Physiotherapy Advice Leaflets

Achilles Tendonitis
Exercises for the Quadriceps Muscle
Lateral Ankle Ligament Sprain
Low Back Pain
Neck Pain
Post-Injection to the Shoulder

What is Achilles Tendonitis?

Advice:

Stretches:
Read through the instructions for stretches 1 and 2 plus the instructions beneath before carrying out the exercises:

1. Stand facing a wall, near enough that you can comfortably put your hands flat against it. Stand with one foot in front of the other about a foot apart, the back leg being the one you are going to stretch. Keep the back leg straight, heel on the floor throughout the stretch. Both feet should remain pointing forwards. Lean forwards, hands flat against the wall for support, bending your front leg, until a stretch is felt in the back calf.

2. Stand in a similar stance to the first stretch, the injured leg at the back, but with your feet closer together. Keep both heels on the floor and bend both knees until a stretch is felt in the calf of the back leg. You may wish to use a flat surface, of about table-height, to support yourself.

Hold each stretch for 10-15 seconds; repeat 10 times.
Try to keep your body weight off the stretching leg (light load only),
the body weight should be borne through the arms and front leg.

(Christine Jennings MCSP, SRP; Alan Leigh MSC, MSCP, SRP; Kate Fernyhough MCSP, SRP)

(Back to Top)

(Quadriceps = Muscles on the front of the thigh)

KNEE EXTENSIONS:

1. Lying on your back with legs together and straight, place a firm roll under the knee of the leg you wish to stretch. This knee should now be slightly flexed. Tighten the muscles on the front of your thigh to raise your heel and straighten the knee (lifting the lower half of your leg off the floor).

2. Sitting with back straight, first cross your left leg (shin) over your right shin (so legs are crossed below the knees). Push your legs together with equal force. This should tighten your right front thigh. Now change legs.

3. Standing with back straight and feet slightly apart, let your knees slowly bend a small amount. Keep your heels on the ground. Now tighten your thighs and straighten your knees.

(Back to Top)

Injuries to the ankle joint are the most commonly encountered musculoskeletal (muscle/joint) problem seen in casualty. 90% of the injuries occur to the outer ligament of the ankle. Of this 90%, 40% will have persisting symptoms such as weakness, giving way and pain for months or even years.

It does not have to be this way!
There is a fairly simple "recipe" for reducing these figures. Most people, however, follow the advice they are given for too short a time. Six months' continual effort is a basic minimum, following a recipe such as that outlined in this leaflet.

What is a lateral ankle sprain?
Ligaments connect bones to bones and are passive but IMPORTANT supporting tissues of the joints. The lateral or outer ankle ligament (there are three parts or brands to it) whilst not large, has a vital role in the control of the ankle joint. A sprain may occur to one or all three parts of the ligament and to varying degrees, from minor tears (sprains) to complete rupture. Your GP or physiotherapist will discuss your particular injury with you.

(Back to Top)

Disease of and injuries of the low back (lumbar spine) may cause pain or a combination of pain and many other symptoms, e.g. stiffness, numbness or pins and needles. Pain may be experienced far away from the source of the problem and is termed "referred". Referred symptoms can be from the joints or muscles or ligaments or discs. These symptoms may also be produced by having an irritated or "trapped" nerve (sciatica). The advice and exercises below are designed to help these symptoms.

There are many causes of low back pain (with or without referred symptoms). Most are due to damage and/or inflammation to the joints, muscles etc. This type of back pain is termed "mechanical" or "simple" back pain. It does not mean that the symptoms are minor or not important. Inflammatory pain tends to be present more constantly and may affect your ability to sleep - however, inflammation is not all bad as it tells you there is a repair going on. Unfortunately much of the "repair" occurs at night - possibly some consolation!

This leaflet deals with simple back pain. The exercises and advice will not help all back pains so you should only undertake the help within the leaflet on the recommendation of your GP or Chartered Physiotherapist.

The exercises should help the movement and pain at the same time and improve with each session. Do not work on the idea that your problem has to worsen to get better!

