Exercise? Who me? Yoga or physiotherapy or education…

HealthSkills Blog

Exercise, while one of The Most Important self management approaches for persistent pain, is not an easy sell to someone who is experiencing pain. Especially not if that exercise looks like huffing and puffing, hauling on bits of metal in a gym, or wearing lycra. Not to mention the “sports drinks”…  Those things aside, exercising is a good thing. You heard it from me, and I have declared my body an exercise free zone! The thing is, what kind of exercise, for what purpose, and how to get introduced to it.

Personally I’m a fan of exercise that achieves something else other than “getting fit”. I like gardening, I love dancing, I enjoy cycling (especially to the store to get a GREAT coffee!). Walking the dog is fun. Swimming (especially snorkeling) is awesome! I like my exercise to do more than bring on the endorphins, especially as I don’t get…

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Health, Nutrition, Uncategorized, Wellness

3 Things people in pain want us to know

Taken from a great article on the pain revolution website.

3 things people in pain want us to know

” Jo’s words:

Please hear us,
The most important part of any therapeutic interaction is feeling heard. Too many people have answers for us before they even know us or our pain. We have seen the face you make when we want to tell you our stories, and the way that you want to cut us off because there’s limited time in the clinic. Remember that feeling like we’re an active participant in decision making, and that we have likes, dislikes and preferences, even in the face of pain is critical to us getting better. Listening is a skill – and one that we need to practice, not just in the clinic, but in our everyday interactions with people.

Know you can’t FIX us
Please don’t say you know exactly what’s wrong with us and can fix us. We’ve been to so many people who’ve made such claims, and none of them could. Tell us pain is complex and that we’ll figure out the way forward TOGETHER, as equal partners. When we’re in pain, we really want to believe you, that you do have all the answers, because life gets really big and heavy when everything hurts. Disappointment hurts too. Stick with the science, help us to understand the complexity, and make sense of our stories, and we’ll all do much better in recovering from persisting pain.

Please be a Human
Pain is a human experience. As much as you can, treat me as a friend. You don’t need to “be” my friend, but compassion is sadly lacking in pain care. Pain is hard, for both the person in pain and the person trying to treat them. If we can recognize the humanity in one another we’ll all be better off, on both sides of the equation.”

Full link below:


A huge thank you to Joletta Belton, who writes at http://www.mycuppajo.com for her expert input in to this post. Jo received her expert qualifications in pain through her own experience and recovery from persisting pain (although she did return to University to study it too!). She is changing the world of people in pain with the Endless Possibilites Initiative.

Health, Nutrition, Uncategorized, Wellness

What is the difference between an Osteopath, a Chiropractor and a Physiotherapist?

The differences between osteopaths, chiropractors and physiotherapists can be difficult to differentiate between as they all seem to treat similar areas of the body and are drug free manual therapies. In this article we will attempt to make the professions a little clearer, citing their similarities and differences to help make the right choice.

When investigating the claims of the three professions it can be difficult to choose between the three as they claim to have similar systems of care. Below is a table comparing their philosophies.

Osteopathy Chiropractors Physiotherapy
The body has the natural ability to maintain itself and, by helping this process, an osteopath can promote restoration of normal function. The principle of osteopathy is that the well-being of an individual relies on the way that bones, muscles, ligaments, connective tissue and internal structures work with each other.An osteopath will take the time to understand their patient, and their unique combination of symptoms, medical history and lifestyle. This helps to make an accurate diagnosis of the causes of the pain or lack of function (rather than just addressing the site of the condition), and from that, to formulate a treatment plan that will achieve the best outcome.

They may also provide advice on posture and exercise to aid recovery, promote health and prevent symptoms recurring.

Osteopaths frequently work alongside other health professionals, such as GPs, nurses and midwives as well as alternative medical practitioners. Osteopathy works well to complement other medical interventions including surgery and prescribed medication.

