Category: Physiotherapy in Covent Garden

Work Life Balance

In the lead up to National Work Life Week 2018 (October 1st-5th) we are keen to talk about what simple strategies managers can use to try and support their team in getting the work-life balance right. Not an easy task!

First of all, why should managers even worry about this?

Getting and keeping the right staff!

One in ten parents have refused a new working role because of a lack of flexibility and support with work life balance. This means that your company may be missing out on the top talent or may be losing staff to other companies who are ahead of the game with offering flexible working opportunities.

Loyal staff!

An un-supportive organisational culture can lead to parents regularly working over their normal hours in attempt to meet work targets. This excessive working can lead to reduced productivity, low motivation and poor staff engagement. Staff with more flexible working practices are shown to be more loyal to the company and are much more efficient and happy in their work.

A healthier work force!

Flexible working opportunities give staff the chance to balance their home and working life. This positively effects mood, resilience and their ability to cope with work and home life stress. The risk of burn out is reduced and staff are more likely to make healthier life style choices.

What strategies can managers use to help support their staff?

The obvious, policies and procedures!

Most companies will now have policies and procedures in place which will support you and your staff. This could be a stand alone flexible working policy or it could be part of multiple policies.

For example;

  • Sickness absence policy
  • New and expectant mother policy
  • Working from home policy
  • Leave policy (including options for unpaid leave)

It sounds obvious, but get to know and understand your local policies; ask HR if anything is unclear. If a policy isn’t available then perhaps now is the time to start! Support for writing guidance is available from ACAS

Wellbeing sessions!

Drop in sessions where staff can find out more about looking after both their physical and mental wellbeing are extremely popular. Having an external company pop in and give independent advice and education can be very powerful to engage staff and give them the confidence to make positive changes to their diet, exercise routines, mindfulness, sleep health and much more.

Occupational Health support!

We really want to encourage staff to take an active role in preventing burn out, keeping fit and working efficiently. However, we will all most likely have some health changes impact our working life. This may be a work factor that is affecting health, or perhaps an injury or condition that is making working difficult. As the manager we would recommend that you try and keep open and supportive conversations available to your team so that they can come to when they may need some support. Occupational Health has a very important role to independently assess these factors and to help advise any amendments to working which will protect and support the staff member to keep well at work. If you want to discuss an occupational health assessment, please contact us to find out more at

If you are keen to find out more about creating a happier and supportive flexible working culture, then why not head down to the Changing Culture: best practice showcase in London on Tuesday 2nd October 2018! Email to book your place:  @workingfamuk #worklifeweek




Back Pain and Breast Feeding

Why do we experience back pain whilst breastfeeding?

In celebrating World Breastfeeding Day 2018, we wanted to talk about back pain when feeding your little bundles of joy. I have two children myself and vividly remember the first 6-9 months having varying levels of mid back pain whilst breastfeeding which I could never quite get rid of (here is a little picture of my first for attention!).

So why do so many of us experience these symptoms when feeding?

Well we all know the temporary changes in pelvic and spinal posture we go through when growing these gorgeous babies.

We also have changes in hormone levels (blame high levels of progesterone) affecting our ligamentous status. This is important because the ligaments cross joints and hold the bones in a rigid end position, so these hormone changes cause a ‘loosening’ of the joints. So when we sit feeding our babies we curve our mid spine forwards. The amount of bending is likely to be more so than pre-pregnancy.

We also have reduced core muscles as our pelvic floor and transversus abdominis have been stretched or interrupted during pregnancy and labour.

Lastly, we may have been sitting in a prolonged sitting posture pre-baby (i.e. desk based working) but now we are sitting for very long periods breastfeeding, holding the weight of a baby in our arms, trying to gain a successful latch … all whilst pretty exhausted!

So what practical things can we do to help alleviate some of these symptoms of pain and stiffness we get whilst breast feeding?

  1. Use pillow, and lots of them!

My husband joked that after I gave birth to my first he would fit back in the bed as I had a super huge U shaped pregnancy pillow. Sadly for him, I quickly realised how great it was for propping me up in bed and lifting the baby up closer to me to feed. So I actually kept this pillow for a good 4 months after both babies. Don’t worry if you don’t have one of these, just try and make sure you have plenty of pillows around you (in bed but also other places you feed, like the sofa) so you can make yourself (behind your back) comfortable but also use under the baby to lift them up closer to you.


  1. Try to avoid looking down at your baby all the way through the feed (or your phone).

I know they are so super cute, and you are checking the latch, but once they are latched on well (bottle or breast), try and keep looking ahead rather than down. It might seem super obvious but keeping a more neutral upright position during the feed with certainly help avoid excessive bending through the mid back.


  1. Alternative different feeding positions.

There are such a variety of breastfeeding positions to try so mix up the traditional cradle hold for others such as the football hold or in side lying. Here is a great article about the different hold types.



  1. Try to stretch out!

Of course being a physiotherapist I tried some of the well-known stretches I use with my patients too. Finding the time to complete these is difficulty, especially if you have more than one baby, have returned to work or have a baby with colic. But it is important to try and find even just 3-5 mins a day for yourself and these are brilliant stretches to help.


UPPER BODY TWISTS – in sitting, hands across your shoulders, then twist torso slowly to left and right side x20 reps / x2 sets

TOWEL STRETCH – lie on a rolled towel down between the shoulder blades on the floor. Lie for 2-3 minutes.




5. Treatment – There are certain ‘hands-on’ techniques that can help symptoms of pain and stiffness in the back area such as as massage, joint mobilisation and taping techniques. I did book in for a few treatments over the first 6 months just to help keep symptoms at bay whilst I used all the above techniques.

If you want to speak to one of our London Physiotherapy Team about symptoms you experiencing, do give us a call on 020 8901 6464 or email me at

Do let us know if you have any questions of if you would like to speak to one of the team!


Focus on Shin Splints

What are Shin Splints?

Medically known as Medial Tibial Stress Syndrome, shin splints is a term used to refer to pain along the inside of the tibia or shin bone. The exact pathology that causes the pain of shin splints is unclear and imaging such as ultrasound produces similar results when compared to persons who don’t have shin splints. The pain of shin splints is usually felt over the area where two particular muscles insert into the tibia. These muscles are Tibialis Posterior and Flexor Digitorum Longus.

Despite having an unclear pathology, this can be a debilitating condition that can impact activity levels significantly. The pain can be quite limiting and may even be an early warning sign of a stress fracture and this will need to be ruled out by a medical professional.

What are the Symptoms?

Shin splints are typified by persistent leg pain, usually along the inside of the shin, halfway down the lower leg. The pain might be felt during exercise or directly after. Some people experience a dull ache over their shin that lasts for quite a while after exercise stops, while for others the pain may be sharp and fades quickly.

The pain is often progressive, becoming worse with shorter distances. Eventually, shin splints can severely impact activity levels as the pain becomes too severe to continue exercise.


What are the Causes?

