Subacromial Impingement
Subacromial impingement is a common condition where pain is felt over the top of the shoulder and upper arm. It can affect golfers, tennis players or non-athletes.
Subacromial impingement is a common condition where pain is felt over the top of the shoulder and upper arm. It can affect golfers, tennis players or non-athletes.
Patella tendinopathy was called jumpers knee due the high incidence amongst athletes involved in jumping sports- such as volleyball, basketball and netball. However this condition may occur in both the sporty and non-sporty population groups.
Achilles tendon pain is one of the most common lower-limb problems seen in active adults — and one of the most manageable, when addressed early and correctly. Despite the dramatic mythology behind its name, Achilles tendinopathy today responds well to evidence-based physiotherapy in the vast majority of cases.
At Vitality Physiotherapy, we regularly assess and treat Achilles tendinopathy across our Esher and Southwark clinics, working with runners, gym-goers, and recreational athletes to get them back to the activities they love.
What Is the Achilles Tendon?
The Achilles tendon is the largest and strongest tendon in the body. It connects the calf muscle complex — the gastrocnemius (medial and lateral heads) and soleus — to the heel bone (calcaneus), forming a thick, powerful structure that stores and releases energy with every step. It is central to walking, running, jumping, and pushing off the foot.
What Is Achilles Tendinopathy?
Achilles tendinopathy describes a spectrum of pain, stiffness, and structural change within the tendon caused by overload rather than a single traumatic event. It is fundamentally a condition of load and adaptation: the tendon is being stressed faster than it can recover and remodel.
There are two distinct clinical presentations:
Typical Symptoms
Achilles tendinopathy tends to develop gradually. The most common presentation includes:
Symptoms often fluctuate, particularly in the early stages, which can make it tempting to push through — though this typically delays recovery.
Common Causes and Risk Factors
Achilles tendinopathy is rarely caused by a single factor. It usually develops when a combination of load, tissue capacity, and biomechanical variables converge.
Training-related factors
Physical and biomechanical factors
Lifestyle and equipment factors
How Is It Diagnosed?
In most cases, Achilles tendinopathy is diagnosed clinically, without the need for imaging. A thorough physiotherapy assessment will typically include:
Ultrasound imaging is occasionally used where symptoms are atypical, progress is unexpectedly slow, or a more serious pathology needs to be excluded — but it is not routinely required to begin rehabilitation.
Treatment and Rehabilitation
The evidence for conservative management of Achilles tendinopathy is excellent, and the majority of people make a full recovery with physiotherapy.
Treatment at Vitality Physiotherapy focuses on identifying the underlying load issue and systematically rebuilding the tendon’s capacity. Rehabilitation is progressive and structured — and critically, it does not involve complete rest.
Load management The first step is to reduce aggravating activities to a level the tendon can tolerate, while maintaining as much training as possible. Complete rest is rarely helpful and may slow recovery.
Progressive strengthening Tendon rehabilitation is driven by loading, not by passive treatment. A structured programme will typically begin with isometric calf exercises to manage pain, progressing to heavy slow resistance training, in our private well- equipped gym and ultimately to sport-specific loading and plyometrics. This progression is evidence-based and forms the cornerstone of recovery.
Mobility and biomechanics Where reduced ankle range of motion, calf tightness, or altered gait mechanics are contributing factors, these will be addressed as part of your programme. For runners, gait analysis may be appropriate.
Return to activity Recovery is guided by your symptom response and functional testing rather than arbitrary time frames. A structured, phased return to your sport or exercise is planned from the outset.
How Long Does Recovery Take?
Recovery timelines vary depending on how long symptoms have been present and their severity:
It is worth noting that progress is driven far more by the quality and consistency of loading than by time alone. This is why structured physiotherapy input tends to produce better outcomes than self-managed rest.
When Should You See a Physiotherapist?
We would recommend seeking an assessment if:
Early intervention consistently leads to faster recovery and significantly reduces the risk of symptoms becoming chronic.
Red Flags — Seek Urgent Medical Attention
While most Achilles pain is the result of overload and responds well to physiotherapy, the following symptoms may indicate an Achilles tendon rupture or other serious injury requiring urgent assessment:
If an Achilles rupture is suspected, do not stretch or load the leg. Seek same-day medical evaluation.
Achilles Tendinopathy Treatment in Esher and Southwark
Whether you are based in Southwark, Waterloo, London Bridge or in Esher or the surrounding areas — including Claygate, Thames Ditton, Cobham, or Weybridge — our physiotherapy team can assess your tendon, identify the contributing factors, and build a rehabilitation programme tailored to your sport, lifestyle, and goals.
We offer accurate clinical diagnosis, evidence-based loading programmes, structured return-to-running plans, and long-term strategies to reduce recurrence.
To book an assessment with George at our Esher clinic, https://www.vitality-physio.co.uk/book-an-appointment-online or call 02071939928
Back Pain is one of the leading causes of sickness related absenteeism at work in the UK.
There are several sources from which back pain can arise. A recent study in the UK, showed that Physiotherapy is clinically effective and cost efffective in the management and treatment of musculoskeletal disorders (MSD).
ITB Friction syndrome is a very common complaint amongst elite and amateur runners alike. It is caused by the friction of the outside thigh muscle against the lateral aspect of the thigh bone (the lateral aspect of the end of the femur).
Training for a triathlon? Swimming injuries are rare. They are more likely to occur in the upper extremity of the body (neck or shoulder in particular) than the lower extremity.
Some common training errors and faulty biomechanics are…
Tennis elbow (lateral epicondylitis) is a condition that results in pain around the outside of the elbow. It is a bit of a misnomer, as it seldomly affects tennis players. It often occurs after continuous or stenuous overuse of the muscles and tendons of the back of the forearm, near the elbow joint.