What makes it a Sports Massage? by Matt Scarsbrook

What makes it a Sports Massage?

Sitting down to write this piece has opened up a rabbit’s hole, nay an entire warren, of topics surrounding massage therapy, its history and potentially its future – of which I am very lucky to be a part.  But I shall save those details for another day, because I intend to keep this fairly brief for the time-pressed readers among you.

Where massage, or a form of therapeutic touch, originated from is difficult to pin down and is likely to be as old as humanity itself.  Our instinct to rub a sore spot could conceivably have led to offering to treat others’ hard-to-reach places (such as the back – a favourite treatment area for many clients!) and there are references aplenty demonstrating the practice of massage in the ancient cultures of China, Egypt, India, Greece, and so on.

A massage therapist massaging a woman's calf muscle

Indeed it seems that massage has waxed and waned as an orthodox, mainstream treatment for peoples aches and pains over the centuries but it was the introduction of Swedish Massage in a gymnastics setting (accredited in the 1800’s to Per Henrik Ling and developed further by Johan Georg Mezger) that appears to have set the foundation for remedial massage in the West.  After scandals caused by the sex industry, the Society of Trained Masseuses was formed in 1894 in the UK, developing over time and in 1944 becoming The Chartered Society of Physiotherapy, as it stands to this day.

However, as the new profession of Physiotherapy looked to broaden its scope of practice (developing some great new approaches along the way) the focus on massage was reduced until it disappeared almost entirely from undergraduate physiotherapy training.  My wife is a physiotherapist and was taught massage skills for only a few days within a 3-year degree. In contrast, my qualification followed a full year focussed purely on massage techniques and their role in injury rehab.

It was then in the 1980’s, during the first running boom, that industry leaders such as Mel Cash (Founder and Director of the London School of Sports Massage (LSSM) and the Institute of Sports and Remedial Massage (ISRM), of which I am a member) started to explore the application of massage to a sporting context, with the benefits quickly becoming obvious to therapists and athletes alike.  The blending of ‘traditional’ massage techniques with advanced methods used by Osteopaths led to the development of the highest level of massage qualification – ‘Soft Tissue Therapy’, whose practitioners are experts in assessing, treating and rehabilitating a range of minor and chronic injuries and painful conditions.  

So how does this circle back to Sports Massage?  Well, fundamentally ‘Massage’ is… massage, and ‘Sports Massage’ is massage given in a sporting context – be that pre- or post-competition or training, or performed on an athlete/sports person.  However, it is commonly misconstrued as ‘like massage but harder’, and almost by inference, ‘painful’!  Yet – It doesnhave to hurt, and thanks to advances in research we can extrapolate with some confidence as to why…

Scientific research into the efficacy of massage is, frankly, pretty poor.  When comparing the quality of the research available to us, if massage was a pill sold by a pharmaceutical company then you’d seriously question any doctor willing to prescribe it!  However, we can make cautious assumptions about what is occurring in the body when it is receiving massage based on our understanding of the neural responses to touch (1)(2) helping us to dispel myths and/or question unsupported claims about ‘energy flows’, ‘releasing’ sticky layers of tissue, ‘affecting blood circulation’ (3) and so on.  We are now far more comfortable with the notion that the majority of the effects of massage impact on the recipients’ nervous system, notably the autonomic system, which may explain the marked improvements clients can experience in their mood (specifically depression and anxiety) (4), range of movement, pain perception, and overall well-being.  We know that in and of itself, massage is seldom a cure for someone’s ills, but based on the evidence available, we understand that it can form an important part of a client’s journey to enhanced movement, reduced pain (5), and ultimately greater fulfilment in life.  When properly paired with informed assessment and evidence-based rehabilitation advice, massage can provide a window of opportunity for clients to take responsibility for their own health improvements – be they an elite athlete, or someone wanting to enjoy playing with their grandchildren

  1. Massage-StLouis.com [Internet]. Sanvito A. How Does Massage Work?; 2016 December 31 [cited 3rd December 2019]]
  2. Loken LS, Wessberg J, Morrison I, McGlone F, Olausson H. Coding of pleasant touch by unmyelinated afferents in humans. Nature Neuroscience. 2009 May;12(5):547–548.
  3. Shoemaker JK, Tidus PM, Mader R. Failure of manual massage to alter limb blood flow: Measures by Doppler ultrasound. Medicine & Science in Sports & Exercise. 1997;1:610–14
  4. Moyer CA. Affective massage therapy. Int J Ther Massage Bodywork. 2008;1(2):3–5.
  5. Jane SW, Chen SL, Wilkie DJ, Lin YC, Foreman SW, Beaton RD, Fan JY, Lu MY, Wang YY, Lin YH, Liao MN. Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: A randomized clinical trial. Pain. 2011 Oct;152(10):2432–42.

Tired Calves & Feet while skiing? by Jo Pollard

Get tired calves and feet while skiing & snowboarding? Here’s why & ways to help prevent it



When it comes to ski and snowboard training we often to tend to focus on the juicy exercises involving the quads, gluts and hamstrings.  However when hitting the slopes, most of us feel that our calves ache, and feet get tired, right?  Any pre-ski training should involve exercises to work the muscles below our knees, not only our calves, but our peroneals, posterior and anterior tibilais muscles.  All these muscles stabilise the foot and consequently the knee.  These muscles, if not strong or able to cope with the demand whilst skiing and snowboarding, can cause uncomfortable cramps, or worse become pulled or strained.

Specifically snowboarders – do you ever feel like your calves and feet are on fire while on your toe edge snowboarding? Definitely give these exercises a go to give you more stamina and hold those edges longer! – no gym equipment or excuses needed!