(Institute of Osteopathy, GOsC)

Chiropractors are trained to diagnose, treat, manage and prevent disorders of the musculoskeletal system (bones, joints, and muscles), as well as the effects these disorders can have on the nervous system and general health. They have a specialist interest in neck and back pain, but when they assess patients, they take their entire physical, emotional and social well-being into account.Chiropractors use a range of techniques to reduce pain, improve function and increase mobility, including hands-on manipulation of the spine. As well as manual treatment, chiropractors are able to offer a package of care which includes advice on self-help, therapeutic exercises and lifestyle changes.

Chiropractic treatment mainly involves safe, often gentle, specific spinal manipulation to free joints in the spine or other areas of the body that are not moving properly. Apart from manipulation, chiropractors may use a variety of techniques including ice, heat, ultrasound, exercise and acupuncture as well as advice about posture and lifestyle.

(British Chiropractic Association)

Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability. Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice.

They maintain health for people of all ages, helping patients to manage pain and prevent disease.

The profession helps to encourage development and facilitate recovery, enabling people to stay in work while helping them to remain independent for as long as possible.

Physiotherapy is a science-based profession and takes a ‘whole person’ approach to health and well-being, which includes the patient’s general lifestyle.

At the core is the patient’s involvement in their own care, through education, awareness, empowerment and participation in their treatment.

(The Chartered Society of Osteopathy)

Essentially, they are all non-invasive, drug-free, manual techniques, which aim to improve physical health and well-being.

In the UK, physiotherapy is most integrated within the NHS and consequently better known. There is no charge to visit physiotherapists on the NHS with referral via the GP but waiting lists can be long. Physiotherapists work both on the NHS and in private practice. Osteopathy is not as widely available on the NHS and the majority of osteopaths and chiropractors work in private practice, where no referral is needed.

What we believe to be essential here, regardless of profession is that your healthcare professional of choice operates of the best available evidence to treat your condition. A recent article on comparison between the three professions had Dr Andrew Leaver, Senior Lecturer in Physiotherapy at the University of Sydney pointing out that evidence-based practice is “not a black and white proposition”. It is important to understand that there is not enough robust evidence available for every condition.

Whether you see a physiotherapist, chiropractor or osteopath, Dr Leaver says the most important thing is that you find a practitioner who “operates under an evidence-based paradigm”.

“So physiotherapy is not a treatment — it’s the person who provides the treatment. And similarly, chiropractic is not a treatment — it’s the person who provides the treatment.”

What you want to avoid, he says, is somebody who makes false promises of a cure and takes too much credit for natural recovery. Correcting “misaligments” for example do not fit with the later scientific understanding of pain.

“You don’t want to be seeing somebody who is holding out a false promise of a cure with lots of interventional treatment — so somebody who does lots of things to you, rather than teaches you to do things for yourself.”

“You want to see someone who empowers you look after your own body, and to look after yourself, who teaches you good strategies for dealing with day-to-day pain,” Dr Leaver said.

The article featuring Dr. Leaver’s views can be found below:



Jumper’s Knee – Patellar Tendinopathy


The patella (kneecap) tendon runs from the bottom of the knee cap to the top of the shin bone. You can feel it move by putting your hand just underneath the kneecap and straightening the leg.

Tendons like constant and gradual loading. So when they are asked to perform a new task that is significantly more load, such as a huge training change for athletes or when people go from doing nothing over Christmas to going 100mph in the gym, they get irritated.


The tendon is injured by repetitive stress, and is very common on athletes participating in jumping sports, hence the name – Jumper’s Knee.

Interestingly, the tendon experiences the highest load when LANDING NOT JUMPING. This is because on jumping the quadricep muscle shortens and on landing it lengthens or ECCENTRICALLY CONTRACTS.

The questions to be asking yourself:

• Is the pain on below the kneecap directly on the tendon running into the shin bone? • Has there been a recent change in loading in training or activities?
• Is it better for movement once you’ve warmed up and worst a while after exercising?
• Pain on bending the knee fully (This stretches the tendon)?

