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By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. Axial spondyloarthritis, often shortened to axial SpA, is an inflammatory condition mainly affecting the spine and the joints connecting it to the pelvis. Ankylosing spondylitis is a form with characteristic changes visible on X-rays. People with non-radiographic axial SpA do not have those changes on ordinary X-rays. This guide concerns recognition and referral. It cannot diagnose the condition from a symptom checklist. A pattern worth discussing Back or buttock pain beginning before age 45 and lasting more than three months can warrant a closer look, particularly if it began gradually, is troublesome at night or after rest, and improves with movement. Tell your GP about persistent heel or tendon-attachment pain, swollen joints, psoriasis, inflammatory bowel disease, episodes of eye inflammation or a relevant family history. None of these proves the diagnosis alone. Axial SpA can affect women as well as men. Describe the overall pattern rather than only the most painful area. If the condition is suspected, rheumatology assessment can bring together the history, examination and relevant tests. Normal tests do not settle every case Normal inflammation markers, a negative HLA-B27 blood test or a normal plain X-ray do not individually exclude axial SpA. A specialist decides whether further assessment or imaging is appropriate. Non-radiographic axial SpA does not automatically progress to ankylosing spondylitis. The purpose of diagnosis is to understand and manage your current condition, rather than predict an inevitable future. Eye symptoms need prompt help Eye pain, a very red eye, sensitivity to light or blurred vision needs urgent same-day medical advice through your GP, eye service or NHS 111. Uveitis is one possible cause. Mention known or suspected inflammatory arthritis. Loss of vision is an emergency: go to A&E or call 999. The next step Medical assessment should take priority when inflammatory disease is suspected. Osteopathic care must not delay rheumatology referral or be presented as preventing inflammatory joint damage. If you already have a diagnosis, follow your medical plan and discuss activity with a specialist physiotherapist. The separate guide to living with axial spondyloarthritis and ankylosing spondylitis explains treatment, exercise and precautions. For other types of arthritis, use the arthritis overview. Sources and further information NICE NG65: recognising and diagnosing spondyloarthritis NHS: ankylosing spondylitis NHS: uveitis NASS: complementary therapies and precautions Sources checked: 13 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. Bursae are small fluid-filled sacs that reduce friction between tissues around joints. An irritated or inflamed bursa can cause tenderness, pain and swelling. Not every painful area near a joint is bursitis. Outer-hip pain is not always bursitis Pain over the bony outside of the hip has often been called trochanteric bursitis. Greater trochanteric pain syndrome (GTPS) is a broader term because the gluteal tendons, nearby bursae or both can be involved. Side-lying, walking uphill, stairs and rising from a low chair may be uncomfortable. These symptoms need assessment in context; they do not establish which tissue is responsible. Read the hip and outer-hip pain guide for other possible causes, including hip-joint and back-related pain. Practical changes for outer-hip symptoms Try shorter, flatter walks if longer or hillier routes repeatedly aggravate symptoms, then increase gradually as tolerated. A handrail may make stairs easier. Avoid lying directly on the painful side when this provokes pain. Try the other side with a pillow between the knees, or lie on your back. Change prolonged crossed-leg sitting or leaning onto one hip if these are uncomfortable. Rehabilitation often combines adapting aggravating activity with gradual strengthening. Repeatedly stretching an irritable outer hip is not automatically helpful. Ask for exercises suited to your assessment and a plan for progressing them. Bursitis around the knee The bursa in front of the kneecap may become irritated after repeated kneeling or a direct blow. Temporarily reducing kneeling or using appropriate padding can reduce pressure. Infection is another possible cause, particularly after a skin break. A new or unexplained lump behind the knee should be assessed by your GP. A Baker’s cyst is one possibility, but the location alone cannot confirm it. For other knee symptoms, start with the knee-pain guide. Symptoms that need prompt medical help A suddenly painful, hot or swollen joint, especially with fever or feeling unwell, needs urgent GP or NHS 111 assessment. Infection needs medical treatment; massage or routine osteopathic care is not the appropriate first step. New or worsening swelling, warmth or redness in one leg also needs urgent advice because a blood clot can resemble a ruptured Baker’s cyst. If leg pain and swelling occur with chest pain or breathlessness, call 999. See your GP if symptoms are worsening or have not improved after one to two weeks of self-care. Assessment and treatment options Assessment considers the history, the affected area and whether a joint, tendon, bursa or another problem may be involved. A clinician may recommend tests or removal of fluid for analysis where