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Monday 10am - 8:35pm Tuesday 10am - 8:30pm Wednesday 10am - 8:30pm Thursday 10am - 8:30pm Friday 10am - 8:30pm Saturday 10am - 8:30pm Sunday 10am - 8:30pm

http://www.ntsportstherapy.com/

NT Sports Therapy, Manchester (2026)

30/10/2026

Twisted your ankle? Understand what a sprain really means.

An ankle sprain happens when excessive force stretches or tears the ligaments that stabilise the joint. Most commonly, the ankle rolls inward, affecting the lateral ligament complex, particularly the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Sprains range from Grade I (mild ligament damage) to Grade III (complete rupture). According to Marta and Kawiyana (2016), injury severity influences clinical presentation, joint stability and rehabilitation requirements.

Although frequently confused, sprains and strains involve different tissues. A sprain affects ligaments connecting bones, whereas a strain involves injury to muscle fibres or the muscle–tendon unit. Strains typically result from excessive stretching or forceful muscular contraction, often affecting the hamstrings, quadriceps or calf muscles. Järvinen et al. (2000) describe muscle strain injuries as involving varying degrees of fibre disruption, followed by inflammation, tissue regeneration and remodelling.

Ankle sprains commonly produce pain, swelling, bruising and reduced weight-bearing tolerance. Clinical assessment should establish injury severity and, when indicated, exclude fractures. Rehabilitation requires more than symptom reduction. Halabchi and Hassabi (2020) emphasise early functional support, progressive loading, strengthening, proprioceptive training and sport-specific exercises to restore stability and reduce recurrent injury risk. Persistent instability may indicate incomplete functional recovery and require further assessment.

26/10/2026

Understanding Tailbone Pain: Causes, Assessment, and Rehabilitation

Coccydynia, commonly known as tailbone pain, is a musculoskeletal condition affecting the coccyx at the base of the spine. Common contributing factors include direct trauma, prolonged sitting, childbirth and abnormal coccygeal mobility. According to Lirette et al. (2014), structural variations, joint degeneration and repetitive mechanical pressure may contribute to symptoms, highlighting the multifactorial nature of coccygeal pain.

Clinical presentation typically involves localised tenderness over the coccyx, aggravated by prolonged sitting, leaning backwards, or transitioning from sitting to standing. Assessment includes clinical history, palpation, functional examination and screening for alternative causes of pain. Mabrouk, Alloush and Foye (2020) describe the potential value of sitting and standing radiographs for identifying abnormal coccygeal movement, particularly in persistent cases where instability is suspected.

Rehabilitation focuses on reducing mechanical irritation, improving sitting tolerance and addressing associated muscular dysfunction. Conservative management may include pressure-relieving cushions, activity modification, postural adjustments and pelvic floor physiotherapy when clinically indicated. Lirette et al. (2014) report that approximately 90% of cases respond to conservative management, although some improve spontaneously. Persistent symptoms may require multidisciplinary assessment and additional treatment.

10/10/2026

De Quervain’s Tenosynovitis: When Repetitive Thumb Loading Becomes Painful

De Quervain’s tenosynovitis is a painful condition that affects the first dorsal compartment of the wrist and involves the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. Repetitive thumb movements, gripping and mechanical loading may contribute to tendon sheath thickening and restricted gliding. According to Charzewski and Starzyk (2025), anatomical variations and degenerative tissue changes may also contribute to its development, suggesting that repetitive loading is not the sole factor.

Clinical presentation commonly includes pain and tenderness over the radial styloid, particularly during gripping, lifting and thumb movement. Finkelstein’s and Eichhoff’s tests may reproduce symptoms, although clinical findings should not be interpreted in isolation. Mak (2018) highlights the importance of differentiating these manoeuvres and using ultrasound when necessary to identify tendon thickening, sheath abnormalities or anatomical variations. Importantly, repetitive occupational activity has not been conclusively established as a direct cause of the condition.

Management focuses on reducing symptom-provoking loads while restoring functional thumb and wrist movement. Conservative options include activity modification, thumb-spica splinting, corticosteroid injections and rehabilitation incorporating graded tendon-loading exercises. Charzewski and Starzyk (2025) describe progressive strengthening as part of functional recovery, although the optimal exercise protocol remains uncertain. Treatment should therefore reflect symptom severity, functional demands and individual response rather than relying on repetitive exercise alone.

02/10/2026

Cuboid Syndrome: The Often-Overlooked Source of Lateral Midfoot Pain

Cuboid syndrome is a frequently overlooked differential diagnosis in individuals presenting with lateral midfoot pain, particularly following inversion ankle sprains or repetitive mechanical loading. The condition is thought to involve subtle disruption of calcaneocuboid joint congruity or arthrokinematics, potentially affecting midfoot stability and force transmission during gait. Patterson (2006) proposed altered peroneus longus mechanics, excessive pronation, and repetitive microtrauma as contributing factors, although the underlying mechanisms remain incompletely understood.

