Musculoskeletal Information

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Are you suffering from muscle, back or joint problems?

This area will give you information and guidance to help you improve and manage your aches, pains and stiffness from muscle and joint problems. If you’re already under the care of a specialist, this area will also help to boost your recovery.

If you received a copy of ‘Joint Planning, my personal plan’, and would like to print out extra copies, please click here.

For some definitions related to muscle, back or joint problems, click on the links below.

What is musculoskeletal pain?  >

Musculoskeletal pain (usually called MSK) is pain in the muscles, ligaments, tendons or bones.

MSK can be caused by:

  • The wear and tear of daily activities
  • Trauma e.g. jerking movements, falls, fractures, sprains, dislocations and direct blows to the muscle
  • Postural strain
  • Repetitive movements
  • Overuse and prolonged immobilisation

What is physiotherapy?  >

When someone is affected by injury, illness or disability, physiotherapy helps to restore their movement and function through:

  • movement and exercise
  • manual therapy including manipulation
  • electrotherapy
  • acupuncture
  • hydrotherapy
  • education
  • advice
  • techniques associated with cognitive behavioral therapy.

Physiotherapists work alongside other health professionals to provide seamless care and ensure the patient receives the right combination of treatment first time. Physiotherapists are able to refer into additional services such as health trainers and exercise groups to ensure patients continue to improve after discharge.

They are regulated by:

What is osteopathy?  >

Osteopathy uses a systematic examination of the musculoskeletal system to identify the underlying cause of pain. Treatment is strongly evidence-based manual therapy and may involve using a variety of subtle soft tissue and joint manipulations to restore normal function.

Osteopaths commonly use therapeutic exercises, lifestyle advice, posture and movement to ensure optimal recovery.

They are regulated by:

What is chiropratic?  >

Chiropractic is concerned with the diagnosis, treatment and management of disorders of the musculoskeletal system, particularly those of the spine and their effects on the nervous system and general health.

Chiropractors take a biopsychosocial approach to health and wellbeing: this means that they consider your symptoms in the context of your full medical history, your lifestyle and your personal circumstances in order to help you to manage your problem and prevent it recurring.

They use a combination of treatments such as:

  • manual therapy
  • spinal manipulation
  • ultrasound
  • acupuncture
  • advice about pain control, lifestyle, posture and exercise

They are regulated by:


Tips and advice to help you recover

Evidence has shown that some simple lifestyle changes can greatly improve your chances of early recovery.

  • Regular exercise plays an important role in  losing weight and reducing pain levels
  • Giving up or reducing smoking increases your body’s ability to repair itself
  • It’s important to discuss pain relief with your GP and take prescribed tablets at their full dose. Better pain relief helps you sleep and move better which will help your body to recover more quickly

The good news is that you don’t need to wait to see a GP or be referred to a physiotherapist to start recovering. It has been shown that people who follow simple advice from the start, experience the best overall long-term improvement in their symptoms.

To find out more information, click on the links below.

How can I help my arm and shoulder mobility?  >

Frozen shoulder  >

What is a frozen shoulder?

A frozen shoulder occurs when there are changes within the shoulder capsule which cause restrictions in the normal movement of the shoulder. This makes it difficult to lift and rotate the arm and activities such as dressing, driving and lifting may become difficult.

The exact cause of frozen shoulder is not known. There are 2 main types:

  • Primary frozen shoulder – Occurs spontaneously and is more common in people with certain health conditions including diabetes, heart disease and thyroid problems. It usually occurs in patients between the ages of 40 and 60, and is more common in women
  • Secondary frozen shoulder – Occurs as a result of trauma or a period of immobilisation for example after surgery. It can also occur secondary to other shoulder conditions such as impingement.

How long will it last?

It often takes a year to improve but can take longer depending on the severity of your symptoms. There are three stages of frozen shoulder:

  • Stage 1 – This stage normally lasts between 2 to 9 months, but can take longer, especially if you are diabetic. The first symptom is pain, usually worse at night and the shoulder can feel painful to lie on. The shoulder will start to become stiff
  • Stage 2 – This stage can last between 4 and 12 months. At this stage pain is often much more manageable and you are able to sleep better at night. The stiffness remains and may worsen, especially outward rotation of the arm. Your muscles may start to waste due to you not using the affected shoulder as much
  • Stage 3 – This stage usually lasts between 1 and 3 years. During this stage your shoulder will start to loosen and will slowly become easier to move. In some cases your normal range of motion may never fully return.

