Category Archives: Knee Pain

Acupuncture – how does it work? And will it cure Man-Flu?

A lot of people ask us about acupuncture. Not only the obvious things like: Does it hurt? How big are the needles? But also, How does it work? And, Will it help my sciatica/mood/tight muscles?

Sensible questions all round! Here, we try to provide some (mostly sensible) answers. Watch out for the science (anyone else remember Jennifer Aniston in the L’Oreal advert?) Let’s start at the beginning.

What is Acupuncture?

It’s the insertion of very thin needles into specific points on the skin. Part of Chinese medicine that’s been around for over 2000 years, it has been used commonly in Western societies since the 1970s. Physiotherapists use acupuncture for many different purposes, but the main ones are: to relieve pain, to reduce muscle tension, and to promote the body’s own healing processes as an accompaniment to other treatments such as manual therapy and relaxation teachniques.

Acupuncture (Copyright First Class Physiotherapy 2014)How Does Acupuncture Work?

*Science bit* By creating a very small and controlled amount of “sterile trauma” with the needle, acupuncture stimulates the body to produce endorphins (happy/pain-relieving hormones) and their receptors (which means not only do you have more hormone to create an effect, you also have a greater catchment area to “feel” that effect), as well as serotonin (stress-busters). The needle also stimulates A? nerve fibres. This produces another chemical which blocks the C fibres – the nerve endings for PAIN – from accepting input. Long story short: you swap the pain sensation for something more like a tingling or a heaviness, or a nice relaxed feeling instead.

Does it Hurt?

Well, not any more than you might expect from a very small needle (each one is about the width of a human hair). And quite often, a whole lot less than you’d expect. It depends what area we’re working on. Some parts of the body have more concentrated nerve endings per unit area, and these will natually be more sensitive (your hands and feet, for example). Some have fewer nerve endings (thighs, back etc). If there is a lot of muscle tension in the area, you can get a very strong sensation but conversely, you may not feel the needle at all.

So What Will I Feel?

Alongside the tingling or warm, heavy feeling, you may feel a little sleepy or even giggly (this one more common in men in my experience). Some people feel a little light-headed, and there can be side-effects that aren’t as much fun, like nausea or fainting. Usually the treatment won’t feel unpleasant at all, but if you don’t wish to proceed at any time, we’ll take the needles out immediately. ( (

Where Will the Needles Be Put?

This will depend on what your symptoms are and where you feel them. Because of the way the channels are lined up in your body and along your limbs (think of them kind of like a long train track with lots of stations along it), you wouldn’t necessarily have to have the needles exactly where your pain is to still get a good effect. There are some points that are usually used in conjunction with others (called “formula” points), for instance the “4 gates”, which are points in both hands and both feet and help relieve pain. And there are points away from the spine, as well as closer to the spine on those “tracks” or Meridians, which will help send those messages along the appropriate nerve fibres to give you relief where you need it.

Are the Needles Sterile?

Yes, every one is individually packed and disposed of in our sharps boxes after a single use. Each needle also comes in its own plastic guide tube so your physiotherapist will not touch the part inserted into your skin.

How Many Sessions Will I Need?

Most conditions are treated with good effect in fewer than 6 appointments, but you might feel better after only one or 2 sessions. It will generally be clear after 2-3 sessions if the acupuncture is of benefit.

I Have (select an option) Epilepsy/a Pacemaker/Man-Flu, Can I Still Have Acupuncture?

Well, unfortunately no is the answer for some conditions like unstable heart conditions or over infected or broken skin, or for women in their first trimester of pregnancy. For people with diabetes, hepatitis, high/low blood pressure or a history of metal allergies, blood disorders or cancer, we’ll help you decide with more in-depth questions whether it’s best to proceed with acupuncture or not. We’ll also work with you to make sure that any treatments given are the current best practice for your specific condition, and in many cases, this doesn’t include acupuncture (man-flu included.)

When Can I BoGet In Touchok?

Any time by sending us an email (, giving us a phone (0141 2372 721) or popping in to see us. We offer a free 15 minute consultation, where you can tell us what ails you and we’ll let you know if physiotherapy would be advised (and if acupuncture is an option, how we suggest proceeding.)

