Taking part in a cyling endurance event this summer? Read our 10 top tips for staying injury free and making it to the end!

I recently spent the weekend with my brother, Anthony, and his wife who live just outside Salisbury. Anthony has recently given up full time GP practice and now just helps out one day a week at a lovely, little, local practice.

Alongside his long career as a GP my brother has worked as the doctor for many charity bike rides. This has combined his love of cycling, travelling, photography and medicine as well as helping to raise a huge amount for various charities.

He has also learnt a thing or two about how to avoid injury and make it to your final destination in one piece!

Exciting announcement!

I’m proud to announce that Physio on the River is going to be one of the sponsors for the parents of Barnes Primary School who have formed a team of 42 cyclists and will be riding to Amsterdam this June to raise money for the school. We are keen to help them every way we can. So when visiting my brother I asked him for his top tips for doing a long cycling event like the one to Amsterdam. Together with some of our own ideas, here are 10 pieces of good advice.

Our 10 top tips for staying the distance

1. Gears

Get used to your gears – REALLY used to your gears. Otherwise you will simply get exhausted and you won’t make the distance.

2. Speed

You should be pedalling between 60-90 revolutions per minute. If you are going much faster, you will never make it to Amsterdam or wherever your heading.

3. Handlebars

Don’t grip the handlebars tightly. Get used to holding them loosely and let your elbows relax. Otherwise you can end up with Tennis Elbow or Carpal Tunnel syndrome (irritation of the nerve that passes across the front of your wrist and supplies your thumb, index and middle fingers).

You might even consider wrapping more sponge around your handlebars so you can’t grip as tightly. The padding will also provide more cushioning, so you are less likely to develop Carpal Tunnel syndrome.

4. Bums are less important than knees!

If you suffer from knee problems, have your saddle a little higher. If it’s too low your knees won’t make it to Amsterdam, but your bum will and it’s no good if you can’t walk when you arrive!

5. Saddles

Don’t wear a saddle cover because they slip around and can blister your bum. Get yourself a gel saddle but not a gel saddle cover. Don’t get anything with hair on it. Anthony once saw someone with a tiger fur covered saddle and the rider only lasted two hours! It just creates too much friction where you really don’t want friction…..

6. Training tips

When training don’t forget to throw in some swimming, especially backstroke as it’s great for strengthening your back and your back will take a lot of punishment on the ride. You want it to be strong and supple. It’s a great antidote to all that crouching over the handlebars.

In fact, my physio team and I would recommend plenty of variety in your training – not just cycling. Just like any big sporting event, addressing all aspects of fitness will help your performance.

Something like yoga or a stretching regime can help with flexibility. Hip flexors which cross the front of your hips, can get very short and tight in cyclists.  

Pilates exercises are great for improving your core strength. For your legs to power you efficiently you will need a strong core from which your leg muscles can work.

As mentioned earlier swimming is both good for back muscles and good for fitness. Going to the gym to strengthen your leg muscles is essential and whilst there, work on your aerobic fitness with some cardio work like rowing, running and cross trainer. Perhaps not cycling as I’m sure you will be spending plenty of time on that in your training already!

Try and mix up your training so you include a selection of activities through the week. If you need any help both Physios, Richard and Dave, offer personal training at our clinic.

7. Bike fitting assessment

It’s important to make sure your bike is set up absolutely correctly for you. Our cycling ‘guru’ and Physiotherapist, Richard Game, is trained to carry out Bike Fitting assessments in our clinic.

The advantage of having a Physiotherapist carry out your assessment is that they can not only look at how the bike fits you – but also, how you fit the bike.

Very few people are completely symmetrical and most of us have areas of weakness or tightness in our bodies. For example, even though your bike may be set up correctly for you, you may cycle with one knee falling inwards. This may be because your buttock muscles are weak and have nothing to do with the bike set up. This is something that a Physiotherapist will pick up on and can help you address.

8. Working proactively on injury prevention

Bike fitting

Physio Richard can do a Physio screening assessment to identify any weak points in your body that could start to give you problems as you increase your mileage and up your training. Remember that cycling is a very repetitive sport! Once identified he can design a bespoke programme of strength and conditioning and flexibility exercises. You can be working on this programme alongside your normal cycling training. Prevention is so much better than cure.

9. Getting your soft tissues in tip top condition

Many keen cyclists have a very sedentary day job. Spending lots of time in front of your computer can often lead to poor posture and tight hamstring, hip flexors, neck and back muscles. Having some regular sports massages can help to get your muscles and other soft tissues in the best condition.

The Massage Therapist can work on your tight muscle groups and improve your flexibility. Massage is also a useful way to aid recovery following the event. We have a team of three Massage Therapists who are all experienced in pre and post-event massage. In fact, Rachel is a triathlete herself, so knows all about preparation and recovery for big events.

10. Hydration and nutrition

Especially when abroad, use a capped water bottle. You are far less likely to get stomach problems – it’s amazing what the front wheel flicks up!

Anthony recommends that nibbling long-burn carbs/protein (nuts and fruit) is more fun than putting additives into your water bottle. The latter is only necessary on rides over 100k. Anthony advises to avoid meat at lunchtime as it ruins afternoon performance and isn’t needed.

He stressed the importance of ensuring you are pre-loaded with water at the start of your day. If you have not peed by 11 o’clock you should be worried. If you haven’t peed by 12.30, stop riding as dehydration lurks.

We hope you find these tips useful and we wish charity teams all the best for their endeavours over the summer months!

Next steps…..

If you would like to book a Bike Fitting Assessment or a Cycle Screening Physio Assessment with Richard, or you are interested in a sports massage, personal training or our Yoga and Pilates classes, just:

Call us on 020 8876 5690

Email us here

Or simply pop in for a chat – we are always happy to chat things through first.

Complex Regional Pain Syndrome – what’s it all about and how can we help?

The month of November is Complex Regional Pain Syndrome (CRPS) awareness month so we though we would try and shed some light on this complicated and painful syndrome.

Richard Game is one of our team of Physiotherapists and he undertook a Master’s degree in Pain Science in 2006. I did a Q & A session with him to find out more about this uncommon condition.

Q1. Hi Richard. Could you please explain to our readers what CRPS is?

Complex Regional Pain Syndrome, Physiotherapy and rehabRichard: yes of course – CRPS is the term given to a group of conditions that involve severe pain that is beyond what the initial injury normally involves. It is usually associated with two or more of the following symptoms: swelling, colour changes, temperature changes, hair growth or loss, nail changes, numbness, weakness and wasting.

CRPS is a condition that varies greatly from person to person. So the management strategies that may work best for one person may not be totally suitable to another person.

Q2. I know there are two types of CRPS – could you explain the differences?


CRPS I – involves the onset of some or all the previously mentioned symptoms, perhaps following an injury to a body part, although an injury is not always a feature. Indeed, some people suffer with it no obvious reason.  In type I, there is no identifiable injury to any part of the nervous system directly.

CRPS II – can be described as type I, but the main difference is that there has been definite identifiable damage or injury to a major nerve or part of the nervous system and neuropathic pain may be experienced.

Q3. How much is known about the disease?