** If you think you have an injury or weakness it is always best to have a consultation and a specific exercise plan – get in touch for more info.  Be particularly aware if you have history of Achilles tendinitis



Start this exercise with your foot flat on the floor.  No trainers, or only minimalist shoes are good to encourage more stability in your foot.  This differs slightly from off the step calf raises – your ankle and foot must work hard to maintain alignment and balance.  This exercise can be done in sets such as x12 reps x 3sets and/or static holds to build endurance – i.e try holding the position 1 min at a time x3

Off a step is good for adding weight to increase calf complex strength and also achieving a mechanical stretch.  Allow yourself to be balanced with heels off  step  -raise all the way up and then drop the heels all the way down.  Unlike the variation above, I advise you hold on so that you can work on strength and add weight (no gym needed – using a back pack full of books is just as good.  Start with free body weight.  When you can complete x12 x3 easily, then start to add weight).



This is exactly the same as the exercise above, but with the knees bent.  Why?  Because there is another very important muscle lying under the calf, called the soleus, which also needs to be exercised.  It works hard constantly to maintain even just you standing upright – but particularly hard so that you don’t fall over skiing.  Its also going to allow snowboarders to stay more balanced and strong on their snowboarding toe edge.  Exercising this muscles will help to prevent that toe edge burn kicking in as quickly!




Following on from the exercises above, this exercise is designed to add a bit more instability and challenge – just like you would be faced with when out on the ski slopes.  Try and maintain balance with knees bent, while throwing and catching.  This is best done with a partner so you can challenge your throws!  However on your own, a wall is good enough!




As the exercise above – but with the knee straight to focus more on the calf muscle




While skiers need strength in this muscle, this one is focused more for the snowboarders.  It targets the muscle at front of your shin, known as your tibialis anterior. At any stage of snowboarding, if this muscle is strong it will certainly help.  While you are learning this muscle is constantly battling to try and maintain your balance on those tricky edges!  As you ride more, those challenging traverses often need stability and endurance from this muscle to maintain your heel edge.  Most snowboarders will be familiar with the burn and dreaded fear of  a heel edge traverse!  These exercises will certainly help:

  1. toe taps: keep the foot flat and try and tap your toes up and down as quickly and as many times as you can in 30secs (you will find this harder than you may think) – repeat 3-5 times.  You can then add a flat (disc) weight if at the gym and try and lift the weight up.  At home a bag of sugar or similar can work.
  2. pogos: imagine you are skipping with a rope – but you are going to keep you feet flat – i.e. not jump on your toes as normal.  Perform these flat footed bounces as fast as you can – again aim 30 secs x3 – 5 (think to focus on weight through the heels, and keep the toes lifted up)



PLYOMETRICS: peroneals

The aim of this exercise is to work on plyometrics and eccentric load for the muscles on the outside your lower leg.  These muscles again are vital in stabilising the foot in skiing and snowboarding – but particularly in snowboarding.  Often these muscles have to work in a slightly lengthened position, or have to fight mixed terrain within the snowpack, so need this ‘reactive’ type of strength and stability.

Start standing on a step (or your stairs).  Start from two feet and hop down onto one foot.  As soon as your foot makes contact with the floor, immediately hop up and think to flick your toes inwards (like tapping a ball inwards with your big toe), before your foot comes back down to land neutral.

This can be slightly progressed by starting single leg on the step and jumping off, landing, then hoping straight off that same side.


There are many exercises that can help –  here are just a selection.  Any single leg reaching with the foot or arm, or balance cushions and wobble boards are all great ways to do this.  You do not have to do this as a complete workout-  you may prefer to add one or two of these exercises at the end of your normal workout.

Future blogs I will look at some more balance focused exercises which will also help the endurance and stability of these muscles, which will hopefully allow you to ride better for longer!

Ali Burlingham: Women’s Wellbeing Talk

We enjoyed a great training afternoon last week with Ali Burlingham. Founder of Women's Wellbeing and a Holistic Core Restore Coach. Learning about pre and postnatal physical, anatomical and emotional changes and how we can help mums to be! 

A bit about Ali: 

Having worked in the pregnancy and postnatal industry for the past five years I took the opportunity in 2018 to build my own business, centred around women’s health.

My own pregnancy journey to motherhood was a steep learning curve but one I thrived in, so much so that my interest in pregnancy, birthing and motherhood grew. Combining the experience of having three children, my own professional expertise and passion for education this naturally developed into a career centred around women.

I am passionate about educating women about their bodies, capabilities and choices throughout the main stages of their lives – pregnancy, postnatal (you are always postnatal after a baby!) menopause and beyond.

I teach KGH Hypnobirthing ® classes either 1-2-1 or in a group, as well as refresher courses for those that have experienced this incredible journey before. Alongside this I am a Holistic Core Restore ® coach and offer Everywoman Courses again 1-2-1 or in a group. My work is based in North Somerset and South Bristol.

I will always be happy to give you advice or signpost you to other professionals that I recommend and work with if that is the most appropriate next step. So please feel free to contact me via the link on FaceBook or email me at aliburlingham71@gmail.com"

We enjoyed refreshing our education on the trimesters - including the new addition of the fourth trimester! It was interesting to discuss the various changes the body and mind go through to accommodate the growing baby. We learnt various techniques and several factors to consider when treating pregnant ladies. Lastly, we learnt that there is a huge network of people to help our understanding of women's health.

Please see Ali's pages for more info!



And our pages for more on pregnancy massage: 


Basketball England Head of Physiotherapy & Sports Science – Andy Howse

Andy has recently been made Basketball England‘s Head of Physiotherapy & Sports Science – Congratulations to Andy from the Team! 

