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Physiotherapy Related Articles and Information

Back Pain

If your back hurts don’t ignore the pain. Physiotherapists have the training to correctly assess the problem and provide safe, effective treatment. For rapid recovery, see your physiotherapist early.

Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve, which runs from the elbow into the hand, becomes pressed or squeezed as it passes through the wrist into the hand. The median nerve controls sensations to the palm side of the thumb and fingers (except the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel is a narrow, rigid passageway composed of the ligaments and bones of the wrist . Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm.

Frozen Shoulder

Adhesive capsulitis is a painful condition in which the shoulder gradually loses its range of motion over time. This condition is also referred to as “frozen shoulder” because of how difficult it is for a person to move their shoulder. The shoulder is not actually frozen, just stiff.

Sprained Ankle

The ankle is the most frequently sprained joint. The outside of the ankle joint has 3 ligaments, that may be injured individually or in combination. A minor sprain results when a ligament is stretched. In more serious sprains, the ligament may be partially or completely torn. A sprain can be very painful, with any movement of the joint increasing the pain. With a severe sprain, it is often too painful to bear weight on the affected leg.

Golfers’ Elbow

Golfers’ elbow is generally classified as an overuse or injury to the tendon on the inside of the elbow. Infrequently it is caused by playing golf, but is more common in tennis players Golfers’ Elbow is the same as Tennis Elbow but the problem is on the inside of the elbow. It is due to overuse and repetitive strain or injury to the tendon on the inside of the elbow . The muscles from the inside of the forearm that flex the fingers towards the palm and flex the wrist originate from one tendon – the common flexor tendon – which attaches to the inside bony part of the elbow.

Tennis Elbow

Tennis elbow is usually caused by an overstraining of the muscles where they insert into the bone. The muscles that extend the fingers and the wrist originate from a small projection of bone on the outer side of the elbow. In the case of tennis elbow, pain is concentrated around this area and may radiate to the forearm.

The pain is caused by tiny breaks in the connective tissue that holds the muscles to the bone. The tissue is irritated and an inflammation sets in, causing swelling in the area. It often heals spontaneously but in a few cases the pain can last for more than five years.


People who experience whiplash may develop one or more of the following symptoms, usually within the first two days after the accident:

  • Neck pain and stiffness
  • Headaches
  • Pain in the shoulder or between the shoulder blades
  • Low back pain
  • Pain or numbness in the arm and/or hand
  • Dizziness
  • Ringing in the ears or blurred vision
  • Difficulty concentrating or remembering
  • Irritability, sleep disturbances, fatigue

Cervical Spondylosis

Pain in the neck is common and may be a natural consequence of aging in people over 50. Like the rest of the body, bones in the neck (cervical spine) progressively degenerate as a result of ageing. Over time, arthritis of the neck (cervical spondylosis) may result from bony spurs and problems with ligaments and disks. The spinal canal may narrow (stenosis) and compress the spinal cord and nerves to the arms. Injuries can also cause spinal cord compression. The pain that results may range from mild discomfort to severe, crippling dysfunction.

Osgood Schlatter’s Disease

It is not a disease! This is very common condition that occurs mostly in adolescents (generally between the ages of 10-15) who are very active, especially in activities that require running, jumping, or weight lifting.

Is it Really a ShoulderProblem?

We’ve all been there, a patient presents with an ache around the shoulder area, with possibly some pain spread around the upper arm and scapular area. The patient is convinced that it’s a “shoulder problem”, but following a general musculoskeletal examination of the patient’s shoulder we’re not so sure..

Sports Massage

As a sportsman or woman your performance counts. Adding sports massage to your workout routine can improve your performance. As the training and playing hours pile up, so do the aches and pains. These little aches and pains can turn into nagging or even more serious injuries. After a strenuous workout or race, sports massage will hasten your recovery and alleviate any pain. You may find that you will benefit from a 30 minute session on a particular problem area, or a longer session for more general maintenance work.

Stretching a Point

Flexibility is assumed to be an essential component of athletic activity. There are a vast number of reports within literature venerating the benefits of stretching. These include; improved athletic performance, reduced risk of injury, prevention and reduction of DOMS, and improved co-ordination.

However, recent research has challenged some of these claims. This is because of the ‘mixed populations’ utilized in some studies. We all know of people who never stretch have a good range of movement at joints and never “pull muscles” and we know of people who persistently stretch, have limited joint motion and never get injured.

Should Bench be Banned?

“What do you bench?” is a common question asked within gyms throughout the world. The answer is often used as a measure of the athlete’s prowess. But, to paraphrase Monty Python, “What has the bench press ever done for us?”

Sure, it’s a compound movement at both the shoulder and the elbow, and it has several alternatives such as incline, decline, narrow grip, wide grip and can be carried out with either barbell or dumbbell. But what benefits, FUNCTIONALLY, does having a good bench-press confer on the athlete?

