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Frozen shoulder treatment in kingston

Preventing Shoulder Pain

By Uncategorised

The most common causes and strategies for preventing shoulder pain

Shoulder pain is very common as we lead a combination of sedentary, desk based lives with the occasional hour or two of vigorous exercise thrown into the mix every week. To follow is a focus on the most common cause and strategies for preventing shoulder pain.

The three most common causes are ;

  1. Injury through a specific incident – either a fall, sport related or not, 
  2. Overuse either with gradual onset due repetition of a specific movement either with sport or life in general
  3. And also pain due to Osteoarthritis within the shoulder joints.

The second category is the one most often seen in practice and so it will be the main focus 

Symptoms, Cause, Treatment and Preventing shoulder pain


A ‘catching’ pain as the arm is raised either out in front of you or to the side. As the painful point is reached there can be a sense of weakness. As you move past the catching point the pain reduces.

Pain at night and stiffness in the morning on the painful shoulder

A sense of weakness in the gym and a loss of power.

An aching pain into the deltoid at the front or side when the arm is held in a certain position.

If these symptoms sound familiar to you then the following advice and exercises can help. It is often due to inflammation or tear of the one of the tendons in the Rotator cuff muscles. The rotator cuff is a number of muscles that converge around the head of the shoulder joint to give it mobility and stability.

External rotators of shoulder
Shoulder showing Rotator cuff muscles

Note: If you have pain at night and reduced movement in all planes of motion then you could have Adhesive Capsulitis or Frozen Shoulder. Please follow this link to read more about how best to treat this condition.


In our daily lives we spend most of our time with our arms forwards. Either at a desk in front of computers, driving or working with our hands. This brings our shoulders forward and over time muscles at the front such as our pectoral muscles become shorter and muscles at the back of shoulders become stretched.

The stretched muscles highlighted in orange on the image above can become fatigued and the loose their flexibility.

It then only takes something relatively innocuous like a bad night’s sleep on that shoulder, a harder session in the gym, a fall or carrying a heavy bag for a long time for the muscle to tear or a tendon (where the muscle attaches to the bone) to become inflammed.

As these muscles are in constant use, and they are on a stretch as well and blood flow in that area is not great the healing process can take a long time.  More often than not the small tear becomes a little bigger and the inflammation becomes greater. And what was a mild discomfort becomes something quite painful.

It’s at this point that many of us go to our GP and get some anti-inflammatories. It helps a bit. We rest it and the pain reduces. We then start using the shoulder more, perhaps return to the gym and the pain returns.

If at this stage the muscle tear is relatively small <5mm then this can heal and physical therapy is best placed to help this. As it is impossible to tell without an MRI GPS recommend rest, anti inflammatories and physio therapy in the first instance. If after this symptoms persist then more often than not an MRI is requested. Based on the findings a specialist can recommend whether surgery is the best option or further physical therapy.

PreventionPhysical therapy & Exercises

In order to prevent shoulder pain we need to address the cause. By reducing the ‘stretch’ by loosening off the muscles that are pulling our shoulders forward.

At the same time you need to reduce the inflammation. 

A combination of rest, strong anti-inflammatories and ice will help. Sometimes a steroidal anti inflammatory injection can be very effective.

However you still need to address the cause of the injury.

Addressing the cause of the injury

Reduce the tension and tightness of the internal rotators of the shoulder. The Pectorals, Biceps short head , Teres Major and Subscapularis. This can be done through a combination of soft tissue release massage and exercises designed to return these tight muscles to their longer resting length

Internal Rotators

And then combine this with strengthening the external rotators: Teres Minor and Infraspinatus.

External rotators of shoulder
Teres Minor and Infraspinatus for external rotation of shoulder

The exercises need to be done regularly at least twice per day to offset the inputs we give it for hours at a time at our desks.


To Release tension of Internal Rotators on Right Shoulder
To activate and increase flexibility of External Rotators on Left Shoulder

5 ways to prevent Neck and Upper back pain

By Uncategorised

Five ways to prevent Neck and Upper back pain

Neck and Upper back pain can affect all of us at one time or another in our lives. So here are 5 easy ways to help prevent it occurring.

As a rule we have quite sedentary lifestyles and the use of mobile phones, laptops and computers plus driving, cycling and looking after small children can maintain a position of arms forward and head up.
We may hold this position for hours at a time. This can lead to fatigued muscles and inflamed joints.

What can you do to prevent this?
These ‘overworked’ muscles and joints need a break regularly. Muscles need fresh blood with oxygen and nutrients and joints need to be moved to increase the lubrication of synovial fluid within the joint itself.

