factors that may contribute to an impaired ability to balance, which can result in a fall.

Strengthening exercises are often recommended but this won’t be effective if your balance problem isn’t due to muscle weakness. This is why a thorough assessment is vital to establish which system (or systems) need to be retrained.

A specialist falls physiotherapist will be able to help you work out which systems are affecting your balance and improve them with an individualised, targeted programme.

Don’t hesitate to contact us if you have any questions at all,

The Physiofit Team!

Golfer's Elbow Pain - symptoms, causes & treatment

Golfer's Elbow pain

Golfer’s elbow is similar to tennis elbowbut the pain is felt on the inside of your elbow rather than the outside.

The medical term for golfer’s elbow is medial epicondylitis. It’s a painful problem affecting the tendons that help you grip, so people that use their hands a lot for work – for example, using screwdrivers or a hammer regularly – are prone to developing this condition, along with people who work at a computer.

What are the symptoms of Golfer’s elbow?

If you are experiencing pain on this inside of your elbow which comes on during activities when you are gripping something, twisting your forearm or lifting, then it’s likely that you have golfers elbow. It’s also common to have some tenderness around the bone and your grip might not feel as strong as usual.

Golfer’s elbow self-test

You can try this test to see if you have golfers elbow:

Self test for golfer's elbow

Straighten your elbow and turn your palm up. Keeping your elbow and wrist straight, use your other hand to press down on your palm. If your inner elbow pain increases, then the test is positive.

Golfer’s elbow treatment

Golfer’s elbow gets worse if you push through the pain. So in the early stages you’ll need to make some adjustments to the way you do things to allow your symptoms to settle. This doesn’t mean stopping everything entirely. You can continue to use your arm but some activities might need to be reduced to a level where they can be completed comfortably.

If you have a manual job, this might be difficult but you can try using a golfer’s elbow strap to reduce pain during some tasks. Wrapping tennis racket grip tape around the handle of your tools to increase the diameter of the handle (so you don’t have to grip as hard) can also be helpful.

Using an ice pack at the end of the day will help with pain relief. Something that moulds to your skin like a gel pack or packet of frozen peas is best. Wrap a wet tea towel around the ice pack and apply for up to 10 minutes. Check your skin occasionally and take off the ice pack if your skin goes numb, to prevent an ice burn.

Physiotherapy treatments like acupuncture, taping, myofascial release and deep friction massage can also help to relieve your symptoms.

Wrist strengthening exercises for Golfer’s Elbow

In the early stages, it’s best not to push into pain to exercise the muscles of your forearm.Try this ‘press and hold’ exercise to help relieve pain:

Isometric exercise for golfer's elbow

Sit with your elbow bent and resting on the arms of a chair or table. Turn your palm upwards. Press down on your palm with your other hand and upwards with your affected side (so there is no movement). Press and hold for 10 seconds – without pain – and repeat 5 times every hour.

After you’ve finished, stretch out your forearm by straightening your elbow (palm up) and using your other hand to increase the stretch:

Wrist stretch for golfer's elbow

Hold this stretch for 30 seconds and repeat three times.

Take home message …

In the short term modifying your activities to reduce pain is vital.

A physiotherapist can treat your elbow to relieve your symptoms and will be able to advise on the equipment you use and alternative ways of doing things to prevent your symptoms from recurring.

The exercises we’ve recommended are specifically for golfer’s elbow and not for other types of elbow pain. In fact, some nerve problems can mimick the symptoms of golfer’s elbow, so if your pain doesn’t improve with these exercises it’s a good idea to speak to your GP or arrange an assessment with a physiotherapist to rule this out.

Get in touch with us if you have any questions at all,

The Physiofit Team!