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Tennis Elbow (Lateral Elbow Tendinopathy)

Written by George Eaton, MSK Physiotherapist, Vitality Physiotherapy

Pain on the outer elbow that catches when you grip, lift, or twist is one of the most common presentations we see in clinic. It interrupts ordinary tasks — carrying shopping, opening jars, using a mouse — in a way that quickly becomes difficult to ignore.

Tennis elbow tends to build gradually, often over weeks, before it becomes persistent enough to seek help. With the right assessment and a structured approach to rehabilitation, the vast majority of cases resolve well.

 

What is tennis elbow?

Tennis elbow — clinically known as lateral elbow tendinopathy — is a condition affecting the tendons that attach the forearm extensor muscles to the outer elbow. The tendon most commonly involved is the extensor carpi radialis brevis (ECRB), which plays a central role in controlling wrist and hand movement.

Despite the name, most people who develop it have never played tennis. It affects office workers, tradespeople, gardeners, and gym-goers equally — anyone who places repeated demand on the forearm extensors beyond what the tendon is currently conditioned to handle.

 

 

Tennis elbow is fundamentally a condition of load and adaptation. The tendon is being stressed faster than it can recover — and that mismatch is what drives the pain.

It is not simply an inflammatory condition, which is why anti-inflammatory treatments in isolation rarely resolve it. Understanding this distinction is important — it shapes the entire approach to rehabilitation.

 

The anatomy

The muscles along the back of the forearm are responsible for extending the wrist and fingers and generating grip force. They attach collectively to a bony prominence on the outer elbow called the lateral epicondyle.

When these tendons are exposed to load they cannot currently tolerate, they undergo structural change at a tissue level. This leads to pain, stiffness, and a progressive reduction in the ability to perform activities that were previously unremarkable.

 

Symptoms

Tennis elbow typically develops gradually. The most common presentation includes pain on the outer aspect of the elbow, particularly with gripping or lifting; tenderness directly over the lateral epicondyle; weakness when carrying, opening jars, or using a mouse for extended periods; and morning stiffness that often eases with movement. In more established cases, localised swelling or a palpable thickening in the tendon may be present.

Symptoms often fluctuate in the early stages, which makes it tempting to push through on better days. This typically delays recovery.

Do I have tennis elbow?

The Chair Lift

For this test, you need a chair. The use of one that is not too heavy.

Start off by straightening your arm and bending your wrist (your fingers should be pointing downwards.) Lift the chair with your middle, index finger, and thumb. Try not to use your pinky and ring finger in this one. If there is any sharp pain or you are not able to lift the chair at all, then you may have Lateral Epicondylitis.

 

Why does it develop?

Tennis elbow develops when the cumulative demand placed on the tendon exceeds its current load capacity. This can result from a sudden increase in activity — a new role involving repetitive manual tasks, a return to racquet sport, or a change in training volume — or from sustained lower-level loading without adequate recovery time.

Common contributing activities include repetitive gripping, lifting and carrying, prolonged keyboard or mouse use, screwdriver work, gardening, and decorating. It is most frequently seen in adults aged 35 to 60, though it can affect anyone whose forearm extensors are regularly being asked to perform beyond their current conditioning.

 

Assessment

Diagnosis is made through clinical assessment. Imaging is rarely required and adds little to what a thorough hands-on examination can determine.

Your physiotherapist will take a detailed history — covering the onset and behaviour of symptoms, aggravating activities, and your work and sporting demands. Clinical tests typically include palpation of the lateral epicondyle, grip strength measurement, and resisted wrist and middle finger extension testing.

Assessment also looks beyond the elbow itself. Shoulder strength, cervical spine function, wrist mobility, and overall movement patterns all influence how much load is transferred through the lateral elbow. Identifying and addressing these contributing factors is often the critical step in achieving full, lasting recovery.

 

Treatment

The goal of physiotherapy is not only to settle the pain but to restore the tendon’s capacity to tolerate the demands being placed on it.

Load management

The first step is identifying activities that are currently aggravating the tendon and modifying them strategically. This is not the same as rest. Tendons respond poorly to complete unloading — the aim is to maintain activity at a level the tendon can tolerate while recovery progresses.

Pain management

Isometric exercises — generating force without joint movement — are effective at reducing tendon pain in the early stages and can be used to maintain muscle function while load is being managed. A supportive brace or taping technique may reduce strain during aggravating activities, and heat therapy can ease discomfort following loading.

Manual therapy

Hands-on treatment, including joint mobilisation, soft tissue work, and movement retraining, can improve mobility and reduce pain — particularly in the earlier stages of rehabilitation. It is most effective as a complement to a structured exercise programme rather than as a standalone intervention.

Progressive strengthening

This is where lasting recovery is built. Tendons adapt to progressive mechanical load — that stimulus drives the structural remodelling that restores capacity and resilience. Rehabilitation moves from isometric and eccentric exercises through to heavy slow-resistance training, before progressing to movements that reflect the specific demands of your work, sport, or daily life.

Tendons recover through load — the right kind, at the right pace. Progressive strengthening is not one option among many; it is the mechanism by which the tendon actually rebuilds.

 

Our Rehabilitation Facility

Vitality Physiotherapy’s clinics include a private rehabilitation gym equipped for clinical use and reserved exclusively for patient rehabilitation — not shared with the public.

This allows your physiotherapist to guide  and progress your loading programme within the same clinical environment across all stages of recovery: from early pain management through to grip and wrist strengthening, upper limb conditioning, and sport-specific or work-specific return-to-activity testing.

For patients returning to manual work, racquet sport, or high-demand training, supervised gym-based rehabilitation provides a level of structured progression and oversight that home exercise programmes cannot replicate — and significantly reduces the risk of recurrence without the limitations of home exercise or the distractions of a commercial setting.

Common rehabilitation errors

Many cases of tennis elbow become persistent as a result of avoidable mistakes in management.

Complete rest reduces tendon capacity over time and typically makes the return to activity more difficult, not less. Returning to full load before the tendon has rebuilt sufficient capacity leads to symptom recurrence. Passive treatments — massage, ice, bracing — can reduce pain temporarily, but without a progressive strengthening programme the underlying deficit remains. Inconsistent exercise is one of the most frequent reasons tendon rehabilitation fails to progress; these tissues require regular, structured loading to adapt.

 

When to seek assessment

A physiotherapy assessment is advisable if elbow pain has persisted for more than a few weeks, if symptoms are affecting work or exercise capacity, if grip strength is measurably reducing, or if self-management has not produced meaningful improvement.

Early assessment leads to faster, more straightforward recovery. The longer lateral elbow tendinopathy is left unaddressed, the more established the tendon changes tend to become.

 

Book an assessment

If you are unsure whether your symptoms represent tennis elbow, or if you have been managing elbow pain for some time without improvement, a single assessment is usually sufficient to give you a clear diagnosis and a structured plan for recovery.

We see patients at our Esher (KT10) and Southwark (SE1) clinics — including access to our private rehabilitation gym at Southwark for patients requiring supervised progressive loading. We also cover Claygate, Thames Ditton, Cobham, and Weybridge. Call 020 7193 9928 or visit vitality-physio.co.uk to book.

