Anatomy lab
Conditions: anatomy, assessment and rehabilitation
40 common musculoskeletal and nerve conditions, each with symptoms, causes, physiotherapy assessment, treatment approaches and exercises.
Head & neck
Cervical spondylosisAge-related changes in the discs and joints of the neck.
Age-related changes in the discs and joints of the neck. These changes are very common and often cause no symptoms; in some people they are associated with neck pain and stiffness, and sometimes with nerve or spinal cord compression.
Relevant anatomy
Discs lose height, the facet joints develop osteoarthritic changes and bony spurs (osteophytes) may form around the vertebrae.
Common symptoms
- Neck pain and stiffness, often worse in the morning or after holding one position
- Reduced turning range
- Headache from the upper neck
- Sometimes arm pain, tingling or weakness
Causes and risk factors
- Ageing
- Previous neck injury
- Repetitive or sustained neck postures
- Genetic factors
Physiotherapy assessment
- History and red-flag screening
- Range of motion
- Neurological examination of the arms (and gait and hand function to screen for myelopathy)
- Imaging only when it would change management
Treatment objectives
- Reduce pain
- Maintain neck movement
- Improve postural endurance
- Self-management of flare-ups
Physiotherapy approaches
Education & self-management · Range of motion exercises · Strengthening exercises · Joint mobilisation · Soft tissue mobilisation · Superficial heat therapy
Rehabilitation exercises (examples)
Chin tucks · Cervical rotation · Neck isometric exercises · Scapular retraction
Recovery and progression
Symptoms tend to come and go. Regular exercise and activity help many people manage flare-ups; the scan findings themselves do not usually change.
Prevention and self-care
- Change position regularly at work
- Keep active with regular exercise
- Set the screen at eye level
Seek urgent medical advice if:
- Clumsy hands, dropping things or unsteady walking: needs prompt medical review
Neck pain (non-specific)Neck pain without a specific identifiable cause such as a fracture or nerve compression.
Neck pain without a specific identifiable cause such as a fracture or nerve compression. It is one of the most common musculoskeletal problems.
Relevant anatomy
Pain may come from the facet joints, discs, muscles and ligaments of the neck, influenced by the sensitivity of the nervous system.
Common symptoms
- Pain and stiffness in the neck
- Pain into the shoulders or between the shoulder blades
- Headache
- Pain on turning or looking up
Causes and risk factors
- Sustained postures and long screen time
- Sleeping awkwardly
- Stress and poor sleep
- Low physical activity
Physiotherapy assessment
- History and red-flag screening
- Range of motion and posture
- Neurological screen if arm symptoms are present
- Palpation and joint assessment
Treatment objectives
- Reduce pain and worry
- Restore movement
- Improve neck and shoulder endurance
- Prevent recurrence
Physiotherapy approaches
Education & self-management · Strengthening exercises · Range of motion exercises · Joint mobilisation · Soft tissue mobilisation · Therapeutic massage
Rehabilitation exercises (examples)
Chin tucks · Cervical rotation · Neck isometric exercises · Scapular retraction
Recovery and progression
Many people improve within weeks, though some have recurring or persistent symptoms. Exercise combined with manual therapy is supported by the JOSPT neck pain clinical practice guideline.
Prevention and self-care
- Take regular breaks from screens
- Strengthen the neck and upper back
- Manage stress and sleep
Cervical radiculopathyIrritation or compression of a nerve root in the neck, causing pain and sometimes numbness or weakness in the arm..
Irritation or compression of a nerve root in the neck, causing pain and sometimes numbness or weakness in the arm.
Relevant anatomy
A disc herniation or narrowing of the intervertebral foramen by bony spurs affects a nerve root, most often C6 or C7.
Common symptoms
- Sharp or burning pain spreading into the arm
- Pins and needles or numbness in part of the hand
- Weakness of specific arm muscles
- Pain that increases on looking up or turning towards the painful side
Causes and risk factors
- Disc herniation (more common in younger adults)
- Degenerative narrowing of the foramen (more common in older adults)
Physiotherapy assessment
- Neurological examination: dermatomes, myotomes and reflexes
- Spurling’s test, distraction test and upper-limb neurodynamic test
- Monitoring for progressive weakness
Treatment objectives
- Reduce arm pain
- Restore function
- Protect and monitor nerve function
Physiotherapy approaches
Education & self-management · Neural mobilisation · Range of motion exercises · Strengthening exercises · Joint mobilisation
Rehabilitation exercises (examples)
Chin tucks · Cervical rotation · Scapular retraction
Recovery and progression
Many people improve without surgery. Progress is monitored, and worsening weakness needs prompt medical review.
Prevention and self-care
- Regular movement breaks
- Neck and upper-back strength
Seek urgent medical advice if:
- Progressive arm weakness
- Symptoms in both arms or the legs, or problems walking
Forward head postureA posture in which the head sits forward of the shoulders.
A posture in which the head sits forward of the shoulders. Posture varies greatly between people, and the link between posture and pain is weaker than often assumed, but sustained positions can contribute to discomfort.
Relevant anatomy
The lower neck flexes and the upper neck extends; load on the neck extensors and the upper trapezius increases.
Common symptoms
- Neck and upper-shoulder ache with sitting
- Fatigue in the neck muscles
- Headache
Causes and risk factors
- Long periods at screens or phones
- Low endurance of the deep neck flexors and shoulder-blade muscles
- Workstation set-up
Physiotherapy assessment
- Observation of habitual posture
- Deep neck flexor endurance
- Thoracic spine mobility
- Work and daily habits
Treatment objectives
- Improve endurance and movement variety
- Ergonomic changes
- Reduce symptoms
Physiotherapy approaches
Education & self-management · Strengthening exercises · Range of motion exercises · Soft tissue mobilisation
Rehabilitation exercises (examples)
Chin tucks · Scapular retraction · Wall slides
Recovery and progression
Changing habits and building endurance is gradual; the aim is comfort and varied movement rather than a “perfect” posture.
Prevention and self-care
- Screen at eye level
- Move every 30–45 minutes
- Keep the upper body strong
Tension-related neck painNeck and shoulder pain linked to sustained muscle tension, often with stress, and sometimes with tension-type headache..
Neck and shoulder pain linked to sustained muscle tension, often with stress, and sometimes with tension-type headache.
Relevant anatomy
The upper trapezius, levator scapulae and the muscles at the base of the skull are commonly tender.
Common symptoms
- A tight, aching neck and shoulders
- Tender spots in the muscles
- Band-like headache
Causes and risk factors
- Stress and anxiety
- Poor sleep
- Sustained postures
- Low physical activity
Physiotherapy assessment
- History including stress, sleep and headaches
- Palpation
- Range of motion
- Screening for other headache causes
Treatment objectives
- Reduce pain
- Improve relaxation and sleep
- Build activity and fitness
Physiotherapy approaches
Education & self-management · Therapeutic massage · Soft tissue mobilisation · Strengthening exercises · Superficial heat therapy
Rehabilitation exercises (examples)
Chin tucks · Scapular retraction · Cervical rotation
Recovery and progression
Usually improves with self-management, exercise and attention to stress and sleep.
