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8 Things You Can Do to Avoid Back Pain

On average, an office worker will spend approximately 5-6 years of his or her life sitting at a desk. The typical human will spend 9.5 years of their life watching television. Driving your car takes up almost 5 years of your life, 3 months of which are spent stationary in traffic (undoubtedly more in London). That means over 20 years of the average human’s life is spent parked on their bottom, which is quite shocking.

Back painAccording to recent reports, the NHS spends a total of around £1 billion per year on back pain treatment and general medical costs associated directly with back pain. That is a staggering amount of money for something that is known to progress the more you sit.

There are lots of ways in which you can prevent the development of back pain or limit the progression of your condition.  Here are our top 8:


There has been a highly correlative relationship shown in decreased mobility rates and increased back pain. Our spines are made to move. The nature of the joints in our back is to be supportive, yet move with fluidity. Poor posture and maintaining unhealthy positions for extensive periods of time are very damaging to our backs and our bottoms alike.  It is therefore no surprise that individuals, such as those mentioned above who spend 20 years sat on their rump, will develop back pain.

Work with a Physio

Your physiotherapist can prescribe gentle mobility exercises and stretches with their distinct knowledge of the spine. These can both prevent and alleviate any problems you may already have or could develop in the future.

Tighten that tummy

Improving the musculature around your stomach and back provides extra support to the spine. When moving and bending, good muscle tone around the stomach and back reduces the strain and stress points on the bones themselves.


Some of our physiotherapists at Physiocomestoyou are also trained in Pilates; this further contributes to their anatomical knowledge of the back, as well as improving their ability to identify which muscles can be contributing to poor posture and increasing injury risk. This is can be used to progress and advance the exercises you’re performing independently.

Workstation Assessmentdesk posture

If you are spending most of your time behind a desk, at least make it a safe or appropriate working space. It is possible to have your physiotherapist assess your desk space and work area in order to limit strain to your back whilst working. This may consist of altering your seating, desk arrangement, or general advice to improve posture.

Standing Meetings

In some businesses, there has been the introduction of formal meetings being hosted whilst standing, with desks and other equipment placed on raised desks to allow individuals to work whilst upright. This is to reduce the amount of time being sat down while at work. Incentives like this are being used in conjunction with awareness schemes to promote walking around the office at regular intervals.  Is this something you could consider introducing at your workplace?


It’s all well and good standing, walking regularly, exercising and correctly moving your back when picking up objects, but if your posture is bad, you will be vulnerable to back injury. Slouching, rolled shoulders and sitting in a slumped position fatigues the muscles of the back. They become over-stretched and weak, meaning their workload is placed on other muscles and structures of the back.  Excessive load on these structures makes them prone to injury.

Improve Your Sporting Technique

If you’re suffering from an aching back following intense sport, your technique could be contributing to a lot of issues, resulting in pain. Sports such as golf, cricket and hockey require a lot of twisting forces to be exerted on the spine, which are often contributed with flexed postures. Over-training can be an issue with the spine where the muscles will fatigue, or bones can stress (sometimes even resulting in a fracture). Having your therapist analyse your sporting technique alongside your coach can identify any movements increasing your risk of injury, as well as identifying weaknesses in your sporting performance.

By following this advice and considering the above when you next experience back pain, you can potentially limit its progress or reoccurrence. You may still be susceptible to back pain from the nature of your work or damage already dealt to your spine, but working alongside a physiotherapist can limit the disabling nature of this pain, and help you get back on track.

Back pain

Post by Zoe Birch, Head of Orthopaedic Physiotherapy at Physiocomestoyou.

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This Could Be the Cause of Your Heel Pain: Plantar Fasciitis

The plantar fascia is a thick band of tissue, which runs from the heel of the foot towards the ‘ball’ of the foot. Along with other structures, it contributes to supporting the natural arch underneath the foot.

Plantar Fasciitis or ‘Jogger’s Heel’

There are a number of issues a patient can present with if their plantar fascia is irritated or a little unhappy. The most common symptom is pain on the bottom of your heel whenever you put weight onto the foot, particularly when running or jogging. This presentation is suitably nick-named ‘jogger’s heel’. The pain starts right at the back of your foot’s sole and can radiate up to the base of your toes. This can be diagnosed with ultrasound or x-ray imaging to identify a thickening of the tissue, showing that it has become inflamed and sensitised.

plantar fasciitis

The Pain May be Caused by a Change in your Lifestyle

Causes of this can be due to minor changes in your lifestyle, including exercise, or something as simple as different footwear. Shoes with poor padding, especially running trainers, can contribute to the development of these techniques. This is why ‘bare-foot’ or minimalist running shoes have caused some controversy within medical circles.