What can I do to help myself?

  • Keep moving – It is important to keep using your arm as normally as possible, as the pain allows, which will prevent the shoulder from becoming any stiffer
  • Good posture – Your shoulder movement can be affected by your posture. Sitting and standing in a good posture with your shoulders back will help your movement.
  • Heat – Some people find gentle heat (e.g. a hot water bottle or wheatbag for 10-15 minutes) will help ease the pain
  • Ice – An ice pack (or a bag of frozen peas) applied to the shoulder area for a maximum of 10 minutes twice a day can be a very effective way of reducing your pain. Make sure the ice is wrapped in a towel to protect your skin from burns
  • Medication – Anti-Inflammatory medication or painkillers may be prescribed to help relieve the pain. You should take them at regular intervals according to the instructions. Consult your GP if you don’t feel your medication is helping
  • Exercise – Exercises are a very effective way to restore movement at the shoulder joint and help keep the muscles strong. Keeping your shoulder moving is very important but you should avoid pushing too far into very painful movement.

Other treatments that may be offered

  •  Physiotherapy treatment can include mobilisations, exercises and other modalities. You will be assessed fully before treatment options are discussed
  • A steroid injection into the painful area may help to relieve the pain. Your GP/Physiotherapist can advise if this is appropriate for you based on your presentation and other medical factors
  • Surgery is not commonly used but may be offered in some cases. Your GP or physiotherapist will be able to offer more advice on this.

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Golfer’s elbow  >

What is Golfer’s elbow?

Golfer’s elbow, sometimes referred to as medial epicondylitis, is a condition that results in pain around the inside of the elbow (over the medial epicondyle). This is often due to repetitive stress or overuse of the forearm muscles that bend and twist the wrist. It may be caused by daily activities or sports which involve lots of gripping.

Common symptoms

  • Pain and tenderness on the inside of your elbow
  • Pain can also spread into the upper/lower arm
  • Weakness of the forearm, particularly with activities which involve gripping
  • Difficulty in fully straightening your arm

How long will it last?

In most cases golfer’s elbow will gradually improve, but the recovery time can vary from weeks to months.

What can I do to help myself?

  • Activity – Continue your normal daily activities but try to avoid any activities that aggravate your symptoms such as heavy lifting. Try and take regular breaks from activity
  • Medication – If you have been prescribed pain relief take it at regular intervals. Anti-inflammatories may also help to reduce the inflammation of the affected area. Your GP can advise you on this
  • Ice – Try applying ice to the area for approximately 10 minutes several times a day. Wrap ice in a towel before using
  • Brace – In some cases an elbow brace or strap may help. Your Physiotherapist or GP will be able to advise you on this
  • Exercises – If your symptoms worsen on doing exercise then stop and ask your GP or Physiotherapist for advice

Other treatments that may be offered

  • You may be referred to a Physiotherapist, who might use taping, acupuncture or alternative exercises appropriate for your individual case
  • If sport or occupation is contributing to your symptoms, you may need an assessment of your technique to help prevent recurrence
  • If pain is difficult to settle, a steroid injection might be considered. In some cases you may be referred to an Orthopaedic surgeon, but this is rarely necessary.

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Shoulder impingement  >

What is impingement?

Shoulder impingement occurs when muscle tendons (or bursa) are irritated within the shoulder joint on certain movements, leading to pain, stiffness and restricted motion.

Common symptoms

Symptoms vary from person to person and may come on gradually or as the result of an injury. Common symptoms include:

  • Shoulder and upper arm pain, which can radiate down the arm in more severe cases. The pain can present as an ache, a sharp pain, or a combination of the two
  • Pain on activities such as lifting, reaching, overhead movements or driving
  • Pain when lying on the shoulder

How long will it last?

This will depend on the severity of your symptoms and it may take up to a few months to improve. In most cases symptoms will respond well to physiotherapy. However, if you find that physiotherapy is not successful, there may be other management options available to you. Your GP or physiotherapist will be able to offer more advice on this at a later date.