Prevention and self-care
- Regular exercise
- Relaxation techniques
- Movement breaks
Seek urgent medical advice if:
- A sudden, severe or new type of headache needs medical assessment
TMJ dysfunctionTemporomandibular disorders (TMD) cause pain and dysfunction of the jaw joint and the chewing muscles..
Temporomandibular disorders (TMD) cause pain and dysfunction of the jaw joint and the chewing muscles.
Relevant anatomy
The joint between the mandibular condyle and the temporal bone, with an articular disc and the masseter and temporalis muscles.
Common symptoms
- Jaw, ear or temple pain
- Clicking or popping
- Limited or deviated mouth opening
- Pain on chewing
Causes and risk factors
- Clenching or grinding (bruxism)
- Stress
- Disc displacement
- Injury
Physiotherapy assessment
- History of clenching, grinding and stress
- Mouth opening range and pattern
- Palpation of the joint and muscles
- Screening of the neck
Treatment objectives
- Reduce pain
- Restore comfortable jaw movement
- Reduce clenching habits
Physiotherapy approaches
Education & self-management · Soft tissue mobilisation · Range of motion exercises · Superficial heat therapy
Rehabilitation exercises (examples)
Recovery and progression
Many TMD cases improve with self-care, education and exercises; a dentist may advise on a splint. Jaw exercises such as controlled opening with the tongue on the roof of the mouth are taught individually.
Prevention and self-care
- Avoid excessive gum chewing
- Be aware of daytime clenching
- Manage stress
Shoulder & upper limb
Frozen shoulderAdhesive capsulitis: the shoulder capsule becomes inflamed and thickened, causing pain and a marked loss of movement..
Adhesive capsulitis: the shoulder capsule becomes inflamed and thickened, causing pain and a marked loss of movement.
Relevant anatomy
The glenohumeral joint capsule contracts and thickens, especially in the rotator interval.
Common symptoms
- Gradual onset of shoulder pain, often severe at night
- Progressive stiffness in all directions, especially turning the arm outwards
- Difficulty with dressing and reaching
Causes and risk factors
- Often no clear cause
- More common in people with diabetes and thyroid disease
- After a period of immobilisation
- Most common between 40 and 60 years
Physiotherapy assessment
- Loss of active and passive range, particularly external rotation
- X-ray is sometimes used to exclude arthritis
- Screening for diabetes may be advised
Treatment objectives
- Manage pain
- Maintain and gradually restore movement
- Maintain function
Physiotherapy approaches
Education & self-management · Range of motion exercises · Joint mobilisation · Manual stretching · Superficial heat therapy · Strengthening exercises
Rehabilitation exercises (examples)
Pendulum exercise · Wall slides · Shoulder external rotation with a band
Recovery and progression
The condition usually improves over a long period. Physiotherapy, sometimes combined with steroid injection from a doctor, helps manage pain and restore movement.
Prevention and self-care
- Keep the shoulder moving after minor injuries
- Good diabetes control
Rotator cuff injuriesRotator cuff-related shoulder pain covers tendinopathy and partial or full-thickness tears of the cuff tendons, most often the supraspinatus..
Rotator cuff-related shoulder pain covers tendinopathy and partial or full-thickness tears of the cuff tendons, most often the supraspinatus.
Relevant anatomy
The rotator cuff tendons (supraspinatus, infraspinatus, teres minor and subscapularis) attach to the head of the humerus.
Common symptoms
- Pain on the outer upper arm when lifting
- Night pain
- Weakness lifting or rotating the arm
- A painful arc of movement
Causes and risk factors
- Age-related tendon changes
- Repetitive overhead activity
- A fall onto the arm (acute tear)
- Sudden increases in load
Physiotherapy assessment
- Range of motion and painful arc
- Strength testing (external rotation, Jobe’s test)
- Lag signs for larger tears
- Ultrasound or MRI when surgery is being considered
Treatment objectives
- Reduce pain
- Restore strength and control
- Return to function and sport
Physiotherapy approaches
Education & self-management · Strengthening exercises · Resistance training · Range of motion exercises · Functional training
Rehabilitation exercises (examples)
Shoulder external rotation with a band · Scapular retraction · Wall slides · Pendulum exercise
Recovery and progression
Most rotator cuff pain responds to progressive exercise. A sudden traumatic tear with marked weakness should be assessed early, as surgery may be considered.
Prevention and self-care
- Build strength gradually for overhead work and sport
- Avoid sudden spikes in workload
Seek urgent medical advice if:
- Sudden inability to lift the arm after a fall
Shoulder impingementPain from the tendons and bursa in the subacromial space when the arm is raised.
Pain from the tendons and bursa in the subacromial space when the arm is raised. Many clinicians now use the term “subacromial pain” or “rotator cuff-related shoulder pain”.
Relevant anatomy
The supraspinatus tendon and the subacromial bursa lie beneath the acromion.
Common symptoms
- Pain between about 60° and 120° of arm elevation (painful arc)
- Pain reaching overhead or behind
- Night pain
Causes and risk factors
- Overload of the rotator cuff tendons
- Repetitive overhead work or sport
- Reduced scapular control
Physiotherapy assessment
- Painful arc, Hawkins–Kennedy and Neer tests (in combination)
- Strength and scapular movement
- Response to modifying symptoms
Treatment objectives
- Reduce pain
- Strengthen the rotator cuff and scapular muscles
- Return to overhead activity
Physiotherapy approaches
Education & self-management · Strengthening exercises · Resistance training · Joint mobilisation · Soft tissue mobilisation
Rehabilitation exercises (examples)
Shoulder external rotation with a band · Scapular retraction · Wall slides
Recovery and progression
Exercise-based rehabilitation is the first-line treatment; trials show subacromial decompression surgery gives little benefit over placebo surgery for many patients.
Prevention and self-care
- Gradual build-up of overhead activity
- Shoulder and upper-back strength
Tennis elbowLateral elbow tendinopathy: pain and sensitivity of the wrist extensor tendons where they attach to the lateral epicondyle.
Lateral elbow tendinopathy: pain and sensitivity of the wrist extensor tendons where they attach to the lateral epicondyle. Most people who have it do not play tennis.
Relevant anatomy
The common extensor tendon, especially extensor carpi radialis brevis, at the lateral epicondyle of the humerus.
