Hear how Physio Dave helped a keen runner with persistent Achilles Tendinopathy

I recently caught up with one of our keen running clients, Patrick, who came to the clinic complaining of chronic Achilles Tendinopathy. Read on to find out how Physio, Dave Burnett, helped Patrick recover so that he could return to distance running again.

Hi Patrick- tell us a bit about yourself and what sport and exercise you do?

As a retired rugby player and triathlete my body has taken a bit of a battering over the years. Nowadays I cycle as my main sport but still enjoy running and swimming.

How and when did you develop your running Injury?

Achilles tendinopathyIt was probably a combination of not warming up properly, pushing too hard and the uneven surface that must have aggravated my Achilles tendon problem. When you are only a short distance out the tendency is to keep going to the end which probably just aggravated the situation even further.

What did your physiotherapy involve and how did you find it useful?

Dave at Physio on the River was great! Things were made easier as I was being treated by him for a shoulder injury at the time and he saw me hobble in and immediately diagnosed the issue – which was a Chronic Achilles Tendinopathy. So, after a couple of sessions of manual therapy treatment and stretching exercises for the calf, hamstrings and glutes (buttocks) we started the Shockwave treatment.

Describe your experience of shockwave therapy?

Shockwave for the achilles tendonI had 4 sessions of Shockwave which involved getting hammered by metal pads 100 times a second! It hurts the first time, although I think this was psychological and then after that it became quite therapeutic!

Whilst you mustn’t run immediately after the treatment, you can stretch and it’s important to do loaded strengthening exercises.

Every week I felt some progress. Once we had finished the Shockwave sessions we were able to progress to more explosive “plyometric” exercises. Apart from a blip when I may have done too much too soon, I was able to gradually build up the time and distance I was running and eventually the pace.

I am making great progress now. The important thing is to listen to your body and take your time. When you get injured after 50, it’s about managing the condition. The shoulder injury also helped as it forced me to go swimming and I was able to do more rigorous plyometrics in the pool. The positive benefits of swimming are extensive!

How are you getting on now and have you achieved your goals?

I’m in a good place now and am hopeful of continuing Park Run regularly and getting to that all important 22-minute milestone. My ultimate aim is to get back to half marathons.

What’s your brief understanding of how to manage your Achilles tendon problem in the long-term?

Should it return I should first  reduce the load, gradually re-load, add plyometric exercises and load even more -with marginal increments and take my time! Thanks very much Dave!

Thanks, Patrick, for sharing your story and illustrating so nicely how we treat and help people manage chronic tendon problems like yours.

Next steps….

If this has struck a chord with you and you’re suffering with a tendon problem, to make an appointment with Dave just:

Book online

Call 020 8876 5690

Email us here

Or pop in for a chat!

Double jointedness – loose joints – joint hypermobility: what is it and how can physio help?

Do you or your children suffer different joint aches or seem to be constantly injuring different joints?  If so, you may have Joint Hypermobility. In this blog we describe this condition and give some useful tips to help you manage the symptoms and show how Physiotherapy can help.

20-30% of individuals worldwide have some level of hypermobility and it affects both children and adults.  In the past this condition was largely overlooked and management was often ineffective or even aggravating.  There is a real difference between being flexible,  having Joint Hypermobility and having  Joint Hypermobility Syndrome. There is a spectrum of flexibility seen within the population with some people seemingly stiff as a board and others super bendy and there is yet another group who have additional symptoms. Read on to learn more about the differences.

So what is joint hypermobility?

If you were to google it right now the differences in definitions can be quite alarming.  This can also cause inaccurate self diagnosis.

In summary:

Joint Hypermobility

double jointed thumb

People with joint hypermobility are particularly supple and able to move their limbs into positions that other people find impossible. Joint hypermobility is what some people refer to as having “loose joints” or being “double-jointed”.  Some people have just one or two joints involved and others have more – and this is measured on a scale called the Beighton scale.

It is often hereditary. Some people outgrow symptoms as they get older and their joints naturally stiffen up a little.

