What is physiotherapy?
Physiotherapy helps people affected by injury, illness or disability through movement and exercises, manual therapy, education and advice (The Chartered Society of Physiotherapist). Some problems resolve quickly, others take more time to improve, and some problems have to be managed as they are a long-term problem.
Aim of physiotherapy
Physiotherapy aims to help patients manage their pain, improve their problem, prevent re-injury and promote health and wellbeing.
This can be achieved by:
- Increasing your confidence to move
- Improving movement in your joints
- Strengthening your muscles
- Providing advice on daily living
- Improving pain by learning strategies to reduce and manage it
- Providing education about healthy living and exercises
What to expect
The initial appointment will last up to 45 minutes. You will be asked questions about your problem, how it affects your daily life, and discuss your medical and general health. This will allow the physiotherapist to have a good understanding of you, your problem and goals of treatment.
A physical assessment will also be carried out, where you will be asked to demonstrate certain movements, so wear suitable clothing, such as a vest top (for arm problems) or shorts (for leg problems). In some instances, you may be asked to remove clothing if the problem area is covered such as mid and lower back regions. During a face to face appointment, the physiotherapist may touch you in order for them to assess your muscles and joints.
After the physical assessment, the physiotherapist will discuss with you the possible cause of your problem and agree a treatment plan with you. The physiotherapist will also give you exercises. It is important that you follow your physiotherapists instructions on how to do them.
Follow up appointments will last up to 30 minutes.
If you would like a physiotherapist of the same gender, please inform us prior to your appointment. We will try to accommodate this.
If you are unable to attend an appointment, please call in advance to cancel and rearrange. If you miss an appointment and make no contact for 2 weeks afterwards, you will be discharged back to your GP. If you are late for an appointment, you may not be seen. If you cancel 2 consecutive appointments, you may be discharged back to your GP.
Remote appointments:
We are also now offering remote appointments (via video or telephone) as well as face to face appointments. Your referral will be triaged by a senior clinician and you will be offered an appropriate appointment for your condition. You can request a video or telephone assessment if you would prefer this method, however you may be asked to come for a face to face if the clinician feels this is necessary.
For remote appointments please plan to be somewhere; quiet, private, has space for you to move around in and be able to remove clothing if appropriate to expose the problem area.
Getting the best out of your physiotherapy treatment
Physiotherapy requires your participation. The more you are involved in making decisions on your treatment plan, the more likely you will achieve a better outcome. Think about how your condition affects your life and what support you may need. Have clear, realistic goals you would like to work towards which you will discuss with your physiotherapist.
After you have been discharged from physiotherapy, consider staying active, joining an exercise class in the gym or at home remotely, and carry on with the physiotherapy based exercises and advice you were given.
Consent
Before and during all your physiotherapy appointments, we will be obtaining your consent to be treated. You can withdraw your consent at any time, for any tests or treatment plans.
What the service provides
Physiotherapy treatment may involve:
- Patient information in a variety of formats
- Patient advice – group and individual sessions
- Home exercise programmes
- Gym based exercise classes
- 1:1 gym session
- Manual therapy
Tests / Scans
Scans can be a helpful diagnostic tool, but are only warranted in a very small number of cases. This is because structural changes on a scan can be completely normal and may not be the cause of the problem. Therefore, a scan may not be able to tell you why you are experiencing problems and give you the answer you are looking for.
Your physiotherapist will be able to test structures for problems, including weakness, stiffness and tightness and identify what is causing the pain, without the need for a scan in most cases.
If you still have any concerns, your physiotherapist can speak to a highly specialised physiotherapist who is able to provide expert opinion and order scans if they feel it is appropriate.
For further information, please see the leaflet in Patient Information tab above.
The hand injury unit provides specialist rehabilitation of the arm and hand following injury or surgery to adults and children. Depending on your needs we offer treatment which may include:
- Exercise
- Management of scar, swelling or pain
- Activities and advice to improve daily function
- Joint protection
- Splinting
The Community Pain Management Service (Hounslow) provides assessment and interventions for patients presenting with a wide range of persistent musculoskeletal pain conditions including:
- Persistent back pain
- Arthritic pain
- Degenerative conditions
- Persistent widespread bodily pain (Fibromyalgia)
- Complex regional pain syndrome
- Persistent pain following surgery or medical treatments.