Common symptoms
- Pain on the outer elbow when gripping, lifting or twisting
- Tenderness over the lateral epicondyle
- Weak grip
Causes and risk factors
- Repetitive gripping and wrist extension
- Sudden increase in manual work or racquet sport
- Most common between 35 and 55 years
Physiotherapy assessment
- Pain on resisted wrist or middle-finger extension
- Pain-free grip strength
- Screening of the neck and the radial nerve
Treatment objectives
- Reduce pain and load sensitivity
- Rebuild tendon capacity
- Return to work and sport
Physiotherapy approaches
Education & self-management · Strengthening exercises · Resistance training · Taping, bracing, splints & orthoses · Soft tissue mobilisation
Rehabilitation exercises (examples)
Eccentric wrist extension · Wrist flexor and extensor stretch
Recovery and progression
It often improves over months with load management and progressive strengthening. Corticosteroid injections can relieve pain in the short term but are associated with higher recurrence.
Prevention and self-care
- Gradual increases in gripping work
- Good tool and racquet grip size
- Forearm strengthening
Golfer’s elbowMedial elbow tendinopathy: pain where the wrist flexor and pronator tendons attach to the medial epicondyle..
Medial elbow tendinopathy: pain where the wrist flexor and pronator tendons attach to the medial epicondyle.
Relevant anatomy
The common flexor–pronator origin at the medial epicondyle; the ulnar nerve runs just behind it.
Common symptoms
- Pain on the inner elbow when gripping or turning the palm down
- Tenderness over the medial epicondyle
Causes and risk factors
- Repetitive gripping, throwing or golf
- Manual work with sudden increases in load
Physiotherapy assessment
- Pain on resisted wrist flexion and pronation
- Ulnar nerve screening (tingling in the little finger)
Treatment objectives
- Reduce pain
- Progressive tendon loading
- Return to activity
Physiotherapy approaches
Education & self-management · Strengthening exercises · Resistance training · Soft tissue mobilisation
Rehabilitation exercises (examples)
Wrist flexor and extensor stretch · Eccentric wrist extension
Recovery and progression
Usually managed with load management and graded strengthening, similar to tennis elbow.
Prevention and self-care
- Gradual loading
- Good technique in throwing and golf
Carpal tunnel syndromeCompression of the median nerve in the carpal tunnel of the wrist..
Compression of the median nerve in the carpal tunnel of the wrist.
Relevant anatomy
The median nerve and nine flexor tendons pass under the flexor retinaculum.
Common symptoms
- Tingling or numbness in the thumb, index, middle and half of the ring finger
- Symptoms at night that wake the person
- Clumsiness or a weak pinch
- In longstanding cases, wasting of the thumb muscles
Causes and risk factors
- Pregnancy
- Diabetes and thyroid disease
- Repetitive forceful wrist use
- Wrist fracture or arthritis
Physiotherapy assessment
- Phalen’s and Tinel’s tests
- Sensory and thumb strength testing
- Nerve conduction studies when the diagnosis is uncertain or surgery is considered
Treatment objectives
- Relieve symptoms
- Protect nerve function
- Modify aggravating activities
Physiotherapy approaches
Taping, bracing, splints & orthoses · Education & self-management · Neural mobilisation
Rehabilitation exercises (examples)
Wrist flexor and extensor stretch
Recovery and progression
Mild cases often respond to a night splint and activity modification; persistent or severe cases may need injection or surgery.
Prevention and self-care
- Neutral wrist positions
- Breaks from repetitive gripping
Seek urgent medical advice if:
- Constant numbness or thumb muscle wasting: seek medical review
Wrist sprainAn injury to the ligaments of the wrist, usually from a fall onto an outstretched hand..
An injury to the ligaments of the wrist, usually from a fall onto an outstretched hand.
Relevant anatomy
Ligaments connect the radius, ulna and carpal bones; the scapholunate ligament is an important stabiliser.
Common symptoms
- Wrist pain and swelling
- Pain on weight-bearing through the hand
- Reduced grip
Causes and risk factors
- A fall on an outstretched hand
- Sports injuries
Physiotherapy assessment
- Exclusion of fracture, especially of the scaphoid (tenderness in the “anatomical snuffbox”)
- Range of motion and grip strength
- Ligament stability tests
Treatment objectives
- Protect, then restore movement and strength
- Return to function
Physiotherapy approaches
Taping, bracing, splints & orthoses · Range of motion exercises · Strengthening exercises · Cryotherapy · Proprioceptive exercises
Rehabilitation exercises (examples)
Wrist flexor and extensor stretch · Eccentric wrist extension
Recovery and progression
Minor sprains improve with protection and graded exercise. Persistent pain, clicking or weakness should be reassessed for ligament or bone injury.
Prevention and self-care
- Wrist guards for activities such as skating
Seek urgent medical advice if:
- Tenderness on the thumb side of the wrist after a fall: needs X-ray and medical review
Shoulder instabilityThe head of the humerus moves out of the socket too easily, either after a dislocation (traumatic) or because of general joint laxity (atraumatic)..
The head of the humerus moves out of the socket too easily, either after a dislocation (traumatic) or because of general joint laxity (atraumatic).
Relevant anatomy
The shallow glenoid depends on the labrum, capsule, ligaments and rotator cuff for stability.
Common symptoms
- A feeling of the shoulder slipping or coming out
- Apprehension with the arm raised and turned out
- Pain and weakness
Causes and risk factors
- Previous dislocation, especially at a young age
- Contact and overhead sports
- Generalised joint hypermobility
Physiotherapy assessment
- History of dislocations
- Apprehension, relocation and load-and-shift tests
- Assessment of hypermobility and muscle control
- Imaging to look for labral or bone injury when needed
Treatment objectives
- Improve dynamic stability and control
- Strengthen the rotator cuff and scapular muscles
- Return to sport safely
Physiotherapy approaches
Strengthening exercises · Proprioceptive exercises · Resistance training · Functional training · Education & self-management
Rehabilitation exercises (examples)
Shoulder external rotation with a band · Scapular retraction · Wall slides
Recovery and progression
Atraumatic instability usually responds to a long-term exercise programme. After traumatic dislocation in young athletes, the risk of recurrence is higher and surgery is sometimes advised.
Prevention and self-care
- Shoulder strength and control training for sport
Spine & back
Lower back painPain between the lower ribs and the buttocks.
Pain between the lower ribs and the buttocks. In most people no single structural cause can be identified (non-specific low back pain).
Relevant anatomy
Discs, facet joints, ligaments and muscles of the lumbar spine can all contribute, together with the sensitivity of the nervous system.
Common symptoms
- Aching or sharp pain in the low back
- Stiffness and muscle spasm
- Pain with bending, lifting or prolonged sitting
Causes and risk factors
- Lifting or bending when unaccustomed or fatigued
- Physical inactivity
- Stress, poor sleep and low mood
- Smoking and obesity are associated risk factors
Physiotherapy assessment
- History and red-flag screening
- Psychosocial factors (e.g. the STarT Back tool)
- Movement and neurological examination
- Imaging is not routinely recommended
Treatment objectives
- Reassurance and understanding
- Stay active and return to normal activity
- Build strength and confidence in movement
Physiotherapy approaches
Education & self-management · Strengthening exercises · Core stabilisation · Functional training · Joint mobilisation · Superficial heat therapy
Rehabilitation exercises (examples)
Cat–cow stretch · Bird dog · Pelvic tilts · Bridges · Core stabilisation (dead bug)
Recovery and progression
Most acute episodes improve substantially within weeks; recurrence is common. NICE NG59 recommends exercise and self-management, with manual therapy only alongside exercise.
