Long term conditions

Some problems are not going to be cured, and treating them as though they should be is why people give up on treatment and conclude nothing works.

That is the wrong conclusion, and it comes from measuring the wrong thing. If the target is a pain score of zero, a long term condition looks like a failure. If the target is what you are able to do, most of these conditions respond considerably better than people have been led to expect.

More information

Which page do I need

If a joint is worn and stiff and aches with use, read arthritis. If your joints move further than they should and you have a long history of sprains, instability and injuries that never quite settle, read hypermobility. If the pain has lasted longer than three or four months and scans have not explained it, read persistent pain. If your neck, shoulders and back ache from long hours at a desk, read desk and posture pain.

The thing all four have in common

Doing less makes all of them worse. That is counterintuitive when something hurts, and it is the single most important idea on this page.

NICE recommends therapeutic exercise as a core treatment for osteoarthritis for everybody who has it, regardless of age, severity or what a scan shows, and it does not accelerate wear. For persistent pain, NICE guidance recommends supervised exercise programmes and advises against starting opioids. For hypermobility the answer is strength and control rather than the stretching people are so often told to do. And for desk pain, movement variety and strength do far more than achieving a perfect sitting position, which is largely a myth.

What treatment looks like here

Different from a course of treatment for an injury. We start from what you can and cannot do now and what you want back, then build strength and capacity gradually, and work on pacing, because doing a great deal on a good day and paying for it for three afterwards is close to universal.

We will not promise to make the pain disappear, and we will not put you through months of passive treatment that leaves you dependent on appointments. Where a pain clinic, a rheumatologist or a psychological therapy would help more than we can, we will say so and write to your GP.

Conditions that need a doctor first

Hot, swollen joints, morning stiffness lasting more than an hour, or several joints affected symmetrically may indicate inflammatory arthritis, which needs medical management rather than being treated as wear and tear.

Older woman walks with trekking poles on a grassy path beside pink-flowering bushes
Woman stretching at a standing desk in a bright office by a large windowPatient holds 1 kg blue dumbbell while a clinician supports their forearm

Frequently Asked Questions

Is there any point in physiotherapy if my condition will not go away?
Yes, and often more than for a short lived injury. NICE recommends exercise as a core treatment for osteoarthritis regardless of age or severity, and strength and confidence make a substantial difference to what you can do with a condition that is not going anywhere. The goal is function rather than cure, and it is a realistic one.
Will exercise damage a worn joint?
No. Appropriate exercise does not wear joints out and is one of the most effective treatments for osteoarthritis pain. The instinct to protect a painful joint by using it less leads to weaker muscle around it, which usually makes the pain worse rather than better.
What about pain that has lasted years with no clear cause?
Persistent pain is real and it is treatable, but the approach is different from treating a fresh injury. It works on how sensitive the system has become, on graded return to activity, and on confidence, rather than on hunting for damage to fix. We will be honest with you about what that involves.