How it works
Once referred, you will be invited to a multidisciplinary pain assessment by a team of highly specialist clinicians. The team includes Physiotherapists and Psychologists working within a biopsychosocial framework aimed at assessing mobility and exploring the different factors that impact on a patient’s pain experience and their quality of life.
The biopsychosocial approach aims to offer a holistic approach that focuses on the many aspects of the pain experience, such as: physical sensations that we experience; our thoughts, feelings and actions in relation to this; how our difficult experiences in life affect us, and how these may all impact upon each other.
Pain is complex and the team aims to support and help patients to manage their persistent pain whilst trying to maintain and improve their functioning; reduce distress, and improve their quality of life. The team currently offers group and individual interventions, and these may involve fitness and exercise advice; education around pain biology; stress and anxiety management; activity management, and a focus on exploring ways to live a values-based life, despite pain.
Together with the multidisciplinary team, the patient will decide on the most appropriate management strategies to work on.
Referral information
To be referred to this service, the patient must:
- Be registered with a Hounslow GP
- Be aged 16 years and over
- Have a written referral from an agreed health care practitioner (usually a GP)
- Have had a musculoskeletal problem for more than 3 months
- Be open to exploring non-medical interventions for pain management
We cannot see patients who are:
- Under 16 years of age
- Have persistent pain due to a non-musculoskeletal problem, including primary headaches
- Are continuing to seek solely medical investigations and interventions for their pain condition.
Please see the 'Contact us' tab for the relevant contact information to refer patients to the Hounslow service.
Treatment locations
Patients referred to the Pain Management Service may be offered telephone, video, or face-to-face consultations. Face-to-face consultations will take place at:
Therapy Centre
O-Block (West Middlesex Hospital site)
Where needed, patients will be guided through the video consultation process.
Understanding pain
Flippin’ Pain: www.flippinpain.co.uk
The pain toolkit: www.paintoolkit.org
The British pain society: www.britishpainsociety.org
Pain by Irene Tracey, a Ladybird Expert Book My live well with pain: www.my.livewellwithpain.co.uk
Fibromyalgia Action UK: www.fmauk.org
The Independent Voice of UK Fibromyalgia: www.ukfibromyalgia.com
Pain is really strange: Steve Haines and Sophie Standing
Our adult women’s health physio service in Richmond and Hounslow provides specialist physio assessment and management advice for the following issues:
- Urinary incontinence (i.e. bladder) www.nhs.uk-urinary-incontinence
- Stress urinary incontinence: Leaking urine/pee during a run, cough or sneeze
- Urinary frequency, urgency and urge incontinence: The feeling of needing to empty the bladder frequently and/or rush to get to the toilet in time, often accompanied with loss of control of urine
- Pelvic organ prolapse www.nhs.uk-pelvic-organ-prolapse
- Faecal incontinence www.nhs.uk-bowel-incontinence
- Flatus incontinence (inability to control wind)
- Bowel evacuation disorders such as constipation
- Faecal urgency: the feeling of needing to empty the bowel with little warning
- Sexual dysfunction (for example pain during sexual intercourse)
- 3rd and 4th degree perineal tears post delivery
Once referred to our women’s health services, you will be assessed by a fully qualified and state registered physiotherapist. Together with your physiotherapist, you will then decide on the most appropriate management and plan a course of treatment, which may include:
- Pelvic floor muscle retraining
- Bladder and bowel retraining
- Lifestyle advice
- Manual therapy
- Core strengthening exercises and postural advice
- Pelvic floor advice class
Your therapist will decide with you which treatment is most suitable for you.
What to expect at your first appointment:
- Discuss your condition
- Examine you
- Assess your needs
- Design a treatment plan for you
Part of your assessment may include a pelvic floor muscles examination. This can involve an internal vaginal or anal examination. We will explain any examination or procedure we carry out to you at your appointment. If you do not want to be assessed you can opt out. This won’t affect your treatment.
You can bring a family member or friend with you if you would like a chaperone.
If you are concerned about any part of the assessment, please call us before-hand, or discuss your concerns with your clinician on the day.