What can I do to help myself?

  • Medication –  If you have been prescribed anti-inflammatories or painkillers, take them at regular intervals. Consult your GP if your medication is not helping
  • Exercise – It’s essential to start active exercises as prescribed by your GP or physiotherapist. This will help  reduce your pain, increase the mobility in your shoulder and improve the strength and stability of the muscles around the shoulder. The exercises should be done slowly, moving into discomfort but not into excessive pain
  • Sleeping positions – Sleep on a supportive mattress and avoid sleeping directly on your shoulder. If you have to lie on that side, then try a thicker pillow or two pillows. Alternatively, try sleeping on your opposite side with a pillow tucked under your armpit. Choose whatever position is best for your pain levels
  • Posture – Good posture is important as this will place the shoulder joint in a better position and avoid aggravating your pain. Regularly sit up straight, pull your shoulder blades together and tuck your chin in. A small rolled towel placed in the small of your back may help support a better posture when sitting
  • Hot/cold – Either heat or cold can be used to help pain and muscle spasm. Use frozen peas in a damp tea towel for up to 10 minutes, or alternatively try a hot water bottle in a cover. Use whatever gets best results for you. Make sure to regularly check your skin to avoid skin damage

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Tennis elbow  >

What is tennis elbow?

Tennis elbow, also known as lateral epicondylitis, is a condition that results in pain around the outside of the elbow. This is often as a result of overuse of the muscles and tendons in the forearm. It may be due to certain sports or everyday activities especially if you do a lot of heavy or repetitive arm activities.

Common symptoms

  • Pain and tenderness on the outside of your elbow
  • Pain can also track down your forearm
  • Pain on repeated wrist movements, gripping activities or rotation of the arm.
  • Difficulty in fully straightening your arm.

How long will it last?

In most cases, tennis elbow will gradually improve. This is a process that can vary in time from weeks to several months in some cases.

What can I do to help myself?

  • Activity – Continue your normal daily activities but do try to avoid any activities that aggravate your symptoms such as heavy lifting. Try and take regular breaks from activity, especially repetitive or sustained activities such as computer work
  • Medication If you have been prescribed pain relief take this at regular intervals until the pain settles. Your GP can advise you on this
  • Brace In some cases a tennis elbow brace or clasp may help. Your Physiotherapist or GP will be able to advise you
  • Ice – Try applying cold to the area for 8-10 minutes several times a day. Wrap ice in a towel before using to prevent burns to the skin
  • Exercises – If your symptoms worsen on doing exercise then stop and ask the advice of your GP or Physiotherapist

Other treatments that may be offered

  • In some cases your GP may use a steroid injection or GTN patches to help ease the pain
  • You may be referred to a Physiotherapist. They may use acupuncture, taping or alternative exercises that are suitable for your individual case
  • In cases of severe pain which does not improve you may be referred to an Orthopaedic Surgeon for a surgical opinion. However this is rarely necessary

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How can I help my back or neck mobility?  >

Acute low back pain  >

What is acute low back pain?

Most back pain is not due to any serious disease or damage to the spine. Onset can be sudden which usually settles within a few days or weeks at the most. What you do in the early stages is very important. The back is designed for movement and staying active will help you get better more quickly and prevent further back problems. People who cope the best with back pain are those who maintain an active lifestyle.

Warning signs
If you have severe pain, which gets worse over several weeks, or if you are unwell for example have a fever, you should contact your doctor. If you develop any of the symptoms below you should see your doctor/attend A&E straight away:

  • Difficulty passing urine or controlling your bowels
  • Numbness around your back passage or genitals
  • Numbness or pins and needles in both feet
  • Weakness in both legs or unsteadiness on your feet

What can I do to help myself?