What Can Your Therapist Do?

With pain on the plantar fascia, your therapist can treat the tissue using an abundance of techniques.  Gentle massage, ultrasound, taping prior to activity, provision of orthotics and exercises to re-align a more ergonomic position of the foot are common approaches to combating this condition. It is a condition, which will gradually settle with conservative treatment, although sometimes it can require a steroid injection by your surgeon to ‘cool’ the area down ad promote the healing of the damaged and irritated tissues.

As with many physical ailments in the joints around the foot, this issue can be due to a neighbouring structure or joint. There are some schools of thought that believe that minor issues within the knees and hips such as slight muscle imbalance and tightness, can develop and manifest into pain and extreme loading around the ankle and foot. In cases, which present with plantar fasciitis, you can expect your therapist to do a thorough assessment of your leg to attempt to identify the causal factors of your issues, as opposed to treating the symptoms alone.

A Common Injury

Around 1 in 10 people will develop some pain from their plantar fascia in their lifetime, with the majority of cases being individuals between the age of 40 and 60. Most people recover from plantar fasciitis within a few months to a year, however there have been some cases, which have lasted significantly longer.

Have you ever had heel pain investigated and identified as plantar fasciitis? How did you find your treatment with a therapist?  Let us know in the comments section below or via Facebook or Twitter!

Post by Zoe Birch, Head of Orthopaedic Physiotherapy at Physiocomestoyou.

Looking for relief from Plantar Fasciitis? Read our blog post here.

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Top Five Facts About Gout

There are many types of arthritis, which get a lot of media attention. Charities raise awareness for the two ‘big players’ of Arthritis, Osteoarthritis and Rheumatoid Arthritis. These affect the joints in severe ways, and often require surgery for them to regain any function, however, one of the types of arthritis, which is commonly overlooked, is Gout.

1.  Gout is caused by a build up of a waste product called urea

Urea is present in your blood and is usually filtered out by your kidneys. Your kidneys are usually able to maintain a level of urea in the blood, which the body can cope with.  With old age and illness, your kidneys can struggle to handle the level of this waste product in the blood, meaning a raised level remains in your body. When there is a certain concentration of urea in the blood, it begins to crystallise inside the joints of the body. These crystals are tiny, and can remain unnoticed for the majority of someone’s adult life, only causing pain and other symptoms when there is a large amount of crystals of considerable size.

2.  Gout usually affects the big toe

The number one symptom of gout is pain and the most commonly affected joint in the body is the big toe, however, it can affect any joint of the body as the crystallised waste-product can merge together to make large clusters within any affected joint. These large crystals grind on the bones and erode away the protective cartilage surrounding the bones, leading to irreversible damage.

3.  Gout can deform the joints

As well as the crystallised waste product affecting the surfaces of the joint, they can also protrude out of the joint, irritating the structures around it, inflaming the tissues causing acute pain and redness. In severe cases, the joints are so severely deformed that some joints such as hands and toes can appear like those of late-stage Rheumatoid arthritis sufferers.

4.  Excess alcohol and rich foods cause gout

Gout is highly correlated with a lavish lifestyle, and those who overindulge in rich foods and alcohol are often associated with developing gout. One of the most famous gout sufferers was Henry VIII – his love of red wine and fatty foods was instrumental in his development of gout.  Taking simple steps to change your lifestyle by reducing your alcohol intake and exercising more can play a role in reducing the incidence of Gout. Gout does have a strong genetic link, making those with relative historically suffering with gout more susceptible, but that doesn’t mean your risk can be reduced.

5.  Exercise can help reduce the pain caused by gout

Exercises to the affected areas can reduce the pain associated with gout, similar with other types of arthritis. Your physiotherapist can prescribe exercises in order to reduce the pain and other symptoms.  Regular stretching and moving the joints throughout range frequently can reduce the build up of these crystals, but it often requires surgical intervention just like the other types of arthritis mentioned previously.

Post by Zoe Birch, Head of Orthopaedic Physiotherapy at Physiocomestoyou.

Looking for an Exercise to Build Strength in your Thighs?

Our MD Rebecca shows you a simple exercise with some ankle weights to build up the quad muscles at the front of your thigh.

Want to try this at home?  To purchase some ankle weights, please visit our online shop here.

How do I Choose the Right Running Shoes?


Footwear plays a very important role for posture and anatomically correct movement both during sport and in our everyday lives. There are so many different types of footwear out there, with each brand offering the latest niche or styling with claims to increase performance, it can be difficult to choose.