Many people with hypermobile joints don’t have any problems, and some people – such as ballet dancers, gymnasts and musicians – may actually benefit from the increased flexibility. This is because it allows them to perform at a higher level – but unfortunately it also makes them much more susceptible to injury.

Joint Hypermobility Syndrome 

However some people with joint hypermobility can have a number of unpleasant symptoms as well, such as:

  • pain and stiffness of the joints
  • Clicking joints
  • easy bruising
  • joints that dislocate (come out of the correct position) easily
  • fatigue (extreme tiredness)
  • recurrent injuries – such as sprains
  • digestive problems such as constipation and irritable bowel syndrome (IBS)
  • dizziness and fainting
  • thin or very stretchy skin

    Ankle Sprainpain and stiffness in the joints and muscles

(, 2017)

If hypermobility occurs alongside symptoms such as these, it is known as Joint Hypermobility Syndrom. This syndrome is widely thought to be a feature of an underlying condition affecting connective tissue called Ehlers-Danlos syndrome (EDS).  The Brighton Scale, Beighton scale and other clinical tests are often used to diagnose the syndrome.

How can Physiotherapy help?

Joint hypermobility is a long-term condition therefore it is important to know how to manage it.

  • Gentle, low-impact exercise such as swimming and cycling are advised because it is gentle on the joints – as opposed to high-impact exercise that involves running, jumping and hopping.
  • Maintaining a healthy weight is important to keep the loads placed through the joints to a minimum.
  • Not exercising can make the symptoms worse – it’s just a matter of finding the right sort of low-impact exercise.
  • It is also important to normalise hypermobility in children early because for them it is their norm and we need to encourage them to exercise to help manage their symptoms. We don’t want them to be afraid to move and become over protective of their joints.
  • Physiotherapy can help identify which areas of the body are affected. We can help you pitch the level of exercise and tailor an exercise programme according to your particular symptoms.
  • We can point you in the right direction to confirm full diagnosis if required.
  • Pilates is often very good for hypermobility because it is gently strengthening without putting pressure through the joints. It can help increase energy, reduce pain levels and allow movement without fear of dislocation. The benefit of training with a physiotherapist is the improvement of muscle strength, fitness, posture and balance. The level of exercise is targeted specifically to the individual and we take care to go at the individual’s pace.

Our Physiotherapist Katherine Ashmore has a special interest in Hypermobility and has trained especially in Pilates for Hypermobility.   If you suspect that you or your child may have Joint Hypermobility please do book an appointment with Katherine to be assessed and to attend her one-to-one Pilates sessions. Or see any one of our experienced team of Physiotherapists.

To book an appointment, simply:

Call 0203 916 0286

Email us here

Book a Physiotherapy appointment online here

Or just pop in for a chat!

12 top tips for avoiding a skiing injury this Spring!

At Physio on the River we work closely with the Orthopaedic Consultants at Wimbledon Clinics (at Parkside Hospital) who are specialists in managing skiing injuries. They are experienced and keen skiers themselves so understand the sport completely. If you are unlucky enough to get injured this Christmas or Spring we can refer you quickly to their fast track clinic for injured skiers.

However, prevention is so much better than cure!

We run a Get Fit to Ski class to help you prepare for the slopes and we will be continuing this class in the New Year to help those preparing for the half term or Easter holiday break. The class is Physio led and covers all aspects of fitness, flexibility, strength and conditioning and balance to get you in tip top condition. It’s also a great way to shed those extra pounds put on during the festive period!

Jonathan Bell from Wimbledon Clinics has written this excellent top 12 tips for avoiding injury, which I would like to share with you in this blog.

1. Take lessons

The better your technique, the less chance you’ll put undue strain on your joints.

2. Get the right kit

Have your ski or board bindings set up by a pro because, if your bindings are incorrectly adjusted, or you borrow a friend’s skis, you’re more likely to injure your knees. In the hire shop, provide an accurate weight and estimate of your ability and don’t use boards or skis that are too short or long.

3. Have a rest day

Ignore the “first lift / last lift” banter and take a break. You’re likely to get more from your holiday. Why? Because the highest risk of an accident is after 3pm on day three of your holiday as muscle fatigue reaches its peak 48 hours after you hit the slopes.