Clinical presentation commonly includes localised cuboid tenderness, discomfort during weight-bearing, reduced push-off tolerance and pain during lateral movements. Symptoms frequently resemble those of ligament injuries or peroneal tendon disorders. Durall (2011) emphasises that no definitive validated diagnostic test exists, making clinical history, physical examination and differential diagnosis essential. Imaging is generally more useful for excluding fractures and other structural pathology than for confirming cuboid syndrome.

Conservative management may include selected manual therapy techniques, external support through taping or orthoses, and progressive rehabilitation addressing foot mobility and muscular function. Although published case reports describe symptom improvement following cuboid manipulation, robust clinical trials establishing treatment effectiveness remain lacking. Patterson (2006) describes manipulation and supportive interventions as commonly used approaches, but these findings should be interpreted in light of the limitations of the available literature.

01/10/2026

Biceps Tendinopathy: Understanding Anterior Shoulder Pain Under Load

Long head of the biceps tendinopathy can cause anterior shoulder pain, particularly during repetitive overhead movements, lifting, and activities involving sustained mechanical loading. The condition involves inflammatory or degenerative changes affecting the tendon as it passes through the bicipital groove. According to Nho et al. (2010), repetitive traction, friction and rotational forces may contribute to tendon pathology. However, isolated biceps tendinopathy is relatively uncommon and frequently coexists with rotator cuff disorders, labral pathology or other shoulder conditions.

Clinical presentation may include localised tenderness over the bicipital groove, pain during resisted shoulder flexion or forearm supination, and reduced tolerance to repetitive upper-limb activity. Diagnosis requires careful assessment because symptoms overlap with other shoulder disorders, and individual provocative tests have limited diagnostic reliability. Nho et al. (2010) emphasise the importance of clinical history, physical examination and appropriate imaging when indicated.

Rehabilitation generally focuses on modifying aggravating activities, restoring shoulder function and progressively rebuilding loading tolerance. McDevitt et al. (2022) identified expert consensus supporting resistance exercise, manual therapy and patient education within a multimodal physiotherapy approach. However, these recommendations reflect expert agreement rather than definitive evidence of treatment effectiveness. Management should therefore be individualised based on symptom irritability, functional limitations, and associated shoulder pathology.

27/09/2026

TFCC Injuries: Understanding Persistent Ulnar-Sided Wrist Pain

The triangular fibrocartilage complex (TFCC) is an important stabilising structure of the ulnar wrist and distal radioulnar joint (DRUJ), particularly during forearm rotation and loading. TFCC injury may follow trauma involving a loaded, dorsiflexed wrist or develop through repetitive mechanical stress. According to Jain and Wahegaonkar (2021), TFCC pathology is a frequent differential diagnosis in ulnar-sided wrist pain, but similar symptoms can arise from DRUJ, lunotriquetral, ulnocarpal and tendon disorders.

TFCC injury commonly presents with ulnar-sided pain, particularly during gripping, axial loading or pronation-supination, and may be accompanied by clicking, reduced grip strength or instability. Satria, Aprilya and Hadinoto (2025) identify foveal tenderness as an important clinical finding, while emphasising that its proximity to the extensor carpi ulnaris tendon can make differentiation difficult. Clinical assessment should therefore combine history, anatomical palpation, provocative testing and appropriate imaging rather than relying on a single test.

Persistent ulnar-sided wrist pain should therefore not automatically be labelled as a TFCC injury. ECU tendinopathy, ulnocarpal impaction, lunotriquetral injury and DRUJ pathology can produce overlapping symptoms. Jain and Wahegaonkar (2021) emphasise systematic assessment to identify the anatomical source of symptoms, while MRI and, where indicated, wrist arthroscopy can support the diagnosis. Management then depends on tear location, chronicity, and the presence of instability rather than pain alone.

24/09/2026

Hallux Limitus: How Restricted Great-Toe Motion Alters the Propulsive Phase of Gait

The first metatarsophalangeal joint plays an important role during terminal stance and propulsion, when adequate hallux dorsiflexion allows the body to progress efficiently over the forefoot. According to Tovaruela-Carrión et al. (2025), hallux limitus restricts this movement and can interfere with the forefoot rocker during the final phase of gait, producing biomechanical adaptations in how the foot accepts and transfers load.

Functional hallux limitus specifically describes restricted great-toe dorsiflexion during weight-bearing, despite adequate motion during non-weight-bearing assessment. Durrant and Chockalingam (2009) describe potential compensations including lateral deviation of the centre of pressure, increased pronation, earlier heel lift and altered hip and knee extension. Restricting first metatarsophalangeal motion has also been associated with a lateral shift in plantar pressure during propulsion, suggesting that push-off may be redistributed away from the first ray.

