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MSK medicine involves the examination, diagnosis and treatment of problems arising from the musculoskeletal system. These often include disease and injuries associated with bone, muscles, ligaments and tendons of the the limbs and spine.

Physiotherapists are anatomy and physiology experts. It takes many years of learning about the human body; the intricacies of all the body systems working harmoniously. The relationship of muscles, ligaments, nerves, tendons and joints to ultimately produce fluid and every efficient movement.

However, from time to time one of these may not work as fluently as we would like usually as a result of an injury,  repetitive movements or prolonged positions.

As a physiotherapist it is my job to identify what structures may be responsible via a broad range of examination techniques and together formulate a treatment plan to address these issues and get you back to doing the things you enjoy.

Low back pain (LBP) is a common musculoskeletal complaint. Approximately 75%-85% of people report an incidence of LBP in some point in their lives which is reported to be on the rise globally.

A systematic review by Hoy et al (2014) reported that out of 291 conditions studies, LBP was ranked 6th and caused more disability worldwide than any other condition. It is responsible for the 15 million sick days taken in 2013 and with it carries significant health care costs.

Although incidences of LBP can be extremely painful, less than 1% are a result of any sinister pathology (e.g cancer) and only approximately 10% can be diagnosed as some form of nerve root involvement. Typically LBP is mechanical in nature and during the acute and sub-acute phases physiotherapy can assist in pain reduction, facilitate range of movement and implement a graded exercise programme. The key is to restore movement and return to activity as soon as possible.

However, for approximately 5-10% of people their symptoms continue to persist for greater than 3 months and their pain becomes chronic. 

Chronic pain, as already described in the pain chapter, is complex and multifaceted and evidence highlights education and exercise is equally important when compared to other form of treatment.

Unfortunately, in an attempt to identify their source of pain, people turn more to investigatory measures such as x-rays and MRI scans. However, evidence shows that there is no correlation between a persons scan and their symptoms in a large majority of low back pain sufferers. In fact, a study by Hancock et al (2007) reports that 76% of people who reported no symptoms associated with lower back pain but received some form of imaging had some form of 'disc bulge' or 'disc degeneration'.

Unnecessary surgeries still continue and a study by Baber & Erdek (2016) report between 20%-40% of people report no improvement in pain.

As a Physiotherapist, I am an expert at diagnosing and treating lower back pain in both their acute and chronic forms. I understand the complex, multifaceted nature of this condition and I am expertly trained to provide advice and education, and work collaboratively with you to formulate a plan to get you back to doing the things you enjoy and to avoid the risk of unnecessary surgical interventions.

Pain is probably the most common symptom that people report when they seek help from a physiotherapist.

Pain is an output from the brain as a result of a complex cascade of events. It is evolutionary very useful, as it is designed to help prevent further damage to the area.

In the early stages of an injury, also know as the acute phase, tissue damages results in inflammation within the area which activates nerves known as nociceptors. These send signals to the brain and it is here where, based on the brains interpretation of the stimuli and the person's emotions and feelings, the output of pain is created.

In the acute phase it is important that pain is addressed early to help reduce inflammation and encourage gradual range of motion exercises. Not only this, acute pain has to be addressed early and appropriately to prevent what is known as 'chronic pain'.

The most common definition of chronic pain is when the symptoms persist for greater than 3 months. By this time, any damage from the acute injury would have resolved yet the patient continues to experience pain. 

Unfortunately, it appears as though the incidence of people living with chronic pain in the UK is on the rise and is predicted to carry on rising. A systematic review by Fayaz et al (2016) highlighted that 1/3 to 1/2 of people in the UK suffer from chronic pain. That equates to approximately 28 million people.

In search for a solution people often turn to various medication and alternative treatments and medications in an attempt to alleviate their pain. A large body of evidence highlights that this is not the answer, and chronic pain has a far more complex mechanism behind it than simply addressing the biological aspects. As a trained physiotherapist, particularly at King's College London, one of the best universities in the world for teaching the most up to date evidence base, I have a sound understanding of the multifaceted components that can contribute to chronic pain. 

Together we can devise a graded and gradual return to activity, providing education and advise to aid with your understanding of your condition.

Unfortunately whether you're a seasoned professional, an amateur or occasional participant, sports injuries are common. According to Heron (2015) sports related injuries contribute to the 20% of musculoskeletal related injuries seen within GP practices.