4. Take the lift at the end of the day!

vector graphics, modern flat illustration, eps 10

Later in the day, you’ll be tired, the pistes may be icy and crowded, and there will possibly be bare patches in the snow – all of which are risk factors for injury. So take the lift!

5. Control your weight

Good advice for life is to maintain a healthy weight. It’s also good to prevent injuries. The heavier you are, the more strain you put on your knees and the harder you fall.

6. Keep within your comfort zone

Control is good, bravado is bad, and icy moguls – especially if you already have any damage to your knees – are a menace. Mogul falls can result in serious injury, especially to the shoulder in
firm conditions.

7. Minimise alcohol at lunchtime

Alcohol slows your reactions and makes you more reckless.

8. Be careful getting off the chairlift

It’s easy to fall when trying to get off a chairlift. And, while it might be funny, it can be serious. We also see many people who’ve ruptured their knee ligaments when the person next to them
falls across their skis.

9. Ski off-peak

The quieter the slopes, the less danger there’ll be of being called on to take sudden evasive action. If your ability allows, learn to ski off-piste where it’s often quieter. Do make sure you learn about the risks before going off-piste and have the correct equipment and insurance.

10. Don’t wear a knee brace but do wear wrist guards if you snowboard

We recommend knee braces only for a small number of people. These include skiers returning to the sport with an old or partially healed ligament injury (they might want to use a hinged brace) or
those with mild arthritis (who might benefit from a neoprene sleeve).

Otherwise, skiing without a brace improves the ability of the muscles around the knee to respond effectively to the different stresses and strains. Wrist guards for snowboarding are useful and
significantly reduce incidents of wrist fractures.

11. Seek advice immediately after injury

Clinics in ski resorts are versed in treating ski injuries. Above all, do not ski with an injury – get it checked out. Even though it might be tempting to carry on skiing through an injury, ignoring it may result in a longer lay-off. Then, once you are home, speak to your physio about a referral to Wimbledon Clinics.

12. Wear a helmet

Helmets can reduce the severity of mild to moderate head injuries.

If you are interested in joining our Get Fit to Ski class or giving a loved one a voucher just:

Call us on 0203 916 0286

Email us by clicking here

Or simply pop by for a chat!

Are you elderly or have an elderly relative who is frightened of falling? Read how Physio can help prevent falls.

Towards the end of my father’s life he became more frail  and this affected his balance and strength. He became less inclined to go out and his social life began to suffer.

Twice he pirouetted outside our front door and landed in my husband’s favourite shrub! Thankfully he didn’t hurt himself. This prompted me to put him through a Physiotherapy assessment to get to the bottom of his falls!

It is thought that about 1 in every 4 older adults have a fall each year. Not surprisingly the percentage of people who report a fall increases with age. Falls are the main reason that older people lose their independence.

What are the indications that someone is at risk of falling?

  • Elderly person helped to walk

    People who have fallen once are more likely to fall again

  • Listen out for an older person reporting that sometimes when they are walking they feel unsteady
  • If you notice your relative holding onto the furniture when moving about their home this is a sign of poor balance
  • If you notice that your relative has to push themselves up with their hands to get out of a chair this may indicate that they have lost strength in their legs
  • Having difficulty stepping up onto a curb is also a sign of weakness in the legs
  • If they have been advised to use a stick or frame to get around they may already be at greater risk of falling.

But the really good news is that there is so much that Physiotherapy can do to help! In this blog I explore the reasons that older people fall and how we can help tackle this to prevent falls.

What causes older people to fall?

There are many reasons, but the more common causes are:

  • Loss of muscle strength

    A loss of muscle strength. From about the age of 30 we start to slowly lose muscle strength unless we are actively and regularly working to combat this natural change. By the time we reach 80, research has shown that this loss of power can be as much as 40%! When this happens in the large muscles of the legs and buttocks we lose the ability to do everyday tasks such as getting out of a chair, climbing stairs and even simple walking.