Foam Party

What is foam rolling?

iliotibial band foam rollingFoam rolling is used more and more as a tool which allows self myofascial release. In other words it is being used as an aid for self-massage to release muscle tightness (trigger points) and to target the damaged fascia of the muscle.


So what is the fascia?

Fascia covers and protects your tissues, tendons, bones, ligaments, organs and, last but not least your muscles. Its main role is to prevent injuries by resisting internal and external forces that are placed on these structures. Its structure enables it to contract and relax; making it perfect for stabilisation, mobilisation and flexibility of your joints.

When a muscle is over exerted the fascia can be left with areas of scarring and rigidity (trigger points). This in turn can create tension in surrounding structures, which can produce pain, known as trigger points; this has a knock on effect throughout the body. Additionally it can reduce blood flow to particular areas, causing further damage and reduced healing times.


piriformis foam rollingPiriformis foam rolling

Okay, but how can foam rolling help?

Through applying pressure to specific trigger points, you are able to aid in the muscles recovery and assist in returning them to normal function. It can release these areas of damaged/ hardened tissue; in turn restoring blood flow and letting the muscles return to their ordinary strength and flexibility.

It can help your muscles go back to being elastic, healthy, and quick to respond when required. Finally, rolling your muscles can increase the flexibility, mobility and stability of your joints; leaving you less prone to injuries (yippee!).

Foam rolling or stretching?

Well, the simple answer is …BOTH!

Studies have found that the greatest results in flexibility and mobility, and decreased occurrence of injuries are shown when foam rolling and dynamic stretching are combined (C.Goad et al, 2014). The benefits of stretching alone before exercising is a grey area, with reports it lowers performance and energy.


So when should I use the foam roller?

foam rolling, trunk, back

As mentioned above, the foam roller is a great way to warm up a muscle prior to exercising; it also works well for increasing muscular recovery.

After a big workout or run, we can often feel quite sluggish and those ‘few stairs’ seems to bear more of resemblance to Mount Everest. This is called DOMS (delayed onset of muscle soreness) and the peak of this pain is normally 48 hours post exercise (hence the ‘delayed’ part). One of the most popular uses of the foam roll is to decrease the incidence and the severity of the DOMS experience; allowing athletes to return to training and normal muscle functioning earlier.

Foam rolling with First Class Physiotherapy

As Physiotherapists we have seen the benefits of incorporating foam rolling into our patient’s home exercise / running programmes; so much so that we have introduced a class which is suitable for all individuals no matter your previous rolling experience.

As a runner I personally do not know what I did before rolling; my patients and current class would tell you that I am a big fan of the ‘game changer’ – the foam roller.

Classes run on Wednesday evenings from 5.15pm and can be booked by phone or email.

If you have any further questions or would like to give it a go, please do not hesitate to contact us.

Best ‘Foam party’ you will attend.

New services for runners and cyclists

We have been working hard over the last few months planning some exciting new services for all you keen runners and cyclists out there. In the clinic we see a number of patients who sustain injuries through their sport which stops them from participating for a period of time. As physiotherapists we consider prevention just as important as treatment and so have decided to launch a new running service in January 2016, followed by a cycling package in May 2016.


Our new running prehablitation service will include a biomechanical assessment, a strength and conditioning class, bespoke running plans and a running group. We are also going to host evenings with guest speakers, including a nutritionist, a podiatrist and a sports psychologist.


RUNNERS…… Do you regularly get niggles or even injuries that stop you from being able to run the distance you want to run or do they slow you down? Would you like a full biomechanical assessment to help prevent injuries and improve your running style?

What is a biomechanical assessment?

A biomechanical assessment involves analysis of your running technique wwhich allows our expert physiotherapists to highlight errors in the way you move and problematic areas in your running gait. In addition to this our physiotherapists will assess joint and soft tissue movement, flexibility and strength; this is a series of movements that highlight mechanical faults that often cause running injuries. From this information we will develop a bespoke rehabilitation program including strength and conditioning, mobility/flexibility, running cues and running drills.

Who is a biomechanical assessment for?

This assessment is for any individual who enjoys running, long- or short-distance, who sustains recurrent niggles or wants to improve their running technique or performance.

Is there anything I should do before attending the appointment?