Different sports require a different skill set. While some require a series of dynamic and explosive movements, others require finesse and controlled movements. As a result, injuries can vary from sprains and strains, through to tendinopathies and in some sports, bony and nerve injuries.

Careful examination can highlight structures that may be responsible for your symptoms, however some sports require a complex sequence of combined movements and it may be during these that you experience your pain. Being able to understand and break down these complex movements to identify at what point your symptoms are produced is key, and being an athlete that has competed at a high level allows me to do this.

Rehabilitation is a key component to enable you to return to sport. It is important that the journey is progressive, incorporating flexibility, strength, sensory motor control, endurance and motor relearning. Failure to adequately rehabilitate can increase your risk of rein jury significantly. For example, Creighton et al (2010) highlighted that previous injury is associated with up to a 4-fold increase in the risk of reinjury. Richie and Izadi (2015) reports that of those people who suffer an acute ankle sprain, between 19%-72% will suffer the same injury in the future, with 70% of people developing reoccurring ankle sprains known as chronic ankle instability.

Being a competitive badminton player who has reached top 40 in the national rankings, I have had my fair share of injuries. I have used my knowledge to not only accelerate my rehabilitation to get back to playing sport quicker but also ensured that I employed the correct measures to stop it from happening again. And I can do the same for you too.

Sports Tape

Although perhaps not as popular as Kinesiology Tape, the rigid properties of sports tape provides a multitude of uses. These include:

Mechanical support - for example offloading hypersensitive areas of tissue / fascia to help with the healing process.

Instability - To allow improved joint control

Proprioception - Injury to a joint is said to affect the body's ability to identify where it is in space. By having tape around the ankle it is suggested that this feedback mechanism is improved and will help with overall joint control.

Tape is seldom used independently and is commonly used as an adjunct to other treatments (i.e sports massage, physiotherapy, gentle exercise and movement etc). Due to the tape's properties it provides the stability within the early stages of rehabilitation to help facilitate you back to your activities sooner.

A recent study by Halim-Kertanegara et al (2017) highlighted that those participants who reported chronic ankle instability and had their ankle taped versus a placebo reported increased self-efficacy and confidence with no adverse affects to performance.

Kinesiology Tape

This form of taping was devised in the 1970's by Dr. Kenzo Kase who felt that, whilst the traditional zinc oxide tape provided stability to the muscles and joints, range of motion was limited and eventually created the Kinesio Taping technique. This tape is reported to be able to stretch 120%-180% of its original size and is said to provide the support of the sports tape but allowing the flexibility for joint range of movement.

Kase et al (1996, 2003) and Murray and Husk (2001) claimed that K-Tape had five main benefits:

Normalisation of muscular function

Increased vascular and lymphatic flow

Reduction of pain

Relief of muscle tension to correct joint misalignment

Increased proprioception

It also claimed that Kinesiology Tape can also facilitate muscle activation and muscle inhibition.

The evidence of the use of K-Tape within the literature remains mixed, with studies typically enrolling low numbers of participants and a high risk of bias. A recent study by de Freitas et al (2018) highlighted that the application of K-Tape to the quadriceps muscle did not increase the maximum voluntary contraction during knee extension. 

A study by Craighead et al (2017) highlights that K-Tape demonstrated a modest increase in skin blood flow.

Another study by Lee and Lee (2017) highlighted that the application of K-Tape on people with chronic ankle instability resulted in immediate improvements in postural stability without a reduction in range of motion.

Further high quality evidence is clearly needed to identify whether there is a benefit to kinesiology tape. However, at my clinic I will use kinesiology tape as an adjunct to other therapies I provide. 

However, Brukner et al (2017), a leading expert in clinical sports medicine, emphasises the importance of wearing a prophylactic support such as tape or a brace to help support the injured tissues / joint when undertaking a gradual return to sport programme.

Rehabilitation is a journey that begins on your first appointment with us. While in the initial stages we want to address your symptoms, we also want to be able to device an individual exercise programme to help reduce the chance of re-injury.

That's why from your very first visit we will work together to produce an individually tailored home exercise programme that will be reviewed during further treatments to ensure they are progressed adequately.

It's important to stress that by exercise programme we do not expect you to go to the gym! Working with you, we can devise a plan to be able to fit exercises / activity within your daily routine to ensure that they do not become an inconvenience.