Prevention and self-care
- Regular physical activity
- Gradual increases in lifting tasks
- Varied postures
Lumbar disc herniationMaterial from the centre of an intervertebral disc protrudes through the outer layer and may irritate a nerve root..
Material from the centre of an intervertebral disc protrudes through the outer layer and may irritate a nerve root.
Relevant anatomy
Most commonly at the L4–L5 and L5–S1 discs, affecting the L5 or S1 nerve root.
Common symptoms
- Low back pain
- Leg pain below the knee, often worse than the back pain
- Numbness, tingling or weakness in the leg or foot
- Pain worse on sitting, coughing or sneezing
Causes and risk factors
- Age-related disc changes
- Lifting with bending and twisting
- Genetic factors
- Smoking
Physiotherapy assessment
- Neurological examination
- Straight leg raise and slump tests
- MRI if symptoms persist or surgery is considered
Treatment objectives
- Reduce leg pain
- Maintain activity
- Restore strength and movement
Physiotherapy approaches
Education & self-management · Neural mobilisation · Core stabilisation · Strengthening exercises · Functional training
Rehabilitation exercises (examples)
Pelvic tilts · Cat–cow stretch · Bird dog · Bridges
Recovery and progression
Many disc herniations shrink and symptoms improve over time without surgery. Surgery may be considered for persistent severe leg pain or progressive weakness.
Prevention and self-care
- Regular exercise and core strength
- Good lifting technique and avoiding sudden load spikes
Seek urgent medical advice if:
- Bladder or bowel changes or saddle numbness (possible cauda equina syndrome): go to the emergency department
- Progressive leg weakness or foot drop
SciaticaPain along the course of the sciatic nerve, from the buttock down the back of the leg, usually caused by irritation of a lumbar nerve root..
Pain along the course of the sciatic nerve, from the buttock down the back of the leg, usually caused by irritation of a lumbar nerve root.
Relevant anatomy
The sciatic nerve forms from the L4–S3 roots and runs through the buttock and down the back of the thigh.
Common symptoms
- Leg pain below the knee
- Burning, shooting or electric pain
- Tingling or numbness in the leg or foot
- Weakness in some cases
Causes and risk factors
- Disc herniation (most common)
- Spinal or foraminal stenosis
- Less commonly, problems in the buttock region
Physiotherapy assessment
- Neurological examination
- Straight leg raise and slump tests
- Red-flag screening
Treatment objectives
- Reduce pain
- Keep moving and working where possible
- Restore nerve mobility and strength
Physiotherapy approaches
Education & self-management · Neural mobilisation · Strengthening exercises · Functional training · Core stabilisation
Rehabilitation exercises (examples)
Pelvic tilts · Bridges · Bird dog
Recovery and progression
Most sciatica improves over weeks to months. NICE NG59 advises exercise and self-management; urgent review is needed for neurological red flags.
Prevention and self-care
- Stay active
- Back and hip strength
Seek urgent medical advice if:
- Bladder or bowel changes, saddle numbness, or sciatica in both legs: emergency assessment
ScoliosisA sideways curve of the spine with rotation of the vertebrae.
A sideways curve of the spine with rotation of the vertebrae. Adolescent idiopathic scoliosis is the most common type.
Relevant anatomy
The thoracic and/or lumbar spine curves to the side and rotates, creating a rib hump on bending.
Common symptoms
- Uneven shoulders, waist or hips
- A rib hump on bending forward
- Back pain in some adults
Causes and risk factors
- Idiopathic (no known cause) in most adolescents
- Congenital or neuromuscular causes
- Degenerative scoliosis in older adults
Physiotherapy assessment
- Adam’s forward bend test and scoliometer
- X-ray to measure the Cobb angle
- Monitoring during growth
Treatment objectives
- Monitor the curve during growth
- Maintain strength, flexibility and posture
- Reduce pain in adults
Physiotherapy approaches
Strengthening exercises · Core stabilisation · Education & self-management · Flexibility exercises
Rehabilitation exercises (examples)
Bird dog · Cat–cow stretch · Core stabilisation (dead bug)
Recovery and progression
Management depends on age, growth remaining and curve size: observation, scoliosis-specific exercise, bracing or, for large curves, surgery.
Prevention and self-care
- Early detection through screening during growth
Postural dysfunctionDiscomfort associated with sustained or habitual postures.
Discomfort associated with sustained or habitual postures. Posture alone rarely explains pain, but long periods without movement can lead to aches.
Relevant anatomy
Increased thoracic curve, rounded shoulders or prolonged slumped sitting change the load on spinal joints and muscles.
Common symptoms
- Aching in the neck, upper or lower back after sitting or standing
- Relief with movement
Causes and risk factors
- Long periods of sitting
- Low activity and muscle endurance
- Workstation set-up
Physiotherapy assessment
- Observation of posture and movement
- Thoracic mobility
- Endurance testing
- Work habits
Treatment objectives
- Improve movement variety and endurance
- Ergonomic changes
- Reduce symptoms
Physiotherapy approaches
Education & self-management · Strengthening exercises · Range of motion exercises · Functional training
Rehabilitation exercises (examples)
Scapular retraction · Cat–cow stretch · Bird dog · Chin tucks
Recovery and progression
Symptoms usually ease with regular movement and exercise; the best posture is the next posture.
Prevention and self-care
- Regular movement breaks
- Regular exercise
Mechanical back painBack pain that changes with movement, posture and load, as opposed to constant pain from systemic causes.
Back pain that changes with movement, posture and load, as opposed to constant pain from systemic causes. It overlaps with non-specific low back pain.
Relevant anatomy
Joints, discs, muscles and ligaments of the spine.
Common symptoms
- Pain that varies with bending, sitting, standing or lifting
- Relief with rest or a change of position
- Morning stiffness that eases within about 30 minutes
Causes and risk factors
- Load beyond current capacity
- Prolonged postures
- Deconditioning
Physiotherapy assessment
- Movement and repeated-movement testing
- Red-flag screening
- Strength and endurance testing
Treatment objectives
- Identify easing positions and movements
- Build load tolerance
- Return to full activity
Physiotherapy approaches
Education & self-management · Strengthening exercises · Core stabilisation · Joint mobilisation · Functional training
Rehabilitation exercises (examples)
Cat–cow stretch · Pelvic tilts · Bird dog · Bridges · Core stabilisation (dead bug)
Recovery and progression
Usually improves with graded activity and exercise; flare-ups can be managed with the same strategies.
