Clinical Pilates – has started at IONA Physiotherapy!

What is Pilates?

Pilates is a whole body type of exercise that focuses on strengthening (particularly deep abdominal, back and shoulder blade muscles), flexibility, co-ordination and breathing. This total body workout promotes muscle balance and postural awareness. It is therefore favoured by athletes who want to avoid injury, those rehabilitating following an injury, people who want to become more active and improve posture and those who want to maintain lean, toned muscles without building bulk.

The Pilates system of exercise was originally developed by “Joseph Pilates”, a German, in the 1920’s. Since then, with advancement in scientific and biomechanical knowledge, many of the exercises have been modified but still reflect the basic principle that a “strong core” allows for easy, efficient movement throughout daily life.

What is Clinical Pilates?

Clinical Pilates is an adaptation of the original type of pilates exercises that have been developed and modified by physiotherapists to reflect current scientific evidence with regard to injury prevention and rehabilitation. Clinical Pilates is taught by a qualified physiotherapist who has also trained as a pilates instructor. Crucially, the class sizes are small. This allows the physiotherapist to give each participant individual attention ensuring that each exercise is mastered with precision and control.

Each pilates exercise can also be modified by the physiotherapist for each individual participant, depending on their level of ability and the nature of their injury. Please let us know if you currently have an injury so that we can tailor your pilates programme specifically for you.

I have an injury, can I do Pilates?

In most cases- yes! Please speak with Ciara Shields before signing up for a course of classes so that we can discuss if you are ready to start and so that we are aware of the types of modifications that will need to be made throughout the class. Pilates is not a substitute for having your injury treated, but is often a great addition to your rehabilitation programme to aid your recovery.

Should the exercises hurt?

No. The exercises should feel like an effort and you should feel your muscles are being exerted but the exercises should not cause pain. Please stop an exercise if it is causing you pain and let your instructor know. Often a simple modification or correction by the instructor will allow you to continue the exercise. It is your responsibility to let the instructor know if an exercise is hurting or does not feel right for you.

Pilates in Pregnancy
Antenatal Pilates classes, like all of our other pilates classes are always run by a chartered physiotherapist. Classes will be commencing on 31st of October 2015. These are suitable for women from the second trimester onwards. Please phone to register your interest.

Post Natal Pilates- when can I start?

You can start after your six week check up (normal delivery) or after 10 weeks post C-Section. However, this is not a deadline! You may feel for a variety of reasons that you would prefer to wait a little longer and this is perfectly okay. In the meantime, you will benefit from doing some gentle pelvic floor and deep abdominal muscle exercises – and may prefer to have a one on one session for an individual assessment and exercises prior to signing up to a course of classes.

We have not started a specific post natal class yet, but you are welcome to join a beginners class (even if you have done pilates before. ) It is important that you do the right type of abdominal exercises in the early days, to allow any separation of your tummy muscles to close, otherwise all your effort will be counterproductive. If you, or a group of your friends would like to form a group for post natal pilates, please let us know and we will try to facilitate!

Where are the classes located?

The Clinical Pilates classes will run in our newly built pilates studio within IONA Physiotherapy, Cian House, 1 Cian Pk, Drumcondra, Dublin 9.

What should I bring and wear?

A towel, a bottle of water and comfortable clothing. Clothing needs to be loose enough so that you can move easily but not excessively baggy or bulky- this way, the instructor can easily see your movements. If you are an asthmatic, please bring your reliever inhaler.

What time should I arrive?

For your first pilates class with us, please arrive 15 minutes before the class is due to commence. Please use this time to fill out a questionnaire that will be left in the reception area for you. You can bring this into the class with you and give it to the instructor. There may be a class in progress while you arrive or the physiotherapist may be currently with a patient. Please wait in the reception area and your class will be called from this area.

Can I bring my personal belongings into the class?

Please use the designated area outside the pilates studio to store your shoes and coat. For the comfort of all participants, the pilates studio is a “no shoe zone.” Please bring any valuables you may have (phone, money, laptop etc) into the class with you.

What if I can’t attend a class?

A course of classes are booked and prepaid in advance. Please let us know if you cannot attend a specific class. We will do our best to facilitate your attendance of another class within a week of your missed class, however this may not always be possible. Your co-operation is appreciated in this regard.

Reasons to contact Ciara Shields MISCP before booking a course of classes

  • Have you ever been diagnosed with low bone density or osteoporosis? If so please forward me a copy of your dexa scan and contact me prior to booking a course of classes.
  • If you are pregnant, have had a baby in the last 6 months, or know that you have a separation of your tummy muscles (diastases) please contact me prior to booking a course of classes.
  • If you have any concerns as to whether a pilates class is suitable for you, please do not hesitate to contact me!

Ankle Sprain

Ankle Fractures

Ankle sprains can occur when a person rolls over on their ankle (often on an uneven surface) or when landing down from a height or a step. Symptoms may include immediate pain, swelling (most commonly on the outside of the ankle), bruising and difficulty walking due to pain. These symptoms can be quite similar to that of an ankle fracture, so assessment by a doctor or a chartered physiotherapist to determine if an X-ray is indicated is important. With an ankle sprain, the ligaments of the ankle (ligaments connect bone to bone) may be stretched or torn.