  • Painkillers – Simple pain killers can be used to help manage your pain. Ask your local pharmacist for advice. Please follow the instructions on the packet carefully.Your GP can prescribe stronger medication if required
  • Cold/heat – You can apply cold or heat packs over the painful area for 10 minutes for short-term relief. Make sure you protect your skin from burns with a towel
  • Keep active – Keeping active and maintaining your normal everyday activities will help you recover more quickly from back pain
  • Good posture – Good posture is important as this will aid the healing process and help prevent the pain from getting worse
  • Exercise – It is essential to start active exercises as soon as you are able. This will help to increase the mobility in the back and reduce the pain

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How can I help my leg or hip mobility?  >

Achilles tendinopathy >

What is an Achilles tendinopathy?

Achilles tendinopathy involves damage to some of the fibres of the tendon. This can be after an injury or it can occur if the tendon is repetitively stressed over time. It is thought to be due to repeated small tears (microtrauma) which do not heal fully and lead to loss of the normal strength of the tendon. You may also get local thickening of the tendon.

What are the symptoms?

  • Pain at the back of the ankle, just above the heel bone
  • Pain and stiffness in the tendon especially in the morning or after periods of rest
  • Pain after exercise and walking, especially up hill or up stairs
  • Tenderness over the tendon
  • Swelling, thickening or nodules over the Achilles tendon

How long will it last?

The process of recovery will vary according to the severity of your symptoms, other contributing factors and your compliance with Physiotherapy rehabilitation. With the right exercises, most people make a good recovery within a period of 3 months, but occasionally symptoms can last longer.

What can I do to help myself?

  • Rest – It is important initially to avoid your aggravating activities such as running, to prevent repetitive trauma to the tendon and allow it to heal.
  • Ice – This should be applied to the tendon twice a day for 10 minutes. Use an ice pack or bag of frozen peas wrapped up in a damp tea towel. Do not apply ice directly to the skin
  • Stretches – These will help to improve the flexibility of the tendon. They should be held for 30 seconds and completed at least 3 times a day

Other treatments that may be offered

  • Referral to a podiatrist for biomechanical assessment and provision of insoles for your shoes
  • GTN patches (Glyceryl trinitrate) are sometimes used over the area to help with pain. Your GP can advise and prescribe these if needed
  • Surgery is rarely needed but possible to remove nodules or adhesions and encourage normal healing within the tendon.

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Osteoarthritis of the hip and knee >

What is osteoarthritis?

Osteoarthritis is the most common form of joint arthritis. The cartilage covering the joints gradually becomes worn and damaged. Bony growths may appear and the capsule surrounding the joint becomes thicker. Some ligaments may become weaker. This process can lead to deformity of the joint.

Common symptoms

  • Pain
  • Stiffness (often worse in the morning)
  • Grating/grinding on movement
  • Swelling

What can I do to help myself?

  • Heat – using gentle heat such as a wheat bag for 10 minutes
  • Cold – using crushed ice/bag of frozen peas wrapped in a towel for 10 minutes
  • TENS – a small machine that can help to block out pain signals
  • Walking aids – such as a stick to help support when walking
  • Aids to daily living – Make daily activities easier and reduce stress on joints e.g. chair/bed raises, sock aid, toilet seat raise, bath aids, grab rails

Other treatment that may be offered

Referral for surgery is normally considered only if:

  • All core treatments (i.e. pain control, physiotherapy and OA exercise class) have been tried
  • Quality of life is adversely affected. Patient specific factors such as age, smoking, obesity, gender and co-morbidities should not stop referral for assessment.

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Plantar fasciitis  >

What is Plantar fascitis?

Plantar fasciitis is thickening of the plantar fascia. This is a strong band of tissue that stretches from the heel to the middle bones of the foot. It supports the arch of the foot. Minor injuries or repetitive stress to the plantar fascia can lead to thickening which can cause pain.

Common symptoms

  • Pain on the underside of the heel which may be tender to touch.

How long will it last?

This will depend on the severity and cause of your symptoms. In some cases it may take several months or more to go. Your GP or Physiotherapist will be able to offer more advice on this.

What can I do to help myself?