Prevention and self-care
- Keep active
- Build strength gradually
Seek urgent medical advice if:
- Long morning stiffness (over 30 minutes) improving with exercise in a young adult can suggest inflammatory back pain and needs medical review
Spinal mobility limitationsReduced movement of the spine from stiffness, pain, ageing, inflammatory disease or after injury or surgery..
Reduced movement of the spine from stiffness, pain, ageing, inflammatory disease or after injury or surgery.
Relevant anatomy
The facet joints, discs, ligaments and muscles of the spine and the sacroiliac joints.
Common symptoms
- Stiffness on bending or turning
- Difficulty with tasks such as putting on socks
- Aching after inactivity
Causes and risk factors
- Inactivity
- Age-related changes
- Inflammatory conditions such as axial spondyloarthritis
- After spinal surgery or fracture
Physiotherapy assessment
- Range of motion measurements (e.g. modified Schober test)
- History of inflammatory symptoms
- Functional tasks
Treatment objectives
- Improve and maintain mobility
- Reduce stiffness
- Maintain function
Physiotherapy approaches
Range of motion exercises · Flexibility exercises · Joint mobilisation · Strengthening exercises · Education & self-management
Rehabilitation exercises (examples)
Cat–cow stretch · Pelvic tilts · Bird dog
Recovery and progression
Regular mobility exercise is a key part of long-term management, including in inflammatory conditions alongside medical treatment.
Prevention and self-care
- Daily movement and exercise
Hip & pelvis
Hip osteoarthritisA common joint condition in which the cartilage and bone of the hip change, causing pain and stiffness..
A common joint condition in which the cartilage and bone of the hip change, causing pain and stiffness.
Relevant anatomy
The articular cartilage of the femoral head and acetabulum thins and the bone beneath it changes.
Common symptoms
- Groin or thigh pain on walking
- Stiffness, especially after rest
- Reduced internal rotation
- Difficulty with shoes, socks and getting into a car
Causes and risk factors
- Age
- Previous hip injury or developmental hip conditions
- Genetics
- Higher body weight
Physiotherapy assessment
- Clinical diagnosis from age, activity-related pain and morning stiffness (NICE NG226)
- Range of motion, strength and gait
- X-ray when the diagnosis is unclear or surgery is considered
Treatment objectives
- Reduce pain
- Improve strength and walking
- Maintain an active life
Physiotherapy approaches
Education & self-management · Strengthening exercises · Functional training · Gait training · Joint mobilisation
Rehabilitation exercises (examples)
Bridges · Clamshells · Side-lying hip abduction · Sit to stand
Recovery and progression
Exercise and weight management are core treatments (NICE NG226). Hip replacement is considered when symptoms remain severe despite these.
Prevention and self-care
- Stay active
- Maintain a healthy weight
- Strengthen the hip muscles
Hip bursitis (lateral hip pain)Greater trochanteric pain syndrome: pain on the outer hip, now understood to come mainly from the gluteal tendons rather than the bursa alone..
Greater trochanteric pain syndrome: pain on the outer hip, now understood to come mainly from the gluteal tendons rather than the bursa alone.
Relevant anatomy
The gluteus medius and minimus tendons attach to the greater trochanter, with bursae nearby.
Common symptoms
- Pain on the outside of the hip
- Pain lying on the affected side
- Pain climbing stairs or standing on one leg
Causes and risk factors
- Tendon overload
- Crossing the legs or hanging on one hip
- More common in women after middle age
Physiotherapy assessment
- Tenderness over the greater trochanter
- Pain on single-leg stance for 30 seconds
- FABER and resisted abduction tests
Treatment objectives
- Reduce compression of the tendons
- Progressive tendon loading
- Improve sleep and walking
Physiotherapy approaches
Education & self-management · Strengthening exercises · Resistance training · Functional training
Rehabilitation exercises (examples)
Bridges · Side-lying hip abduction · Clamshells
Recovery and progression
Education and progressive loading exercise showed better long-term results than a corticosteroid injection in a large trial (the LEAP trial).
Prevention and self-care
- Avoid prolonged hip adduction postures
- Progress activity gradually
Piriformis-related painButtock pain sometimes with leg symptoms, attributed to the piriformis muscle irritating the sciatic nerve (deep gluteal syndrome).
Buttock pain sometimes with leg symptoms, attributed to the piriformis muscle irritating the sciatic nerve (deep gluteal syndrome). The diagnosis is debated and made after excluding spinal causes.
Relevant anatomy
The piriformis runs from the sacrum to the greater trochanter; the sciatic nerve passes beneath or occasionally through it.
Common symptoms
- Deep buttock pain
- Pain on sitting
- Sometimes pain down the back of the thigh
Causes and risk factors
- Prolonged sitting
- Overuse in running or cycling
- Direct trauma to the buttock
Physiotherapy assessment
- Exclusion of lumbar spine causes
- Palpation and stretch tests (e.g. FAIR test)
- Neurological examination
Treatment objectives
- Reduce pain
- Improve hip strength and mobility
- Return to sitting and sport
Physiotherapy approaches
Education & self-management · Soft tissue mobilisation · Flexibility exercises · Strengthening exercises · Neural mobilisation
Rehabilitation exercises (examples)
Clamshells · Bridges · Hip flexor stretch
Recovery and progression
Most people improve with exercise and activity changes; persistent cases need re-evaluation for other causes.
Prevention and self-care
- Breaks from sitting
- Balanced hip strength
Hip impingement (FAI)Femoroacetabular impingement syndrome: a shape difference of the femoral head or acetabulum causes abnormal contact, giving hip pain with certain movements..
Femoroacetabular impingement syndrome: a shape difference of the femoral head or acetabulum causes abnormal contact, giving hip pain with certain movements.
Relevant anatomy
Cam (femoral head–neck) or pincer (acetabular rim) shapes can affect the labrum and cartilage.
Common symptoms
- Groin pain with deep hip flexion, sitting or twisting
- Clicking or catching
- Reduced hip rotation
Causes and risk factors
- Bone shape developing during adolescence, especially in high-level sport
- Genetic factors
Physiotherapy assessment
- FADIR test and range of motion
- X-ray to confirm bone shape (the shape is common in people without pain)
- MRI for labral assessment when needed
Treatment objectives
- Reduce pain
- Improve hip strength and control
- Modify provocative positions
Physiotherapy approaches
Education & self-management · Strengthening exercises · Core stabilisation · Functional training
Rehabilitation exercises (examples)
Bridges · Clamshells · Side-lying hip abduction
Recovery and progression
Physiotherapy-led care is a first-line treatment; arthroscopic surgery is considered for some people with persistent symptoms.