Physiotherapy advice for gynaecology/urology patients
Pelvic organ prolapse: pogp.csp.org.uk-Prolapse
- Pelvic floor exercises for women: pogp.csp.org.uk-PelvicFloor
- Promoting continence with physiotherapy: pogp.csp.org.uk-Continence
- Physiotherapy advice for patients with bowel issues Improving your bowel function pogp.csp.org.uk-BowelFunction
- Anal sphincter exercise: www.stmarkshospital.nhs.uk-Anal-sphincter-exercises
Physiotherapy advice during and after pregnancy
- Exercise in pregnancy: pogp.csp.org.uk
- Pelvic girdle pain in pregnancy: pogp.csp.org.uk-PGP
- Exercise post natally: pogp.csp.org.uk-postnatal
- Post- natal running guidelines: www.running-postnatal-guide
Useful links for patients
- Bladder and Bowel Community - for support, information and guidance: www.bladderandbowel.org
- POGP – pelvic obstetric and gynaecological physiotherapy: pogp.csp.org.uk-POGP
- NHS Couch to 5k app: www.nhs.uk-get-running-with-couch-to-5k
- Walking app nhs: www.nhs.uk-walking-for-health
- IUGA- international urogynecological association: www.yourpelvicfloor.org
- RCOG – Royal college of obstetricians and gynaecologists: www.rcog.org.uk
NHS.UK
NHS.uk provides information about common conditions and treatment options.
The Chartered Society of Physiotherapy (CSP)
The CSP is a professional, education and trade union for physiotherapist. It provides information about common conditions and treatment options.
Versus Arthritis
Versus Arthritis are a charity organisation providing support and education to those living with arthritis. It provides useful information about common conditions and treatment options.
ESCAPE Pain
Escape Pain is a rehabilitation programme for people with chronic joint pain of the knee, hip or back.
NHS Fitness studio
NHS fitness studio offers you a range of free online exericse workouts, ranging from 10 to 45 minutes.
Couch to 5K
Couch to 5K is a running plan for absolute beginners, to gradually get you towards running 5km in just 9 weeks.
Shared Decision Making Tool
A Shared Decision Making Tool combines all the known information about treatments and interventions for a particular condition.
NHS Every Mind Matters
The NHS Every Mind Matters website provides a range of support, resources advice on mental health and wellbeing.
Every Mind Matters - NHS (www.nhs.uk)
Talking Therapy Services
Sometimes, we can all experience common problems like stress, anxiety and depression. These problems can make you feel low, interfer with your sleep, and sometimes make it difficult for you to manage events, activities and/or emotions. Talking therapy services can help you with these problems.
Hounslow talking therapy service
Richmond talking therapy service
Long Covid
The symptoms of long Covid can be wide ranging, and affect people in different ways. The below links can help you understand what has happened and what you might expect as part of your recovery.
Common back pain and what to expect
Many patients have a combination of back pain, leg pain and leg numbness. These symptoms can be very distressing for you, but they don’t usually require urgent medical attention.
How to relieve back pain
The following tips may help reduce your back pain and speed up your recovery:
- stay as active as possible and try to continue your daily activities – this is one of the most important things you can do, as resting for long periods is likely to make the pain worse
- try exercises and stretches for back pain Exercises to help with back pain | NHS inform; other activities such as walking, swimming, yoga and Pilates may also be helpful when your body feels ready to do them
- take anti-inflammatory painkillers, such as ibuprofen – remember to check the medicine is safe for you to take and ask a pharmacist if you're not sure
- use hot or cold compression packs for short-term relief – you can buy these from a pharmacy, or a hot water bottle or a bag of frozen vegetables wrapped in a cloth or towel will work just as well
Causes of back pain
In most cases, it is not possible to identify the exact cause of back pain. This is known as non-specific back pain. It is important to know that any kind of structural damage is rare.
While it can be painful and upsetting, this type of back pain usually gets better quickly. It can be managed through advice and remaining active. Watch this video to find out more https://youtu.be/W_6jUM1RC0M
Non-specific low back pain can sometimes cause nerve pain in the leg (sciatica) and this usually improves within a few weeks or months. Here is some useful information and advice about causes of sciatica and how to manage it: Ten sciatica facts - South Tees Hospitals NHS Foundation Trust
Stress, problems at work or home, lack of sleep and poor lifestyle choices are amongst the other factors which can turn up the volume on your back or leg pain. Although it can be difficult, it helps if you stay optimistic and recognise that your pain should get better.
Sometimes there are specific causes for back pain, especially when pain is worsening or not improving at all in the first 4-6 weeks after it started. You may need some physiotherapy to help things along. If needed, you could be referred to a specialist. A small percentage of people who have back pain require an injection or surgery.
