Sussex Physio

Tennis Elbow

‘True’ Tennis Elbow is an overuse injury, usually affecting the tendons that are attached to the outside of the elbow (the epicondyle). However, the term often gets applied to any sort of elbow pain- a bit like saying ‘cooking’ or ‘gardening’, it can cover a multitude of things!!
Tennis Elbow is very common, affecting up to 1 in 100 adults. It’s usually self limiting, though rarely settles if you keep doing the activity that strained the elbow in the first place.
There is usually inflammation or damage of the Common Extensor Tendon, as it crosses over the outside of the elbow, or where it attaches to the outer tip of the humerus, just above the elbow. Sometimes, the source is the joint at top of the Radius bone, and occasionally it involves the ligaments that stabilise the outside of the elbow joint. Occasionally, there some nerve irritation higher up the arm, or near the neck, which causes the elbow pain.

After detailed questioning and physical examination to identify the true source of pain, we usually treat with relative rest (avoiding the upsetting stresses), local massage, ultrasound electrotherapy, and specific graded strengthening exercises. Some patients also need a steroid injection to settle their inflammation down, but it’s important to loosen up the tissues involved AND restrengthen them as well. We may prescribe the use of a rigid Tennis Elbow Strap support- we stock these and trial them with our patients before recommending any purchases.

Lawn & Indoor Bowls Physio Clinic

Sussex Physio offers a private and professional sports injury service to support people of all ages in the pursuit of an active lifestyle.

Our physiotherapists and sports masseurs are dedicated to returning you faster after an injury, keeping you playing comfortably and improving your performance.

What do we do

We offer a fresh approach to the treatment and management of injuries to help you get the most out of your practice. Our aim is to support you medically so that you can enjoy your sport and competition more, safe in the knowledge that you are gaining the full health benefits of a healthy active lifestyle.

Benefits to you

We are skilled in providing you with an accurate and correct diagnosis of your problem to give you peace of mind and an understanding of what needs to be done to resolve it.

Call us on 01403 276272

The benefits of our individualised treatment plans are:

• A faster return to sport and exercise
• Reduced risk of recurrence
• Enhanced performance
• Increased enjoyment and participation
• Improved physical activity levels
• Higher levels of health & wellbeing

Call us now on (01403) 276272 or web request a call back to book an appointment or discuss your problem before booking.

Triathlon Physio Clinics

At SussexPhysio we know the demands placed apon triathletes by this most challenging of events.

We have expertise in working with triathletes of all levels and skills in treating injuries caused by the disciplines of swimming, cycling and running.

Our aim is get you fit and back to training as fast as possible to keep you competing through the season. We can also help with close season prevention and performance enhancing programmes to help you prepare for future competitions.

Call us now on (01403) 276272 or web request a call back to book an appointment or discuss your problem before booking.

Call us on 01403 276272

Running Injuries Physiotherapy Clinic

We offer a specialist physiotherapy running services to cater for the needs of all standards and disciplines of running.

Our Physiotherapists have extensive knowledge and experience in working with running related disorders to help get you back on the road or track fast.

We specialise in the diagnosis, treatment and rehabilitation of running injuries and focus on technique, performance and prevention to help you make the most of your training time and keep you competitive.

We also work closely with Podiatrists who can also help with running shoe advice and insoles and orthotics where required.

Call us now on (01403) 276272 or web request a call back to book an appointment or discuss your problem before booking.

Call us on 01403 276272

Physio for Golf Injuries

Sussex Physios at the Bartholomew Way Clinic can help you get a little more swing into your golfing performance.
Our team can help improve your biomechanics and movement control to maximise your driving,
pitching and putting. We concentrate on alignment, stability, and control to allow you to deliver the
correct sequence of movements needed on the fairway. A top to tail approach is taken to help you
get the most out of your game whatever your handicap.

Call us now on (01403) 276272 or web request a call back to book an appointment or discuss your problem before booking.

Call us on 01403 276272

Great Tendon Rehab course

On the 4th June Martin and I attended a fantastic one day course at St Thomas Hospital in London.

The course was taught by Dr Peter Malliaras, a Senior Clinical Lecturer who leads the masters programme in Sport and Exercise Medicine at Barts and the London School of Medicine and Dentistry, Queen Mary University London.

Thanks to PhysioUK and St Thomas Hospital for an enlightening day course.

An early morning in London

Physiotherapy Fee Change

We are pleased to have been able to have frozen your physiotherapy consultation fees  over the last five years.  Our prices last increased  in August 2006.

On the 1st August 2011  a one hour initial  physiotherapy assessment at Bartholomew Way Clinic will increase to £55 and a 45 minute treatment appointment will increase to £35.