Which Shoes Are Best?

The correct running shoe should:

  1. Maintain your foot’s natural structure,
  2. Allow adequate movement
  3. Provides sufficient support

But finding the pair that ticks all of these boxes can be difficult. Your physiotherapist can analyse your natural foot position to help you narrow down your shoe choices. They will look at the shape of your foot, the arch positioning, as discussed our previous blogs How to Treat Pes Cavus (High Arched Feet)and How to Treat Pes Planus (Flat Feet), as well as the movement and alignment of your ankles and knees.

Prone to Injuries?Runner Injury

If you are prone to a lot of injuries whilst running, this could be down to the footwear you wear.  The best way a physiotherapist assess this, is to see you running on a treadmill in your usual trainers. There are occasionally facilities in gyms or clinics, which film you running on the treadmill to allow for a more in-depth analysis. Surprisingly, something as simple as a slightly incorrect foot positioning during the foot placement of a stride when running, can be responsible for those troublesome recurrent ankle and knee injuries.

Should I Get Minimalist Running Shoes?

The new craze of “minimalist” running shoes which promote a “natural experience’” whilst running have quite varied research conclusions.  Some research is claiming that they minimise injuries, whilst others are displaying monumental increases in injury rates. In a particular study by Ryan et al in 2013, Examining Injury Risk and Pain Perception ibarefoot shoen Runners Using Minimalist Footwear, they drew some interesting conclusions when comparing three different types of running shoes. They suggested that during the 12 weeks when study was conducted, this new minimalist footwear might contribute to an increase in specific injuries in recreational runners, most notably in the participant’s shins and calves. In the conclusion, however, they do not completely discourage the use of shoes.  The authors of the study claim “minimalist shoes can contribute to improve running form following guidance from an experienced coach of medical professional, such as a physiotherapist”.

If you are considering changing your footwear, or are having problems with recurrent injuries with your current pair, it may be an idea to book an appointment with a physiotherapist to have your running analysed.  Our physios can see you at a time and location convenient to you so get in touch today.

Post by Zoe Birch, Head of Orthopaedic Physiotherapy at Physiocomestoyou.

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Advice on Strength Training For Children

Not to be confused with weight-lifting, strength training with free weights, weight machines and resistance bands can offer many benefits to children including increased muscle strength and an overall improvement to health and fitness.

Is Weight Lifting Safe for Kids?

Weight lifting, body building and power lifting can put too much stress on young developing muscles, as well as areas of cartilage that haven’t yet turned to bone (growth plates).  However, supervised strength training offers improved sports performance, increased bone mineral density, improved cardiovascular fitness, improved posture, improved body image, improved motor skills and a reduction of the risk of sport related injuries.

Children should use light resistance and controlled movements and an adult should supervise children at all times to ensure they use the proper technique, and don’t over exert themselves so that injuries are prevented in the long run.

What Age Can Children Begin Strength Training?

It is recommended that strength training can be commenced around 7-8 years of age following a ten-minute warm up. A professional should provide a specific strength-training programme and once 15 repetitions can be performed, the weight can be increased by 10%.

If you feel your child would benefit from a strengthening programme please get in touch and our specialist physiotherapists will be able to provide your child with an appropriate programme.


Post by Victoria Healey, Head of Paediatric Physiotherapy at Physiocomestoyou.


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How to Use A Theraband

Looking for an exercise to improve your posture?

Our MD Rebecca shows you a simple exercise with theraband (also known as resistance band) which can strengthen your upper back and help bad posture.

Want to try this at home?  To purchase a theraband, please visit our online shop here.

Little Known Risks of a High Body Mass Index (Heavy Weight)

As we have previously mentioned in Little Known Risks of a Low Body Mass Index (Low Weight), BMI refers to your Body Mass Index in which your weight and height is used to calculate whether you are under or overweight in relation to your height.  Even though BMI is one of the most commonly used weight and height calculations used in healthcare, it isn’t the most accurate. Those with very high muscle mass may still show as overweight in relation to their height, and this is one of the biggest flaws of the BMI scale. For a more accurate reading, The Water-Displacement Measurement is often used as an alterative.  This is where you are submerged in a large tank of water. The amount of displaced water is measured and from this, your total body fat can be estimated.  However, this method is not widely available and requires a laboratory setting with a skilled technician, which is why the BMI scale is widely used.

One of the largest strains on health services is the increasing frequency and severity of operations and treatments, which are required due to overweight individuals (usually those with a high BMI reading).  There are many physical issues that arise from an individual being obese, which are not just limited to the heart and other internal organs.

