There are over 100 different forms of arthritis. The most common form, osteoarthritis (a degenerative joint disease) can be the result of trauma to the joint, infection of the joint or natural ageing.

Osteoarthritis (OA) can affect both the larger and the smaller joints of the body, including the hands, feet, back, hip or knee. The disease is essentially acquired from daily wear and tear of the joint. It is also more likely to be found if a significant injury has occured to the joint in earlier years.

Osteoarthritis begins in the cartilage and eventually leads to the two opposing bones eroding into each other. Initially, the condition starts with minor pain while walking or moving the affected area but soon the pain can become continuous and even occur at night. The pain can be debilitating and prevent those affected from doing any type of activity. About 8 million people in the UK have some degree of osteoarthritis by age 65*.

There is no cure for osteoarthritis, but the symptoms can be eased by using a number of different treatments. Mild symptoms can often be managed through exercise or by wearing suitable footwear. Humid and cold weather often increases the pain in many patients.

 Signs and symptoms

  • Pain and sometimes swelling of the affected joints.
  • Stiffness of the area and difficulty with moving and walking
  • Warmth and sometimes redness
  • A change in shape of the affected joint
  • Occasionally affected joints may also be filled with fluid.

How physiotherapy can help

Physiotherapy and gentle exercise has been shown to significantly improve function, decrease pain, and delay the need for surgical intervention in even advanced cases of osteoarthritis.

If you think you have osteoarthritis, some useful advise to consider includes:

  • Wearing shock-absorbent shoes such as trainers with thick, soft soles. This will lessen the impact to your feet, knees and hips and help to reduce pain in the lower limb joints
  • Using a walking stick if you are struggling to get around
  • Wearing a knee brace or a support for your thumb if indicated, as this helps reduce pain
  • Hot and cold packs can help alleviate some of the pain
  • For those who are overweight, weight loss may also be an important factor to help reduce the amount of load that the affected joint is having to support.



A fracture is a broken or cracked bone. It can affect any bone in the body. Fractures usually occur from direct trauma such as a blow, or indirectly through a fall, eg onto an outstretched hand.

Bones can break in a simple way (closed fracture), which is a clean break to the bone that does not damage any surrounding tissue, or break through the skin. These can usually be treated with a simple plaster cast. 

A compound (or open) fracture occurs when surrounding soft tissue and skin is damaged. This type of break may require an operation to fix it correctly.

There are many different types of fractures usually named and classified by body area, size or grade, the nature and type such as spiral or oblique fracture.

Signs and symptoms

Features of a fracture include pain, tenderness, localised swelling, restriction of movement, and in some cases deformity.

The time it takes for the bone to heal depends on the type of fracture you sustain, where it is and if it is open or closed. Healing is a gradual process and can take anything from a few weeks to a few months, depending on the area and the type of fracture.

How physiotherapy can help

Physiotherapy has an important role to play in your recovery following the removal of your plaster cast and once your Consultant has indicated they are happy for you to begin rehabilitation. After the removal of your cast you will experience joint stiffness and muscle weakness, even wasting in some cases. Physiotherapy can help with all these problems, after a detailed and thorough assessment has taken place. Treatment may consist of a combination of hands-on treatment, exercises and advice tailored specifically to your individual needs to rehabilitate you back to your former level of fitness and ability.

Jaw pain (tempromandibular dysfunction)

The term 'tempromandibular dysfunction' (TMD) refers to acute or chronic pain, inflammation, clicking, clunking or locking that originates from the tempromandibular joint (the jaw joint). The tempromandibular joint is formed by the cheek bone and the jaw, or the muscles of the face related to movement of the jaw (also known as muscles of mastication).

Signs and symptoms

The most common complaint people suffering from TMD report is earache, which often results in numerous visits to their GP, with numerous courses of antibiotics.

TMD can vary in its presentation, and will often involve more than one structure associated with the tempromandibular joint, for example, muscles, joint and capsule, ligaments, tendons and nerves. The cause of TMD varies too. Often the main factor, in the absence of trauma, is stress, grinding or clenching your teeth (bruxism), and extensive dental surgery.

Symptoms which could be associated with TMD

  • Pain or difficulty with yawning
  • Pain or difficulty with chewing or biting
  • Stiff and/or pain with opening or closing your mouth
  • Earache
  • Pressure within or blocked ears
  • Headache
  • Dizziness
  • Neck pain
  • Shoulder pain
  • Facial pain.

How physiotherapy can help

Physiotherapy can be effective in the management of pain from TMD through the application of anti-inflammatory modalities (eg therapies that involve physical or electrical therapeutic treatment such as ultrasound), soft tissue management techniques, acupuncture, joint mobilisations and correction of habitual positions of the mouth and jaw.

Top tips

Think about postures you adopt or habits you have with regard to your mouth and jaw, for example biting your lip, clenching your teeth and even chewing gum can all impact on this condition.

Continuing with or finding an activity or hobby is extremely beneficial in helping to manage stress, which is often a major cause of TMD.