  • A loss of flexibility. If an older person has arthritis or loses flexibility through lack of exercise they are more prone to falling because they are simply less agile.
  • Poor general health. If an elderly person is incapacitated for a period of time they become weaker in their muscles and may ‘go off their feet’.
  • Deteriorating eyesight means they may be less alert to hazards around their house.
  • Dizziness like that caused by labyrinthitis and benign paroxysmal positional vertigo can upset your balance.
  • Some medications can cause a loss of balance too.

But do not fear! Physiotherapists are trained to assess all the factors that can cause older people to lose mobility and independence and there are lots of things we can do to prevent falls occurring.

What will a Physio look for?

A Physiotherapy assessment first involves finding out about the person’s history of falls and possible reasons for them becoming more prone to falling. We find out about their general health to screen out any other possible reasons for falling other than the physical. A thorough physical assessment by a Physio will test a person’s:

  • functional abilities like walking, stairs, and getting up and down from a chair.
  • muscle power in their legs and arms
  • the range of movement in their joints
  • their ability to balance

If necessary we can visit their home to discover if they need any handrails or handles about their house.  We also check for potential hazards like rugs or uneven surfaces.

What can be done to help prevent falls?

Once we have assessed the elderly person, we make a plan of action. This usually involves a programme of exercises to loosen up their stiff joints, to strengthen their weak muscles and to work on their balance. All these things can be trained and improved.

We include functional exercises such as getting up and down from their chair. We might need to raise the seat of the chair at first and, once they have mastered the exercise at that height, we slowly lower the surface until they are able to do the exercise from a normal height chair.

Joyful seniors with walking canes

Similarly when practising steps we might start with a very low step and gradually increase the height until they can manage a normal height step.

We might feel that they need some help from one or two sticks or a frame and we show them how to use these safely.

We often find that after a fall an elderly person loses confidence but through practising these skills in a safe environment they can usually regain that confidence and get back to a more independent lifestyle.

My father went through this exact process and found it enormously helpful. In fact he didn’t fall again and my husband’s favourite shrub was saved – and so too, our marriage!

So if you have an elderly relative or neighbour who you think could benefit from our Falls Prevention Programme just:

Call us on 0208876 5690

Email by clicking here

Book online by clicking the green button at the top of the page

Or pop in for a chat first!

Read how Physio Dave helped an Open Water Swimmer recover from shoulder surgery


Earlier this autumn, Physio Dave Burnett interviewed one of his clients about his recovery from shoulder surgery. Read on to learn of his challenges and triumphs!



Dave: Hi Matt, tell us a bit about yourself and what sport & exercise you do?

Matt: Hi Dave. I’m a 36 year old Australian Structural Engineer. I have been living in the Barnes and Mortlake area for nearly 10 years and I have a pretty hectic lifestyle, trying to balance work travel commitments with a young, active family.

Between work and family, I manage to squeeze in some time to play a good variety of sports including rugby, surfing, tennis, squash and swimming. Over the past few years I have tended to focus on Open Water Swimming. This means training at least 2-3 time per week for distances of between 1 -3 km.

Sourced from Adventure - how stuff works

Sourced from Adventure – how stuff works

Dave: Can you tell us how and when your shoulder problem started?

Matt: I have historically had a weak shoulder from playing rugby. I’ve found swimming a great help to keeping fit but last year I began to notice some pain in my arm below the shoulder joint after training. This progressively became more painful to a stage where I was struggling to lift my arm above my head.

Dave: Please tell us about the operation you underwent?

Matt: I was fortunate enough to have a Physio-focused surgeon who encouraged me to investigate all avenues before surgery was undertaken. But in the end I had a Subacromial Decompression procedure.

As you explained to me, this is an operation to make more space under the bony arch above the shoulder joint where important tendons pass. Before the operation there was not enough space under this arch and the bones and tendons were rubbing against each other. The tendon was overloaded and in time became thickened and weakened.

I believe it’s a condition that can typically come one with a lot of repetitive overhead movements like in swimming.

Dave: In what ways did you find the  Physiotherapy  helped you recover after the operation?

Matt: Dave was a great help in aiding my speedy recovery by helping me to set realistic strengthening goals and not overload me too early with too many exercises.