We want to maintain the quality of care we provide to you, and to do this have found we must increase our prices to cover what have been significant rises in our costs throughout the last five years.

We look forward to continuing to care for you into the future.

Knee Pain – Ultrasound Imaging

We see lots of patients with knee pain. When the cause is due to soft tissue damage or problems, tissue changes can often be seen clearly with ultrasound scanning. However, nothing ever replaces the standard, detailed physical examination- we only use the scan to confirm our assessment findings, but it’s often fascinating to be able to ‘see’ the tissues involved.
Healing and resolution can also be monitored using follow up scans.
The images below show marked thickening and increased darkness (hypo-echoic signal) in a kneecap tendon – Patella Tendinopathy.
Whilst the patient reported improvement in his symptoms of pain and reduced function with a course of treatment (stretching, and muscle re-strengthening), repeated scans later showed very little change in the size of the tendon. He was intrigued by the early scan result, but very reassured to see the tendon was intact.

Patellar tendon scan

David is not a qualified sonographer. However like many physiotherapists in musculo-skeletal practice, he has received basic training in the use of ultrasound imaging equipment and uses it to confirm his assessment findings and measure progress in recovery from certain injuries.

Tennis Elbow – Ultrasound imaging

Tennis Elbow is the term often used for pain on the outside of the elbow; technically, it is for inflammation of the local tendons (Common Extensor Tendons). However, there can be several different causes for the pain, and careful assessment is needed to make a correct diagnosis, prior to treatment. Following the usual physiotherapy assessment, David may use the dynamic ultrasound scanner to image the local tissues, gaining more information about the local condition.
On the scan below, you can clearly see in the right hand frame very significant thickening and darkening of the Common Extensor Tendons which cross over the Radial Head and elbow joint, compared with the opposite elbow, which is pain free in the left hand frame. We’ve added an anatomy drawing to help you identify the tissues involved. (David says this is the biggest one he’s seen- they aren’t all like this! We referred this patient on for a formal scan)

Tennis Elbow Ultrasound scan

David is not a qualified sonographer. However like many physiotherapists in musculo-skeletal practice, he has received basic training in the use of ultrasound imaging equipment and uses it to confirm his assessment findings and measure progress in recovery from certain injuries.

Achilles Tendon – Ultrasound Imaging

Achilles tendonois or Tendinitis?
There’s a huge amount of information in the ‘net about Achilles Tendonitis but you need to know for sure whether you have got inflamation (which is “-itis”) or the longer lasting, harder to treat “tendnosis”; these two conditions feel pretty similar but they’re managed very differently. You need an expert!!

When patients present with any Achilles tendon complaint, David usually completes his usual physiotherapy assessment with a dynamic ultrasound scan, comparing the affected tendon with the ‘normal’ one.
In tendonosis the tendon feels thickened and tender to palpation, and loses some of it’s pliability; an ultrasound scan shows this thickening very clearly, especially when compared with the unaffected side. The condition is one of tendon overgrowth
(In ladies, the Achilles tendon is usually 3mm to 4mm thick; in males its usually 4mm to 5mm. This can double in tendonosis.)

This longitudinal scan shows a significantly enlarged achilles tendon in the right frame, with a more normal sized tendon on the left

This transverse scan shows a significantly enlarged achilles tendon in the right frame, with a more normal sized tendon on the left

However, when tendonitis is present, much less enlargement occurs because the condition is one of inflammation; the edges of the tendon can appear darker (hypo-echoic)

(Occasionally, we may see irregularities in the tendon structure, in which case we refer back to the GP for formal scanning and reporting. If there is no tear, we can proceed with vigorous remedial exercise protocols.)

Repeat scans:
We will often repeat a scan during a course of treatment, in order to compare record any changes. Since our clinical records are digital, we can embed a detailed image of each scan into the patients notes.

As tendonitis settles, responding to rest, ice, stretching and a gradual return to exercise, the ‘darkness’ (hypo-echoicity) reduces.
In tendonosis, the patients respond well to a graded exercise scheme called “eccentric exercises”; they begin to report less pain & stiffness early in the mornings and less discomfort on exercise. However, on rescanning, we often find that the tendon size has not reduced- occasionally, it has enlarged further.
This is thought to be because the condition is not an inflammatory one, but one of overgrowth. Patients can be disappointed when the tendon still seems to be thick and lumpy but we can reassure them that it is a normal part of the condition.
What is really great is that 80% of patients with this chronic problem respond very well to our treatment protocol, returning to normal daily activity and sport (even when they’ve had problems for many months).

David is not a qualified sonographer. However like many physiotherapists in musculo-skeletal practice, he has received basic training in the use of ultrasound imaging equipment and uses it to confirm his assessment findings and measure progress in recovery from certain injuries.