Andy is also Head of Sports Science and Medicine for British Basketball, a post he was appointed to in October 2018! Fantastic achievements and well deserved.

Read more below! 

Bristol Physio Birdwell

****Birdwell Clinic****New Location****

Diane Ouzman is retiring from her physiotherapy practice at Birdwell Clinic after 30 years serving Long Ashton and the surrounding community. However, the physiotherapy practice will be passing into good hands and merging with Bristol Physio to form Bristol Physio Birdwell.

Bristol Physio Ltd would like to wish Diane all the best for her well deserved retirement and hope she enjoys every minute of it! 

Bristol Physio Ltd has taken over from January 2nd 2019

 We warmly welcome our new staff members Gemma and Inga! Gemma Addison is taking over from Diane and is also practicing from our Clifton location. Inga Rogers will be continuing at the practice in Birdwell.   

Gemma. Birdwell - Bristol Physio
Inga Rogers. Birdwell - Bristol Physio

Bristol Physio Birdwell will be our 4th clinic with 3 other clinic sites throughout Bristol and North Somerset. Bristol Physio Ltd are determined to provide you with the same great service. We are registered with all major insurance companies.

  All our therapists have over 5 years experience enabling us to offer the the latest in evidenced based treatment options:

  • Shockwave Therapy
  • Joint manipulation
  • Soft tissue massage and manipulation
  • Gait assessment including running assessments
  • Rehabilitation
  • Injury Diagnosis
  • Pre & Post Operative Rehabilitation
  • Ultrasound Diagnostics
  • Injection Therapy
  • Acupuncture
  • Pregnancy Massage
  • Hydrotherapy
  • Biomechanical Assessments
  • Podiatry

To get an appointment at Bristol Physio Birdwell please go online to bristolphysio.com or phone 01179237506.  All appointments are 40 minutes long.  

Shockwave Therapy & New machine Jan 2019!

~ new machine jan 2019!! ~


by Charlotte Page - Sports Therapist 

What is it?

Extracorporeal shockwave therapy is a non-evasive, non-electrical, high energy sound wave that passes through the soft tissue via a hand-held gun-like attachment. The sound wave combines with a pressure wave to create a unique treatment that breaks down scar tissue and boosts circulation and collagen production. This promotes renewed recovery, healthier tissue and more efficient muscles, tendons and ligaments.”​

What Does This Mean?

  • Extracorporeal = 'outside the skin' 
  • Non-evasive = 'does not pierce the skin or enter any orifice'

Shockwave is similar to ultrasound in the type of energy that is being directed through your skin. 

A sound wave has a high frequency (higher than we can hear) and we alter the amplitude (or pressure) to create a different intensity of treatment.  

Sound Wave

This wave interacts with your cells within your muscle, tendon or ligament and causes them to vibrate. This movement boosts circulation to the area. The higher the amplitude (or pressure) the more these cells vibrate - eventually they break down and are processed by your body's 'waste management' lymphatic system. We target old cells and scar tissue within shockwave therapy.  

The process is pro-inflammatory, meaning that the treatment stirs everything up and annoys the area to boost your body's natural inflammatory response. 

What is Shockwave For?

  • Chronic Injuries
  • Tennis Elbow/Golfer's Elbow
  • Plantar fascitiis
  • Patellar tendinopathy or Osgood-Schlatters disease
  • Achilles tendinopathy or Severs Disease
  • Chronic ankle sprains
  • Frozen shoulder or Rotator Cuff strains
  • Hand Pain (De Quervain's, trigger finger)
  • Bursitis (hip, elbow, knee)
  • Muscle strains (hamstring, calf)
  • Back pain

How Does It Feel/what to Expect?

We place some ultrasound gel on the treatment site which can be a little chilly! You will hear a loud clicking sound when the treatment has started.

Most patients feel a tapping sensation which varies from barely noticeable to quite heavy, depending on the location of the treatment and the issue being treated. Some patients also feel a slight stinging or pinching sensation, this is normal and is linked to how close bone is to the treatment site. 


Treatment usually lasts between 2 and 5 minutes (depending on the frequency we select for your injury).

Each injury will require 3 to 6 sessions, these are repeated between 3 and 10 days apart. 

Am I allowed to have shockwave?

Due to the nature of shockwave as a pro-inflammatory treatment there are a few cases where it would not be advised. 

You must not have shockwave if you:

  • Are pregnant
  • Have a blood clotting disorder (including thrombosis)
  • Are taking oral anti-coagulants (warfarin/heparin)
  • Received a Steroid injection within 6 weeks (cortisol or similar)
  • Have a Pacemaker fitted
  • Have tumours present at the treatment site
  • Are Under 18 (except in the treatment of Osgood-Schlatter disease)
pregnancy massage.
Guided Injection. Hydrodilatation. Steriod

What else?

Shockwave Therapy is always used as part of a treatment process. You will be assessed and diagnosed and the treatment options explained to you. If you and your injury are eligible you will be recommended shockwave by your therapist. 

Typically in each treatment will include assessment, soft tissue work, shockwave, occasionally acupuncture, and rehabilitation exercises.

~ new machine  jan 2019!! ~

Shockwave Masterplus 50

~ All of our physios and sports therapists are qualified and experienced in providing shockwave therapy ~

Pregnancy Massage

At Bristol Physio we can offer massage through all trimesters of your pregnancy and post natal too. We advise you to consult your GP or midwife before booking in for pregnancy massage if you have any concerns, particularly if you are experiencing morning sickness or have a high-risk pregnancy.

During the nine months of pregnancy, the human body goes through many changes to accommodate the baby and to prepare the body for labour. These changes can make things a little uncomfortable, whether it is lower back pain from the weight of the baby or pelvic pain from relaxed ligaments. Massage is an excellent way to help your body and mind cope with these changes.  