Understanding Tendinopathy: Why Tendons Become Painful — And How to Get Them Strong Again

Written by George Eaton, MSK Physiotherapist, Vitality Physiotherapy

 

 

As a physio who spends a good chunk of my own time in the gym, I’ve seen first-hand how frustrating a tendon injury can be. You’re in the middle of a solid training block — progress is happening, you’re feeling strong — and then a nagging pain in your Achilles, knee, or shoulder starts to creep in. You try to push through, rest it for a few days, maybe Google it… and you end up more confused than when you started.

The good news? Tendinopathy is one of the most treatable musculoskeletal conditions — when you understand what’s going on and approach it the right way. So let’s break it down.

 

What Is Tendinopathy?

A tendon is the tough, rope-like structure that connects your muscle to your bone. Its job is to transmit the force your muscle generates so you can move, jump, push, and pull. When working well, tendons are incredibly resilient — they absorb and release energy like a spring.

Tendinopathy is the umbrella term for a painful, dysfunctional tendon. It’s caused by an overload — where the load placed on the tendon consistently exceeds its capacity to recover.

You might have heard the old term ‘tendinitis,’ which implied the problem was inflammation. We now know the picture is more complex than that — and that understanding the actual pathology changes how we treat it.

 

Tendons commonly affected include:

  • Achilles tendon (heel/calf area) — particularly in runners
  • Patellar tendon (just below the kneecap) — common in jumping sports
  • Gluteal tendons (outer hip) — frequently seen in women, especially around menopause
  • Rotator cuff tendons (shoulder) — often in gym-goers and overhead athletes
  • Hamstring tendons (sit-bone area) — particularly in distance runners
  • Elbow tendons (lateral or medial epicondyle) — tennis or golfer’s elbow

 

What’s Actually Happening in the Tendon?

This is where things get interesting — and where a lot of online advice goes wrong.

Tendons don’t behave like other soft tissues. They have a poor blood supply and a slow metabolic rate, which means they adapt and heal more slowly than muscle. When a tendon is repeatedly overloaded, the collagen fibres — which normally run in neat, parallel lines — begin to disorganise. The tendon responds by producing more collagen, but it’s not the same high-quality collagen. Instead, you get a disorganised matrix, new (often painful) nerve ingrowth, and sometimes areas of degeneration within the tendon substance.

 

The Three Stages of Tendinopathy

Researchers have described a continuum of tendon pathology, which helps explain why some tendon pain responds quickly to treatment, while other cases are more stubborn:

Stage 1: Reactive Tendinopathy

This is an early, acute response to overload. The tendon swells and becomes thickened, but the change is largely reversible at this stage. You’ve spiked your training too quickly, changed your footwear, or done something your tendon wasn’t ready for. Rest and load management can resolve this effectively.

Stage 2: Tendon Dysrepair

The tendon has tried to repair itself but is struggling. You start to see more disorganised collagen and some early cellular changes. The tendon isn’t in crisis, but it’s not healing cleanly either. This is where many people sit when they’ve had symptoms for several weeks to months.

Stage 3: Degenerative Tendinopathy

In more longstanding cases, areas of the tendon may become truly degenerative — with cell death, disrupted collagen architecture, and fatty or calcific deposits. Interestingly, the most degenerated areas of the tendon are often not the most painful. Pain in tendinopathy is complex and driven by nerve sensitisation as much as tissue damage.

 

Why Does It Hurt?

Tendon pain can be a confusing beast. Here are a few things that make it different from other injuries:

 

  • It’s load-sensitive. Tendons love consistent, progressive loading — but hate sudden spikes. The pain is often provoked by activity and may ease once you warm up, only to return later.
  • Morning stiffness is classic. Many people describe a stiff, achy tendon first thing in the morning that loosens off after a few minutes of movement.
  • Compressive loads can be particularly aggravating. Positions that compress the tendon against a bony surface — such as stretching a tendon under tension — can be more provocative than simple tension. This is especially relevant for Achilles and gluteal tendons.
  • Pain doesn’t equal damage. The level of pain doesn’t reliably indicate how much structural damage is present. Some badly degenerated tendons are painless; some reactive tendons are extremely painful.

 

Treatment: What Actually Works

Let me be direct here: the evidence for tendinopathy management has moved on enormously in the past decade. Rest alone doesn’t fix tendons — in fact, complete rest weakens them further. What tendons need is the right kind of load, applied progressively and intelligently.

 

1. Load Management

The first step is always to identify what has changed in your training or activity that caused the tendon to become overloaded. This might be a sudden increase in mileage, a return to sport after time off, new footwear, or a change in surface. We reduce the provocative load — not eliminate it entirely — and create a stable baseline from which to build.

 

2. Isometric Exercise: The Pain-Relieving Starting Point

Isometric contractions — where you contract the muscle without any movement — have been shown to reduce tendon pain quite quickly and are a great starting point. They provide load to the tendon without the compression or repeated movement that can aggravate it. For example, a wall sit for a patellar tendon, or a calf press held in a fixed position for the Achilles.

 

3. Heavy Slow Resistance Training

This is the cornerstone of tendinopathy rehabilitation. Research consistently shows that heavy, slow resistance training — where muscles and tendons are loaded through their full range in a slow, controlled manner — stimulates collagen remodelling and improves tendon structure over time.

This is exactly the kind of work I love in the gym environment. Exercises like heavy heel raises, leg press, hip thrusts, and cable pull-throughs can all be used therapeutically, depending on which tendon is affected. The key is progressive overload — we gradually increase the load as the tendon adapts.

 

4. Energy Storage and Return Loading

Once the tendon is tolerating slow, heavy load, we progress to exercises that challenge the tendon’s spring-like properties — things like hopping, bounding, and sport-specific movements. This phase is essential if you want to get back to running, jumping, or dynamic sport. Skipping it is one of the most common reasons people re-injure.

 

5. Addressing Contributing Factors

Tendinopathy rarely exists in isolation. We always assess the whole picture: hip strength and control, foot mechanics, training load patterns, sleep, nutrition, and for women in particular, hormonal status — oestrogen plays a significant role in tendon health, which is why gluteal and Achilles tendinopathy are especially common around perimenopause.

 

What to Avoid

A few things that commonly make tendinopathy worse — even though they seem logical:

  • Complete rest: Tendons need load to heal. A short period of relative rest is fine, but prolonged offloading weakens the tendon further.
  • Aggressive stretching: Stretching a painful tendon under compression can provoke symptoms, especially for insertional tendinopathies (where the tendon meets the bone).
  • Repeatedly testing the tendon: Many patients check their symptoms throughout the day by bouncing on their heels or pressing the tendon. This sensitises the area and slows recovery.
  • Ignoring the warning signs: A tendon that is repeatedly provoked without adequate recovery will progress along the pathology continuum. Address it early.

As someone who lives and breathes the gym myself, I know how important it is to have the right environment to train in — especially when you’re recovering from a tendon injury. That’s why I’m particularly proud of our fully equipped gym at our Esher and Southwark clinics.

How Long Will It Take?

Honestly? Tendons are slow to heal — and this is one of the hardest things to communicate to patients who are used to soft tissue injuries resolving in a few weeks.

A reactive tendinopathy caught early might resolve in 6–8 weeks with good management. A more established tendinopathy with significant dysrepair or degeneration may take 3–6 months of consistent, progressive rehabilitation.

The key is that progress doesn’t have to mean pain-free. We use simple monitoring tools — like the Visual Analogue Scale or the VISA questionnaire — to track your symptoms and guide progression. Some discomfort during rehab is expected and acceptable; sharp spikes in pain lasting beyond 24 hours after exercise are a signal to pull back.

