• A tendon is a band of tissue that connects muscles to bones.
•  Tendinopathy refers to a group of conditions involving the tendon, which are characterized by structural tendon changes and clinical symptoms of pain and limited function. 
•  Tendons become tendinopathic, when they experience high loads, beyond their capacity. This can often happen when you have increased your training load suddenly.

​How do we manage tendinopathy?

• Since tendinopathy is thought to result from the incongruence between the load placed on the tendon and its load capacity, consideration of the tendon load is essential to its management.
• Whilst you may think rest will help your symptoms, complete rest may only make matters worse, as the tendons capacity is decreased further and therefore your ability to bare load also declines.
• A graded loading programme is key to your management. 
• This may start with isometric exercises, which have been found to have pain relieving effects. Heavy slow resistance programmes or eccentric exercises may then be suggested to rehabilitate the tendon. 
• Knowing how much to load the tendon can be challenging. A physiotherapist can work with you to help guide you through this process.

*New research* - Pavlova AV, Shim JSC, Moss R, et al (2023) ‘Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis British Journal of Sports Medicine 2023;57:1327-1334.

• New research into tendinopathy management released this October, found that exercise programmes that involved added loads (dumbbells, TheraBand’s, weighted machines etc) were found to be more effective for treating tendinopathy than compared to just using body weight exercises.
• Completing rehabilitation sessions at a higher intensity, with added load and then allowing of sufficient recovery was also found to be more effective than a high frequency of sessions at lower intensity.

​Addittional treatment 

• For unresolving tendon pain, Shockwave therapy is also a useful management strategy. 
• The treatment involves low energy soundwaves (shockwaves) being delivered by a handheld device to the painful area to stimulate a healing response.
• You can read more about this on our Shockwave Therapy Page.

If you are suffering with what you think may be a tendinopathy, then call for help and you can discuss with one of our team a plan to get you back to your best! 

In 2022, Incontinence UK stated that at least 7 million people in the UK are living with
urinary incontinence. Urinary incontinence is defined by NHS England as unintentional
passing of urine. It’s a common issue that isn’t often spoken about.

There are several types of urinary incontinence including:

• Stress incontinence – when urine leaks at times when the bladder is under pressure,e.g. coughing, laughing, sneezing, jumping and running.
• Urge (urgency) incontinence – when urine leaks as you feel an intense urge to pee. This can be split into wet or dry meaning that you may not leak when you have a strong urge.
• Overflow incontinence – when you have the urge to urinate but can only release a small amount due to being unable to completely empty your bladder, this may cause frequent leakage.
• Mixed incontinence – you may experience more than one type of urinary incontinence. Most often this is a combination of stress and urge incontinence.

Potential causes of urinary incontinence can vary, often it is the result of weakening or
damage to the pelvic floor muscles. Urge incontinence may be the result of overactivity in
the pelvic floor muscles.

What are the Pelvic floor muscles?
The pelvic floor muscles are made up of a group of deep and superficial muscles which
support your pelvic organs, maintain continence of urine and faeces, and aid in sexual
function. It is difficult to know whether your pelvic floor muscles are weak or overactive as
you can’t see them, if you are experiencing any symptoms of incontinence this is not normal
(even if you’ve had a baby!) and you may benefit from a pelvic floor assessment.

What can I expect from a Pelvic floor Physiotherapy assessment?
During the assessment, we will take a detailed history of the problem you may be suffering
with to determine the cause of the issue. We will also conduct a pelvic exam which involves
an assessment of the health of the tissue around the vagina, an assessment of your pelvic
floor muscles and a treatment plan going forward. This may involve strengthening your
pelvic floor muscles, relaxation techniques, biofeedback or electrical stimulation if indicated.

I think I am suffering from incontinence, what should I do next?
Please go to our webpage for more details
or alternatively call 01225 683007 to book an appointment with our
women’s health physiotherapist Liv. You do not need to detail why you need to the
appointment when booking if you choose not to, this will be discussed with the
physiotherapist at your first appointment.

Many people are unsure what to expect from Chiropractic sessions so our top Chiropractor Bryony has put this useful blog together to outline what a session might involve.

 As I’ve had a number of patients not knowing what to expect from treatment when they see me, I
thought it would be useful to show a couple of examples as to how I can use different
techniques to achieve the same valuable outcomes.
Chiropractic care can be tailored to safely treat all ages and the likes and dislikes of the
patient. I pride myself as a clinician who finds huge value in getting to know your unique
preferences and goals, and I thrive on being able to find ways to enable chiropractic care to
be inclusive to all.
​
The patient below had completed a full initial consultation and report of findings, to ensure
chiropractic care and the techniques used were safe, effective and the most appropriate
form of care for them. Both of the chiropractic adjustment videos display a quick but gentle
movement, resulting in a clicking sound which is audible on the videos (incase you’d prefer
to turn your volume down to not to hear this).