All of our appointments are around an hour long depending on your comfort and needs, we can work on a particular area or treat your whole body. Typically you will be treated in side lying and/or sat up - feel free to bring your favourite pillow or cushions for your comfort. 

Pregnancy massage is very beneficial throughout the pregnancy for many women for a variety of reasons: 

  • Reduce Cramping
  • Lower risk of Varicose Veins
  • Lower risk of High Blood Pressure
  • Reduce Stretch Marks
  • Relieve Sciatica
  • Induce Better Sleep
  • Promote Wellbeing

Massage during pregnancy is fairly similar to 'usual' massage. Typically, the strokes are much lighter than sports massage and focus on problem areas. Our therapists are also more aware of good positioning of yourself and bump and will monitor your comfort. We will also give you advice on stretches, gentle exercises and self massage techniques

Skiing tips for beginners

I have recently gone skiing for the first time and I thought I’d share some helpful insights on trying out the sport.  I’ll try and give some general advice on picking up skills and some physio advice on preparation and injury prevention.


General tips:

  1. I found this intro to skiing video really useful for just knowing how to carry the skis! There’s also a nice insight on what to expect (until he starts talking about jumping!) https://www.youtube.com/watch?v=_yfFGDuJ2g0&t=897s 
  2. Take sun block and lip protection. A minimum of SPF 50. Good pair of sports sunglasses are also essential.
  3. Shop around for things like Salopettes, Jacket and gloves. Don’t go expensive, you may not want to go again! We got some great stuff in Go Outdoors.
  4. Kit hire: we used Ski Set where we hired skis, poles, boots and helmet.

Please wear a helmet, you only get one noodle and as a beginner you will be falling!

  1. Make sure you are happy with your boots. That was the advice given to me by most when talking about skiing. You can take them back if you’re not happy after 1, 2 or 3 days!
  2. When walking to the ski lift don’t do up the top straps it’s so much easier to walk.
  3. Go to Ski School! It’s worth every penny. The instructor will select the most appropriate places to ski for your level. They can also teach you about what it means to ski in the different conditions (fresh snow or poor visibility, for example). We used ESF (A French Ski School which is well known across the French resorts).


Physio tips:

  1. Strengthen up! Target your glutes and quads (thighs), but you would benefit from all muscle groups in your legs. Do repetitions up to a light burn and in sets of 3.  You will not get stronger unless you get the muscle to the fatigue point (burn).
  • Crab walks
  • Sumo squats
  • Step ups
  • Walking lunges
  • Goblet squat
  • Skaters
  • Wall sits
  • Toe walking
  1. Flexibility and stretching.  Maintaining your flexibility is very important when it comes to injury prevention. Performing these during your holiday will also alleviate the stiffness/discomfort from a day on the slopes.
  • Quads
  • Hamstrings
  • Glutes
  • Soleus* & Gastrocnemius (calf)
  • Upper traps


Skiing tips:

Here are just a few pointers I needed to be reminded of throughout the week.

  1. Fight the instinct to lean backwards and lean forwards pressing your shins into your boots.
  1. You need to get a little speed to help you turn, especially when you start parallel turning….leading onto my next tip…
  2. Bring your BRAVE PANTS!
  3. When turning your weight must be in the ‘downhill’ foot (so turning right your weight is in the left foot and turning left the weight is in the right foot)
  4. Chair lifts and drag lifts:
  • Look at the lift as its coming round behind you
  • Lean forwards once you have the drag lift between your legs, some of them tug you forwards and then drop the tension – if you are leaning back or sitting you will fall off!
  • When getting off both the chair lift and drag lift, again lean forwards so that you slide away from the lift exit making way for others, apply you snow plough to stop.
  1. Most of all just have FUN!!

Bristol Physio to be represented at the Commonwealth Games 2018

Bristol Physio are proud to announce that physio Andy Howse will be travelling to Australia for the 2018 Commonwealth Games in April.  Andy is continuing his association with basketball and is travelling as the physio for the Team England Women’s Basketball programme.


Andy has been working for British Basketball since 2012 and became the Lead Physio for the Senior Women in 2015.

Andy and the squad fly out to Australia on 22 March and the Games begin on Friday 6 April.  Should England make it through their pool then the Semi-Finals and Final will be held on the Gold Coast near Brisbane.  Team England’s Women have been drawn against Australia, Canada and Mozambique in their pool and they have high hopes of  a successful competition.

Andy told us he is thrilled to be able to represent Bristol Physio and his country.  He is “thoroughly looking forward the to challenge.”


Team England play at the following times (Australian time):

Fri 6th April – 18.30 – Canada

Sun 8th April – 11.30 – Mozambique

Mon 9th April – 17.30 – Australia

Tues 10th April – Qualifying Finals (if required)

Fri 13th April – Semi Finals

Sat 14th – Medal Games


Shoulder Injury?? Specialist Physiotherapist Tony Gill shares his wisdom

Shoulder pain is one of the most common musculoskeletal problems in the human body after Back pain. Millions  of pounds are lost in the UK each year to sickness and time off work due to shoulder pain. Our Bristol Physiotherapy Clinic is lucky enough to have its own dedicated shoulder specialist who is able to assess diagnose and treat your problem. Tony Gill is not only a shoulder specialist but also a qualified diagnostic ultrasonographer and injection therapist. This means as well as this specialist service our Bristol Physio Clinic has onsite diagnostic ultrasound, guided ultrasound injections and excellent links to all the top shoulder specialist surgeons in Bristol to fast-track your care if appropriate.

