Diagnosing Headache, Physiotherapy and how Acupuncture can help

Headache, Physiotherapy and Acupuncture

For many people headaches can be extremely disruptive to daily life and stop them from being able to do basic daily tasks, concentrate properly or carry out work duties.  Migraine is the most common type of headache with a lifetime risk of 43 per cent in women and 18 per cent in men, affecting those mainly of working age. Typically, it presents as a throbbing pain on one side of the head and is associated with nausea and increased sensitivity to light or sound.  Migraine can be present with or without symptoms of aura, which are visual, sensory or motor changes.  Of those with migraine 1-2% can develop persistent symptoms which do not go away.

Migraine is the most common diagnosis of a patient with an intermittent and persistent headache without neurological symptoms.  Tension type headache is another very common type of primary headache which presents as a milder headache affecting both sides of the head, generally without throbbing and migrainous features.

Cervicogenic headache is another common cause of headache, classed as a secondary cause.  With cervicogenic headache symptoms are generally present with neck pain, and symptoms provoked with movement of the neck would help to confirm this.

Headache symptoms can also be triggered by changes with the body’s hormones, for example with onset of menstruation in women.  Medication overuse is another cause of headache. Persistent long term use of analgesia for pain can cause this, and is called a medication overuse headache.

Physiotherapy and acupuncture treatment in Hitchin

Physical treatment is not always the first thing to consider, as accurate diagnosis must identify the headache type and if physiotherapy can help.  The British Association for the Study of Headache (BASH) guidelines assist with this and should always be referred to aid diagnosis.

There is evidence that physiotherapy and acupuncture can be beneficial for the treatment of tension headaches, cervicogenic headache and migraine.  Treatments such as spinal mobilisation, manipulation and massage can all help to relieve symptoms.  Acupuncture is a modality which can be very effective for reduction of pain related to these types of headache.  Acupuncture is now a treatment option recommended through the national institute of clinical excellence (NICE) for migraine and tension type headache.

If you experience headaches and would like to discuss if physiotherapy could help, contact Anthony on 01462 431033 at Physio Three Sixty in Hitchin for a consultation, or book an appointment online.

Anthony Cahill, BSc, MSc, MCSP, MAACP
Specialist MSK Physiotherapist

Physiotherapy in Hitchin at Xchnage Fitness


Tennis Elbow - symptoms, causes and management

What is tennis elbow?

Tennis elbow is a condition which is known medically as lateral epicondylalgia. ‘Epicondyl’ refers to the anatomical landmark on the outside of the elbow and ‘algia’ refers to the presence of pain. With tennis elbow pain can be felt on the outside of the elbow which in some cases can spread down towards the forearm or wrist.   Tennis elbow used to be known as epicondylitis with ‘itis’ referring to inflammation, but we now know that there is little in the way of true inflammation especially with persistent long term symptoms.  Instead the source of pain comes from strain and overload on the tendon causing it to breakdown at a cellular level (ref).

What causes tennis elbow?

Tennis elbow starts when the tendons which run from the muscles on the back of the forearm into the elbow are overloaded or strained.  This causes micro-tears in the tendon where it inserts into the elbow leading to pain. 
Tennis elbow can be brought on by an acute injury or sudden movement producing high forces through the tendon, but more commonly the onset is gradual over time with repetitive movements requiring lots of wrist and hand movement or gripping, e.g. gardening, cleaning, DIY, manual work or typing. 

How do I recognise the symptoms?

Typically, symptoms of pain on the outside of the elbow can be made worse by:
·         Bending or fully straightening the arm
·         Holding heavy objects or opening cans and bottles
·         Typing or writing for long periods of time
·         Using heavy items for prolonged periods such as a drill
·         Twisting or doing rotational movement in with the arm e.g. racquet sports
·         Pain can be produced by touching the outside of the elbow

What can I do to manage the pain?

There are a number of different things you can do to help yourself. The most important of all is reducing the weight that goes through the injury site, or the amount of work you are doing with your arm.  Working through the pain is rarely advisable as this will continue to overload and place stress on the injured tissue.

Other useful adjuncts for relieving pain include the use of analgesia such as paracetamol or non-steroidal anti-inflammatory medication.  Using ice packs can also be useful for symptomatic relief of pain even though there may be little in the way of actual inflammation.  
You shouldn’t take ibuprofen or aspirin if you’re pregnant or have asthma, indigestion or an ulcer until you’ve spoken to your doctor or pharmacist. Medication can have side-effects so you should read the label carefully and check with your pharmacist if you have any queries. Always seek medical advice if needed before taking medication.

How can Physiotherapy help?

