Back and neck Pain: Sciatica, Lumbago, disc herniation/prolapse, joint sprains, ligament and muscle strains, previous fracture, degenerative changes, arthritis and rheumatism.
Lumbar Intervertebral Disc Injury
The Lumbar Intervertebral Discs are located in the spine between the bony vertebra. The discs have a gel centre and a tough fibrous outer ring. They are mainly responsible for shock absorption through the spine.
Repetitive strain of the lower back can cause small cracks in the outer ring of the disc. The gel can seep into these cracks to the edge of the disc and cause it to bulge, this is called a herniated disc. If the gel breaks through the edge of the disc, this is called a prolapsed disc and is more severe.
Symptoms A lumbar disc herniation can cause a deep underlying low back and buttock ache. If it presses on a nerve root then this can cause a shooting pain into the leg and ankle, and commonly tingling, numbness and weakness.
A lumbar disc prolapse will commonly cause severe low back pain and restriction of movement. Bending forward is particularly difficult in most cases. The irritation of the nerve root is commonly greater when a disc prolapses in comparison to a disc herniation, therefore the symptoms of tingling, numbness and weakness into the legs are also significantly worse.
Causes
Repetitive forward bending of the spine, particularly if rotating at the same time
Habitual slumped seated posture
Heavy lifting
Violent trauma (sports / road traffic accidents)
Rib strains. It is very common for patients to present with strains to rib joints, bruising to the bone of the ribs, injury to the cartilage that attaches to the ribs at the front and strains to any of the many muscles that move the rib cage. The ribs act as a protective cage surrounding the various organs of the thorax and can often suffer from traumatic injury or long term stresses and strains. Often the pain is acute and patients may even find it hard to breathe. Due to its many articulations with the spine and sternum and the many muscular and ligamentous attatchments it can have a secondary influence on how the whole upper body functions.
Frozen shoulder is a painful, persistent stiffness of the shoulder joint. Movements of the shoulder become reduced, sometimes completely 'frozen'. It is thought to be due to scar-like tissue forming in the shoulder capsule. Scar tissue may form for a number of reasons, such as after a minor shoulder injury or from heavy exercise, but sometimes there is no obvious cause.
Frozen shoulder affects about 1 in 50 adults at some stage in their life. It most commonly occurs in people aged between 40 and 60. It is more common in people who have diabetes.
Symptoms The typical symptoms are pain, stiffness, and limitation in the range of movement of the shoulder. The symptoms typically have three phases.
Phase one - the 'freezing', painful phase. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain is typically worse at night, and when lying on the affected side.
Phase two - the 'frozen', stiff phase. This typically lasts 4-12 months. Pain gradually eases but stiffness and limitation in movement remain and can get worse. All movements of the shoulder are affected but the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste as they are not used.
Phase three - the 'thawing', recovery phase. This typically lasts 5-24 months. The stiffness gradually goes and movement gradually returns to normal.
There is great variation in the severity and length of symptoms. Untreated, on average the symptoms last 2-3 years in total before subsiding. In some cases it is much less than this.
The menisci are two tough pads of cartilage located in the knee joint between the thigh bone (femur) and the shin bone (tibia). One is located on the inner knee joint surface (the medial meniscus), and one on the outer knee joint surface (the lateral meniscus). Their job is to provide a good fit for the femur on the tibia so body weight is distributed evenly across the knee joint.
Symptoms Individuals who experience a meniscus tear usually experience pain and swelling as the primary symptoms. Another common complaint is joint locking, or the inability to completely straighten the joint. This is due to a piece of the torn cartilage physically impinging the joint mechanism of the knee. The most common symptoms of a meniscus tear are:
Knee pain
Swelling of the knee
Tenderness when pressing on the meniscus
Popping or clicking within the knee
Limited motion of the knee joint
Causes The two most common causes of a meniscus tear are due to traumatic injury (often seen in athletes) and degenerative processes (seen in older patients who have more brittle cartilage). The most common mechanism of a traumatic meniscus tear occurs when the knee joint is bent and the knee is then twisted.
