The descriptions of problems and injury on this page are for the purposes of illustrating the types of problem that can be treated using physiotherapy techniques.  If you are concerned about pain, soreness, stiffness or swelling we would advise in all cases to get it checked. 



Pregnancy and post-birth can be difficult times for your body. Liz is a specialist physiotherapist in this area and Kim has young children and knows how it can feel.

Just because you are pregnant you can still be treated. You don't have to just 'live with the pain'. Gentle manual therapy and soft tissue techniques can help relieve back pain and referred leg pain (sciatica). You can learn simple exercises to help your movement and posture, particularly the important practical issue of lifting existing small children.

After birth your core stability can be compromised making moving and lifting difficult. In normal birth the pelvic floor muscles, which work to help stabilise the back and pelvis, can be disrupted, and in caesarian sections the same problems can occur with stomach muscles.

In that sense recovering from pregnancy and birth is no different to a sports injury or an operation - a personalised programme of rehabilation and exercises is likely to reduce pain, speed recovery and make life that little bit easier.


Bad posture, good posture, indeed any posture, maintained statically for long periods and combined with heavy stress can increase tension in the muscles.

Massage and soft-tissue techniques can often immediately relieve tension in these muscles and simple exercises can help prevent tension building in the future. Of course, the theories say that if we all took regular breaks then problems wouldn't build up but realistically if you have a busy stressful job there are always going to be periods where you are under pressure and you don't move around enough or do the right exercises. When the tension builds up to the point of pain or injury then we are always available to help.

You don't need to be sitting at a computer to suffer this kind of posture-related problem. For example dentists and hairdressers must repeatedly place themselves in awkward positions many times a day.

If your problem is related to manual work e.g. the repeated use of heavy weights, pushing, pulling and lifting, we can diagnose the problem provide immediate pain relief, identify areas of weakness that may make you more vulnerable and work with you to strengthen them and fix the problem.

Over the years we've treated people with from all kinds of professions involving manual work including landscape gardeners, carpet fitters, roped-access workers, delivery drivers, and workers on oil rigs, railways and assembly lines.

Repetitive Strain Injuries (RSI)are also common and can be thought of as a subset of work-related injury.


After both major and minor surgery Physiotherapy treatment can speed the return to full activity. In some cases you may be surprised at how quickly you can return, although we would always advise caution and to seek professional advice when starting exercise after surgery.

In many cases movement is important to prevent stiffness, weakness and reduced joint mobility even away from the operated area. For example, not moving an arm with a broken wrist could lead to a "frozen" shoulder.

As well as focusing on the problem area there is often much useful work that can be done to gain stabilisation and strength in connected areas at an early stage e.g. before you are fully weight-bearing or whilst wearing a cast. As well as reducing the time to achieve full recovery, a tailored rehabilitation program can also help you to feel you are doing something positive and moving forward on the road to recovery with the reassurance you are reducing the risks that could cause setbacks.


Arthritis simply means joint (arth) inflammation (itis). There are over 100 different categories. "Arthritis" is a term that is widely used, often non-specifically, in cases of wear and tear of joints. This can simply be part of the natural ageing process we are all undergoing and need not mean an end to the activities you enjoy.

Even if the underlying cause cannot be cured, physiotherapy treatment can reduce pain, increase your capacity for activity and minimise or even prevent further joint damage.

Personalised strength and exercise programs are obviously the key long term tools for these kinds of degenerative conditions, but a biomechanical assessment can also flag up problem areas that can be eased and managed through soft tissue manipulation and massage.

Fractures and Breaks

Our view on fractures and breaks is very similar to recovering from surgery - there is a lot you can be doing even whilst in plaster, whilst being non weight-bearing, or whilst having to rest and take special care of the injured area.

Repetitive Strain

We commonly see two types of RSI:

  • Generalised wrist or arm pain usually from typing
  • "Tennis Elbow", that is tendonitis of the elbow from small repetitive loads e.g. screwdriver work, cooking, gardening, typing, using scissors, and of course tennis

Treatment involves checking the biomechanics of the arm including the shoulder and neck as a small change or tension higher up can change the load on the elbow or wrist. We use soft tissue massage to release problem areas and provide exercises to strengthen weak points. For stubborn cases we find acupuncture can be effective.

