| HOW WE TREAT
Treatment Modalities
How we treat, why, and when. Made simple and interactive.
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Relief, Rehabilitation, Resilience
A needle can quieten an irritable nerve for a fortnight. Hands can free a stiff joint for an afternoon. Shockwave can wake a tendon that has stalled. All of it useful, and none of it changes the tissue itself. Loading does. That is the distinction the three phases are built around: the first buys you a window, the second uses it, and the third makes sure you keep what you gained. Most treatment that fails does so by stopping at the first.
Relief — Settle it down
The goal here is narrow: reduce irritability enough that the area can be moved and loaded. This phase is not the treatment. It is what makes treatment possible.
- Aim
- Bringing symptoms down to a level where you can move, sleep and load. Frequently achieved to some degree in the first session.
- Treatment effect
- Minutes to weeks.
- Done when
- You are unable to load the area without it flaring for days afterwards.
What we use here
On its own, this phase does not hold. Nothing here has changed the capacity of the tissue, which is why relief alone tends to be temporary.
Rehabilitation — Rebuild it
The part that changes the tissue. Muscle, tendon, bone and blood supply adapt to what is repeatedly asked of them, and this is where that happens. It is also the part that takes time.
- Aim
- Restoring strength, range and control to the level the task needs.
- Treatment effect
- Weeks to months. Tendon and bone run at the longer end.
- Done when
- Pain has settled to a level that lets you tolerate doing more.
What we use here
How long does the tissue take?
- First change
- 2–4 weeks
- Still adapting
- 8–12 weeks
Strength improves within a fortnight or two, but early gains are largely the nervous system learning to recruit what you already have. The muscle itself contributes more to longer-term improvement. Working the other way, disuse costs roughly half a percent a day, with the steepest loss in the first week or two.
Gabbett & Oetter, Sports Med 2024
- First change
- About 2 months
- Still adapting
- 12 weeks and beyond
Tendon responds to loading within about two months, and programmes running twelve weeks or longer do better than shorter ones. Contraction intensity matters: around seventy per cent of maximum appears to be the threshold. This is why tendon rehabilitation feels like nothing is happening for weeks, and why people abandon it just before it works.
Bohm et al. meta-analysis, in Gabbett & Oetter 2024
- First change
- Up to 4 weeks
- Still adapting
- 3–12 months
Bone remodels in a set sequence. Resorption takes up to four weeks in cortical bone, and full mineralisation of the new bone three to twelve months, longer again in trabecular bone. That sequence is why stress reactions need the time respected rather than pushed through.
Warden et al., in Gabbett & Oetter 2024
- First change
- 4–10 weeks
- Still adapting
- 6–12 months
Healing runs through inflammation, proliferation from around week four to ten, then remodelling. Structure resembling the original takes six to twelve months, and the repaired tissue frequently does not regain full tensile strength. A ligament that feels fine at three months is usually still remodelling.
Hubbard & Hicks-Little, J Athl Train 2008; ligamentisation literature
Indicative only. Cartilage adaptation is not linear and does not follow a timeline, so this bar shows roughly when change is plausible rather than a course it runs.
- First change
- Non-linear
- Still adapting
- Poorly characterised
Cartilage deforms under load and recovers within about thirty minutes of walking or running. Its longer-term adaptation does not follow a tidy timeline, which is why the bar above is only a guide. What can be said is that there is no strong evidence strenuous exercise causes arthritis in a healthy joint.
Gabbett & Oetter, Sports Med 2024
Indicative only. The time depends entirely on how far the axon has to grow, so a nerve at the wrist and one at the shoulder sit at opposite ends of this bar.
- First change
- Days to weeks
- Still adapting
- 1–2 mm per day
Sensitivity can change quickly, which is why symptoms sometimes settle fast. Where an axon has been damaged, regrowth runs at roughly one to two millimetres a day, so the time depends entirely on the distance to be covered. There is a recognised window of around twelve to eighteen months for muscle to be reinnervated, which is where this bar ends.
Grinsell & Keating, Biomed Res Int 2014
Typical ranges for healthy tissue, not promises. They describe what the tissue is doing rather than when you will feel better, and the two often differ. Age, health and training history all shift them.
This is where most people stop early, because pain settles well before capacity returns. Feeling better and being ready are different things.
Resilience — Keep it
Capacity beyond where you started, so the same thing is less likely to happen again. This phase belongs to you rather than to us, which is rather the point.
- Aim
- Building headroom, and making the gains stick without supervision.
- Treatment effect
- Ongoing, and increasingly self-managed.
- Done when
- We have achieved your initial treatment goals.
What we use here
The aim of the whole thing. A programme you understand and can keep going with is worth more than an open-ended course of appointments.
The Five
What Each One Is For
Each of these has its own page. In short:
Exercise
The only treatment that changes the tissue itself, and the only one you keep for the rest of your life. Muscle, tendon, bone and blood supply all adapt to what you repeatedly ask of them.
Manual Therapy
Hands-on work to settle symptoms and restore movement. It buys a window in which loading becomes possible, which is what it is for.
Advice & Education
Understanding why something hurts changes how you behave around it, and that changes the outcome. The least glamorous item here and frequently the most useful.
Acupuncture & Dry Needling
For muscle and tendon pain that has not settled with loading alone. It quietens things down; it does not do the rebuilding.
Radial Shockwave Therapy
For persistent tendon problems that have stalled. Used alongside a loading programme rather than instead of one.
How They Fit
Why the Combination Matters
Almost nobody gets one of these in isolation. What determines the mix:
How Irritable It Is
A structure too sore to load needs settling first. That is where hands-on work, needling or shockwave earn their place — not as the treatment, but as the thing that makes treatment possible.
What the Tissue Is
Tendon, muscle, joint, nerve and bone adapt on very different timescales. A tendon does not respond in the way a muscle does, and expecting it to is a common reason people give up too early.
What You Are Aiming At
Getting back to the coast path is a different programme from getting back to rugby. The endpoint shapes the route.
What You Will Actually Do
The best programme is the one that gets done. Three exercises you will do beats twelve you will not, and we would rather build the honest version.
What to Expect
What a Course Usually Looks Like
Every case differs, but the shape is fairly consistent:
Common Questions
Frequently Asked Questions
Which treatment will I get?
Whichever the assessment points to, and usually more than one. We would be wary of any practice that decides before examining you — the answer depends on what is wrong, how irritable it is, and what you are trying to get back to.
Do I have to do exercises?
In almost all cases, yes, because it is the only part that changes the tissue itself. But the programme should be built around what you will realistically do. If a plan needs an hour a day and you have fifteen minutes, it is the wrong plan.
Can I just have the hands-on treatment?
You can, and it will often help in the short term. It tends not to hold on its own, though, because it has not changed the capacity of the tissue. We will always be straight with you about what a passive-only approach is likely to achieve.
How many appointments will I need?
Fewer than you might expect. Most people need a handful of well-spaced sessions rather than a long block, because the work happens between appointments rather than during them.
What if none of this is right for my problem?
Then we will tell you, and point you to whoever is right — a GP, a consultant, or another service. Knowing the limits of what we can offer is part of the job.
Not Sure if Any of This Can Help You?
That is what the assessment is for. Come in, and you will leave understanding what is going on and what the plan is. You will see the same clinician each time.
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