​If you have any further questions, or would like to find out if chiropractic care is a suitable
form of treatment for you, give us a call on 01225 683007.
​

Chiropractic adjustments, what can I expect during an adjustment and what is it?

A chiropractic adjustment, also known as spinal manipulation when applied to the neck or
back, will vary in nature depending on the area of the body being treated.
When treating the neck, spinal manipulation is a process whereby your chiropractor will
apply a quick but gentle movement to your head and/or neck, this may or may not produce
an audible clicking sensation known as an audible release.
Adjustments throughout the midback and low back are achieved through a quick and firm
impulse applied to the area, similarly to neck adjustments this may or may not produce an
audible clicking.
Adjustments can also be applied to a number of joints in the arms or legs, whereby this
similar quick and firm impulse can be utilised to manage pain in these regions.
​
The adjustment itself isn’t painful, although some individuals do experience a muscular
pulling sensation in surrounding regions to the adjustment site whilst your practitioner is
getting you into position prior to performing an adjustment. This is common and nothing to
be concerned about, although important that you let your clinician know if you do
experience this, so they can change your positioning to ensure your comfort throughout.

 What are the benefits of chiropractic adjustments?

If you and your practitioner have deemed chiropractic adjustments as an appropriate form
of management, they could help you gain benefits such as:

• Decreasing pain within your joints and surrounding muscles
• Increasing your range of movement of your neck or back, to reduce sensations ofstiffness and restricted movement
• Some individuals have been shown to obtain improved posture with a tailoredchiropractic treatment plan
• Some studies have shown adjustments to help improve athletic performance
• Many also find that chiropractic adjustments reduce their need to rely on pain medications

These benefits can increase your capacity to complete exercise rehabilitation in clinic
or from home, facilitating recovery

What common conditions can a chiropractor help treat?

Chiropractors treat conditions or pain arising from the musculoskeletal and peripheral
nervous system, meaning they treat the joints, muscles, tendons, ligaments and nerves
throughout the whole body. This means chiropractors can treat a vast variety of conditions
which involve these areas of the body, however common conditions that chiropractors
regularly see and treat in clinic include:

• Neck pain
• Headaches and migraines
• Pain in the arms or associated joints
• Midback pain
• Low back pain
• Sciatica
• Leg pain or pain in the joints of the legs or feet
• Sports injuries

As chiropractors can utilise a range of treatment techniques, from chiropractic adjustments
to massage and soft tissue release techniques, there’s a broad spectrum of conditions
they’re able to help you manage.

What is it?
Sciatica is a term used to describe pain which starts in the low back or buttock and travels
down the leg into the foot. It occurs when a large nerve which travels from the low back
into the foot, called the sciatic nerve, is compressed or irritated. This compression can come
from a variety of sources in the back and can be identified by seeking help from one of our experienced Bath Chiropractor and Physiotherapy team.
It’s also important to note that there are a variety of causes of low back, buttock and leg
pain other than sciatica. If you’re unsure of what’s causing your pain, our clinicians at
Physioimpulse can help in identifying the cause of your discomfort.

What symptoms could suggest sciatica?

• Pain which originates in the low back or buttock and travels into the foot
• Numbness or tingling in the leg or foot
• Loss of muscle strength in the lower part of the leg or foot

How will my Bath Chiropractor diagnose sciatica?
Typically, a chiropractor will be able to determine the presence of sciatica through your
symptoms and testing of the nerves, joints and muscles in the lower limb. These tests are
non-invasive, and your clinician will explain what they’re doing as they go. In some cases a
clinician may decide to refer you for a scan, however recent evidence has proved that a scan
isn’t always essential for an accurate diagnosis of sciatica.

​How can sciatica be treated in clinic?

• Manual therapy techniques administered by your chiropractor or physiotherapist  to reduce discomfort and stiffness
• Tailored advice on how you can adapt your activities of daily living to reduce theimpact sciatica has on your daily life
• Exercise rehabilitation to support your body’s recovery
• Education on the associated risk factors to aid recovery and reduce the risk of reoccurrence

What can I do in the meantime to reduce my chance of developing back pain and sciatica?
The latest evidence tells us that keeping active, eating a varied and balanced diet to
promote overall health, and abstaining from smoking are some of the key factors in
reducing our chances of suffering with low back pain or sciatica.
Interestingly, we’ve also learnt through research that walking appears to be the gold
standard exercise type in preventing and treating generalised low back pain. However, if
you’re unsure of what other types of exercise can help treat low back pain or sciatica, or
​have any additional questions or concerns with your low back pain, give us a call and one of
our clinician’s will happily help guide you.