It is worth while to keep a running diary for up to 4 weeks before the assessment. Usually this can be done from memory and when booking the appointment you will be provided with a template to complete. Try not to make any changes to your running style or training pattern prior to this assessment.

How long does this assessment last?

This assessement will last 60 minutes, trainers and running clothes must be broght along to the appointment. The trainers should be your usual footwear when running.


Running Group

We will be starting a running group for all levels in the first week in January 2016, date to be confirmed soon. The meeting point will be at the clinic, entrance through 82 Gordon Street, you will be able to get changed and leave your belongings in the clinic and head off with a Jog Scotland qualified group leader and a another qualified physiotherapist. On completion of the run you are free to return to the clinic for some socialising where juice and a snack will be waiting.


Personalised running plans

Do you have ambition or desire to increase your running distance or speed, maybe you are considering competing in a 5k, 10k, half marathon or even a marathon, not sure how to go about safely and effectively increasing your distances to avoid injury. When not book in with one of our physiotherapists to discuss your requirements and create you a plan to meet your goals. This appointment will last 45 minutes and will involve 1-to-1 goal setting and a written training plan.


Strength and conditioning class

Most runners tend to enjoy one thing and one thing only….. running! They have no problem racking up the miles but neglect to look after the muscles that keep them running. It is important to encompase strength, condition and flexibility into your work out to avoid any unwanted injuries and to keep you balanced, make you stronger and faster. This 45 minute class will include specific exercises to target the key muscles involved in running, to improve core strength and general flexibility.


Cyclers…… don’t worry there will be a similar programme launching in 2016 and we will be in touch in the new year with more information on this.


If you have any questions or would like to book in for any of these services, please do not hesitate to contact us on 0141 2372 721 or email

All you need to know about… muscle cramps

We’ve all had them. Whether it’s a calf in the second half of a football match,  your fingers after writing or typing all day or toes in the middle of the night (just me?), cramp is something we’ve all experienced. But what causes it? What’s the best way to get rid of it, and how can you avoid it?

cramp, leg pain, physio, physiotherapy, glasgow

What IS cramp?

When we talk about cramp, we are generally referring to the sensation of our muscles tightening up involuntarily, leaving us temporarily paralysed and usually in a lot of pain. Cramp can come on for several reasons and is usually harmless (apart from the excruciating pain, obviously), but it can indicate underlying pathology.

One of the most common areas to cramp is the calf muscle, and 75% of these cramps occur at night time. Many people suffer from this for no apparent reason (this is known as an idiopathic condition), but some people have cramps as a result of a pre-existing condition such as pregnancy, diabetes or liver disease. You might cramp more often if you’ve been exercising excessively during the day, or if you are on certain medications e.g. for high cholesterol or high blood pressure (statins or diuretics).

Some cramps last only a few seconds and happen occasionally, but they can last up to 10 minutes and occur more frequently. If the latter is the case with you, or you are experiencing swelling or numbness along with the cramps, it’s worth visiting your GP.

What causes cramps?

Dehydration is thought to be one of the most common causes, and although we may think we are drinking enough in a day, we could always take on board that extra glass or two.

physio cramps physiotherapy glasgow pain massage

A deficiency in salt is also a popular theory for cramping, however this doesn’t necessarily mean you should laden up your chips tonight just in case! Potassium (a mineral which can be found in bananas, spinach, mushrooms, raisins and oranges amongst other foods) is an important missing factor in many people’s diets, and eating a little more each day can reduce cramping.

Fatigue is another common reason for cramp. If you have been doing more exercise than usual during the day, or if the weather has been particularly warm (as it was this lovely summer), it’s natural that your body will sweat more and therefore be losing more water and salts than usual.

As we age, our tendons (attaching muscles to bones) naturally shorten, pulling more on the muscles causing them to tighten, which may be one reason people over 60 experience cramp more often.

To prevent cramps…

There is no guaranteed way of preventing cramps (unless you listen to my Granny, whose cure involving nettle leaves and tuna fish is a sure-fire winner…) but there are ways of reducing the severity and frequency. Try to include some moderate exercise into every day, especially targetted stretching of the affected muscles (i.e. a few calf stretches before bedtime). Walking, taking a flight of stairs here and there, even a few extra stretches when on a break from your desk – but do remember that unusually heavy exercise (relatively) may increase the occurrence.