A Final Word From Me

Tendinopathy is genuinely one of my favourite conditions to treat — partly because the science is fascinating, and partly because when patients commit to the process, the results can be remarkable. I’ve seen people go from barely being able to walk without heel pain to completing marathons. I’ve watched gym-goers with years of patellar tendon trouble get back to squatting heavy again.

The secret is not a magic injection or a passive treatment. It’s smart, progressive loading — guided by someone who understands tendon biology. That’s what we do at Vitality.

If you’re dealing with a stubborn tendon that isn’t responding to what you’ve tried so far, come and see us. We’ll assess what’s going on, explain exactly what’s happening, and build you a programme that gets you back to doing what you love.

 

Book your tendinopathy assessment: vitality-physio.co.uk

Clinics in Southwark (SE1) and Esher (KT10)

 

This article is for educational purposes and does not constitute personalised medical advice. If you have symptoms, please consult a qualified physiotherapist or healthcare professional.

Patellar Tendinopathy “Jumper’s Knee” Understanding Pain Below the Kneecap

That nagging ache just below the kneecap. The stiffness at the bottom of the stairs in the morning. The way it flares after a hard session and lingers for days. If this sounds familiar, you may be dealing with patellar tendinopathy — one of the most common overuse injuries we see at Vitality Physio.

 

Also known as ‘jumper’s knee’, patellar tendinopathy affects the tendon just below the kneecap and is especially prevalent in sports that demand explosive, repetitive effort: football, rugby, basketball, volleyball, netball, and athletics. But you don’t need to be an elite athlete to develop it. Recreational gym-goers, runners, and anyone who has ramped up their training too quickly can find themselves dealing with the same persistent, frustrating symptoms.

 

The good news — and it is genuinely good news — is that patellar tendinopathy responds very well to the right approach. Not rest, not waiting it out, but a progressive rehabilitation programme built around gradually rebuilding what the tendon can handle. With the right guidance, most people return fully to the sport and training they love.

 

What Is Patellar Tendinopathy?

The patellar tendon connects the kneecap (patella) to the shin bone (tibia). It plays a central role in virtually everything that involves the knee: running, jumping, squatting, kicking, and landing.

 

Patellar tendinopathy develops when the tendon is repeatedly overloaded without sufficient recovery. Over time, the tissue becomes irritated and painful — particularly at the attachment point just beneath the kneecap.

Importantly, this is not simply an inflammatory problem. It is better understood as a tendon overload condition: the demands placed on the tendon have outpaced its current capacity. Understanding this distinction matters, because it shapes everything about how we rehabilitate it.

 

Common Symptoms

 

  • People with patellar tendinopathy typically describe:
  • Pain directly below the kneecap
  • Discomfort during jumping, sprinting, or explosive movements
  • Aching with squatting or lunging
  • Stiffness at the start of a session that eases as the tendon warms up
  • Symptoms that return after exercise — often later the same day or the following morning
  • Localised tenderness when pressing on the tendon

Symptoms often fluctuate in line with training load and sporting demand. Unlike many ligament injuries, patellar tendinopathy is not typically associated with significant swelling, locking, or instability of the knee.

 

Why Does It Develop?

The most common trigger is a sudden spike in the load placed through the tendon. This can take many forms:

  • A sharp increase in training intensity or frequency
  • Significantly more jumping or sprinting than usual
  • Returning to sport too quickly after time off
  • Playing multiple matches or tournaments in a short window
  • Changes in training surface, footwear, or technique
  • Rapid increases in gym-based loading — particularly heavy squats or leg press

 

A number of physical factors can also increase vulnerability, including:

  • Quadriceps weakness
  • Reduced calf strength and ankle mobility
  • Poor landing mechanics or running patterns
  • Hip and core weakness
  • Inadequate recovery between training sessions

 

In many cases the tendon itself is not ‘damaged’ in the traditional sense — it is simply being asked to cope with more than it currently has the capacity for.

 

Who Is Commonly Affected?

Patellar tendinopathy is most prevalent in sports involving repeated explosive movements, but it crosses all levels of participation:

  • Football and rugby players
  • Basketball and volleyball athletes
  • Netball players
  • Sprinters and field athletes
  • Gym-based athletes, particularly those focused on strength and power
  • Recreational runners
  • Adolescents and young adults carrying high training volumes

 

It is especially common during periods of increased sporting demand, condensed competition schedules, or when returning after a break.

 

How Is Patellar Tendinopathy Diagnosed?

Diagnosis is primarily clinical — based on a careful, detailed assessment rather than imaging alone. At Vitality Physio, our assessment examines:

  • The precise location and behaviour of symptoms
  • Tendon tenderness on palpation
  • How symptoms respond to loading during the session
  • Your training history and any recent changes in load
  • Lower limb strength and movement control
  • Jumping and landing mechanics
  • Hip, knee, and ankle function

 

Imaging such as ultrasound or MRI can provide useful supporting information, but it is rarely the deciding factor — many people with significant tendon changes on scan have no symptoms at all, and vice versa.

 

Does Rest Actually Help?

Complete rest is rarely the answer — and can sometimes make things worse.

 

While temporarily reducing the activities that aggravate symptoms makes sense in the short term, tendons respond far better to carefully graded loading than to prolonged inactivity. Extended rest reduces tendon capacity, making it even harder to return to sport when the time comes.

 

Our approach focuses on managing load intelligently while progressively rebuilding tendon strength. In practice, this often means:

  • Temporarily reducing jumping and sprinting volume
  • Modifying gym-based exercises
  • Adjusting training intensity and frequency
  • Maintaining activity within tolerable limits
  • Gradually reintroducing explosive movements as capacity improves

 

 

Pain Monitoring in Rehabilitation

 

A useful guide during rehabilitation is the pain-monitoring model:

 

✔  Mild discomfort (≤ 4/10) during exercise is acceptable

✔  Symptoms should settle relatively quickly after activity

✔  Pain should not be significantly worse the following morning

 

If symptoms consistently flare beyond these parameters, load adjustment is likely needed.

 

What Does Physiotherapy Treatment Involve?

At Vitality Physio, rehabilitation is built around improving the tendon’s load tolerance while addressing the contributing factors that drove the problem in the first place.

Progressive Tendon Loading

Exercise-based rehabilitation is the cornerstone of evidence-based tendon management. Programmes are structured to progress through distinct phases:

  • Isometric exercises for initial pain management and tendon engagement
  • Heavy slow resistance training to drive tendon adaptation
  • Eccentric strengthening work
  • Plyometric and energy-storage drills
  • Return-to-sport loading progressions

 

The pace of progression is guided by your symptoms, strength levels, and the demands of your sport — not a fixed calendar.

 

Strength Rehabilitation

Targeted strengthening commonly focuses on:

  • Quadriceps strength and capacity
  • Glute and hip stability
  • Calf strength and load absorption
  • Core control

 

Building robust lower limb strength reduces the stress concentration through the patellar tendon during sport and training.

 

Movement Retraining

Where poor landing mechanics, running patterns, or jumping technique are contributing to tendon overload, we address these directly — making them part of the rehabilitation process rather than an afterthought.

 

Load Management

Understanding how to balance training, competition, and recovery is one of the most important — and often most overlooked — aspects of tendon rehabilitation. We work with you on practical load management strategies to reduce the risk of recurrence.