Richard: left hand with Complex Regional Pain syndromeone of the features of CRPS that makes coping with the pain and symptoms more difficult is that there are many unanswered questions that patients may have.  However, there are certain things we do know and they are:

  • Inactivity, either forced or in order to avoid bringing on the pain, severely worsens the syndrome
  • Secondary problems such as osteoporosis, muscle loss and contractures are due to inactivity and are also a part of the disease process
  • CRPS affects more women than men
  • Though uncommon, children can be affected by this condition
  • The pain is most commonly in hands & wrists or feet and ankles but can often spreads further up the limb
  • All authorities on the syndrome agree on the importance of early detection and most vitally, mobilisation and strengthening through home exercises and physiotherapy led exercise programs. This should also include some psychosocial input to provide coping mechanisms to deal with the day to day experiences of living with the syndrome and to help with any inactivity
  • Medications can include drugs targeting all the aspects of pain & symptoms. However, no single medication will work for everyone, so you may have to be trialled on several different medications before you can get the right mixture for you

Q4. Can you give an example of the sort of patients you have seen with the condition?

Richard: yes, of course. Probably the most common scenario I’ve seen is a middle aged woman following a wrist fracture. I’ve had a few patients over the years who have suffered with much more severe pain than would normally be expected and this has usually been in conjunction with marked swelling, sweating and colour changes in the skin. Another example was a young teenager who fractured their ankle and suffered with similar symptoms. Both were reluctant to move their injured wrist and ankle due to the pain when they did so.

I had to coax them into using the limb normally, exercising to free them from stiffness and strengthen their muscles and I used massage techniques to desensitise the hand and foot.

Q5. So is there any physical treatment that helps?

Richard: yes, physiotherapy is imperative in getting the most from any medical procedures undergone, preventing secondary movement & strength losses, maximising your function and controlling your pain.

The physiotherapy input is to manage a programme of exercises and sensory stimulation that is designed specifically for each individual CRPS sufferer.  There is sound scientific evidence to show the importance of movement and exercise in the management of CRPS types I & II.

Q6. So how does exercise help?


  • Exercise causes the release of opioids – the body’s natural ‘happy drug’ that has an analgesic effect on pain
  • Weight bearing exercise increases blood flow throughout the body, increases nutrition of the joints and helps in the prevention of osteoporosis
  • A stretching program helps avoid contractures of the muscles and allows for better functional performance
  • Cardiovascular exercise causes chemical reactions that can help control the level of pain
  • Moving against an applied resistance will maintain & improve muscular strength, prevent muscle wasting and increase performance
  • Taking part in a specific exercise regime helps monitor how your symptoms are changing over time

Q7. What exercises do you recommend?

Richard: it’s important to remember that your exercise programme is exactly that, YOUR EXERCISE PROGRAMME! The Physio will tailor the exercises to your particular physical needs.

Q8. I know people often find it difficult to stick to an exercise routine – have you any tips?

Richard: often it is hard to build a routine around the exercises and this is because there may be some perceived barriers to doing the exercises. Frequently mentioned barriers are not having the time, not believing you will be able to do it, or most commonly because it will hurt.

The important message here is that doing specific exercises through a certain amount of pain is beneficial in the overall management of your condition. Pain in this situation is not harmful and is not making your condition any worse – in fact it’s helping!

Q9. You mentioned sensory stimulation – what is that?

Richard: through research, it is known that due to changes within the nervous system (due to CRPS), individuals often have altered sensation.

CRPS sufferers express feeling a huge variety of sensations such as burning pain, numbness, intense coldness, pins & needles, feeling of water running over the surface of their skin, deep ache, sharp pain and hyper-sensitivity.  Sensory stimulation aims at reducing the level of these abnormal sensations by “bombarding” the nerves with different normal sensations.  The techniques we use might include stroking the skin, tapping it, firm massage,  hot & cold soaking, gentle poking with a blunt object and more.

The over-riding message is that we can help you manage your rehabilitation on a daily basis, using simple strategies to help you live a more normal life. Although this condition is painful and hard to understand, we are here to support you.

Next steps…..

If you have been diagnosed with CRPS and would like to talk to Richard about your condition and how he might be able to help just

  • call 020 8876 5690
  • email us here 
  • or pop into the clinic for a chat – Richard is here on Mondays, Wednesdays and Fridays and some Saturdays so it’s best to call first.


Need to exercise but short on time? Let us help you with some top tips!

I used to find exercising really easy as I had a lovely, lively, young Springer Spaniel who had bags of energy and was a struggle to keep up with! But sadly she is now 12 years old and, except on really good days or when she sees a unsuspecting squirrel, she is trailing several feet behind me! I realise that my old workout is no longer the aerobic fix I need….

I wonder if any of you watched the ‘Trust me I’m a doctor‘ programme on BBC 1 on Thursday 13th September? I love watching it when I’m around and that episode was particularly interesting.

The affects of ageing on our muscles

The programme explained how over the age of 50 we start to lose muscle mass at a rate of about 1% per year and muscle power at a rate of about 2% per year. This in part explains why older people become more ‘frail’ and are more susceptible to falls.

1% or 2% per year may not sound much but if you think about it that adds up to 30% loss of power by the time you are 80. This can have a significant effect on your ability to walk distances, climb stairs and even such simple things as getting up out of a chair. Muscle weakness can also affect your balance and increase your chances of having a fall.

So keeping up our exercise when we are over 50 is absolutely essential if we want to maintain our muscle mass and independence.

The shocking statistic is that 40% of middle aged adults take less than 10 minutes continuous brisk walking per month!

So what can you do to reverse this affect?

weight liftingThe programme also explains how important it is to do resistance exercise such as weight lifting at the gym, to combat this effect. They recommend you do this twice a week. They also demonstrated some simple body weight exercises (ones that we frequently prescribe to clients) that can be done without the need to go to the gym.

Common excuses for not exercising!

The most common excuse for not exercising is a lack of time. So some scientists at Bath university carried out an experiment looking at blood sugar levels and blood fat levels at intervals after a block of 30 minutes brisk walking and compared this to 6 x 5 mins of simple exercises and taking no exercise at all. The simple exercises included sitting to standing, going up on your toes in standing, squats and marching on the spot.

They chose blood sugar and blood fat levels as these can be harmful in the extremes. If not kept under control they can lead to Diabetes and heart disease.

The team of doctors were all surprised to find that both exercise groups benefited equally with a 40% drop in both blood sugar and fat levels following the experiment. Not surprisingly the control group who took no exercise had no drop in blood sugar or fat levels at all.

This is a really useful finding as it means that those who are time poor but can squeeze in 5 mins here and there into their daily schedule can still do something really worthwhile for their health!

Top tips for sticking to an exercise regime!