Prevention and self-care
- Gradual training load
- Hip and trunk strength
Pelvic instability (pelvic girdle pain)Pain in the sacroiliac joints and/or the pubic symphysis, most often during or after pregnancy..
Pain in the sacroiliac joints and/or the pubic symphysis, most often during or after pregnancy.
Relevant anatomy
The two sacroiliac joints and the pubic symphysis form a ring supported by ligaments and muscles.
Common symptoms
- Pain at the back of the pelvis or over the pubic bone
- Pain turning in bed, on stairs or standing on one leg
- Clicking
Causes and risk factors
- Pregnancy (hormonal and mechanical changes)
- Previous pelvic injury
Physiotherapy assessment
- Pain provocation tests (e.g. posterior pelvic pain provocation test)
- Active straight leg raise test
- Functional assessment
Treatment objectives
- Reduce pain
- Improve load transfer and stability
- Adapt daily activities
Physiotherapy approaches
Education & self-management · Core stabilisation · Strengthening exercises · Taping, bracing, splints & orthoses · Functional training
Rehabilitation exercises (examples)
Bridges · Clamshells · Pelvic tilts · Core stabilisation (dead bug)
Recovery and progression
Most pregnancy-related pelvic girdle pain improves after birth; a minority have longer-lasting symptoms that respond to rehabilitation.
Prevention and self-care
- Exercise before and during pregnancy (with professional advice)
Hip and groin muscle strainsTears of the adductor or hip flexor muscles, common in sports that involve kicking, sprinting and changing direction..
Tears of the adductor or hip flexor muscles, common in sports that involve kicking, sprinting and changing direction.
Relevant anatomy
Adductor longus and the hip flexors (iliopsoas, rectus femoris) are most often involved.
Common symptoms
- Sudden groin pain during sport
- Pain on squeezing the knees together or lifting the leg
- Bruising in more severe strains
Causes and risk factors
- Kicking, sprinting and cutting sports
- Previous groin injury
- Reduced adductor strength
Physiotherapy assessment
- Palpation and resisted tests
- Squeeze test
- Grading of the injury
Treatment objectives
- Protect, then progressively load the muscle
- Restore strength and running
- Return to sport
Physiotherapy approaches
Strengthening exercises · Resistance training · Functional training · Flexibility exercises · Cryotherapy
Rehabilitation exercises (examples)
Bridges · Side-lying hip abduction · Clamshells
Recovery and progression
Return to sport is based on pain-free strength and sport-specific testing.
Prevention and self-care
- Adductor strengthening programmes (e.g. the Copenhagen adduction exercise) reduce groin injuries in football
Thigh & knee
ACL injuriesA sprain or rupture of the anterior cruciate ligament, often during a sudden change of direction or awkward landing..
A sprain or rupture of the anterior cruciate ligament, often during a sudden change of direction or awkward landing.
Relevant anatomy
The ACL runs inside the knee from the front of the tibia to the back of the femur and controls forward sliding and rotation of the tibia.
Common symptoms
- A pop at the time of injury
- Rapid swelling
- Instability or giving way
- Difficulty returning to pivoting sports
Causes and risk factors
- Pivoting, cutting and landing in sport
- Knee collapsing inwards (valgus) on landing
- More common in female athletes
Physiotherapy assessment
- Lachman test (the most accurate clinical test)
- Pivot shift and anterior drawer tests
- MRI to assess associated meniscus and cartilage injury
Treatment objectives
- Reduce swelling and restore full extension
- Restore quadriceps strength and neuromuscular control
- Safe return to sport
Physiotherapy approaches
Strengthening exercises · Proprioceptive exercises · NMES · Functional training · Range of motion exercises · Cryotherapy
Rehabilitation exercises (examples)
Static quadriceps (quad sets) · Straight leg raises · Terminal knee extensions · Mini squats · Single-leg balance
Recovery and progression
Rehabilitation, with or without reconstruction, takes many months. Return to sport should be based on strength, hop tests and psychological readiness, not on time alone.
Prevention and self-care
- Neuromuscular warm-up programmes such as FIFA 11+ reduce ACL injuries
- Landing and cutting technique training
Seek urgent medical advice if:
- Rapid swelling after a twisting injury needs assessment
Meniscus injuriesTears of the medial or lateral meniscus, either traumatic (twisting) or degenerative (age-related)..
Tears of the medial or lateral meniscus, either traumatic (twisting) or degenerative (age-related).
Relevant anatomy
The menisci are C-shaped fibrocartilage pads between the femur and tibia.
Common symptoms
- Pain along the joint line
- Swelling over hours
- Catching or locking
- Pain with twisting or deep squatting
Causes and risk factors
- Twisting on a bent, weight-bearing knee
- Age-related degeneration
Physiotherapy assessment
- Joint line tenderness, McMurray’s and Thessaly tests (in combination)
- MRI when it would change management
Treatment objectives
- Reduce pain and swelling
- Restore strength and movement
- Return to function
Physiotherapy approaches
Strengthening exercises · Range of motion exercises · Proprioceptive exercises · Functional training · Education & self-management
Rehabilitation exercises (examples)
Static quadriceps (quad sets) · Straight leg raises · Mini squats · Terminal knee extensions
Recovery and progression
Degenerative tears in middle-aged and older adults usually do well with exercise therapy; trials show arthroscopic partial meniscectomy offers little extra benefit for most. A locked knee needs surgical opinion.
Prevention and self-care
- Leg strength and control
Seek urgent medical advice if:
- A knee locked and unable to straighten
Patellofemoral pain syndromePain around or behind the kneecap, common in adolescents, young adults and runners..
Pain around or behind the kneecap, common in adolescents, young adults and runners.
Relevant anatomy
The patella glides in the trochlear groove of the femur; the joint surfaces and surrounding tissues become sensitive to load.
Common symptoms
- Pain around the kneecap on stairs, squatting, running or prolonged sitting
- Usually no swelling or giving way
Causes and risk factors
- Increase in training load
- Reduced quadriceps and hip strength
- Changes in running or jumping volume
Physiotherapy assessment
- Pain on squatting
- Hip and knee strength
- Movement assessment (step-down)
- Training history
Treatment objectives
- Reduce pain
- Build hip and knee strength
- Manage training load
Physiotherapy approaches
Strengthening exercises · Education & self-management · Taping, bracing, splints & orthoses · Functional training
Rehabilitation exercises (examples)
Mini squats · Clamshells · Side-lying hip abduction · Bridges · Sit to stand
Recovery and progression
Combined hip and knee strengthening with education is supported by the 2019 JOSPT clinical practice guideline; symptoms can be persistent, so a long-term plan is useful.
Prevention and self-care
- Gradual training progression
- Hip and quadriceps strength
Knee osteoarthritisA common joint condition in which the cartilage, bone and soft tissues of the knee change, causing pain, stiffness and reduced function..
A common joint condition in which the cartilage, bone and soft tissues of the knee change, causing pain, stiffness and reduced function.