To combat the dehydration issue, spread your fluid intake throughout the day – having a bottle of water at your desk to sip is a good tip, as is having a glass of water after every time you visit the toilet (not from the toilet I hasten to add). Lots of people don’t like to drink too much before bedtime, so the best advice is to drink as much water as possible throughout the day before dinnertime.

If your cramps are worse at night, make sure your ankles are relaxed when you sleep (in other words, don’t sleep with your toes pointed). Your sheets should also be kept quite loose, to allow your muscles to move.

For those with persistent cramping, your GP might prescribe you medication, but the main methods of preventing cramps (as above) should be exhausted first. If your leg cramps occur during pregnancy, especially in the last trimester, you should find these ease once you’ve had your baby.

What should I do when I get cramp?

Ah, the all important part. With any luck, you’re probably already doing some of the right things to help ease cramp when it does occur, but here is a quick rundown of how to help.

physiotherapy glasgow cramp calf stretch pain physio

First and foremost, try to get the cramping muscles into a stretch (see the picture opposite for a calf stretch). Some people find a standing stretch easier, others ask for help and have someone else flex their ankles for them while they lie on their backs. Having someone assist you is often easier for hamstring (back of the thigh) cramps.

Massage the tight muscles gently to try to release the cramp. Once the cramp has shifted, you might be left with a fatigued and sore muscle which can be massaged properly to help return normal sensation and function.

Use warm water to try to ease the pain and tightness if you can.

If you are concerned about the cramps you’re having, it is worthwhile making an appointment to see your GP. If you’d like to book a physiotherapy appointment, or even book a massage, please get in touch by calling us on 0141 2372 721, or emailing


How Will Physiotherapy Help You?

When you hear the word physiotherapy, what do you think of? A football match and the person running on with the bag to aid the stricken drama que… sorry, the injured player? The athletes at the Olympics and their fancy coloured tape? Or do you have personal experience of working with a physiotherapist, and know us more for working with people with disabilities, working with sportsmen and -women to improve their fitness or helping injured people learn to walk again?

Many of you lovely blog-readers will know, or know of, a physiotherapist, but not know much about what sorts of skills they have or how you could benefit from them. That’s where this blog comes in!

Here are a few ‘did you know’ items about the physiotherapists at First Class Physiotherapy:

  • We use movement, exercise, education and advice along with our own manual skills and banks of knowledge to help people manage their pain and other symptoms and prevent disease
  • We can promote recovery from an injury to help you get back to full function (and back to work) as soon as possible
  • We understand that injury or pain affects you as a person and we design a treatment program around what you expect, what is realistic and what is most beneficial for you
  • We promote health not only through physical treatment but also advice on how to lose weight and give up smoking (amongst many other things!)
  • We can help you stay relaxed as well as preventing injury by offering sports massage, Swedish massage and hot stones massage (all together now, aaaaaahh)
  • We offer a mobile service to your workplace or home so that you don’t have to take extra time out of your day to visit the clinic
  • We can help you access physiotherapy through an insurer so that you don’t have to pay up front

A typical patient we may see will have back pain (much like 60-80% of the population at some point in their lifetime) and will be wondering whether or not to see their GP. That’s an excellent start, and will help you find the right pain medication if that is the route you’d like to take. The GP might then refer you on to a physiotherapist, and through the NHS in the Glasgow area, you could wait up to 6 months for an appointment. Hmm, that’s quite a long time to be stuck with a sore back… Happily, your back pain will most likely have resolved by then.

Instead of waiting to find out if your pain does become chronic (in other words, if it lasts longer than 3 months), you could self-refer to see a physiotherapist.

First Class Physiotherapy Glasgow

That’s where First Class Physiotherapy comes in! We’re here to offer you an appointment – even before you see your GP – within 48 hours of you first contacting us. Even if it’s just for advice or reassurance, if you are concerned about a pain, stiffness or weakness contact us today, and put yourself on the road to recovery. Then you’ll have first hand experience of what a physiotherapist really does when she’s not nursing the drama queens!

ACL Injuries – just in time for Euro 2012!

Quite a few people have been asking about specific injuries and with Euro 2012 heating up we’ve decided to cover injuries to the knee – specifically the anterior cruciate ligament (ACL), a “favourite” with footballers.