  • Exercise snacking! Remember that 5 mins brisk walking performed 6 times a day is just as good as 30 minutes of continuous brisk walking. So move regularly and take lots of mini breaks of exercise if you don’t have time to take it all in one go.
  • Find a gym buddy! Remember that weight training for the over 50’s has lots of benefits to health including preventing that decline in muscle power and helping bone density. A good way to increase your chances of sticking to it is to find a gym buddy. This extra bit of commitment and the thought you might be letting someone else down is a great way to motivate yourself. My gym buddy (my son, Sam) has been away in New Zealand for the last 5 years so I’m looking forward to his return a week today and his help in motivating me to go to the gym more often!
  • Joining a class can be a really helpful way to stick to exercise. The social aspect helps to make it fun and more than just exercise. We run 34 classes of Pilates, Yoga  and Dance,Tone and Stretch classes each week so there’s something here for everyone!
  • Diarising your exercise – simply popping a regular time in your diary can help to prevent other things taking over that time.
  • Get it done early! Its so easy to put things off as the day progresses so try and get your exercise done early in the day before you get too busy and distracted by other things.
  • Work exercise into your daily life – personally I walk to work (15 minutes) and on the way home I take a circuitous route for 50 minutes. It’s a great opportunity to listen to a book on audible or a podcast and I get home feeling refreshed and no longer thinking about the clinic! I know other people who cycle to work or walk their children to school and work exercise into their day that way.
  • Personal training – some people just like the one to one attention and motivation of a personal trainer to keep them on track. The advantage to this is that the trainer can tailor the exercises specially to you and your physical needs. We have two physios (Richard and Dave) who both have a background of sports science degrees before training as physiotherapists and they offer personal training in our studio at the clinic. Using a doubly qualified Physio for your training means their in depth knowledge of the body will keep you exercising safely!
  • Sign up for a charity event. There’s nothing like a good cause to spur you on! And it’s nice to share the experience with others.
  • Share your exercise resolutions with friends. Telling people your intentions makes it much more likely you will stick to it. They say it can take 21 days of doing something regularly to form a habit so persevere!

Here at Physio on the River we aim to support you by getting you better and more healthy and keeping you that way through appropriate exercise.

Next steps…..

If you’d like to join one of our classes or arrange for a personal training session with Richard or Dave just:

  • call us on 020 8876 5690 and speak to one of our receptionists
  • email us here
  • or pop in for a chat! We are always happy to talk things through first

If you have a physical health issue that is stopping you from exercising then one of our team of physios may be able to help you back to fitness. Or if you have an elderly relative who is becoming frail and is at risk of falling – find out more about our falls prevention programme.

Find out more about our small group Pilates Classes

Our articles on Pilates

How Physio helps recovery from Anterior Cruciate Ligament skiing injury

With the Easter holidays underway, it’s that time of year again for skiing fun!

Hopefully you will have done your pre-skiing preparation but unfortunately, even with the best laid plans, injuries can still occur.

Katherine Ashmore is one of our team of Physiotherapists and a keen skier herself. In this blog she runs through the common mechanisms of ACL injury, how the diagnosis is made, the options for treatment and how Physio is vital to recovery whether you choose surgery or not.

Common mechanisms of injury

Common down-hill skiing injuries to the knees occur when landing from a jump or going over moguls, colliding with another skier as you exit the ski lift, or simply falling and twisting your knee.

We also see upper limb injuries when falling onto the outstretched hand or landing heavily onto the shoulder.  The injuries are often brought on by one too many at lunchtime, bad snow, tiredness at the end of a day or when bindings do not release!

The most prevalent types of injury are bone fractures, joint dislocations or soft tissue injuries such as ligament strains, tears and ruptures. The knee is the most common area to injure and more specifically –  injuries to the ACL (anterior cruciate ligament), MCL (medial collateral ligament) and medial meniscus (inner cartilage) tears being top of the list!  A combination of all three is called ‘The Unhappy Triad’.

Focusing on the Anterior Cruciate Ligament

sourced from www.sportsmedicineeuk.co.uk

The anterior cruciate ligament (ACL) is located deep inside the knee joint and attaches the thigh bone (femur) to the main shin bone (tibia). It keeps the knee stable by preventing the forward motion of the shin from going too far and the knee from rotating too much.

The vast majority of ACL injuries happen during slow-speed turns, often in sticky, slushy snow, towards the end of the day when the skier is distracted and tired. The ski goes one way and the skier’s body weight goes the other causing rotation of the knee. Because of the slow speed the bindings don’t release.

This tends to happen to beginners, but can also happen to experts who have their bindings very tight and get momentarily distracted in the conditions described above. At higher speeds, the bindings release and the injury is less likely; hence, the advice is to ski positively and ensure that the ski bindings set properly.

How do I know it’s an ACL injury?

With severe injury, one hears a loud pop or feels a snapping sensation, followed by intense pain and immediate swelling and difficulty walking.   Diagnosis is confirmed by a specialist (Physiotherapist or Orthopaedic Consultant) and MRI.  An arthroscopy can detect a partial tear. Much less usually very experienced skiers can carry on skiing after injury.

How can Physiotherapy help?

sourced from milfordphysio.co.nz

Once you have your diagnosis there are two routes – surgery versus non-surgery.

A surgeon will weigh up the factors with you: your age, lifestyle and sports interests and whether you wish to go through the surgical route.  The knee can be very strong and able without requiring a functioning ACL and these options will be discussed with you, including any associated risk of further injury or limitations in exercise or mobility.

Whether or not you opt for surgery, Physiotherapy is vital to strengthen the knee and get you back to full fitness. Without Physio the knee can remain weak and more susceptible to recurrent injury.

What is prehab?

Often if surgery is required, the surgeon will wait for the swelling to go down first.  This is a great opportunity to receive ‘prehab’. Our Physios will help you to strengthen your knee muscles prior to surgery and get you physically and mentally prepared for your operation. Having knowledge of the exercises you will need to do post surgery is a great help and we find our clients do better with this preparation.

Post op rehab

Where the prognosis indicates surgery, the surgeon will discuss with you whether you use one of your own tendons (commonly a bit of the hamstring) to repair the ACL or use a synthetic option. It is a very common procedure and depending on your level of exercise will take 8-12 months of graded physiotherapy rehabilitation to get back to full sport.  You may even be back to skiing within the year!

What does rehab involve?

Treatment will involve:

  • a carefully graded exercise programme
  • advice on swelling reduction measures
  • graded return to exercise (we can tell you what exercise, how much and at what stage) and
  • latterly sports specific exercise drills if required

Some surgeons have very specific protocols they like us to follow and others are not so prescriptive. but either way we have the expertise and experience to guide you through the process.

We work closely with Orthopaedic Consultants locally and in central London clinics and can fast track you to be seen quickly with one of them if necessary.

Should you receive a skiing injury we are here to help you with both diagnosis and treatment. 

Please don’t hesitate to book an appointment with our Physiotherapist,  Katherine Ashmore, or another member of our Physio team. 

To book an appointment:

Call 020 8876 5690

Book an appointment online

Email us here

Or just drop in for a chat with one of our Physios!

If you have enjoyed this blog and would like to read our other skiing blogs click here.


Are you considering joint replacement surgery? Read how we can help you prepare and recover!

This time of year is a popular time to consider having a hip or knee replacement – in the hope you will be fit in time for summer!

Many of our clients end up having both knees or both hips operated on and it’s noticeable how much quicker they recover after the second. This is usually because they know what to expect and are already familiar with the exercises and rehab that is required.

For this reason we would urge anyone considering the operation for the first time to come and see us about 3-4 months beforehand so that we can do some ‘prehab’. We can make sure they are as good as they can be before surgery and are fully informed about what the surgery and rehab will entail. Forewarned is forearmed!

What are the effects of having osteoarthritis?


