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COVID Update Nov 2020

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We are happy to announce that our governing body (The Chartered Society of Physiotherapy) has advised all members in all sectors that they can continue to run physiotherapy services during the national lockdown.

Hart Physio will continue to follow all safety measures already in place to appropriately treat current and new patients during this difficult time. Please call us on 01252 811773 to find out how we can support you.

Where clinically indicated we are now open for face to face sessions- double click to find out more……

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At Hart Physio we are proud to be members of the Chartered Society of Physiotherapy. This is a time where working together and under their lead has never been so important. We are closely following guidelines and procedures that allow us to open the clinic safely. Environmental and individual risk assessments are taking place to establish whether we continue with virtual or move to face to face appointments. We have made a number of modifications to our day including extending appointments to ensure plenty of time for cleaning of the room as well as factoring in time for phone screening patients before attending the clinic. We are also well supplied with all necessary PPE. The above chart highlights the factors which will be considered to follow our professional guidelines.

Hart Physio Online and Insurance Companies

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Hart Physio are offering physio online to all self funded and insurance patients.

Health Insurance providers Bupa, Axa PPP and a number of others have confirmed that during the Covid-19 pandemic they will cover all Physio treatment received via a virtual video consultation, we can use Zoom, Whats App, Facetime or telephone for your virtual appointments. We are using a specialising App to help you with your rehabilitation.

Bupa and Axa PPP have also confirmed that we can continue to accept new patients for a full assessment and continuing treatment plan as well as existing patients already being treated by Hart Physio

Now Providing Remote Physiotherapy through Video Consultations

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During these challenging times at Hart Physio we are now offering online/video consultations with Physitrack. We will spend time with you discussing your concerns and provide advice to assist you with recovery from musculoskeletal issues. Condition information and individual exercise programmes will be provided alongside. Please phone us on 01252 811773 or visit

Causes of Neck Pain

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Neck pain refers to pain that occurs anywhere in the region starting at the base of the skull and ending at the shoulders. The neck comprises the bones and joints of your cervical spine, otherwise known as your neck vertebrae; the muscles and ligaments that keep the cervical spine together; and the discs separating your vertebrae and serving as shock absorbers.

It’s not unexpected that your neck muscles, ligaments and bones are subject to the same wear and tear as the rest of your body. Overuse, poor positioning or injury can take their toll, leading to stiffness, soreness or extreme pain.

Chronic conditions are one cause of neck pain. Damage to the discs in your neck over time can lead to a pinched nerve, causing pain in one side of the neck that may involve tingling, numbness and pain that radiates down to your hand, while osteoarthritis can cause pain due to joint breakdown.

In addition, poor positioning of your neck may also cause pain or stiffness, and there are numerous culprits for such behaviour. You may spend a lot of time hunched over your computer or your cellphone; you may sleep with your neck at an odd angle; or you may angle your neck unnaturally, as required to hold a phone between neck and shoulder. In addition, dealing with a lot of stress often leads to neck tension.

Finally, injury can lead to neck pain, discomfort that is sudden and severe. Car accidents and the resulting whiplash, sports collisions at speed or direct blows to the back of the head are sources of acute injury and pain. Neck injuries must be approached with caution, because an injury to the spinal cord could be involved.


If you experience trauma to the neck, the injury could be serious. Your neck should be immobilized until you can be moved safely and evaluated medically to ensure that there is no spinal cord injury.

Chronic conditions require ongoing treatment that may include physiotherapy, while a garden variety stiff neck should first be treated with rest and ice to prevent inflammation – apply the ice during the first 24-to-48 hours after injury.

You may also want to take over-the-counter non-steroidal anti-inflammatory medicine to relieve the pain. Afterwards, you may wish to use heat on the neck to stimulate blood flow and promote healing.

To speed your recovery and prevent a recurrence of neck pain, you’ll want exercises that stretch and strengthen the muscles in your neck, shoulders and back.

A physiotherapist will be able to guide you in appropriate therapeutic exercises. Your regime will probably include isometric exercises, where neck muscles are tightened against and opposing force, and range-of-motion exercises that work to relax and lengthen your neck muscles.

Physiotherapists also employ treatments such as ultrasound, soft tissue release and joint mobilisation. To keep the neck strong and flexible over with a good range of motion, you’ll want to continue prescribed exercises on an ongoing basis.


If you have been dealing with a stiff neck, no doubt you don’t want to experience another one. There are a number of measures you can take to keep it from recurring.

  • At night, sleep on your side or your back, rather than on your stomach. People who sleep on their stomachs tend to twist their necks into awkward positions during the night. In addition, don’t use too many pillows in bed, because more than one pillow under your head can restrict its range of motion.
  • At work, don’t sit in one position for too long; be sure to get up and move around regularly so your neck isn’t stuck in an awkward position.
  • Ensure that your computer screen is at eye level so your neck isn’t tilted inappropriately; if you’re using a tablet, tilt the screen to a 45-degree angle or prop it on a pillow; if you leave it flat, your head will be bent down, stretching the ligaments.
  • If you spend a lot of time on the phone, wear a headset or an earpiece to prevent awkward positioning of your head and neck.

