Hotline: 07483 807551
Horsham: 01403 597373
East Grinstead/Lingfield: 01342 537610
physio horsham and east grinstead

Myofascial Pain Syndrome


Musculoskeletal disorders are the main cause of disability in the working-age population and are among the leading causes of disability in other age groups. Myofascial pain syndrome is a common painful muscle disorder caused by myofascial trigger points. Pain and limited function of the locomotor (or musculoskeletal) system are two of the most common reasons for consulting a doctor or therapist. The fascia & muscles have a key role in this, because of their anatomical and functional properties. The importance of the muscles is frequently underestimated in practice, however, although muscular imbalances, muscle tension and painful disorders of muscle function play a large part in both acute and chronic locomotor system symptoms, according to current knowledge. The clinical correlate is the myofascial trigger point (mTrP). We rely for the most part on the guidelines of the pioneers in the field of trigger point research, Janet Travell and David Simons (Travell, Simons 2002). Simons et al. (1999) have claimed that myofascial trigger points (TrPs) from neck and shoulder muscles might play an important role in the genesis of mechanical neck pain. There are epidemiological studies suggesting that TrPs represent an important source of musculoskeletal disorder (Chaiamnuay et al., 1998).

We understand the mTrP to be a site or band that is hypersensitive and palpably tense compared to the surrounding area in a muscle that is often shortened, and which demonstrates changes in tone and consistency (‘taut band’). It is painful when palpated and from it pain and autonomic disorders may be caused in an area that cannot usually be attributed to a particular segment (‘referred pain’). We describe the resulting muscle pain as myofascial pain syndrome (MPS). The formation of TrPs may result from a variety of factors, such as severe trauma, overuse, mechanical overload or psychological stress (Simons et al., 1999). Recent studies have hypothesized that the pathogenesis of TrPs results from injured or overloaded muscle fibres. This leads to involuntary shortening, loss of oxygen supply, loss of nutrient supply and increased metabolic demand on local tissues (Mense et al., 2000).

Diagnostic criteria are:

  • A localised, dull, pressing, dragging, occasionally burning spontaneous pain associated with acute or chronic muscular strain
  • The pain is often described as spreading or radiating.
  • Referred pain is an important characteristic of a trigger point
  • Tenderness with typical pain reproduction within a palpable ‘taut band’ of muscle,
  • A pain that predominantly radiates in a distal direction after mechanical stimulation,
  • Painful limitation of movement,
  • Muscular weakness without atrophy.

As these are not ‘hard’, evidence-based criteria but subjective information and findings, an appropriate finding oriented medical differential diagnosis is an indispensable prerequisite for making the diagnosis of ‘myofascial pain’ with or without limitation of movement

In the head and neck region, myofascial pain syndrome with trigger points can manifest as tension headache, tinnitus, temporomandibular joint pain, eye symptoms, and torticollis. Upper limb pain is often referred and pain in the shoulders may resemble visceral pain or mimic tendonitis and bursitis. In the lower extremities, trigger points may involve pain in the quadriceps and calf muscles and may lead to a limited range of motion in the knee and ankle.

                                                      Myofascial Pain Syndrome 1

The muscular fascial network suggests the following applications in relation to trigger points: pain sensations caused by trigger points supposedly originate mostly from fascial receptors which have undergone sensitisation. A possible treatment plan is a therapeutic stimulation and proprioceptive sensitisation of other fascial receptors (preferably in the area belonging to the same cortical area). Fascial changes supposedly also play a key role in changed muscle stiffness in the area around a trigger point as well.

Principles of Treatment:

PHYSIOTHERAPIST –PATIENT RELATIONSHIP: The key influential factor for the success of treatment is a ‘healing’ physiotherapist–patient relationship. In patients with chronic myofascial pain, in particular, psychosocial stress factors must also be evaluated and included early on in the consultation.

The treatment plan for myofascial trigger point therapy (MANUAL TECHNIQUES AND DRY NEEDLING) – Ischaemic compression of the mTrP, Manual stretching of the mTrP region

Fascia stretching technique, Manual stretching of the superficial and intramuscular fascia etc

Functional training, ergonomics, Physiological weight-bearing and exercise support the regeneration process and make the muscles more resilient

  • Ergonomics reduces incorrect strain on the muscles


The aim of trigger point therapy is to provide a permanent cure for myofascially caused pain and functional disorders. Otherwise, recurrences inevitable

This requires:

  • finding the relevant active trigger point,
  • deactivating the relevant trigger point using manual techniques and/or dry needling,
  • providing thorough manual treatment of the connective tissue changes which occur as a reaction, especially with chronic symptoms,
  • recognising the factors which cause the problem to persist and including them in the treatment process
  • Predisposing and perpetuating factors must be recognised and included in the treatment strategy in the form of ergonomics and functional training of the muscles