Difficulty rising from a chair

Most clients awaiting surgery have had osteoarthritis in their joint for some years. The disease causes the following things to happen:

  • the muscles surrounding the joint become weakened and wasted
  • they lose some of their range of movement because of stiffness of the joint
  • the surrounding ligaments and muscles often tighten up further restricting movement
  • the pain and weakness causes the person to limp and usually limits their walking distance. They often resort to a stick or crutch.
  • Everyday activities such as getting up from a chair or ascending and descending stairs become harder to do
  • With activity levels limited people often take less exercise and put on weight which becomes a vicious cycle

How can Physiotherapy prehab help?

We carry out a comprehensive assessment of your range of movement, muscle strength, walking gait, posture and ability to do everyday activities. From this we can tailor a programme of exercises that will help to:

  • build back some muscle strength in your trunk, hip and knee
  • allow you to become familiar with the exercises that you will need to do after surgery
  • where possible restore some movement in your joint
  • improve your walking pattern and learn what a normal gait is and what you should concentrate on after surgery. Even practise using crutches in advance of your surgery
  • practise everyday activities and become better at performing them, as you gain more strength and flexibility

If you have limped for some time you tend to forget the normal way of walking as the limp becomes a learnt habit. People normally limp because they are in pain and because their muscles are weak. If you can strengthen the muscles that support the arthritic joint then the pain is often reduced and walking becomes easier.

We also give advice on:

  • footwear to reduce stress through the arthritic joint
  • some clients require an appointment with our podiatrist who can help them correct foot posture that may be having an adverse affect on their hip or knee – for example excessively rolling your ankle in or out too much
  • the benefits of low impact exercise which, although may be painful, does not have a harmful effect on the joint and will not make the disease any worse
  • the benefits of keeping your weight under control to reduce stress in the arthritic joint
  • what to expect after your surgery and a plan of how your rehab will progress

We do sometimes find that clients postpone their surgery as a result of working on their prehab particularly if they have not had Physiotherapy before being offered surgery!

Your post-op rehab

Sadly in many NHS hospitals patients are discharged with little or no Physiotherapy help with their rehab. It’s absolutely essential that the muscles surrounding the joint have their strength restored if you are to get the most potential from your new hip or knee. We see many clients who come to see us a year after surgery and who have failed to regain their movement and are struggling with everyday activities due to poor muscle strength.

The muscles that surround the hip and knee are some of the largest in the body. They waste very quickly and need focused attention to be restored to their former glory! They are the muscles that get you up from sitting, help you walk along the flat and up and down hills and help you climb the stairs. When these muscles are not retrained it’s common to develop lower back pain as the back will take much of the strain.

Retraining your walking pattern so you can shed your crutch or stick is an urgent priority. We will teach you drills to get you from climbing stairs one step at a time to climbing them normally. Our aim is to break all these tasks down into bite sized pieces and gradually progress the difficulty until you master the skill in question.

To book an appointment with one of our Physio team just:

Call 020 8876 5690

Contact us by email here

Book online

Or just pop in for a chat!


Read how new shockwave therapy can help those stubborn tendon problems and more!

Here at Physio on the River, we are always working to ensure we deliver the most up to date evidence based therapies to our clients.

We are very pleased to now offer Shockwave therapy . This is a very effective therapy for many chronic painful musculoskeletal problems, examples of which are: Plantar Fasciitis of the foot, Achilles Tendonopathy, Tennis Elbow and Calcific Tendonitis of the shoulder.

sourced from Complete Pain Care

This type of treatment is now recommended by the majority of Consultant Orthopaedic surgeons when muscular, connective tissue (the web of connecting tissue between structures) and tendon problems become chronic (i.e. lasting longer than 3 months).

What is shockwave therapy?

There are many different types of machines that use varying physical mechanisms to produce shockwaves. The machine manipulates these shockwaves to deliver the appropriate dosage to bodily tissues to achieve a therapeutic response.

The most recent mode of doing this is electromagnetic pulse shockwaves. Here at Physio on the River, we are excited that we can offer this type of shockwave therapy. It uses rapid electromagnetic pulses to create precise, low amplitude shockwaves directly to tissues. The major benefit of this is that it is far less painful than many other forms of shockwave production and delivery, for example compressed air.

Can it do any harm?

As well as having a large body of academic evidence for the positive outcomes of this type of therapy (e.g. Legat 2014; Loska 2017; Moya et al 2015), it has the added benefit of having very few risk factors or contra-indications.

The National Institute of Clinical Effectiveness (NICE) guidelines have been produced for the use of shockwave therapy for many common musculoskeletal conditions including: plantar fasciitis, tennis elbow, Achilles tendinopathy and trochanteric (hip) pain syndrome. As you may have read in the press NICE are a hard nut to crack and endorsement from this organisation carries weight.

At initial assessment, if shockwave is for some reason not the best clinical option for you, the physiotherapist will discuss alternative options either at Physio on the River or referring you to a different healthcare provider, as appropriate.

What does the treatment involve?

The package of care for shockwave therapy will involve an initial Physiotherapy assessment followed by a package of as many treatments as required. The number of treatments required on average vary between 4 and 10, depending on area to be treated and the reaction to treatment.

The machine has  a small hand-held device through which the shockwaves are given. The treatment is quite noisy and can sometimes feel uncomfortable but is only given in short bursts of time. We only treat to a person’s tolerance!

How much does it cost?

Sessions of Shockwave are typically charged at £150 -£200 per session throughout the clinics in London that provide it. We are offering outstanding value – a block of 4 Shockwave treatments (typically 4-10 sessions are required) for only £300 – meaning a potential saving of up to £500!

Some health insurance companies, including Bupa, are now offering cover for this treatment so if you hold a policy it is worth checking with your company first.

If you would like to book an appointment:

Call the clinic on 020 8876 5690

Book online by clicking here.

Contact us by email here.

Or pop into the clinic in person – we’d love to have a chat!



Do you have a gymnast in the family complaining of aches and pains?

Do you have a gymnast in the family? And are they frequently complaining of aches and pains?

As a parent it’s often hard to know how much to worry about your child’s injuries.

We are used to children getting cuts and bruises in the normal course of play and they usually bounce back very quickly.

We have asked Katherine Ashmore, one of our team of musculo-skeletal Physiotherapists, to explain a little more about why children and teenagers are different from adults and what you should look out for if your child gets injured.

Katherine is an ex-gymnast herself so she knows all about the demands of the sport. She has a special interest in helping children and adults recover from gymnastic injuries. She can also help with screening to identify areas of weakness and potential injury risk.

How are children’s skeletons different from adult’s?

Presentation of child’s lower limb skeletal system

The way children’s bodies react to injury can be very different to that of an adult, especially when they are going through a growth spurt.

Sometimes what you think is nothing more than a muscle ache might be something more – especially if your child is specialising early in gymnastics where the demands on the body are high.

The immature skeleton contains growing tissue that is not present in an adult – so they shouldn’t be regarded as a ‘mini-adult’.

Growth spurts

Children go through two growth spurts – one around the age of 6 to 8 years old and the other more major one is during puberty. This can start at about age 10-12 in girls and around age 13-14 in boys.