Ligament sprains

Ligaments are strong bands of tissue that link bones together and help to hold joints in position. Ligaments allow normal movement to occur at joints but prevent excessive movement that could make the joint unstable. Sprains can occur when a ligament is suddenly stretched or torn. Sprains are most common in ankles, knees and wrists.  

What are the signs and symptoms of sprains?

  • Pain
  • Swelling  
  • Bruising
  • Not being able to move or use the joint.

Sometimes people feel a pop or tear when the injury happens. A sprain can be mild, moderate, or severe. A minor sprain is when a ligament is stretched or partially torn. In severe sprains the ligament is completely torn. Sometimes the end of the bone to which a ligament is attached can crack or be pulled off, this is called an avulsion fracture.

The first treatment for a sprain can be remembered using the acronym RICE.

  • Rest: The sprain should be rested. No additional force should be applied on site of the sprain. If, for example, the sprain were an ankle sprain, then walking should be kept to a minimum.
  • Ice: Ice should be applied immediately to the sprain to minimise swelling and ease pain. It can be applied for 20-30 minutes at a time, 3-4 times a day. Ice can be combined with a wrapping to minimise swelling and provide support.
  • Compression: Dressings, bandages, or wraps should be used to help compress the area to prevent swelling and provide support.
  • Elevation: Keeping the sprained joint elevated above heart level will also help to minimise swelling.

Top tips for preventing ligament sprains

  • Don't exercise if you are tired - your muscles will be tired too and offer less support to your joints. Injuries can occur as a result of being tired from playing sport or doing strenuous activity
  • Warm up and stretch before playing a sport
  • Wear supportive shoes that fit correctly.

A physiotherapist can give you specific advice and treatment such as deep friction massage and exercises to maintain movement and strengthen the affected area. They will also provide a thorough assessment and determine factors that may have made you more susceptible to a ligament sprain. It is important to have a thorough assessment and rehabilitation programme to help prevent the problem occurring again.

Pelvic girdle pain

About 1 in 5 pregnant women will suffer with pelvic girdle pain during their pregnancy*. This is often a misunderstood and misdiagnosed condition which can leave women struggling with sometimes severe and disabling pain in the joints of the pelvis. The pain can force some women to use of crutches or even a wheelchair as even the simple task of walking can become too painful to bare.

Pelvic girdle pain (or PGP), which is also known as symphysis pubis dysfunction (or SPD), can come on at any point throughout a pregnancy or after you have given birth. It can develop during your first pregnancy or your third pregnancy and if you’ve had it before in a previous pregnancy you are more likely to develop it again in any subsequent pregnancies.

It is characterised by pain around the sacroiliac joints (located at the back of the pelvis where you find two dimples above the buttocks), the symphysis pubis (the joint at the front of the pelvis), the groin, the lower back or pain which radiates down the thighs. It can develop suddenly or gradually over a few days. Each women presents differently and with varying amounts of pain and immobility.

What causes it?

Women are often told that the pain is due to the pregnancy hormone Relaxin and that nothing can be done about it, but in fact it is as a result of a mechanical problem with the joints of the pelvis.  This happens as a result of the abdominal muscles and pelvic floor muscles being stretched as the baby grows which means that these muscles are not as able to continue to support the joints of the pelvis and the lower spine. Asymmetrical movement can start to occur around the pelvic joints which results in inflammation of these joints, muscle spasm and pain. If the altered mechanics are not addressed then the pain will continue and may become more debilitating.

Signs and symptoms

The pain can come on suddenly or gradually around the joints of the pelvis. The severity and location of the pain varies from woman to woman. There may also be clunking or grinding felt or even heard around the pelvic joints.

Normally activities which place force or weight unevenly through the pelvic joints cause pain. This can be pain with:

  • Walking, especially up or down stairs
  • Standing on one leg such as when getting dressed
  • Turning over in bed
  • Getting in/out of the car or the bath
  • Twisting movements such as pushing a shopping trolley or buggy.

How physiotherapy can help

It is important to remember that it is safe to receive physiotherapy during all stages of pregnancy. You will need to make sure that your physiotherapist has the necessary training to treat PGP. This can be a women’s health physiotherapist or a musculoskeletal physiotherapist who has had additional training to assess and treat women with PGP.

The physiotherapist will assess the joints of your pelvis and will then use a range of hands-on techniques to address any mechanical dysfunctions found. These techniques may include mobilisations of the pelvic joints, massage, muscle energy techniques, acupuncture, kinesiotaping and exercises to strengthen your pelvic floor muscles and core/deep tummy muscles.

You may also require the use of a sacroiliac belt which provides additional support to the joints around the pelvis whilst your muscles get stronger. Your physiotherapist will also be able to give you advice about exercising safely during pregnancy, managing your pain and planning for labour.


Post-operative orthopaedic conditions

Post-operative Orthopaedic conditions relates to any problem associated with bones, joints or soft tissue, including muscles / tendons or ligaments, in any part of your body that has required surgery.

At Spire Dunedin Physiotherapy Department, we assess and treat patients following many different types of surgery e.g.’ keyhole’ (arthroscopic) surgery, joint replacements, spinal surgery and ligament repair e.g. ACL repairs.