Shin splints are predominantly seen in runners who increase their distances quickly, often while training for an event. Activities that require repetitive weight bearing of any kind, such as jumping and high impact sports have also been shown to cause shin splints. Although the pathology of shin splints is unclear, studies have been able to identify certain risk factors that may predispose someone to shin splints. These include:

  • An abrupt increase in activity level
  • Improper footwear and support
  • Higher BMI
  • Training on hard or uneven surfaces
  • Tight calf muscles
  • Flat feet
  • Increased external rotation range of the hips
  • Females are more likely to develop shin splints than males.
  • Prior history of shin splints
  • Wearing or having worn orthotics


How Can Bespoke Physiotherapy Help?

The first step for your Physiotherapist will be to address any contributing factors and help to adapt your training programme to a level that is optimum for you. A period of relative rest may be recommended along with a targeted strengthening and stretching program for any tight or weak muscles.


Switching to low-impact activities such as swimming, cycling, and yoga may also help to maintain fitness during recovery. Your running technique will be analysed and any training errors may be corrected. When getting back into your training routine, it is usually recommended that distances are not increased by more than 10% per week as this allows the tissues of the body to react to the increased demands and adapt accordingly.


None of the information in this blog is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.


What is an Achilles tear?


The Achilles tendon is a band of fibrous tissue located at the back of the ankle. Its main role is to connect the calf muscles to the heel of the foot. This tendon is the largest tendon in the body and when it tightens, as the calf muscles contract, it pulls the heel allowing you to stand on tiptoe or to point your foot.

Achilles tendon tears commonly occur in athletes, however, this injury can affect anyone and surprisingly, a complete tear is actually more common than a partial tear.


These tears are commonly located at the part of the tendon where there is poor blood flow approximately 6cm above its attachment to the heel. Since there is poor blood supply, this part of the tendon is both vulnerable to injury and slow to heal.


What are the Symptoms?


Primarily, an Achilles tendon tear will cause difficulty in activities such as walking, running and jumping. Other signs and symptoms of an Achilles tendon tear include:

  • A loud pop or snap is heard
  • Sudden and severe pain at the back of the calf or ankle
  • Feeling of having been kicked in the calf
  • There is a gap between the tendon and the heel (about 2 inches above the heel)
  • Swelling and stiffness followed by weakness and bruising
  • Difficulty walking particularly during push off
  • Standing on tiptoe may be impossible


What Causes It?


Anyone can tear their Achilles tendon if the tendon is subject to excessive force or overstretching, however there are some factors that can increase your risk of injury. The most common activities that cause this injury are running and jumping.


The Achilles tendon can thin and weaken both as we age and also if it is not used. As a result of this weakening, it becomes prone to injury like tear or rupture with less force or stretching required before an injury occurs. A tear of the Achilles is often observed in people with pre-existing Achilles tendinitis. Other factors such as certain medications including antibiotics and steroids and some illnesses like diabetes and arthritis can also result in weakness of the tendon, increasing injury risk. Being obese is also a risk factor as excess weight puts additional strain on the tendon.



How Can Physiotherapy Help?


Treatment for Achilles tendon tear will depend on the patient’s age, how severe the injury is and the patient’s activity level. For young people especially athletes, they opt to have surgery while older people choose conservative treatments including physiotherapy.


Physiotherapy treatment for an Achilles tendon tear will involve exercises to strengthen the calf muscles and the Achilles tendon and exercises for stability. Many people are able to return to their normal activities within 4 to 6 months. Functional rehabilitation is also part of the program as it focuses on how you coordinate your body and how to move it. The aim of functional rehabilitation is to help you return to your highest level of performance.


None of the information in here is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.


Osteoporosis is a condition characterized by very low bone mass or density. This is caused by the body either losing too much bone, not making enough or both. Osteoporotic bones become weak and fragile and can break from small forces that would normally be harmless.

In osteoporotic bones, as well as loss of bone density and mass, there may also be abnormal changes to the structure of the bone matrix, which further contributes to the bone weakness.

Osteoporosis is an extremely common bone disease and women are more affected than men. As it is a progressive disorder that worsens with age, while the disease process might begin earlier, the effects are usually only noticed and diagnosed in people who are 50 years and older.


What are the Signs and Symptoms?


Often called a silent disease, many people with osteoporosis will have no idea that they have the disease, as there are no obvious symptoms. In fact, sometimes the first sign that an individual has osteoporosis is when the first bone is broken. Along with fractures, which are the most serious signs of this disease, osteoporosis can cause the upper back to become excessively hunched (itself often a result of spinal wedge fractures) and there maybe widespread pain as bony tissue is increasingly unable to withstand normal forces.

Fractures are a serious problem, especially in the elderly population. Bone breaks due to osteoporosis occur most frequently in the wrist, spine or hip. When the spine is affected by osteoporosis, people may develop a hunched or stooped posture, which can itself lead to respiratory issues and places pressure on the internal organs. Osteoporosis can severely impact a person’s mobility and independence, which can have a huge impact on quality of life.


What Causes It?

As this is primarily a metabolic disorder, there are a variety of things that can cause osteoporosis if they either interfere with the body’s ability to either produce bone tissue or encourage excessive breakdown. This can be anything from gastrointestinal conditions that prevent absorption of calcium, lack of dietary calcium or low levels vitamin D, which is essential for absorption of calcium.

Certain medications may also cause bone loss especially if they are taken for a long time or in high doses. A good example is the long-term use of steroids. Although steroids are used to treat various conditions, it has been proven that steroids can cause bone loss and eventually, osteoporosis.

As bones respond to force and weight bearing by building more bone, having a sedentary lifestyle or doing activities with low impact can also lead to osteoporosis and this has been shown be an issue amongst professional swimmers and cyclists.


How Can Physiotherapy Help?

Physiotherapy can help you to improve your overall bone health, avoid or recover from fractures. Physiotherapy exercises can direct you to safely increase your weight bearing, which can help build bone mass. Balance training is also an important factor as this can reduce the risk of falls. Your physiotherapist can also educate you on how to adjust your lifestyle, at home or at work, to protect your bones and improve your posture.


None of the information here is a replacement for proper medical advice. Always see a medical professional for advice on your individual condition. Book a consultation with us here.

Run Fit 5 – Indispensable Stretches: The 5 stretches critical to injury prevention in runners #runfit5

Stretching is something that most runners do in one form or another. However, often stretching is done rather haphazardly as runners are unsure regarding which is the best technique, how long a stretch should be held, and what you should feel.


First of all, every stretch should be comfortable; you should never stretch into pain. A longer, mild to moderate stretch is infinitely more effective than a short-lasting strong stretch. Thus you should be looking to hold each stretch for 20-30 seconds and repeating each stretch twice, all the while feeling a comfortable stretch in the muscle.


