Low Back Pain

Low back pain is extremely common. Two out of three people can expect to have back pain bad enough to prompt them to seek help. Symptoms vary enormously ranging from localised back pain to referred pain into the hip, thigh, lower leg and foot. Thankfully most back pain is self limiting. There are however various activities that can either promote or delay recovery.

Shoulder Pain

Shoulder pain is very common but is most often felt in the upper arm rather than in the joint itself. Pain from whatever source in the shoulder begins to alter the natural movement patterns and complex balance of muscles that exists there. This is often difficult to identify oneself and requires professional help in overcoming the complaint and treatment may follow more than one direction. The following are some of the commonest employed:

  • Some form of anti-inflammatory tablet. This may be prescribed by your doctor, or you can buy several different types over the counter at the chemist. Nurofen is probably the most common, this is a proprietary name for Ibuprofen.
  • Injection of some cortisone into or around the shoulder joint.
  • Physiotherapy to concentrate of mobility, stability and correct of pattern of muscle recruitment.

The tissues most commonly involved are:

  • Tendons
  • Ligaments
  • Capsule

It is not uncommon for the neck to be involved in shoulder pain. It can be the major cause or a sequele to shoulder problems. Head posture will definitely affect the shoulder as many muscles and nerves travel between these two areas. A physiotherapist will show you good ergonomic postures and exercises to help maintain them.

Neck and Shoulder Pain

The neck can also be the source of shoulder and arm pain. Be especially aware of symptoms that extend below the elbow and if you get tingling or a deadness in the hand try to analyse if they are confined to any specific fingers or are generally throughout the hand. This sort of information can be very useful in coming to a more accurate diagnosis and therefore effective treatment.

For both neck and shoulder problems a combined approach using both physical therapy and drugs seems most beneficial.

Neck Pain

Although symptoms may have come on extremely suddenly, the cause is generally more long standing. The commonest contributory causes which are increasing in frequency are:

  • A sedentary occupation involving prolonged sitting, driving, computer/desk work with poor posture.
  • Adopting a common position known as a forward head posture. It is very common in office workers, teachers, designers etc. this occurs when the head is held in a position in which the chin is poked forward and the lower part of the neck and upper mid-back are held in a forward bent position.

This results in:

  • Tightness and shortening of the muscles at the base of the skull and back of the neck, which usually leads to headaches.
  • Stretching of the ligaments of the middle part of the neck resulting in excessive movement in the joints, leading to pain and eventually to pressure on the nerves as they emerge from the neck.
  • It is also a major reason for developing what has come to be called a dowager’s hump. The lower neck joints are held continually in a forward position and get stuck there. To compensate the very mobile joints directly above arch backwards so putting more emphasis on the disfiguring “hump”. This can become very painful.
  • A stiff thoracic spine, i.e the middle of your spine between your shoulder blades. This puts too much strain on your neck which has to move more to compensate for the lack of movement in the mid back.
  • People who are excessively mobile. They sometimes will catch part of the joint lining which can double over on itself in those with sufficient movement.

Common Neck Complaints

  • Sudden onset acute pain restricted to the neck or shoulder. Often occurs in younger very mobile people and characterized by sudden loss of movement, forcing the head to be held slightly to one side.
  • Gradually development of neck and or arm ache which becomes more severe. this can be extremely painful. There may also be a sensation of pins and needles or numbness in the hand or arm. Muscle weakness is also a possibility. This is due to involvement of the nerves in the neck that supply the tissues of the arm. This can occur, for differing reasons, in any age group.
  • Increasing stiffness in neck movements together with a constant ache in the neck and possibly also the shoulders. This is more common in the over forties but probably due to altering work habits we are beginning to see this in the younger age group as well.
  • Headache, normally associated with some neck dysfunction.

All the above would benefit from physiotherapy. This will probably involve some form of manipulation, plus exercises to improve either movement and or muscle strength and most importantly to improve the overall head/neck alignment and general spinal posture. I find this is one of, if not the most important aspect to deal with, if the problem is not to return in a few months time.

Tennis/Golfer’s Elbow

Lateral/Medial Epicondylitis
Tennis elbow is a term used when the tendon of muscles that lift and hold your wrist upright has become inflamed. It is normally sore and painful on the outer part of your elbow, which is where the tendon inserts into the bone. Occasionally pain is felt on the inner side of the elbow. This is called golfers elbow and is due to a similar inflammation, but this time it is the tendon which bends your wrist and hand forward rather than backwards. Both of these conditions are caused by repetitive movements or sustained gripping.