Bath Chiropractic
​ 01225 683007

The impact of tennis injuries can be reduced by careful management of swelling, protection of the injured structures from further injury, and by enlisting the support of one of our Bath chartered physiotherapist or our sports chiropractor or osteopath.

Collateral tissue damage can be minimised by following the POLICE or PRICE guidelines, standing for protection, optimal loading/rest, ice, compression and elevation.

Current evidence as published by the Association of Chartered Physiotherapists in Sports & Exercise Medicine (ACPSEM) should be followed to minimise collateral tissue damage.

• Protection: splints, taping, crutches, modifying activity
• Optimal loading/rest: load the tissues relative to their state of injury and repair
• Ice: cold compress, cold water immersion
• Compression: strapping, compression garments
• Elevation: place injured part higher than the heart

Painkillers such as paracetamol can be very effective in controlling pain associated with tennis injuries.

Anti-inflammatories are not recommended in the first 5-7 days after injury, as inflammation is the body’s way of healing.
Swelling needs to be managed, but stopping inflammation from occurring at all is not advised.

A chartered physio will perform a thorough assessment to evaluate how well joints and muscles are functioning.

In addition the physio will assess muscle power, strength and endurance as well as balance, co-ordination and joint position awareness.

Injured players will be guided from the initial phase after the injury to the end phase of return-to-play testing.

It is important to rehabilitate fully after any injury as failure to do so often leads to re-injury often resulting in a longer period off play.


Rotator cuff tear
What is it? The rotator muscle complex provides stability and controls movement of the shoulder joint. Tears may be due to overuse or acute trauma.

How does physiotherapy treat rotator cuff tears? Acute soft tissue management as evidenced by the PRICE guidelines (above) should be undertaken to reduce secondary damage from swelling. Simple painkillers may be taken but anti-inflammatories should be avoided at this stage.

Once again a thorough examination will guide the treatment plan which may include mobilisations, soft tissue techniques, taping, acupuncture and other physiotherapy modalities.

The physiotherapist will write a graded rehabilitation plan including return to play testing. 

Shoulder injuries: famous tennis examples Maria Sharapova had surgery to repair two rotator cuff tears in 2008 and has since suffered other problems with her shoulder.


Lower back pain 
What is it?This is very common among tennis players because of the repetitive nature of the game and the demands of the strokes, especially serving. Acute pain may result from a sudden stretch or fall or ongoing ache may be experienced.

Physical conditioning is very important to minimise the risk of low back pain in recreational as well as elite tennis players.

How does physiotherapy treat lower back pain?A full assessment of movement control, flexibility, strength and endurance will guide the treatment and rehabilitation plans.

Our Team may use hands-on techniques for joints and soft-tissues, taping, acupuncture, exercise prescription, and practical advice.

Back injuries: famous tennis examples Roger Federer has suffered long-term issues with his back that he manages with core strength training and by playing fewer tournaments, while Andy Murray underwent surgery last year to address a long-standing problem.


Wrist sprain
 What is it? The wrist contains many small joints and ligaments and has a cartilage structure, TFCC, like the knee meniscus, which can be injured.

How does physiotherapy treat wrist sprain?The physiotherapist will follow the PRICE guidelines (above) and may protect the joint with a splint or strapping. A full examination will be undertaken to determine which structures are involved.

A graded exercise program, including return to play testing, will be undertaken alongside hands-on treatments.

Carpal tunnel syndrome
What is it? This condition occurs when the median nerve that passes through the wrist is compressed, causing pain throughout the hand, wrist and forearm.

How does physiotherapy treat carpal tunnel syndrome? The first priority is to reduce any swelling in the carpal tunnel region and ensure the forearm muscles are functioning properly.

An assessment of the neck and neural system will be done to rule out any problems further up the movement chain.

An assessment of racquet grip and tennis stroke may help to identify any technical issues.

Wrist injuries: famous tennis examples Juan Martin Del Potro has suffered serious injuries to both wrists that have been reported as career-threatening. Nikolay Davydenko is another player to have struggled with a wrist injury.

​Patella tendonopathy 
What is it? This injury involves pain in the tendon that connects the kneecap (patella) to the top of one of the shin bones (tibia) and is usually caused by overuse. It can be either acute or chronic in nature.