1. Take a break from your desk regularly– ideally every 30 mins- and get your upper back and shoulders moving.

2. Reduce ‘Arms forward’  position. This contracts your pectoral muscles which in turn pull your shoulders forward. Stretch your pectoral muscles regularly at work, after driving, cycling.

Neck Rotation exercise

Neck rotation exercises

3. Get your neck moving .If you are making sure your upper back is moving better with exercise 1 your neck will benefit too. But gentle exercises for the neck will improve mobility too. This exercise keeps the neck still but moves the shoulders, increasing overall rotation.





4. Change how you move. If you get aching pain on one side of your neck and shoulder in particular look at how you interact with your work colleagues. Do you always turn to one side to talk to them? Do you find yourself turning to one side as someone walks past? Are your computer screens to one side? These will have an effect on your neck and shoulder muscles causing one side to work more than the other. If you can, change your desk position. Rather than turning to talk to your colleagues move your whole body and face them head on. Align your screens so they are straight ahead of you. Hopefully you get the picture.

5. Consider a vertical mouse
If you experience shoulder and neck pain on the same side as you use your mouse then this can really help. You may not believe it but your Biceps is responsible for turning your hand anti-clockwise which you do every time you click on your mouse. The Biceps can become really tight and as it is also attached to your shoulder, it can pull your shoulder forward.  This, in turn, can cause fatigue in the corresponding shoulder and neck.

Help reduce shoulder and neck pain with a Vertical Mouse

Vertical Mouse stops the Biceps from being involved completely. Patients who have used this said it has really made a big difference. Their cheap too- get them on Amazon.

I hope you have found the exercises and advice useful. Remember all the exercises shown should be pain free. If not, then just stop and get in touch and I can modify them for you.

Heel mobility and related back pain

By Back Pain, Uncategorised

Heel Mobility and related back pain

This article describes how a lack of heel mobility can have a related effect on back pain as well as other common foot and heel problems.

Basic Foot biomechanics

As the heel strikes the ground there should a relatively small inward rotation or ‘pronation’ followed a similar but greater movement of the mid foot (the arch). The force and weight is then transferred to the metatarsals before push off by the big toe and others.

Heel action as we run or walk

Causes of some common foot/heel problems

If the heel does not roll in then the mid foot has to roll further. This in turn increases the stresses through the connective tissue along the base of the foot called the plantar fascia. The lack of movement at the heel also causes greater stress through the Achilles tendon. These increased stresses over time can cause Plantar Fasciitis as well as heel spurs and tendonitis.

This extra roll of the mid-foot has been termed ‘over-pronation’ and it can lead to greater stress and force through the joint at the base of the big toe.

The body responds by laying down more bone in that area to cope with the extra force. The joint becomes larger and the toe is forced inwards forming what is commonly known as a bunion.

How can lack of movement in the heel create back pain and vice versa?

There are two perspectives to consider when looking for causes of heel and back pain.

Ground up forces. That’s to say the forces involved as the heel strikes the ground and the chain reaction of energy and movement as it passes up through the leg to the spine.

 Top down forces. That’s to say how gravity acts on our spine and pelvis and how they adapt to cope with it and the effects on the biomechanics of the hip, knee and foot

 Top Down

The weight and therefore force of our torso, head and arms is distributed through our lumbar spine and evenly distributed through our pelvis via our sacrum into our legs. To help manage this we have large lumbar vertebrae, thicker discs, strong postural muscles and a matrix of interconnected pelvis and hip muscles such as gluteal muscles and hip flexors and core abdominal muscles.

However with our increasingly sedentary lifestyles our hip flexor muscles can become more contracted and shorter. This can lead to a slight forward tilt in our pelvis.

Fig 1. Forward hip tilt causing internal roll of hips, legs and foot


You can see from Fig 1 how it can increase an inward movement on the upper and lower leg and ultimately encourage increased pronation in the foot. This in turn can lead to foot and lower leg problems described earlier.




Fig 2. Hip tilt due to shortened iliopsoas (hip flexors) and an increased arch (lordosis) of the lower back

Also this can lead to tighter lower back muscles (see Fig 2) and increase the risk of lower back pain.

Ground up

As the heel strikes the ground it is designed to roll inwards. This is called pronation and it is totally natural. The mid foot follows followed by flexion of the toes and especially the big toe.

This inwards roll of the heel bone initiates a subsequent inwards rotation of the lower leg then the upper leg and eventually the hip. It is the inner rotation of the upper femur and hip that gives the gluteal muscle the cue to contract and extend the hip, propelling the body forward to the next step.