ANRC Phases of Rehabilitation

  • Deactivation of trigger points and Pain Relief ( Trigger Point Therapy, Myofascial Release, Taping, Electrotherapy modalities, relaxation Training etc)
  • Restoration of Range of movement – Stretches, Postural training, Basic Strength Training
  • Maintenance Phase & Improve the activity of daily living – Intensive Strength Training, Ergonomic Training etc


Myofascial Trigger Points Comprehensive diagnosis and treatment; Edited by Priv. Doz. Dr. med. Dominik Irnich: Toronto 2013 First edition published in English © 2013, Elsevier Limited. All rights reserved.

Trigger Points: Diagnosis and Management DAVID J. ALVAREZ, D.O., and PAMELA G. ROCKWELL, D.O., University of Michigan Medical School, Ann Arbor, Michigan.

Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study

C. Ferna´ ndez-de-las-Pen˜ as_, C. Alonso-Blanco, J.C. Miangolarra Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorco´n, Spain Received 12 November 2004; received in revised form 4 January 2006; accepted 3 February 2006

ANRC Physiotherapy & Sports Injury Clinic Horsham, East Grinstead and Lingfield

Lower back pain- Physio Horsham and East Grinstead

Low back pain- Physiotherapy Horsham and East Grinstead

The low back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the low back are responsible for flexing and rotating the hips while walking, as well as supporting the spinal column. Nerves in the low back supply sensation and power the muscles in the pelvis, legs, and feet.Most acute low back pain results from injury to the muscles, ligaments, joints, or discs. The body also reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain.

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Plantar fasciitis

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Heel pain is a very common problem that may be attributed to several etiologies, including heel spurs, plantar fascia irritation (acute or chronic), and bursitis. Plantar fasciitis is thought to result from microtears in the fascia due to repeated biomechanical stress on the arch of the foot on weight-bearing. Plantar fasciitis is an inflammation of the plantar fascia & the perifascial structures. Chronic stress to the origin of this fascia on the calcaneus may cause calcium to deposit, forming a spur (plantar calcaneal spur).  Plantar Fascia is a Dense, broad band of connective tissue attaching proximal and medially to the calcaneus and fans out over the plantar aspect of the foot and works in maintaining the stability of the foot and bracing the longitudinal arch.

Plantar fasciitis 2

The pain is maximal when the patient first stands in the morning and tends to decrease with walking. Ten percent of people may experience pain under the heel (plantar heel pain) at some time during their life.


Plantar fasciitis is the most common cause of heel pain in the adult population with an incidence of around 10%. It affects adults across the age spectrum with an incidence in women twice that of men. Ethnicity does not influence incidence. There is a higher preponderance in those who play sport either recreationally or professionally. Increased body weight and an increased body mass index (BMI) have also been shown to be significant risk factors for developing plantar fasciitis. Pregnancy, flat feet, high arched feet, poorly fitting or worn footwear, Calf muscle tightness, gait abnormalities, prolonged standing, running, jumping and walking are additional contributory factors. Excessive lumbar lordosis—a condition in which an increased forward tilt of the pelvis produces an unfavourable angle of foot strike when there is a considerable force exerted on the ball of the foot—can also contribute to this problem. Running on soft surfaces are also potential causes of plantar fasciitis.

Clinical features

  • The patient presents with a history of severe plantar medial heel pain typically on initial mobilization after a period of non-weight bearing such as in the morning after getting up from bed or sitting for long periods.
  • With further mobilization, the pain often improves but then reoccurs and increases throughout the day with ongoing weight-bearing.
  • The diagnosis is usually made clinically with tenderness on palpation of the plantar fascia and pain on passive dorsiflexion of the toe


Looking for Swelling, Arches, Deformity, Gait, posture, tenderness, Tight Structures etc & History


For the treatment of heel pain or plantar fasciitis, research has not indicated any consensus on a specific treatment regimen that has proven to resolve heel pain with any statistical significance. However nonsurgical treatment is ultimately effective in approximately 90% of patients.

It is equally important to correct the problems that place individuals at risk for plantar fasciitis, such as the increased amount of weight-bearing activity, increased intensity of activity, hard walking/running surfaces and worn shoes.

