MSK conditions treated in Twickenham

What it is: Pain coming from the muscles, joints, and soft tissues of the cervical spine, often linked to posture, prolonged sitting, or sustained head positions.

How it presents: Stiffness on waking or after long periods at a screen, restricted neck rotation, and aching across the upper shoulders. Often worse by the end of the day.

What it is: Irritation or compression of a nerve root in the cervical spine, often producing symptoms that travel into the shoulder or arm.

How it presents: Sharp pain or pins-and-needles spreading down the arm into the hand, sometimes with weakness in specific muscle groups. Particular neck positions can make it worse.

What it is: Pain or stiffness in the middle of the back, often related to prolonged sitting, desk work, or postural loading rather than a single injury.

How it presents: A localised ache between the shoulder blades, stiffness on twisting or deep breathing, and discomfort that builds through the working day.

What it is: The most common adult musculoskeletal complaint. Pain arising from the muscles, joints, and discs of the lumbar spine, usually without a single cause.

How it presents: Dull aching or sharp catches in the low back, stiffness after sitting or driving, and pain on bending, lifting, or rolling over in bed.

How it is treated: Manual therapy has NICE-guideline-level evidence for persistent mechanical low back pain. Sessions combine joint mobilisation, soft tissue work, and movement retraining, with progressive exercise to reduce the risk of recurrence. Most people respond within 4 to 6 sessions.

What it is: Symptoms produced by irritation or compression of a lumbar nerve root, often referring pain down into the buttock, leg, or foot.

How it presents: Sharp, burning, or shooting pain from the low back into the leg, sometimes with pins-and-needles or numbness. Bending, sneezing, or sitting can flare it.

What it is: Pain arising from the sacroiliac joint at the back of the pelvis, often confused with low back pain or hip pain.

How it presents: Localised pain at the dimple of the buttock, sometimes spreading into the groin or thigh. Often worse on standing from sitting, climbing stairs, or rolling in bed.

What it is: The most common shoulder complaint. Pain arising from structures under the acromion, including the rotator cuff tendons and subacromial bursa.

How it presents: Pain on lifting the arm overhead or out to the side, catching or pinching in mid-range, and aching when sleeping on the affected shoulder.

What it is: Pain and dysfunction in the tendons of the rotator cuff muscles that stabilise the shoulder, often from repetitive load or sustained postures.

How it presents: A deep ache around the shoulder or upper arm, weakness on lifting or reaching, and difficulty with tasks like reaching into the back seat of a car or fastening a bra.

How it is treated: A progressive shoulder loading programme targeting the rotator cuff and scapular stabilisers is central to lasting recovery. Manual therapy reduces pain in the short term while graduated loading addresses the underlying tendon dysfunction. Research shows combined treatment produces significantly better outcomes than passive approaches alone.

What it is: A distinct condition where the shoulder joint capsule becomes thickened and tight, gradually restricting movement. More common in women aged 40 to 60.

How it presents: A painful early phase followed by progressive loss of movement in all directions, especially turning the arm out and lifting overhead. Often worse at night.

What it is: Pain arising from the small joint where the collarbone meets the shoulder blade, often from sport, falls, or repetitive overhead work.

How it presents: Pinpoint pain on the top of the shoulder, worse on reaching across the body or lying on that side. May be tender to touch.

What it is: A shoulder that feels loose, slips, or has previously dislocated. Common in younger sports populations and after trauma.

How it presents: Apprehension when the arm is in certain positions (especially overhead and rotated outwards), feelings of the shoulder slipping, and reduced confidence in sport.

What it is: Tendon irritation on the outside of the elbow, where the wrist extensor tendons attach. Common in racket sports, manual work, and repetitive gripping.

How it presents: Pain on the outer elbow that worsens with gripping, lifting a kettle, shaking hands, or twisting movements like opening a jar.

How it is treated: A graded loading programme for the wrist extensor tendons is the cornerstone of recovery, combined with manual therapy and activity modification. Passive treatment alone carries a high recurrence rate. Progressive tendon loading is what drives lasting change. Most people see significant improvement within 6 to 8 weeks of consistent loading.

What it is: Tendon irritation on the inside of the elbow, where the wrist flexor tendons attach. Despite the name, gardening, lifting, and gym work cause it more often than golf.

How it presents: Pain on the inner elbow with gripping, pulling, or wrist flexion. May radiate down the forearm.

What it is: Irritation of the tendon sheath on the thumb side of the wrist, often from repetitive thumb and wrist movements. Common in new parents and prolonged phone use.

How it presents: Pain at the base of the thumb and side of the wrist, worse on gripping, lifting a child, or moving the thumb across the palm.

What it is: Compression of the median nerve at the wrist, producing symptoms in the hand. Common in pregnancy, repetitive hand work, and certain sleeping positions.

How it presents: Pins-and-needles, tingling, or numbness in the thumb, index, middle, and half of the ring finger. Often worse at night and on waking. Weakness or clumsiness in later stages.

