Face to Face Physiotherapy Sessions (For Some) From 1st June
We have been working hard throughout the ongoing Covid-19 crisis to find a way to best help our thousands of Physiotherapy patients. We have been amazed at the uptake of our Virtual Physiotherapy Sessions and these will continue for the majority of our patients.
Now new guidance from Government, our Governing body and relevant Clinical Interest Groups has shown how we can begin to open our doors to those patients who cannot be treated effectively ‘virtually’ but that we can do it in a way that keeps you and us as safe as possible.
Things have to look different for the time being but rest assured the level of clinical excellence, experience and compassion will remain the same!
It is important to note that:
This is not a return to practice as usual.
Personal Protective Equipment (PPE) will be used
We are still promoting a ‘virtual first’ approach for the majority.
“Hello, nice to meet you, I’m Sam Bowden. What brings you in to see me today”? A simple question, asked thousands of times. I’ve lost count of the number of times a patient has answered with ” it’s my knees, they’ve gone!”. As a consummate professional, I fight the instant, infantile reaction to answer with ” well you better get after them quick”!
I blame my father for my terrible sense of humour, but maybe I should thank him for providing a great illustration that some arthritic joints don’t necessarily become painful. I have no reason to think that some cosmic force has chosen to spare him osteoarthritis in the knees, whilst failing to spare his back, hips, thumbs and big toes. What I do know is that well into his seventies, he still manages a 10K walk every morning with his dogs and his knees seem to be holding up pretty well!
So why are some osteoarthritic joints painful and some aren’t?
Knee Pain – What is Cartilage?
Cartilage is a connective tissue made up of specialised cells called chondrocytes. There are 3 types:
Fibrocartilage found in the jaw, knee meniscus and spinal discs.
Elastic cartilage is what makes up the wobbly bit of your ear.
Hyaline cartilage which covers the articulated surfaces of bones.
When Knee pain patients get told their joints are going or that they have worn cartilage, it is hyaline cartilage which is being talked about. In the knees this is complicated somewhat, by the presence of a meniscus, which is made of fibrocartilage. It’s normally the meniscus which is affected when someone has a ‘torn cartilage’.
Knee Pain – What is Osteoarthritis?
Osteoarthritis refers to the degeneration of articular (hyaline) cartilage and underlying bone. It’s more common from middle age and can lead to swelling and pain in the joint. There are some risk factors such as a family history, bone deformity, previous joint injury and obesity.
It’s not the same as Rheumatoid Arthritis, Rheumatism or Osteoporosis.
Knee Pain – What Helps Reduce Pain?
Articular cartilage is aneural, which means it doesn’t have its own nerve supply. This probably explains why studies do not associate cartilage wear with pain. It is far more likely that damage to the subchondral bone below the cartilage is where the pain receptors are activated.
Applying ice to your knees, taking Non Steroidal Anti inflammatory Drugs like Ibuprofen or having a steroid injection can all provide some temporary pain relief.
The great news is that a safer and easier way of getting some relief, is to get moving!
It may seem a contradiction, that moving a painful arthritic joint has been shown to be just what the knees want and need. However research has shown that recreational runners are far less likely to develop osteoarthritis in the knee and hip, when compared to non runners!
What if I already have a bit of osteoarthritis? Reassuringly, research appears to show that those patients who walked an average of 7000 steps a day did not develop any worsening of osteoarthritis two years later.
What if my knees are too painful to walk or run? The trick here is to find a type and level of exercise that your knees can tolerate. Once you’ve got that baseline, try to increase from there. The patients I see who can’t yet walk or run, can almost always cycle, use an eliptical trainer or swim.
It might be the case that whilst you can’t walk down the hill from Denbies, you can walk around the big field at Brockham! That’s fine. Start somewhere!
Knee Pain – The Exercises My Physio Gave Me Hurt
If you have Osteoarthritis, your Doctor, Physiotherapist, Personal Trainer or best friend might have suggested you build up your Muscles. It makes complete sense that to protect your knee joints, you will benefit from having stronger supporting muscles, like your Gluteal, Quadriceps, Hamstrings and Calf muscles.