Chain reaction

So that first small inwards roll of the heel starts a chain of events culminating in the contraction of the most powerful muscle in the body. However if that inwards roll doesn’t happen then ultimately the gluteal muscle does not contract as efficiently and the lower back postural muscles become involved as they help out the hip to make the next step. That is on top of the job they already have providing stability and mobility to the lumbar vertebrae. A recipe for over work and fatigue of the lower back muscles and ultimately back pain.

Why does the heel become less mobile?

Tight calf muscles can be one cause of restriction of movement into the Achilles tendon which in turn attaches to the heel.

Achilles tendon attaches to heel bone (calcaneus)

A reduced mobility of the calf muscle can be due to a number of reasons. Here are some.

Increased weight: As we get older increase in weight can go onto our tummies. This in turn can change our centre of gravity and bring it slightly forward. Our calf muscles get involved helping to pull us backwards and maintain our balance and CoG over our mid point.

Sports: such as cycling that put a greater load through the calf muscle and in one direction can lead to tight calf muscles

Shoes: that elevate our heels can cause a shortening of our calf muscles. Research has also shown that there is a correlation between high heeled shoes worn and Bunions. The foot is placed in extreme flexion and forces are compressed at the base of the big toes.

A lack of heel movement can also be due to previous ankle injuries: significant ligament strains and fractures can lead to a lack of movement between the joints in our ankles and the heel bone. This in turn can lead to increased load on the calf muscles and tendons.

Implications for effective treatment

In order to effectively treat foot pain and injuries from calf through to big toe Hugo assesses all aspects of the foot, leg, hips and lower back. Evaluation their mobility and ability to move as part of a chain reaction of events.

Sports injury rehab in Kingston and Surbiton

Sports injury rehab in Kingston and Surbiton

Likewise if back pain is the symptom Hugo will always assess foot and hip movement as part of the process and treat accordingly.

Hugo uses 3D Functional movement exercise as integral part of his treatment to help enhance the movement of joints and muscles and combines this with Osteopathy treatment to improve tissue health and return you back to pain free movement as quickly as possible.

Sciatic pain During Pregnancy? Help is at Hand

By Back Pain, Pregnancy, Uncategorised

Reducing Sciatic pain during pregnancy

If you are suffering from Sciatic pain during pregnancy then help is at hand. Often in the third trimester of pregnancy you can start to feel pain into the gluteal (buttock ) area and it can travel down the back of the leg and can go into the calf.

As the pregnancy progresses and the extra weight at the front continues to increase,  the pain down the bacpregnancy and sciatic paink of the leg can increase from occasionally uncomfortable to very painful.

Pain Killers are not recommended so what can you do?

You may think that there is no other option than to look up some stretches on Google and hope for the best!

Why does Sciatica occur?

The cause of sciatic pain in pregnancy is most often due to overworked muscles close by the sciatic nerve that runs from your lower back down through the buttock area and down each leg. As ligaments become increasingly relaxed, ready for the birth, your muscles have to work harder in your pelvis and hips to provide you with stability in that area. This often coincides with a slight rotation of the pelvis either to the right or the left. This could have been a pre existing rotation prior to the pregnancy or occurred during it as the body manages the extra weight. This causes one set of pelvic muscles  to become slightly shorter and contracted on one side and on the other side they become slightly stretched and overworked. Over time this leads to inflammation of the overworked muscles and pressure on the sciatic nerve leading to the term Sciatica.

What can you do to calm it down?

As an osteopath my aim is to improve the health of the tissues, in this case, the muscles on the overworked side and to address the structural changes, the rotation.  I improve the health of the tissues on the side of the sciatic symptoms by improving the circulation through soft tissue massage and sometimes Medical Acupuncture. The structural change, the rotation, on the opposite pain free side, I address through Therapeutic Functional exercise. I tailor the exercises to the patient but one of exercise that forms the basis is this exercise.


Patients normally report a reduction in symptoms with 3-4 days after the initial treatment. After one follow up session and patients continuing to do the exercises as prescribed for a further 7 days, and patients report that the symptoms significantly reduce to just an occasional ‘niggle’.

I had experienced Sciatica occasionally with my previous two pregnancies with my previous children and it normally went with rest. However this time it was just getting worse and worse. I couldn't stand, sit or walk for any length of time. Rest wasn't working!

I saw Hugo and he explained why it was happening. He gave me some specific exercises to do on the opposite side of the pain. He also gave me some acupuncture and massaged the muscles which was quite painful but it felt like it was helping. After 3 days I could feel the difference. One more treatment and doing the exercises religiously for approx 7 days and my Sciatica had all but gone. I can't recommend Hugo enough. If you are pregnant and experiencing sciatic pain don't suffer, go and see him.

Libby, Mum of two soon to be three!