Common problems include;

Shoulder Impingement and Sub-Acromial pain

Frozen Shoulder or Adhesive Capsulitis

Rotator Cuff tear

Shoulder Instability/ Dislocation

Acromio-Clavicular shoulder pain and dysfunction


Click HERE for more information on each Injury.

If your shoulder is giving you pain or dysfunction then use the  Contact Form or call us on 0117 923 7506 to book a session.

Shoulder Diagnosis By Tony Gill

Common Shoulder Injuries by Tony Gill

 Shoulder Pain, Shoulder Problems and Shoulder Dysfunction

Shoulder Impingement

The most common of shoulder problems, this is a symptom not a diagnosis as lots of separate conditions cause impingement.

Overuse, trauma, rotator cuff weakness or rotator cuff tear all cause Impingement.

Symptoms: Pain raising the arm above horizontal or above the head. A weak shoulder with power movements like throwing  can be painful to lie on but usually has a good hand behind the back movement.

Treatment: Manual therapy to treat tight painful muscles and joints. Specific exercise to retrain the Rotator Cuff to optimise the shoulder control. Exercise and posture work to maximise the trunk and Scapula control which are the base the shoulder works from.


Frozen Shoulder

Also known as Adhesive Capsulitis this is a condition that usually occurs in our late 40’s to 60’s and has genetic links. Early diagnosis is crucial as treatment is far more effective in the first 6 weeks and we strongly recommend an early Steroid injection as this condition can last anywhere between 6 months and 3 years. In the initial stages inappropriate therapy can actually prolong the condition and lead to more pain and dysfunction and why it is important to be seen by a specialist who can recognise this condition and arrange the most effective treatment.
This condition usually has 3 stages. The initial painful stiffening freezing phase.  The less painful but stuck frozen phase and finally the improving thawing phase.

Symptoms: Shoulder begins to stiffen and has reduced movements behind the back and out to the side, painful to lie on and severe pain with reaching out movements or jerk movements.

Treatment:  Early Treatment usually involves discussion regarding a capsular Steroid injection which we are able to perform in clinic with discussion with your G.P.
We then treat the associated cervical and myofascial symptoms with a care not to flare the shoulder and worsen or prolong the problem.


Rotator Cuff Tear


Under the age of 30 these are rare and usually involve a high impact trauma. As we age and get closer to 50-60 years even small forces can cause a tear in an already worn tendon.

Symptoms: They give similar symptoms as shoulder impingement. When the symptoms are more severe we are unable to move the arm away from the body with any power, but might be able to move it with the other arm. This indicates the stability muscles may be torn.

Treatment: Treatment depends on accurate diagnosis highlighting why suspected tears should be seen by a specialist. If a large tear is suspected this should be referred for investigation and a shoulder surgeons opinion. We have excellent links to surgeons in the area and can have you seen rapidly when required.
Smaller tears can be optimised with therapy and even larger tears that are non operable can be treated effectively with specialist physiotherapy.


Shoulder Instability


Shoulder Instability is a big group of problems including Dislocation, Labral tear, Hyper-mobility laxity, Muscle patterning,  Subluxations. 

Symptoms: This is too big a group to discuss in a simple page but if you have dislocated your shoulder and continue to have problems, feel the shoulder keeps popping out or almost popping out or is weak after a trauma then it should have a specialist assessment from a shoulder therapist or surgeon.

Treatment: This depends on the diagnosis but with stable Labral tears, laxity without trauma or hyper-mobility, very specialist exercise and therapy is required. This can get very complex and usually the area we shoulder specialist therapists spend a great deal of time rehabilitating. For the dislocation group it is very important we make sure there is no structural damage and we usually organise specific scans or investigations and/or shoulder surgeon advise to ensure you have the best treatment.


Postural Shoulder Pain


This is becoming far more prevalent with the use of laptops, mobile phones, Ipads and general reduced extension or upright activities in our lives.

Symptoms: Pain in the epaulette area and scapula and upper back region. Can be worse with static sitting postures and also give us pain in the neck area.

Treatment: Its unrealistic to think any therapist can fully cure this without addressing the postural issues. Treating this effectively requires your full effort to work on posture changes, exercise to stabilise and give more power to your upper trunk plus awareness of the bad habits that are adding to the problem. A good therapist will spend time identifying these as well as giving specific exercise and lifestyle changes. We also use manual techniques to change the joint stiffness, muscle tightness and pain.


A/C joint (Acromio/Clavicular Joint) pain


I see many of these and when we are young it is usually from trauma even from a fall on an outstretched hand as well as impact to the shoulder. These are often missed as a source of continual shoulder pain post road traffic accident (RTA) form the seatbelt. As we age usually 40 years onwards this joint can become slightly degenerative and give pain.

Symptoms: Pain on top of the shoulder you can usually put one finger on. Painful with across body movements and end of range high arc movements.

Treatment: As a shoulder specialist who is able to treat with steroid injection as well as physiotherapy, my treatment of choice tends to be a steroid in the vast majority of these as it seems to be the most effective treatment I can offer. I also settle them with manual therapy and acupuncture. If the pain is not settling I do not think it is fair to continue to treat you if it is not improving the problem.

Ski and Snowboard Fitness

Well guys…Winter is coming…

In line with the first UK snowfall, Bristol Physio have produced two exercise regimes for you to try to increased your fitness prior to heading off to the slopes.  We hope this will increase your enjoyment of your week or two away but also reduce the risk of injuries.   Injury prevention on the slopes can hugely improve your enjoyment and also reduce that second to third day muscle soreness that people tend to get.

Unfortunately we cannot control the weather, but you can control your fitness and strength therefore crack on with these exercises and you will help to prepare your body for the mountains.