Sports Injuries


All the bones in the arm and shoulder, including the shoulder blade, are connected to the other bones in your body through one small joint at the end of the collar bone, just below your chin. This whole system of bones is effectively floating and is supported and stabilised through a network of muscles.

This means the shoulder and arm are very vulnerable to changes in muscle balance. What may appear to be minor changes in your posture at the shoulder can be transmitted down the arm to cause problems in the wrist and hand.

It is fairly common for pain caused by the shoulder to be felt in the upper arm and not actually in the shoulder itself.

Shoulders can also be vulnerable when falling, as you tend to use your arms to protect yourself. Falls can lead to joint injuries and dislocations. Unlike the hip, the shoulder socket is very shallow and held in place by soft tissues, which is why shoulder dislocations are far more common than hip dislocations.

Dislocations should be reported to Accident and Emergency for relocation. Subsequently physiotherapy is important to regain full range of movement and to strengthen for future support and protection.

Frozen shoulder refers to the shoulder joint seizing up. Whilst this can be caused by trauma e.g. shoulder surgery or a fall, there can often be no obvious cause or reason. certain populations appear to be more susceptible including diabetics and over-40s, particularly women. Depending on the severity, physiotherapy treatment can be tried, or referral to orthopedic shoulder specialists may be preferable.

Impingment or rotator cuff injuries occur when the stabilising soft tissue structures are damaged or worn, which can occur in a sudden event or over time. Associated pain in the shoulder or upper arm is usually sensitive to movement of the arm and shoulder i.e. some movements may be pain free and others not. Treatment involves soft tissue work and strengthening to loosen up and rebalance the shoulder complex.

Arm pain must be correctly diagnosed as the source of the pain could be the shoulder, the neck, the thoracic spine or even locally, at the point of the pain.


The knee is a complex joint with many structures in a relatively small space. Accurate diagnosis of knee injuries is vital. Physiotherapy has a range of diagnostic tests with relatively high levels of reliability.

Knees get a lot of use throughout your life and wear and tear is common. This need not mean and end to activity. A progressive strengthening program can help reduce pain and future wear and tear and help keep you active. Try it and see where it gets you.

There are very many categories of knee problem. Common knee problems include:

Iliotibial band (ITB)
The ITB is a thick fibrous band running down the outside of the leg over the hip and knee. A variety of underlying causes can lead to tightening in the band causing it to rub over the knee or hip leading to pain. Pain is most commonly on the outside of the knee. Treatment involves loosening the band as well as identifying and addressing the underlying causes. ITB is very common in cyclists and runners. Running downhill especially can aggravate the symptoms.
Meniscal cartilage tear
The menisci are crescent shaped cartilage structures that provide cushioning and stabilisation for the knee. They can be torn during a sudden event and over time are likely to experience general wear and tear. Classic symptoms of a torn meniscus are a popping, clunking or blocked knee. Minor tears can resolve over several weeks whilst some tears will require arthroscopy. Wear and tear of the menisci can lead to pain but this can often be managed by stengthening the surrounding muscles to minimise load on the meniscus.
ACL/PCL tears
The ACL and PCL are ligaments in the middle of the knee that stabilise the knee against twisting forces. Tears or ruptures are usually sudden events with a popping or ripping feeling and rapid swelling. If these ligaments are torn your knee will be less stable but, once recovered, that might not prevent activity. In some cases reconstructive surgery may be recommended. Whether through physiotherapy treatment or surgery, the goal is always to reach the best level of activity without risking new injury.
Kneecap pain
Experiencing pain over the front of the kneecap (patellofemoral joint) is very common. It occurs when too much load is put through the kneecap. Causes can be muscle weakness; abnormal biomechanics around the pelvis, hip, knee and foot; training errors or even just doing something your body is not used too, such as a long hilly walk. Treatment usually involves identifying the cause, managing the joint load and undertaking a full rehabilitation program.
Patella tendonitis
Patella tendonitis manifests as a pain in the tendon at the front of the knee below the kneecap. It tends to be an overuse injury and is sometimes known as jumper's knee. Treatment involves releasing any tight structures that may be agravating the problem and a carefully managed strengthening program. Too much load will further aggravate the problem, too little will prevent resolution of the pain.


