The information given here is very general and cannot take into account your particular physical or medical condition. As such, it is meant to be practical and informative but is not intended to be a substitute for professional advice. It is not meant to replace any relationship that exists between you and your doctor, hospital specialist, physiotherapist or other healthcare professional.

Topics covered on this page include:

Accidents and injuries
Back pain
Chronic pain
Neck pain
Pelvic organ prolapse
Plantar Fasciitis
Repetitive strain injury
Scar tissue

Accidents and injuries

Fractures, sprains and strains are common injuries that can occur anywhere in your body. Of course every individual injury is different and will require specific treatment, but a frequent complication after healing, is the ongoing pain, swelling and stiffness. These symptoms can be a sign of restrictions in the surrounding tissues which need to be released.

If you have suffered a sports injury, it is important to allow your body to heal and follow rehabilitation advice to gradually return to your full activity. Many athletes re-injure the same area because they have built up too quickly.



Many of us live in a permanent state of fight or flight; possibly because of previous traumas, or the stresses of everyday modern life. If our system is already on high alert, it does not take much in the way of extra stress to tip us over the edge into full-blown panic or meltdown.

Your system carries tissue and cell memory. This does not record only past physical traumas, but the associated emotions too. This is why some situations instantly catapult us back to old memories, feelings, or reactions.

If you have suffered a trauma, your fascial system and subconscious mind will have recorded the position that you were in at that point. Your mind then associates that particular position with
danger or pain, so it will try to avoid it as much as possible. Have you ever noticed that some movements have a funny kink in them, or that if you try to do a certain movement it doesn’t feel safe, so you just don’t do it?

As far as your mind is concerned, the danger that you are reacting to doesn’t have to have actually happened. You know that feeling when you think that the truck is going to hit your car? Or when you are riding and your horse suddenly spooks and you think that you are going to be thrown? The shot of adrenaline that flies through your system at that moment when you think that you are going to get seriously hurt is as real as the adrenaline that is released when you are actually injured.

In this way, old injuries and traumas (physical or emotional) lead to compensations that can affect you every day of your life. So it doesn’t take much to shift your body from just about coping into spasm, pain, and inflammation. The thing that pushes you over your limit is often stress.

Stress has become the normal state for many of us, and over time it has an effect on your mind and body. Your brain interprets the tension as a sign of danger, and keeps the sympathetic nervous system on high alert. This cycle of chronic stress can lead to depression, pain, tightness, fatigue, and breathing and digestive problems. Your fight-or-flight response is only meant to be in place for a couple of hours or days at the most. However, a lot of people are living in a permanent state of fight or flight, which affects their physical and emotional health.

If your stress response continues, it stops being helpful and can damage your health, immunity, mood, and quality of life, adding to the feelings of stress and anxiety. Then it is quite easy to trigger an extreme reaction like a panic attack or hyperventilation. It may also result in phobias.


Back pain

According to NHS England, back pain is the largest single cause of disability in the UK.

Back pain can be as a result of several different pathologies, and some people will have more than one problem contributing to their pattern of pain. These can include damage to muscles, tendons, ligaments, discs and vertebrae. Having said that, most back pain is not related to anything serious and by keeping moving, avoiding aggravating tasks, doing gentle exercise and stretches it should be possible to control it.

An article that was published in the Lancet examined the research into low back pain assessment and treatment. The conclusion was that there was very little evidence for most of the invasive investigations, x-rays, scans, injections and surgeries. They did show that some manual therapy was helpful, together with a graded exercise programme.

However, there are some ‘red flag’ symptoms which may indicate a more serious problem and if you are experiencing any of these, it is very important to seek medical attention so that you can be checked and treated if necessary; especially if they come on following trauma such as a fall. The symptoms to look out for are:

• Numbness or pins and needles between your legs, in the area which would be in contact with a saddle
• Inability to pass urine
• Urinary or bowel incontinence
• Leg weakness
• Extreme pain in both or one of your legs

Intervertebral discs are the soft, gel-filled cushions that sit between each vertebra in your spine. They act as shock absorbers, while allowing safe movement of your spine. Spinal scans often report degenerative changes of the discs or wear and tear. This is a natural change as you age and the water content of the discs reduce from the 80% that you are born with.