Their skeletons are not fully formed until they have gone through puberty. This is about 15-16 years for girls and 18-19 for boys (and sometimes as late as 21-22 years) – when they finally stop growing.

How do I tell if it’s just growing pains?

Growing pains are a recognised condition and are typically:

  • felt more in the legs below the knees
  • experienced by boys and girls equally
  • symmetrical although they can be worse in one leg
  • rarely cause the child to limp
  • felt only at night and intermittently
  • not brought on by an injury


gymnast demonstrating hypermobility

Another factor that makes children who get into gymnastics a bit more susceptible to injury is that they are often hypermobile – or, in plain language, double jointed!

They can have one or two isolated joints that are extra bendy or they may have multiple joints affected which is called hypermobility syndrome.

It is often this increased flexibility that attracts them to the sport in the first instance and makes them excel at it.

The demands of the sport

The nature of the sport involves very repetitive actions and extremes of joint movement.

In the young competitive world of gymnastics children have high training schedules making them susceptible to overuse injuries.

Types of injuries

The most common gymnastic injuries are in the wrist, back, knee and ankle.  This can be due to the explosive force of power put through the arms and legs on push off and landing.

Commonly gymnasts have a higher incidence of soft tissue injuries (muscle and ligament strains, sprains and dislocations) and bone fractures.  Landing awkwardly is often a cause of these injuries – for example affecting shoulder muscles or ligaments when landing on your hands, or causing an ankle sprain when landing awkwardly on your feet.

floor exercises

Certain types of gymnastic disciplines may give more problems than others –  with the vault, uneven bar, balance beam, pommel horse and floor exercises having the highest incidence of injury.

5 good reasons why a young gymnast should consult a Physio

  • Suffering from lower back pain: this tends to be more common in girls and in those with poor core stability. Pain is commonly due to repeated hyperextension (over-arching of the lower back).  In extreme cases this repeated hyperextension can cause a Spondylolithesis (a small bony stress fracture in the spine) which often goes undetected until the child is seen by a physiotherapist.
  • Knee pain felt in children in their early teens can sometimes be due to a condition called Osgood Schlatter’s disease. This is where the quads muscle attaches via a tendon onto a bump of bone under the knee called the tibial tubercle. This bump is a centre of bone growth called an apophysis. When teenagers put on a sudden growth spurt this junction between tendon and growing bone can become stressed and painful.
  • Hypermobility can make children more susceptible to injury but Physio can help by identifying the problem and showing them how to manage this condition by strengthening their supporting muscles. So if your child seems to complain of frequent aches and pains it would be worth having them assessed by one of our Physios.
  • Poor core stability: we don’t really know when children gain good core control (muscular control around their back and stomach) but we often surprisingly observe poor core stability in children doing quite high level sport. This lack of strength around their middle can also raise their risk of injury. Exercises can help them to restore this strength.
  • A simple sprained ankle: spraining your ankle is always seen as a relatively minor injury but we know that unless the ankle is properly rehabilitated recurrent problems can occur. In children instead of simply straining the ligament they can sometimes pull off a small piece of bone from the ankle bone as well

How Physio can help

So in summary, we can help by assessing your child to:

  • rule out hypermobility or teach your child to manage it
  • identify any weaknesses that may lead to injury and set a programme of exercises to work on them
  • by treating any injury that may occur whilst screening for anything more serious.

To book an appointment with Katherine or one of our Physio team:

Call 0208 876 5690

Email us here

Pop in for a chat or book online here!


Dizzy – oh? Try Physio!

Dizziness is a very common problem in more mature populations. In fact, dizziness is the most common single health related complaint for people aged 75+!

It accounts for nearly 1 in 10 of GP visits by people aged 65+ and about 1 in 5 by people aged 85+. So it’s no small problem.

Dizziness can adversely affect your quality of life whether you suffer a single bout or have a longer term problem.

It often makes you feel as though the room is spinning which causes nausea and unsteadiness and furthermore, it is associated with a high proportion of falls that cause trauma and other health issues. In severe cases it is called ‘vertigo’.

Dizziness can have several different causes. A thorough assessment is crucial to determine the system of the body most likely causing the dizziness and then targeting treatment to cure, relieve or manage the problem. We asked Richard Game, one of our experienced team of Physios to talk us through the common causes and what we can do to help…..

The most common causes relate to:

  • the inner and middle ear (50%) – this can be a bacterial infection or virus called labyrinthitis. It can also be due to a condition known as Benign Paroxysmal Positional Vertigo (BPPV)
  • the nervous system (30%)
  • the vascular system
  • and other more specific causes such as Meniere’s disease (5%)
  • and Migraine (10%)
  • or ischaemic vertigo (5%).

At Physio on the River we have some good news if dizziness affects you or a loved one. We are able to perform a thorough assessment for the causes of dizziness and then discuss the likely diagnosis and appropriate treatment or management.

Even better news is that the bulk of cases (50%) are treatable with very gentle manual techniques which have been shown to achieve resolution of the dizziness in up to 95% of cases.

Benign Paroxysmal Positional Vertigo (BPPV)

As previously mentioned this condition falls into the most common causes of dizziness.

What is BPPV?

It is Benign as, although it can be quite disabling, it is not due to serious disease; Paroxysmal because it occurs in short bursts of up to one minute; Positional as it is provoked specifically by movement to or from certain positions; Vertigo – dizziness defined as an illusion of movement.

Who is affected by BPPV?

BPPV is estimated to affect roughly 50% of all people at some time in their lives and, as mentioned above, it becomes progressively more common with age.

What are the symptoms of BPPV?

The vertigo is generally rotational (like getting off a roundabout) but sometimes sufferers, on lying down, will feel that they are falling through the bottom of the bed or, on getting up, that they are being thrown back onto it.

The classic provoking movements to induce BPPV are: lying flat, sitting up from lying flat; turning over in bed; looking up (e.g. hanging washing) or bending down, especially if also looking to the side. The duration of the vertigo is brief; usually five to 30 seconds but very occasionally lasts up to two minutes.

However, some of these symptoms are common to other causes so it is important to have a full assessment so that you can be tested to differentiate from other diagnoses and causes.

What causes BPPV?

BPPV is caused when loose chalk crystals get into the wrong part of the inner ear. These microscopic crystals should be embedded in a lump of jelly. The crystals weigh the jelly down and make that part of the ear sensitive to gravity.

The crystals are constantly being re-absorbed and re-formed and over time fragments come loose. Lying flat can then occasionally cause some of the loose debris to fall into one of the semi-circular canals; the parts of the ear responsible for sensing rotation. Movement in the plane of the affected canal causes the crystals to move along the canal, stimulating it and giving the sensation of rotation.

How can Physio help?

Most cases that do not resolve rapidly can now be relieved by the appropriate Particle Repositioning Manoeuvre; of which the most commonly performed is the Epley Manoeuvre which offers instant relief of symptoms in 9 out of 10 patients.

So why wait? Book in for an assessment and at the very least, you’ll get directed to the most appropriate care for your needs.

To book an appointment with one of our Physio team:

You can do this online by clicking the Book Now button at the top of this page, call 020 8876 5690, email by clicking here or pop in for a chat if you are passing!

Are you a first time marathon runner or new to distance running? Read our top tips for avoiding the injury pitfalls!