So, don’t let your pain in the neck debilitate you. Seek the treatment you need and commit to an ongoing prevention regimen.

Understanding Core Stability

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Core stability is a hot topic amongst rehab and fitness professionals. What does core stability really mean? Do sit ups, crunches, and planks count as core stability? Is it possible to have strong abdominals and still have a weak core? What type of core stability is best for people recovering from an injury and transitioning back to the gym?

Movement is medicine for the body and core stability is a vital part to any injury recovery or prevention program. Breathing, stretching and strengthening exercises can improve your posture, relax tense muscles and provide an overall sense of well-being.

The History of Core Stability

Core stability was initially described by academics “as the ability to withstand buckling from compressive forces” (Crisco, Panjabi 1995) and over time refined into “the ability to prevent shear and spin at each level of the vertebrae and pelvis”. (Bogduk et al 1995) The working definition of core stability has since evolved to include an integration of the body’s control, passive and active systems. These 3 systems contribute equally to spinal stability. The goal of exercises prescribed to “improve core stability” should be to train these three systems to produce effective movement.

The Active System

This system includes identifying, isolating muscles and integrating them into functional movements. This is one of the most important parts of the systems from a rehabilitation point of view and has 2 components which are the Local Active system and the Global Active system.

Coordinating the local and global muscles of the trunk is like coordinating musical instruments in an orchestra. Each instrument contributes to the final sound, but individual contribution is needed for optimal function. Local stability muscles need to be isolated to bring awareness without global system compensation. Once this is learned with awareness then it can begin to be recruited unconsciously while we move.

The Local Active System

The local system is a group of small muscles that contribute to developing control of local segments or “blocks” of the spine. These muscles control stiffness and position of spinal segments in relation to one another. Effectively, our spine is a complex stack of blocks. Each block or spinal segment balances on top of one another. These muscles will engage prior to movement and can be recruited unconsciously to keep them balanced. These muscles only need to be recruited for 25% MVC (maximum voluntary contraction) to be effective.

Dysfunction occurs when these muscles are inhibited and cause decreased strength, endurance and increased movement of spinal segments.

These local muscles work together to form the inner core unit of the body or the CORE 4. They need to work in balance to one another.

  1. Diaphragm – The diaphragm is the primary muscle for inspiration. It descends into the abdominal cavity when it contracts to help open the rib cage.
  2. Pelvic Floor – The pelvic floor is a group of muscles at the base of the pelvis that serve to help control bladder and bowel function, stabilize the sacrum and support the pelvic organs. The pelvic floor work together with the diaphragm.
  3. Transverse Abdominis – This “corset” muscle is the deepest abdominal layer. It runs horizontally to flatten and create tension from the pelvis to ribcage.
  4. Multifidus – These multiple muscles extend, stack and rotate individual spinal joints.  They prevent the shear and rotation in the spinal joints. These muscles act like “pulleys” in the spine decreasing the work need to move.

The Global Active System

These are muscles that generate torque, create movement and transfer load from ribs to the pelvis. They control movement and support posture. Dysfunction of the local system may present as imbalanced over-activity and tightness within the global system. This may result in excessive compression, increased intra-disc pressure and loading through the spine resulting in risk of degeneration and pain. (Nachemson and Morris 1964).

The Passive System

The passive system includes the skeletal structure, ligaments, and intervertebral discs that passively limit movement of the spine. Neutral alignment is where we start training the core muscles. Finding and working in neutral alignment is optimal because the local muscles are easier to isolate and it offers the least impact to the passive system. If the passive system is injured or is unstable it becomes important to enhance the other components of stability. The passive system can also become compressed when there is an exaggerated active response.

The Control System

The Control system includes our nervous system. The nervous system is challenged to control and move the spine. The control system must continually interpret the status of stability and plan appropriate responses. Control errors come as forces that are ‘too small, too large, too early or too late or not at all’. (Gardner-Morse et al 1995)

For example, imagine being bumped while standing. Your body naturally adapts to reverse the force to stay upright prevent tipping over. This reaction has to be perceived, the right intensity, the right timing and the right direction to be effective. The same can be said about core stability. Knowing which muscles to use, in the right timing and at the right intensity is essential to create an efficient system.

Pain turns off and “lowers the volume” on your ability to contract the local muscle system. This often presents as delayed muscle response, loss of awareness of abnormal passive movement (shear and spin). This loss of local stability causes pain and the cycle continues. Pain results in muscle bracing, stiffness, fatigue and overall sense of discomfort. Over recruitment or a “too large” response leads to chronic over-activation of the global system. Often, core stability training is relearning how to quiet the large global muscles in order to identify the deeper local system. This requires mental focus and concentration. Developing this awareness is essential to developing a balanced and efficient core. Imagining and connecting images to these body parts and exercises helps reinforce this awareness and control.