Calf Muscle Tear – Ultrasound imaging case study

Ultrasound scanning will immediately show us whether you have a tear or a simple strain. Tears show up very clearly, as do collections of blood in the muscle.

At first assessment 5 weeks post injury

The scan above (fig 1) shows a large tear of the Gastrocnemius muscle. Amazingly, this was some 5 weeks AFTER the trauma. The left hand frame shows a dark area (called a hypo echoic signal) between two parts of the muscle that should be attached; it is 12mm deep; in the right hand frame the gap is closed down to 6.5mm by firm pressure via the scanner head. It was clear that the gap was filled with blood / fluid. Under live scanning, we could see the fluid & debris moving within the defect
We were able to surface mark the entire extent of the haematoma in this gentleman’s calf muscle using ultrasound scanning.
The patient was treated with regular sessions of local ultrasound therapy, gentle remedial exercises and massage, with firm compression support 24 hours a day.

2 weeks after treatment has begun

The second scan (fig 2) was taken 2 weeks later, and shows the gap closing satisfactorily with treatment.

4 weeks after beginning treatment

The third scan (fig 3) was taken 2weeks later, and continues to show good progress.

Healing continues....

The fourth scan shows no hypo echoic signal, and you can clearly see the two parts of the muscle are now joined together by scar tissues. The scar is thicker (3.42mm) than the normal tissues that would be there (intermuscular septum) but they are, at least, now attached. He was able to increase his weight bearing exercsie steadily throughout the healing period, safe in the knowledge that the tissues were healing.

Final scan

A further scan was taken two months later, following increasingly dynamic muscle work and re-education. It shows that the scar has been stretched open a little, and now measures 5.11mm. however, it is functionally strong, and he has returned to Martial Arts sports.

David is not a qualified sonographer. However like many physiotherapists in musculo-skeletal practice, he has received basic training in the use of ultrasound imaging equipment and uses it to confirm his assessment findings and measure progress in recovery from certain injuries.

Interesting Ultrasound Scan

We’ve added another, unusual scan, just for your interest.
A young lady slipped on a wet floor and fell onto broken glass- she cut the front of her knee badly, but was stitched up by a local doctor, and seemed to make a good recovery. Back in the UK several months later, the kneecap tendon was still lumpy and sore and came to see David. The image below shows the damage in then left hand frame, which had gone quite deep- the normal patella tendon is shown in the right hand frame.
Again we recommended further investigation. However, she made a very good functional recovery without any surgical intervention.

Interesting patellar tendon ultrasound scan

Sciatica

SCIATICA is the term given to pain running down the back of the buttock and leg, in the areas supplied by the SCIATIC NERVE.
The nerve itself is made up of several nerve roots that come from Spinal Cord in the lower back (Lumbar Spine). It supplies the muscles that move the buttock, back of the thigh, calf, shin and foot, and the skin that covers them. (The Femoral nerve supplies the muscle and skin on the front of the thigh).
What causes sciatica?

The most common cause of sciatica is a bulging or ruptured disc in the spine pressing against the nerve roots that lead to the sciatic nerve. However, sciatica also can be caused by the nerve tissue being compressed or irritated by very stiff spinal joints, bone spurs (small, bony growths that form along joints) caused by wear and tear arthritis, or even narrowing of the spinal canal (a condition called Spinal Stenosis). Occasionally, the sciatic nerve can be irritated by excess muscle tone deep in the buttock, PIRIFORMIS SYNDROME (pseudo-sciatica). In rare cases, sciatica can also be caused by conditions that do not involve the spine, such as tumors or pregnancy.

What symptoms do you get?

Usually pain, but also tingling and numbness can occur, either constantly or intermittently. You may also experience muscle weakness in the affected leg.

TREATMENT

Our Physiotherapists use a thorough physical examination to determine the cause of the pain, and decide where the nerve irritation is occurring. (Areas of sensation change or muscle weakness in the leg help us to work our which nerves are affected)

Treatment plans are drawn up together with the patient to relieve pain, promote relaxation and restore movement. The treatments offered will vary, depending on the cause of your pain, and may include joint and soft tissue manipulation or mobilisation, traction, electro-therapies and remedial exercises.

There are many types of exercise; we use them to maintain or restore movement and muscle control, to correct posture and improve lifting technique.

We use clinic based treatments to promote recovery, but we are also committed to giving patients confidence & freedom to augment that treatment with home exercises whenever possible: our aim is to teach and educate as much as possible.

We will monitor your progress and progress the treatments as your body responds.

Patients with chronic or recurrent back problems often need to re-establish good CORE STABILITY by retraining muscles; Dynamic Ultrasound scanning enables us to see muscle activity levels as they occur, and gives our patients great encouragement in the form of visual feedback.