Technique and positioning are also essential to effective stretching. Stretches should always be eased into (and out of) and should be held consistently – never ‘bounce’ a stretch. Also make sure you are in a stable position as trying to stretch and balance leads to inefficient stretching / falling over. Stretching pre exercise should be particularly gentle and should be preceded by 5-10 minutes of warm up. Stretching post exercise is most effective when done shortly after you finish rather than an hour or later on when you have cooled down.


The 5 stretches below are simple yet effective. Most people would have seen them before and perhaps already do them. The key with these exercises is technique. Technique is everything. So make sure you read the technique tips for each exercise to maximise their effectiveness. And of course if you have any questions, shoot us an email.


  1. Kneeling hip flexor stretch

There are several components to making this an effective stretch. Firstly, place a pillow or something soft under the knee you are kneeling on otherwise your kneecap with get sore. Secondly, make sure you squeeze your glutes and tuck your tailbone under to position the pelvis correctly. You should feel a stretch in the front of the hip or down the front of the thigh; either is fine.

Hip flexor stretch for runners


  1. Step calf stretch

For this one, place the foot you are stretching on the edge of the step so that your heel is hanging off the step. Your other foot should be completely on the step. Slowly lower the heel on the stretching leg – transferring weight to that leg, until you feel a stretch in your calf.

calf stretch for runners.


  1. Standing hamstring stretch

Place your foot on a step or a low park bench. Have your standing knee slightly bent. Keep your back straight and bend forward at the hip until you feel a stretch down the back of the thigh. Repeat with the knee straight and the knee bent.

hamstring stretch for runners


  1. Lying quad stretch

Nice and simple. Lay on your stomach and pull your knee towards your bottom until your feel a stretch in the front of your thigh. To get a better stretch gently contract your Gluts to push your hips into the floor.

Quad stretch for runners.


  1. Foam roller

Strictly speaking not a stretch but the best way to loosen off the pesky ITB. Have the leg you are rolling straight and the other leg bent forward at the hip and the knee with the foot on the ground (this takes some of the weight off your rolling leg and makes it more comfortable…….slightly). Slowly roll up and down, stopping before the roller gets to the bony outer part of your hip and the outside of your knee. You only need to repeat this 7 or 8 times on each side for it to be effective. Be aware that it will be a bit painful for most people though and consult your doctor or physio if you are taking blood thinning medications.

ITB stretch / release for runnersstretch to ease runner's knee


Obviously these are general exercises so if you want a full and thorough assessment and an individualised programme, combined with expert guidance, book an appointment with us at Bespoke Physiotherapy in Covent Garden. Individualised care is especially important to those returning to running from an injury, or those increasing their training.


Make sure you explore the other blog posts in our runfit5 series to discover more running injury prevention tips.


If you would like to discuss anything with us directly or learn more about Physiotherapy and running please contact us at You can also follow us on Facebook, instagram and Twitter.


Until next time, keep on running and run smart.


Jon Castle

Director and Principal Physiotherapist

Bespoke Physiotherapy

Running Injuries – FREE advice, Covent Garden Physio

NEW Running Injury Workshops, Covent Garden


Bespoke Physiotherapy are extremely excited to have finally met our neighbours ‘Runners Need’ in Holborn last week. With the overlap between foot biomechanics and lower limb injuries, we hit it off straight away!

These running specialists are highly trained in helping runners choose the best products and have helped many of our patients get the best out of their runs. They offer shoe fitting, gait analysis and provide a complete range of products to suit all types of runners.

Bespoke Physiotherapy is now teaming up with Runners Need, Holborn to offer additional advice to runners of all abilities through our NEW workshops. These will take place on the first Tuesday and the second to last Thursday of every month between 1-2pm (in store at Runners Need, Holborn WC1V 6DW)


r need


What can runners expect?


This workshop is free to all customers, just turn up on the day between 1-2pm and come and say hello. We can help with:

  • Injury assessment
  • Injury advice
  • Advice on physiotherapy treatment options
  • Advice on training schedules
  • Gait analysis
  • Foot wear advice
  • Advice of keeping physically fit for running




Bespoke Physiotherapy and Runners Need are also offering our joint customers 10% off in store or on physiotherapy services when you present our discount voucher (please ask in store or your physiotherapist)


Should I bring anything along with me?


If you are keen to have your gait analysis completed and / or your trainers reviewed, please feel free to come in your gym kit and bring your trainers along with you!


When is the next workshop?


The workshops are held in store at Runners Need, Holborn WC1V 6DW on the first Tuesday and the second to last Thursday of every month (between 1-2pm). Our first workshop will be held on:


** TUESDAY 5th JULY 1-2pm **


We look forward to seeing you there – if you want to speak to a member of the team before attending, please feel free to contact us on

Back Pain – How to manage it!

New back pain guidelines – what does it all mean?


Are you wondering what to do for the best for your back pain? Well the National Institute for Health Care and Excellence (NICE) guidelines for the early management of low back pain (2009) are currently under review with some interesting changes!


Health care practitioners use these guidelines to keep on top of best practice to ensure their patients receive the best care and treatment. This keeps their fingers on the pulse of the current evidence base which is crucial for physiotherapists.


Here at Bespoke Physiotherapy, we are extremely interesting in these up and coming revised guidelines as low back pain is single handed the most common injury we see in our busy Central London, Covent Garden clinic.


So what treatments are we doing right that is not changing?


Exercise, exercise and more exercise! Whether it is specific physiotherapy exercises, normal daily activity or even aerobic exercise or yoga; exercise is still the first and most crucial step in managing low back pain.


Running strength Exercise - Bridging 2. Bespoke Physiotherapy Covent Garden London


Hands-on treatment, such as massage and manipulation by your physiotherapist, should always be used alongside home exercises because there is not enough evidence to show they are of benefit when used alone.

Combining physical and psychological treatments (i.e. talking therapies) are recommended for patients who have not seen an improvement in their pain on previous treatments or who have psychological and social barriers to recovery (i.e. low mood or anxiety).


What has been put on the back burner when managing back pain?

The guidance no longer recommends acupuncture for treating low back pain as there is limited evidence to support its benefit when compared to a control sham group.



Paracetamol was previously the first option for managing low back pain however, the new draft guideline recommends that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried first. Weak opioids, such as codeine, are now only recommended for acute back pain when NSAIDs haven’t worked or aren’t suitable.


Why come and see us at Bespoke Physiotherapy?


All the physiotherapists at Bespoke Physiotherapy are highly skilled and trained at identifying the root causes of low back pain and can help you restore function and activity as soon as possible. We also have the full use of the Oasis Sports Centre multi gym to use during your treatment sessions to ensure that you can exercise safely whilst your injury recovers.


Our physiotherapists are also extremely good listeners and can help you decide whether additional psychological treatments may compliment your physical treatment plan. They are confident to refer you on to such services and can liaise with you GP as required.


consult 2

What are the key points to take away for both physiotherapists and back pain sufferers?