At IONA Physiotherapy, a comprehensive assessment to determine which structures have been injured will be undertaken and will guide your management programme. Treatment is likely to include advice regarding control of swelling, manual therapy to restore movement and exercises to improve strength and proprioception. Proprioception, or joint position sense, is your ability to tell where a joint is in space without looking at it.

When you hear someone say they “have a weak ankle”- they probably mean that they keep rolling over on their ankle, and one of the reasons for that is likely to be poor prioprioception.

Proprioceptive retraining has been shown in research to reduce the rate of recurrence of ankle injuries and will therefore be a crucial part of your rehabilitation.


Wrist fractures


The wrist is most commonly fractured by falling on an outstretched hand (FOOSH). You can fracture one of the long forearm bones (most commonly the radius) or one of the smaller wrist bones (carpal bones) such as the scaphoid. If you do sustain a FOOSH and have immediate wrist pain and an inability to put weight through the hand or move the wrist, along with immediate swelling, it’s likely that you may have a wrist fracture and you should seek medical assessment.

A Colles (radius) fracture is the most common wrist fracture and often displays a ‘dinner fork’ deformity meaning that the back of your wrist resembles a fork turned downwards. This may treated by immobilisation or surgical repair. Physiotherapy will commence after your orthopaedic surgeon has told you that the fracture has united and rehabilitation can begin.

A fracture of the scaphoid bone is less symptomatically severe as a Colles fracture. This bone is found at the base of the thumb. The reason a fracture of this bone is somewhat infamous is because not all scaphoid bones heal well after fracture. The blood supply to this bone can be compromised by fracture, leading to crumbling of the bone over time (avascular necrosis) which leads to longer term problems with the wrist. For this reason, it’s extremely important that this fracture is identified early and treated effectively.

Top tips for wrist fracture

  • It is very important to keep your fingers, elbow and shoulder joints moving while you are immobilised for your wrist fracture. This means moving at least 3 times a day throw full available range of movement.
  • Once your orthopaedic surgeon has confirmed that your fracture has united, rehabilitation will begin in earnest. At IONA Physiotherapy we will give you the appropriate exercise programme and help your regain movement at the wrist as soon as possible.

Research-Based Useful Consumer Resources

Neck Pain

There are many useful resources online to provide you with more information about how to treat different types of neck pain. We can discuss these in detail at your initial consultation with us, when we will work out together what treatment best suits you.

NHS Choices – Neck Pain and Stiff Neck
NHS Choices – Osteoarthritis of the Neck (Cervical Spondylosis)
NHS Choices – Whiplash Associated Disorders
University of Queensland’s Consumer Guide to Researched Treatments for Whiplash



Neck Pain

When you present for your physiotherapy assessment, the first step of the clinical exam is to triage the seriousness of the cause of neck pain. This means that by taking a detailed history and undertaking a specialised manual exam, we can categorise your neck pain as mechanical neck pain, radiculopathy (a trapped nerve in the neck leading to sharp shooting arm pain) or likely due to a serious spinal pathology that requires further medical assessment. Less than one out of a hundred people presenting with neck pain have a serious spinal pathology but we are always on the lookout for such a presentation.

Once your triage reveals a more straightforward musculoskeletal source of your neck pain, a specialised manual exam of your neck and upper back will reveal where the symptoms are coming from and also the consequences to your joint movement and muscle function. This detailed examination will form the basis of your treatment plan.



Picture Conor McCabe Photography.

Current research suggests that the most effective treatment for neck pain is an approach that combines manual therapy (joint mobilisation, manipulation or soft tissue massage) and exercise. On their own, manual therapy or exercise do not have as good an effect as when they are combined so you can expect your treatment session at IONA Physiotherapy to include both elements.

Manual therapy leads to short to medium term improvements in pain and disability i.e. helping you to get back to doing your daily activities comfortably and exercise seems to lead to longer term improvements. Each exercise programme is based on individualised assessment and will vary for each patient. For example, some people with neck pain are tight in certain muscles and weak in others around the neck and shoulder, so their programme will feature a range of exercises to correct this muscle imbalance.

Advice is also important for treating neck pain, for example if your neck pain is postural in nature, your work station may need to be analysed to ensure it is set up correctly so that better work posture can be achieved.

The most important advice to someone who has Whiplash is to manage your pain well, so that you can go about your everyday activities without disruption. This may mean taking prescribed medication to keep pain levels down, to enable you to go to work, do your exercises etc. We now know from research that if you rest for too long after a whiplash injury, your recovery can be slowed down so the focus to your treatment will be towards active recovery.


Am I at risk of a Running Injury?

For recreational runners the incidence of running related injuries is 10 per 1000 hours of running, which is relatively high compared to other sports. Knee injuries, such as Patellofemoral Pain syndrome are the most common (19%), followed by foot injuries (17%), such as plantar fasciitis or stress fracture, but lower back, thigh, lower leg and ankle injuries are also common.

