Tag Archives: specialist physiotherapy


It’s tight…it’s being protected

Tight as steel rope

Tightness in the muscle is a common complaint. Often part of a profile of symptoms following an injury and frequently a stand alone sense that persists, tightness and stiffness need addressing to normalise movement and control of movement. Normalising movement is a key part of desensitisation in that it is one less reason for the body to protect itself.

Tightness can be an expression of protection – what is being protected and why?

To address persisting tightness we must determine why and what is being protected. There could healing tissue, a pocket of inflammation or sensitivity to movement within the nervous system (mechanosensitivity). A detailed assessment of the problem, the preceding history and prior events reveal the nature and underpinning source(s), i.e. biological mechanisms. These mechanisms are then targeted with appropriate treatment and strategies.

Nerve | Blood supply

A common treatment method that we use is called neurodynamics. This is a range of hands-on techniques and movement-based exercises that nourish and mobilise the nervous system. Bearing in mind that our tissues will only be as healthy as the nerves that supply them (a general rule of thumb, but other factors are important including the immune system and endocrine system), it is very important that the nervous system be moving and its blood supply patent.

Tightness can be a sign of guarding. Guarding is protection orchestrated by the brain and can occur at a motor planning level. This means that before moving, the brain increases the activity of certain muscles as a way of protecting a body region for when movement actually occurs. A common example of guarding is in the case of back pain when the muscles remain ‘on’ as the spine is flexed forwards. These muscles should switch off and relax, however the fact that they remain active means that the movement is not normal. Addressing this is important for re-establishing motor control.

Local treatments are often used and can help in the short-term. However, these should be used as part of a rounded programme addressing the pain, symptoms, impact, limitations and other dimensions of the problem. Delving into the details and observing the sometimes subtle changes in movement and control of movement allows us to elucidate the reason(s) for protection and deal with persisting tightness.


Mastering your rehabilitation – Part 1: why exercise & train?

When we sustain an injury or experience a painful condition, our movement changes. In the early stages this can be obvious, for example we would limp having sprained an ankle. Sometimes the limp, medically termed an ‘antalgic gait’, persists without the individual being aware. This is the same for other forms of guarding that is part of the body’s way of protecting itself. By tightening the affected area or posturing in a manner that withdraws, the body is changing the way that we work so that healing can proceed. Clearly this is very intelligent and useful. The problem lies with persisting guarding or protection that continues to operate.

Physiotherapy London

We know that when the brain is co-ordinating a response to a threat, a number of systems are active. This includes the nervous system, the motor system, the immune system and the endocrine system (hormones). This is all part of a defence in and around the location that is perceived to be under threat. It is important to be able to move away from danger and then to limit movement, firstly to escape from the threat (e.g. withdraw your hand from a hot plate) and then to facilitate the natural process of healing by keeping the area relatively immobilised. Interestingly, at this point our beliefs about the pain and injury will determine how we behave and what action we take. If we are concerned that there is a great deal of damage and that movement will cause further injury, we will tend to keep the area very still, looking out for anything or anyone who may harm us. Over-vigilance can lead to over-protection and potentially lengthen the recovery process. This is one reason why seeking early advice and understanding your pain and injury is important, so that you can optimise your potential for recovery.

We have established that we move differently when we are injured and in pain. In more chronic cases, the changes in movement and control of movement can be quite subtle. An experienced physiotherapist will be able to detect these and other protective measures that are being taken. These must be dealt with, because if we are not moving properly, this is a reason for the body to keep on protecting itself through feedback and feed-forward mechanisms. Re-training movement normalises the flow of information to and from the tissues to the brain. Often this process needs enhancement or enrichment as the sensory flow and position sense (proprioception) is not efficient. Movement is vital for tissue and brain health, nourishing the tissues with oxygen and chemicals that stimulate health and growth.

To train normal movement is to learn. The body is learning to move effectively and this process is the same as learning a golf shot, a tennis stroke, a language or a musical instrument. Mastery. You are asking yourself to master normal movement. What does this take? Consistency, discipline, practice (and then some more practice), time, dedication, awareness and more. The second part of this blog will look at mastery as a concept that can help you understand the way in which you can achieve success with your rehabilitation.