Relevant anatomy
Cartilage thins, bone changes and osteophytes develop, most often on the inner (medial) side of the knee.
Common symptoms
- Pain on walking, stairs and standing up
- Morning stiffness lasting less than about 30 minutes
- Swelling and creaking
- Reduced function
Causes and risk factors
- Age
- Previous knee injury or surgery
- Higher body weight
- Genetics
Physiotherapy assessment
- Clinical diagnosis (NICE NG226)
- Strength, range of motion and gait
- Functional tests such as the 30-second chair stand
Treatment objectives
- Reduce pain
- Increase strength and physical function
- Weight management where relevant
Physiotherapy approaches
Strengthening exercises · Education & self-management · Functional training · Gait training · Joint mobilisation · Taping, bracing, splints & orthoses
Rehabilitation exercises (examples)
Static quadriceps (quad sets) · Straight leg raises · Sit to stand · Mini squats · Terminal knee extensions
Recovery and progression
Exercise is a core, long-term treatment and benefits pain and function at all stages. Knee replacement is considered for severe symptoms despite these treatments.
Prevention and self-care
- Stay active and strong
- Maintain a healthy weight
- Prevent and rehabilitate knee injuries
Runner’s knee (iliotibial band syndrome)“Runner’s knee” is used for both patellofemoral pain and iliotibial band syndrome.
“Runner’s knee” is used for both patellofemoral pain and iliotibial band syndrome. Here it refers to iliotibial band syndrome: pain on the outside of the knee in runners and cyclists.
Relevant anatomy
The iliotibial band passes over the lateral femoral epicondyle, where the underlying tissue becomes sensitive to compression.
Common symptoms
- Sharp pain on the outer knee during running, especially downhill
- Pain coming on at a predictable distance
Causes and risk factors
- Rapid increases in running distance
- Downhill running
- Reduced hip strength
Physiotherapy assessment
- Tenderness over the lateral femoral epicondyle
- Noble compression test
- Running and training load analysis
Treatment objectives
- Reduce pain
- Adjust training load
- Improve hip strength and running technique
Physiotherapy approaches
Education & self-management · Strengthening exercises · Functional training · Soft tissue mobilisation
Rehabilitation exercises (examples)
Clamshells · Side-lying hip abduction · Bridges · Single-leg balance
Recovery and progression
Load modification and hip strengthening usually allow a gradual return to running.
Prevention and self-care
- Increase running distance gradually
- Hip strength training
Hamstring strainA tear of one or more hamstring muscles, most often the long head of biceps femoris during sprinting..
A tear of one or more hamstring muscles, most often the long head of biceps femoris during sprinting.
Relevant anatomy
The hamstrings run from the ischial tuberosity to below the knee and work hard as the leg swings forward when sprinting.
Common symptoms
- Sudden sharp pain in the back of the thigh
- Pain on walking, stretching or bending the knee against resistance
- Bruising in more severe strains
Causes and risk factors
- Sprinting and high-speed running
- Previous hamstring injury
- Fatigue
- Low eccentric hamstring strength
Physiotherapy assessment
- Palpation and resisted tests
- Range of motion (e.g. active knee extension test)
- MRI in elite sport or suspected tendon avulsion
Treatment objectives
- Protect, then progressively load the muscle
- Restore strength and sprinting
- Prevent re-injury
Physiotherapy approaches
Strengthening exercises · Resistance training · Functional training · Flexibility exercises · Cryotherapy
Rehabilitation exercises (examples)
Bridges · Hamstring stretch · Single-leg balance
Recovery and progression
Recovery depends on the severity. Return to sport is guided by pain-free strength and sprint testing; re-injury is common if rehabilitation is rushed.
Prevention and self-care
- Eccentric hamstring exercise such as the Nordic hamstring curl reduces injury rates
- Regular exposure to high-speed running
Seek urgent medical advice if:
- A large bruise and a felt gap after a forceful injury (possible tendon avulsion): needs prompt assessment
Quadriceps strainA tear of the quadriceps muscles, most often rectus femoris, during kicking or sprinting..
A tear of the quadriceps muscles, most often rectus femoris, during kicking or sprinting.
Relevant anatomy
Rectus femoris crosses both the hip and the knee, which makes it more vulnerable during kicking.
Common symptoms
- Pain at the front of the thigh
- Pain on kicking, sprinting or straightening the knee against resistance
Causes and risk factors
- Kicking and sprinting
- Previous strain
- Fatigue
Physiotherapy assessment
- Palpation and resisted tests
- Range of knee flexion (e.g. prone knee bend)
- Rule out a contusion (dead leg)
Treatment objectives
- Progressive loading
- Restore kicking and running
Physiotherapy approaches
Strengthening exercises · Resistance training · Functional training · Flexibility exercises · Cryotherapy
Rehabilitation exercises (examples)
Static quadriceps (quad sets) · Straight leg raises · Mini squats
Recovery and progression
Graded loading and sport-specific progression guide the return to sport.
Prevention and self-care
- Warm-up and progressive kicking load
Lower leg, ankle & foot
Plantar fasciitisPlantar heel pain from the plantar fascia where it attaches to the heel bone (also called plantar fasciopathy)..
Plantar heel pain from the plantar fascia where it attaches to the heel bone (also called plantar fasciopathy).
Relevant anatomy
The plantar fascia runs from the medial tubercle of the calcaneus to the toes.
Common symptoms
- Sharp heel pain with the first steps in the morning or after sitting
- Pain after long periods of standing
- Tenderness under the inner heel
Causes and risk factors
- Increased standing, walking or running
- Higher body weight
- Reduced ankle dorsiflexion
- Unsupportive footwear
Physiotherapy assessment
- Palpation of the medial calcaneal tubercle
- Windlass test
- Ankle dorsiflexion range (knee-to-wall)
- Screening for nerve entrapment or stress fracture
Treatment objectives
- Reduce pain
- Improve load tolerance
- Address calf flexibility and foot strength
Physiotherapy approaches
Flexibility exercises · Strengthening exercises · Taping, bracing, splints & orthoses · Education & self-management · Manual stretching
Rehabilitation exercises (examples)
Plantar fascia and calf towel stretch · Calf stretch against a wall · Calf raises
Recovery and progression
Most people improve with conservative care, though it can take months. The 2023 JOSPT heel pain guideline supports stretching, taping, orthoses and manual therapy.
Prevention and self-care
- Gradual increases in standing or running
- Supportive footwear
- Calf flexibility and strength
Achilles tendinopathyPain and reduced load tolerance of the Achilles tendon, either in its middle portion or where it attaches to the heel..
Pain and reduced load tolerance of the Achilles tendon, either in its middle portion or where it attaches to the heel.
Relevant anatomy
The Achilles tendon joins the gastrocnemius and soleus to the calcaneus.