These adaptations do not mean that every person with restricted hallux motion will demonstrate the same gait pattern. In a case-control study of 80 participants, bilateral hallux limitus was associated with subtle rather than extensive gait differences, and many measured variables did not differ significantly between groups (Tovaruela-Carrión et al., 2025). This supports assessing great-toe mobility within the broader gait pattern rather than assuming that restricted motion automatically produces a specific compensation.

12/09/2026

Costovertebral Joint Dysfunction: An Overlooked Contributor to Thoracic Pain

Thoracic pain can arise from several musculoskeletal and visceral structures, making identification of the pain generator challenging. The costovertebral and costotransverse joints form important articulations between the ribs and thoracic spine and can contribute to posterior thoracic symptoms. According to Young et al. (2008), experimental stimulation of costotransverse joints produced predominantly local, ipsilateral pain described as a deep, dull ache or pressure, demonstrating their potential to generate thoracic pain.

Clinically, costovertebral or costotransverse dysfunction may present with localised posterior thoracic pain, sometimes extending to the anterior chest, and symptoms may worsen with deep breathing, coughing, sneezing, or trunk movement. Fruth (2006) described a patient with restricted and painful mobility of the costovertebral and costotransverse joints at ribs 3–6 alongside significant upper thoracic pain and movement restriction.

However, thoracic pain should not automatically be attributed to rib-joint dysfunction. Pain patterns from thoracic structures can overlap, and the reliability of passive costovertebral and costotransverse mobility assessment remains insufficiently established. Young et al. (2008) specifically cautioned that pain distribution alone is unreliable for identifying the precise anatomical source. A thorough differential assessment is therefore important, particularly because cardiac, pulmonary, gastrointestinal and other visceral disorders can also produce thoracic or scapular pain.

08/09/2026

Closed vs Open Kinetic Chain Rehabilitation: Understanding the Mechanical Difference

Open and closed kinetic chain exercises differ primarily in how the limb interacts with its environment. In open kinetic chain (OKC) exercise, the distal segment is free to move, as in seated knee extension or straight-leg raising. In closed kinetic chain (CKC) exercise, the distal segment remains fixed against a surface, as in squats, leg presses or step-ups. According to Ng et al. (2022), both approaches are used clinically for knee rehabilitation but represent different movement conditions and exercise demands.

This mechanical distinction influences how rehabilitation exercises are performed and progressed. OKC exercises can target movement around a particular joint through tasks such as knee extension, whereas CKC exercises incorporate weight-bearing patterns such as squatting and stepping. Adegoke et al. (2019) compared eight weeks of OKC and CKC rehabilitation in people with knee osteoarthritis and found that both groups improved pain, function and knee range of motion, with no significant difference between the approaches for these outcomes.

Therefore, open and closed kinetic chain exercises should not be automatically viewed as competing rehabilitation methods. Each can provide a distinct mechanical and functional stimulus, and selection should reflect the rehabilitation objective and the movement demands to be restored. Evidence indicates that both approaches can improve quadriceps strength and clinical outcomes, while their combination may also be appropriate (Ng et al., 2022). The key is not simply whether the chain is “open” or “closed”, but why that particular loading strategy is being used within the rehabilitation programme.

05/09/2026

Muscular Power Deficits After Injury: Why Strength Alone Does Not Equal Performance

Restoring maximal strength is important after injury, but strength and athletic performance are not interchangeable. According to Suchomel, Nimphius and Stone (2016), sporting performance depends heavily on force-time characteristics such as rate of force development (RFD) and mechanical power. Many sporting actions, including sprinting, jumping and rapid changes of direction, provide only a short period in which force can be produced, meaning the ability to generate force rapidly can be as important as the amount of force an athlete can ultimately produce.

Greater strength provides an important foundation for power, but athletes must also develop the capacity to express that strength under the speed and coordination demands of sport. The review found substantial associations between muscular strength and external mechanical power and describes maximal strength as a foundation upon which power can be developed (Suchomel et al., 2016). This distinction is clinically important: an athlete may demonstrate good force production during a controlled strength assessment while still requiring further development of explosive and sport-specific performance qualities.

Rehabilitation, therefore, should not treat strength restoration as the only physical requirement for a return to performance. Chen et al. (2025) found that injury-prevention programmes incorporating strength reduced overall injury risk, while more complex knee and ankle injury prevention benefited from multicomponent approaches incorporating qualities such as balance, proprioception, coordination and plyometric exercise. Together, the evidence supports progressing rehabilitation beyond isolated strength towards the rapid, coordinated and task-specific expression of force required in sport.

NT Sports Therapy

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Monday	10am - 8:35pm
Tuesday	10am - 8:30pm
Wednesday	10am - 8:30pm
Thursday	10am - 8:30pm
Friday	10am - 8:30pm
Saturday	10am - 8:30pm
Sunday	10am - 8:30pm