Try the following advice, but ask yourself the following questions first:

If the answer is YES to any or all of the above, you should try the advice in part 1. If the answer is NO to all and you know what started it, use parts 2,3 and 4. You may find using part 1 from time to time will help you progress more quickly through parts 2-4.

As symptoms improve move through the parts in sequence.

Part 1

1. Rest in a lying position of comfort. Try lying on your front or side using pillows under your stomach or between your knees for support - resting positions are however very individual. Sit only to eat and toilet. Try some walking, even just around your home or gentle movements of your legs in bed. Try to increase your activities when you are able to.

2. Try using heat (a hot water bottle wrapped in a towel) or ice wrapped in a thin towel. They both have similar effects and which one you use is dependent on which you tolerate best. Alternating the hot and cold is good for improving the circulation.

3. Do take your medication and try the following exercises: DO NOT PUSH INTO OR THROUGH PAIN.

Part 2

Your pain is now decreasing - this may take a few days or possible weeks. Be guided by your Physiotherapist and GP. Try the above two exercises more vigorously. This should still be painless apart from an occasional twinge and ONLY at the time of the exercise and NOT afterwards. Any ache or throbbing pain should be avoided. Occasional sharp twinges on movement are usually not to be worried about. Of course, there should be general improvement both in the pain and ability to move. Increase your walking and begin very short spells of sitting correctly or "perching", i.e. sitting on the edge of a chair.

Continue to do the two previous exercises but increase the number of repetitions and firmness of them. Particularly with the "half push up" try and raise your body higher to lock out your elbows when you progress to part 3.

Part 3

Your ability to move around should be continuing to improve, as should your pain. It is quite normal for the pain to (a) centralise or locate itself in a small part of the spine and be reducing in the legs if there have been referred symptoms, (b) the pains may split into some local back pain and isolated areas in the leg(s) - Both should fade.

Both situations may cause concern BUT are actually signs of improving - no need to panic! It is important to try and strengthen the muscles that  control and support the spine for the future, so try the following two exercises, continue with those in part 2.

Part 4

Returning to work and/or normal life and sport.
Most back pains with or without referred symptoms resolve and do not have to become a permanent part of your life. It is quite normal for some back troubles to take 12-16 weeks and is NOT a sign of serious disease. Pain is useful but recognising what pain means is difficult. Generally dull pain that goes on and on arising from exercise or activities means that you have overdone things. Occasional sharp pain that comes and goes with only certain activities often particular activities that require you to work through the pain. Obviously as you do so you should find that the frequency and severity of the pain DOES lessen and DOES NOT produce a dull, constant ache.
Begin planning your return to work, sport and home activities CAREFULLY - do not expect to go from being very limited in what you can do, to normality quickly. Think through what your job etc. entails and try beginning to do short intervals of similar activities.

SOME RULES!!

(Back to Top)

Disease and injuries of the neck may cause neck pain. Pain may also be felt in the arms, hands and chest - these pains are called "referred" pains and also come from the neck. Referred pain does not necessarily mean you have trapped a nerve, indeed most referred pain is from the joints, muscles and ligaments. The exercises described within this section are designed to help neck pain and/or referred pain from the neck.

Pain arising from the joints, muscles, ligaments or discs when they are not working as well as is possible is termed "mechanical pain".

Another type of pain is inflammatory pain and is due to inflammation arising from disease or injury. Inflammatory pain tends to be more constant and of a deep, aching sensation and particularly may be felt more at night. However, inflammation is not all bad as it is part of the repair process.

This leaflet mostly deals with mechanical pain although your doctor or physiotherapist may ask you to follow the advice in this leaflet for inflammatory pain.

The advice in this leaflet will not help all neck pains. You should undertake the exercises on the recommendation of your doctor or physiotherapist.

The exercises should help the movement and pain at the time and improve with each session.

*DO NOT WORK ON THE IDEA THAT YOUR PAIN HAS GOT TO GET WORSE TO GET BETTER*

Try the following advice, but ask yourself the following questions first:

If the answer is YES to any or all of the four questions, then your problem is very acute and you should only follow advice in Part 1. If the answer is NO to all, use parts 2 & 3.