Twisting is the cause of most of the common injuries to ankle. In many cases the ankle ligaments are stretched or torn. However there are other structures within the ankle which can be damaged during a twist or sprain. These include damage to tendons, the joint surface (chondral lesion) and the syndesmosis - a ligament that holds the tibia and fibia together.

In some cases a small reduction in the range of movement of the ankle can affect biomechanics as a whole leading to injuries elsewhere.

For treatment to be effective accurate diagnosis is important. In general, initial treatement aims to reduce swelling followed by hands-on manipulation to regain full ankle movement, then rehabilitation to restore strength and balance.


Excessive load on the calf can lead to tightening, spasm and sometimes tears, commonly in running based sports. Initial treatments involve restoring optimal tension and length, addressing the cause of the excessive load and then an optimal strengthening program.

Our experience has been that calf injuries require lots of respect but in less severe cases an early but gradual return to exercise is usually effective.


Hamstrings are large muscles that can pull and tear with a sudden change of speed or direction e.g. during sprinting activities. Assuming a sensible regime less severe pulls will often heal fairly quickly.

Ongoing hamstring pain with no sudden cause can indicate muscle imbalance elsewhere, often weakness in the glutes (bum muscles), causing tightening and load in the hamstring. The hamstring tendon is particularly vulnerable to injury during running, especially on the hills of Sheffield, and during certain gym exercises. Pain is usually felt at the top of the hamstring.

A personalised strength and loading program is required to resolve this problem.


Shin splints is a general term for pain around the shin. It could be caused by overuse to the tendon attaching to the shine bone, but could also be compartment syndrome or a stress fracture, both of which are also overuse injuries.

With all three problems a full biomechanical assessment is recommended to identify any contributing factors. If the problem is diagnosed as tendon soreness then soft tissue work and careful rehabilitation is often effective.

Compartment syndrome is caused by increase pressure in the compartments in the lower leg which can restrict blood supply to the foot or compress nerves. Causes are not always clear although overdeveloped or tight muscles could contribute. Pain tends to subside when exercising is stopped as the pressure reduces. Treatment varies depending on the severity and response to treatment and can range from soft tissue work through to surgery.

Stress fractures in the shin require several weeks rest, although we can advise on alternate activities to maintain fitness levels, and help with managing a safe recovery program.


Pain in the hip region could be related to the hip joint itself or to the many soft tissues that connect to or travel over the hip joint. Pain caused by these soft tissues can manifest in all areas around the hip, including the groin, lower back and the outside of the hip.

If diagnosis shows a soft tissue problem then we identify any muscle imbalances and if possible provide immediate release and stretches for tight structures and a strengthening program, often involving glutes (bum muscles) work.

Muscle imbalances can also cause hip joint problems, in which case treatment is similar. Sometimes referral for further investigation, such as an X-Ray, is required.

Even if you been diagnosed with arthritis in the hip, stretching and muscle strengthening can still help reduce pain and improve function.


There are more than 25 bones, 30 joints and a 100 muscles and tendons in the foot.

If a problem occurs there is a lot to assess and accurate diagnosis can be difficult.

Planta fasciitis is pain under the heal often caused by overuse. The cause of the condition must be identified and corrected, which includes assessing overall biomechanics of the lower limb including ankle movement, calf tightness and foot pronation. A carefully managed strengthening program is essential to help resolve this painful condition.

Stress fractures are an overuse injury. Initial treatment involves rest, usually a minimum of 4 weeks, although we can advise on alternate activites to help maintain fitness levels. Before returning to sport it is important to try to determine the underlying cause, which may or may not be biomechanical.