How does physiotherapy treat patella tendonopathy? Management of inflammation and restoration of movement range and control are key factors in this condition early on then a graded loading rehab programme is key.

This condition need not stop a tennis player from playing, but the physiotherapist may suggest modifications to the amount or intensity of play. 

Medial collateral ligament (MCL) sprain 
What is it?This ligament limits excessive sideways movement of the inner side of the knee joint.

It has close links with the knee meniscus (cartilage) and the anterior cruciate ligament. The Unhappy Triad is the name given when all three structures are injured together.

MCL injuries can vary from overuse strains to full ruptures. A ruptured MCL may be managed conservatively or surgically. 

How does physiotherapy treat medial collateral ligament sprain?Immediate treatment involves the PRICE guidelines (above). Protection may be offered in the form of bracing and / or use of crutches. Painkillers can be used but anti-inflammatories should be avoided in the immediate aftermath of the injury.

Restoration of normal range of motion is one of the first targets even if weight bearing is still reduced. Movement control including balance and co-ordination skills will form part of the rehabilitation plan along with hands-on techniques and strengthening.

The physiotherapist will guide the patient through graded exercises from squatting and lunging type exercises to jumping, hopping and landing skills.

Knee injuries: famous tennis examples Rafa Nadal suffers knee tendonitis that requires ongoing management, while Richard Krajceck battled back from a severe knee ligament injury to win further tournaments.

Calf strain
 What is it?Injuries to the calf complex can affect the deep and superficial calf muscles, the Achilles Tendon and the Plantar Fascia of the foot. 

How does physiotherapy treat calf strain? Immediate treatment involves the PRICE guidelines (above). Protection may be offered in the form of bracing and / or use of crutches. Painkillers can be used but anti-inflammatories should be avoided in the immediate aftermath of the injury.

Restoration of normal range of motion is one of the first targets even if weight bearing is still reduced. Movement control including balance and co-ordination skills will form part of the rehabilitation plan along with hands-on techniques and strengthening.

The physiotherapist will guide the patient through graded exercises from squatting and lunging type exercises to jumping, hopping and landing skills.

Sprained ankle 
What is it?The most common injury is a strain to the lateral (outside) ligament but the deltoid ligament on the inside/medial side of the ankle can also be injured. Excessive strain on the ankle where it ‘rolls out’ can cause the lateral ligament to stretch or rupture and medial ligament to compress and get squashed.

How do physiotherapists treat sprained ankle?I mmediate treatment involves the PRICE guidelines (above). Protection may be offered in the form of bracing such as a walking boot, and / or use of crutches. Painkillers can be used but anti-inflammatories should be avoided in the immediate aftermath of the injury.

Restoration of normal range of motion is one of the first targets even if weight bearing is still reduced. Movement control including balance and co-ordination skills will form part of the rehabilitation plan along with hands-on techniques and strengthening.

The physiotherapist will guide the patient through graded exercises from squatting and lunging type exercises to jumping, hopping and landing skills.


If you are suffering with any of these injuries or any others just call for help and support getting you back to your best!

​

​Pilates was originally developed by Joseph Pilates in the 1920's.  It is a conditioning exercise program that targets the deep postural muscles of the abdomen and spine to improve overall core stability and posture.

Clinical pilates consists of a series of exercises in various different body positions which have been adapted by physiotherapists to make them more suitable for use with patients groups.  Essentially I prescribe exercises based on an individuals’ clinical need, taking into consideration factors such as their injury or pain, their posture, areas of muscle weakness or over activity, and movement dissociation.

I teach clinical pilates underpinned by the Australian Physiotherapy and Pilates Institute.  The APPI has modified the original 34 Pilates matwork exercises to incorporate the recent research on lumbar instability, muscle imbalance and adverse neural tension.  This makes the exercises highly versatile and accessible to a broad range of individuals, of any age and any physical ability.

I feel that there is a large emphasis on not only what the exercise is, but also how the exercise is performed, i.e. having the correct technique; using the correct muscles; and utilising the appropriate amount of energy in order to work effectively and efficiently.  This makes clinical pilates a gentle form of exercise and ensures optimal gains whilst minimising the likelihood of injury aggravation.  However, this doesn’t mean that I can’t put you through your paces if that’s what you are after!