  • The best treatment for low back pain is to keep up with normal activities and to exercise as pain allows.
  • Be open minded to talking therapy if you pain persists despite treatment or if you feel you are experiencing symptoms of low mood or anxiety, as this can help expedite recovery alongside your physical therapy.
  • Liaise with your GP for analgesia support, which can be progressed to Codeine based medication should the anti-inflammatories not be effective.

If you have any concerns or questions regarding your back pain or recovery, please feel free to contact our team on

Written: 23rd June 2016 by Clare Henson-Bowen, Director and Principal Physiotherapist at Bespoke Physiotherapy in Covent Garden, Central London

Run Fit 5 – Essential Strength: 5 simple strength exercises every runner should do #runfit5

Running is fantastic. It is one of the most efficient ways to exercise and it’s also great for blowing off steam and managing stress. You don’t need a gym membership or any expensive equipment. What you do need is good strength and control throughout your body.


Running puts high demand on your lower limbs. Every time you go for a run they provide shock absorption, stability and drive thousands of times over. A failure to appreciate this quite often leads to overuse injuries in runners.


The following 5 exercises really work on lower limb strength, control and endurance to allow the muscles in your legs to work better for longer while you run. This ultimately means less injuries and improved performance.


  1. Hamstring Bridging

This really works your hamstrings and glut max, which are essential to driving you forward with running.

Start with your heels on the ball and your hips and knees bent at 90º. Slowly lift your hips up without letting the ball move away (i.e. don’t straighten you knees).

Running strength Exercise - Bridging 1. Bespoke Physiotherapy Covent Garden London Running strength Exercise - Bridging 2. Bespoke Physiotherapy Covent Garden London


  1. Step Ups

Great work for Quads, gluts as prime movers and Glut med and min as stabilisers.

Try and keep your pelvis level and keep the centre of your kneecap over your 3rd toe to maintain good alignment with this one. Make sure you really drive up tall when stepping up and keep control when coming back down.

Running strength Exercise - Step Up 1. Bespoke Physiotherapy Covent Garden London Running strength Exercise - Step Up 2. Bespoke Physiotherapy Covent Garden London


  1. Wall External Rotation

Really hones in on Glut med and Min to improve hip control.

Stand next to a wall, bend the hip and knee closest to the wall and place your foot behind your standing knee, which should be slightly bent. Hold that position while pushing the knee of the non-grounded leg into the wall. Hold for 30+ seconds and you will get an almighty burn in your Gluts.

Running Strength Exercise Bespoke Physiotherapy Covent Garden


  1. Single Leg Squats

Another great functional exercise that uses all of the muscles worked in running, in a controlled environment.

As with the step ups, keep your pelvis level and the centre of your kneecap over your 3rd toe to maintain good alignment. Do this one in super slow motion and don’t go too deep.

Running strength Exercise - Single Leg Squat. Bespoke Physiotherapy Covent Garden London


  1. Single Leg Balance

Fantastic for building control and endurance throughout the whole leg, and so easy to do!

Stand on one leg with the knee slightly bent and stay as still as possible for as long as possible, up to a minute. You can use a Bosu Ball at the Gym or a cushion at home if you want make it harder. Other good progressions include closing your eyes or throwing and catching a ball.

Running strength Exercise - Single Leg Balance. Bespoke Physiotherapy Covent Garden London

The key to all of these exercises is how you do them. In themselves they are very basic but done correctly they make a huge difference. Concentrate on good technique, form and control throughout the exercise. Do them nice and slowly to really get a good burn and Stop for a rest when you start to lose form. If you can, do these in front of a mirror to check your alignment and see what is happening with your hips, knees, ankles and feet.


To get a thorough assessment of your lower limb biomechanics and expert guidance on how to build your strength in tandem with your running programme, click HERE to book an appointment with Bespoke Physiotherapy in Covent Garden.


Also check out the rest of our Run Fit 5 series for more great injury prevention and rehabilitation insights.


Another great resource is the website of our runfit network partner in Australia, InClinicPhysiotherapy.


If you have any questions you would like to ask me or the team directly, feel free to drop me a line at


Jon Castle

Director and Principal Physiotherapist

Bespoke Physiotherapy

Run Fit 5 – Golden rules: Maximising performance and preventing injury in runners

As simple as running seems, going for your Sunday jog requires an incredibly complex interaction of different body systems. The body is such an amazing machine that it does all of this automatically, so that you can get out there and burn what it is you need to burn (calories, stress, energy).


In order to maintain this harmony we do need to help our bodies out and understand a few basic principles. Today we are going to go through the 5 most important principles to maximising performance and preventing injuries in runners.

 1. Start Low and Slow

What this means is that, if you are just starting out with running, your first runs should be slow in pace and short in distance. Your body needs time to establish a good base in terms of technique, cardiovascular fitness and lower limb control. Once this has occurred then build up your programme in a graduated manner. Many people have come unstuck by building up their miles and pace too quickly. This also applies to established runners who are increasing their miles and training. Things that your body will absorb over 5-10km will come to head if you start running 12+km. Gradual progression allows your body to consolidate gains in strength, control and cardiovascular fitness to provide a solid base for further progression.


2. Never change 2 variable factors at one time

This relates to our previous point regarding gradual progression. During any given run, don’t try and run faster and further. This will outstrip your body’s ability to deal with the loads placed on it and therefore will increase the likelihood of overuse injuries. In practical terms this means focusing on distance for certain runs and pace for others (e.g. a long run and an interval run).


3. Have rest Days!

Rest days are essential. Your body needs to recover from your previous run (at least partially) before you run again. You should be having at least 2 rest days per week if you are a regular runner, and if you are starting out or returning after injury, rest for at least 48 hours between runs.


4. Incorporate cross training

Rest days don’t necessarily mean sitting around on the couch (although it is very important to incorporate some of these into any running programme). Use your rest days to cross train. Cycle, swim, gym and complete the runfit5 Strength exercises! You can also include Yoga and Pilates to help your running.


5. Run to a programme

Having a set programme is key to tying all of these points together. It also really helps with motivation. There are many great training programmes out there for everyone from first time runners to those doing their 20th ultra-marathon. Make sure you look for the above principals in any programme you might want to use. Also look at joining a club. Most running clubs have a ton of very experienced runners who are happy to help with anything from technique to running programmes. Joining a club also adds motivation and a social aspect to a sport that can otherwise be very individual.


The experienced team at Bespoke Physiotherapy in Covent Garden specialise in the prevention and treatment of running injuries. So if you need an expert running assessment and individualised care, BOOK NOW for an initial assessment.


Make sure you arm yourself with the knowledge to get the most out of your running by exploring the rest of our runfit5 series and visiting the site of our runfit network partners inclinicphysiotherapy.


To talk to our team directly or learn more about Physiotherapy and running please contact us. You can also follow us on Facebook, instagram and Twitter.


Until next time, happy running!


Jon Castle

Director and Principal Physiotherapist

Bespoke Physiotherapy

Run Fit 5 – Top Training Tips for Runners #runfit5

Running. One of the purest forms of exercise and fitness you can take part in. No other sport requires less equipment and is more flexible than running. Step outside your front door and you can begin your workout – no gym membership required. Whether you are training for a marathon or a 5k, it can become a passion, an addiction.