As the symptoms improve move onto part 2 and only if improvement continues, onto part 3.

Part 1

1. Rest in a lying position of comfort. Ideally use one pillow, but finding a position of ease is more important initially. Do this for 24-48 hours. Sit ONLY to eat and toilet, slowly increase the time spent sitting. Try some time walking - this may only be around your home. Try to increase when able.

2. Improve your posture.

3. Take your prescribed medication - DO NOT FIGHT THE PAIN.

4. Try either using ICE or HEAT (a hot water bottle is best) over the neck. Make sure that there is a good layer of towel between the ice and/or hot water and your skin. Leave on for at least 20 minutes.

NOT ALL PEOPLE CAN TOLERATE ICE OR HEAT, SO DO NOT PERSIST.

*IT SHOULD IMPROVE YOUR PAIN*

Part 2

Try the following exercises - do not push through the PAIN. You may push as far as an initial experience of pain and then you must back off. The pain should be so very mild and not get worse with each further repetition and there should be no ache left at the end of an exercise session.

1. Neck retraction in lying (chin tucking): Lie down on your back, head resting on a pillow or two if required for comfort. Gently tuck in your chin, this will give you a double chin! Hold for a second and release.
   Repeat 6-10 times and 2-3 times a day. This should include first thing morning and night.

2. Neck rotation (turning): Lie on your back either on the floor or bed with one or no pillows - this is all based on your comfort. There should be no pain.
   Let your head ROLL OVER TO EITHER THE LEFT OR RIGHT as far as is comfortable.
   Now GENTLY press your head around further (to look over your shoulder) with one hand. Return to the start position and then try the other direction.

Part 3

If all your symptoms are improving as well as the amount of movement, try part 3.

1. Increase the pressure exerted during the last two exercises and attempt them in sitting.

2. Sitting assisted extension (looking at ceiling):

DO NOT TRY THIS EXERCISE if you have or experience light-headedness,
dizziness or ringing in the ears

Repeat 6-10 times and 2-3 times a day - NEVER in the morning or night.

FOLLOWING EACH PART IN TURN SHOULD REDUCE YOUR PAIN AND HELP YOU MOVE BETTER. IF NOT, THEN SEE THE GP OR PHYSIOTHERAPIST WHO ISSUED THE ADVICE SHEET.

(Mr Alan Leigh MSc, MMACP, GDMT (NZ), Chartered & State Registered Physiotherapist)

(Back to Top)

The shoulder is a complicated joint - it involves 4 joints and 22 muscles. It requires that all these structures work together.

YOU SHOULD NOT:

YOU SHOULD:

Not all people can tolerate ice - so use HEAT such as a hot water bottle wrapped in a towel.

TRY THE FOLLOWING EXERCISES

* DO NOT PUSH INTO PAIN *

It is important to realise that the information contained in this leaflet is designed to help those people who have a mechanical reason for their pain.

The advice in this leaflet will not help everyone, so you should not persist with these exercises without phoning your GP or Physiotherapist at the surgery.

Exercise 1 - Pendular Exercise

Exercise 2 - Shoulder Elevation Exercise - LYING

Exercise 3 - Shoulder Elevation Exercise - STANDING OR SITTING

WHAT NEXT?

Point 1 - Take your medication as prescribed. Consult your doctor before reducing or stopping your medication.

Point 2 - If your shoulder is not improving or is worsening after 3 weeks, see your doctor or your physiotherapist.

Point 3 - Follow exercises 1-3. Push into the beginnings of pain or stiffness. Do exercises 4 and 5.

Exercise 4 - Shoulder Rolling

Exercise 5 - Reach up your back

At no time should the exercises produce deep, persistent ache.

The exercises should increase your movements and improve your pain.

(Mr Alan Leigh MSc, MACP, GDMT(NZ), Chartered and State Registered Phsiotherapist)

(Back to Top)