Tips –

  • The exercises are split into 3 levels.  We would recommend spending 2 weeks on each level, trying to complete the exercises 3-4 times a week.
  • Try to stretch through the quads, hip flexors, adductors or groin muscles, hamstrings, glutes and calfs muscles daily.
  • Remember stretches need to be held for a minimum of 30 seconds to get the most benefit from them.


Click here for Snowboard Fitness regime: 

Snowboard Fit11.15

Click here for Ski Fitness regime:


Post-Event Sports Massage

Sports massage is a form of deep tissue massage that is mostly focussed on alleviating the stress and tension which builds up in the body’s soft tissues. It works by breaking down muscular adhesions brought about by physical activity.

Muscle adhesions, also known as ‘knots’, occur where there is a greater demand or stress on particular parts of the muscle. During exercise, minor injuries and lesions (tears) occur, due to overexertion and/or overuse. The body then heals, producing stronger and additional muscle fibres. It is during this healing process that the fibres can ‘glue’ together forming a tight bundle. I often describe this as being similar to when cooking spaghetti and the strands clump together! This leads to an in-efficient muscle as the individual fibres are unable to fully contract or stretch. Furthermore, blood flow to the area becomes restricted, reducing oxygen and nutrient delivery and removal of waste products.

The aim of post-event massage is RECOVERY and geared towards reducing the muscle spasms and metabolic build-up that occur with rigorous exercise. The massage usually takes place 0-24 hours after the event. However, a light recovery sports massage lasting 10-20mins immediately after a race is very helpful in removing metabolic waste. The pressures applied are modified to provide a soothing effleurage – the pace is slow, rhythmical and gentle. Avoid any deep tissue massage as it could actually be more damaging than beneficial as the muscle will be in a highly stressed state.

The Good Stuff

  • Flush away waste products that build up during exercise i.e. lactic acid through the promotion of blood and lymphatic flow.
  • Fresh oxygen and nutrients are also brought into the muscle which are vital for repair and replenishing.
  • Reduce the risk of delayed onset muscle soreness (DOMS) therefore allowing for a quicker return to training.
  • Relaxation. Massage is a wonderful way to relax after an event and gives you time to mentally recover as well as helping to return the muscles to a relaxed state. In addition, massage is an excellent way to improve mood, reduce anxiety, lower blood pressure and increase the feel good chemicals i.e. dopamine, oxytocin and endorphins.
  • Help an athlete with their cool down routine, this is especially good after an event when an athlete is often too tired to cool down properly.
  • Post event massage can also be that first assessment for potential injuries and more serious medical conditions (heat exhaustion, hypothermia) which may be identified early and treated promptly.

To optimise full recovery recommended things to do post massage:

  • Foam Rolling (check out our channel on YouTube to see how it’s done)
  • Self-massage with a hard ball (hockey, cricket or specialised trigger point balls)
  • Stretching
  • Light exercise – active recovery
  • Heat – especially now it’s approaching winter. Keep your muscles warm by adding layers and/or wearing compression clothing


The Surfers Shoulder

Written by Tony Gill.

As a shoulder specialist physiotherapist in Bristol I see quite a few surfers shoulders.

Often labelled as a swimmers shoulder, there are specific differences between these conditions:


1: Swimmers performing crawl rotate around the central axis or spine, imagine a hog on a spit. Surfers cannot rotate around this central axis in the same way due to the buoyancy of the board. This requires more force to be produced at the shoulder, as the trunk musculature cannot generate the same force through the rotational movement as a swimmer can.

2: The stroke in surfing requires more power in mid-range of the stroke as you are riding far higher on the surface of the water and unable to generate any power at the end of a swimmers stroke as your arm is already clear of the water. This means you have to generate more power in the middle of the range which increases the stress of the shoulder as the hand is further away from the trunk. It’s basic physics of the long lever.

3: Surfers manage to generate force through good thoracic and lumbar extension range and dynamic stability. If they lack this, the shoulders are far more likely to have to overwork as a compensation for the stiffness or weakness. Anecdotally, I find this seems to be especially so for the weekend surfer who spends many hours on a day to basis hunched like a prawn in-front of a laptop or desktop. ( you know who you are!!)
There is an old saying “you are what you eat” – the same holds true for what you do.
I suspect sitting flexed for hours a day teaches habitual postures, tightness’s and weaknesses that are difficult to break once or twice a week on a board. Usually this effects 30-60 year olds and in my practice seems to effect the office worker more often than a manual worker. I acknowledge this may be a bias of my client group rather than a true link between impingement and posture.

4: The swim stroke on a board has to be further away from the body due to the width of the board which increases the lever effect on the shoulder. This in turn increases the stresses placed on the stabilisers of the shoulder ball into its socket. (Rotator cuff)

5. Surfers ask for short sprint power repetitively to get through the breaking waves and then another sprint to catch the wave. It is rare a swimmer operates on sprint/rest/sprint/rest approach to a given distance. Their swim tends to be paced.

6: Surfers push up on an unstable surface, swimmers don’t. This can increase the stress on the top joint of the shoulder where the collar bone joins the scapula called the A/C joint. For some of is this joint already starts to have arthritic changes in our 30’s and while this is usually not a problem, if irritated already can flare with continual push up postures that surfing requires.

Both swimmers and surfers suffer from impingement symptoms. In layman’s terms the ball needs to stay centralised into the socket but is only able to do this by activating 4 dynamic muscles called the rotator cuff. If they fatigue the powerful Latisimmus Dorsi Upper Trapps and Deltoid act together to internally rotate and elevate the ball in the socket which increases the joint pressure and over time can cause pain and dysfunction.