If you are moving to lighter weight running shoes or barefoot running we would always advise to do so slowly to build up strength and tolerance in the foot.


Pain at the back of the ankle could be related to the achilles tendon which could be sore (tendonosis), inflamed (tendonitis), torn or ruptured.

Tendonosis is a general soreness which tends to be from overuse. Tendonitis is inflammation of the tendon usually caused by an acute (sudden) event.

After diagnosing the type and severity of the injury you will need a treatment strategy that addresses the causes of the problem plus a personalised loading and strengthening program: too much load and the problem will perpetuate and even deteriorate, too little and repair is not able to take place which means the tendon is still vulnerable when it is put under stress.


Back or Neck Pain

Back pain occurs when the back is put under a greater load than it is strong enough to cope with. This can occur in a single incident or repeatedly over a period of time. Often an innocuous movement e.g a twist, can be the trigger, but in many cases problem has been building up over time.

Treatment involves manual therapy to relieve pain and exercises and education to improve strength. Simple exercises can often provide immediate pain relief.

Slipped discs also lead to back pain back often with similar causes i.e. prolonged sitting and bending. The problem needs diagnosing and may be treated differently.

There are a wide variety of causes of Neck pain. You may have just slept in an unusual position, you may have a build up of tension in the neck and shoulder due to stress or poor posture, or even repeatedly hunching your shoulders up against a cold wind. Another common cause is a sudden movement of the head, usually termed Whiplash

Problems in the neck could be related to muscles, nerves, joints or discs. After diagnosis, treatment is often aimed at restoring normal posture and movement. Soft tissue release and joint mobilisation work can help reduce short term neck pain. Movement tends to help speed recovery as we often find patients with neck pain are reluctant or unable to move their necks through the full range.


Sciatica is the common name for pain down the leg that is referred from the lower back. True sciatica is caused by irritation of the nerves in the back but there are many other structures in the back that refer pain down the legs. Diagnosis and treatment tends to be similar to back pain

Slipped Disc

The discs are the soft cushioning between each verterbra in the spine. They can be especially vulnerable to injury in people who sit or bend a lot. Treatment is based on alleviating pain which can often be non-prescriptive e.g. painkillers, manual therapy, acupuncture and avoiding sitting and bending

Slipped discs can often be difficult to settle down and there is often no quick fix. However it is important to correctly differentiate a disc problem from normal back pain.


This is a common term used to describe general lower back pain.


Whiplash refers to a pain in the neck following a sudden forward and backward, or side to side, motion of the head. It can occur in car accidents but also through tripping, falling, slipping or whilst playing most sports e.g. snowboarding

You should get suspected whiplash checked by a medical professional but in general once checked it is important to keep it gently moving

Treatment is similar to that for neck pain.


Joint Pain

Joint pain has many causes and a full assessment is usually needed to identify the structure causing the pain as well as potential contributing factors to the development of the pain. Treatment is based on pain relief and addressing the contributing factors through soft tissue release and strengthening.

Pulled Muscle

A pulled muscle can happen anywhere in the body. Muscles are made of fibres which can be overstretched leading to tears. In a minor pull only a few fibres are torn, in a bad pull many are torn - potentially all the fibres in the muscle.

Symptoms of pulled muscles include pain, swelling and bruising. In severe cases pulled muscles can be very painful with lots of bruising, often away from the site of the pull.

In cases of less severe muscle pulls gentle movement generally helps healing. As soon as movement becomes tolerable gradual stretching and movement is beneficial.

Treatment usually involves gentle rehabilitation. We work with you to ensure the muscle is able to heal at an optimal rate whilst avoiding further damage.

Swelling or Stiffness

Swelling and stiffness are two of the symptoms of inflammation in the joint. Causes can be categorised as acute (sudden) sprain or chronic (longer-term). A full assessment to diagnose the underlying causes, which may not be biomechanical, is very important so that appropriate treatment or further investigation can be undertaken.

Kim Baxter and Associates, 828a Ecclesall Road Sheffield, S11 8TD, 0114 2661138. Free Phone Consultation on 07930 867 829

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