Tennis Elbow ( Lateral Epicondylitis)

The main symptom of tennis elbow is pain and tenderness located on the outside of your elbow. There may also be areas of pain within the bulk of the muscle on the outside of your forearm.

The pain is thought to be due to damage to the tendons that attach to the outside of the elbow. These tendons are the attachment of the muscles that function to cock the wrist back An injury can cause microscopic tears are incompletely healed within the tendon and lead to inflammation and scarring of the tendon

The most common symptoms of tennis elbow are:
  • Pain over the outside of the elbow, on the bony prominence
  • Pain when lifting objects
  • Pain radiating down the forearm into muscles
  • Pain on wrist extension
  • Pain when the wrist is moved against resistance towards the little finger- such as chopping the ball on a backhand
  • Pain with twisting movements or gripping

Despite its name, tennis elbow, racquet sports are only thought to be the cause in about 5 in 100 people.

Proposed Causes:

Improper raquet grip size

  • Improper stoke execution (not “leading with the elbow”)
  • Improper string tension (higher string tensions has been implicated in the cause of tennis elbow. Keep stringing tension at the lower end of the manufacturer’s recommendation. While higher string tension provides enhanced ball control, it also increases the torque and vibration transferred to the arm.
  • Too much wrist action on the shot “elbow crunch” (see below)
  • Light racquet weight
  • Head-heavy balance
  • Too stiff a frame

Measuring Your Grip Size

The correct grip size makes a huge difference in how the muscles of the forarm have to work- both too small a grip, and too large a grip can cause the muscles which extend the wrist to have to generate too much force, which can ultimately cause tennis elbow.

Measure your grip size using a tape measure. With your hand open and fingers straight, place the end of the tape on the bottom crease of your palm and measure to the tip of your ring finger.

Elbow Crunch is a rapid shortening of one of the muscles which extends the wrist on impact with the ball which produces a muscle spasm that stresses the tendons. The muscle suddenly shortens and rapidly pulls (Elbow Crunch) on the tendons that attach it to the elbow, and are repeated with each shot causing microscopic tissue are also bad.


Tennis elbow can become a chronic problem if not treated properly. If identified early then it can be rapidly sorted with minimal loss of time from squash.

It is always good to seek early advice from a suitably experienced physiotherapist, as there are several other areas which may be causing pain that appears to be tennis elbow; such as neck or shoulder problems. If you have a diagnosis of tennis elbow then the following rehabilitation programme can be used. In general, the rehabilitation process can be divided into three stages:

Acute stage (first 3-5 days) Goals: decrease inflammation and pain,

  • Rest – this is relative rest. Avoid activities that cause pain- this includes off court activities like DIY. On court, avoid shots that cause your elbow pain.
  • Ice – although there is debate as to whether there is inflammation associated with tendon problems, the ice will act as a pain killer, and will help if there is associated muscle injury
  • Maintain normal pain free elbow, wrist and shoulder function.

Healing Stage (week 2-6)

Goals: Improve flexibility, increase strength and endurance, increase functional activities and return to pain free squashfunction

Gentle stretching exercises including wrist flexion, extension (Figure 3 & 4) and rotation. The elbow should be extended. These stretches should be held for 20-30 seconds and repeated 5-10 times, at least twice a day.


With the elbow bent and the wrist supported perform the following exercises:

1. Wrist Extension Place a light weight or resistance band in hand with palm facing downwards, with your elbow on your knee. Extend your wrist slowly, hold 2 seconds, and lower slowly over 4 seconds. There should be little pain as you carry this exercise out .3×10 repetition

2. Wrist Flexion Place a light weight or resistance band in hand with palm facing upwards, with your elbow on your knee. Flex your wrist slowly, hold 2 seconds, and lower slowly over 4 seconds. There should be little pain as you carry this exercise. 3×10 repetitions

3. Combined Flexion/Extension. Attach one end of a string to a pole, and attach the other end to a weight. In standing, extend your arms and elbows straight out in front of you. Roll the weight up from the ground by turning the wrists, then slowly reverse and lower the weight. 3×10 repetitions

4. Forearm Pronation/Supination (Figure 7,8,9). Grasp you racquet with your forearm supported on your knee and the racquet pointing straight up. Rotate hand to palm down position, return to start position. 3×10 repetitions.

Remodelling Stage (week 7 onwards)

Goals: Improve muscular strength and endurance, maintain and improve flexibility, and gradually return to prior level of sport or high level activity.

Continue the stretching and strengthening. Begin court drills; start with 20 minutes, and if no pain during/after, increase time on court over subsequent sessions.

If there is no improvement in your symptoms, see the advice of a suitably qualified sports medicine person.

