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!

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​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 

In clinic we use these techniques to sneak a bit more range of movement out of your joints and soft tissues.
Give them a try yourself and see how you get on!

Check out these fantastic exercises for thoracic mobility, demonstrated by our director Stuart

If these exercises dont do the trick then give us a call to try some expert manual therapy!
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​Pilates exercise is a mind–body exercise approach requiring core stability, strength, flexibility, and attention to muscle control, posture, and breathing. Pilates can either be practiced on an exercise mat (matwork Pilates) utilising gravity against body weight, either with or without small pieces of equipment such as resistance bands, or Pilates can be practiced on larger pieces of equipment such as a Pilates reformer, which is a bed-like frame with a moveable carriage and uses spring resistance.
 
The method was originally created in the 1920s by Joseph Pilates and was popular with gymnasts, dancers and boxers. Since this time the Pilates method of exercise has gained worldwide popularity, and is used by people of ranging abilities, from sports people to those that are inactive; those who have back pain or are rehabilitating from an injury; those that are very young or elderly, and it is also used pre-and post-pregnancy. Research has shown that Pilates exercises are effective in improving flexibility, dynamic balance, core posture and muscular endurance.
 
Pilates is not trademarked, therefore instructors can gain certification from a wide variety of teaching programs, and as such you may have experienced different methods and styles of teaching.  At Physioimpulse we teach Clinical Pilates, which stems from the ‘modern’ Pilates approach. Clinical Pilates is influenced by Physiotherapy, biomechanics and evidence-based principles, where exercises are tailored to an individuals’ needs and abilities, and emphasis is placed on developing body awareness. So for example, Pilates can be beneficial to those who wish to improve their sporting ability; those who suffer with aches, pains or an injury; and even those who wish to improve their ability to sit at their desk for work all day. Emphasis is placed on the quality and precision of the movements performed rather than just the number of repetitions.

​Lockdown will have affected peoples’ physical and mental well-being in differing ways. Many will have experienced feelings of anxiety, loneliness or depression. Some will have missed the gym and the swimming pools, or their usual exercise classes; some have been stuck working from home at make-shift desks, which may not be set up in the best way; or they are busy with childcare and as such have had little time for themselves. Others have been taking the opportunity to tidy their gardens and take on DIY projects, which is great for keeping active but can result in various aches and pains.
 
Exercise is a great way to help look after our physical and mental well-being, and this can take on many forms.  If you are interested in Pilates either as a form of exercise in its own right, or as a tool to help you achieve a particular goal then please get in touch to discuss your needs. Our Physiotherapists are able to offer 1:1 matwork and reformer Pilates sessions in a safe clinical 

As a cyclist you have many options when it comes to getting the right bike and making sure you are 
riding it comfortably. 

At the very start of the journey you hope to have selected the correct frame size and type of bike for your intended use. Most bike shops will be able to get this part of process right for the rider, though  some  are  better  than  others. We  are  lucky  in  Bath  to  have  a  couple  of  great  shops  with knowledgeable  staff   who  are  passionate  about  cycling  rather  than  some  of  the  larger  chains  with disinterested store assistants. 
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So  you’ve  got  the  bike  and  hopefully  all  is  well.  But  there  are  often  a  number  of  reasons  why things don’t go to plan and we may start to develop discomfort when we are riding or even start to aggravate or cause an injury. ​

Here are some of the reasons why riding that new bike may be causing you some issues:
• Changed frame geometry which can affect riding position
• Altered contact points relationship (e.g saddle to bar drop)
• New saddle
• Over-exuberance with the new bike leading to a drastic increase in ride mileage
• Different gearing from your previous or other bike
• Unsuitable crank length

If you start to develop some issues your first port of call may be to pop back to the bike shop. In 
some cases the solution to your problems may be beyond the shop’s remit and a bike fit may be 
recommended to address your problem. 

Bike  fitting  is  a  process  through  which  a  trained  professional  can  make  adjustments  to  the 
position  and  set  up  of  the  bike  to  best  match  the  rider’s  current  capacity  -  whether  that  be 
flexibility, strength, stability etc. 
Most bike fits will be offered by individuals who have undergone some training in how to deliver 
this  process  using  various  check  sheets,  average  values  for  joint  positions  and  possibly  motion 
capture systems that generate a ‘recommended’ set up. 

As  specialist  therapists,  we  have  worked  with  cyclists  for  many  years  helping  them  to 
overcome various problems and injuries. It is this specific knowledge that allows us to go beyond 
a simple check-box formula based approach to bike fit. 

At Physioimpulse we ensure  each  rider  is  individually  screened  and  if  there  are  any  injuries  picked  up  these  form  an important  part  of  the  basis  of  the  bike  fitting  decisions  made  in  the  session  to achieve  the  best possible outcome.
In the case that injury is already established then it is most likely that the bike fit will not ‘cure’ the 
problem  as  a  stand  alone  intervention.  Once  again,  as trained  specialist therapists,  we  can  offer 
guidance  on  the  importance  of  setting  up  a  comprehensive  rehabilitation  programme  to  ensure 
the problem is addressed both on and off  the bike. 

So,  if  you  are  out  riding  but  you  are  not  totally  comfortable,  or  you  have  been  picking  up  small 
injures here and there its time to consider having your bike fit re-assessed more comprehensively. 
Please feel free to get in touch if you have any questions about your bike fit or if you would like 
more information about our bike fitting service. We are always more than happy to answer questions.  

What is Sports Massage?
At Physioimpulse sports massage therapy is delivered as part of our interdisciplinary team approach and is utilised in many cases we see in clinic as a strategy for injury management and prevention. Cases of a stiff neck and upper back from professionals in a desk based occupation are one of the most common patient complaints we receive on a daily basis. Often the port of call is sports massage, where techniques such as deep tissue release combined with muscle lengthening techniques can go a long way towards restoring normal functionality. They work by releasing areas of increased tension from poor working posture or repetitive strain, and can help to break down areas of focal tone (commonly known as knots).
Specific uses of sports massage:
Maintenance:
After long bouts of exercise from activities such as resistance training or running, muscles are exposed to micro trauma in the form of small tears in the fibres they are made up of. This creates areas of swelling which can become irritable and often sore. Sports massage and rehabilitation can help to remove irritable substances such as lactate away from the site and can aid in the promotion of delivery of fresh and nutrient rich blood, providing the body with everything it needs for a speedy recovery process post exercise.
Injury Management:
Scar tissue is what the body uses to repair damaged areas in muscles. Sometimes scar tissue can be dysfunctional and form as unorganised and weak material which puts the area at risk for re-injury. Sports massage and rehab can help provide a framework to begin to remobilise this tissue, make it more pliable and less prone to re-tearing.
Healthy Body, Healthy Mind:
Stress is an emotion experienced by everyone on a daily basis. No matter what level of stress, or whether it be physical or mental stress, the implications can cause negative effects on the body. Relaxation techniques are often used by the therapists at Physioimpulse, they allow for the targeting of the body as a whole and ultimately resulting in an elevation of both mood and bodily function in many of the patients we see.
What Can You Do To Reduce Muscular Tension?
-Daily stretching routine
-Foam rolling and self-applied massage
-Work at a standing desk
-Incorporate adequate rest and sleep
-Receive regular sports massage therapy