If you have just got your first place in the London Marathon for 2018 – congratulations! Or perhaps you are new to distance running? Either way you’re no doubt excited but perhaps equally anxious about the challenges ahead.

Training for, and then running a marathon is a great achievement but there are lots of potential pitfalls along the way to overcome. Read on to find out our Running specialist, Dave Burnett’s top tips to help you glide along the road to success! Dave heads up our Running Clinic team of Physiotherapists.


1. Training programmes

“What do you mean? – I don’t just start running?!”

Whether you are just looking to get round or have a timed goal in mind, a marathon training programme is vital to success.

The programme you choose will depend on lots of factors including: your previous running experiences, the time you have available to train, your general health, your level of fitness and any injuries you may have or have had in the past.

If you are new to exercise, have any significant cardiovascular or bone health problems or are overweight, it’s a good idea to see your GP before you start training.

If you are new to running and don’t exercise regularly, it’s best to start with a Beginner’s Training Programme such as:



If you have some running experience or you are generally fit and exercise regularly the below link offers Marathon Programmes from beginner to advanced.


You will notice that your plan includes lots of activities that aren’t running. This is because we know that working on all the different aspects of fitness – flexibility, cardiovascular, core strength, muscle power and running pattern can help your all round performance and lower risks of injury.

2. Distance runners get injured frequently – so lower your injury risk!

Since the 1980’s the yearly risk for regular runners to get injured has remained as high as 70-80% despite advances in training methods and footwear technology.

As a ‘running beginner’ (i.e. less than a year’s experience), or if you have had any previous running injuries, you are at a higher risk of getting injured.

‘Overuse’ or ‘training load errors’ are common pitfalls in distance running. Beginners are often susceptible to injuries caused by ‘too much, too soon, too fast!’.

Simply put – if your training load (frequency, intensity, time and type) is higher than what your tissues can tolerate, you’ll get injured.

Our tissue tolerance is multi-factorial and related to: our age, our genetics, our general health, any previous injuries, our strength and mobility, our biomechanics, ability to recover, sleep, nutrition and lifestyle!

How we can help: At Physio on the River we offer a Physiotherapy Running Screening Assessment. Our physios can give you expert advice to reduce your injury risk and help you to progress through your training programme. The running assessment includes:

  • Health screening to help flag up any important health or disease factors that could affect your running
  • Physical screening tests specifically tailored to running which will highlight movement restrictions or imbalances in muscle strength or control
  • Treadmill video analysis of your running to identify any technical issues with your running pattern
  • Advice on running based strength and conditioning exercises to complement your training schedule

3. Do you need an injury MOT?

Research shows that runners often carry old injuries that have never been properly sorted out. An old niggle can place you at higher risk of developing a further injury so it’s really essential to get these assessed and treated properly before you start out on your running journey.

Common problem injuries may include calf muscle or Achilles tendon injuries, kneecap or knee tendon problems, buttock, hamstring and groin injuries or lower back pain.

Our physios are specialists at assessing the way you move and identifying the causes of injury. They can help you resolve ongoing issues.

4. Treat your feet!

It may sound obvious but a decent pair of running shoes will help reduce risk of injuries and make those longer runs much more bearable down the line.

The type of shoe you choose will depend on several important factors including:

  • your foot posture and shape of your feet (narrow or wide, high arch or flatter arch etc)
  • your running style – whether you are a heel striker or a forefoot striker
  • your running biomechanics – i.e. how all your joints from the lower spine to the toes move in a chain. Running can be affected by seemingly remote things like a stiff big toe or a stiff upper back!

It is therefore good to consider buying some shoes from somewhere that has the knowledge and skills to identify these factors properly. Locally we recommend Sporting Feet in Putney or Up and Running in Sheen.

5. Food for thought – literally!

A late and a croissant on the train to work simply won’t cut it in the world of marathon training! Your training schedule isn’t a license to eat just what you fancy!

  • So base your diet around mainly fresh, unprocessed foods – vegetables, fruit, wholegrains, meat, fish, eggs, dairy products, beans and lentils, nuts and seeds.
  • Don’t forget to include some healthy fats like olive oil, avocado and oily fish to support your immune system, which may be compromised by heavy training. These healthy fats can help your joints recover from pounding the pavements.
  • Eat more on your long run days and less on your rest days, particularly starchy and sugary foods.
  • Keeping alcohol to less than 14 units per week is also advisable.

To read more about nutrition and hydration for your marathon training and the race day itself read our blog here.

So to summarise: start by sorting out any old unresolved niggles, get yourself a proper training plan suitable to your particular level of experience, come and have a Running Assessment Screening session or Injury MOT with Dave, get yourself a decent pair of running shoes and don’t forget to fuel yourself properly!

If you would like to book a session with Dave or one of the team of physios, just call 020 8876 5690, email us here , book online by clicking the book online button on the right here or drop in for a chat.

If you have found this blog useful and would like to read our other running and marathon blogs just click here.

Golfers elbow and how physiotherapy can help

What is golfers elbow?

Golfer elbow causes pain for many golfersGolfers elbow is a pain on the inside of your elbow affecting the flexor tendons that flex your wrist, hand and fingers and attaches to the inside of your elbow. We used to think it was caused by an inflammation of the tendon which links the muscle to the bone. However, it is really a ‘tendinopathy’ with the tendon struggling to cope with the forces put through it because its structure has become weakened.

The good news is that although these problems can be rather persistent there are lots of things we can do to help and it is usually possible to get rid of it completely if you follow our physio’s advice!

Improve your golf swing and get rid of elbow pain for good

Dave Burnett is one of our Physiotherapists and he is a Titleist accredited Golf Rehab Physiotherapist. He is also a very keen golfer and loves helping golfers recover from injury. Dave shares his knowledge about research on elbow injuries in golfers and best practice for getting them better.

Why amateur players get more elbow pain than professionals

elbow pain in golfers

golfer demonstrating good follow through

Elbow injuries account for up to 15% of chronic golf injuries in professionals and up to a massive 30% in amateurs! This is usually because restrictions in flexibility and range of movement around your hips, trunk and shoulders mean that the club head speed in amateurs is generated more by the wrists and elbows. This extra stress on the elbows can cause the elbow pain known as golfer’s elbow.

Professionals, on the other hand, tend to be looser in their hips, trunk and shoulders. They generate forces from the ground up that are shared between all the joints of their body and the stresses are not concentrated in one area.

It is therefore important to consider your swing technique and your flexibility and strength through your whole body. This is something that our Sports Rehab Physiotherapists are trained to assess and treat. We are movement specialists and analysing technique and correcting weaknesses is all part of our role.

6 common factors of elbow pain in golfers

  • Surprisingly Golfer’s Elbow (where pain is felt on the inner point of the elbow) is less prevalent in golfers than Tennis Elbow (pain over the outer point of the elbow)!
  • It is also surprising that a right handed golfer can suffer from it on either the left or right arm!
  • Commonly the elbow pain starts within 1-2 days after hitting a lot of practice balls or playing on hard ground or mats.
  • A sudden increase in playing or practice frequency or returning to intense practice after a few weeks off can also provoke its onset
  • A change in your golf swing or grip can also cause the problem

How can Physiotherapy treatment help golfers elbow?