Common symptoms
- Pain and stiffness in the Achilles, worse in the morning
- Pain at the start of activity that may ease, then return afterwards
- A thickened, tender tendon
Causes and risk factors
- Rapid increases in running or jumping
- Reduced calf strength
- Age, higher body weight and some medicines (e.g. fluoroquinolone antibiotics)
Physiotherapy assessment
- Palpation and the arc sign
- Single-leg heel raise endurance
- Ultrasound when the diagnosis is uncertain
Treatment objectives
- Load management
- Progressive tendon loading
- Return to running and sport
Physiotherapy approaches
Strengthening exercises · Resistance training · Education & self-management · Functional training
Rehabilitation exercises (examples)
Calf raises · Calf stretch against a wall · Single-leg balance
Recovery and progression
Progressive calf loading programmes are the main treatment and usually take several months; complete rest is not recommended.
Prevention and self-care
- Gradual increases in training
- Calf strength
Seek urgent medical advice if:
- A sudden snap or feeling of being kicked in the heel with weakness: possible rupture, seek same-day assessment
Ankle sprainsAn injury to the ankle ligaments, most often the lateral ligaments when the foot rolls inwards..
An injury to the ankle ligaments, most often the lateral ligaments when the foot rolls inwards.
Relevant anatomy
The anterior talofibular ligament (ATFL) is most commonly injured, followed by the calcaneofibular ligament.
Common symptoms
- Pain and swelling on the outer ankle
- Bruising
- Difficulty walking
- Later, a feeling of instability
Causes and risk factors
- Rolling the ankle in sport or on uneven ground
- A previous sprain (the strongest risk factor)
Physiotherapy assessment
- Ottawa ankle rules to decide whether an X-ray is needed
- Ligament tests (anterior drawer, talar tilt)
- Balance and strength testing
Treatment objectives
- Early protected weight-bearing and movement
- Restore strength and balance
- Prevent repeat sprains
Physiotherapy approaches
Balance training · Proprioceptive exercises · Strengthening exercises · Taping, bracing, splints & orthoses · Cryotherapy · Range of motion exercises
Rehabilitation exercises (examples)
Ankle pumps · Ankle circles · Resistance band ankle exercises · Single-leg balance · Calf raises
Recovery and progression
Most sprains improve within weeks; completing balance and strength training reduces the risk of repeat sprains and chronic instability.
Prevention and self-care
- Balance training
- Bracing or taping after a previous sprain
Seek urgent medical advice if:
- Unable to bear weight or bony tenderness: X-ray to rule out fracture
Shin splintsMedial tibial stress syndrome: pain along the inner border of the shin with running or jumping..
Medial tibial stress syndrome: pain along the inner border of the shin with running or jumping.
Relevant anatomy
The bone and its covering (periosteum) along the lower two-thirds of the medial tibia react to repeated load.
Common symptoms
- Diffuse pain along the inner shin with exercise
- Tenderness over a length of the bone
Causes and risk factors
- Sudden increase in running
- Hard surfaces
- Previous injury
- Low bone health and energy availability
Physiotherapy assessment
- Palpation (diffuse tenderness)
- Exclusion of stress fracture (focal tenderness, hopping pain, night pain)
- Training load review
Treatment objectives
- Load reduction, then gradual return
- Calf strength
- Address risk factors
Physiotherapy approaches
Education & self-management · Strengthening exercises · Functional training · Cryotherapy
Rehabilitation exercises (examples)
Calf raises · Single-leg balance · Calf stretch against a wall
Recovery and progression
Usually settles with relative rest and graded return to running.
Prevention and self-care
- Gradual training progression
- Adequate nutrition and recovery
Seek urgent medical advice if:
- Focal bone pain, pain at rest or at night: possible stress fracture
Flat feetA low or collapsing medial arch (pes planus).
A low or collapsing medial arch (pes planus). Flexible flat feet are common and often cause no problems.
Relevant anatomy
The medial longitudinal arch is supported by bones, the plantar fascia, ligaments and muscles such as tibialis posterior.
Common symptoms
- Often none
- Aching in the arch or inner ankle
- Tiredness in the feet and legs
Causes and risk factors
- Genetics and joint laxity
- Tibialis posterior tendon dysfunction in adults
- Higher body weight
Physiotherapy assessment
- Foot posture assessment
- Single-leg heel raise (arch should form)
- Tibialis posterior strength
Treatment objectives
- Reduce symptoms if present
- Strengthen foot and calf muscles
- Footwear advice
Physiotherapy approaches
Strengthening exercises · Taping, bracing, splints & orthoses · Education & self-management · Balance training
Rehabilitation exercises (examples)
Calf raises · Single-leg balance · Resistance band ankle exercises
Recovery and progression
Painless flexible flat feet do not need treatment. Painful or progressive flat feet in adults should be assessed.
Prevention and self-care
- Foot and calf strength
- Appropriate footwear
Seek urgent medical advice if:
- A newly collapsing arch on one side in an adult needs assessment (tibialis posterior dysfunction)
Foot and ankle mobility problemsReduced ankle and foot movement, often after a fracture, a sprain, immobilisation in a cast or boot, or from arthritis..
Reduced ankle and foot movement, often after a fracture, a sprain, immobilisation in a cast or boot, or from arthritis.
Relevant anatomy
The talocrural and subtalar joints and the calf muscles determine much of the ankle’s range.
Common symptoms
- Stiffness, especially walking up stairs or squatting
- Altered walking pattern
- Swelling after activity
Causes and risk factors
- Immobilisation after injury or surgery
- Ankle arthritis
- Calf tightness
Physiotherapy assessment
- Weight-bearing dorsiflexion (knee-to-wall test)
- Joint mobility
- Gait and balance
Treatment objectives
- Restore range of motion
- Normalise walking
- Rebuild strength and balance
Physiotherapy approaches
Joint mobilisation · Range of motion exercises · Flexibility exercises · Strengthening exercises · Gait training · Balance training
Rehabilitation exercises (examples)
Ankle pumps · Ankle circles · Calf stretch against a wall · Calf raises · Single-leg balance
Recovery and progression
Range improves progressively with exercise and, where suitable, joint mobilisation; follow the surgeon’s weight-bearing advice after fractures.
Prevention and self-care
- Early movement where safe after injury
References and sources
Content is written by physiotherapists for education, summarising widely used clinical guidelines and textbook anatomy. Evidence labels describe the general state of research and do not apply to every person.
- NICE NG59: Low back pain and sciatica in over 16s: assessment and management (2016, updated 2020)
- NICE NG226: Osteoarthritis in over 16s: diagnosis and management (2022)
- JOSPT clinical practice guidelines: Neck pain (2017), Patellofemoral pain (2019), Lateral ankle ligament sprains (2021), Heel pain – plantar fasciitis (2023), Achilles pain (2018), Knee pain and mobility impairments: meniscal and articular cartilage lesions (2018)
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