What it is: Wear-and-load changes in the hip joint cartilage, common from middle age onwards. One of the most frequent reasons adults seek manual therapy.

How it presents: Groin or front-of-hip pain, stiffness on getting out of a chair or car, restricted movement on putting socks and shoes on, and aching after walking.

What it is: Pain on the outer side of the hip from irritation of the gluteal tendons and bursa around the greater trochanter. More common in women, especially in middle age.

How it presents: A localised ache or sharp pain on the side of the hip, often worse lying on that side at night, climbing stairs, or after walking.

What it is: Persistent tightness or irritation of the hip flexor muscles at the front of the hip, common in desk-based workers, runners, and cyclists.

How it presents: A pulling feeling at the front of the hip on standing up after sitting, restricted hip extension on running or walking, and sometimes referred low back ache.

What it is: Pelvic girdle pain, sacroiliac joint discomfort, or low back pain related to the changes of pregnancy and the postnatal period.

How it presents: Pain at the front or back of the pelvis, difficulty turning in bed, pain on walking or climbing stairs, and discomfort with single-leg activities like dressing.

What it is: Wear-and-load changes in the cartilage and joint surfaces of the knee, common from middle age onwards.

How it presents: Stiffness in the morning or after sitting, pain on stairs and getting up from a chair, occasional swelling, and aching that worsens with activity.

What it is: Pain at the front of the knee around or behind the kneecap, often related to load and movement patterns rather than a single injury.

How it presents: Aching at the front of the knee with stairs, squatting, prolonged sitting, or running. Common in active adults and runners.

What it is: Irritation along the outside of the knee where the iliotibial band sits, common in runners and cyclists who increase load too quickly.

How it presents: Sharp or burning pain on the outer side of the knee, usually predictable into a run or ride and easing with rest.

What it is: Damage or wear to the meniscal cartilage of the knee, often from a twist injury or gradual loading over time.

How it presents: Catching, locking, or clicking sensations, swelling after activity, and pain on twisting or deep bending. Onward referral arranged if surgical assessment looks needed.

What it is: A muscle or tendon injury in the back (hamstring) or front (quadriceps) of the thigh, usually from sprinting, kicking, or sudden load.

How it presents: Sharp pain at the time of injury, sometimes with bruising or swelling, and pain on stretching or contracting the affected muscle.

What it is: The most common acute musculoskeletal injury. Damage to the ligaments on the outer side of the ankle, usually from rolling over on an uneven surface or in sport.

How it presents: Pain, swelling, and bruising on the outside of the ankle, difficulty weight-bearing initially, and ongoing weakness or instability if not rehabilitated well.

What it is: Pain and dysfunction in the Achilles tendon, common in runners, those returning to sport, and adults over 40 who have increased their activity.

How it presents: Stiffness and pain in the back of the ankle on first steps in the morning, an aching that warms up and then returns after activity, and tenderness on the tendon.

How it is treated: Progressive tendon loading (heavy-slow resistance or eccentric loading programmes) is the most evidence-supported approach, combined with manual therapy to manage pain and maintain function during loading. Most people improve meaningfully within 8 to 12 weeks of consistent loading. Running does not need to stop entirely in most cases.

What it is: Irritation of the plantar fascia under the foot, classically producing heel pain. Often linked to load changes, footwear, and prolonged standing.

How it presents: Sharp pain under the heel on first steps in the morning, easing as the foot warms up but returning after rest or at the end of the day.

What it is: Irritation or weakness of the posterior tibial tendon and supporting structures of the inner arch, common in middle age and after weight gain.

How it presents: Aching along the inner ankle and arch, fatigue on standing, and a sense of the arch dropping or the foot rolling inwards through the day.

What it is: Aching, tightness, and stiffness across the neck, upper shoulders, and upper back from prolonged sitting, screen work, or sustained postures.

How it presents: A familiar tightness across the trapezius and base of the skull that builds through the working day, sometimes with tension headaches by evening.

What it is: Persistent tightness across multiple muscle groups from cumulative load, repetitive activity at work or home, or simply not enough variety in daily movement.

How it presents: Diffuse aching that does not pinpoint a single joint, difficulty fully relaxing, and the sense of feeling "stuck" in the body even after rest.

What it is: Headaches with a recognised musculoskeletal contribution, often involving the muscles and joints of the upper neck and base of the skull.

How it presents: A band-like or pressing pain across the forehead, temples, or back of the head, often worse at the end of the working day and linked to neck stiffness.

How it is treated: Upper cervical joint mobilisation and soft tissue work targeting the suboccipital muscles and upper trapezius have Cochrane-level evidence for cervicogenic headache. Combined with posture and load management advice, most patients notice a significant reduction in headache frequency and severity within 4 to 6 sessions.

What it is: Soreness, stiffness, and recovery from training load. Includes delayed-onset muscle soreness (DOMS) after new or increased exercise, and slow recovery between sessions.

How it presents: Generalised muscle soreness 24 to 72 hours after activity, a sense of heaviness on the next training session, and a desire for soft tissue work to support return to load.