It’s certainly true that Quads (thigh) weakness has been associated with increased cartilage damage 3 years down the line (as seen on MRI scan studies). Surely it makes sense to strengthen those Quads then?
Like so much in life, things can be slightly more complicated than they seem on the face of it. The irony is, the exercises that are best for building muscles are often those that load the osteoarthritic joint the most. So many patients tell me that they’ve been doing their muscle building exercises and they now feel worse!
Put simply, it’s likely they have been doing the wrong exercise or even the right exercise in the wrong way. It may well have been the right exercise for you 20 years ago but your fitness level could have changed!
That’s fine. All we need to do is make things a bit more manageable, and then build you up from there.
Alentorn-Geli et al, Running and Osteoarthritis: Does Recreational or Competitive Running Increase the Risk? Journal of Orthopaedic & Sports Physical Therapy, 47, 6, 2017
Chin, C et al, Quadriceps Weakness and Risk of Knee Cartilage Loss Seen on Magnetic Resonance Imaging in a Population-based Cohort with Knee Pain. Journal of Rheumatology, 2019 Feb;46(2):198-203.
Snazell, N, Cartilage – Can it Repair? InTouch, 160, 2017
White, D et al,Prospective change in daily walking over two years in older adults with or at risk of knee osteoarthritis: The MOST Study, Osteoarthritis and Cartilage, 2016 Feb; 24(2): 246–253.
Spring is here, bulbs are flourishing, and the grass is growing. Whilst many keen gardeners will have been busy preparing for this season, most of us don’t even think about getting out in the garden until the lawn looks almost unmanageable and we’re running the risk of losing our kids in the jungle.
Now that the coronavirus has necessitated self-isolation, people who haven’t tended their gardens for years, have decided to order seeds and bulbs online. They have dug out (pardon the pun) the gardening book that Uncle Steve gave them for Christmas in 2010 and found a fork at the back of the shed, hidden amongst the cobwebs. Now, what’s left before starting to turn over those old raised beds?
How about a warm up and a few basic bits of advice?
There are lots of myths regarding back pain and gardening. Is it bad for us? The truth is that if we are sensible, gardening is a great form of exercise both physically and psychologically.
Remember when we start those jobs in the garden to:
Plan jobs.
Do some gentle warm up exercises and stretches before you start.
Take regular breaks.
Vary the jobs you are doing. Don’t use the same action repeatedly for hours.
Know your limits. Do more trips instead of overloading your wheelbarrow. Don’t overfill refuse bags.
It is normal to feel a bit stiff and achy having been in the garden working hard. However, if you follow the advice above, you should reduce the chances of this happening. Remember to build up slowly. You wouldn’t and shouldn’t take up running by going out for a 10-mile run first time out!
If you develop pain or sciatic type symptoms that persist, then you should seek advice from a physio or your GP.
If you’re lucky enough to have a garden, have fun gardening but don’t injure yourself!
We hope you have found this article useful and if you have any concerns or questions, we are always happy to have a chat, so please contact us.
Blog post written by Sam Bowden, Head2Toe Physiotherapist Director at Head2Toe Dorking, Leatherhead, & Crawley Clinics.
Head2Toe Physio provides clinic based assessment and treatment sessions within Surrey and West Sussex, providing flexible appointments to suit you.
Visit us at one of our clinic locations at Dorking, Leatherhead or Crawley.
All Face to Face Physiotherapy Sessions Postponed From 23rd March
Due to the escalating numbers of cases in the UK, it is with a heavy heart, that at the weekend we made the decision to close the clinic (temporarily!!). This is with immediate effect.
With regret, we have stopped any face to face consultations in the clinic for the time being.
We feel this is now a necessity, and the responsible thing to do. With the exception of some hospital and community Physiotherapists, we cannot see how any outpatient Physiotherapists can justify remaining open at this time. Encouraging patients to attend clinics is promoting movement of the public, increasing possible exposure to the virus and runs counter to all current advice.