Ultimately, I also appreciated the time he took to focus on what Physiotherapy exercises would specifically help improve strength for my long distance swimming in the longer term.

Dave: How are you getting on now and have you achieved your goals?

Matt: I had my operation in late January 2016 and I was back swimming competitively in summer 2016 – about 8 months of hard work, carefully guided by Dave!


Sourced from Amphibian open water challenge

Sourced from Amphibian open water challenge

Dave: Do you feel confident you can keep your shoulder fit for the future?

Matt: I am significantly more confident with my shoulder strength now – to a stage where I don’t think twice to do an activity which I previously might have thought would strain it.

I will continue to see Dave and the physio team on a quarterly basis to ensure that my recovery is maintained.


If you are suffering with a shoulder injury or facing shoulder surgery and would like to book a Physiotherapy appointment click here or call us on 0203 916 0286.

Running a marathon? Read these top tips on footwear!

Are you running a marathon? Do you know how often you should change your shoes?

Have you thought about the race day and what you will be wearing?

We’ve asked Dominic Stead of Sporting Feet to give us his top tips on footwear and more!

Sporting feet

Dominic and co-owner Geoff Ross run Sporting Feet – a sports footwear shop with branches in Putney and Richmond. Here at Physio on the River we have sent several clients for advice and the feedback we have received has been excellent. Friendly, informative staff and great products! Read on to find out Dominic’s best advice for those running a marathon.

How often should I change my running shoes?

  • Running shoes typically last for about 500 miles, so make sure your shoes still have plenty of life left in them.
  • It’s often a good idea to rotate a couple of pairs of your favourite shoes so that one of your pairs is nice and fresh for the race (but not brand new!).
  • Don’t buy a new pair less than 4 weeks out from the race. You need time to run them in – literally!

How do I know I have the right shoes for my feet?

  • If you are getting blisters or any other niggles, do go to a running specialist retailer to check that you have the right shoes for your gait.
  • It’s also vitally important to make sure you have the right size and width too. It sounds obvious but you’d be surprised how often runners are wearing the wrong size!
  • In general, the longer the race (and therefore the amount of training you are doing) the more space you should have in your shoes.
  • Running shoes should normally be a half to whole size bigger than your regular shoe size. We usually say you need half to a whole thumbnail of space from the end of your biggest toe to the end of the shoe.

What sort of socks should I wear?

Make sure you wear good quality technical running socks. These are not made of cotton but man-made fibres that keep your feet cool and reduce sweating.

Have you any advice about clothing and the unpredictable great British weather?!

We waste a huge amount of energy trying to regulate our own body’s temperature when running, if we are either too hot or too cold. So it’s essential to get this right.

The trick to clothing is the layering system. Wear several layers of light, breathable fabrics rather than one heavy layer.

  • Just as with your socks, your running clothing should be good quality, breathable technical gear too. These sophisticated fabrics wick away sweat and help you regulate your temperature.
  • When training, work out how many layers you need to wear to stay at the right temperature for different weather conditions.
  • Check out the weather forecast for the day a few days ahead of race day so you can plan ahead.
  • It’s best to have a dry run to prepare fully for the day, so have a nice long run in the shoes, socks and clothing that you intend to run in as part of your training plan.

Special offer!

Dominic and Geoff kindly offer our clients a 10% discount on running shoes. To take advantage of this offer pick up one of their flyers from the clinic and take it with you when you visit their shop.

To find out more about Sporting Feet click here to visit their website. They have an excellent range of both running shoes and shoes for many other different sports. They cater for adults and children alike and have a wealth of experience in this area.

For further advice on your running technique do book an appointment with one of our Physiotherapists who are trained to analyse your running gait and can help you with any issues or injuries you may have.

We also have a Podiatrist, Sas Ahmadi, who is a specialist in the biomechanics of running gait. He can help if you have alignment problems and require custom built insoles to go inside your shoes to support your feet or ankles.

To book an appointment with one of our team just call 0203 916 0286, email us here or pop in for a chat.

If you have enjoyed reading this blog and are interested in our other running blogs then click here.

  • Physio on the River

    The Old Ticket Office
    Barnes Bridge
    SW13 0NP
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