If a disc is compressed too much on one side – by trauma or muscle tension, the gel is forced out to the other side (imagine what would happen if you filled a balloon with water and then squeezed it on one side). This pushes the disc out of its normal position and into the space occupied by the nerves; a slipped disc, resulting in very painful conditions such as sciatica and nerve pain down your arms.

When seeking treatment for disc problems, it is important to remember that even though your pain may be on one side, the cause is probably on the other side. Relieve the compression and the disc will have space to come back into its rightful position, as long as it has not completely ruptured or displaced too much.


Chronic pain

A British Medical Journal report found that chronic pain affects between one third and half of the population of the UK, which is approximately 28 million adults.

Pain is defined by the International Association for the Study of Pain as, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

This means that the mind and body cannot be separated, and everyone’s perception of pain is different. The amount of pain felt doesn’t only depend on how much damage has been sustained, but will vary according to what has happened to you in the past.

The pain felt after an injury is a necessary, protective mechanism that makes you aware of the damage and ensures that you take action. It is a warning sign that needs to be acknowledged and responded to, not suppressed. But in some people, this mechanism becomes stuck, leading to chronic or long-term pain.

You feel pain when the nerve endings that are sitting within your tissues are stimulated. There are receptors to pick up lots of different sensations, and some of them are specialised to sense those that may be harmful, such as heat, pressure or chemicals. They communicate those sensations via your spinal cord to your brain, which is when you feel them. When those sensations reach a critical level, you will feel them as pain.

If the nerve endings in a certain area are over-stimulated by constant irritation (such as pressure from the surrounding tissues or inflammation) even those that previously did not detect pain, become pain sensitive. It has been estimated that fascial restrictions put up to 2000 pounds per square inch of pressure on your nerve endings, which is the equivalent of a fully grown draught horse sitting on you! This is how chronic pain (lasting more than three months) develops.

When the pain pathways from your nerve endings are stimulated, the receptors in your brain interpret this as your tissues being damaged and your brain sends pain-killing chemicals to the area and triggers an inflammatory response and the repair process. This is essential when you actually have hurt yourself, but it becomes a problem when the cycle is being continued not by a new injury, but by the continued pressure on the nerve endings from your fascial restrictions.

The pain cycle can become an issue if when an area is injured and then becomes swollen and inflamed, the resulting tightness and scar tissue further irritates it. So the area never has a chance to settle and the nerve endings keep telling your brain that there is damage. So then the inflammation also becomes chronic and the cycle keeps going round and round.

Chronic pain affects all areas of life as it can lead to lack of sleep, fatigue, irritation, depression and anxiety. People’s relationships and jobs suffer and previously enjoyable activities become difficult or even impossible. Conditions such as myalgic encephalomyelitis (ME or CFS), Long Covid and fibromyalgia have significant impact on day to day living.

Taking medication is the most common solution offered by doctors but remember that the cause of your pain may be in a completely different part of your body to wear you are feeling the symptoms. Medical investigations to find out if there is any cause of your pain that needs immediate treatment is essential, but medication can mask what you are feeling and does not necessarily address the root cause.



Fibromyalgia is a chronic condition that causes widespread pain and fatigue all over the body. Sufferers often also report muscle stiffness and increased sensitivity. As this condition presents differently in each person and does not have a definitive diagnostic test at the moment, diagnosis is dependent on your doctor being aware of the condition and its implications.

Dr Ginevra Liptan is an American doctor who also has Fibromyalgia and she now specialises in treating patients with Fibromyalgia and researching the condition. Her excellent book, The FibroManual has a lot of information and if you are interested in finding out more, we recommend reading this and following her on social media as she regular publishes updates on the latest research.

Although some Fibromyalgia sufferers have to stop exercising altogether for at least a period of time, there are many who find that exercise is beneficial to their general well-being. This is a condition that is worsened by stress, so finding a low impact, enjoyable form of exercise that releases endorphins and helps to strengthen your core muscles is invaluable.