The Covid-19 virus is not producing shoulder injuries, back pain and fractures. It is a life threatening disease!
We will of course resume as soon as is deemed safe to do so. This is to safe guard you, and to comply with government instruction. Our magic fingers don’t work from 2 metres away I’m afraid!
We have been in contact with all current patients to offer video consultations and this service is open to anyone should you feel this may be appropriate for you.
Thank you for your understanding in this difficult time, and we hope you are all keeping safe and well. Please feel free to contact me should you wish to discuss anything regarding your treatment.
We will be in contact as soon as we know more, and have some idea when we may be able to resume physiotherapy treatment for you all.
We know the reason many of you want to come and see us is because you get expert assessment and treatment. This often includes hands-on treatment. However, in these fast-changing times, it’s become clear that there are sections of our community who are being asked to self-isolate and avoid non-essential contact with others.Telephone or web based appointments could be a great solution!
The Government advise that this is particularly important for those over 70 years old, those with underlying health conditions and pregnant women.
We have received calls from very concerned patients who have referrals to see us from their GP’s or consultants. They have phoned to ask how they can be expected to attend, when they fall into one of the at-risk categories.
How does it work?
Where there is no better option, we have now started carrying out telephone or video appointments and follow up appointments. We are still able to collect a number of subjective and physical measurements. This allows us to make a diagnosis, formulate a treatment plan and give you good advice.
After your assessment we can give appropriate advice and the rehabilitation exercises you need to get better. Exercises will be sent with pictures and videos to help you get them right.
If Physiotherapy management is not appropriate, we are able to write referral letters to GP’s and consultants.
What are we doing to keep Patients and Staff safe?
The need for patients to receive high quality assessment, advice and treatment when they are in pain has not stopped because of coronavirus. People still need to recover as well as possible from orthopaedic operations, find out whether they have a frozen shoulder or a nerve entrapment or learn how to walk again after a stroke.
So how are we keeping patients safe when they come in to see us?
As well as observing and displaying posters with current government advice, Head2Toe Physio have taken a number of measures to reassure patients that we are doing everything we can to keep them as safe as possible when they visit our clinics.
All our clinic rooms have basins for patients and staff to wash their hands before and after their session.
Between sessions, we are wiping down all couches and treatment equipment used.
All towels used are single use and washed before re-use.
Offering telephone, skype or facebook messenger appointments to those patients who cannot get in to the clinic or who have self isolated after feeling unwell.
What are we asking patients to do to help us?
Be aware of the most common signs of Coronavirus (COVID-19) which are recent onset of a new continuous cough and/or high temperature.
If you have these symptoms, however mild, stay at home and do not leave your house for 7 days from when your symptoms started.
If someone in your household displays these symptoms, do not leave your house for 14 days.
If your symptoms worsen during home isolation or are no better after 7 days, contact NHS 111 online.
Wash your hands more often than usual, for 20 seconds using soap and hot water; particularly after coughing, sneezing and blowing your nose, or after being in public areas where other people are doing so.
To reduce the spread of germs when you cough or sneeze, cover your mouth and nose. Use a tissue, or your sleeve (not your hands). If you don’t have a tissue, and throw the tissue away immediately. Then wash your hands or use a hand sanitising gel.
Dignity Action Day was held on 1st February to highlight the importance of Dignity in Care and the responsibility of all care providers to uphold this basic human right.
As a Neurological Physiotherapist I have had the privilege of working with clients with a wide range of impairments and disabilities and the fundamental link that pulls us all together is listening to and respecting their wishes.
I always treat people how I would want to be treated myself or how I would want my family members to be treated. Everyone has their own expectations and ideals regarding dignity and as a clinician it is vital that during the assessment process we gauge these and have an awareness of that person as an individual.
Everyone has their own story and working collaboratively we can help to maintain a level of respect, privacy and dignity during the treatment process.
In my opinion, a big part of maintaining dignity is to ensure that a client has all the relevant information and choices available to them and that we do not impose our own thoughts or expectations on them.