When you should consult your GP
In some cases, you may need to speak urgently with your GP when back pain occurs with other more serious features, or with other medical conditions. These include:
- Severe pain at night which keeps you awake for hours or stops you from being able to lie on your back
- Unexplained weight loss
- Fever
- Have or have had tuberculosis (TB) or a urinary tract infection (UTI – infection of your water works)
- HIV infection
- Past history of cancer – breast, lung, bowel, prostate, kidney and thyroid
When you should seek immediate help
If you develop any symptoms of cauda equina syndrome you need to seek immediate help, either by calling NHS 111 or by going to your local accident and emergency department.
What is cauda equina syndrome?
Cauda equina syndrome is a very rare but serious condition involving compression of the nerves at the bottom of your back. These nerves control your legs, your bladder and bowel control and they supply sensation to the skin around your bottom, back passage, genitals and inner thighs. When these nerves are compressed, it can cause the symptoms outlined below and requires urgent medical attention.
Cauda equina syndrome symptoms:
- New pain, pins and needles or numbness travelling down both legs
- New weakness in your legs – this may cause you to stumble or trip, or not be sure where your feet are landing
- Numbness or tingling around your inner thighs, genitals, back passage or buttocks
- Any new changes to how your bladder and bowels work e.g. difficulty peeing/starting the flow, peeing more often, not knowing when you need to go to the toilet, peeing or pooing yourself, etc.
- New changes for men in their ability to achieve an erection or ejaculate or loss of sensation during sexual intercourse
- New changes for women in their ability to fully feel sensation in the genital or vagina area or climax during sexual intercourse
All of this information on when to seek urgent or immediate help for back pain is summarised in this video: https://www.macpweb.org/Resources/86f5045c-3423-4f29-b21c-492a5f77e265
The warning signs for cauda equina syndrome are summarised on this credit card resource: https://www.macpweb.org/Cauda-Equina-Information-cards
Knee exercises
All videos open in YouTube.
Level 1
- Isometric Quadriceps Contraction
- Straight Leg Raise
- Double Legged Bridge
- Side Lying Hip Abduction
- Step Ups
- Balance Exercises (Tandem Stand/Single Leg Stand)
- Double Legged Heel Raise / Single Leg Heel Raise
- Supported Squat
- Standing knee flexion
- Sit to Stand
- Assisted Knee Flexion whilst Sitting
- Wall Squat
Level 2
- Single Leg Bridge
- Squat
- Backwards Step Down
- Sideward Step Down
- Straight Leg Raise With Weight
- Side Lying Hip Abduction With Weight
- Knee Flexion with Weight in Standing
- Wall Squat with Weight
- Sit to Stand Progressions
Nerve slider/glider exercises
All videos open in YouTube.
- Median nerve slider - Level 1
- Median nerve slider - Level 2
- Median nerve slider - Level 3
- Ulnar nerve slider - Level 1
- Ulnar nerve slider - Level 2
- Ulnar nerve slider - Level 3
- Radial nerve slider - Level 1
- Radial nerve slider - Level 2
- Radial nerve slider - Level 3
- Slump slider - Level 1
- Slump slider - Level 2
- Slump slider - Level 3
Flippin’ Pain: www.flippinpain.co.uk
The pain toolkit: www.paintoolkit.org
The British pain society: www.britishpainsociety.org
Pain by Irene Tracey, a Ladybird Expert Book My live well with pain: www.my.livewellwithpain.co.uk
Fibromyalgia Action UK: www.fmauk.org
The Independent Voice of UK Fibromyalgia: www.ukfibromyalgia.com
Pain is really strange: Steve Haines and Sophie Standing
Physiotherapy advice for gynaecology/urology patients
Pelvic organ prolapse: pogp.csp.org.uk-Prolapse
Pelvic floor exercises for women: pogp.csp.org.uk-PelvicFloor
Promoting continence with physiotherapy: pogp.csp.org.uk-Continence
Physiotherapy advice for patients with bowel issues Improving your bowel function pogp.csp.org.uk-BowelFunction