If the cause of the problem is identified early, then the time away from sport will be minimal. If ignored, the condition could take over 4 months of rest from provocative activities.


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Bentham, S.H., Hatcher, J., & Horsley, I.G. (2001). The Influence of an Aircast Sports Stirrup Ankle Brace on the Ankle Joint Propriception of professional Soccer Players. Sports Medicine, Training, and Rehabilitation 10, (4) pages 223-234.

Horsley, I (2003) Lisfranc Injury of The Foot. SportEx Medicine, pages 8-9

Herrington,L., Turner,M., Horsley,I (2004) The Relationship Between ACL Deficiency,Functional Performance and a Break in the Isokinetic Moment Curve of the Knee Flexors.  Isokinetic and Exercise Science 11 Pages 239-244 Horsley,I (2005) The Assessment of The Shoulder With Pain of A Non-Traumatic Origin. Physical Therapy in Sport 6, pages 6-14. Horsley, I and Brooks, J. (2005) Red Rose Rugby. Sportslink, Australian Physiotherapy Association; 4: pages 22-24 Horsley, I. (2006) Supersize Your Stamina. England Rugby Magazine: 17: pages 104-105 Herrington, L., Horsley, I., Whitaker, L., Rolf,C. (2008). Does a tackling task effect shoulder joint position sense in rugby players. Physical Therapy in Sport 9, (2) pages 67-71. Herrington, L., Horsley, I (2009). Electromyographic Analysis of Selected shoulder Muscles During a rugby Football tackle.Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2009, 1:10 doi:10.1186/1758-2555-1-10 Jones, D.R., Funk, L., Ross, J., Horsley, I., Herrington, L., (2009). Return to rugby after shoulder stabilization in professional rugby players. Presented at International Sports Science and Sports Medicine Conference 2009 Herrington, L., Horsley, I., Rolf, C., (2009) Evaluation of shoulder joint position sense in both asymptomatic and rehabilitated professional rugby players and matched controls. Physical Therapy In Sport Fowler, E., Horsley, I., Rolf, C., (2010). Clinical and arthroscopic findings in recreationally active patients. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2010, 2:2 Horsley, I., Herrington, L., Rolf, C., (2010) Does a SLAP lesion affect shoulder muscle recruitment as measured by EMG activity during a rugby tackle? Journal of Orthopaedic and Surgery Research, Horsley,I (2010) Is it really a shoulder problem?; Differential diagnosis of shoulder pain. SportEx Dynamics (24) April, 20-23 Horsley,I (2010) Shoulder Injuries in: Sports Rehabilitation and Injury Prevention, Comfort and Abrahamson (Eds), Wiley-Blackwell Horsley, I (2010) The case of the “shamstring”. Case study Sports Injury Bulletin. October 2010 Horsley, I.G., Pearson, J., Green, A., Rolf, C.R. (2012). A Comparison of the musculoskeletal assessments of the shoulder girdles of professional rugby players and professional soccer players. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, 4:32 Herrington, L., Horsley, I.G. (2013). Effects of latissimus dorsi length on shoulder flexion in canoeists, swimmers, rugby players, and controls.Journal of Sport and Health Science 1-4 Elias, J., Herrington, L., Horsley, I. 2012 The Interrater reliability of the Functional Movement Screen within an athletic population using untrained raters Journal of Strength and Conditioning Research (in press) Herrington L, Myer G, Horsley I. 2013 Task based rehabilitation protocol for elite athletes following Anterior Cruciate ligament reconstruction: a clinical commentary Physical Therapy in Sport (in press) Chapman V, Horsley I, Rolf C. Increased anterior translation of the knee in professional rugby players following one-hour game-related training: An etiological factor for anterior cruciate ligament rupture. OA Sports Med. 1(1): 10-15, 2013 Horsley, I.G, Herrington, L.C. (2014). Optimal Management of Glenohumeral Joint Injuries in Athletes Playing Rugby. J Trauma Treat 2014, 3(2) MacKenzie, T.A., Herrington, L., Horsley,I.G., Cools, A. (2015). An evidence-based review of current perceptions with regard to the subacromial space in shoulder impingement syndromes: Is it important and what influences it? Clin Biomech (Bristol, Avon). 2015 Aug;30(7):641-8. AH Bdaiwi, TA Mackenzie, L Herrington, I Horsley, AM Cools (2015). Acromiohumeral distance during Neuromuscular Electrical Stimulation of the lower trapezius and serratus anterior muscles in healthy participants. Journal of athletic training 50 (7), 713-718 TA Mackenzie, LC Herrington, L Funk, I Horsley, A Cools (2015). Sport specific adaptation in resting length of pectoralis minor in professional male golfers. Journal of Athletic Enhancement 4 (5) TA Mackenzie, LC Herrington, L Funk, I Horsley, A Cools (2015). Sport specific adaptation in scapular upward rotation in elite golfers. Journal of Athletic Enhancement 4 (5) TA Mackenzie, LC Herrington, I Horsley, A Cools (2015). Acromio-humeral distance in athletes’ shoulders. Annals of Sports Medicine and Research 2 (7), 1042 MacKenzie, T.A., Herrington, L., Funk, L., Horsley,I.G., Cools, A (2016). Relationship between extrinsic factors and the acromio-humeral distance. Man Ther. 2016 Jun;23:1-8. Griffin,V.C., Everett,T., Horsley ,I.G. (2016). Comparison of hip adduction to abduction strength ratios, in the dominant and non-dominant limb, of elite academy football players. Journal of Biomedical Engineering and Informatics 2(21):109-118 TA Mackenzie, LC Herrington, I Horsley (2016). Factors influencing the Acromio-Humeral distance in elite athletes. University of Salford. TA Mackenzie, L Herrington, L Funk, I Horsley, A Cools (2016). Sport Specific Adaptation in Rotation Range of Motion in the Elite Golfer’s Shoulder. J Athl Enhancement 5: 2. University of Salford AH Bdaiwi, TA Mackenzie, L Herrington, I Horsley, A Cools (2017). The Effects of Rigid Scapular Taping on Acromiohumeral Distance in Healthy Shoulders: An Observational Study. Journal of sport rehabilitation 26 (1), 51-56. Bayam L, Arumilli R, Horsley I, Bayam F, Herrington L, Funk L (2017). Testing Shoulder Pain Mapping. Pain Med. 2017 Feb 22