appropriate, particularly if infection is a concern. Reducing pressure on the area may help. For short-term comfort, a cold pack wrapped in a towel can be used for about ten minutes, with breaks between applications. Ask a pharmacist or GP about suitable pain relief. Medical options depend on the diagnosis. Antibiotics are needed for an infected bursa; steroid injection may be considered for selected non-infected problems. An injection is not a substitute for confirming the cause. At Eastbourne Osteopathy, Andy can discuss whether exercise, activity advice and optional hands-on care are suitable. Agree a useful goal and review the response. For hip arthritis, use the separate osteoarthritis guide. Sources and further information NHS: bursitis NHS: Baker’s cyst Kingston and Richmond NHS: GTPS NHS: deep vein thrombosis Sources checked: 13 October 2026. General patient information; assessment and care depend on your individual circumstances. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. Tennis elbow usually causes pain and tenderness on the outside of the elbow, particularly with gripping, lifting or wrist movements. It can interfere with work, hobbies and sleep. Recovery varies; some problems settle relatively quickly, while others last many months. What may be contributing? The wrist extensor tendons attach near the outside of the elbow. A change in their workload can be relevant: more decorating, gardening, tool use, carrying or racquet sport, for example. Sometimes there is no clear trigger. The term tendinopathy describes a painful tendon problem. Persistent tendon pain is not adequately explained by tight muscles or inflammation alone. An uncomfortable workstation may aggravate symptoms, but one posture does not prove the cause. Tennis elbow, golfer’s elbow or a nerve problem? Golfer’s elbow affects the tendon attachment on the inside of the elbow. Joint problems and nerve irritation can cause similar pain. Numbness, tingling or loss of hand strength need attention and should not automatically be labelled tennis elbow. Seek urgent assessment for severe pain and difficulty moving the arm, an injury with a snap or altered shape, or arm numbness. A hot swollen area with fever or feeling unwell also needs urgent medical advice. Our arm and hand guide gives the medical-help routes. Making everyday tasks more manageable Reduce or adapt the activities that repeatedly provoke symptoms while keeping the elbow moving comfortably. Split heavy shopping into smaller loads, use both hands for a pan, or bring an object closer before lifting. Try a looser grip or a different handle if it makes the task easier. Alternate repetitive jobs with a less demanding activity. When comfortable, lifting with the palm or thumb facing upwards may be easier than lifting palm-down. A forearm strap or wrist support may help some people during particular tasks. Ask about fitting; stop using it if it causes numbness or more pain. A pharmacist can advise about suitable pain relief, including whether a gel is appropriate for your health and medicines. Follow the product instructions. Exercise and returning to activity Rehabilitation may include gradually increasing wrist and forearm strength. The starting load and progression should reflect your symptoms and the work or sport you want to return to. A generic exercise list is not a substitute for assessment when the diagnosis is uncertain. Agree how much discomfort is acceptable and what to do if pain remains worse afterwards. Change one part of the workload at a time, such as duration or weight, and review your response. Complete rest for a prolonged period is not usually the goal. Track something meaningful: carrying a kettle, using a mouse, opening a jar or the amount of a hobby you can manage. Improvement may take weeks to become clear. Treatment choices and review See your GP if symptoms remain after at least two weeks of self-care, or sooner if they are worsening. Physiotherapy or an NHS musculoskeletal service may help with rehabilitation. Steroid injections may give short-term relief but have disadvantages, including poorer longer-term results in some studies. They are not an automatic next step. Surgery is reserved for selected persistent cases after discussion with a specialist. At Eastbourne Osteopathy, assessment may include the wrist, shoulder or neck where relevant. Any hands-on care should support an agreed activity and exercise plan. No single treatment suits everyone or guarantees a quick recovery. If progress is limited, review the diagnosis and options rather than continue the same approach indefinitely. Read after your appointment and choosing the right help. Sources and further information NHS: tennis elbow Oxford University Hospitals: tendon rehabilitation and treatment choices NHS: elbow and arm pain, including urgent symptoms Sources checked: 13 October 2026. General patient information; assessment and care depend on your individual circumstances. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. Referred pain is pain felt in a different area from the tissue or organ contributing to it. The place that hurts does not always identify the source, so assessment considers your symptoms and health history as well as the painful area. Pain in an arm or jaw is not always musculoskeletal. If you suspect a heart attack, call 999. Chest tightness or squeezing, or chest pain spreading to the arms, neck or jaw, needs emergency help. Do not wait for an osteopathy appointment or drive yourself to A&E. Basics of Referred Pain Muscles, joints and internal organs can produce referred pain. One proposed explanation is that signals from different tissues share pathways in the nervous system. The mechanisms are complex; it is not simply a message travelling along the wrong part of one nerve. For example, some problems in the lower back or pelvic region can produce pain in the buttock or thigh. Patterns overlap, so a diagram or the location of pain cannot reliably identify a particular joint or muscle as the cause. How it Differs from Sciatica Sciatica describes leg symptoms associated with irritation or compression of the sciatic nerve or its nerve roots. Somatic referred pain comes from other tissues, such as joints or muscles, without that being the same nerve-root problem. The symptoms can overlap, and both may need to be considered during an assessment. Shooting pain, tingling, numbness or weakness may suggest nerve involvement, but no single symptom confirms the cause. Whether an area is tender to touch does not reliably distinguish sciatica from referred pain. New or worsening weakness needs prompt medical assessment. Identifying and Managing Referred Pain At Eastbourne Osteopathy, Andy will ask about your symptoms, medical history and how pain affects daily activities, then examine relevant movement and physical findings. The aim is to assess possible causes and whether osteopathic care is suitable. Further medical assessment may be needed if the cause is unclear or there are concerning symptoms. Where appropriate, management may include advice, exercises and hands-on treatment tailored to your needs. The plan depends on the assessment; treating a presumed “root cause” does not guarantee relief. For more about leg symptoms and assessment, see our sciatica guide. Go to A&E or call 999 if back or leg symptoms include sciatica on both sides, severe or worsening weakness or numbness in both legs, numbness around the genitals or bottom, or new difficulty controlling or passing urine or controlling bowel movements. These can be signs of a serious spinal problem. See the NHS sciatica guidance for details. Do not wait for a routine appointment. Sources and further information NHS: heart attack symptoms NHS: sciatica and urgent symptoms Reference links checked: 13 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. Hip or knee osteoarthritis can make walking, stairs, dressing or getting out of a chair uncomfortable. Symptoms may be intermittent or may interfere substantially with daily life. Care should focus on what you want to do more comfortably. Understanding the diagnosis Osteoarthritis affects several tissues within a joint. It is not simply a prediction that the joint will keep wearing away until it needs replacement. Symptoms and their effect on daily life do not always match the appearance on an X-ray. Hip symptoms may involve the groin, thigh or knee, with difficulty putting on shoes. Knee symptoms may be noticeable on stairs, after sitting or during longer walks. Other problems can cause similar symptoms, so assessment matters. A typical presentation can often be diagnosed clinically without routine imaging. Tests may help when features are unusual, another condition is suspected or the result would change management. Exercise and everyday goals Tailored strengthening and aerobic activity are central to osteoarthritis care. A starting goal might be standing from a chair more easily, managing stairs or completing a familiar walk. Choose a plan you can repeat between appointments. Some discomfort can occur when beginning exercise. Ask how to recognise a manageable response, adjust the amount and decide when reassessment is needed. An exercise that is too difficult can often be adapted. The Getting active guide includes ideas for walking and everyday movement. An individual programme can take account of other health conditions, confidence and access to equipment or support. Other options to discuss A walking aid, changes to demanding tasks or appropriate pain relief may help. If weight management is relevant, support can be discussed sensitively alongside the rest of your care. A pharmacist or GP can explain medicine choices and risks in relation to your health history. Selected injections or a surgical opinion may be considered when appropriate. Referral for joint replacement depends on the impact on quality of life and whether suitable non-surgical care has helped, rather than the presence of arthritis on an image alone. Where hands-on care fits For hip and knee osteoarthritis, NICE says manual therapy may be considered alongside therapeutic exercise. Evidence is insufficient to support using it alone. It does not restore cartilage or reverse the underlying joint changes. If hands-on care is included, agree what benefit you are looking for and when to review it. Any short-term relief should contribute to a useful overall plan rather than lead automatically to repeated appointments. When to seek further advice A sudden hot, swollen or very painful joint needs urgent medical advice, especially with fever or feeling unwell. Contact NHS 111 for a knee that locks, gives way, cannot take weight or has changed shape. A new problem should not automatically be attributed to your usual osteoarthritis. Read