Here at the clinic we also have access to our own independent gym comprising of free wights, pilates balls and cardiovascular equipment. This facility will allow me to properly demonstrate any exercises you are ensure of, and also provide expert advice to make the most out of your exercise programme.

Acupuncture is used as a part of an integrated approach used by physiotherapists to address the management of pain and inflammation by stimulating the body's own healing chemicals to help aid and enhance recovery.

Acupuncture dates back as far as 1000BC, founded on the concept that in order for the body to achieve balance in health and fitness, both YIN (negative) and YANG (positive forces) forces must be balanced in order to restore balance within the body.

It is said that there are meridians within the body that link the deeper organs to the superficial skin, and within these meridians is a flow also known as QI (pronounced 'chee'), and this flow can be influenced via specific acupuncture points within the skin. During injury, disease or infection it is said that the natural flow of QI is altered within the meridians thus causing pain, inflammation, weakness, exhaustion or chronic illnesses. It is hypothesised that by inserting needles at specific acupuncture points the flow of QI and therefore the body's balance is restored.

Modern day medicine now provides clinical research and evidence behind the use of acupuncture, and by performing a thorough assessment to identify the source of imbalance, I can identify the correct points to address the imbalance.

How Does Acupuncture Work?

Once the acupuncture points have been identified via a thorough assessment, between 1 and 10 needles may be used for a duration of between 20-30 minutes. Insertion of the needle enhances the pain modulating systems locally, segmentaly (at the spinal cord) and in the higher centers (Periaqueductal Grey matter) in order to release endorphins to reduce pain, melatonin to promote sleep and serotonin to promote well being to name a few. By allowing the body to release the own pain modulating chemicals, it allows other interventions such as manual or exercise therapy to be implemented.

Acupuncture can also be used to address trigger points, where a needle is placed in a hypersensitive piece of tissue in order to facilitate muscle relaxation which can help improve range of motion and relieve tension.

Sports massage is a treatment designed to manipulate the soft tissues such as muscle, skin, tendons, ligaments and fascia. Repetitive and strenuous activity as well as trauma result in hypersensitive tissues and sports massage can be applied either prior or after exercise to aid maximise performance, aid recovery and prevent injury.

Periods of increased activity beyond a point to which the body is used to can result in overload of the tissues. In order to prevent further stress to the soft tissues they can become stiff and painful. Via varying techniques  that include petrissage and effleurage as well as PNF stretching, sports massage attempts to address these hypersensitive and stiff tissues. 

Sports massage has a number of effects:

• Stretches soft tissue
• Relieves muscle tension
• Improves flexibility & range of motion
• Reduces muscle spasm
• Improves the formation of scar tissue
• Reduces swelling
• Increases blood flow to an area whilst removing lymphatic fluid following injury
• Removes waste products
• Relieves pain
• Aids recovery from delayed onset muscle soreness (DOMS)
• Improves physical performance
• Relieves tension and anxiety
• Sports massage can benefit all ages and all levels of activity. 

It is also worth mentioning that sports massage may not only benefit those who participate in sport, but ANYONE who is suffering from sore and stiff muscles. Prolonged sitting positions as well as jobs with heavy living and repetitive movements can also overload the muscles, in affect leading to the same hypersensitive tissues.

Book today and find out for yourself how you can benefit from a sports massage

Conditions

As a Physiotherapist I am specialised in treating various conditions, with the most common being:

• Acute back pain 
• Chronic back pain
• Neck pain
• Headaches
• Shoulder pain
• Elbow pain
• Wrist pain
• Repetitive strain injuries
• Post trauma injuries (e.g fractures)
• Post orthopaedic surgery 
• Sacroiliac joint pain
• Hip pain
• Knee pain
• Ankle pain
• Rheumatoid / Osteoarthritis
• Sports injuries
• Work related injuries
• Sprains and strains / soft tissue injuries
• Treatments

Following a detailed subjective and objective assessment I have a range of treatment options available to me. These include:

• Manual therapy techniques (joint mobilisations, manipulations)
• Soft tissue techniques (massage, myofascial release, trigger point techniques, stretches, PNF)
• Patient-specific exercise prescriptions
• Structured exercise programmes 
• Advice and education
• Chronic pain management advice
• Functional restoration programme for those with long standing pain.