Recent Presentations

PSITCC London 2008

“Management of Acute Musculoskeletal Injuries within the pitch side setting”

World Congress of Sports Trauma Hong Kong 2008 4 Papers from PhD research Accepted for presentation World Congress of Physiotherapy Vancouver 2008 Poster presentation; SLAP + EMG In the rugby tackle Southport Shoulder Conference Southport 2008 “Accelerated Rehabilitation of TheShoulder” IPSTCC London 2009 “Management of Acute Musculoskeletal Injuries within the pitch side setting” Southport Shoulder Conference Southport 2009 “Rehabilitation of the post operative shoulder” CSP Conference (2 days) Liverpool 2009 “2012 and Beyond” Theme lead and chairman

ACPSM Shoulder Study Day Leeds 2009 “Shoulder Injuries and Rugby-A Match Made In Hell?”

IPSTCC Hong Kong 2010 “Management of Acute Musculoskeletal Injuries within the pitch side setting” Hong Kong Rugby Football Union Hong Kong 2010 “Management of Shoulder Injuries in Professional Rugby” EIS Shoulder Workshop March Lilleshall 2010 “Anatomy and Biomechanics Of the Shoulder Girdle”- also Course lead EIS Shoulder Workshop April Lilleshall 2010 “Anatomy and Biomechanics Of the Shoulder Girdle”- also Course lead OCPPP Conference Nottingham 2010 “Can shoulder Injuries Be Prevented in Professional Rugby?” Spire Hospital Musculoskeletal Manchester 2010 Study Day “Management of Hamstring Injuries” Primary Care Rheumatology Society Kettering 2010 CPD Study Day “Basic Examination of the Knee” MACP Evening Lecture Wolverhampton 2010 “Advanced Upper Limb Rehabilitation” Connect In service Training Manchester 2010 “Theory and Practice of Kinesio Taping” Primary Care Rheumatology Society Kettering 2011CPD Study Day “Clinical examination of the shoulder-Making sense of the tests” lecture & practical ACPSM Bi-Annual Conference Cardiff 2011 “Proprioception in the Rugby Shoulder” podium presentation ACPSM Bi-Annual Conference Cardiff 2011 “Influence of tackling and shoulder Proprioception” Poster Dutch Physiotherapy Conference Holland 2011 “Visceral causes of shoulder pain” British Cardiovascular Society Annual Manchester 2012 Conference: Recovery from Injury Journal of Sports Therapy Web Site Birmingham 2012 Re Launch : Rehabilitation of the AthletevShoulder Wrightington Shoulder Conference Wigan 2012

Assessment of the contact athlete shoulder Rehabilitation of the contact athlete shoulder

BASEM Conference 2012 St Georges Park The role of screening in prevention of Musculoskeletal injuries BOSTAA Conference 2012 St Georges Park Rehabilitation of the athletic shoulder Warwick Shoulder Conference Warwick 2012 Prevention and rehabilitation In instability The throwing athlete; prevention and rehabilitation considerations CSP Yorkshire & Humberside Network Doncaster 2013

Tissue quality and time frame considerations in the Management and rehabilitation of the injured patient.