 

Common Rehabilitation Mistakes

Patellar tendinopathy frequently becomes persistent when rehabilitation is managed incorrectly. The most common pitfalls include:

  • Resting completely for prolonged periods — reducing tendon capacity further
  • Returning to jumping or explosive work too early in the process
  • Progressing plyometrics too aggressively before adequate strength is in place
  • Ignoring underlying strength deficits
  • Training through significant pain
  • Neglecting load management outside of physiotherapy sessions

 

Successful tendon rehabilitation takes patience and consistency. The good news is that with the right approach, the outcomes are genuinely excellent.

 

How Long Does Recovery Take?

Patellar tendinopathy typically takes longer to resolve than people expect — often longer than a straightforward ligament sprain or muscle strain.

 

Most people notice meaningful improvement within 8–12 weeks of consistent rehabilitation. Full recovery — including return to unrestricted sport — can take several months, particularly if symptoms have been present for some time before treatment begins.

 

The people who recover best tend to share a few things in common: they stay consistent with their rehabilitation, progress loading gradually rather than rushing, avoid repeated flare-ups through sensible load management, and address the strength and movement factors that contributed to the problem in the first place.

 

When Should You Seek Physiotherapy?

We recommend a physiotherapy assessment if:

  • Pain is limiting your sport, training, or exercise
  • Symptoms have persisted for more than two to three weeks
  • Jumping, running, or squatting is becoming increasingly painful
  • You are experiencing repeated flare-ups with activity
  • Symptoms are beginning to affect your performance or confidence

 

Please seek urgent medical assessment if:

  • Symptoms followed a significant injury, fall, or trauma
  • The knee has become notably swollen
  • You are unable to bear weight through the leg
  • The knee is locking or giving way repeatedly

 

How Vitality Physio Can Help

At Vitality Physio, we provide evidence-based assessment and rehabilitation for patellar tendinopathy and sports-related knee pain across our clinics in Southwark SE1 and Esher KT10.

 

Our approach combines thorough clinical assessment, progressive tendon loading, targeted strength rehabilitation, movement retraining, and practical load management — giving you both the tools and the understanding to return confidently to the sport and activity you love.

 

Early intervention generally leads to faster recovery and significantly reduces the risk of symptoms becoming persistent. If you are experiencing pain below the kneecap, we would be glad to help.

 

Book an Assessment

 

Southwark SE1  |  Esher KT10

vitality-physio.co.uk

 

Why There’s No Single Best Exercise for Back Pain — And What That Means for You

 

By Janine Enoch, Founder and Clinical Director, Vitality Physiotherapy

If you search online for the best exercises for back pain, you’ll find confident, contradictory advice in abundance. Pilates. Yoga. McKenzie method. Core stability. Dead bugs. Deadlifts. Walking. Swimming. Everyone has a favourite, and most of them claim the evidence is on their side.

Here’s the honest truth from the research: no single exercise type has been shown to be consistently superior for low back pain in the long term. And understanding why that is actually liberates you to focus on what really matters.

What the Studies Show

Pilates vs. Stationary Cycling

A well-designed study compared Pilates to stationary cycling over eight weeks. Both groups improved in pain, disability, and catastrophic thinking. At eight weeks, the Pilates group showed better results. At six months, the difference had disappeared.

This pattern — early advantage for the more ‘specific’ or ‘targeted’ intervention, no long-term difference — appears repeatedly in the back pain literature. It may reflect the power of receiving treatment that feels relevant and purposeful, rather than any specific physiological superiority.

Walking vs. Back-Strengthening Exercises

In another study comparing a simple walking programme to specific back-strengthening exercises, both groups improved similarly. For previously sedentary people, general movement may be as valuable as targeted exercise — because getting moving at all is the intervention.

High Load vs. Low Load

A randomised controlled trial comparing high-load and low-load motor control programmes found better short-term outcomes in the low-load group, but no meaningful difference at 12 or 24 months. Both groups also received pain education, which may have been the most influential component.

What a Systematic Review Found

A comprehensive review of the exercise literature concluded that whole-body programmes — combining strength, resistance, and general movement — had beneficial effects for back pain. Not because of any single mechanism, but because exercise in general is more effective than most passive alternatives.

Why Core Stability Exercises Aren’t the Whole Answer

Core stability has dominated back pain rehabilitation for years, and it isn’t without value. But the evidence has complicated the picture. Studies show that improvements from core exercises are often unrelated to actual changes in abdominal muscle function. The benefit may come from factors like increased confidence, exposure to movement, and the therapeutic relationship — not from ‘switching on’ a specific muscle.

More concerning, an excessive focus on core bracing and spinal stiffness may inadvertently reinforce the very protective guarding that perpetuates pain. People with back pain already tend to show increased muscle co-activation and reduced spinal movement. Training them to brace harder is not always the right answer.

Reduced movement variability — moving in a more rigid, restricted way — is consistently associated with persistent back pain. The goal, for many patients, is actually to feel safer moving freely: to decrease stiffness, not increase it.

So What Should You Do?

The best exercise for back pain is the one you will do consistently, that you find manageable and — ideally — enjoyable. Beyond that:

  • Variety matters: combining different movement types, loads, and intensities tends to produce better long-term outcomes than any single modality
  • Pain education matters: in almost every high-quality study, groups receiving pain education alongside exercise did better than those doing exercise alone
  • Consistency matters more than perfection: a good programme done regularly beats a perfect programme done sporadically
  • Your whole life matters: sleep, stress, nutrition, and relationships all influence how your body responds to exercise and how quickly you recover

The Vitality Physiotherapy Approach

back pain rehabilitation vitality physiotherapyWe don’t have a house exercise for back pain. What we have is a framework: assess the whole person, understand their presentation (how irritable is the pain? what are their goals? what does their daily life look like?), and design a programme that introduces load progressively, builds capacity over time, and adapts as they improve.

We use a macro and microcycling approach to treatment planning — structuring rehabilitation in phases, with clear goals at each stage, and building in the flexibility to adjust based on how an individual is responding. No two programmes look the same. This programme (alongside)is for informational purposes only and does not constitute medical advice. If you are experiencing back pain, please consult a qualified physiotherapist.

Jas’s Story

Ten years ago, I met Jas — a woman in her late 40s  who had just been diagnosed with osteoporosis. Her bone density scans showed a T-score below -2.5, and her fracture risk was classified as high. She was frightened. She loved being active, and the diagnosis felt like a threat to everything she wanted her life to look like.

We started carefully. Weight-bearing and resistance exercises, introduced gradually, progressing as her capacity grew. Regular reassessment. Small adjustments. Alongside her rehabilitation, she made changes to her diet — increasing calcium-rich foods and vitamin D — to support what her body was working hard to do.

There were hard days. But her consistency never wavered.

When Jas returned for her annual review, her scans told a different story. She had moved from osteoporosis into the osteopenia range — a clinically meaningful improvement and a real reduction in fracture risk. Her bones had responded exactly as the evidence predicted: progressively, with appropriate load, given sufficient time.

Jas’s story is one of the highlights of my career. Not because what we did was complicated — it wasn’t. But because it worked precisely because we respected the body’s need for gradual adaptation, built a programme around her as a person, and trusted the process.

That is what good rehabilitation looks like. And it is available to everyone.

Ready to find out what a personalised, evidence-based back rehabilitation programme looks like for you? Get in touch with the team at Vitality Physiotherapy. Clinics in Southwark (SE1) and Esher (KT10).