Early recognition and treatment usually lead to a shorter course of treatment as well as an increased probability of success with conservative treatment measures

S.M.A.R.T. approach to prevent plantar fasciitis

The Canadian Physiotherapy Association (CPA)

  • Stretch
  •  Move
  • Add it up
  • Reduce strain
  • Talk to a physiotherapist

Calf and Achilles stretching is achieved by performing asymmetrical stretching exercises

ANRC Phases of Rehabilitation

Phase 1- Pain Relief (Trigger Point Therapy, Myofascial Release, Sports massage, Taping, Electrotherapy modalities, Postural Correction, Basic Home exercises etc)

Phase 2- Restoration of Range of movement and muscle length (Stretches, Exercises for the small muscles of the foot, Postural training, Basic Strength Training, Orthotics if needed)

 Phase 3- Maintenance Phase & Improve the activity of daily living (Intensive Strength Training, Ergonomic Modifications in Sports & Daily Activities

Plantar fasciitis 3
Plantar fasciitis 4
Plantar fasciitis 5
Plantar fasciitis 6


  1. ABC of Common Soft Tissue Disorders, First Edition. Edited by Francis Morris, Jim Wardrope and Paul Hattam. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.
  2. Musculoskeletal Interventions, techniques for therapeutic Exercises, Edited by Barbara J. Hoogenboom, Michael L. Voight, William E. Prentice @ 2014 by McGraw-Hill Education ISBN: 978-0-07-179370-4
physiotherapy horsham Covid 19

Am I safe from coronavirus ,(COVID 19)

The most effective way to protect yourself against the new coronavirus is by frequently cleaning your hands with alcohol-based hand rub or washing them with soap and water.

If you feel unwell:

  • stay at home
  • call NHS 111. 👨‍⚕️👩‍⚕️(S)he will ask about your symptoms, where you have been & who you have had contact with. This will help ensure you get the right advice & stop you from infecting others coronavirus.

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shortness of breath

But these symptoms do not necessarily mean you have the illness.

The symptoms are similar to other illnesses that are much more common, such as cold and flu.

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Interferential Current Therapy

What is Interferential Current Therapy ?

Interferential current therapy is an effective therapy option used by many physiotherapy clinics to relieve pain and accelerate the self-healing process, getting your body back to a healthy, pain-free state. The high-frequency signals of an IFC penetrate through the skin into deeper lying muscle tissues.

Electrodes are placed on your skin around the injured body part. The Interferential Current device then transmits electrical impulses in minute quantities through your skin. Underlying tissue and nerves are stimulated which begins the healing properties.  These impulses are not painful in the least. In fact, patients describe the sensation as a minor prickle on their skin. Frequencies produced by the IFC have been proven to stimulate endorphins, the body’s natural pain killers. This can help to create a self-healing process without the need to for medications. This form of therapy is also extremely useful in reducing pain, inflammation, curing edema, and spasms.

  • Reduces or eliminates your pain safely.
  • Noticeable decrease in swelling and inf
  • Restores lost movement and improve restricted movements and coordination.
  • Stimulates the natural hormones which can help your body heal faster.
  • Considered by many experts as a highly effective form of treatment for chronic pain.

How the Interferential Current Therapy Helps

Interferential Current stimulation is very useful in the treatment of circulatory and muscular disorders, stiffness of joints, edema, and inflammation. If you suffer from health problems such as cumulative trauma disorders, body pain, joint injuries, or are pre or post orthopedic surgery, interferential current therapy is an important option.

Interferential current therapy has been in use for many years, and there have been numerous case studies and research reports that have documented its versatility in treating diverse symptoms, accelerating the healing process and restoring normal movement. Patients who chose to undergo interferential current therapy have fewer post-op complications compared to people who rely exclusively on medications for pain relief. It also helps in blood circulation and hastens the healing process by stimulating endorphins.

Common Questions

Are interferential devices safe?

Does my insurance cover the cost for interferential treatment?

Where does interferential currency therapy work best?

Is interferential current therapy better than TENS?

How does interferential current work?

Coverage Options

ANRC  physiotherapy services are covered by most health insurance companies. Not sure if you’re covered? No problem. We can help you find out (and usually within the hour). Just call us  at

Hotline: 07483 807551
Horsham: 01403 597373
East Grinstead/Lingfield: 01342 537610

At ANRC  we believe your health should come first. We take care of the paperwork so you can focus on getting better, plus we offer direct insurance billing, saving you time and upfront costs.

Learn More About pt Health Coverage Options


  1.  The journal physical Therapypublished a research summary in 2006 which talked about interferential therapy used in various models of inflammatory pain.
  2.  TheIrish Medical Journal published a research summary in 1989 which discussed “interferential therapy for the treatment of stress and urge inconsistency”.
ANRC Physiotherapy & Sports Injury Clinic Horsham, East Grinstead and Lingfield

Importance of pelvic floor strengthening exercises re-emphasised

UK physiotherapists used Valentine’s Day to launch a campaign to encourage members of the public to perform physiotherapy exercises to tighten up their pelvic floors.