Spring is upon us here in the Northern Hemisphere, the days are getting longer and the weather is getting warmer (sort of). As such many people are increasing their running programmes and signing up for their next running Challenge. With this in mind Bespoke Physiotherapy are releasing a series of blogs on injury prevention in runners. In these blogs we will go through specific exercises and stretches and also discuss the best way to increase speed and distance without increasing the chance of injury.


The vast majority of running injuries are not traumatic but due to over-use (excessive repetitive loading of a particular joint, muscle or tendon). This, generally speaking, is a biomechanical issue. What this means is that there is an issue with poor alignment and/or muscle imbalance, which leads to excessive loading of one particular structure.


Many of these issues come to the fore with a sharp increase in activity. With runners this tends to be from running too much and doing too little cross-training. Put simply, most people run to get fit rather than getting fit to run. The best way to avoid injury while running is to gradually build miles and pace, have rest days and incorporate cross-training into the overall programme.


In this series we are going to go through some simple, practical and effective exercises to get you fit to run. We shall also go through recovery exercises and useful tips to manage your body and prevent injury, and ultimately to get you through your training and smashing your PB in the big race!


So keep an eye out in the coming days and weeks for our #runfit5 series!


If you want to speak directly to one of our Principal Physiotherapists contact us here. To get a full biomechanical assessment and specialised injury prevention or rehabilitation programme click here to book an appointment at Bespoke Physiotherapy in Covent Garden.


Before you go, check out our blog post from last year on the 2 most common injuries and mistakes.

Also visit the blog page of our run fit partners In Clinic Physiotherapy for more great content on injury prevention.


Jon Castle

Director and Principal Physiotherapist

Bespoke Physiotherapy

Ski Fit 5 – Whole Body Health #SkiFit5

In this the final post in the current Ski Fit 5 series I would like to concentrate on some more general tips rather than specific exercises. Most of the tips below may seem elementary but you would be surprised how many people neglect the simple things when on the annual ski trip and just push their body too hard. The body is a magnificent piece of machinery but we still have to look after it in order for it to function at an optimal level. Here’s how to keep your body in top shape on top of the mountain.



Keep hydrated

This may seem obvious but skiers and borders frequently suffer badly with dehydration when on the slopes. Drink plenty of water when you’re in the Chalet and stop at least once or twice a day for a drink (in addition to lunch). Packing a small water bottle to take with you is also a good idea if you want to make the most of your time on the hill.


Listen to your body – recognise fatigue

Many skiing injuries, particularly with recreational skiers and boarders, are closely related to fatigue. Fatigue is a natural by-product of not skiing for most of the year and then fitting 12 months worth into 1 week. Although this is completely natural it does mean that the chance of injury increases considerably. When you are fatigued your reaction times will suffer and you will be more likely to make mistakes on the snow. You will also be more at risk of overuse injuries.

The best way to manage this is to recognise it early and act accordingly. If you notice the signs of fatigue then either stop for a decent lunch and a break, or call it a day early. Also, if you are skiing for a week or longer, consider taking a rest day in the middle. You will be surprised how much difference it will make.


Get a decent night’s sleep (or as close to decent as possible)

Following on from the previous point, one the best ways to manage fatigue is to get a good night’s sleep. This again tends to be more of an issue for those on the annual ski trip. Combined with pushing your body hard during the day on the slopes, the temptation may be to play just as hard in the evenings. This is all well and good, however staying out until the wee hours of the morning and then getting up early to hit the hill will adversely affect your performance and also markedly increase your risk of injury. It is important to get a good 7-8 hours of sleep per night while skiing to allow adequate time for the body to rest and recuperate.


Get the right kit

As with any sport, having the right equipment in skiing and snowboarding is a major factor in the prevention of injury. This doesn’t mean you have to go out and get the top of the range gear, it just means there are several key aspects to be considered when buying or hiring equipment.

The most important of all is comfortable ski/board boots. Ill-fitting boots are a major contributing factor to injuries on the slopes. Too loose and your foot is moving around in the boot, which means diminished control. Too tight means discomfort, pain and damage to the skin, all of which can ruin your skiing experience in themselves, as well as leading to compensations in your technique which can result in greater injury. When hiring boots, take your time to make sure they fit properly, and if they are uncomfortable at any point, go back the shop and change them out. If you hit the slopes regularly I recommend investing in your own pair of boots, although when doing this, do your research and try a range of boots to get the perfect fit for you.

A good pair of socks is also, perhaps surprisingly, one of the most of important pieces of equipment for comfort and injury prevention on the slopes. You can have the best boots in the world but if you don’t have decent socks you can still get a lot of rubbing, blisters and pain in the feet.

Lastly, make sure you have a decent pair of goggles. Many an injury on the slopes could have been easily prevented if the skier or boarder could see where they were going!


Do the #SkiFit5 exercises!

The Ski Fit 5 exercises are designed to be simple, effective exercises that don’t require a gym or a great amount of time to do. By going through the #SkiFit5 programme you can not only help prevent your risk of injury on the slopes but can also maximise performance, which ultimately means you will also maximise your enjoyment and really get the most out of your winter sport.

If you are preparing for a ski trip following an injury or you are looking for more specific advice and an individualised exercise programme, click HERE to book a Ski Fit Assessment with Bespoke Physiotherapy Covent Garden.

Should the worst happen and you do suffer an injury on the slopes, the Ski Fit network has associate practices in many major resorts in Europe, Japan, Australia and New Zealand. We also have clinics in  London and Perth Australia to look after you when you get home. The team at Bespoke Physiotherapy Covent Garden offer the highest level of care for skiing and boarding injuries and are expert in the key area of injury prevention.

Cast an eye over the rest of the blogs in the #SkiFit5 series for more tips and also check out the blogs of our Ski Fit Network Partners In Clinic Physiotherapy.


Finally, now that Spring is upon us here in the Northern Hemisphere, many people are increasing their running programmes and signing up for their next running Challenge. With this in mind Bespoke Physiotherapy is releasing a series of blogs on injury prevention in runners. Keep an eye out in the coming weeks for the Run Fit 5 Series! #runfit5

Ski Fit 5 – Après Ski Stretches #SkiFit5

5 Simple stretches to do following a day on the slopes.


In our previous posts, we talked about simple exercises to get the lead out of your legs both in the morning and after lunch. One of the best ways to achieve this is actually to spend a few minutes stretching at the end of the day. Stretches are much more effective post exercise and doing these 5 exercises will ease the pain of the next morning and have a large role to play in preventing injury. Admittedly there are often much more fun Après Ski activities to take part in, but if you can find 5 minutes to do these at some point before you go to bed your body will thank you.