PEACE & LOVE: The Modern Approach to Managing Back Pain

For decades, the standard advice for soft tissue injuries was RICE: Rest, Ice, Compression, Elevation. It was simple, memorable, and widely used. It was also increasingly at odds with the evidence — and has now been largely superseded by a more sophisticated framework that better reflects how tissue healing actually works.

That framework is PEACE & LOVE. Developed by sports medicine researchers and published in the British Journal of Sports Medicine, it offers a more nuanced, phase-based approach to injury management that optimises recovery rather than simply managing symptoms.

PEACE — The Early Phase

In the immediate aftermath of a back pain episode or acute flare, the PEACE principles apply:

P — Protect

Unload the painful area briefly to prevent further aggravation. This does not mean bed rest — it means temporarily modifying activity to avoid movements that provoke severe pain. The emphasis is on brief and temporary.

E — Elevate

Less directly applicable to back pain than to limb injuries, but broadly: reducing swelling and fluid accumulation around irritated tissues supports the early healing environment.

A — Avoid Anti-Inflammatories

This is perhaps the most counterintuitive element of PEACE. Inflammation is not the enemy — it is the first stage of a necessary biological process. Anti-inflammatory medications, particularly NSAIDs, can blunt the inflammatory response and may interfere with long-term tissue healing. Current evidence suggests using them cautiously, if at all, in the early phase of injury.

C — Compress

Gentle compression reduces swelling. For back pain specifically, structured support from clothing or a light brace can provide comfort in the very early stages, but should not become a long-term crutch.

E — Educate

This is the element that distinguishes modern injury management from older approaches. Patient education — about pain science, about what is happening in the tissues, about what to expect — consistently improves outcomes. Fear and uncertainty worsen pain. Understanding reduces it.

LOVE — The Recovery Phase

Once the acute phase settles, the LOVE principles guide the return to full function:

L — Load

As we discussed in our previous article on load and capacity, early and progressive loading is central to recovery. Tissues heal more effectively when they are appropriately loaded. Movement is medicine, and this is where the rehabilitation begins in earnest.

O — Optimism

The psychological dimension of recovery is not secondary — it is foundational. Patients who approach recovery with a belief that they will improve consistently do better than those who catastrophise. This is not about positive thinking for its own sake — it reflects the genuine neurological relationship between pain beliefs and pain experience.

V — Vascularisation

Aerobic exercise — walking, cycling, swimming — promotes blood flow to healing tissues and supports recovery. It also has significant benefits for mood, sleep, and stress — all of which influence pain. Cardio is not separate from back pain rehabilitation. It is part of it.

E — Exercise

Structured, progressive exercise is the most evidence-based treatment for back pain at every stage. This means exercises targeted at restoring movement, building strength, and progressively loading the spine and supporting structures. It should be guided by a physiotherapist, particularly in the early stages.

Why This Matters

The shift from RICE to PEACE & LOVE reflects a deeper change in how musculoskeletal medicine understands injury and recovery. Passive, rest-based approaches have consistently underperformed compared to active, education-led, exercise-centred ones. The body heals best when it is given accurate information, appropriate load, and the opportunity to adapt.

At Vitality Physiotherapy, PEACE & LOVE principles underpin how we approach every new back pain presentation — whether you are coming to us acutely, or months into a problem that has not resolved elsewhere.

In our final article in our blog on Back pain, we tackle the question we are asked most often: what is the best exercise for back pain?

Ready to get help with your back pain? Our physiotherapists at Vitality Physiotherapy see patients at our well equipped gyms in Southwark (SE1) and Esher (KT10) clinics. Book a consultation today — we will assess your individual situation and build a plan that actually works for you.
Call us or book online at vitality-physio.co.uk

Load, Capacity, and Why Gradual Is Always the Answer

By Janine Enoch, Founder and Clinical Director, Vitality Physiotherapy

Whether you’re a runner, a desk worker, a gym-goer, or someone who simply bent down to pick something up and felt a sharp pain — there is one framework that explains almost every musculoskeletal injury. It’s called load versus capacity, and once you understand it, you’ll never think about back pain — or injury — in quite the same way.

The Basic Principle

Every tissue in your body — muscle, tendon, bone, disc, ligament — has a capacity. That capacity is the amount of load it can absorb without sustaining damage. When the load placed on a tissue exceeds its capacity, injury becomes more likely.

This can happen suddenly, as in a trauma or accident. But the vast majority of back pain we see in clinic doesn’t happen that way. It happens gradually, when someone increases load faster than their tissues can adapt. A new running programme. A return to the gym after a long break. A week of heavy lifting at work. The load wasn’t catastrophic — it just outpaced the body’s ability to keep up.

The Body Is Adaptive — If You Give It Time

Paralympian performing extraordinary tasks despite assymmetryHere is the part that gets overlooked in most conversations about back pain: capacity is trainable. When load is introduced progressively, tissues respond. Muscles strengthen. Bones become denser. Tendons grow more robust. Discs adapt. The body is not a static, fragile structure — it is a dynamic, responsive system.

Paralympians offer a vivid illustration of this. Athletes competing with significant anatomical asymmetries, limb differences, or structural ‘abnormalities’ perform at extraordinary physical levels. Because their bodies have adapted, gradually and progressively, to the demands placed on them. The body does not require perfection — it requires time.

When Capacity Drops

Capacity isn’t just determined by training history. It fluctuates. And this is why back pain so often seems to come ‘out of nowhere’ — the same movement that was fine last week suddenly causes pain this week.

The factors that reduce capacity include:

  • Poor sleep — even a few nights of disrupted sleep measurably reduces pain tolerance and tissue resilience
  • High stress — the nervous system in a heightened stress state is more sensitised to pain signals
  • Illness — recovery from infection diverts resources away from tissue repair
  • Poor nutrition — inadequate protein or micronutrient intake limits the body’s ability to maintain and rebuild tissues

This means that the injury isn’t always about what you did differently. Sometimes you did exactly what you always do — but your capacity had temporarily dipped, and the same load that was previously manageable was now too much.

What About Deadlifts and Rounded Backs?

Few questions come up more often in clinic. There has been enormous fear — among patients and some healthcare professionals — around spinal flexion under load, fuelled by an older theory suggesting that bending the spine while lifting causes dangerous increases in disc pressure.

That theory was based on studies conducted on cadavers. Living tissue behaves very differently. The current evidence does not support the idea that a rounded back during lifting is inherently dangerous. What matters is whether your tissues have been progressively loaded to handle that pattern of movement. The movement itself is not the problem — an unprepared tissue encountering that movement is.

The Practical Takeaway

If you are currently in pain, the immediate goal is to reduce load to a level your tissues can tolerate — not to rest completely, but to find a manageable baseline and rebuild from there.

If you are returning to activity after a period of rest or injury, the principle is the same: gradual, progressive loading. Slower than feels necessary. With attention to how your body responds. Adjusted based on sleep, stress, and how you’re feeling overall — not just on a fixed timeline.

The question to ask yourself is not ‘did I move wrong?’ It’s ‘did I change something too quickly?’ That shift in perspective is often where recovery begins.

At Vitality Physiotherapy, we build progressive, personalised rehabilitation plans that respect your body’s need for adaptation. Whether you’re recovering from injury or trying to prevent the next one, we’re here to help. Clinics in Southwark (SE1) and Esher (KT10).

