Head2Toe Physio Coronavirus Update

Telephone Web based Appointment

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.


If you or anyone you know requires Physiotherapy input at this time, please click here for more information.


Telephone, Skype, WhatsApp or Facebook Messenger Appointments

Telephone Web based Appointment

Why Physio Telephone/Video Appointments?

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.

Initial assessment price – £40

Follow up / review price – £30

To request a call back from a Physiotherapist:

Call us – 01306 876072 or 01293 535884

Click here to email us

Head2Toe Physio Coronavirus (Covid-19) Update


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.
  • Keep up to date at https://www.nhs.uk/conditions/coronavirus-covid-19/

Click here If you want to talk to the team about anything in this update.

If you want to arrange a telephone or web appointment click here.


How We Tackle Patient Dignity as Physiotherapists

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.

Pippa Graham



head2toe physio, physiotherapy, physiotherapist  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.

Are You Ski Fit?

Ski Fit, skiing, ski exercises, snowboarding, winter holiday

Are you ski fit for this seasons winter break?

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.


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

double leg squats

  • Jump squats

jump squats

  • Clock face single leg squats

single leg squats, clock face

  • Sumo squats

sumo squats

  • Lunges: either static, alternating or jump lunges


  • Lateral hops over an object or onto a step and then over the step

lateral hops

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.viola vajova, physio, head2toe physio, physiotherapy




head2toe physio, physiotherapy, physiotherapist  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 TJNimphius SStone 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.

Current Issues in Flexibility Fitness.,DV Knudson, P Magnusson, M McHugh – President’s Council on Physical Fitness and Sport Research Digest, series 3n 10, June 2000 – ERIC

Pollock ASDurward BRRowe PJPaul JP.Clin Rehabilitation.2000 Aug;14(4):402-6.What is balance?

Patellofemoral Pain

What is Patellofemoral Joint Pain?

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.


Cycling and Knee Pain – Get on your bike!

Cycling – Why does my knee hurt?

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.


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.

Pelvic Pain in Pregnancy

Pelvic Pain in Pregnancy

Pelvic Pain in Pregnancy

Ah the wonders of pregnancy! The full-bodied luscious hair, the glowing skin, the swollen ankles….

Not everyone glides through pregnancy with ease. Among the common ailments of pregnancy, is pelvic pain. It is estimated that 1 in 5 pregnant women will experience some pelvic or back pain through their pregnancy, most commonly in the second and third trimester.

Most people with pelvic girdle pain have pain in the buttock, back, groin, thigh or pubic bone. The pain tends to be aggravated by standing and walking and some can start to have a ‘waddling gait’. Other mums-to-be have pain when turning in bed or getting out of a car. 

For some lucky ladies, this can resolve by itself. For others, the pain can become quite disabling. This can be especially difficult as the chances of getting pelvic pain increases with pregnancies. Having a reduction in mobility and a three-year-old to run around after is quite testing to put it mildly.

Although pain in the pelvis and low back is relatively common, around 50 to 70% of pregnant women will experience symptoms in their pregnancy. This does not have to be normal.

Despite all of this I would like to let you know that physiotherapy can help!

Why do we think women get pelvic pain in pregnancy?

Well the evidence we have, suggests that there are multiple factors. Previously it was thought that the hormone relaxin was responsible. This helpful hormone is released to loosen the pelvic ligaments ready for pelvis to widen for the birth of the baby.

It has been found that these hormones peak at around 12-14 weeks, this does not correlate to when we normally see symptoms developing so there must be another reason!

Research has suggested that the pelvic joints moving asymmetrically and altered activity of the muscles around the back and pelvis are having an impact. Essentially the altered biomechanics that occur in the body to accommodate the growing baby seem to be responsible.

There are many risk factors that predispose some women to this more than others. What we do know is that early intervention is thought to give the best chance of avoiding more severe problems further on in pregnancy. 

What treatment can you have when you are pregnant?

Seeing a physiotherapist who is experienced in this area is important as they can give appropriate advice and treatment for the problem.

Treatment includes muscle training around the pelvis, spine and abdominals, manual therapy for the spine, pelvis and hip and pain relief such as acupuncture.

Acupuncture has been well researched and is shown to be safe in, as long as the practitioner is specifically trained in pregnancy acupuncture.