A Physiotherapy assessment can help by pinpointing the cause of symptoms and ensuring you get an accurate diagnosis.  Once this have been obtained an appropriate treatment plan can be put together.  Physiotherapy treatments include using tape or straps which take pressure off the injured tissue and can be worn during activities that typically cause discomfort.  Soft tissue massage, elbow mobilisation, acupuncture and shockwave therapy can also be used for pain relief and to promote healing.  Long term management with specific strengthening exercises is strongly supported by research and this often forms the foundation of management in physio.

Medical management - Steroid injections

If you don’t respond to conservative treatment your GP or physio may suggest a steroid injection could be of benefit. Injections can work extremely well for some and for others can have little impact.  Your physio can help with referring you on for a steroid injection if they think you would benefit from this and discuss the pros and cons.

Don’t just put up with symptoms – get the injury checked out!

Whatever you do, don’t just sit and rest the injury.  Rest on its own is rarely useful for persistent symptoms and if anything can lead to making things worse as the muscles and tendon loose strength.  So don’t delay, book an appointment on 01462 431033 or contact us for further information on assessment and treatment.  Click here for more information about Physio Three Sixty.

Anthony Cahill
​Specalist MSK Physiotherapist, Physio Three Sixty, Hitchin
Shoulder pain and the signs of rotator cuff injury

Injury to the rotator cuff is common among all age groups and is characterised by a pain or ache from the top of the shoulder that typically spreads down the middle of the upper arm.  Most of the time pain is brought on by trauma or a sudden movement causing a strain and damage to the rotator cuff muscle or tendon.  Symptoms can also develop gradually over time through repetitive movements or overuse.

What makes up the rotator cuff?

The rotator cuff is made up of 4 muscles (supraspinatus, infraspinatus, teres minor and subscapularis), starting from the shoulder blade (scapula) and attaching onto the long bone of the arm (humeral head). The shoulder joint has a wide range of movement, which can make it prone to injury in certain positions if excessive force is applied.


What are the symptoms?

Pain is typically intermittent or only present when making certain movements with the arm, though in more severe cases pain can be there most of the time. Reaching out for things at waist to shoulder height tend to produce a sudden catch, particularly with added weight.  Carrying bags on the affected side if often uncomfortable too.

What can I do to improve my symptoms?

Non-steroidal anti-inflammatory drugs (NSAIDs) can be useful in the early stages when taken 48 or more after the symptoms started.  It is always wise to check with your GP or local pharmacist if you would like advice or guidance on taking a course of NSAIDs.  Often within 4-6 weeks symptoms can spontaneously resolve with general activity, but if they persist you should attend a physiotherapy consultation, either through your GP or self referral.

What can physiotherapy do to help?

A Physiotherapy consultation will help to determine an accurate diagnosis and put together an appropriate management plan to improve symptoms.  Applying tape and using massage or acupuncture can be used for relieving pain.  These can be used along with a graded exercise programme to build strength back into the shoulder. The exercises provided will be tailored to your particular goals, e.g. some may want to get back to high level sport, and for others day to day function.

How long does it take to get better?

For mild cases 4-8 weeks, for moderate strains 8-16 weeks and more severe injury can take six months or more to resolve.

What if my shoulder pain doesn’t improve?

It is important to keep a healthcare professional posted on the progress you make with your symptoms.  If you do not make the expected progress it may be appropriate to be referred for a specialist opinion with an Orthopaedic Consultant.  A chartered physiotherapist or GP will be able to provide advice on this.

Don’t put up with symptoms – get the injury checked out!

Whatever you do, don’t just sit and rest the injury.  Rest on its own is never useful for persistent shoulder pain, and if anything can lead to making symptoms worse as the muscles loose strength and the shoulder gets stiff which makes the road back to health even longer.  So don’t delay, book an appointment and get the shoulder checked out.

​Specialist MSK Physiotherapist - Anthony Cahill
​Physio Three Sixty, Hitchin

Running analysis for injury prevention

Running analysis for injury prevention, Hitchin

This month we have shared a video of a running analysis done recently in clinic.  The video demonstrates how the way we run can
explain the injuries we have and how to go about improving this.  Have you had a running injury before that didn't get better with physio alone? A gait
analysis will likely reveal why.  Sometimes all you need to do is modify your technique for injuries to resolve...

Anthony Cahill - Specialist MSK Physiotherapist
Physio Three Sixty, Hitchin

Specialist Physiotherapy and Sports injury management


"Wouldn't hesitate to recommend Physio Three Sixty. Got an appointment when I needed one and without having to wait. Friendly and professional service. My running injury was resolved by treatment on the day….


With vast experience across the public and private sectors in musculoskeletal physiotherapy, we have treated thousands of different injuries.  Check out our list of commonly treated conditions.


Check out our monthly blog to find out what’s going on at Physio Three Sixty and for tips & advice to keep you injury free throughout the year.