The Real Reason You’re Still in Pain

Most back pain episodes resolve within a few weeks. The tissue heals, the inflammation settles, and people get on with their lives. But for a significant proportion of people, pain continues long beyond the point where any tissue damage remains — sometimes for months, sometimes for years.

This is not weakness. It is not laziness. And in the vast majority of cases, it is not structural deterioration. There is a well-understood explanation for why pain persists, and understanding it is often the single most important step in recovery.

Pain Is a Protection System, Not a Damage Meter

 

 

 

 

The most important thing to understand about pain is this: pain is produced by the brain as a protective response, not by damaged tissue. Pain is an alarm — and like all alarms, it can be miscalibrated.

Think of it like a smoke detector. A smoke detector is designed to alert you to fire. But if it is too sensitive, it goes off when you make toast. It is not broken — it is doing its job — but it is responding to a threat level that does not warrant the alarm. Persistent pain works in exactly the same way. The nervous system, having been through an injury, can become sensitised — lowering its threshold and producing pain in response to stimuli that would not normally trigger it.

This is sometimes called central sensitisation. The pain is entirely real. It is just no longer a reliable signal of ongoing tissue damage.

 

 

The Role of Fear Avoidance

One of the most significant drivers of persistent back pain is a pattern called fear avoidance. It works like this:

  • An injury occurs, and pain is experienced
  • The pain is interpreted as a signal of danger — ‘my back is damaged’, ‘I must not move’, ‘this will get worse’
  • Movement is avoided to protect against further harm
  • Avoidance leads to deconditioning — the muscles weaken, the tissues become less resilient
  • When movement is attempted, it feels more painful — confirming the original belief that it is dangerous
  • The cycle reinforces itself

 

 

Flowchart of the Fear-Avoidance Model of chronic pain showing the cycle from initial injury to pain catastrophizing, movement avoidance, and muscle deconditioning

 

Fear avoidance is not irrational. When you are in pain, protecting the area makes intuitive sense. But it is one of the most reliable predictors of back pain becoming chronic — and it is almost entirely driven by beliefs about what the pain means, rather than by the degree of tissue damage.

Research consistently shows that patients who catastrophise about their pain — who believe the worst about what it means and what will happen — have significantly worse outcomes than those who maintain a more balanced view, even when their initial injury is identical.

What the Evidence Says About Recovery

The good news — and this is very well supported by research — is that fear avoidance is modifiable. The most effective treatments for persistent back pain combine movement with education that specifically addresses pain beliefs.

Cognitive behavioural therapy (CBT) approaches applied to pain have strong evidence behind them. Graded exposure — gradually reintroducing feared movements in a structured, supported way — consistently outperforms passive treatments such as rest, heat, and medication alone.

Recovery rarely happens in a vacuum. Having an evidence- based clinician who explains what is happening, takes your experience seriously, and walks alongside you through movement makes a measurable difference to how well — and how quickly — you recover.

What We Do Differently at Vitality

At Vitality Physiotherapy, pain education is not an add-on to treatment — it is central to it. We spend time at every assessment exploring what our patients believe about their pain, because those beliefs shape behaviour, and behaviour shapes recovery.

We will never tell you that your pain is ‘in your head’. It is not. But we will explain that your nervous system may have become more sensitive than the situation warrants, and that the most evidence-based path forward involves gradually — and safely — rebuilding trust in your body’s ability to move.

In our next article, we look at the load and capacity model: why most back injuries happen not because the spine is fragile, but because load outpaces the body’s current ability to adapt.

Ready to get help with your back pain? Our physiotherapists at Vitality Physiotherapy see patients at our Southwark (SE1) and Esher (KT10) clinics. Book a consultation today — we will assess your individual situation and build a plan that actually works for you.
Call us or book online at vitality-physio.co.uk

 

Back pain, scans don't tell the full story

Why Your Back Isn’t as Fragile as You’ve Been Told

 

By Janine Enoch, Founder and Clinical Director, Vitality Physiotherapy

You’ve had a scan. The report mentions disc degeneration, a bulge, or some other finding that sounds alarming. Your GP or a previous clinician may have warned you to be careful, to avoid certain movements, to protect your back. And now you’re frightened — not just of the pain, but of making things worse.

Here’s what we want you to know: your back is almost certainly far stronger and more resilient than you’ve been led to believe. The evidence on this is now very clear, and it changes everything about how we approach low back pain at Vitality Physiotherapy.

What the spine actually looks like

The lumbar spine — the lower back — is made up of five vertebrae connected by facet joints that allow you to flex, extend, bend sideways, and rotate. Between each vertebra sits an intervertebral disc, long cast as the villain in the back pain story.

You’ve probably heard the phrase ‘slipped disc.’ It’s one we don’t use, because it isn’t accurate. Discs don’t slip. They are anchored firmly in place by strong ligamentous attachments. A better way to picture a disc is as a car tyre: thick, fibrous outer walls surrounding a more gel-like centre. Robust. Designed to absorb load and enable movement.

Discs can bulge or sustain injury — but this is far less catastrophic than the language around it implies.

What scans actually show us

This is where the science gets genuinely surprising. A landmark systematic review examined imaging findings in over 3,000 people who had no back pain whatsoever. Here’s what they found:

  • By age 40, around 50% of pain-free people had disc degeneration visible on MRI
  • By age 50, the majority showed disc bulges — without any symptoms
  • Facet joint changes and other ‘degenerative’ findings were similarly common across all age groups

The conclusion is unavoidable: degenerative changes on imaging are a normal part of ageing, not a diagnosis. A finding on a scan does not tell you why you are in pain, or even whether it is responsible for your pain at all.

Treating a scan result rather than a person is one of the most common mistakes in back pain management — and one we are very careful to avoid.

The posture myth

Few beliefs about back pain are more entrenched — or less well supported — than the idea that posture causes pain. For decades, patients have been told to sit up straight, to avoid slouching, to buy ergonomic chairs, and to never cross their legs.

The research does not back this up. A study of over 1,100 teenagers found no association between sitting posture and pain. In adults, even workers required to maintain awkward positions for sustained periods show no reliable increase in back pain risk. Experts cannot even agree on what constitutes ‘bad’ posture — the concept owes more to military tradition than to biomechanical evidence.

There is no perfect posture. There is no perfect chair. What matters is that you move — regularly, in a variety of ways, and without fear.

So why does back pain happen?

Back pain is real and it can be genuinely debilitating. But the cause is rarely structural fragility. In the next articles in this series, we explore the neuroscience of pain, the crucial relationship between load and capacity, and what the evidence says about treatment and exercise.

The starting point, though, is this: your spine is not broken. It was built to move, to load, and to adapt. And that is exactly what we help you do.

If you have been told your back is damaged and you’re not sure what to do next, our team at Vitality Physiotherapy can offer a thorough assessment and a clear, evidence-based plan. Clinics in Southwark (SE1) and Esher (KT10).

POST-PREGNANCY RECOVERY Your Complete Guide from a Women’s Health Physiotherapist

Everything you need to know about recovering well after having a baby – backed by clinical evidence, written in plain English.

Having a baby is one of the most significant physical events a woman’s body will ever go through. Yet postnatal recovery is often under-discussed, under-resourced, and misunderstood. This guide answers the questions we hear most often in clinic — honestly, practically, and with your long-term health in mind.

Written by Tamara Figaji, Associate Women’s Health Sports Physiotherapist at Vitality Physiotherapy.

