Physiotherapists in Leeds treat many different conditions including the issues profiled below.

Tendon Bone and Ligament Bone Junctions

Tendons and ligaments have important functions in the body and their ability to perform their functions depends on their connections to the skeleton, on which they exert their forces or their restraining influences. The junction between a tendon or ligament and the bone is called an enthesis and inflammation of that area is known as enthesitis. There is an important group of arthritis conditions where the enthesis is the main site of inflammatory change, as well as normal musculoskeletal problems secondary to injury or degenerative changes. Typical conditions include ankylosing spondylitis, psoriatic arthritis and reactive arthritis.

Entheses vary in their structure: fibrous ones have the ligament or tendon continuing in their normal structure until they contact the bone; fibrocartilaginous ones have a piece of fibrocartilage on the site of attachment and it is this latter group that are mostly of interest in arthritic diseases. The cartilage makes the end of the tendon stiffer and cushions the sudden changes from flexible tendon or ligament material to the hardness of the bone. The management of the stresses which are transmitted through ligaments and tendons to the bone are complex and the body has adapted with a series of anatomical modifications.

Intervertebral Discs and Ageing

Ageing starts early in the discs and proceeds through life. Initially a loss of proteoglycan occurs, and as these chemicals attract and hold water into the centre of the discs, a degree of loss of hydration steadily occurs. The collagenous tissues lose some of their suppleness and resistance, becoming more brittle and more likely to suffer injury. As the discs have no central blood supply and rely on nutrition and oxygen diffusing in, a limitation of this process will accelerate the degenerative process going on in the disc centres. The tops and bottoms of the vertebrae, the endplates, are cartilage but can become calcified, further reducing supplies to the nucleus inside.

The outer part of the disc, the annulus, has layers of collagen material and these thicken and can develop defects. Overall the central disc material becomes drier, fibrosed and stiffer with a smaller volume as it loses water, throwing compressive forces onto the back of the disc annulus. The annulus becomes both stiffer and weaker with age, the increased stiffness perhaps offset by the increase in defects in the disc wall with time. Studies of discs have shown that they do not generally decrease in height with age.