During the rehabilitation process the overall aim is to assist an individual to return to a certain level of function and well-being. A huge part of this process involves regaining their identity and self- worth, sometimes after a debilitating, life changing event such a stroke or brain injury.
A person can find themselves unable to carry out their own personal care or may have to be hoisted in and out of bed and a huge adjustment process must take place. As Physiotherapist’s I believe we we can support our patient’s dignity by having an awareness of an individuals knowledge, skills and attitudes and by always being empathetic and respectful.
We hope you have found this article useful and if you or a loved one could benefit from some Physiotherapy sessions, we are always happy to have a chat, so please contact us.
Blog post written by Pippa Graham, Head2Toe Physiotherapist at Head2Toe Dorking, Leatherhead, & Crawley Clinics.
We aim to improve function and relieve pain
Head2Toe Physio provides clinic based assessment and treatment sessions within Surrey and West Sussex, providing flexible appointments to suit you.
Visit us at one of our clinic locations at Dorking, Leatherhead or Crawley.
The ski season is upon us. The idea of skiing is tantalizing whilst you sit behind your computer at work, counting down the minutes until your holiday. You’ve paid for your trip, got all the gear and in theory you’re ready for the white, snow filled slopes. But are you ski fit?
Bliss… But before you go, there are few things you need to consider and I don’t mean just the condition of your skiing equipment or whether you’ve got this seasons style jacket!
Are you ski fit?
Are you fit enough to tackle the slopes from the first to the last day of your week?
Can you confidently ski without pain from past injuries?
If you’re the type of skier who likes a leisurely ski down the blue (beginner’s) and red (intermediate) slopes, combined with frequent stops in the café; If you have done some form of exercise regularly throughout the year, then the answer is likely to be, yes.
Would you like to be a little more adventurous or you are returning to skiing after a long break? If your exercising has been sporadic throughout the year, then we at Head2Toe Physiotherapy would strongly advise you to improve your physical fitness.
Injury and Skiing
Some accidents cannot be prevented, (Knee Injuries Whilst Skiing) but many can. We can also try and reduce the risk of injuries. If you have any preexisting injuries, it is best to address them before you get your ski boots on.
By getting fitter you can improve your performance, comfort on the slopes and reduce fatigue which in turn can reduce the risk of injuries.
Ski Fitness
There is a lot to consider when it comes to your general fitness. In this blog post we will concentrate on specific strengthening exercises. In a perfect world you should probably aim to perform a 6 to 12-week training program depending on your starting level of overall fitness. However, as long as you take it slowly, doing something is better than doing nothing!
Muscle strength/ power
Greater muscle strength can enhance sport performance, increase your speed, prolong performance and enhance change of direction during skiing.
Muscle power is needed for fast and efficient movement. After the age of 30, you begin to lose 3% to 5% of your muscle mass over a decade.
Take a look at some of the suggested exercises later on.
Cardiovascular fitness
Training your cardiovascular system keeps your heart, lungs and soft tissue healthy so they are able to pump sufficient amounts of blood into your body/muscles.
Larger muscles require more oxygen to work effectively over period of time for lasting performance.
You’re most likely to be fatigued on your third day of your skiing trip. By then you have skied 4-6 hours over two consecutive days.
To improve your cardiovascular fitness, you will have to try and perform 20 minutes to 1 hr aerobic exercises 3 times a week. That can be done by cycling, jogging (watch the knee loading) or cross trainer use.
You should be warm but able to hold a conversation whilst performing this type of exercise.
Balance and flexibility
Balance is used to maintain, achieve or restore upright posture during an activity.
We need to be flexible enough to achieve the range of motion our joints need for skiing, without an injury to our joints or muscles.
Exercises
Warm up suggestions (5 minutes of any of the following)
Jogging on the spot
Side step jog
Knees up jog
Heels to bottom jog
Can-can walk
Squat jumps
Main Exercises
3 x 10-15 reps (possibly more/less depending on your fitness level).
You should feel mildly fatigued after performing each exercise.
