Other Conditions

Definition

Osteoporosis is a condition in which reduced bone strength increases the risk of fractures. It develops as bone density and structure change over time and often causes no symptoms until a fracture occurs.

Cause

Bone loss occurs when resorption by osteoclasts persistently outpaces formation by osteoblasts, commonly linked to declining oestrogen after menopause and age-related slowing of bone metabolism.

Risk Factors

• Postmenopausal women and older adults
• Long-term inadequate calcium and vitamin D intake
• Lack of weight-bearing exercise or prolonged immobility
• Long-term corticosteroid use

Common Symptoms

• Back pain from vertebral compression fractures
• Gradual height loss
• Stooped posture or kyphosis
• Fractures from minor falls or impact

Management

Physiotherapy focuses on appropriately prescribed weight-bearing and resistance exercise to support bone strength and physical function, together with balance and gait training to reduce fall risk. Exercise selection and intensity are adjusted according to fracture risk and individual ability.

Prevention

Regular weight-bearing and resistance exercise, adequate calcium and vitamin D intake, avoiding smoking, and limiting excessive alcohol intake can support bone health and help reduce fracture risk.

Definition

Gout is an inflammatory arthritis caused by chronically elevated blood uric acid, leading to deposition of urate crystals in joints and surrounding tissue, triggering acute inflammation. It typically presents as sudden severe pain, redness, and warmth in the affected joint, with symptom-free intervals between flares.

Cause

When uric acid production exceeds excretion or renal clearance is impaired, blood levels remain elevated; once concentration exceeds saturation, urate crystallises and deposits in joint tissue, triggering an acute immune response.

Risk Factors

• Persistently elevated blood uric acid
• Impaired kidney function or certain medications such as diuretics
• Excess body weight or metabolic conditions
• Excessive alcohol intake and some dietary factors

Common Symptoms

• Sudden severe pain in a single joint, often the big toe
• Redness, warmth, and swelling of the joint
• Pain markedly worsening at night
• Tophi formation with recurrent attacks

Management

An acute gout flare requires appropriate medical management to control pain and inflammation. During this period, protect the painful joint and temporarily reduce aggravating activity. Once symptoms settle, physiotherapy can help restore comfortable movement, strength, and function where these have been affected.

Prevention

Long-term gout management includes appropriate control of blood uric acid together with a healthy diet, moderation of alcohol, regular physical activity, and weight management where appropriate. Medical treatment may be required to reduce recurrent flares and complications.

Definition

A muscle or tendon tear occurs when tissue fibres are damaged by force exceeding their capacity. Muscle injuries are commonly described as Grade 1 (minor fibre damage), Grade 2 (partial tear with reduced strength), or Grade 3 (a complete or extensive tear with substantial loss of strength and function). This is a simplified classification, and tendon injuries are more appropriately described as partial or complete tears.

Cause

A tear can occur when a muscle or tendon is exposed to a sudden force greater than it can tolerate, such as forceful contraction, rapid stretching, or direct trauma. Some tendon tears occur in tissue that has already undergone degenerative change, reducing its ability to tolerate a sudden high load.

Risk Factors

• Sudden increases in training intensity, speed, or load
• Previous muscle or tendon injury
• Inadequate strength or conditioning for the required activity
• Tendon degeneration associated with age or repeated loading

Common Symptoms

• Sudden, localised pain during activity or injury
• Weakness or difficulty using the affected body part
• Swelling, bruising, or tenderness around the injured tissue
• A snapping sensation, palpable gap, or marked loss of function with a severe tear

Management

Physiotherapy initially protects the injured tissue while maintaining safe movement and function. Rehabilitation progresses from muscle activation to strengthening, controlled loading, and relevant functional exercises. Progression is guided by symptoms, movement, strength, and task performance. A suspected complete tear, palpable gap, or major loss of strength or function requires prompt medical assessment, as some tendon tears may need surgical review.

Prevention

Gradually build the strength and capacity required for regular activities and avoid sudden large increases in physical load. After an injury, completing appropriate rehabilitation before returning to demanding activity may reduce the risk of another tear.

Definition

Bursitis occurs when a bursa becomes irritated and swollen. Bursae are small, fluid-filled sacs that reduce pressure and friction where tissues move over bones. Bursitis commonly affects areas such as the elbow, knee, shoulder, hip, or heel and may make movement or direct pressure painful.

Cause

Bursitis may develop through repeated pressure, such as frequent kneeling or leaning on an elbow, or following repetitive movement and a sudden increase in activity. A direct impact can also irritate a bursa. Less commonly, bursitis may result from infection, gout, or another inflammatory condition.

Risk Factors

• Repeated kneeling or leaning on a hard surface
• Repetitive movement or a sudden increase in activity
• Direct trauma to the area over a bursa
• Gout, inflammatory disease, or a nearby skin wound

Common Symptoms

• Localised pain and tenderness over the affected bursa
• Visible swelling, particularly around the elbow or kneecap
• Pain with direct pressure or movements involving the area
• Warmth or redness, especially when infection is present

Management

Management depends on the affected bursa and underlying cause. Physiotherapy identifies and modifies activities or positions that repeatedly irritate the area. Where appropriate, rehabilitation restores comfortable movement, strength, and function while limiting repeated compression. Hot, red, rapidly increasing swelling, broken skin, fever, or general illness requires prompt medical assessment for possible infection.