Key benefits of Clinical Pilates include retraining:
* Neutral lumbo-pelvic alignment and activation of the key lumbo-pelvic stabilising muscles
* Correct ribcage/thoracic alignment
* Scapulo-thoracic stabilisation
* Deep neck flexor retraining to stabilise the cervical spine
* Balance
* Spinal mobility
* Flexibility of the key trunk and lower limb muscles groups
* Body awareness/postural awareness.
* Normal movement patterns, which is especially important in the case of injury or pain as this aids rehabilitation & reduces the risk of re-injury

Pilates Principles
1.     Concentration: Focus on correct performance of each Pilates exercise and the specific muscles involved.
2.     Centering: Focus on achieving neutral spine and activating the core stabilising muscles (pelvic floor and transversus abdominus) to support the lower back and pelvis
3.     Control: Maintain optimal posture and control with all movements.
4.     Flowing Movement: Work smoothly and efficiently with all movements.
5.     Precision: Perform each Pilates exercise with attention to detail to ensure correct technique.
6.     Breathing: Maintain relaxed, normal breathing throughout all pilates exercises. Do not hold your breath.

6/ Skills, drills and technique: do spend time on how to handle the bike so as to be safer and also reduce losing time in any races/events. Simple things like practice taking water bottle in and out, reaching into pockets for food and eating on the go. Plan a specific drills session where you make a mini circuit that involves tight corners and practice going in both directions. As a general rule, if turning right, left foot is pressing into the left pedal and leg straight, the left hand is pressing into the left handle bars and straightish. The right leg is bent as is the arm with little weight on it. The extent of both is corner angle dependant. Practice taking the right line so you slow going into it but can speed away as you come out of the corner. Think about gearing too so you will need to change down into easier gears going in so you do not grind a big gear, thus losing momentum and speed coming out of the turn. Then there is descending. Again practice. Similar rules apply as to cornering.

7/ Train to race/complete the event: once you enter a key event/race have a look at the profile and try to train on as similar terrain as possible i.e. if it is flat train mainly on the flat, if it’s hilly train hilly and do try and be in the position you hope to race in as much as possible so if you plan to be on the drops or aero bars then be in that position in training so you train the muscles in that position. There is no point doing most of your training on the hoods to then expect yourself to do well on aero bars for several hours. Not only will you feel uncomfortable but you and your muscles will not be efficient and strong in this position as it is relatively new for you. Make exceptions for long club rides but key sessions do try and be in the race position as much as possible, or at least when you’re doing efforts/intervals.

Include strength work, so over gear hill reps in the saddle.e.g 6x5min at 65-70rpm in big gear. If you can’t find a hill long enough do somewhere that has an incline or on the flat but put in the biggest gear. Then have a few mins easy or descend freely with little effort focusing on technique and bike handling.

If you’re racing more road races and criteriums then include power surge work.e.g 10x10 sec out the saddle max effort with 1.50 easy. Spin for 5mins and repeat 2-3times. In group rides include some chain gang work going through and off work and understanding where you need to be to get the most shelter and in what side the through and offs should be in regards to wind direction and corners.

For long endurance races, include longer and longer intervals at race pace effort depending on the distance e.g. in a 3hour ride have 30min warm up then for the next 2hours include 10-30mins at race pace with 5mins spin between and do for the remainder of the ride but do a decent warm down.

8/ Functional fitness: this is the bit everyone forgets. It’s the small bits that count in enhancing performance and reducing injury risk to ensure you are using the correct muscles as the correct time and they are strong enough to maintain their work. People may have heard of “core stability” but it is more of a functional stability according to what you are doing and aiming to achieve, so yes it is about the lower transabdominal muscles but also about your gluteal (bum), lower back and shoulders and how they connect together to give you a stable platform to work from.

9/ Flexibility: this is very important. A tight muscle is a weak muscle so do spend time on stretching after your ride. Doesn’t have to be immediately but definitely that day. Focus on hip flexor and quadriceps and gluteal but do not forget hamstrings, calves, neck, shoulders and back. Hold each stretch for 30sec and ideally do 2-3times. A foam roller is also good for self massage before stretching as is finding a good yoga class to enhance your flexibility, stability and breathing. Many sports people are turning to yoga to enhance their performance and reduce injury risk.

10/ Bike fit: this is imperative in reducing injury, enhancing performance and maximising your efficiency and comfort. When you buy a bike you should have it fitted to you at the shop and this is great but you then having it looked at closer, so it fits you and your biomechanics, flexibility, stability and functional stability together will give you the perfect ride. Here at Physio Impulse our Bike fitter and Osteopath Jasper will do exactly that and offer advice re exercises, stretches and training so as to help you achieve your goals and limit injury.

Have a foam roller or peanut ball lying around gathering dust? Why not try these exercises to get some mobility into that spine!

If you need further help then one of our team will be happy to fully assess your spine