So what can you do?…… If you live in the South West you should be visiting us at Bristol Physio!

The simple rules I apply to all rehab are:
What movements cause the pain?
What areas seem to be weak?
What areas seem to be tight or stiff?
Can we address the dysfunction and optimise function?

i.e. what task is being required of the body?
How is this different from the norm?
How do we optimise the desired function?

If therapists miss the unique differences and requirements a surfers shoulder is under, we fail to address the primary problems driving your pain.

If your suffering from a painful shoulder with surfing, my advice would be to see a good therapist who understands the stresses places on surfers shoulders and how to address this. If we the therapist are not teaching you how to change this and address the problem within 3-5 sessions then your either being lazy with your rehab, we haven’t identified all the dysfunctions to correct or it might not be able to respond to rehab and requires more help in the form of a steroid injection or surgical input.

Your welcome to come see us in Bristol but be prepared to be actively involved in your own rehab as its your body and therefore will require you to make the changes to optimise your recovery.

If your interested in rehabilitating your own shoulder we have a few links to sensible exercises below for common problems associated with surfers shoulder issues. But this is not a recipe and I would always advise seeing a good shoulder Physio.

Thoratic Flexibility and Strength

Rotator Cuff External Rotation Elevation with Band

Press Up Plus

Dynamic Side Plank


Posture and Flexibility for Maximum Triathlon Performance

Modern lifestyle has got us sitting for hours at a time in a poor position, whether it’s at a desk for work or web browsing at home or slumped on a couch watching TV and using a laptop. This leads to muscle imbalances causing postural problems, even in the active triathlete.

In triathletes, there is the additional training factor that both swimming and cycling tend to develop hunched shoulders. If you do not have the muscle flexibilities and strength balances to naturally hold proper, efficient posture all the time, you will struggle to reach your potential, no matter how hard you train!

In summary, forward head, round-shouldered posture decreases triathlon performance because:

  1. A forward head requires more energy to hold up during cycling and running, which can prematurely fatigue the neck, shoulders, and upper back.
  2. Changes to spinal curvature top to bottom occur, making the body less biomechanically efficient. Pelvic angle and limb range of motion also affects running stride.
  3. Hunched shoulders and tight chest muscles impede upward movement of the ribcage, increasing the energy necessary for breathing.
  4. Decreased shoulder range of motion due to tight chest and shoulder muscles decreases swim stroke length and strength.
  5. Forward head posture positions the head further down into the water, forcing one to roll excessively and work harder to breathe.

Most importantly, taking care of your postural imbalances will prevent injuries of all kinds. For example; the swimming and cycling aero position increases load on the neck, which when combined with forward head posture, increases the probability of ruptured discs and pinched nerves.

At Bristol Physiotherapy we aim to address these imbalances brought about by poor posture and educate you on how to avoid injury and enhance performance.

By Emma Davies

Running Technique

In 2012 Australian Triathlete Pete Jacobs achieved his 10 year dream of winning the Ironman World Championships in Hawaii. Here’s a video of his tips on how to improve your run technique.


Running Posture

Running tall with a proud posture and your chest up will help you to maintain alignment. As soon as you slump forwards in your posture, you’ll start dropping your hips back – sticking your butt out! As Pete says “if you drop your hips back, you slow down a lot”.

Holding your posture tall encourages you to hold your hips over the landing foot, leading to a lighter, quicker contact on the ground.

Foot Contact

Pete recommends a very flat midfoot strike, with the heel and ball of the foot striking the ground in unison, with more weight being put through the ball of the foot.

This is a great option for so many distance runners, far less aggressive that the forefoot strike many attempt to achieve. Of course, appropriate foot strike pattern will vary from runner to runner, and even within an individual from pace to pace. Experiment on your runs!

Cadence & Arm Carry

So frequently overlooked is the inherent link between the rhythm of the upper body and that of the legs.

Once you’ve perfected the relatively simple action of the arm swinging back and forth, independent of the torso, the rhythm of this movement will directly influence leg speed. Keeping a relatively short, fairly choppy arm carriage at marathon pace will keep your legs turning over quickly and efficiently.


Pete recommends to focus on remaining relaxed, and removing feelings of tension through muscles that “don’t need to be working”. As long as your core is strong and switched on, everything else will “find it’s place more easily”.


Knee Injuries

The knee is a complicated joint and there a variety of injuriesknee-pain that can occur, but the two most common injuries are patellofemoral pain syndrome (PFPS) and Illio tibial band syndrome (ITBS). Both of these conditions have a nasty habit of starting off slightly niggly and then developing into a full-blown chronic injury if not assessed and rehabilitated appropriately.

These injuries generally occur when there is a sudden increase in running volume and frequency or changes have been made to the type of training, i.e adding hills or sprints (interval training). These changes exacerbate pre-existing flaws in running technique, biomechanics or muscle balance leading to such injuries.

Should you find yourself fighting with a niggly knee or you have just developed a knee injury, then RICE (Rest, Ice, Compress and Elevate) should be applied. I advise my athletes to use Physicool (physicool.co.uk), a cooling bandage that can be easily applied to any peripheral joint – much easier than trying to secure a bag of peas to your knee not to mention a lot more comfortable!

Check your Trainers! Are they over 2 years old? Have they done more than 400 miles? If you answered ‘yes’ to either of those questions then you need to update them. I also advise that you go to a reputable running shop with a gait analysis service. It may be a bit more expensive than what you can find online, but you will be fitted with the correct trainers for you and should there be an issue you can take them back. We recommend our clients to go to Moti.

lower limb imbalanceNext, would be to address your biomechanics. Anatomically speaking, the knee is positioned in an unfortunate position. It is located between two very mobile joints: the hip and the ankle. We often find that control at the hip and/or foot and ankle is compromised, disrupting the alignment and loading of the knee as we run. Hence, exercises designed to strengthen your hip (Glutes) and core stability are nearly always prescribed in knee injury rehabilitation AND prevention.