Lumbar Flexion/Extension Stretch – Hold for 20-30 seconds. Repeat twice each way

 DCIM100GOPROGOPR0945.DCIM100GOPROGOPR0946.Lx Flex/Ext stretch

#SkiFit5 tip – If pushing up onto your hands is a bit too much try resting on your forearms instead


Lumbar Rotation Stretch – Hold for 20-30 seconds. Repeat twice on each way



Kneeling Hip Flexor Stretch – Hold for 20-30 seconds. Repeat twice on each leg



Glut Stretch – Hold for 20-30 seconds. Repeat twice on each leg



Piriformis Stretch – Hold for 20-30 seconds. Repeat twice on each leg



Remember to perform these exercises slowly and hold at a point where it is comfortable. These stretches should never cause pain.

For more great ski injury prevention exercises check out the rest of the #SkiFit5 series.

If you would like to come in  for thorough and expert assessment and a personalised prevention/rehabilitation programme click HERE for an appointment at Bespoke Physiotherapy Covent Garden.

Our Ski Fit network partners In Clinic Physiotherapy also have more great advice on ski specific injury prevention. Check out their blog.

Ski Fit 5 – After Lunch Looseners #SkiFit5

One of the worst times for injuries on the slopes is the afternoon session, when you’re fatigued from a morning of pushing hard and you’ve stiffened up during lunch. These simple loosening exercises can be done on the hill and will get you set for the afternoon. #SkiFit5


Standing rotation – repeat slowly 3 times each way

 Tx Rot stretch 1Tx Rot stretch 2.


Leg swings – repeat slowly and smoothly 5 times on each leg

 Leg Swings 1Leg Swings 2


Squats – Repeat 5 times



Heel / Toe Rockers – Repeat 10 times


Standing hamstring stretch – Hold for 20-30 seconds. Repeat twice on each leg


Remember that you will have stiffened up a bit over lunch (and you will probably be full of Schnitzel or Croque Monsieur) so do these exercises slowly and smoothly. Although these exercises are very simple they are remarkably effective in improving the extensibility of the muscles used in skiing and snowboarding, which ultimately means a significantly reduced risk of injury.

Check out the rest of the Ski Fit 5 series for more great tips on injury prevention on the slopes.

If you are unsure if you are ready to hit the slopes or have any specific injury concerns BOOK HERE for a Ski Fit Assessment at Bespoke Physiotherapy.

Also, check out our Australian Ski Fit partners In Clinic Physiotherapy for more great exercises to prevent ski injuries.

Ski Fit 5 – Morning Warm Up Essentials #SkiFit5

Getting ready for a day on snow? Feeling rough from your previous day on the slopes (and the inevitable Après Ski)? All skiers and snowboarders, whatever their level, can relate to this. Apart from a hearty breakfast and some decent fluids, there are some really simple exercises you can do to warm yourself up and prevent injury on the slopes. These ones are our top 5. #skifit5

Leg swings – repeat slowly and smoothly 10 times on each leg

Leg Swing 1Leg Swing 2


Threading the needle – repeat slowly and smoothly 5 times on each side
Threading the Needle 1Threading the Needle 2Threading the Needle 3

Step calf stretch – Hold for 20-30 seconds. Repeat twice on each leg with a straight knee and with a bent knee

Calf Stretch 2. Calf Stretch 1



Quad stretch – Hold for 20-30 seconds. Repeat twice on each leg

Quad Stretch











Hamstring stretch – Hold for 20-30 seconds. Repeat twice on each leg



Do these exercises slowly, smoothly and gently. They should be comfortable and pain free. Wait until you hit the hill to push your limits. #SkiFit5




Ski Fit 5 Minute Masterclass – #SkiFit5

As part of the Ski Fit network, the team at Bespoke Physio are releasing a short series of blogs on preventing injuries on the slopes. This follows on from the fantastic series published last month by our Australian Ski Fit partners In Clinic Physiotherapy.

Pic Blanc

What better place to write these blogs than from the lovely village of Alpe D’Huez in France. For the next 5 days we shall be releasing one 5 minute blog post per day. Today’s post is on preparing yourself for the Slopes. Enjoy our first post in the #SkiFit5 series!


SkiFit5 – Pre-Ski Strength


Booked your ski holiday? Time to get ski fit. Skiing and snowboarding are very demanding on the body. They require strength, endurance, flexibility, cardiovascular fitness and balance. Exercise such as running or cycling is great for improving general fitness and should form an essential part of your preparation. However, in order to prepare adequately for the slopes, sport specific exercises must also be included. The 5 exercises below are simple yet challenging and you don’t need to go to the gym to do them. The best thing is they get great results! Check them out. #SkiFit5



  1. Decline Squats

You can do these on a decline board at the gym or you can place a rolled yoga mat under your heels to replicate it at home.

Decline Squat 1Decline Squat 2


  1. Single Leg Squats

Be sure to keep your hips level and line up the centre of your kneecap with your 3rd toe to maintain a good alignment throughout the leg. Don’t go too deep and concentrate on maintaining good control. Progress on by moving your arms and trunk or standing on a bosu ball.

Single Leg Squat 1 Single Leg Squat 2


  1. Double Leg Bridging

Fantastic for Glut and Hamstring strength. You can progress this using a gym ball or by moving to single leg bridging – very hard work!


  1. Lateral jump squats

The main thing here is to have soft knees for a controlled landing. A great whole body workout.

  1. Single leg balance

Balance and proprioception are so often over looked but in dynamic sports like skiing and snowboarding they are as important as strength. Single leg balancing is a really simple and effective way to sharpen up your proprioception. Progress it on by using a wobble board or bosu ball, or add in throw and catch aspect.

Single Leg Stand 1 Single Leg Stand 2


Stay tuned for the second instalment of the SkiFit5 series from the French Alps! #skifit5

If you would like a more individualised assessment and individualised conditioning programme BOOK NOW with Bespoke Physiotherapy.

For those Living in the Southern Hemisphere we thoroughly recommend you check out our Australian Ski Fit Network partners In Clinic Physiotherapy for expert care and advice.

Flying long haul this winter? 4 tips for trouble free travel

Sitting in Dubai Airport halfway through a long haul flight back to London I thought this was a good opportunity to pen down some simple tips to help people get through long flights. Looking after your body on a long haul flight can seem a challenge, but it is really very simple. Here are my top 4 tips.


Keep Hydrated

Make sure you drink a decent amount (of water!) during a flight. The pressurised cabin of an aeroplane provides for a very dry and dehydrating environment. Don’t wait for the cabin crew to come around if your thirsty – press the assistance bell.


Get into the zone (time-zone that is)

One of the biggest things to overcome in long haul travel is jetlag. Traversing multiple time zones in a single day really plays havoc with your body clock. One simple way to assist with your body’s transition and is to change your watch to the time zone of your destination as soon as you get on the plane. From that point forward throughout the flight operate as if you were in the time zone of your destination. This means trying to get some sleep if it is night-time, or trying to stay awake if it is daytime at your destination. Make sure you pack some earplugs and an eye mask to help with this.