In the early stages:

  • In the early stages when it’s very painful we often use taping or a brace/clasp round the elbow to offload the painful tendon.
  • Resting an injured elbow may not be as effective as applying an optimal load to it. We use a process of POLICE – Protection, Optimal Loading, Ice, Compression and Elevation.

 As pain settles:

  • Exercises are the primary treatment for golfer’s and tennis elbow. We show you how to gradually load the tendon to strengthen it. This starts with isometric exercises (working the muscle without moving the joint). Then isotonic exercises (where we work the muscle through joint movement) and finally to speed work.
  • Sometimes we find the elbow joint is stiff and needs loosening up with gentle manipulation
  • We often treat the soft tissues with massage techniques

 Vital aspects for preventing a recurrence of the problem:

  • Assessing and working on restrictions in flexibility through the ankles, knees, hips, trunk, spine and shoulders
  • Assessing and working on strength through the same chain and especially addressing weakness of your core muscles
  • Considering the grip width of the club which affects the forces used as your gripping muscles attach at the elbow
  • Considering the stiffness of the shaft of the club – this can affect the forces transferred through the elbow. The stiffer the club the more force taken and the more flexible the club shaft the more forgiving on your elbow joint.
  • A good warming up routine loads the elbow gradually before a game to fully prepare muscles and tendons.

elbow pain in golfersWithout addressing these longer term issues elbow pain very often recurs so there are no short cuts to getting it completely resolved. Clients have a tendency to tail off their rehab once the pain is more under control. But the really important part is addressing the weaknesses and restrictions through the body that set professionals apart from amateurs. So completing a full rehab programme is essential. Our Physiotherapists will complete a thorough assessment of your body as a whole. They will then tailor your programme specifically to address the imbalances they find.

If you are unfortunate enough to experience golfers elbow or other elbow pain and would like to book an appointment with one of our Physiotherapy team just call 020 8876 0286, email us here or pop into the clinic for a chat.

If you have enjoyed this article, you will also like this one on avoiding and treating back pain for golfers:

Need to improve your golf swing performance and banish back pain? Physiotherapy could be the answer!

Use this link to see a good description of golfers elbow from The Mayo Clinic


Read our top tips for preventing tennis elbow

Tennis elbow is a very common complaint at this time of year. It’s more difficult to help once it becomes established and chronic. There are some useful steps that can be taken to reduce your chances of developing it. Read this infographic for our top tips.

We used to think that tennis elbow was a tendinitis – inflammation of the tendon. But we now recognise it as a tendinopathy – a degeneration of the tendon such that it struggles to cope with the loading put through it. Nowadays we treat the condition mainly with specific exercises to strengthen the tendon.

If you are unlucky enough to start experiencing the symptoms of tennis elbow which are typically:

  • pain and tenderness over the outer point of the elbow
  • aggravated by tennis strokes
  • aggravated by lifting a kettle or even a cup if very acute!
  • can be worse with typing
  • felt on gripping things

come and see one of our Sports Physiotherapists who can help you recover and give you tailored advice on prevention.

Need to improve your golf swing performance and banish back pain? Physiotherapy could be the answer!

We know that lower back injuries are the most common amongst golfers. In fact, in professionals they account for up to 63% of all injuries.

Wouldn’t it be nice to be free of pain and improve the effectiveness of your swing?

Follow these 5 top tips to banish pain, prevent injury and maximise your golf swing…


  1. Have you warmed up?

picture of warm up exercises sourced from www.dalehavesgolf.com

image sourced from www.dalehavesgolf.com

That first tee drive demands a complex series of full body movements which can place up to 8 times your body weight through the spine!

Learning a series of simple on-course stretches and warm-up movements helps prepare your body for the high demands of your golf swing and reduces strain on your spine.


  1. How is your flexibility?

stretching from www.mikepedersengolf.com

image sourced from www.mikepedersengolf.com

Your golf swing requires a lot of both side-bending and shearing forces forwards and backwards in your lower back.

If this area hasn’t got good freedom of movement you can put excessive strain on the discs, ligaments, muscles, nerves and joints of the spine.

Having an assessment of your spine and the way you move will help tailor a programme to reduce pain and prevent injuries.

A course of Sports massages can also be a useful way to address muscular tightness.


  1. Don’t forget stability!

picture of strengthening exercise for golf

image sourced from www.golfdigest.com

We know that people who experience low back pain, particularly if it has persisted for more than 3 months, have reduced deep (core) abdominal and lower spinal muscle strength and control.

This has a significant effect on the spine’s ability to control the force of your golf swing and how well you are able to generate power to strike the ball.

Working on your deep trunk muscles is essential if you want more distance and less pain! Sports Physiotherapy and our Pilates classes are a great way to achieve this!


  1. Power up!

strengthening for golf

image sourced from www.fitnessbyandrew.com

Preventing back injuries and reducing low back pain is not just about focusing on the spine.

Research has shown that the major muscle groups of the leg (buttocks/thighs), shoulder (rotator cuff muscles) and forearm are placed under high loads during the different complex phases of your golf swing.

Weakness and/or past injuries to other areas of your body may have an impact on both potential for back injury and the quality and power of your swing.


  1. Get specific!

Most golfers also enjoy other sports and may use the local gym to help keep fit.

However Sports Physiotherapy can offer a bespoke assessment of the way you move, as an individual. This is then used to tailor a programme to make you “golf-fit”. Specific muscle tightness, joint stiffness, poor movement control and muscle weakness can be quickly identified, treated and rehabilitated.

We have two Senior Physiotherapists with a specific interest in golf – Dave Burnett and Sophie Cannon. Both keen golfers themselves – they know what is required to improve your game and keep you free of back pain.

To benefit from a golf assessment with one of our Sports Physiotherapists then give us a call on 020 8876 5690 or click here to contact us.

Running the London Marathon? Why it’s a good idea to get checked out by a Physio first

Thousands of people will be doing the London Marathon for the first time this April. Some will be experienced runners ready for a challenge and others may be relatively new to running and may not fully appreciate the stresses and strains put on the body with such a repetitive sport.

So how can a Physio help me?

Physios are trained to analyse the way we move and to be able to identify when someone is not using the best strategy. I’m sure you’ve noticed many different running styles!

My husband always laughs at the way I point out to him runners in Richmond Park who have quirky habits that I know may well lead to trouble later on. Some are obvious asymmetries like an exaggerated kick out to the side that even my husband can spot! But others have small, subtle variations that, when repeated over time, can be just as troublesome.

As well as looking at someone’s overall style of running we can then break our assessment down into much finer focus.

sourced from milfordphysio.co.nz

sourced from milfordphysio.co.nz

Flexibility:  Sometimes an old niggle which has not been properly resolved can lead to joint stiffness. Or you can just be on the stiffer end of the flexibility scale. Some runners can be hypermobile (too flexible) meaning they can have issues in controlling their limbs sufficiently. We examine your range of joint movement to ensure you have sufficient flexibility in your body to run fluidly.

sourced from inshapenewsflash.com

sourced from inshapenewsflash.com

Core strength: It is very important that the deep postural muscles of the trunk – like the deep abdominals, back and shoulder blade muscles – are doing a good job. If you lack this ‘core stability’ then there is no firm platform from which your leg and arm muscles can work from. The pelvis and shoulder girdle and surrounding muscles provide this platform. We will check all the deep postural areas.

sourced from www.pilates9.com

sourced from www.pilates9.com

Power: Strength in your lower limbs is important if you are to avoid injury. Being such a long race you need endurance too.




sourced from inshapenewsflash.com

sourced from inshapenewsflash.com

Postural symmetry: Simple things like favouring one side of your body and leaning too much one way can lead to problems on one side. We will look at the symmetry of your body and make sure your alignment is as good as it can be.



sourced from blog.syracuse.com

sourced from blog.syracuse.com

Muscle length and tightness: We look at the length of your muscles to check you are not overly tight in one or two muscle groups – or that you have tightness in one side of your body.