When asked to consider what operations people may have if they are overweight, the majority of people may suggest gastric band or bypass operations. Not many people would associate operations such as total knee or total hip replacements with those who are obese, but there is a very strong correlation between the two. Increased load from excess bodyweight on limbs alters joint mechanics, making them more susceptible to osteoarthritic changes and general ‘wear-and-tear’.

With a high BMI, the complications following surgery such as insufficient wound healing, infection and a poor surgical outcome are also more commonly displayed.  Those with a high BMI are also more susceptible to experiencing increased pain following surgery.  This is due to increased forces being put through the new joint prosthesis, which puts more strain on the metal implant and the surrounding bone.

It is not only the bones and joints themselves that are susceptible to damage from excess body weight; it is also the soft tissues, which undergo extreme forces. For example, ligaments in the ankle are more likely to rupture from the additional strain that the body weight puts on them during a fall or stumble.  When these structures are repaired, the outcome isn’t as good for overweight individuals as the same force is being sustained through the structures.

Your physiotherapist can help you with a personal training program in order to facilitate weight loss, as well as allow you to achieve a more manageable weight and a lower BMI reading. It has been shown through studies that with every 5kg loss from an overweight individual, they can reduce their chance of requiring knee surgery for osteoarthritic means by up to 20%.

Have you had any personal training input from the staff at Physiocomestoyou? Let us know your experiences in the comments section below!

Post by Zoe Birch, Head of Orthopaedic Physiotherapy at Physiocomestoyou.

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Should My Physio Treatment be Painful?

Our Bristol Manager and physio Leanne Plenge clarifies whether there is actually any truth in the ‘no pain no gain’ cliché, and whether the exercises your physio prescribes should be painful. 

In the years I have been practicing as a physio I have heard the statement no pain no gain many times.  Sometimes from behind the curtain as another physio suggests this to a patient, sometimes from a patient expressing a tight grimace when I have asked how their exercises are going or how a particular treatment feels!

It’s one of those statements that everyone will have heard before. We apply it to ourselves when we push hard towards a sporting goal or tighten the purse strings to save for a holiday. It’s a powerful statement but with regards to physio, it can be sometimes be misleading and sometimes harmful.

Every person is different. Every treatment is also unique. I would say that the vast majority of treatment techniques should not be painful. Sustaining pain in muscle tissues for often and long enough will ultimately risk sensitising those tissues to pain sensation and therefore risk a situation where chronic pain may develop. This is why I suggest that in my experience, exercise should on the whole be relatively pain free. This enables maximum muscle unit recruitment and building without inhibition, whilst also avoiding sensitising that person to pain.  Any physio that tells you that the exercise will be excruciatingly painful is being lazy – there are always alternatives!

Some hands on treatments can be uncomfortable, maybe even mildly painful when performed. A good example of this is trigger pointing or deep tissue massage for a tight or overactive muscle. The therapist might use their elbow even to press deep and hard into the centre of the painful muscle where it is felt to be most tight to release it off.  What you do see though is almost immediate improvement in flexibility at the joints affected by this muscle, or reduction in the tenderness and tightness when the muscle is next touched. This pain is short lived and useful.

So, when you next see a physiotherapist or a chiropractor, osteopath or therapist, make sure they are explaining to you how you should feel during the treatment and why it will feel like that.  Make sure you understand what that particular treatment is trying to achieve for you. That way you will gain the best from the therapy and not risk further harm.

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Top Tips to Avoid Injuries whilst Trail Running

In this blog post, our MD Rebecca Garrod reveals how to avoid injuries whilst trail running.

Trail Running is a very popular sport but it is linked with a high injury rate with 19-79% of runners sustaining an injury each year (van Gent et al 2012).  Injuries often occur from incorrect training and runners pushing themselves too far too soon as the body needs time to adjust and strengthen to the new demands.

There is a lack of evidence regarding age and gender being factors in causing injuries, however, we do know that as we age our body does take longer to heal.  Our body mass index (BMI) and physical fitness impact on how well you can run and train and can predispose you to injury. Terrains are extremely variable with trail running and there is evidence to show that running on softer surfaces can reduce the strain on our musculoskeletal system (Tessuti et al, 2012).

Previous injuries can certainly predispose you to sustaining another injury, either because the original healing did not heal properly or there may be an underlying reason such as abnormal lower limb biomechanics such as increased foot pronation (feet collapsing, or flat feet).  Therefore wearing the correct footwear is paramount.

