The most important aspect of your problem is to obtain a definitive diagnosis and more particularly, the source of your pain (symptoms). Generally, with appropriate orthopaedic assessment which includes a full history and physical examination, the physiotherapist can ascertain the structure involved in producing this pain. Furthermore, he/she can then ascertain the weakness that has over-loaded this structure. These weaknesses are generally caused by habitual patterns (see below) which must immediately be recognised/adjusted.
For example, the sciatic nerve is a common source of pain that accompanies lower back symptoms. It is often irritated by another structure such as a stiff/tight spinal joint or a disc that separates two spinal joints. The position of the stiff joint or disc will in most incidences be dictated by poor muscular control (weakness) in muscles such as gluteals (buttocks)/abdominals etc. These weaknesses are created by habitual patterns
Thus, all aspects of the problem must be determined and addressed to give long term relief.

Treatment modalities

Manual therapy

Despite the move towards a more movement bias form of treatment there is still a place for manual therapy within the practice of physiotherapy. This can involve soft tissue massage/release work and manipulation of spinal joints and peripheral joints (knee, elbow, wrist etc). This will/must always be accompanied by a tailored rehabilitation program.


Crucial to any regime of physiotherapy is the rehabilitation program. Patients will be asked to participate in this from day one. Appropriate exercises for either mobility, flexibility or strength will be given at initial assessment. 

Patient ‘buy in’ at this stage is of paramount importance or the regime will fail.  Unfortunately, whilst physiotherapy can give some excellent immediate results , for long term resolution a strength, mobility or flexibility program (or a combination) together with habit change is vital.

Habitual pattern changes

In clinical lead physio Gary Carr’s experience and opinion this is the paramount element of rehabilitation. There are a lot claims from therapy websites about solving the problem long term. 

Sadly these claims are without substance in most cases. Unconscious habits that we do all day at work (not covered by desk assessments), on the couch at home or lying in bed at night time can set up huge imbalances across the body. Imbalance equals muscle weakness, muscle weakness leads to overload of one or multiple structures, overload equals pain. So, there are always three elements to the condition presenting.

If all three are not addressed then therapy is incomplete. Habit change is tough but it’s crucial.

Ultra sound guided injection service

This comprises of a subjective (medical history) assessment, an objective (physical assessment), a diagnostic ultra-sound scan and an appropriate injection if deemed necessary.

The comprehensive ‘one-stop’ clinic run by clinical specialist physiotherapist Emerson Fernandez offers a full clinical history taking, physical assessment of the problem, ultra-sound imaging diagnosis and injection(s) where deemed necessary. This is followed by a written report.

Types of Injections :

Ultra sounded guided injections can be cortico-steroid or hyaluronic acid based in nature.

Cortico-steroids are anti-inflammatory and fast acting for pain relief and reduction of local inflammation in tissues. They are primarily used to provide windows of opportunity for appropriate rehabilitation of musculo-skeletal problems.

Hyaluronic acid injections help replace the body’s natural joint lubricants lost in the presence of degenerative disease such as osteo-arthritis in joints such as hips and knees.

What are the advantages of ultra-sound guided injections ?

There is a significant body of research which demonstrates that ultrasound guided injections give better outcomes such as improved levels of pain relief, longer lasting benefits, and improve the post-injection function of the injected area, compared with injections that are done without ultrasound guidance ( e.g.blind/surface marked injections). There is also growing evidence that guiding the injection reduces the risk of trauma to local tissues or misplacement of the needle and/or the injection substance. This improves the safety of the injection and reduces the risk of adverse events associated with injection therapy. Because the location of the injection is more precisely known it reduces the chances of having unnecessary injections. Many patients find ultrasound guided injections to be more comfortable as often the required depth of the injection can be reduced


The service is very competitively priced compared to local private hospitals (half of the cost) and is proving a great success. 

Cortico-steriodal injections start at £250 for one joint which includes the clinical assessment and the ultra-sound diagnosis as well as the injection procedure and a written report.  Two joint procedures are available at £400.

Cortico-steriodal injections start at £250 for one joint which includes the clinical assessment and the ultra-sound diagnosis as well as the injection procedure and a written report.  Two joint procedures are available at £400.

Hyaluronic acid injections for osteo-arthritic joints start at £290 fully inclusive as above.

Should you wish to discuss further before proceeding then please kindly contact 0207 482 3875 and ask to speak to Emerson Fernandez, mentioning his Upminster injection clinic. Or you can ask to book in immediately at this clinic and you will be taken through the process accordingly.


The ancient art of acupuncture can be used as part of physiotherapy intervention.  It is based on the release of the body’s own pain relieving chemicals by stimulation with very fine needles. It has no known side effects and is a good accompaniment to other modalities of treatment such as manual and exercise therapy.

Taping techniques

Taping techniques are used quite often in the physiotherapy management of musculoskeletal conditions. Whether used to unload (take the pressure off of) structures for support during rehabilitation or for pain relief, taping can be a very effective modality of treatment short term.

At Excel we use both fixed (rigid taping) for stabilising ie correcting foot position/stabilising a sprained joint. Or softer more flexible taping if support is required alongside movement ie for injured soft tissue such as muscle.