Overuse injuries, such as tendinopathy, shin splints or stress fracture are more common than acute injuries such as ankle sprain or calf strain, which means you will usually have some warning signs or early pain to signal an injury is on the way so don’t ignore early symptoms that are persistent.

There are certain factors that help predict injury and these are listed below. This is very helpful in terms of injury prevention, as addressing these factors reduces the risk of developing a subsequent injury.

Predictors of Injury:
1. Previous lower limb injury in the last year – ensure your complete your rehab from any previous injury
2. Weekly mileage greater than 40 miles (64 km)/ week
3. Training errors like speed training. Interval training e.g. interspersing running with walking actually lowers your risk of injury
4. Less than 3 yrs running
5. Biomechanical abnormalities e.g. genu valgum (knock knees) or genu varum (bow legged), over pronation (flat foot) or supinated foot (high arched foot) type.
6. Muscle Weakness i.e. gluteal muscles

At IONA Physiotherapy we can screen to determine if you are at risk of developing a running injury and give appropriate treatment and advice regarding injury prevention that is specific to you. If you already have an injury, we can diagnose and treat the injury and give you a specific plan to prevent recurrence, as well as advise you on footwear and running technique, if necessary. Contact IONA Physiotherapy and we will be glad to help.


Patellar Tendonitis and Tendinopathy (Jumper’s Knee)


The Patellar tendon joins the lower end of the knee cap to the top of the shin bone. Acute inflammation of this tendon is known as patellar tendonitis. If this is managed appropriately, symptoms should improve within 6 weeks. Assessment by a chartered physiotherapist to address the reason for the acute inflammation e.g. muscle imbalance, biomechanical problem, training error etc is advisable so that the injury does not become more chronic (lasting more than 6 weeks). When pain below the knee cap persists beyond 6 weeks, one possible cause is patellar tendinopathy. Tendinopathy (or tendonosis) means that inflammation in the tendon is no longer present but the tendon shows signs of microscopic degeneration. Many factors can contribute to patellar tendinopathy e.g. overuse, strength imbalance between various muscles, postural mal-alignment of the lower limb, biomechanical foot type, reduced ankle movement and lack of muscle strength or flexibility. At Iona Physiotherapy, we will first take a detailed history e.g. how long the pain has been present, your training regime etc before undertaking a comprehensive biomechanical and physical assessment with regard to the above possible causes. Treatment will include addressing any of the factors that are causing excessive load on the tendon and a progressive strengthening programme. There is a specific type of exercise that has been shown in research to rehabilitate tendinopathy (reversing degenerative changes) and help you return to your sport/activity, which is known as eccentric training


Sportsman’s Groin

hip and groin

Groin pain can become chronic (lasting for more than 3 months or recurrently presenting) for some athletes. A small percentage of this will have a hernia that may require surgical repair (Gilmore’s Groin) but the majority have a collection of non-structural groin problems that will respond to comprehensive rehabilitation.

Bone, ligamentous, tendinous or muscular pain can all occur individually or collectively. The common factor at play is ‘abnormal tension’ on the groin. This may be due to over-training, poor flexibility, poor core control or poor gluteal muscle control.

At IONA Physiotherapy, a detailed assessment of your training regime and physical factors will be undertaken. Sometimes, diagnostic imaging (MRI) may be required to assist in treatment decisions, but in the majority of cases, surgical referral is not considered until conservative management has failed to resolve your symptoms.

Rehabilitation will follow (link to groin strain) and temporary ‘relative’ rest may be necessary to get the symptoms under control and allow progressive rehab.

‘Relative’ rest simply means looking at all training / sporting activities and reducing the most provocative elements to get you down to the point where no symptoms are produced during activity. Total rest does not work – you may not feel pain while you rest, but often the symptoms re-appear more severely when you recommence your sport.


Groin Strain

hip and groin

Certain sports carry with them a risk of acute groin injury/ groin strain. Sports such as GAA, soccer and rugby that involve running, kicking and fast change in direction, carry an increased risk of groin injury compared to repetitive sports like swimming or cycling.
The most common muscle involved is the Adductor Longus and if this is strained, sudden pain will be felt on the inside thigh up to the groin. Often these injuries are very straightforward to diagnose and treat. A thorough history taking and physical exam can usually identify the injured structure.

Treatment will involve advice to rest, ice, compression and protection (taping or brace) to treat the initial pain and swelling and importantly, prevent any further injury from occurring. Strapping can be very effective in the first few days for pain relief. Manual therapy and exercise will follow. Exercise focused towards stretching long-term muscle tightness in the area and strengthening primarily gluteal and core muscles and later, adductor muscles.

Manual therapy (massage) will be used if indicated by the presence of increased adductor muscle tone in the early days or shortened scar tissue a number of weeks later. The key theme of your rehab for a groin strain will be building the blocks towards a safe return to your sport and preventing a similar injury occurring in the future.