In order to prevent injury it’s important to train and strengthen your body in a variety of ways.  Incorporating resistance training, flexibility, interval training, core stability, balance and of course distance running, will give you an all round fitness. Some people are lucky and they never seem to get injured, however, below are some of the most common injuries for trail runners and how you can avoid them.

Sesamoiditis:  Pain in the base of the big toe  

Cause: Feet pronating, a wide stance during walking or running, and stiffness in the foot including toes.

Symptoms: A gradual onset with pain felt more on the inner aspect of the base of the 1st toe.

Avoid it: Ensure that you’re wearing the correct footwear and if you have any qualms about the biomechanics of your feet, get them checked out, especially if you’re upping the ante and training harder. The joint may need to be offloaded with padding and tape.

Achilles Tendinopathy: inflammation and pain in the tendon within the calf 

Cause: Feet pronating and/or tight and weak calf muscles.

Symptoms: Pain felt in the Achilles’ tendon which can present as a niggle to severe pain. The pain is worse after activity.

Avoid it: Ensure that you’re wearing the correct footwear and there are exercises off a step that your physiotherapist can teach to help prevent and sort this problem.

Patellofemoral Pain or Runners Knee: One of the most common complaints of runners

Cause: Feet pronating, tight hip flexors, hamstrings causing the pelvis to tilt forward, and weak gluteal muscles.

Symptoms: Pain behind the kneecap, whilst going downstairs, hill running, especially downhill.

Avoid it: Practice clam, hip flexor and hamstring stretches and foam rollering (again your physiotherapist can show you the most effective ways of doing these).

Patellar Tendinopathy or Jumpers Knee

Cause: Feet pronating, and tight quadriceps, hamstrings, calves, and hip flexors.

Symptoms: Pain just below the kneecap at the front caused commonly by loading the tendon with activities such as jumping.

Avoid it:  Good flexibility and/or foam rollering helps as well as strengthening quadriceps, for instance, squatting on a 25% decline board. This puts the quadriceps in the best position to load the tendon. Do this 3×15, twice per day.

Hamstring Strain

Cause:  Tight and weak hamstrings and/or incorrect pelvis alignment.

Symptoms:  Pain and weakness in the back of thigh and a sudden onset when sprinting.

Avoid it:  Stretching your hamstrings and foam rollering is beneficial. Also, do the one legged bridge exercise ensuring that the pelvis doesn’t drop.

Illiotibial Band Friction Syndrome or ITBS

Cause:  Incorrect alignment of pelvis and/or weak glut muscles.

Symptoms: Pain felt on the outer aspect of knee which is aggravated by running.

Avoid it: Foam roller, do flexibility training and strengthen your hip abductors.

Tibia Stress Fractures

Cause: Pronated feet and stiff, high arched feet.

Symptoms: A gradual onset and you may have leg or calf pain when resting or at night depending on the location of the stress fracture.

Avoid it:  Avoid sudden changes in training especially a significant increase in training over a short period of time, and have your bone density checked out.

Medial Tibial Traction Periostitis or Shin Splints

Cause: Pronated feet and/or a wide stance during walking or running.

Symptoms: Pain along the inner border of the tibia.

Avoid it: Use the foam roller to release the inner aspect of your calf.  Also, strengthen your tibilias posterior: With your toes pointing down, place resistance band around your toes and bring your foot in towards the body 3×15, twice per day.

Plantar fasciitis: Painful Heel

Cause: The heel in most runners is the first point of contact and it is exposed to ground reaction forces up to 3x your body weight.  Painful heels are often caused by high arches and tight calf muscles.

Symptoms: There is a gradual onset of pain in the inner aspect of the heel, which is worse in the morning.

Avoid it:  Stretch the plantar fascia under the arch and use a frozen water bottle or orange under the arch to massage and release tension.

Ankle Sprains

Cause: Unstable ankles.

Symptoms: Pain around the ankle which has a sudden onset and swelling.

Avoid it: Do balance exercises:  standing on one leg, with eyes open and then closed.  Also, stand on a bosu ball, then squat, and then close your eyes.

Peroneal Tendinopathy

Cause: Excessive pronation when running on slopes and/or tight calf muscles.

Symptoms: Outer ankle or heel pain with swelling. Pain felt when moving your ankle in and out.

Avoid it: Ensure you are wearing correct footwear. Also, do strengthening exercises: place a resistance band around your foot and take the ankle outwards.

Are you a runner and have you experienced injuries whilst trail running?  Your physiotherapist will be able to show you how to correctly do the exercises above to avoid injury.  Let us know your avoidance tips in the comments below or by tweeting us at @Physiotoyou!

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