We check your general fitness too – no good having the legs for it but no puff!

It is true that some runners have a very strange running style that never gives them any bother – take Paula Radcliffe and her waggling head! But in general some simple advice and correction given at the start can greatly reduce your risk of developing a problem during your training period up to the marathon and beyond. So if you have just signed up – contact the clinic and book an appointment to get checked out.


Our running clinic specialists can give you a running assessment and advise on improving running performance, avoiding injury and recovering from problems.

Other running articles by our specialists

Knee pain when cycling – and how to avoid it

Cycling is a great way to get fit but it isn’t without risk of pain and injury. Apart from the obvious flesh wounds related to falling off your bike, the most common problems are usually felt around the knee.

Read on to learn more about the common causes of cycling knee pain and how to avoid the pitfalls.

Why does knee pain occur when cycling?

Cycling is a repetitive activity so aches and pains are rarely related to cartilage tears or damage to the deep cruciate ligaments inside the knee – but much more likely to be an overuse condition.

Biomechanical stresses through the knee, caused by muscle imbalances or incorrect bike setup, are often at the heart of the problem.

Typical causes of knee pain when cycling

sourced from www.sportsmedicineeuk.co.uk

sourced from www.sportsmedicineeuk.co.uk

Pain felt around the front of the knee often arises from the knee cap joint (patella-femoral joint). The knee cap should track nicely in a groove on your thigh bone but is often pulled off course by an imbalance of the muscles controlling it – some may become weak and other muscles may become tight. This can cause the underside of the knee cap to rub against the side of the groove.


sourced from www.pro-tecathletics.com

sourced from www.pro-tecathletics.com

The Ilio-tibial band (ITB) is a very strong, long tendon which runs down the outside of your leg from above your hip joint to below your knee joint. It has attachments to the outer side of the knee cap. It commonly becomes tight in runners and cyclists and this can create an uneven pull on the knee cap.

sourced from www.ourhealthnetwork.com

sourced from www.ourhealthnetwork.com

The ilio-tibial band can also become sore as it passes across the outside of the knee joint. If you can imagine that on a long ride your knee may perform up to 5,000 revolutions!  As the knee bends and straightens repetitively the ITB can rub on the side of the knee joint and become inflamed.

Those with a tight ITB are often found to be weak in the Gluteus Medius Posterior muscle – a deep buttock muscle that controls the alignment of your leg and stabilises your hip. If this is weak the leg will tend to drift inwards affecting the alignment of the leg.

sourced from www.theinjuredknee.com

sourced from www.theinjuredknee.com

Those with a weakness of the inner quads – the vastus medialis muscle can also can also experience pain in the knee. Weakness on this inner side means the knee cap can be pulled more to the outer side.

sourced from www.bikeradar.com

sourced from www.bikeradar.com

It may be hard to believe but altered foot posture (rolling the ankle out or in too much) can also impact the knee.


A scoliosis (curve in the spine) can affect the alignment of the pelvis and this can also affect the working of the knee.

How you can avoid knee pain when cycling

Getting your bike set up correctly is essential. For instance, if the saddle is too low this will increase the bend of your knee. The distance of the saddle from the handlebars can have an impact on the knee angle too.

Sometimes your bike set up can be perfect but a tight hamstring muscle or a small difference in leg length, for example, can affect the biomechanics of your cycling action.

The best treatment for knee pain?

Our team of physios are trained to analyse movement and we specialise in treating all these issues which can lead to knee pain in cycling. We will:

  • Check out your alignment – not just in standing but in your cycling position too
  • Test the length and strength of the muscles so we can identify any muscle imbalances
  • Look to see if any old injuries have left you stiff in any of your leg or back joints
  • Look at the way you move – you may habitually cycle with your knee facing inwards, for example.

If you are suffering knee pain, just pop into the clinic and make an appointment or click here to contact us by phone or email.

If you enjoyed this take a look at our other cycling blogs!

How to cope with Osteoarthritis

Did you know that last week was both national ‘Walk to Work Week’ and ‘Arthritis Week’? As Physiotherapists we treat lots of people suffering from arthritis in their joints. A common question they ask us is ‘What form of exercise is safe for me to do?’

Walking and swimming are excellent forms of exercise because we know they are good for the heart but gentle on the cartilage of your joints. Osteoarthritis (OA) is the most common form of arthritis and affects men and women equally. It occurs when cartilage (the tough elastic material that covers and protects the ends of bones) begins to wear. Cartilage is an essential part of the joint; not only does it act as a shock absorber, it also enables the joint to move smoothly. With OA, the cartilage erodes, eventually resulting in pain, stiffness, swelling, muscle weakness and in extreme cases bone-on-bone movement in the affected joint.

Picture of arthritic knee sourced from www.viciouscycleblog.com

image sourced from www.viciouscycleblog.com

Although there is no cure for OA there is much that a person can do to take control of their disease and manage their condition. Physiotherapists can help you minimise your symptoms and delay or even avoid severe damage to your joints. Whilst your doctor can help with appropriate medication, your Physio can help reduce the pain and stiffness in the joints, strengthen weak muscles and give you advice on how to stay active but protect your joints.

Sometimes surgery is necessary and your Physio will be vital in getting you strong and flexible again afterwards and back to the activities you enjoy. Foot posture can sometimes contribute to problems with the knees and hips: orthotics for your shoes made by a Podiatrist can help alignment of the leg.

Exercise forms an important part of the management of OA. Arthritic joints like a little of everything and not too much of any one thing! So keeping gently active during the day – a little but often – is what the joints like. Too much sitting around leads to stiffness on getting up and being on your feet too long may make your lower limb joints painful and swollen. Getting and keeping the muscles that surround your arthritic joint strong helps to offload the joint from too much strain. Regular exercise will also help with weight management and keeping your weight under control will place less stress and strain on the joints and alleviate your symptoms. Acupuncture (given by our Physios) can help with pain relief.

Picture of nordic walking sourced from www.visitgarda.com

Image sourced from www.visitgarda.com

As a sufferer of arthritis myself, I find using Nordic Walking Poles of great help. They allow me to walk without a limp and they give me more of a workout. They also help me increase my walking distance.

Many people, when diagnosed with arthritis, think there is nothing that can be done to help. This simply isn’t true and I would urge sufferers to have an assessment with a Chartered Physiotherapist who will examine every aspect of the problem come up with a plan of action to help.


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Because of our great transport links and free on-street parking we have regular patients and exercise class participants from:
Barnes, Mortlake, East Sheen, Putney and Roehampton