the knee pain guide for further warning signs. If progress remains limited, discuss another assessment or treatment route; Choosing the right help explains the options. Sources and further information NICE NG226: osteoarthritis diagnosis and management NHS: osteoarthritis treatment and support NHS: arthritis NHS: septic arthritis Sources checked: 13 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. The sacroiliac joints (SIJs) connect the sacrum at the base of the spine to the pelvic bones. Pain around this region may be felt in the lower back or buttock, but the location alone does not show that the SIJ is the source. The Role of the SIJ These joints have relatively little movement and help transfer load between the trunk and legs. Pain around them can have several possible causes. Assessment also considers the lower back, hips and relevant medical conditions rather than assuming the pelvis is out of alignment. The SIJ in Pregnancy Pelvic girdle pain during pregnancy can affect the back or front of the pelvis and sometimes the hips or thighs. It should not automatically be attributed to one hormone or a loose joint. Tell your midwife or GP about symptoms so that appropriate assessment and support can be arranged. Referred Pain Pain from structures around the lower back and pelvis can sometimes be felt elsewhere, including the buttock or thigh. This can overlap with sciatica, which involves nerve irritation or compression. A dull ache, shooting pain or tenderness alone cannot confirm which structure is involved. Numbness or weakness needs particular attention during assessment. Managing SIJ Pain Andy will ask about your symptoms and medical history and assess relevant movement and physical findings. The aim is to consider possible causes and whether osteopathic care or further medical assessment is appropriate. Persistent pelvic pain during or after pregnancy should also be discussed with your maternity team or GP. Where appropriate, a management plan may include advice about activity, exercises and hands-on treatment. It should be adapted to your symptoms and goals, with progress reviewed. There is no single treatment that reliably resolves all pain around the SIJ. Our low back pain guide explains more about assessment and when to seek medical help. Go to A&E or call 999 if back or leg symptoms include sciatica on both sides, severe or worsening weakness or numbness in both legs, numbness around the genitals or bottom, or new difficulty controlling or passing urine or controlling bowel movements. These can be signs of a serious spinal problem. See the NHS sciatica guidance for details. Do not wait for a routine appointment. Sources and further information RCOG: pelvic girdle pain and pregnancy NHS: sciatica and urgent symptoms Reference links checked: 13 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. An X-ray can be useful when it answers a clear clinical question. For many people with back or neck pain, however, it will not explain the pain or change the best next step. The decision should follow an assessment of your symptoms and medical history. What can a spinal X-ray show? X-rays mainly show bones. They can help assess some fractures, spinal curves such as scoliosis, or a vertebra that has slipped relative to its neighbour. They may also show age-related changes, including bony spurs and reduced spaces between vertebrae. An X-ray does not show every important structure clearly. MRI is more useful for many questions about nerves, the spinal cord and other soft tissues; CT can give more detailed views of bone. The right investigation depends on what the clinician needs to find out. Does a change on an image explain my pain? Not necessarily. A finding needs to fit your symptoms and examination. Research on MRI and CT scans has found many age-related spinal changes in people without pain. This does not make every finding irrelevant; it means an image cannot be interpreted in isolation. Spinal curves also vary between people. Research on neck curvature has found considerable variation in people without symptoms. A difference from a proposed ideal curve is not, by itself, proof of a problem that needs correcting. What about minor “misalignments”? Small differences in position on an X-ray do not, on their own, establish the cause of pain or show which joint needs treatment. A review of routine spinal radiography found no evidence that using these images to direct treatment improved patient outcomes when there was no clinical reason to investigate serious disease or injury. That is a limitation of the evidence, rather than proof that every possible approach has been tested. Manipulation is a quick, controlled joint movement. A change in symptoms afterwards does not demonstrate that a bone has been put back into place. A genuine fracture, dislocation or spinal instability is a different medical problem and requires appropriate assessment. When is imaging recommended? NICE advises against routine imaging for low back pain, with or without sciatica, in a non-specialist setting. In specialist care, imaging should be considered when its result is likely to change management. This recommendation concerns low back pain; it should not be treated as a single rule for every neck problem. For neck pain, the history and examination also guide whether imaging is needed. An NHS neck-pain guide from the Tyneside Integrated