Prevention

Reduce prolonged direct pressure on vulnerable areas by varying positions or using suitable padding where needed. Increase repetitive or demanding activities gradually and protect cuts or wounds around superficial bursae.

Definition

Tendinopathy involves changes in tendon collagen organisation, thickening, and reduced load tolerance, often causing pain during loading. “Tendinosis” is an older term for these structural changes, which may also appear on imaging without symptoms.

Cause

Symptoms may develop when repeated or rapidly increased loading exceeds the tendon's ability to adapt and recover. This can occur during running, jumping, gripping, throwing, or heavy lifting. Tendon changes usually develop over time and are not caused by inflammation alone.

Risk Factors

• Sudden increases in training or work demands
• Repeated high loads with insufficient recovery
• Previous tendon pain or reduced tendon capacity
• Increasing age, diabetes, or metabolic conditions

Common Symptoms

• Localised tendon pain during or after loading
• Stiffness after rest or on waking
• Tenderness or thickening around the tendon
• Reduced strength or difficulty with activity

Management

Physiotherapy modifies aggravating loads while maintaining tolerable activity. Rehabilitation progresses from suitable tendon loading to heavier strengthening and, when required, faster or energy-storage exercises. Progression follows pain response, strength, and function. Sudden weakness, a snapping sensation, or suspected rupture requires medical assessment.

Prevention

Increase physical demands gradually, allow adequate recovery, and maintain suitable strength. After symptoms develop, restore tendon capacity before returning fully to high-load or explosive activities.

Definition

Rheumatoid arthritis is a chronic autoimmune inflammatory disease in which the immune system mistakenly attacks joint synovium, causing symmetrical polyarthritis and progressive structural damage. It may also affect other organ systems and is often accompanied by generalised fatigue, requiring long-term monitoring.

Cause

Abnormal immune activation leads to sustained cytokine-driven attack on synovial tissue, causing synovial proliferation and inflammation that progressively erodes cartilage and bone, eventually causing joint deformity.

Risk Factors

• Female sex
• Family history or genetic susceptibility
• Smoking
• Increasing age and certain environmental or health-related factors

Common Symptoms

• Symmetrical polyarthritis, commonly in fingers and wrists
• Morning stiffness lasting over 30 minutes
• Joint stiffness and deformity
• Generalised fatigue and low-grade fever

Management

Physiotherapy is adjusted to disease activity: acute flares focus on pain and swelling reduction with joint protection, while remission phases emphasise mobility, strength, and functional training, combined with joint protection education to preserve independence.

Prevention

Rheumatoid Arthritis cannot always be prevented. Avoiding smoking and maintaining general health may help reduce some modifiable risks. Early diagnosis and appropriate medical treatment are important for controlling inflammation and limiting long-term joint damage.

Definition

Sarcopenia is a progressive loss of muscle strength and muscle quantity or quality that can reduce physical function. Frailty is a broader condition in which reduced physical reserve makes a person more vulnerable to illness, falls, and loss of independence. The two conditions often overlap but are not the same.

Cause

Sarcopenia and frailty can develop through a combination of ageing, reduced physical activity, inadequate nutrition, chronic illness, and other changes affecting physical reserve. The contributing factors vary between individuals.

Risk Factors

• Increasing age
• Physical inactivity or prolonged immobility
• Inadequate nutrition, including insufficient protein intake
• Chronic illness or repeated periods of hospitalisation

Common Symptoms

• Difficulty rising from a chair or climbing stairs
• Slower walking speed
• Reduced strength and physical function
• Increased fatigue, falls, or difficulty with daily activities

Management

Physiotherapy focuses on progressive resistance exercise to improve strength and physical function, together with balance, gait, and regular activity. Adequate nutrition and protein intake are also important, and people with nutritional concerns may benefit from assessment by an appropriate healthcare professional.

Prevention

Regular resistance and aerobic exercise, adequate nutrition, and maintaining physical and social activity can help preserve strength, function, and resilience with ageing and may reduce the risk or progression of Sarcopenia and Frailty.

Definition

Recurrent Falls / High Fall Risk describes a clinical situation in which a person has repeated falls or an increased likelihood of falling due to a combination of physical, medical, environmental, and behavioural factors. Falls can cause injury and may lead to fear of falling and reduced activity.

Cause

Fall risk is usually multifactorial. Reduced strength or balance, changes in vision or sensation, dizziness, certain medical conditions or medications, and environmental hazards can interact to increase the likelihood of falling.

Risk Factors

• Previous history of falls
• Reduced lower limb strength or balance
• Impaired vision or sensory function
• Polypharmacy or use of sedative medications

Common Symptoms

• Unsteady walking or difficulty with balance
• Difficulty rising, turning, or changing direction
• Fear of falling leading to reduced activity
• Reduced strength or confidence during daily mobility

Management

Physiotherapy begins with assessment of balance, gait, strength, mobility, and relevant fall-risk factors, followed by individualised balance, strength, and functional training. Home hazards can also be identified, and medication concerns can be referred to the appropriate doctor or pharmacist for review.

Prevention

Regular strength and balance exercise, maintaining safe mobility, appropriate vision and medication review, and reducing hazards in the home can help reduce fall risk. Prevention strategies should be based on the individual's identified risk factors.