The knee joint is the largest joint in the body, and is made up of: 4 bones (the femur [thigh bone], patella [knee cap], tibia and fibula [your shin bones]), an extensive network of ligaments and muscles, menisci (that’s the cartilage) and bursae (for shock-absorption). Just for clarification, your knee joint should be able to flex (bend) and extend (straighten) and have a small degree of rotation.

The ligaments provide the joint stability, sort of like straps holding the bones together. Around the knee there are 4 ligaments – one at each side (the collaterals), and 2 inside the knee (the cruciates), each having a specific role in joining the femur to the tibia and fibula, and stabilising the knee while it bends and straightens.

If one of these ligaments is over-stretched or injured, the knee will become less stable. Ask most sports people and they’ll tell you that the most frequently injured ligament is the anterior cruciate ligament (ACL). Its purpose is to limit rotation and forward movement of the tibia, so the most common way to injure it is by twisting the knee.

If this happens, your physiotherapist will ask you questions (we love questions) and then examine you in order to classify a sprain as one of 3 grades depending on the extent of the damage. You can expect to experience corresponding symptoms.

  • A grade I sprain is where some of the fibres are damaged, and you’ll likely feel some pain in the area as well as local swelling and inflammation.
  • A grade II sprain is when there is more extensive damage to the fibres. You’ll feel moderate pain and moderate joint swelling (this is termed effusion).
  • Finally, a grade III sprain is a complete rupture to the ligament – in other words where the ligament has snapped. There is immediate pain and swelling, and you may also hear the knee ‘pop’.

Sometimes an X-ray is taken to rule out any associated broken bones and the use of MRI scan can be used to identify the soft tissue injury and ascertain whether any other structures have been affected.

When the swelling settles the most common symptom with grade II and III sprains is joint instability. You might not experience any symptoms when moving in a straight line, however, twisting or turning on the affected leg may cause the knee joint may give way or buckle.

After an ACL injury, some people may be able to return to normal activities following a period of physiotherapy to help strengthen the muscles around the joint – these act as the joint stabilisers to “lighten the load” of the ligaments. However, there is an increased risk of re-injury. Others, especially those who participate in regular sporting activities which require them to twist and turn or those who have sustained other soft tissue injuries may require an operation to ‘repair’ the damaged ligament.

The ligament itself can sometimes heal or be stitched together, however, in most cases an ACL reconstruction is the only option. This involves using a tendon (connective tissue which joins muscle to bone) to make a new ACL (more about which ones in a second). Your consultant will normally wait until the swelling has settled and the knee has regained full range of movement before carrying out any surgery, so physiotherapy can be beneficial to help with this.

The operation is a quick key-hole procedure, usually completed at a day surgery and most often involves the use of your own tendons as the graft material. The two common tendons used are the hamstring tendon or the quadriceps tendon (the muscles at the back and front of your thigh respectively), and this is based on the surgeon’s preference. The tendon that has been removed will re-grow over time but during this process the other tendons perform the work required.

Following the operation your wound will be covered with a bandage or tubigrip, and you’ll need crutches to help you get about (plenty of scope for gleaning some sympathy!) A physiotherapist will be involved immediately following your operation and your rehabilitation will start right away.

In the early stages the main aims are to reduce the swelling and regain full movement of the joint. You can expect to ditch the crutches after 2-3 weeks, and get back to driving after about a month (but do make sure that you are able to perform an emergency stop safely and without pain before returning to the roads).

The type of work you do will affect when you are able to return to work. If you have a sedentary job then you will be probably be back behind your desk about a month after the operation. If you perform manual work it will be more like 3 months before you can return to work. You could take up cycling (on a static bike) and jogging (on a treadmill) about 2-3 months post-op, and your physiotherapist will create a strengthening programme specifically for you as the graft begins to heal, the swelling goes down and your knee begins to move more freely.

It is important to note that the graft is at its weakest in the first 10 weeks or so, just when you’re starting to feel great, so don’t push it! Unfortunately for all you sporty people, the return to your twisting and turning sports isn’t recommended until at least 7 months post-op.

If you think you have injured your ACL, or you have knee problems in general, talk to your physiotherapist or GP for advice. Until then, enjoy Euro 2012!