Pelvic floor muscle exercises tone and strengthen these muscles, improving blood supply and nerve activity, all leading to greater pleasure.

Many people are already aware of the importance of tightening the Kegel muscles – those used to stop urine mid-flow – in order to tighten the pelvic floor, but the campaign highlights that it’s also important to practice tightening the muscles around the anal sphincter too.

Studies have shown that doing this can assist in bringing the vaginal walls together for women, while it can also help men to sustain an erection.

In addition, the campaign emphasises the importance of relaxing the muscles after each contraction and suggests fitting in these exercises while performing other activities, such as brushing teeth.

Experts recommend squeezing these muscles ten to 15 times in a row at least once a day and that each squeeze should be short and powerful. Varying the strength of contractions is also important; physios suggest trying to maintain a squeeze for five to ten seconds regularly too, while continuing to breathe normally.
(Article from Just Physio)

ANRC Physiotherapy & Sports Injury Clinic Horsham, East Grinstead and Lingfield

No, I am not just living with fibromyalgia..!!

No, I am not just living with fibromyalgia..!!


No, I am not just living with fibromyalgia – I am living my life to the fullest – and to be honest much better than most people around me! I was diagnosed with fibromyalgia in Apr 2008, almost a full year after I first experienced debilitating pain in my right leg. By the time I found a doctor who could tell me what was wrong with me, it was full blown – I was in pain 24 hours a day and no part of my body was spared – arms & legs, upper back, lower back, even abdomen!!!

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ANRC Physiotherapy & Sports Injury Clinic Horsham, East Grinstead and Lingfield Physiotherapist w

What is iliotibial band syndrome and how is it treated?

Iliotibial (IT) band syndrome is often caused by repetitively bending the knee during physical activities, such as running, cycling, swimming, and climbing. The IT band is a group of fibers that run the length of the upper leg, from the hip to the top of the shin.
The best treatment is often to stop doing the activity that is causing the pain. In more severe cases, surgical options may need to be considered.


1) Pain when running or doing other activities involving the outside of the knee
2) Aclicking sensation where the band rubs against the knee
3) Lingering pain after exercise
4) The knee is tender to touch
5) Tenderness in buttocks
6) Redness and warmth around the knee, especially the outer aspect


IT band syndrome is often relatively easy to treat. There are two main types of treatment for the condition:

1) Reducing pain and swelling
2) Stretching and preventing further injury

Some of the most common ways to treat IT band syndrome include:

1) Resting and avoiding activities that aggravate the IT band
2) Applying ice to the IT band
3) Massage
4) Anti-inflammatory medications, which are often available over
the counter
5) Ultrasounds and electrotherapies to reduce tension

(News from medical news today)

Us our contact form or call today our ANRC Physiotherapy clinics in Horsham, East Grinstead, West Sussex or Lingfield, Surrey which Physiotherapy or Sports injury treatments.

ANRC Physiotherapy & Sports Injury Clinic Horsham, East Grinstead and Lingfield Physiotherapist w

What is a Muscle Knot and How we can treat it?

The medical term for muscle knots is myofascial trigger points. These are occur when muscle fibers or the bands of tissue called fascia underneath them tense and tighten.

These  knots can develop almost anywhere on the body where muscle or fascia is present.The knots feel as if they are small, hard lumps or nodules. A person may have to press deep into their connective issue to feel the knots or trigger points. These knots commonly occur calf muscles, lower back, neck, shins, shoulders

Common causes of muscle knots include:

Stress and tension, injuries related to lifting and repetitive motion, poor posture, prolonged bed rest or sitting without stretching.
A person who spends a significant amount of time sitting at work may develop muscle knots due to staying in the same position for prolonged periods. sedentary lifestyle.
People who play sports or work with their hands may also be at risk because they engage in repetitive activities. Repeatedly, doing the same motion can cause tension and knots over time.

How to treat at home? 
People may want to try home remedies, which are often the first line of treatment for muscle knots. The individual should begin by evaluating why their muscle knots might have occurred.
If someone’s muscle knots are due to prolonged sitting or a prior muscle injury, engaging in regular stretching breaks may help reduce muscle tension.