Why is core stability important after back injury?

Research suggests that exercise, in general, is important for recovery of nonspecific mechanical back pain. Some evidence suggests impaired firing, decreased endurance and strength were found in the local system did not necessarily return on its own. Even further, some evidence suggests that those with impaired function of deep back stabilizers had a higher incidence of repeated occurrences of low back pain. It is recommended to improve your awareness of the local system prior to engaging in higher level core stability and strengthening.

Do crunches and planks count as core stability?

No, crunches and planks are abdominal strengthening exercises but not necessarily core stability exercises. These exercises are not appropriate for everyone. Postpartum mothers who suspect or have been diagnosed with pelvic floor dysfunction or a Diastasis recti are cautioned when returning to these as improper technique and underlying imbalance and weakness within the core can worsen both conditions.

Planking is a very high-level whole body core stability. It is very difficult to do without firing effectively through the local system first. Remember the global system will take over and compensate. If done incorrectly, you may be strengthening your trunk but not necessarily strengthening and balancing your core. There is a difference.

You can have strong abdominals and have a weak core.

What can you do to improve your core stability?

  1. Breathe – Breathe in through your nose and expand your ribcage like an upside down umbrella. Exhale slow through pursed lips (imagine blowing out through a straw). Breathe often, breathe deep and breathe slowly. This helps your body relax and helps increase mindfulness.
  2. Lift pelvic floor – Think of your pelvic floor as a trampoline under your pelvis. As you inhale it relaxes down to ground, and as your exhale it lifts up. Connect your breath and your mind to your pelvic floor. Keep the contraction at a low intensity (20%).
  3. Engage Corset – Think of your Transverse abdominis as an internal corset running from your ribs to your pelvis. Exhale a little more by imagining blowing out birthday candles. Feel some muscle energy between your ribs and pelvis. If it is too strong, turn the volume down to 25% so you can still breathe deep into lower ribs. Try isolating with pelvic floor lift for a deeper connection.
  4. Stack your spine – Sit with optimal posture. Sit balanced evenly on your sitting bones, stack your ribs directly on top of your pelvis and lift neck to sit over top of shoulders. Exhale and peel and flex your spine forward by resting your hands on your knees. Inhale and stack your spine, segment by segment back on your chair. Think of lifting and growing taller as you extend up. Connect your breath to your movement.

Managing Knee Pain

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  • What is Knee Osteoarthritis?
  • What are its risk factors?
  • FAQ 


What Is Knee Osteoarthritis (OA)?

The term Osteoarthritis specifically means a degeneration of joint cartilage and the underlying bone. Knee Osteoarthritis is a chronic condition affecting the cartilage and bone within the knee joint characterised by pain, reducing function and quality of life.

Symptoms may include:

  • Morning stiffness
  • Persistent knee joint pain related to activity
  • Limited knee range of motion
  • Crepitus / joint noises
  • Boney enlargement 
  • Tenderness to the touch

What are the Risk Factors for Developing Knee OA?

  • Advancing age: There is an increased risk 45+ years of age.
  • Excessive weight: Due to the metabolic factors associated with obesity, as well as physically carrying excessive weight, can lead to Knee OA. For example, every 1kg loss of body weight is equivalent to 2kg off the knees.
  • Previous knee injuries: ACL tears, regardless if surgically reconstructed, increase the risk of developing Knee OA along with other repetitive knee injuries.
  • Occupation: Repetitive squatting and kneeling for more than 2 hours per day at work is a risk factor.
  • Gender: Females are more at risk for Knee OA than men after the age of 45.
  • Family History: Genetics play a role in the development of Knee OA.
  • Sedentary Lifestyle: Muscle weakness, particularly through the quadriceps muscles, can lead to Knee OA.

Common Questions For Knee OA

Can I just take anti-inflammatory drugs to treat it?

Knee OA results in joint inflammation; however inflammation isn’t the primary cause, and taking anti-inflammatory drugs shouldn’t be its main treatment. 

Is Knee OA just normal aging and to be expected later in life?

No. It can occur earlier in life, and is important to know it can be prevented. Reducing your risk factors such as weight management, and maintaining regular activities while strengthening your muscles appropriately, help prevent knee OA.

Is Knee OA just normal wear & tear?

No. It is a multi-factorial disease which can be prevented and treated by managing your risk factors.

My knee hurts, do I need X-rays to be assessed and diagnosed?

Not necessarily. An X-ray is not always required with knee pain or even when knee OA is suspected. X-rays don’t do a good job of assessing or correlating with pain or prognosis if a fracture is not suspected. The Ottawa Knee Rules are the guideline for when to receive an X-ray during acute knee injuries.