Maximise your comfort

We all know that aircraft seats are not the most comfortable things in the world, and that can mean you get to your destination with neck or back pain that can really interfere with your trip. Packing a neck pillow is essential and placing the small pillow provided by the airline behind your lower back will place your lumbar spine in a more neutral posture. Also, pack your own headphones. It doesn’t matter if they are over ear or in ear, generally speaking they will be infinitely more comfortable and than airline headphones.



Keep Mobile

This is the most simple of all. Humans are not designed to spend long periods in static posture – we are designed for movement. Get up once every hour that you are awake on a flight. Go to the bathroom or go for a wander down the aisles. It might not feel like much but you’ll feel a lot better on the other end.


Check out the blog next week for more useful tips on travel and exercising in different conditions.


Jon Castle

Bespoke Physiotherapy

Back Pain Mistakes – Clare Henson-Bowen

Clare Henson-Bowen (Director and Principal Physiotherapist at Bespoke Physiotherapy) specialises in complex persistent pain injuries (i.e. those that don’t get better as expected!) – So we wanted to ask her if there any mistakes she sees patients making when managing their back pain. Here’s what she had to say…


The most common of back pain is classed as ‘simple’ non-specific mechanical back pain and this usually clears up in around 4-6 weeks. There are definitely ways to help speed this along as well as some unhelpful things that can slow down and hinder recovery. It can be frustrating for patients when their symptoms do not improve so it’s crucial to find out how acute phases of pain are managed. If not managed well, the back pain can struggle to settle down and patients can move in to more persistent stages of pain.


The 3 most common mistakes I have seen patients make when managing mechanical back pain are:


Wrong level of activity – Trying to get out of bed or down to lace your shoes can be mission impossible when you have acute back pain but the old method of taking off your front door and lying on it completely still for 1-2 weeks has been put to bed . So patients are often torn between the ‘keep moving’ and the ‘you should rest up’ advice. So how much is too much or too little? Our spines do like to move so it is always best to keep moving within your pain levels. Non weight bearing range of movement exercises (I.e. those completed whilst lying down) can help you do this without causing your pain to increase.

Depending on your work activities and hobbies you may need to tailor down the amount you are doing for a couple of weeks until your pain allows you to return to normal activity. When in this stage, returning to normal activities should be paced so that your back can gradually get used to the physical demands you want to place on it. Generally speaking, remaining at work is best for recovery and prognosis so it may be worth speaking to your manager to see if your work activities or hours can be temporarily changed to help support you to stay and / or return to work.


Not taking a holistic approach to understanding pain – The human body is a complex thing and when understanding pain it is vital that not just physical contributing factors are addressed. The biopsychosocial approach to managing pain is well researched and used now by most physiotherapists. This means not only looking at the physical sources of pain but also the social and psychological factors which can drive and amplify pain. The most common psychological factors we see when working with back pain is low mood and anxiety. Sometimes this is an old or pre-existing concern for the patient, or a new thing that has developed after the back pain started. Either way, it is super important to recognise the influence that these can have on the way we feel pain to help us treat all factors involved. Many of my patients have progressed extremely well once these areas are addressed and treatment underway.


Lack of diagnosis and fear of the unknown – A large proportion of back pain is classified as this non-specific mechanical back pain which means that no definitive diagnosis is attached to the pain you are experiencing. This classification of back pain is described as a ‘tension, soreness and/or stiffness in the lower back region for which it is not possible to identify a specific cause of the pain. Several structures in the back, including the joints, discs and connective tissues, may contribute to symptoms’ (NICE Guidelines 2009). Many patients I see feel they would benefit from investigations such as x-rays and MRI scans however these are often not indicated and have actually been shown to negatively affect overall prognosis in some patients. The decision to investigate back pain further needs to be carefully discussed with your physiotherapist.                              


So you have been avoiding all these common mistakes but you continue to feel like you have a knife twisting in your back?


If you haven’t already sought the advice and treatment of a physiotherapist, then now if definitely a time to get that ball rolling. There may be other reasons why the back pain is not settling down and this needs a full physical examination and treatment plan. Patients with non-specific back pain should be offered treatment plans focusing on self-management, exercise-based rehabilitation, manual therapy and / or acupuncture. If the patient is in the more persistent stages of pain, then treatments should focus on reducing pain and its impact on the patient’s day-to-day life, even if the pain cannot be cured completely.



NB/ This blog article only discusses non-specific back pain so if you are experiencing other types of back pain then please discuss with your GP or physiotherapist. If you experience any red flags associated with back pain (i.e. trouble controlling your bladder or bowel movements, numbness in the groin area, foot drop symptoms in both legs) then please seek urgent medical attention.

The 2 most common running injuries & mistakes!

With those lucky enough to have secured a place in next years London Marathon starting to plan their training schedule, we have picked the brains of the very talented and experienced Jon Castle (Director & Principal Physiotherapist at Bespoke Physiotherapy) to talk to us about running injuries, mistakes and and advice for new runners…

What are the 2 most common running injuries you see in London and what is the main cause of each?


The most common running related injuries I see here in London would definitely be patello-femoral pain syndrome (runner’s knee) and Achilles tendinopathy. 

Runner’s knee generally presents as pain at the front of the knee around or behind the kneecap. The most common cause of runner’s knee is poor biomechanics, which is to say poor alignment of the hip, knee and ankle/foot during running. Onset is generally associated with a sharp increase in the amount of running someone is doing.

pfj pain

Achilles tendinopathy presents as pain around the Achilles tendon and or the back of the heel and once aggravated is often worse first thing in the morning and can be quite debilitating if not addressed properly. The main causes of Achilles tendinopathy in runners are poor running technique, a lack of support for the foot and ankle while running (i.e. the wrong running shoes), and once again, poor biomechanics. Functionally speaking, poor mechanics stems from a lack of adequate muscle control at the pelvis hip and knee. This is where Physiotherapy and specific rehabilitation is most useful.


What are the 2 biggest mistakes novice runners make that lead to injury?


The first is that most people go too hard too soon. New runners tend to get the running bug and they increase the distance and volume of running too quickly. The other big mistake is not factoring in sufficient recovery time. In real terms this means a lot of new runners do not have enough rest days, do little or no warm up, cool down or stretching exercises, and focus too much on running and not enough on cross training.


What is your advice for new runners, who have never run before?


I would say start slow and low. Start off running at a comfortable pace for relatively short distances. Avoid running on consecutive days initially and factor in enough time for warm up, cool down and stretching. When you do start to build things up, only change one factor at a time. Start by building up your distance and then work on your pace. Many running overuse injuries stem from people trying to increase speed and distance simultaneously.



What are your 3 favorite stretches for runners?


Obviously everyone is different and there is no set of exercises that will suit every runner. However, these are 3 of the exercises that  I find are most useful to many runners.