Anal sphincter exercise: www.stmarkshospital.nhs.uk-Anal-sphincter-exercises
Physiotherapy advice during and after pregnancy
Exercise in pregnancy: pogp.csp.org.uk
Pelvic girdle pain in pregnancy: pogp.csp.org.uk-PGP
Exercise post natally: pogp.csp.org.uk-postnatal
Post- natal running guidelines: www.running-postnatal-guide
Bladder and Bowel Community - for support, information and guidance: www.bladderandbowel.org
POGP – pelvic obstetric and gynaecological physiotherapy: pogp.csp.org.uk-POGP
IUGA- international urogynecological association: www.yourpelvicfloor.org
RCOG – Royal college of obstetricians and gynaecologists: www.rcog.org.uk
- Lauren Johnson - MSK Clinical Service Manager Hounslow
- Michael Primett - MSK Clinical Service Manager Richmond
- Nati Arnaldos - MSK Business Manager
Hounslow Admin Team:
Anup Shinde
Balbir Chana
Bhavinder Sahota
Corinne Riviere
Maria Ennis
Mayurie Thaker
Michelle Sugrue
Patrice Metzger
Rita Sawyerr
Shilla Evans
Richmond Admin Team:
Sara Butt
Pallavi Jadhav
Manisha Chandegara
Caroline Renow
Gurjit Kaur-Sehra
Esther Namande
Hounslow
Aileen Robinson
Anna Solly
Becky Lydon
Chetan Patel
Claire Wolrich
Harriet Trewhella
Joshua Coles
Mike Primett
Naresh Naidu
Nicola Kelly
Paul Knight
Taneesha Dhillon
Richmond
Charlotte Butcher
Elinor Pearce
Grethe Larsen
Rebecca Fyffe
Claire Clark - Clinical Lead
Corri Chella - Assistant Therapy Practitioner
Michelle Harford
Nina Anderson
Toria Jay
Hounslow
Alan Cuddy
Alexandra Lakos
Annelise Barretto
Claire Cason
Edwin Park
Joshua Coles
Kate O'Sullivan
Lamaan Pryce
Matthew Davies
May Alsop
Michelle Harford
Mohamed Mohamed
Neha Vora
Nikhil Dhupelia
Taneesha Dhillon
Pablo Froglia
Phoebe Cassedy
Prajkta Gawde
Priyanka Sivanupandian
Raziya Bedford
Reena Patel
Rejuan Henry
Richard Lill
Shalene Philip
Sian Knight
Simon Shaw
Sumeer Bhamm
Joyce Chung
Monica Sharma
Verity Wakeling
Sabrina Danzing
Esther Ng
Richmond
Alexandra Moyle
Bronte Marquardt
Charlotte Allen
Charlotte Potter
Gregg Wise
Elly O'Connell
Justice Bentum
Kirsty Greaves
Madeleine Burke
Nic Elorreaga
Penelope Colloff
Rosemary Fernando
Sarah Biffen
Tom Belfield
Victoria Santiago
Nicola Kelly - Clinical Specialist Physiotherapist, Pain Management
Paul Knight - Clinical Specialist Physiotherapist, Pain Management
Anna Solly - Psychologist
Janine Shaw, based at Teddington Memorial Hospital and Centre House
Sian Knight, based at West Middlesex University Hospital O'Block
Lamaan Pryce, based at West Middlesex University Hospital O'Block
Who we can see
To be referred to the MSK Physiotherapy Service, the client must:
- Be registered with a Hounslow GP
- Be aged 16 years and over
- Have a written referral from an agreed health care practitioner or self-referral via GP website: see link: Hounslow self-referral link
We cannot see clients who are
- Under 16 years of age
- Requiring treatment for a non-musculoskeletal problem
Note: for Hand Injury Unit we can see under 16s
Who we can see
To be referred to the MSK Physiotherapy Service, the client must:
- Be registered with a Richmond GP
- Be aged 16 years and over
- Have a written referral from an agreed health care practitioner or self-referral via GP website - see link: Richmond Self Referral Link
- Have a musculoskeletal problem (muscles, bones, joints, nerves)
We cannot see clients who are
- Under 16 years of age
- Requiring treatment for a non-musculoskeletal problem
getUBetter app
The getUBetter App is provided free of charge for patients registered with a GP in Richmond. It can be accessed on a Smartphone or online. It guides through a sequence of exercises and advice based on your area of pain. This includes:
• Lower back pain
• Back and leg pain
• Neck Pain
• Shoulder Pain
• Ankle Pain
• Knee Pain
• Soft Tissue Lower Limb
The App will also connect you to your local treatment, healthcare providers or support services if needed, such as physiotherapy.
You can self-register for the App, or your physiotherapist or GP may signpost you.