The best way to test this is:
• Bend the knee a little (20-30°) while lying on your back or sitting
• Have someone hold your ankle and try to stop you extending the knee fully
• HOWEVER, you must let them win, so that you are resisting as they push and eventually they push your knee from 20 degrees to fully bent while your resist. If this causes pain it is a positive test.

Key for rehab is to find a level of activity that does not aggravate the tendon post exercise. This will tell you what amount of loading is safe for the tendon. Then it is key to SLOWLY AND GRADUALLY build up the tendon tolerance again. This can be a slow process and realistic timescales are needed.

Hope you enjoyed the post folks, stay tuned for more!

West 12 Health Centre





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Empathy and catastrophising influence pain inhibition

HealthSkills Blog

When I went to occupational therapy school I was introduced to nociception and the biological underpinnings of pain. I wasn’t, at that time, taught anything about the brain, attention, emotions or any social responses to pain behaviour. Like most health professionals educated in the early 1980’s, pain was a biological and physical phenomenon. I suppose that’s why it can be so hard for some of my colleagues to unlearn the things they learned way back then, and begin to integrate what we know about psychological and social aspects of our pain experience. Because pain is a truly biopsychosocial experience. Those pesky psychosocial factors aren’t just present in people who have difficulty recovering from pain, they’re actually integral to the entire experience.

Anyway, ’nuff said.

Today I stumbled across a cool study exploring two of the psychosocial phenomena that we’ve learned are involved in pain. The first is catastrophising. And…

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As mentioned in previous posts, Hofa’s fat pad, along with the knee capsule is the MOST PAIN SENSITIVE STRUCTURE IN THE KNEE JOINT.

The Fat Pad is found just below the kneecap, directly behind the patellar tendon. It acts as a cushiom between the kneecap and the thigh bone behind.

Causes of Hofa’s Fat Pad Pain:

1. Direct blow to the knee.

2. Poor Biomechanics – a large Q angle, pes planus, increased internal rotation of the shin bone, instability of the knee.

3. History of knee hyperextension.

Signs and Symptoms of Hofa’s Fat Pad Pain:

• Banana shaped swelling and pain at the front of the knee below the kneecap

• Worse for full extension of the knee or full bending of the knee

• Squatting, running and going upstairs can make it worse

How to test your knee for this Syndrome:

• Lie down with the knee bent

• Therapist presses firmly on either side of the patellar tendon

• Patient straightens the knee as much as possible or the therapist extends the knee with their other hand while maintaining the pressure either side of the tendon

We hope you found this post helpful. The next post will be on PATELLAR TENDINOPATHY. Stay tuned!


Front of the Knee Pain: Bursitis


Bursae are sacs of fluid found between structures like bones and tendon to reduce friction between the structures as they move by one another.

There are many around the knee. #INFLAMMATION of a bursa –> BURSITIS. The main bursae are labelled🔝


Common Causes of Bursitis:

• Trauma
• Overuse
• Infection


Important History Questions:

1. Occupation? carpenters or plumbers on their knees a lot

2. Red and Swollen? Very local and well defined. Not widespread.

3. Trauma? Fall or Hurt

4. Worse for fully BENDING the knee?

5. Pain on prolonged sitting in a low chair?

Then it could be a bursitis


Most Commonly Affected Bursae:

1. HOUSEMAID’S KNEE i.e. Prepatellar Bursa – Common in professions who spend a lot of time on their knees eg carpenters and plumbers. Due ti chronic stress on bursa.

2. CLERGYMAN’S KNEE i.e. Superficial Infrapatellar Bursa – commonly occurs with JUMPER’S KNEE due to repetitive strain on patella ligament in jumping activities.


4. SUPRAPATELLAR BURSITIS (above kneecap) – trauma or repetitive trauma from kneeling or overuse for example.


Hope that was helpful. If that is you, you may benefit from treatment. Don’t hesitate to contact or DM us. Stay tuned for the next knee pain post!