Choose 4 exercises from the following and try to change the four you choose every so often.
Squats: Double leg
Jump squats
Clock face single leg squats
Sumo squats
Lunges: either static, alternating or jump lunges
Lateral hops over an object or onto a step and then over the step
All these exercises concentrate on your lower legs mainly but you shouldn’t forget about the rest of your body either. It’s well worth taking the time to work on some basic ski fit core, back and arm exercises too.
There are so many other useful exercises we could have selected, as well as variations of the above exercises. If you choose to see one of our Physiotherapists before planning your program, we will help you choose which exercises are best for you, based on your current level of fitness and any relevant bio mechanical factors. Come and visit us and we can help you to get ski fit for your holiday.
Have fun on the slopes!
If you are planning a ski trip away or would like some help knowing how to safely get fitter and stronger, please contact us.
Blog post written by Viola Vajova, Head2Toe Physiotherapist at Head2Toe Leatherhead Clinic.
We aim to improve function and relieve pain
Head2Toe Physio provides clinic based assessment and treatment sessions within Surrey and West Sussex, providing flexible appointments to suit you.
Visit us at one of our clinic locations at Dorking, Leatherhead or Crawley.
Suchomel TJ, Nimphius S, Stone MH., The Importance of Muscular Strength in Athletic Performance. SportsMed.2016 Oct. ;46(10): 1419-49
Harvard Health Publishing, Harvard Medical School,Online publication; Trusted advice for healthier life. Preserve your muscle mass, 2016.
Patellofemoral pain is pain involving the kneecap. It gets referred to by a number of other names, including Anterior Knee Pain (AKP), Runner’s Knee and Chondromalacia Patella.
It’s a very common problem we see at Head2Toe Physio and normally means the patients can’t play their sport or do their work normally because of it.
What will your Physio ask you?
When you see your Physio, they will take a full history to try and work out how and when it started. That might involve talking about what hobbies you do, sports you play or what your job involves. Could any of these things have contributed to the pain you’re now in?
They will probably ask you to demonstrate when it hurts before they even think of lying you down and starting to do any formal tests. Patients suffering from Patellofemoral pain will most often show us a squat, knee bend or lunge. All of these types of movement ‘load’ the kneecap and are commonly painful.
When the physio looks at your knee, they might also see some swelling, hear or feel some crepitus (grinding) and find some tenderness around the kneecap. They will look at your joint range and muscle strength, not just of your knee but of your hip and ankle as well.
Treatment for Patellofemoral Pain
Rehab of patellofemoral pain will probably involve, exercise therapy aimed at the hip and knee muscles, some manual therapy aimed at tight tissues and possibly orthotics for the feet.
When I first trained and then started working as a Physio, we were told to work specifically on one of the Quadricep muscles called Vastus Medialis Obliquus (VMO). It always seemed a bit far fetched to me that it was even possible to make one of the Quads work harder or more quickly than the others.
Given I thought it was impossible, I dread to think what our patients thought! Years later it was with great relief that more recent studies seem to show exactly that. The advice now is to gradually load the Quadriceps as a group (not individually) which seems a far more plausible piece of advice.
Your Physio will set you some Quads exercises at a low load that don’t cause a significant increase in your pain. A little increase is probably OK but no more than that. The trick is these exercises need progressing to higher loads as things improve.
Not just your Quads!
As well as muscles on your thigh, your Physio will set you some Gluteal exercises (muscles around your hip). The reason for this is that they help stabilise your pelvis and keep your knee in good alignment when stepping, walking, running, lunging and squatting.
Once things are improving , these muscle groups can be combined at higher loads and in combination. One way is to train wall slides, lunges, squats or step ups/downs. I always try and remember that most of our sporty patients come in with a specific complaint about their knee. It could be they can’t do step classes, lunge for a shuttlecock or get down into a bowls action anymore.
Loading rehab should always aim to finish with sports or activity specific loading. There’s no point coming in with a problem and going away no closer to being able to do it at the end of a 3 month rehab program!