Read about Anna Watson and Ante/Post natal Physio at Head2Toe Physio Dorking here

Assessment and treatment can be administered in the clinic or in the comfort of your own home.

If you or anyone you know is suffering from Womens Health issues and would like to have a physiotherapy assessment with Anna Watson for suitability of Womens Health physiotherapy treatment, contact us here.

Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine 2005; 30(8):983-991.

 Wu WH, Meijer OG, Uegaki K, Mens JM, Van Dieen JH, Wuisman PI et al. Pregnancy related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J 2004.

Elden H, Ostgaard HC, Fagevik-Olsen M, Ladfors L Hagberg H (2008) Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. BMC Complement Altern Med. 26, 8, 34). (49) 

Subacromial Impingement – Shoulder Pain

Shoulder pain

Shoulder Pain

Summer is here (although it feels ironic to say that given the deluge yesterday and the week of rain we have forecast). Summer motivates many of us to get out playing cricket, tennis, stool ball (a Sussex speciality), athletics and golf. For those less athletically minded, many get more active with DIY and gardening throughout.

As is often the case with increased activity we can start to get more aches and pains. All the sports and activities mentioned earlier put us at increased risk of aches and pains, in particular shoulders can begin to suffer if not looked after properly.

The complex nature of the shoulder makes it vulnerable to various different pains and instabilities. Many of us have been diagnosed with a condition called sub- acromial impingement syndrome or shoulder impingement. It tends to cause pain down on the top and the side of your arm, pain lifting your arm overhead, pain at night and sometimes a feeling of weakness. This is specifically what a new review has looked at.


A recent systematic review (a review of relevant studies) looking at shoulder surgery versus physiotherapy rehabilitation in patients with subacromial impingement, has shown that the long-term outcomes of physiotherapy rehab can be as beneficial as surgery if not slightly better! The key findings were:

  • some patients will continue to experience minor pain regardless of whether they have surgery or physiotherapy.
  • placebo surgery studies show us that there is no important benefit of having surgery, on pain or function.

Whilst nothing is clear cut and there are thoughts that if we better divide patients into different groups we may get different results, at the moment we have to work with what we do know. When our patients come in to see us, we do everything we can to successfully rehabilitate them without referring them onto a surgeon.

 The key to success of any rehabilitation is a thorough and accurate assessment and diagnosis by an experienced physiotherapist. A good explanation is needed at the start of the process that it may take a good 4-6 months to see definitive benefits. Physiotherapy should involve manual techniques and most importantly a graded exercise regime which needs to be adapted and increased at appropriate times under the guidance of a skilled physiotherapist.

This should allow you to continue doing your activities whilst being rehabbed although we may need to modify techniques or teach appropriate strapping techniques.

The benefits of an appropriate physiotherapy regime for shoulder pain particularly impingement is no longer in question. This does not depend on your age or how active you are. Some people can have shoulder pain in simple tasks such as putting jumpers on or trying to wash their hair. Don’t continue to suffer the pain in silence.

Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta analysis; Lahdeoja, T et al; British Journal of Sports Medicine, 15/1/19.

If you or anyone you know is suffering from shoulder pain and would like to have a physiotherapy assessment with the team at Dorking , Leatherhead or Crawley , contact us here.

DMVAC Dorking 10’s Event

Dorking and Mole Valley Athletics Club 10’s

Well, a week has gone by and I’ve just about recovered from all the post race sports massage I helped give after the DMVAC Dorking 10K and 10 miler.

As a hands on physiotherapist I think I work pretty hard most days and the site of a 20 stone front row rugby player with a bad back doesn’t scare me. However I have a new found respect for how hard the massage therapists at Head2Toe Physio work on a daily basis!

DMVAC ran both the 10K and the 10 miler again this year. We were happy to help last year and this year only got bigger and busier!

The weather was lovely and the backdrop clearly spectacular. It made for an interesting mix of runners, some local and some from a lot further afield.

It was great to be part of such a well run event and of course we will be back next year…..with some more massage therapists! We will of course look out for any of the ‘spot prize’ winners in the next few weeks.

Congratulations to John, Martin, Louise and all the others who make the DMVAC Dorking 10 event such a success.

If you or anyone you know is suffering from injuries and would like to have a physiotherapy assessment or sports massage with the team at Dorking or Leatherhead , contact us here.