Dr Liptan’s research has found that people with Fibromyalgia showed significant long term benefits from Myofascial Release treatment.



People with Hypermobility Syndrome have the ability to move their joints beyond the normal range, eg, being able to bend their thumbs back on themselves. It is sometimes known as being double jointed. This trait is often passed down through families and there are different grades of severity.

Some families are identified as having a particular syndrome such as Ehlers-Danlos Syndrome (EDS) but many people do not realise that they are hypermobile until they have a problem. But you can be hypermobile without having a serious condition. If you think that you may be hypermobile and are concerned about it, speak to your doctor, who will be able to run some tests and advise you on any treatment that you may need.

The hypermobility is caused by faulty collagen in your connective tissue fibres, which leads to looseness in structures throughout your body such as ligaments and skin. The pain around joints which is a typical symptom is caused by recurrent soft tissue damage from repeated over stretching.

Core strengthening and joint stabilising exercises are the key to exercising safely if you are hypermobile. It is important that you are assessed in person by someone who is qualified to advise you, such as a physiotherapist.



The NHS estimates that 3 to 6 million people in the UK are living with urinary incontinence, with it occurring in approximately 34% of women.

Your pelvic floor is a sling of muscles that attaches to the bottom of your pelvis, supporting your pelvic organs and giving you control over your bladder and bowels. It is as important for men as for women, but often it is only mentioned or thought about after childbirth.

There are two main types of urinary incontinence – stress or urge, with some people suffering from both. The causes and treatment are the same for each type in most cases and men can be affected as well as women.

Stress incontinence is when the pelvic floor is unable to prevent urine from leaking when put under pressure. This may be when you cough, sneeze or exercise.

Urge incontinence is the inability to stop urine flow when your bladder feels that it is full, sometimes called an overactive bladder. It is why some people will always go to the bathroom ‘just in case’ and will normally be very aware of when the next opportunity to go will be.

Urinary incontinence is normally blamed on a weak pelvic floor and sufferers are given exercises to strengthen it. This approach would be effective if that was the only reason, but remember that your pelvic floor is connected to the rest of your body, and it doesn’t work in isolation. So if you have a history that includes back pain, pelvic rotation, childbirth, surgery or trauma (particularly in the abdominal or pelvic area) or pelvic organ prolapse, it is highly likely that they are contributing to the weakness.

Finding and treating the cause will be much more successful than doing exercises alone to try and overcome the problem. Once your pelvic floor is no longer tight and twisted because of strain from other areas of your body, the exercises will be much more effective.


Neck pain

Like back pain, your neck can be affected by the muscles, tendons, joints and ligaments in the area and the pain will be made worse if you are doing anything that puts strain on it.
Often pain that is felt at the back of your neck is due to tension in the muscles at the front. This pulls your head and spine forwards, with gravity also pushing down so to stop you looking at the ground the whole time, the muscles at the back of your neck have to work harder to lift your head back into a more upright position.

If you have had any trauma to your head or neck and then you experience any of the following symptoms, it is important to get checked by a medical professional:

  • Extreme pain in your neck or arms
  • Dizziness
  • Bad headache
  • Weakness in one or both arms
  • Urinary or bowel incontinence
  • Difficulty controlling your legs when walking

The main effect that neck pain has on your posture is the tension that is almost always associated with it. As your head is relatively heavy and being upright against gravity requires you to be balanced, the muscles in your neck and upper back will tend to tense up to support your head and protect your neck.

The more you push your body while you have neck pain, the greater the protective response and this will result in tension being transmitted into your shoulders and down your arms.

This is when your shoulders are held up towards your ears, many times without you realising until you spot yourself in a mirror or someone else points it out to you. Holding your shoulders in this way may be associated with stress or it may simply have become a habit that feels normal.

When you are feeling stressed, your shoulders tend to creep up, which increases the tension in your muscles, causing pain, increasing stress, and so on until it becomes a vicious circle. The trouble is, once this becomes your normal position, your brain gets desensitised to it and it is harder to pick up when it is happening.