 

Q1  When should I start pelvic floor exercises after birth?

This is one of the most common questions we’re asked — and the short answer is: sooner than most people think.

The first 24 hours

Provided you feel comfortable and there are no complications, gentle pelvic floor contractions can begin within the first day after birth — whether you’ve had a vaginal delivery or a caesarean section. In the early days, these aren’t about ‘getting your pelvic floor back’; they’re about encouraging circulation, reducing swelling, and beginning the healing process.

Even if you can’t feel much at first — especially after a difficult delivery or if you’ve had stitches — that’s normal. The nerve supply to the pelvic floor can be temporarily affected by birth, so reduced sensation doesn’t mean nothing is happening.

The first 6 weeks

During this period, focus on low-intensity exercises. These include:

  • Slow, held contractions: gently lift and squeeze, hold for up to 10 seconds, then fully release
  • Quick contractions: short squeeze and releases to activate fast-twitch muscle fibres
  • Deep breathing with diaphragmatic engagement: your pelvic floor and diaphragm work together

 

Equally important is the release. Many women are so focused on ‘tightening up’ that they forget the pelvic floor must also fully relax. A pelvic floor that cannot let go is just as problematic as one that is weak.

 

⚠️  Important: Not all pelvic floor problems mean weakness

Some women experience pelvic floor tension or overactivity after birth, where muscles are tight and unable to relax. Doing more squeezing exercises in this case can make symptoms worse. If you’re experiencing pain, pressure, difficulty with bowel movements, or pain during sex, please seek assessment before continuing with generic pelvic floor programmes.

 

When to progress

From 6–12 weeks, as your body heals and you receive clearance at your postnatal check, you can begin building intensity and duration. This is also the time to start thinking about returning to more demanding activity — we’ll cover running specifically in Q5.

 

✅  Clinical recommendation

Every woman who has given birth — regardless of delivery type, age, or symptom status — would benefit from a pelvic floor assessment with a specialist physiotherapist at or after 6-8 weeks postnatal. This is standard practice in France and many other countries, and something we advocate strongly for in the UK.

 

Q2  What is a Mummy MOT?

The term ‘Mummy MOT’ has become widely used, but it’s worth understanding exactly what it involves — and why it’s so valuable.

What it is

A Mummy MOT is a specialist postnatal assessment carried out by a trained women’s health physiotherapist, typically from around 6-8 weeks after birth, ideally after GP postnatal check. It’s a thorough, evidence-based review of your postnatal recovery that covers:

  • Pelvic floor muscle function — strength, coordination, relaxation and endurance
  • Abdominal muscle assessment — including checking for diastasis recti (tummy gap)
  • Posture, breathing and movement patterns
  • Scar tissue assessment (perineal or caesarean)
                                • Return-to-activity guidance based on your individual findings

 

Why it matters

The standard NHS 6- 8week postnatal check is carried out by a GP, and while valuable, it typically does not include a pelvic floor examination or musculoskeletal assessment. For many women, this means problems go undetected — sometimes for years.

Research suggests that up to 1 in 3 women experience pelvic floor dysfunction after childbirth, including urinary leakage, pelvic organ prolapse, or pain. The majority never seek help, often because they believe these symptoms are ‘normal’ or ‘just part of having a baby.’

They are common — but they are not inevitable, and they are treatable.

 

💬  A note from Tamara

In clinic, I see many women who have been silently managing symptoms for months or years before coming to see us. A Mummy MOT gives us the full picture of how your body is recovering — and means we can create a personalised plan to get you back to doing everything you love, safely and confidently.

 

When to book

We recommend booking your Mummy MOT from 6 – 8 weeks postnatal for vaginal deliveries, or from 8–10 weeks following a caesarean section, or after your GP postnatal check for both. However, assessments can be carried out at any point after this time — it is never too late to be assessed, even years after giving birth.

What’s includedWhat you’ll receive
60-minute one-to-one assessmentPersonalised exercise programme
Pelvic floor internal examination (with consent)Scar management advice if applicable
Diastasis recti checkGraded return-to-activity plan
Full movement & posture reviewReferral or onward support if needed

 

Q3  Why do I still look pregnant months after giving birth?

This is something many women worry about and feel embarrassed to ask. The good news is that there are clear physiological explanations — and in most cases, effective things you can do about it.

Your uterus needs time to involute

Immediately after birth, your uterus begins the process of involution — shrinking back towards its pre-pregnancy size. This takes approximately 6 weeks. During this period, a rounded lower abdomen is entirely normal and expected.

Abdominal muscles have been stretched

During pregnancy, the rectus abdominis muscles (your ‘six-pack’ muscles) are stretched apart to accommodate your growing baby. The connective tissue between them — the linea alba — widens in all pregnancies to some degree. This is called diastasis recti, which we cover in detail in Q4.

A persistent domed or coned appearance to the abdomen, particularly when sitting up or under exertion, is often a sign of diastasis recti that needs attention.

Skin and fascia laxity

The skin and deeper fascial layers of the abdomen have been under sustained stretch for nine months. Skin has limited elasticity after this level of sustained stretch, particularly with larger babies, multiple pregnancies, or when significant weight change has occurred. Some degree of laxity may remain permanently — and this is a completely normal part of having carried a baby.

Posture and muscle inhibition

Postnatal posture changes — often exacerbated by feeding positions, carrying, and sleep deprivation — can make the abdomen appear more prominent. When deep core muscles such as the transversus abdominis are not functioning optimally, the abdominal wall may have a more lax appearance.

Fluid retention

Some women retain fluid for several weeks postnatally, which can contribute to a swollen or puffy appearance across the abdomen and lower body. Staying well hydrated, moving gently, and elevating the legs when resting can help.

 

When to seek advice

If you are experiencing a persistent domed or asymmetric appearance to your abdomen, particularly when you cough, sneeze, or sit up, or if your abdomen feels weak or unsupported when you move, please book a postnatal physiotherapy assessment. These presentations can be assessed and treated effectively with the right guidance.

 

Q4  How do I close a tummy gap (diastasis recti)?

Diastasis recti — the separation of the rectus abdominis muscles — is one of the most searched postnatal topics, and also one of the most misunderstood. Here’s what you actually need to know.

First: what it is and isn’t

Diastasis recti is a widening of the inter-recti distance (IRD) — the space between the two columns of abdominal muscle. A small degree of separation is normal in all pregnancies. Clinically, we tend to consider a distance of 2cm or more, combined with impaired function of the connective tissue (poor tension and depth), as requiring intervention.

Crucially: the goal is not always to ‘close the gap.’ A narrow gap with poor tissue tension and function is more problematic than a slightly wider gap with good tension and load transfer. What matters most is how well the abdominal wall functions as a unit.

What makes it worse

Certain activities can place excessive load on the linea alba and impede recovery. In the early postnatal period, avoid:

  • Traditional sit-ups, crunches, or double-leg raises
  • Heavy lifting without breath and bracing technique
  • High-impact exercise before adequate healing
  • Planks and push-ups if you notice coning or doming of the midline

 

This doesn’t mean these exercises are permanently off-limits — it means timing and progression matter.