Twisting the ankle and causing injury to the outer (lateral) ligaments is one of the most common musculoskeletal injuries. Ligaments are tough fibrous bands that connect bone to bone and are extremely strong. Their job is to provide the joint with stability and resist excessive movement beyond the joint’s normal range.
Symptoms & Classification A sprained ankle is classified into three categories depending on severity:
First degree ankle sprain:
Some stretching or perhaps tearing of the lateral ankle ligaments.
Little or no joint instability.
Mild pain
Little or no swelling
Some joint stiffness or difficulty walking or running.
Second degree:
Some tearing of the ligament fibres.
Moderate instability of the joint.
Moderate to severe pain and difficulty walking.
Swelling and stiffness in the ankle joint.
Third degree:
Total rupture of a ligament.
Gross instability of the joint.
Severe pain initially followed by no pain
Severe swelling
Elbow and hand Problems: Lateral and medial Epicondylitis( 'tennis and golfers' elbow), bursitis, wrist sprains and subluxations/dislocations following falls, Repetetive strain injuries, Arthritic changes.
Tennis Elbow (Lateral Epicondylitis)
Lateral Epicondylitis is an inflammation of the tendons on the bony outer part of the elbow (known as the Lateral Epicondyle). These tendons are responsible for many elbow, wrist and finger movements.
Symptoms Lateral Epicondylitis is characterised by pain, tenderness and swelling in the outer part of the elbow and forearm, particularly on moving the elbow, wrist and fingers.
Causes The tendons can be injured by repeated actions such as:
Racquet sports
Using scissors or shears
Typing
Manual occupations that involve repetitive use of the elbow and wrist such as Decorating or
Plumbing
Direct trauma to the elbow or forearm
Carpal Tunnel Syndrome (CTS)
The carpal tunnel is a narrow passageway of ligaments and bones at the base of the hand/wrist, which houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed leading to Carpal Tunnel Syndrome (CTS) (See diagram).
Symptoms CTS is characterised by a numbness, tingling and pain in the thumb and fingers of the hand, and in some cases the ability to grip with the hand is significantly reduced. Women are 3 times more likely than men to develop CTS, possibly because the carpal tunnel is more commonly smaller in women than men.
Causes
Trauma or injury to the wrist that cause swelling, such as sprain or fracture
Overuse of the wrist
Fluid retention during pregnancy or menopause
Pathologies such as Diabetes / Overactive Pituitary gland / Hypothyroidism / Rheumatoid Arthritis
Osteoarthritis (OA) is the most common form of arthritis, and is the result of wear and tear of the joint surfaces as part of the natural ageing process. When OA affects a joint, the cartilage between the two surfaces becomes damaged and worn causing inflammation.
Symptoms OA hip is characterised by pain and stiffness around the hip joint and groin. Pain is also commonly referred to the knee joint. The symptoms usually develop gradually over months or years, and as the condition progresses the symptoms can become more constant. Loading of the hip joint will become painful as the surfaces wear away, so commonly one of the symptoms is the development of a limp when walking.
Causes
Age - Commonly OA begins in the late 40's, 50's or 60's as part of the natural ageing process.
Obesity - If you are overweight then the loading of the joint is increased causing greater wear and tear. If you remain overweight, then this will potentially worsen the condition.
Joint Injury - A major injury or operation on a joint can lead to an increased risk in OA. Heavy, repetitive activity may also increase the risk of developing the condition.
Lumbar Intervertebral Disc Injury
Frozen Shoulder (Adhesive Capsulitis)
Ligaments are tough fibrous bands that connect bone to bone and are extremely strong. Their job is to provide the joint with stability and resist excessive movement beyond the joint’s normal range.
Tennis Elbow (Lateral Epicondylitis)
Carpal Tunnel Syndrome (CTS)
Osteoarthritis (OA) of the Hip 
