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!

Total Knee Replacement Surgery - tips & exercises

man with joint pain who needs a knee replacement

Replacing your worn out knee joint with an artificial implant can significantly reduce pain and really improve your general quality of life and activity.

However, this doesn’t happen overnight. Although knee replacement surgery is now much more common, it’s still a major operation and it can take time to recover fully.

Milestones – what to expect after your knee surgery and recovery time


Knee bend – you should be able to bend your knee to about 90 degrees when you leave hospital and with the right rehab programme, most people will manage to bend their knee to about 125 degrees within 3 months.

Driving – your consultant is the best person to advise when you will be able to drive again but the majority of people will be able to get behind the wheel after 6 weeks.

Returning to work and daily activities – most of these will be achievable about 6 weeks after your surgery (although this is dependent on your occupation).

Low impact sports – You should be able to get back to low impact activities such as swimming or cycling by 12 weeks post op.

Physiotherapy tips for recovery after your surgery


Pain control

Make sure you take any painkillers which have been prescribed for you regularly. Most people don’t like to feel reliant on medication, but in the first few weeks after your surgery taking your painkillers is really important so you can regain as much knee movement as possible. If you are in pain and can’t move your knee, this can lead to complications and a less successful outcome.


Your knee will look very large and swollen immediately after your operation. This is normal and to be expected. You can help to relieve the swelling (and pain) by applying an ice pack regularly.

It’s best to use something that can be moulded to your skin like a packet of frozen peas or a reusable gel pack. Wrap it in a wet cloth to prevent direct contact with your skin and leave the ice pack in place for up to 20 minutes. Check your skin occasionally during this time and if it goes numb remove the ice straightaway to prevent an ice burn.

You can reapply every 1-2 hours, allowing your skin time to return to its normal temperature in between treatments.

Walking aids

You will probably need to use a walking aid(frame, crutches or a walking stick) in the early stages. Don’t be tempted to discard it too quickly, it’s better to walk normally using a walking aid then to limp without one.


A few tips to make things easier on the stairs … take both legs to each step, leading with your good leg on the way up and your bad leg on the way down.

Early stage exercises after knee replacement


Knee bends

knee replacement exercise to improve knee bend

Lie on your back with your operated knee slightly bent. Bend your knee as far as possible, pushing into a mild stretch. You can loop a dressing gown belt round your ankle to help pull your foot a little closer. Hold for 5 seconds then relax.

Straight leg raise

Thigh strengthening exercise for knee replacement

Lying or sitting. Straighten your knee fully by tightening your thigh muscle then lift your leg 10cm off the bed. Hold for 5-10 seconds then relax. Your leg must remain straight throughout this exercise.

Thigh strengthening

Inner range quadriceps exercise

Lying or sitting with a rolled towel or cushion under your knee. Breathe out and tighten your thigh muscle to straighten your knee. Hold for 10 seconds and lower again slowly. Repeat 10 times.

Sitting knee extensionsexercise in sitting the strengthen your thigh muscles after total knee replacement

Sit on a chair and straighten your operated knee. Hold for 5-10 seconds then relax.

Standing hip extension

functional strengthening in standing- hip extension

Stand holding onto a support ( a wall or the back of a chair). Push your operated leg backwards, moving from your hip. Do not arch your lower back or lean forwards. You should feel your bottom muscles working. Hold for 5-10 seconds then relax.

While you should be back to doing the majority of your activities at about 3 months, people often find that the full recovery process continues to steadily progress over a period of 1-2 years.

Participating in a structured rehab programme will help you to recover more quickly and in the longer term continuing exercise regularly will help to stabilise and support your new knee. Clinical Pilatesis ideal.

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

The Physiofit Team!

How to get rid of shin splints

Runner with shin splints

With Marathon season underway and the weather warming up, lot of us are dusting off our running gear and heading outside.

Running has fantastic health benefits, it’s easy to do and it doesn’t require much equipment or a gym subscription. However, if you’re new to running - or you’re getting back into it after a break – it’s really important to have a steady training plan for building up the miles.

Training errors such as sudden spikes in your distance, pace or insufficient rest days may ‘overload’ the shin bones causing pain in your lower leg that most people refer to as shin splints.

The pain and swelling felt when you have hurt your shin bones will ease with rest but may flare up again frustratingly the next time you try to get out for a run. Left untreated it can become more severe and may eventually led to stress fractures of the shin bones.

Tips to help your shin splints heal

As with other types of sports injury you can relieve pain by applying an ice pack and taking painkillers but you must stop running and allow a minimum of 2 weeks’ recovery time, allowing any inflammation to settle fully.

At our Cambridge clinic we recommend resting until you can press on the bone without any tenderness and hop on the spot at least 12 times confidently and without any pain. Switch to lower impact activities such as cycling or swimming in the short term to maintain your fitness levels.

How to prevent shin splints – the underlying causes

While training errors are often a large factor, there are other things that may contribute like:

  • Worn out, unsupportive trainers
  • Tight or weak calf muscles
  • Over-striding (poor running technique)
  • Running mainly on hard surfaces
  • Flat feet
  • Weakness around the hips

If you don’t address all the underlying factors, then your shin splints are likely to come back again.

A sports physiotherapist will assess your individual weaknesses and movement patterns. They should prescribe a programme of targeted exercises to address any problems and make sure that you return to running again with a progressive plan for loading your shins in the right way so your symptoms don’t return.

Strengthening exercises to prevent shin splints

Here are three of our favourite exercises for runners to practice on their rest days:

Single leg heel raise

Single leg. heel raise strengthening for shin splints

Keep your pelvis level and take your weight onto one leg. Press up onto tip toes keeping your knee straight. Repeat 15 times

Single leg sit to stand

Single leg sit to stand exercise for shin pain


Exercise for preventing shin pain

Stand up from a chair on one leg, then squat slowly to lower yourself back down to the chair with control. Repeat 10 times

Single Leg bridge

Hip strengthening to prevent shin pain

Take home message:

Shin splints are a common injury particularly in runners and continuing to train will make things worse and can result in stress fractures of the shin.

Sufficient rest, strength and conditioning exercises and the right loading programme for returning to running is really important.

An experienced health professional will help you identify and address all the contributing factors to prevent recurrence.

Get in touch if you have any questions at all,

The Physiofit Team!

Related articles

How to run pain free - couch to 5k

Sports Therapy or Physiotherapy - what's the difference?