First 4 Therapy

What is Radial Shockwave Therapy? (r-ECSWT)
It is an effective, clinically proven non-invasive treatment that passes low energy sound pressure waves through the skin and into damaged tissue. It penetrates tissue upto 3-4 cm in depth. This increases local blood flow, enhances collagen synthesis, releases growth factors, and stimulates your body’s healing process to improve pain and help you stay active.

Shockwave therapy has undergone extensive clinical trials and is approved by NICE and the FDA in the U.S for certain musculoskeletal conditions such as Plantar fasciitis, tennis elbow, golfer’s elbow, patellar tendonitis, gluteal tendinopathy, rotator cuff tendinopathy in the shoulder and tendonitis in the foot and ankle.
Along with restricting sports and work function, these injuries can limit daily activities such as doing housework, driving, climbing stairs, and even just sitting or standing.
At First4Therapy we use a Swiss built Storz Medical Radial-SW50 machine.
What Does Treatment Involve?
Conductive gel is applied to the target area and the clinician will move a probe delivering the shockwaves to the area. We will gradually increase the pulses until we reach the therapeutic level.

Sensation: You will feel a rhythmic tapping and mild to moderate discomfort or an ache as the probe passes over the sore area. The intensity is adjusted to your tolerance to keep you as comfortable as possible. Mild soreness or bruising in the area for a day or two afterwards is common and usually settles on its own. Anti-inflammatories or cold application is not recommended for 48 hours after the treatment as the shockwave therapy stimulates the inflammatory pathway to be effective.

The application time is usually 3-10 minutes with an appointment lasting around 20 minutes.
There are no injections, no anaesthetic, and no need for time off for most people.
Most people need 3- 6 weekly treatments to see an improvement.

You will have an initial session to assess your suitability for Shockwave therapy (ECSWT) and to rule out any contra-indications.
Research shows that when ECSWT is used along with a graded tendon loading rehabilitation programme, it acts as an accelerator to healing. The results are far superior than when it is used in isolation.
Which is why at First4Therapy we offer an evidence-based rehabilitation programme tailored to your needs along with the Shockwave therapy.

Why Choose Us?
First4Therapy, is run by Vinita Sood who has 40 years of practice and along with a MSc in Physiotherapy is a member of the Chartered Society of Physiotherapy (CSP) and The Manipulation Association of Chartered Physiotherapists.

We are committed to ensuring our patients the best possible outcomes by using the best available evidence-based treatments.

What does it cost?
We charge £70 per session and £200 for a group of three sessions, spaced one week apart.

Insured patients?
Our practice is registered with most Insurance providers who authorise shockwave therapy with a separate authorisation code.

Understanding Tendinopathy: How Physiotherapy Can Help

Tendonitis vs. Tendinopathy
A tendon is a cord of connective tissue, made of collagen, that attaches muscle to bone and transmits the force of a muscle contraction to move joints. When a tendon becomes inflamed following an injury, this is known as tendonitis – there is usually swelling and pain on movement, and it often settles within a few weeks with rest and a temporary reduction in activity.

Tendon pain that persists for much longer is called tendinopathy. Here the problem is capacity rather than inflammation: if the load being placed through the tendon exceeds what it can currently tolerate, it causes pain.

Why rest alone isn't the answer:

Rest can reduce symptoms, but it doesn't rebuild capability. That's why pain so often comes straight back the moment normal activity resumes – the tendon feels better because it's being asked to do less, not because it has become more resilient. Load needs to be reintroduced progressively, through a structured programme.

How We Treat Tendinopathy
At First4Therapy we use recognised, evidence-based graded tendon loading protocols to guide rehabilitation. Your programme is built around your assessment findings, the demands of your sport or occupation, and the stage your tendon is at.

1. Assessment and diagnosis
Our chartered physiotherapists assess the affected tendon, the joints and muscles around it, and the demands you're placing on it — so treatment targets the cause, not just the sore spot.

2. Settling the irritated tissue
In the early stages, the priority is calming symptoms enough to begin loading — through soft tissue treatment, short-term activity modification and practical training or work adjustments.

3. Graded loading and exercise therapy
The foundation of rehabilitation — rebuilding strength and capacity through gradual, progressive loading, strengthening the whole joint chain rather than the tendon in isolation.

4. Shockwave Therapy (ECSWT)
For stubborn cases, radial Extracorporeal Shockwave Therapy passes low energy acoustic pressure waves into the tissue to increase blood flow and stimulate repair. NICE has published guidance on its use for several persistent tendon conditions. Shockwave is always used alongside your exercise programme, never instead of it.

5. Return to sport and activity
Once capacity has improved, sport-specific or task-specific load is reintroduced so the tendon is properly prepared — whether that's a return to sport or a physical job.

6. Reducing the risk of recurrence
Tendinopathy has a habit of returning if load isn't managed well. We'll help you recognise your own early warning signs and give you a maintenance programme to stay strong once back to full activity.