Dysmenorrhoea & Pain

You may wonder why I am writing about dysmenorrhoea. It is because in a number of cases that I see, there is co-existing dysmenorrhea and other functional pain syndromes. These include irritable bowel syndrome (IBS), migraine, chronic low back pain, pelvic pain, bladder pain and fibromyalgia. Traditionally all of these problems are managed by different specialists with their particular end-organ in mind—e.g./ IBS = gastroenterologist; migraine = neurologist; fibromyalgia = rheumatologist. The science however, tells us that these seemingly unrelated conditions can be underpinned by a common factor, central sensitisation. This is not a blog about dysmenorrhoea per se, but considers the problem in the light of recent scientific findings and how it co-exists with other conditions.

Central sensitisation is a state of the central nervous system (CNS)—the spinal cord and the brain. This state develops when the CNS is bombarded with danger signals from the tissues and organs.  It means that when information from the body tissues, organs and systems reaches the spinal cord, it is modified before heading up to the brain. The brain scrutinises this information and responds appropriately by telling the body to respond. If there is sensitisation, these responses are protective and that includes pain. Pain is part of a protective mechanism along with changes in movement, activity in the endocrine system, the autonomic nervous system and the immune system. Pain itself is a motivator. It motivates action because it is unpleasant, and provides an opportunity to learn—e.g./ do not touch because it is hot. This is very useful with a new injury but less helpful when the injury has healed or there is no sign of persisting pathology.

Understanding that central sensitisation plays a part in these conditions creates an opportunity to target the underlying mechanisms. This can be with medication that acts upon the CNS and with contemporary non-medical approaches that focus upon the spinal cord and brain such as imagery, sensorimotor training, mindfulness and relaxation. In this way, dysmenorrhoea can be treated in a similar fashion to a chronic pain condition although traditionally it is not considered to be such a problem. The recent work by Vincent et al. (2011) observed activity in the brains of women with dysmenorrhoea and found it to be similar to women with chronic pain, highlighting the importance of early and appropriate management.

The aforementioned study joins an increasing amount of research looking at the commonality of functional pain syndromes. We must therefore, be vigilant when we are assessing pain states and consider that the presenting problem maybe just part of the bigger picture. Recognising that central processing of signals from the body is altered in a number of conditions that appear to be diverse allows us to offer better care and hence improve quality of life.

* If you are suffering with undiagnosed pain, you should consult with your GP or a health professional.


Physiotherapy Clinic in Chelsea

Situated just off Sloane Square in Chelsea at 2, Lower Sloane Street, the physiotherapy clinic is in a convenient location close to the tube (Sloane Square) and bus stops. The Specialist Pain Physio Clinics are dedicated to treating pain and injury with modern strategies and therapies based upon the latest neuroscience to promote normal movement and healthy participation in an active lifestyle.

T 07518 445493

Physiotherapy in Chelsea for pain

Visit the profile on The Chelsea Consulting Room website that provides a brief outline of the clinic. The main Specialist Pain Physio website has details about the modern approach to the treatment of pain and chronic pain, the other clinic locations and links to useful sites.

Knowledge and healthy movement for normal self

Specialist Physiotherapy in Chelsea

Local residents, people from all parts of London, across the country and overseas visitors have come to the clinic for treatment of chronic conditions and pain.

Come and visit our blog for regular articles and information.

We see a range of complaints including back pain, neck pain, RSI, recurring and persisting sports injuries, complex regional pain syndrome (CRPS), tendinopathies (e.g./ Achilles, patella, shoulder, elbow & wrist), functional pain syndromes (e.g./ IBS, dysmenorrhoea, pelvic pain, fibromyalgia, chronic back pain), conditions that have failed to respond to treatment and medically unexplained symptoms.

T 07518 445493


Working with the team

Richmond Stace provides a specialist service for athletes and sportspeople who suffer on-going or recurring pain and injury that involves working with the existing medical and physiotherapy team. Either at one of the clinic locations or at the individual’s training facility, the detailed assessment elucidates the pain mechanism(s), factors that are influencing the pain and maintaining the current status, altered sensorimotor function and behaviours. Subsequently a treatment and rehabilitation programme is recommended. This may include the input of other specialists and health professionals depending upon the needs of the individual.

At the point of recommendation, Richmond can implement the programme or provide the structure for the existing team to follow and progress. Follow-ups in person and via telephone/email are standard to monitor and evaluate the programme.


  • Ease symptoms
  • Restore function & fitness
  • Optimise the outcomes through identification of influential factors (biopsychosocial)

The key points

  • The service is dedicated to the more persisting and complex problems that are affecting an athlete’s  ability to perform or return to sport
  • We work closely with the existing medical team
  • Detailed assessment to determine the nature of the problem and influencing factors
  • Bespoke treatment & rehabilitation programme
  • Regular follow-ups