People can also try:

  • Applying a cloth-covered heat pad or ice pack to the affected area
  • Aerobic exercise, such as swimming, jumping jacks, and cycling to loosen tight muscles
  • Taking anti-inflammatory medications, such as ibuprofen to reduce muscle pain
  • If stress is the cause of someone’s muscle knots, they can take steps to reduce it, including:
  • Taking short stretching and deep breathing breaks during the day
  • Exercising for 30 minutes a day
  • Reading a book or listening to music
  • Getting more sleep at night
  • Spending at least 15 to 30 minutes a day on relaxation techniques, such as meditation or gentle yoga
ANRC Physiotherapy & Sports Injury Clinic Horsham, East Grinstead and Lingfield

Rocker bottom shoes

Rocker bottom shoes help strengthen back muscles, reduce low back pain

Sports Physiotherapy- Researchers of the Sports Physiotherapy master’s degree at Valencia’s CEU Cardenal Herrera University have confirmed, in a new study of their research work into back pain, that unstable shoes improve the strength of back muscles in order to maintain balance and stability when walking.

Forefoot Rocker Sole:  A rocker placed just behind the metatarsal heads is much effective at reducing pressure under the ball of the foot and reducing motion in the toe joints. Thus we use it for treating hallux limit us (big toe arthritis) and ball-of-foot pain. Physiotherapy Horsham, Physiotherapy East Grinstead.

Heel to Toe Rocker Sole: This type of rocker sole has the thickest point farther back on the shoe. This type of rocker shoe can be effective for limiting ankle and midfoot movements. Thus, it is helpful when a patient has ankle arthritis or midfoot arthritis. It also can reduce pressure on the heel at heel strike, as the foot rolls faster off of the heel. To contact our Physiotherapy clinic in Horsham or Physiotherapy in East Grinstead please contact us on [email protected],

ANRC Physiotherapy clinic deals with Sports physiotherapy, MSK physiotherapy, and domiciliary physiotherapy

How to self-manage foot pain and swelling

  1. Try these things for a week:
  2. If you can, avoid standing on it-put as little weight as possible on the foot
  3. Apply  an ice pack (or a bag of frozen peas in a towel) on the foot for up to 20 minutes every 2 to 3 hours
  4. Wear comfortable shoes – for example, avoid shoes with heels
  5. Take paracetamol
ANRC Physiotherapy & Sports Injury Clinic Horsham, East Grinstead and Lingfield Physiotherapist w

Treatment for Anterior Knee Pain- Physio Horsham

Treatment of Anterior Knee Pain- Physio Horsham


Physio Horsham-Patellofemoral pain, also referred to as anterior knee pain, is a common musculoskeletal condition in the general and sporting communities.anterior knee pain affects up to 25% of the population, 36% of adolescents and is more prevalent in females.

Patellofemoral Pain Syndrome is categorized by anterior or peri-patellar knee pain in the absence of other knee pathology. This pain can be diffuse or sharp and is usually associated with at least two of the following activities in day to day life:

  •                 Squatting
  •                 Ascending or descending stairs
  •                 Kneeling
  •                 Sitting for long periods
  •                 Walking/running
  •                 Diving

It may be associated with crepitus on knee movements, occasional swelling particularly after exercise, and pseudo locking or giving way. An injury might happen in the past also can be a reason.


Role of physiotherapy in Knee pain-Physio Horsham


Physiotherapy is the mainstay of conservative treatment for this condition and the Chartered physiotherapy profession has received international recognition for anterior knee pain management.


The most effective treatment for patellofemoral pain is a McConnell program, designed and monitored by a physiotherapist according to the patient’s individual needs. This recognized anterior knee pain management program was first introduced by Jenny McConnell, an Australian physiotherapist (McConnell, 1986). The approach uses a specialized, functional exercise program to improve the muscle control around the knee and taping to reposition the patella. In association with electrotherapy modalities.


What can gain by physiotherapy?


When treatment is given by a physiotherapist trained in patellofemoral pain, the results are excellent. In the majority of patients, only five to six treatments are required to enable the patient to return to normal and sporting activities.


Physiotherapy management, based on that described by McConnell, has been shown to be effective in two large case-series (McConnell 1986, Gerrard 1989) with up to 91% of anterior knee pain patients having an excellent or good response. Physiotherapists are currently undertaking the first randomised, controlled trial evaluating the effectiveness of this treatment compared to a placebo control. This project is being funded by the physiotherapy profession via the Physiotherapy Research Foundation.



McConnell J (1986): The management of chondromalacia patellae: A long-term solution. The Australian Journal of Physiotherapy 32(4): 215-223.

Gerrard B (1989): The patellofemoral pain syndrome: A clinical trial of the McConnell program. The Australian Journal of Physiotherapy 35(2): 71-80.

Finding a Physiotherapist


Would you like the names of physiotherapists who have a special interest in McConnell Treatment for Anterior Knee Pain

Contact us on [email protected]   01342537610,