Ultrasound imaging

We use ultrasound imaging in day to day practice. Call David to discuss how imaging of your injury can reduce your pain more quickly.

Contact us to discuss your imaging needs.

Achilles Tendinitis or Tendonosis?

Achilles heel, tendinitis, tendinosis, tendonosis, tendinopathy…. Whatever you call it….It hurts!

We are seeing a lot of Achilles problems that are actually TENDONOSIS not TENDINITIS; Tendinitis is an inflammation problem, usually quite recent and the usual sports injury treatments (R.I.C.E.) especially ice, anti-inflammatory drugs etc work well. However Tendonosis is a longstanding problem, characterised by tendon thickening and tenderness, early morning stiffness, pain on over use,…. but there’s no true inflammation going on so ice and anti inflammatories don’t help much at all.

Tendonosis of the Achilles tendon is often resistant to all sorts of treatments traditionally given for this problem.

However, In recent years there have been a handful of new research studies suggesting a better approach to treating sore and swollen achilles tendon problems.

Our team will use a detailed examination of the tendon and related joints & tissues, often involving ultrasound imaging of the tendon, to measure any swelling or injury. Following this assessment, we will agree a course of treatment tailored to your needs; it will usually include a prescribed course of exercises.

We will offer shoe advice, other physical therapies and may prescribe orthotics as well, but the course of daily exercises (including ‘eccentric’ exercises) are the centre-point for treatment. There will be regular reviews of your progress to keep you on track to full cure, usually over a period of 12-16 weeks.

Elbow & Arm Problems

Do you have tennis elbow? Call to discuss how we can help you.

Wrist & Hand problems

Do you have wrist or hand pain?

Neck Problems

If you have neck pain or whiplash injuries call reception on: (01403) 276272 to arrange a call with David to discuss possible treatments for your problem

Our Chartered Physiotherapist is trained to perform a detailed examination (called Assessment) of your neck problem. This identifies the cause of the symptoms, so that we can agree a plan of treatment together. This first session takes an hour.

The treatment plan will usually consist of some form of manual therapy, including gentle soft tissue massage, joint manipulation and sometimes manual traction. The manipulation is rarely forceful: more commonly, it will be gentle, rhythmic and soothing, especially in acute conditions. Occasionally, more powerful techniques will be necessary; these are carefully planned and performed, and the effects carefully monitored.

You’ll be given clear instructions on some self help techniques, including remedial exercises, which will help to maintain the improvements from treatment, and promote further recovery.

You may have some postural issues that need to be addressed, in order to reduce strain on your neck; these can relate to longstanding habit, lack of muscle strength, or poor work station design/seating. Either way, we will help you deal with it!

Useful advice links: Arthritis and Rheumatism Council:  http://www.arc.org.uk/arthinfo/patpubs/6024/6024.asp

Shoulder Pain

Do you have a painful shoulder problem? Call David for advice how he can help you.

There are many different problems which can cause shoulder pain, and the treatments vary a great deal, so detailed examination and assessment are essential for accurate diagnosis and planning of suitable treatment. Our assessment sessions take an hour and can include ultrasound scanning to test the integrity of muscles and tendons.

Treatment can include stretching & manipulation for stiff limited joints and tissues, electrotherapy to promote the healing process and muscle strengthening exercises to improve the power and stability of the shoulder complex.

Back Pain

If you have back pain problems, have a chat with David Fraser about how our multidisciplinary approach can give you more effective relief from your pain.

Sixty percent of adults suffer from back pain every year, and half of those can become chronic sufferers.

Back pain is often easily treated by suitably qualified physiotherapists, so it makes good sense to seek advice and treatment when you have a back problem.  It can arise from joint, ligament, disc or muscle problems, often with several overlapping issues.

Back problems are usually caused by bad posture, poor lifting technique or lack of fitness, or results from a specific injury or overuse.

Other causes include inflammation, and rarer, more serious problems such as progressive diseases affecting bones and joints.

Our physiotherapists are trained to carry out a comprehensive assessment to diagnose problems in the joints and soft tissues of the body. We will plan a detailed treatment schedule for your particular problem.

Physiotherapy for back pain includes a wide range of treatments to relieve pain, promote relaxation and restore movement. They include manipulation, mobilisation and massage. Exercises are often used to mobilise stiff joints and tissues, increase general fitness, and to strengthen muscles which support the spine.

We use clinic based treatments to promote recovery, but we are also committed to giving patients confidence & freedom to augment that treatment with home exercises whenever possible.

If you are prone to back pain, we can also offer preventive advice

-useful links:

National Back Pain Association
16 Elmtree Road
Teddington
Middlesex
TW11 8ST
Tel: 020 8977 5474
Fax: 020 8943 5318
Backpain website