Osteo-arthritis is sometimes known as wear and tear or degeneration of a joint. It can occur in any joint of the body and is a result of either abnormal use of a normal joint or normal use of an abnormal joint. In other words, you are much more likely to develop osteo-arthritis if you were born with congenital abnormalities, if you have ever injured the joint or if the joint is used over and over again in the same way.

The bony ends that come together to form the joint are covered by a thin layer of cartilage that protects them and produces the joint fluid for lubrication. As the joint begins to degenerate, this layer is gradually worn away so there is less lubrication and more friction between the bone ends. Severe arthritis is when there is very little cartilage left and the bone ends themselves start to wear.
Osteophytes are extra areas of bone that the body lays down to try and repair the damage done by the arthritis. They are normally on the outside of joints and look like nodules. They can cause a lot of pain as they push on nerves in the area that they grow in and lead to inflammation around them.

Typical symptoms are stiffness if you haven’t moved for a while, especially first thing in the morning, and pain, which get worse if you do too much. You can also get swelling around the affected joint and extra bone that is laid down by the body as it tries to correct the damage.

As with other painful conditions, it is the tension around the joint that causes most of the problems. This is because your other muscles need to work differently to maintain your balance and this compensation is felt by your horse, which will then also need to compensate and change its movements.

Arthritis sometimes becomes so severe that surgery is required. Hip replacements and knee replacements are the most common operations. Other joint replacements are also now becoming available, such as shoulders and joints in the feet and hands.


Pelvic organ prolapse

Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. It can be the womb (uterus), bowel, bladder or top of the vagina.
– as defined by NHS UK.

A prolapse can cause pain and discomfort and a heavy, dragging sensation. It may also be associated with incontinence and difficulty emptying your bladder.

It is important to have symptoms like these checked by a medical professional, but often manual therapies, specialist exercise programmes are very beneficial and can avoid the need for surgical intervention.


Plantar Fasciitis

The plantar fascia is the strong membrane on the sole of your foot that holds everything in its place. ‘Itis’ means inflammation of, so Plantar Fasciitis is inflammation of the membrane under your foot.
The main symptom is pain, either in the heel or spreading under the foot or up into the Achilles tendon. The pain is particularly bad when you put weight on your foot first thing in the morning or after sitting for a time. In relatively mild cases, the pain wears off once you have started walking. Our patients often describe having to hobble to the bathroom in the middle of the night or in the morning, but being able to walk normally after that.

Some people also develop bone spurs on their heel, which are small extra growths of bone that gradually develop in response to the irritation caused by chronic inflammation in the plantar fascia. While they are not themselves painful, they do cause pain in the surrounding tissues.

Often the inflammation that starts this condition is caused by tightness in the muscles attaching into the sole of your foot, which is linked to tightness in the muscles in your upper leg, which tense up because the bones of your pelvis are rotated. If you find and treat the cause of the problem, your body is normally able to heal the area of pain by completing the inflammatory cycle.


Repetitive strain injury

Repetitive strain injury (RSI) is a general term used to describe the pain felt in muscles, nerves and tendons caused by repetitive movement and overuse.

It mainly affects your neck, shoulders and arms and can produce symptoms such as pain, stiffness, swelling, numbness, tingling and weakness. It is caused by activities that are repetitive, high-intensity over a long period or in an awkward position forcing you into a poor posture. It is also known to get worse with vibrations, in the cold or if you are stressed.

The most important thing that you can do is to identify the trigger of your RSI, remembering that there may be more than one. If the cause is work-related, your employer has a duty to provide you with the correct equipment and work conditions to prevent incidents of RSI where reasonably possible. Making changes to the things that you spend all day doing will take the strain off your body and help it to heal the inflammation that has built up.



Scar tissue

A scar is your body’s way of replacing tissue that has been removed or damaged. It does this by laying down extra collagen fibres in the area as part of the healing process. This is an essential reaction, but scars can cause long-term problems for some people.