  • The most useful stretch that is under-used I think is the kneeling hip flexor stretch, which helps with pelvic and spinal posture during running, decreasing the risk of associated low back pain and facilitating greater activation of the gluteal muscles.

hip flexor stretch

  • My favourite strength/control exercise would be step ups/step downs. Doing these slowly in        front of a mirror with correct technique and alignment really helps build single leg control, essential for all runners.

step down

  • Finally, an old favourite is rolling out the Ilio-tibial band with a foam roller. It’s not a very comfortable exercise but it’s much more effective than an ITB stretch and it helps prevent patello-femoral pain and ITB friction syndrome.

foam rollar

If you are concerned about your biomechanics, a niggling injury or just want an MOT before you start your training programme, do contact us to arrange a physiotherapy session.

Is it getting cold? Or do I have a frozen shoulder!

What is Frozen Shoulder?

Frozen shoulder (also known as adhesive capsulitis) is a condition of the shoulder where symptoms of pain and stiffness gradually worsen over months and sometimes years. At times, varying other types of shoulder pains are labelled as ‘frozen shoulder’ however true frozen shoulder is actually the significant reduction of movement in the capsular pattern. This means that you are unable to move the shoulder far from your side, reach behind your back or indeed rotate it outwards due to pain and stiffness. It has 3 stages which vary in length and can overlap:

Stage one

During stage one, often referred to as the “freezing” phase, your shoulder will start to ache and become very painful when reaching out for things.

The pain is often worse at night and when you lie on the affected side. This stage often lasts for two to nine months.

Stage two

Stage two is often known as the “frozen” phase. Your shoulder may become increasingly stiff, but the pain does not usually get worse and may even decrease.

Your shoulder muscles may start to waste away slightly because they are not being used. This stage usually lasts 4 to 12 months.

Stage three

Stage three is the “thawing” phase. During this period, you will gradually regain some movement in your shoulder. The pain will begin to fade, although it may come back occasionally as the stiffness eases.

You may not regain full movement of your shoulder, but you will be able to carry out many more tasks. Stage three can last from five months to many years.


What causes Frozen Shoulder?

Frozen shoulder occurs when capsule surrounding the shoulder joint becomes inflamed and thickened. The pathophysiology behind why this happens is unknown however the following can increase your chances of developing it:

– A previous shoulder injury or shoulder surgery

– Diabetes

– Dupuytren’s contracture (a condition where small lumps of thickened tissue form in the hands and fingers)

– Other health conditions, such as heart disease and stroke

Studies of the epidemiology have also highlighted that Frozen Shoulder is more common in women than men and it is most likely to occur between the ages of 40 and 60.


How can it be managed?

Do nothing

We know that frozen shoulders will eventually improve by themselves but this can take up to several years to do so. As you can imagine, this level of pain, stiffness and lack of function is not acceptable to most people for this long, so alternative treatments are sought.


Pain Relief

Pain Killers

Frozen shoulders can be extremely painful, especially in the early stages of the condition. Your GP may prescribe you painkillers, such as paracetamol, a combination of paracetamol and codeine or a non-steroidal anti-inflammatory drug (NSAID).

Some painkillers, such as paracetamol and ibuprofen, are also available from pharmacies without a prescription. Always follow the manufacturer’s instructions and make sure you are taking the correct dose.


Corticosteroid injections

If painkillers are not helping control the pain, it may be possible to have a corticosteroid injection in your shoulder joint.

Corticosteroids are medicines that help reduce pain and inflammation. They may also be given with a local anaesthetic.

These injections can help relieve pain and improve the movement in your shoulder. However, injections will not cure your condition and your symptoms may gradually return.

Corticosteroid injections will not be used after the pain has gone from your shoulder and only the stiffness remains.

Having too many corticosteroid injections may damage your shoulder, and the injections often become less effective over time, so your doctor may recommend having no more than three injections. You will need at least three to four weeks between these.



Evidence for physiotherapy to manage true frozen shoulder have been conflicting over the years. In my experience, in the early stages of the condition, physiotherapy can be extremely useful for pain reduction however, movement often remains restricted. There is however research supporting physiotherapy in the middle to late stages of the condition as well as after more invasive input. After such a long period of immobility the shoulder needs lots of encouragement and muscle patterning retraining to rehabilitate back to full function.


Manipulation under Anaesthetic (MUA)

MUA has been the traditional orthopaedic surgical management of frozen shoulders. Although slightly confusing, there is no surgical incision. This actually involves your specialist manipulating the shoulder joint into full planes of movement (whilst you are under anaesthetic).

The ideal time for manipulation of the frozen shoulder is at the stage when night pain is decreasing but the stiffness has reached a maximum. Physiotherapy at this stage usually makes the shoulder more painful but is of course invaluable immediately after the manipulation and possible steroid injection.




This is a relatively new procedure that is becoming more and more popular for the management of frozen shoulders. This involves a small amount of fluid being injected into the shoulder joint which then expands the capsule. This ‘distension’ of the shoulder joint with fluid is thought to disrupt adhesions (scar tissue), thereby opening or freeing up the joint allowing improved range of movement. The evidence is building around this less invasive procedure having benefits to pain, range of movement and function in patients with frozen shoulder. Smaller studies are also showing that distension with steroid injection appears to be more effective than a steroid injection alone. When compared with a MUA, evidence suggests that it is as effective, with less complications.


Final thoughts…

Many shoulder complaints are placed under the umbrella term of ‘frozen shoulder’ so it is always best to have a full assessment with a musculoskeletal specialist, such as a physiotherapist.


Physiotherapy can be useful for pain relief in the early stages and is extremely important once the stiffness naturally starts to lift or you undergo a MUA or hydrodilation.


If you are unsure of your shoulder diagnosis or whether it is the right time for you to start physiotherapy, do Contact Us as early intervention will significantly improve timeframes for recovery.



Unfit or side stitch? Tips on overcoming a stitch

I recently re-starting my running programme and was shocked to find I could only run 5-10 minutes before having to stop due to pain under the ribs. At first thought I presumed this was due to being deconditioned but when this didn’t settle after a few weeks I sought the advice of my good friend and colleague Daniel Kay (Osteopath at

Thankfully, he had the answer! After listening to me describe my symptoms, he told me it sounded like I was experiencing a side stitch. Interestingly, this injury is really common in new runners, and those who are returning to running, and is thought to be the diaphragm going into spasm.

So of course I was very keen to find out how to treat and overcome this injury and thought I would share the tips he gave me. I have applied these to my training and am now gradually increasing my speed and distance.

TIP ONE: Make sure you are not just mouth breathing and are inhaling as much through nose as possible

TIP TWO: Try to regulate your breathing to follow the same rhythm as your gait, i.e. exhale either every left/right foot step or every other or three, depending on your effort

TIP THREE: Try to fully exhale every 20 – 30 or so breaths to try and get the last 25% out of the lungs

TIP FOUR: Keep your head up and fix your gaze at least 100m ahead, try not to look at your feet or immediately in front for prolonged periods

TIP FIVE: Make sure you are hydrated and have not just eaten