There are various ways of dealing with tennis elbow. The most common are outlined below:

  • Anti inflammatory tablets e.g nurofen, cuprofen, voltarol, sergam.
  • Cortisone injection.
  • Physiotherapy. this includes manipulation, deep massage, some electrotherapy and as the elbow improves a graduated exercise regime.
  • A specific type of strapping may also be used.
  • A tennis elbow band or to give it the “proper” name…….epicondylitis clasp!!!
  • Surgery. Generally the last resort, but can be very successful in those where conservative treatment has failed.

The Hip

The hip joint is a true ball and socket joint which by its design allows a large range of motion but at the same time is extremely stable. It shares many muscles and nerves with the low back and with the knee. It is obviously a major weight bearing joint and as such is subject to great impacts often many times body weight. In order to offer some protection from this it has a thick layer of cartilage covering the bone ends and some extremely meaty muscles! These contract and so shock absorb, moments before the foot hits the ground.

Symptoms can arise from:

  • The bones.
  • The many ligaments that support the joint.
  • The tendons of the very powerful muscles that insert close to the hip.
  • Small sacs of fluid called bursae which cushion or alter the pull of some tendons.

The most common problems seen at the hip are:

  • Osteoarthritis.
  • Groin strain.
  • Trochanteric bursitis.
  • Fractures.


Poor postural habits can lead to secondary problems, e.g. stiffness of the joints in the mid/upper back and hip, excessive movement of the joints in the neck and low back, pressure on nerves, lengthened and weakened muscles or tightened and overly strong muscles. All of these can produce pain and disability and destroy the natural balance of the body.

Wrist Pain

Pain in or around the wrist commonly occurs due to one of the following:

  • Fractures.
  • Tendonitis.
  • Sprained ligaments.
  • Compression of nerves.
  • Arthritis.

Knee Pain

The commonest way to injure either ligament or cartilage is to have most of your weight on the leg with the knee bent and then to twist or be twisted forcefully. It is more common to sprain the medial than the lateral ligament. Pain is normally immediate with ligament injuries and the joint swells within a few hours. Cruciate injuries often involve a sudden deceleration or a slow sitting back manoeuvre, particularly common in skiing debacles. Menisci or cartilages are damaged in the same way as ligaments and injury can vary from a mild fissuring to major tears where a loose flap developes that blocks the joints’ movement.

Pain Around The Knee Cap

Patelofemoral Joint Pain.
This typically happens in the following situations:

  • In young people aged between 12 and 24, often having just undergone a sudden growth spurt and/or are excessively mobile.
  • In people who start from being very unfit and try to do too much too soon.
  • In people who have had enforced immobility e.g leg in plaster, hip or knee joint replaced, the muscles then become weak.

The pain is normally caused by a weakness in the muscle on the front of the thigh which controls the movement of the knee cap. When the muscle is weak the knee cap is pulled by other structures into a painful position which is made worse by certain movements e.g going down stairs or hills, sitting with the knees bent and then having to get up.

Sprained Ankle

A sprained ankle means that you have over stretched or torn one or all of the ligaments on the outside of your ankle. Ligaments are rather like tough elastic bands. their job is to stop the joint from being moved too far. They have a poor blood supply and therefore heal slowly.

Running Injuries

Although running is undoubtedly one of the best ways to keep fit, as a ‘high impact’ activity, ironically it can lead to all manner of injuries. The main causes of running injuries are outlined below.

Static abnormalities – These are genetic characteristics and therefore cannot be altered eg:

  • Leg length discrepancies.
  • Genu valgum or ‘knock knees’.
  • Genu varum or ‘bow legs’.

Functional abnormalities – caused by:

  • Poor rehabilitation following injury.
  • Poor technique.
  • Developmental shortening of muscles.


  • Abnormal lower limb biomechanics.
  • Excessive pronation (rolling in on the mid foot).
  • Excessive supination (running with feet pointing together).

Abnormal pelvic mechanics.

  • Excessive anterior tilt.
  • Excessive lateral tilt.
  • Asymmetric pelvic movement.