Your physio may be able to help you with some simple verbal or visual cues. It might be something as simple as ‘open your knees’ or ‘knee behind toes’. It’s amazing how subtle changes in posture or technique can reduce or change painful loading.
Do Orthotics work?
It may be beneficial to try orthotics to help correct problems with foot position. This can affect loading in the knee and reduce pain. Some patients can get quite good relief from a simple off the shelf orthotic. Others may be advised to seek more expert biomechanical Podiatric advice. At Head2Toe Physio we have excellent links with a number of really good practitioners. We will advise you if seeing them is advisable.
It is essential when seeing your Physio, to go away with a good understanding of joint loading principles. These should help you self manage your condition more successfully in the future.
If you or anyone you know is suffering from knee pain and would like to have a physiotherapy assessment with the team at Dorking , Leatherhead or Crawley , contact us here.
Living and working in the Mole Valley area, means cycling and knee pain is one of the most common issues we get contacted about.
The patella is the kneecap and the Patellofemoral joint is where the kneecap articulates with the femur. Pains from the Patellofemoral joint are called Anterior Knee Pain (AKP) or Patellofemoral joint pain.
Cyclists are commonly troubled by pain at the front of the
knee and at Head2Toe Physio we see a mix of road cyclists and mountain bikers
with this problem.
Essentially the cause of the pain in cyclists can either be due to bike issues or body issues.
Body Issues
In a race cyclist, there are 3 main issues which can
increase force through the kneecap.
The knee rests at about 30 degrees flexion with the pedal in
the lowest position and about 110 degrees at the top of the pedal stroke. The
forces going through the kneecap are enormous as the quadriceps contract to push
the pedal down.
As the knee is extended and the moves towards the floor, the
knee tends to move ever so slightly in a valgus or knock-kneed direction, towards
the crossbar.
If the tibia (shin bone) rotates out when the knee extends,
the femur (thigh bone) rotates in. This inward or medial rotation has also been
shown to increase force through the kneecap.
Bike Issues
The three points of contact on a bike and the three bits of
the bike most commonly adjusted, are the saddle, handlebars and pedals. Lots of
studies have been done on the possible consequences of having a seat which is
too high or too low.
Common injury risks with a high saddle position seem to be
Iliotibial Band (ITB) pain, hamstring tendon pain and Anterior Cruciate Ligament
(ACL) strain.
Low saddle position seems to be more likely to lead to AKP in particular patellofemoral joint pain.
Fitting
Most bike shops will now include fitting sessions before
selling you a bike. It seems sensible to ensure you spend the time and maybe a bit
more money seeing someone with good bike fitting qualifications and experience.
Alterations can be made to saddle height, saddle position
(forward and backward), pedal and handlebar position.
Saddle height can have an effect on patellofemoral joint
loading.
Saddle position can have the effect of moving the knee in front or behind the line of the pedal spindle. This alters the amount of knee bend and could have an effect on loading.
Pedal position, foot shape, shoes worn and cleats used
should all be checked. Cleat systems almost always allow adjustment of
forward/backward, side to side and rotation movements. All these can have an effect
on loading through the kneecap.
Handlebar position is less important for the knee and in clinic the main problems we see with handlebar position are ones involving the neck. That’s another story for another blog post!
Treatment for Knee pain in cycling.
Consideration of bike issues is important to us at Head2Toe Physio. However, it’s our knowledge and experience dealing with the relevant body issues of cyclists that is where we really add value.
Assessment by our Physiotherapists at Head2Toe will highlight where there are tight structures, weak areas or unhelpful postures. Treatment focuses on improving these areas and ultimately helping you have a more comfortable ride!
If you or anyone you know is suffering from knee pain and would like to have a physiotherapy assessment with the team at Dorking , Leatherhead or Crawley , contact us here.
Asplund C, St Pierre P, Knee pain and bicycling. Fitting concepts for clinicians, The Physician and Sports Medicine, 2004, 32 (4).
Callaghan M, PAtellofemoral pain: A vicious cycle? In Touch, 2016, 154.
Have You Been Getting Out in the Garden?