Your hip and leg flexibility also plays an important role in biomechanics. Ensure you are stretching all the major muscle groups after exercise and you should spend at least once a week doing extensive stretching such as yoga or a session on the foam roller. Although, during rehabilitation I frequently advise a daily stretching program.

This advice is based on the most common knee issues. It is strongly advised that you seek an assessment from a Chartered Physiotherapist should you be experiencing any niggle or injury.

Calf Injuries

A common running injury is a calf strain or a tear. The calf muscles, Gastrocnemius and Soleus, are loaded repetitively and heavily during running. With every stride we take when running, the calf gets loaded, firstly to absorb the Gastrocnemius Strain shock of our body weight landing, then to help propel us forward into the next stride. When running, we take roughly 1500 strides per mile. Which makes it easy to see that if there is a weakness in the calf complex, or a fault elsewhere in the kinetic chain or running technique leading to increased load on the calf, injury is almost inevitable.

The calf is classified as a global mobiliser muscle, meaning that its main anatomical function is to absorb and then create large motions and forces. It is accompanied above and below by stabiliser muscles which are responsible for keeping the joints stable – so that it can carry out its main function. However, if stability is compromised, particularly at the foot and ankle complex, leading to excessive pronation, the calf will begin to try and take on a stabilising role also – leading to loading it is not positioned well to cope with. An example of which would be an overpronating foot or weak glutes causing excessive inward rotation of the knee.

Often a poor warm-up is cited as a reason why athletes sustain calf injuries. Most of us appreciate the necessity for a thorough warm-up. I often use ‘blue tack’ as an example when describing how muscles and tendons respond to a warm up. When you try and stretch cold blue tack it is tough and usually breaks, whereas when is has been warmed up it stretches nicely. It is also important to note that as we age, these elastic properties of tendons and muscles diminish – thus accounting for the increased occurrence of calf strains in the more senior of our athletic population.

A final contributor to soft tissue injuries in runners, especially long-distance runners is dehydration. Dehydration negatively impacts muscle function by reducing blood flow to muscles and decreasing muscle elasticity or flexibility and endurance.

Grades of strain or tear:

Muscular strains are classified according to their severity in terms of how many fibres have been disrupted or ruptured:

Grade 1Grade 2Grade 3
This is the least severe of calf injuries. A small number of muscle fibres have been damaged within the muscle. Signs and symptoms of this type of less serious strain may not be noticed until cessation of the activity. Tightness, cramping feelings and slight soreness are common when the muscle is stretched.This is sometimes referred to as a partial calf tear. A greater number of muscle fibres have been torn, but the muscle remains largely intact. More immediate localised calf pain is present during activity, especially walking and running. Often the area is sore to touch.Total rupture. All the muscle fibres have been torn, losing continuity throughout the muscle. This is a serious injury and highly disabling. The athlete will be unable to walk pain free. Often bruising will appear below the tear site and there may well be a palpable bulge where the calf muscle has recoiled upon itself.

Treatment and Rehabilitation:

Initially, the Protection, Rest, Ice, Compression, Elevation (P.R.I.C.E) principal should be followed. Therapeutic Ultrasound, Acupuncture, Sports Massage and Taping are all methods used to facilitate soft tissue healing. Sports massage, however should not be performed until the acute phase has passed (3 days +). Approximate timescales for rest are; 3 weeks for a grade 1 strain and 4-6 weeks for a grade 2 strain. Grade 3 tears will most likely require surgery followed by a 12 week rehabilitation programme.

As with any injury, progressive and comprehensive exercise based rehabilitation is key to avoiding recurrence or secondary injuries. Secondary injuries often occur through compensatory mechanisms which may have become habit during the injured period. The rehabilitation period is also an ideal opportunity to target those areas that get ignored in weekly training routines. Core stability and gluteal muscles are a great place to focus on when activity is restricted. Research has found that the stronger these muscles can become, the more likely a successful outcome is to be reached in terms of injury recovery, injury prevention and most importantly performance.

Rehabilitation Exercises:

Specific single-leg exercises are important to build the strength in the injured limb and to regain balance which will have been lost on the injured side during the injury period. Here are some suggested exercises. However, I recommend you see a Physiotherapist for a tailored program and appropriate guidance.

Single Leg Standing

SLStStand on one leg keeping your bottom squeezed and core engaged. Ensure that your pelvis is level, your knee is facing forward and your trunk is upright. Try not to lock your knee. If you can successfully hold this position on each leg for 15-20 seconds you are ready to progress to a single leg squat.

This exercise targets your core and glute muscles.

Single Leg Squat

Single leg squat

The same principles are applied in this exercise as in the single leg stand. The picture shows the athlete squatting to a chair. The chair provides a nice prompt to ensure that you are squatting correctly (sticking your backside out and not just bending at the knee).

I suggest that you start by only squatting down as far as you can control your knee (keep you knee cap over your 2nd toe) and keep your pelvis level. This may only be a tiny dip to start with, but it will improve.

Supported Heel Raise

This exercise should be pain-free and should therefore not be considered until you are symptom Heel raisers free walking up a flight of stairs. Begin with 50:50 of your body weight in both feet and raise up on to your toes, if you feel the need you may hold onto a rail/kitchen unit for support. Complete 3 sets of 10. If this is easy then you may progress on to 60:40, increasing the load in the injured side. The increases my continue 70:30, 80:20 up to a single leg heel raise.