Within Physiotherapy we offer a comprehensive assessment of your needs both prior to and following your surgery, ensuring you are supported all the way. We offer advice and treatment on post-operative swelling, pain control and returning your operated joint back to full movement and strength. We can re-educate your gait (walking) with the appropriate walking aid if necessary. Usually a comprehensive exercise programme will be devised, taught and progressed, tailored specifically to you and your stage of rehabilitation.

We work and liaise very closely with our consultants who operate at Spire Dunedin Hospital, which gives our patients an unprecedented level of care.

Pregnancy massage

Pregnancy massage can be a wonderful way to ease an aching back or stiff shoulders or any other aches and pains you may be experiencing during your pregnancy, leaving you feeling relaxed and refreshed. As well as being relaxing and a lovely way to spoil yourself, a pregnancy massage is great for the emotional and physiological well being for both mother and baby.

How can pregnancy massage help?

  • Reduces back pain and eases any muscle tension and aches
  • Helps to improve circulation thus reducing fluid retention
  • Stimulates the release of pain relieving endorphins which help to relieve stress, reduce pain and aid relaxation
  • Encourage better sleep
  • Boost energy levels
  • Calms body and mind.

Each pregnancy massage is tailored to your individual needs. Different positions can be used, such as lying on your side, supported with plenty of cushions or sitting, or leaning forwards on a chair, to ensure you are safe and comfortable throughout the massage.

Some women find continuing to have massage once the baby is born, can offer a chance for some precious relaxation and may help with restoring and rebalancing the body after labour. Post-natal massage is available at Spire Dunedin Physiotherapy as soon as you feel ready


Many massage therapists do not recommend massage in the first trimester. Women with certain health conditions may not be able to have pregnancy massage. It is best to consult your doctor or midwife before booking to have any massage .

For treatment costs or to book an appointment, please call 0118 955 3413 or send an enquiry.

Urinary incontinence

Pelvic floor exercises

The pelvic floor muscles

These are a group of muscles which form a hammock that runs from the pelvic bone at the front to the base of the spine at the back. There are three openings in the pelvic floor in women: one for the back passage, one for the vagina/birth canal and one for the bladder. (Men have only two openings). The pelvic floor helps to close these openings, and keep them closed, even on sudden straining such as laughing or coughing.

The muscles of the pelvic floor are made up of two types of fibres which both need to be exercised:

  • Slow twitch fibres – their role is to support the weight of the bladder, womb and abdominal contents above
  • Fast twitch fibres – these fibres need to react quickly to increased abdominal pressure to keep us dry such as when we cough or sneeze.

In women the pelvic floor can become weaker as a result of childbearing or hormonal changes during the menopause. In all people the pelvic floor can be strained by being overweight or having a persistent smokers cough. Weakness of these muscles can lead to urinary incontinence. Urinary incontinence is the involuntary leakage of urine and this can be anything from just a few drops of urine now and then to large floods of urine. It affects women more than men and it can affect you at any age for a number of different reasons. Stress incontinence and urge incontinence are the two most common types of incontinence that we treat.

Stress incontinence

This is the most common type of incontinence. It is the leakage of small amounts of urine when abdominal pressure is increased, such as when coughing, sneezing, laughing, lifting or exercising.

Urge incontinence (overactive bladder)

This is characterised by the really strong need to pass urine and sometimes a small amount of urine leaks before you have time to reach a toilet. The bladder muscle contracts too early, sometimes before the bladder is completely full. This can lead to increased pressure within the bladder which overcomes the ability of the pelvic floor and so some urine can leak out. About 1 in 4 women in the UK currently suffer with some form of urinary incontinence, but we believe that this number is actually more as many women are too embarrassed to report this problem to their GP.* Bladder problems are not a normal part of ageing and can be treated successfully with physiotherapy.

How women’s health physiotherapy can help

A women’s health physio is a physiotherapist who has had specific training in this field. They are experts in pelvic floor rehabilitation and bladder retraining. Your initial appointment with a women’s health physio will usually involve detailed assessment of your symptoms and if appropriate assessing the strength of your pelvic floor. This normally involves an internal vaginal examination in order to feel the pelvic floor muscle working. She will then teach you how to tighten your pelvic floor muscles correctly and give you a structured strengthening programme to improve their strength. She may use different devices such as an electrical stimulator or weighted cones to help with strengthening the pelvic floor. It may be that your symptoms are due to an overactive bladder. In this instance the physiotherapist will give you a programme to retrain your bladder.

Useful advice

  • Try to fit your pelvic floor exercises into your normal daily routine.
  • Make sure that you do them in sitting, standing and lying down
  • You want to do 5-10 quick holds to strengthen the fast twitch fibres and 5-10 slower holds which you hold for up to 10 seconds to strengthen the supporting muscles.

*(Source: Storage symptoms of the bladder: Prevalence, incidence and need for services in the UK. McGrother, C.W, BJU International, 93: 763–769, 2004
Systematic review and evaluation of methods of assessing urinary incontinence. Martin et al., Health.  Technology Assessment, 10(6):1-132, 2006)

Contact us

Call the Physiotherapy team on 0118 955 3413 or

send an enquiry