Treatment for Knee OA is focused on reducing risk factors, pain, and improving mobility and strength.

Is running bad for my knees?

No. It is actually good for your knees to be loaded and let your body adapt to this stress. No loading, or unexpected higher loads than normal, are more of a risk factor for knee pain. The key is to gradually introduce new activities and loads in order to strengthen your muscles, and allow your body to adapt to this stress at a safe rate.

I’ve been diagnosed with knee OA, will I need surgery?

Most people living with knee OA do not get knee replacement surgery. This is generally reserved for very advance cases.

What is the best & first line of defence for Knee OA?

The most important pillars of rehabilitation for Knee OA and many other knee conditions are:

  • Exercise / Physical Therapy
  • Weight Management
  • Patient Education 

Does it matter what kind of exercise I do to prevent Knee OA?

Not necessarily; it is important to listen to what works for your body. Many different types of exercises have been shown to help with function and pain in people suffering from Knee OA. Regular physical activity will help with stiffness, knee function, and reducing disability.

Evidence based guidelines strongly recommend exercise for treating Knee OA. Remember that surgery is not the most common treatment.

Now I know what I should do, but where do I start?

The best and safest treatment is personalised. It is helpful to be assessed by a physiotherapist to determine not only what areas to focus on, but set forth an optimal level of exercise to avoid acute flare ups and in turn maximize improvements. A physiotherapist may also provide adjunct treatment to facilitate better movement and response to exercise. This includes manual therapy and dry needling, but should not be the main form of treatment.

Shockwave for Plantar Fasciitis

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Plantar fasciitis is one of the leading causes of foot pain in adults. Plantar Fasciitis is responsible for over one million visits to the doctor per year. Hart Physio is proud to offer Shockwave Therapy for the treatment of Plantar Fasciitis.

The plantar fascia is a thick sheet of connective tissue located on the bottom of the foot that runs from the heel to the toes. The fascia attaches to the skin on the bottom of the foot. When people have plantar fasciitis, they will complain of pain when they initiate walking. Although the reason people get plantar fasciitis is unknown, Consultants and Physiotherapists believe many factors cause this condition that include: flat feet, decreased ankle mobility, obesity, and prolonged sitting or standing. However, in runners, there seems to be an increased incidence of this condition, some doctors think that repeated microtrauma can be another cause of plantar fasciitis.

Plantar fasciitis was a frustrating condition for people who had this diagnosis. The old treatment paradigm relied on conservative therapy for an extended period. This treatment strategy includes rest, shoe inserts, stretching of the calf muscles, and a glucocorticoid injections for temporary relief. If these treatment modalities did not improve symptoms after six months to a year of treatment, then surgery was someone’s only definitive therapy.

Now, with the invention of extracorporeal shockwave therapy, patients have a new option of treatments that is showing promise when compared to conservative treatment. Although the exact mechanism is unknown, many researchers believe that the shockwaves administered to the plantar fascia causes the break down of the scar tissue and allow the fascia to begin to heal. Scar tissue blocks the regeneration of vessels that can bring nutrients to the damaged tissue. In Europe, this therapy was approved for the past decade. Now it is being used in the United States, Canada and the UK.  This treatment was shown to be is safe for use in the general population5. When comparing shockwave therapy to surgical intervention, studies demonstrate that it had better outcomes6. As of today, no study proves that extra corporeal shockwave therapy is better than conservative therapy head to head, but research shows that a combination of shockwave and conservative therapy is better than conservative therapy alone7. As a result of this research, many orthopedic surgeons are recommending shockwave therapy as a treatment after only four weeks of conservative treatments8. The use of shockwave therapy expedites the healing process by months.

New Shockwave Technology arrives

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Shockwave therapy accelerates the healing process in the body by stimulating the metabolism and enhancing blood circulation to regenerate damaged tissue. Strong energy pulses are applied to the affected area. These pulses occur for short periods of time, creating micro-cavitation bubbles that expand and burst. The force created by these bubbles penetrates tissue and stimulates cells in the body that are responsible for bone and connective tissue healing. In many instances, shockwave therapy is most effective in cases where the human body has not been able to heal itself on its own.

Extracorporeal shockwave therapy (ESWT) is a modern and highly effective treatment method: high-energy sound waves are introduced into the body. With this innovative therapy approach, pathological alterations of tendons, ligaments, capsules, muscles and bones can be healed systematically. It has a great variety of uses in orthopaedic and rehabilitation medicine, these include:

• Plantar fasciitis
• Achilles tendinopathy
• Tennis and golfers elbow

• Osgood Sclatters
• Subacromial pain syndrome
• Calcific tendonitis of the shoulder 
• Chronic low back pain

For further information call us on 01252 811773