What helps

Recovery from diastasis recti is graduated and individual. A well-structured programme typically includes:

  • Breathing and deep core activation: learning to engage the transversus abdominis and coordinate breath with movement is the foundation of diastasis rehabilitation
  • Progressive loading: gradually reintroducing load through the core as tissue tension and function improve
  • Postural optimisation: addressing compensatory patterns that increase intra-abdominal pressure
  • Functional movement retraining: returning to everyday tasks — lifting, carrying, getting up from the floor — with optimal mechanics

 

Realistic expectations

With appropriate intervention, most women see significant functional improvement and reduction in gap width. However, some degree of laxity may remain — and this is not a failure. Many women with a measurable IRD have no functional symptoms whatsoever.

If you’ve been told you have diastasis recti, or if you notice the classic signs — coning at the midline, lower back pain, pelvic instability, or difficulty generating core tension — a specialist physiotherapy assessment will give you a clear, personalised plan.

 

📋  What to expect at a diastasis assessment

At Vitality Physiotherapy, we assess inter-recti distance, tissue quality (tension and depth), load transfer and abdominal function through movement. From this, we create a structured rehabilitation programme that progresses at the right pace for your body and your goals — whether that’s returning to yoga, lifting your toddler, or running a 10K.

 

Q5  Is it safe to run after having a baby?

Running is one of the most popular forms of exercise women want to return to after having a baby. And the answer to whether it’s safe is: yes — but with the right preparation, at the right time.

Why the timing matters

Running is a high-impact activity. Every stride loads the pelvic floor with forces of 1.5–2.5 times your body weight. This is a significant demand to place on tissues that are still recovering from pregnancy and birth.

The landmark guidelines published by specialist physiotherapists Groom, Donnelly and Brockwell — widely adopted in clinical practice — recommend that women wait until at least 12 weeks postnatal before returning to running, and that this return is graduated and symptom-guided.

Signs that you may not be ready

Before returning to running, you should be free of the following symptoms during everyday activity:

  • Urinary leakage (stress incontinence)
  • Pelvic heaviness, pressure, or bulging
  • Pelvic girdle or lower back pain
  • Abdominal coning or doming
  • Difficulty with single-leg activities such as stairs or walking

 

If any of these are present, these are signals to address the underlying issue before introducing running loads.

The readiness tests

Before beginning a return-to-run programme, you should comfortably be able to:

  1. Walk briskly for 30 minutes without symptoms
  2. Single-leg balance for 10 seconds each side
  3. 20 single-leg calf raises without discomfort
  4. 10 single-leg bridges on each side
  5. 20 forward bounds (low-impact hopping), symptom-free

 

Building back up

A graduated return-to-run programme — similar in structure to Couch to 5K — is the safest approach. Alternate running and walking, begin on softer surfaces, and pay close attention to any symptoms during or after sessions.

WeekSession structureSymptom check
11 min run / 2 min walk × 8Leakage, heaviness, pain?
22 min run / 2 min walk × 6Any new symptoms?
33 min run / 1 min walk × 6Confidence improving?
45 min run / 1 min walk × 5Continuous running felt ok?
5–610 min run / 1 min walk × 3Assess for full return

 

If symptoms occur during or within 24 hours of a run, step back one week in the programme and reassess. Persistent symptoms should prompt a physiotherapy review before continuing.

 

🏃  Running with a pelvic floor that’s ready

At Vitality Physiotherapy, we offer specialist return-to-running assessments that combine pelvic floor evaluation with a movement and gait screen. This gives you a clear picture of your readiness, a tailored programme, and the confidence to run without worrying about your symptoms. Whether you’re aiming for your first 5K or returning to half-marathon training, we can help you get there safely.

 

 

Ready to start your recovery properly?

Clinics in London (SE1) and Surrey (KT10 Esher)

Book a Mummy MOT or postnatal physiotherapy assessment

vitality-physio.co.uk

 

About the author

Tamara Figaji is an Associate Women’s Health Sports Physiotherapist at Vitality Physiotherapy, specialising in postnatal recovery, pelvic floor rehabilitation, and return-to-sport. She works with women at both the London (SE1) and Surrey (KT10 Esher) clinics.

 

The information in this article is for educational purposes and does not constitute individual medical advice. If you are experiencing symptoms or have concerns about your postnatal recovery, please book an assessment with a

 

Can AI Replace Your Physio?

Why a Real-Life Physiotherapist Beats an AI Rehab Plan for Back Pain

I recently encountered a post from a runner who shared how they achieved a marathon PB from using ChatGPT. It seemed convenient — quick, accessible, and of course, the running plan was free. When it comes to your back, there’s no substitute for a skilled Physiotherapist who can listen, see, feel, and adapt in real time. That’s the foundation of our learning in orthopaedic medicine.
Having mentored students over many years, I’ve learned that the best Physios listen well, remain curious, and make the complexities of pain less complicated.
Here’s why a real-life Physio beats ChatGPT and all its bot-friends:

Personalised Assessment

AI tools rely on what you type into the search bar, and as we have all discovered, the better the context you give, the better the answer. The problem is that you don’t know what you don’t know.
A Physio asks the important questions, not only the obvious ones, such as what aggravates your pain, but also the less obvious ones- like your lifestyle, nutritional, work, life, and social engagements.
Not only will a good Physio ask great questions, but they will also look critically at how you move. They observe posture, gait, strength, flexibility, breathing, and how your pain changes moment to moment.
Expert human observation is not confined to a singular moment, but is an evolving assessment and reassessment process that matches your needs. This observational cohort study in outpatient Physiotherapy clinics showed that just the history-taking and physical examination performed by physiotherapists produced statistically meaningful improvements in patient pain and function before any “treatment” was applied.

The focus: helping you reach your goals and to get back to doing the things you love. We can spot subtle problems — like pelvic imbalance, poor load transfer, trick movements, and compensations- that no algorithm can detect from text, photos, or even your Garmin data. (No disrespect intended to my favourite data platform.) Furtherore, a skilled practitioner puts you and your goals in the centre and shares in making the important decisions such as when it is best to return to sport.

Correct Diagnosis

Back pain can have many causes, ranging from disc irritation, joint stiffness, muscle spasms, nerve sensitivity, to stress, lifestyle, and even hormonal factors. It’s a nuanced condition. Your pain cannot be oversimplified as a change to your disc or spinal joints. Your back pain also reflects how well your body’s tissues can handle and adapt to the loads placed on them. A great Physio can test, palpate, and clinically reason through these factors. This ensures the plan targets what actually needs fixing.

Real-Time Feedback and Progression

AI gives static exercises, handouts, and guides- a fix-all, monochrome magic formula for everybody. A brilliant Physio provides coaching: correcting form, adjusting load, progressing safely. They lead you to prevent flare-ups and take you beyond what you think is possible. That’s the difference between just doing exercises and doing a targeted goal-oriented, effective, progressive rehab programme.

Holistic Support

Recovery isn’t just physical — it involves sleep, stress, work ergonomics, and movement habits
A real Physio connects all these dots, problem-solves their interconnectedness and helps you stay accountable.

Safety and Trust

If pain worsens or new symptoms appear, an AI can’t respond.
A Physio knows when to modify load (how heavy), mode (how far and what position), rep range and technique. Not only will they provide you with a plan, but they can also adapt it when needed, investigate further, or refer to another medical practitioner when needed.— keeping you safe.
AI can be a great tool for many things; we use it too in our clinics to help write notes and assist with administrative tasks, but it is always Physio-led. For lasting back pain recovery, nothing replaces our expert hands, eyes, clinical reasoning and yes, the trust relationship.
Ready to experience Physio-led care that truly makes a difference? Book your session today and start your path to lasting recovery.