Where Tendinopathy Can Occur
Tendon pain can affect almost any tendon in the body. The areas we see most often include:
Plantar fasciitis
Achilles tendinopathy
Gluteal tendinopathy (lateral hip pain)
Patellar tendinopathy ("jumper's knee") pain below the knee cap
Tennis elbow
Golfer's elbow
Rotator cuff tendinopathy in the shoulder
Tibialis posterior tendinopathy in the ankle

Why Choose First4Therapy?

At First4Therapy we take a holistic approach to tendon pain. Our expert physiotherapists will assess your condition and build a tailored plan that combines graded loading, hands-on treatment and, where appropriate, shockwave therapy. By focusing on capacity and long-term recovery rather than short-term relief, we aim to help you get back to doing what you enjoy — and stay there.

Don't wait for tendon pain to settle on its own. If it's been holding you back for more than a few weeks, we can help.

Continuing with my series of posts on injury prevention in runners.

Achilles Tendinopathy

Achilles tendinopathy presents as pain, stiffness or swelling in the tendon that runs down the back of the leg to your heel. It usually occurs in stages and if the early warning signs such as pain during or after a run are ignored, can progress to swelling and daily tendon pain whist going up and down stairs. Squeezing the tendon will also be painful.
Tibialis posterior tendinopathy presents as pain and swelling on the inside of the ankle, close to the Achilles tendon.
Peroneal tendinopathy is not as common and presents as pain and swelling on the outside of the ankle, mainly occurring after ankle sprains.

Training errors account for as much as 60-80% of runners with tendon problems.
Rapid increases in distance or speed, change of running terrain and not enough rest between training are quite often the cause.

How can you prevent these injuries?

Watch how much and how often you load the tendon. Increase your weekly running mileage by 10%.

Work on either speed or distance but not both together.

Make sure to have rest days between runs.

Your calf muscles give you the push-off needed when running.
The Soleus muscle which runs from your calf to your heel is important for endurance running and the Gastrocnemius for sprinting and speed.

Strengthening the calf muscles with these exercises is a good way to prepare your tendons for running

To target the soleus muscle
Seated heel raises with both legs
Seated single heel raise. You can progress this by doing it with a weight on the knee.

For calf muscle strength
Isometric calf raise.
1. Start by going up on your toes and then holding at the top position
2. You can hold at the top for 45 seconds then take a 2 minute break and repeat up to 5 reps 2x daily
Short hold of

Getting fit and losing weight are usually high on the list of New Year’s resolutions.

While exercising to get fit is fantastic, it should not be a cause for injury!

As a Physiotherapist I think an ounce of prevention is worth a pound of cure. I wouldn't want anyone to find themselves in pain when they could have simply avoided it.

Avoiding common Sports Injuries

Different sports make different demands on the body so there is no one size fits all when it comes to prevention. A key factor to consider is the part of the body which is being used and what role proper preparation for exercise can have on your ability to do it for long periods without experiencing discomfort.

Warming up muscles before exercise can seem time consuming but the role of proper warm ups cannot be overstated, especially in cold weather or if you have had previous muscle injuries. There are many benefits including increasing circulation around the body and ensuring that the muscles themselves are not under as much strain when you do start exercising.

If you are looking to discuss what specific exercises and warm-ups would be good to do in order to avoid injuries in different sports, you can always email me at [email protected] and I will be happy to help.

Running is usually a popular choice in January – there is nothing better than putting on a pair of trainers and hitting the road on a crisp winter’s morning. It is also a leading cause of small-scale aches and pains for this very reason.
I'm going to do a series of posts on how to avoid injuries whilst running 'from the ground up" so look out for my next post on Plantar Fasciitis

Happy New Year !!
Most of us begin the new year with lots of good resolutions about being active and fit. But I thought it might also be a good time to celebrate today _ The Festival of Sleep day.
Sleep is one of the most important human activities. Our bodies rest, heal and develop during sleep. It also helps to process and preserve memory.
Poor sleep and lack of sleep can have multiple adverse effects on our mind and bodies.
So how do we celebrate today? That's easy _ Get into your favourite PJ's and crawl into bed.
Having an uncluttered, calm and temperature controlled environment helps good sleep As does a warm drink and half an hour of no-screen time before bed.
Sweet Dreams!!

In order to treat shoulder pain effectively, a good clinical assessment is essential. MRI scans and ultrasound scans back up clinical diagnosis. What is the best treatment?
Usually a combination of manual therapy, ultrasound and laser therapy, soft tissue release, acupuncture and exercise.

So pleased to be recognised again by our organisation Physio First for providing good,quality care to my patients. An independent audit of how well patients do after coming for physiotherapy to First4Therapy

First4Therapy remains open during this trying time
to provide relief from pain, improve your mobility and function and the quality of your life
we are open for Virtual as well as Face to face consultations.
In order to keep everyone safe
we are following a strict cleaning protocol
Every treatment surface is wiped with virucidal spray and wipes
The treatment room is aired between patients
PPE is worn by the therapist
All patients are required to wear masks &
complete a Covid 19 risk assessment
Temperature is taken on arrival and sanitising hand gel provided in reception
Treatment is by prior appointment only
Please either call 01277 841118 or email [email protected]
Stay safe everyone