The scar that you get on your skin from an injury or operation is very obvious and you will be very aware of it if it is too tight or not healing properly. What is not so easy to detect is the internal scarring that occurs wherever tissue has been changed or disturbed. Sometimes, particularly after abdominal surgery, adhesions can form. These are bands of scar tissue that form between the scar tissue and organs, which can result in chronic pain and problems such as infertility. When excessive scarring occurs following joint surgery, it will cause pain and stiffness long after the expected recovery time.

Any deep scars will alter your posture, strength and flexibility in the local area but they also have the potential to do the same in other areas of your body.

There are many products on the market that claim to reduce visible scarring; my opinion is that the more natural the product, the more likely it is to be able to work with your body to result in changes.
Internal scarring is more problematic, but if you are aware of the potential for post-operative problems they are less likely to occur. Discussing it with your surgeon before the operation is advisable, so that they can tell you what the risks are and what they and you can do to minimise them. After the operation you can help yourself by doing the prescribed exercises, drinking plenty of water and trying to move as normally as possible.

If you are able to have gentle bodywork, it will safely encourage the scar tissue fibres to lay down in the right direction, which makes it less likely to cause problems in the future. No treatment can eliminate scars, but their effects can be altered.



‘Itis’ means inflammation, so tendonitis is simply inflammation of a tendon. Tendons are the strong bands that attach each end of your muscles to bone. They are vulnerable to injury and inflammation because they are not very stretchy and do not have a very good blood supply.

This means that if they are injured, for example being overstretched, twisted or suffer a direct blow, it takes much longer for them to heal. Tendonitis also occurs when stress is put onto the tendon from tightness and restrictions elsewhere in your body. For instance, if your pelvis is rotated, the forces transmitted through your fascial network will put your muscles and tendons under tension. So even if there is a minor injury, the tendon is much more likely to overstretch and become inflamed. This may happen without an actual injury if the irritation from other restrictions is bad enough.

Tendonitis can occur in any muscles, but the most common places are shoulders (rotator cuff), elbows (tennis and golfer’s elbow) and ankles (Achilles tendonitis).



Why do you feel tight?

When your body is loose, relaxed and elastic, it can move and change with you. Over time it is very common to gradually feel tighter, but it isn’t inevitable. Our patients often tell us that they didn’t realise that their tightness was anything that could be changed as they have had it for so long. They blame themselves for not exercising, living with stress and getting older.

There are several possible reasons for tension to build up in your tissues:

  • Dehydration: the fibres in your fascial system need their environment to be fluid to allow them to move and adapt to the forces put on your body. If you are dehydrated, the fibres are less able to do this and they become stuck and locked down. You will feel this as knots in your muscles and stiffness around your joints.
  • Poor posture: if you spend most of your time in positions that put your body under strain, it will react by tensing up to protect itself. For example, looking down for long periods of time will result in tension in the back of your neck.
  • Overusing muscles: as with poor posture, putting your muscles under pressure when they are fatiguing will cause the fibres in the area to tighten up to protect the muscles.
  • Stress: one of the hormones produced by your body in response to stress, stimulates your kidneys to resorb water from your system, which can lead to dehydration.
  • Not stretching properly after exercise: muscles that have worked hard during exercise will naturally shorten as they cool down. If you do not create the conditions that allow them to open up again, that tension will remain.
  • Pain or weakness in a different part of your body: this means that other areas of your body will need to work differently to compensate for the affected part not doing its job properly. The resulting imbalance causes tightness as muscles overwork.

As the pressure builds up in your muscles and they stiffen up, they gradually get thicker and shorter. This means that the blood flow isn’t as good as it should be to help with healing, so you get more scarring, which makes the area even stiffer. Stretching opens up the layers of your muscles, and helps the blood flow and takes the pressure off the nerves. So pain and inflammation can be prevented or improved.

Remember that where you feel your symptoms is often different to where the cause of them is. Your tightness may be due to problems in another part of your body and is your body’s way of compensating and trying to protect itself. So there is no point in simply stretching the tight bit without also finding and treating the cause. If the tension is not released it can become a holding pattern in your body which has to then be compensated for, adding to the cycle of tension.

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