  • Footwear – Trainers or similar shoes may be more comfortable, these shoes are shock-absorbing and have an arch support. Avoid old or worn shoes and walking barefoot
  • Medication – If you have been prescribed pain relief take this at regular intervals until the pain settles. Your GP will advise you on this
  • Heel pads – you can buy various pads and shoe inserts to help cushion the heel
  • Ice – Try applying cold to the area for 10 minutes several times a day. Wrap ice in a towel before using to prevent burns to the skin
  • Exercise -If your symptoms worsen on doing exercise then stop and ask the advice of your GP or Physiotherapist

Other treatments that may be offered

You may be referred to a physiotherapist or a podiatrist for further management which may include:

  • Taping
  • Corrective insoles
  • Further advice
  • Steroid injection –this is usually tried only if physiotherapy and self management have failed to help

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Other information  >

Pregnancy-related pelvic girdle pain  >

What is pregnancy-related pelvic girdle pain?

Pregnancy-related pelvic girdle pain is pain in the joints that make up your pelvic girdle. Around 1 in 5 pregnant women experiences mild discomfort in the back or front of the pelvis during pregnancy. Sometimes there is no obvious explanation for the cause of PGP. Usually there is a combination of factors including:

  • The pelvic girdle joints moving unevenly
  • A change in the activity of the muscles of your tummy, pelvic girdle, hip and pelvic floor which can lead to the pelvic girdle becoming less stable and therefore painful
  • A previous accident or fall that has damaged your pelvis
  • A small number of women may have pain in the pelvic joints caused by hormones

Common symptoms

The most common symptom is  discomfort over the pubic bone at the front, below your tummy, or across one side of the lower back, or both sides. Women may experience different symptoms and these are more severe in some than others.

If you have symptoms that do not improve within a week or two, or interfere with your normal day-to-day life, you may have PGP and should ask for help from your midwife, GP, physiotherapist or other health carer.

What can I do to help myself?

  • Be as active as possible within pain limits and avoid activities that make the pain worse
  • Ask for and accept help with household chores and involve your partner, family and friends
  • Rest when you can
  • Sit down to get dressed/undressed, avoid standing on one leg
  • Wear flat supportive shoes
  • Avoid standing to do such tasks as ironing
  • Try to keep knees together when moving in/out of car
  • Sleep in a comfortable position with a pillow between your legs
  • Try different ways of turning in bed e.g. turning under or turning over with your knees together and squeezing your buttocks
  • Roll in and out of bed keeping your knees together
  • Take the stairs one at a time (try going upstairs leading with your less painful leg and downstairs lead with the more painful one
  • Plan your day – bring everything you need downstairs in the morning
  • If using crutches have a small rucksack to carry things in

Other treatments that may be offered

Further Physiotherapy treatment may include:

  • Manual therapy
  • Acupuncture or TENS
  • Exercises in water
  • Provision of crutches and/or advice on pelvic girdle support belts

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Increased sensitivity  >

What increased sensitivity?

Often after an injury, our nerves can become very sensitive as a protective response. Sometimes, even after the injury fully heals, these nerves can remain highly sensitive.

Common symptoms

  • Hypersensitivity to light touch
  • Pins and Needles
  • Mottled skin
  • Sweating
  • Swelling
  • Avoidance

What can I do to help myself?

You may feel you want to protect the area, but actually we need to expose it to lots of different stimuli to help to normalise nerve function. The principle of these treatments is to send different messages to the brain e.g. change of pressure, temperature and position etc. You could try:

  • Textures – Pick three types ranging from soft to rough as agreed with your therapist. Stroke the texture with full skin contact up and down the area ten times, four times a day
  • Massage – Gentle touch to the area with or without an emollient for five to ten minutes, four times a day. Texture emersion: Fill a container with dry rice, lentils, salt or sand. Immerse the area and swirl for three minutes, four times a day
  • Mirrors – With the hand or foot either side of a mirror, look into the mirror on the unaffected side. As you move through different motion that your therapist will prescribe, watch the mirror image of your affected side. Spend five to ten minutes, four times a day doing this activity

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This web page is provided by NHS Wiltshire Clinical Commissioning Group (CCG) to support patients in their self-management of MSK conditions. The information provided is standard advice for common MSK conditions that respond to self-management. However, this website is not intended to replace the advice of your doctor or any other health care professional and you should not delay seeking professional medical advice. NHS Wiltshire CCG will ensure that information on this website is accurate, complete and current at the date of upload and that any links provided are to reputable websites. The CCG will not take responsibility for information accessed from linked websites.

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