Musculoskeletal Service explains that X-rays or MRI scans are not normally necessary for common neck pain. Investigation may be important after significant injury, with concerning neurological symptoms, or when fracture, infection, cancer or inflammatory disease is suspected. The clinician may choose MRI or CT rather than an ordinary X-ray. A normal X-ray does not exclude every serious condition. Do repeat films show whether treatment is working? Repeating an X-ray needs a clinical reason. Monitoring a fracture or a significant spinal curve can be appropriate. For ordinary back or neck pain, changes in walking, sleep, work and other activities are often more useful measures than repeated pictures taken simply to track alignment. X-rays involve ionising radiation. The risk is generally small, and a justified test can provide much greater benefit. Unnecessary imaging can also reveal incidental findings that lead to worry or further tests without improving care. Questions to ask What condition are we looking for? How would the result change my treatment or referral? Is an X-ray the right test, and what would it miss? Could assessment and a review of progress answer the question without imaging? Symptoms that should not wait With back pain, new difficulty passing urine or loss of bladder or bowel control, loss of sensation around the genitals or anus, or pain, numbness or weakness in both legs needs immediate assessment at A&E. Do not wait for a routine appointment or an outpatient X-ray. Ask someone to take you, or call 999 if necessary; do not drive yourself. For the wider decision about care, see Choosing the right help for muscle and joint pain. Sources and further information NICE NG59: imaging recommendations for low back pain and sciatica NHS: X-rays Tyneside Integrated Musculoskeletal Service: neck pain Brinjikji and colleagues, 2015: spinal imaging findings in people without symptoms Guo and colleagues, 2018: variation in cervical lordosis Corso and colleagues, 2020: evidence review of routine spinal radiography NHS: back pain and urgent symptoms Sources checked: 13 October 2026. General information to support a discussion with your clinician; the appropriate investigation depends on your circumstances. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. Trigger points are tender areas in muscles that may reproduce familiar pain when pressed, sometimes in another area. They are often described as muscle knots. Researchers continue to investigate how these areas develop and how reliably they can be identified. A tender spot alone does not explain every episode of pain. Basics of Trigger Points “Muscle knot” is an everyday description, rather than a complete explanation of what is happening in the tissues. Myofascial pain syndrome is a term used for regional muscle pain associated with tender areas and sometimes referred pain. Its symptoms can overlap with joint, nerve and other pain problems, so assessment should consider more than tenderness alone. There is no fixed recovery time for muscle pain or trigger-point symptoms. Some episodes settle, while others persist or recur. If pain keeps returning, worsens or limits your activities, an assessment can help explore possible contributing factors and decide whether further medical advice is needed. Assessing Muscle Pain At an appointment, I will ask how the pain started, what changes it and how it affects your daily activities. Examination may include movement, muscle tenderness and, where appropriate, checks for nerve involvement. A symptom checklist or pain diagram cannot confirm a trigger point or rule out another cause. Referral Patterns Referred pain is felt somewhere other than its source. Tender areas in muscles can be associated with this pattern, but the location of pain does not prove which tissue is responsible. The illustration shows commonly described patterns around the neck and face; it is not a diagnostic map. My referred pain guide explains why symptoms need to be considered in context. Do not assume toothache comes from a neck or jaw muscle. Contact a dentist if it lasts more than two days, does not settle with pain relief, or comes with fever, pain on biting, red gums, a bad taste or cheek or jaw swelling. The NHS toothache guidance explains when urgent help is needed. When to Seek Medical Advice Persistent pins and needles, numbness or new weakness should not simply be labelled a muscle knot. Seek medical advice, particularly if symptoms are worsening. Call 999 for sudden one-sided weakness or numbness, facial drooping or difficulty speaking, even if the symptoms improve. See the NHS stroke guidance for details. Osteopathy for Trigger Points At my Eastbourne practice, I can assess muscle pain and discuss whether osteopathic care is suitable. Depending on the findings, this may include hands-on treatment, exercises and advice about activity. Treatment should be tailored to you and reviewed according to your response; improvement varies and rapid relief cannot be guaranteed. If the findings suggest another problem, I will explain when medical or dental assessment is more appropriate. You can use the booking button below to arrange an appointment. Sources and further information Royal Orthopaedic Hospital: trigger points and medical pain care NHS: toothache NHS: stroke symptoms Reference links checked: 13 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.