Physiotherapy MSK

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.

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.

Video appointment information

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.

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. 

• 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

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.

MSK patient leaflets

NHS UK provides information about common conditions and treatment options.

The CSP is a professional, education and trade union for physiotherapist. It provides information about common conditions and treatment options.

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 is a rehabilitation programme for people with chronic joint pain of the knee, hip or back.

NHS fitness studio offers you a range of free online exericse workouts, ranging from 10 to 45 minutes.

Couch to 5K is a running plan for absolute beginners, to gradually get you towards running 5km in just 9 weeks.

A Shared Decision Making Tool combines all the known information about treatments and interventions for a particular condition.

NHS England

The NHS Every Mind Matters website provides a range of support, resources advice on mental health and wellbeing.

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

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

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 CSP

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.

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

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.

The warning signs for cauda equina syndrome are summarised on this credit card resource.

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 

• 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

• Pelvic organ prolapse
• Pelvic floor exercises for women
• Promoting continence with physiotherapy
• Physiotherapy advice for patients with bowel issues Improving your bowel function
• Anal sphincter exercise

• 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
• Bladder and Bowel Community - for support, information and guidance
• POGP – pelvic obstetric and gynaecological physiotherapy
• IUGA- international urogynecological association
• RCOG – Royal college of obstetricians and gynaecologists

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