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Monday - Friday 09:00-16:00Saturday and Sunday - CLOSED+441614476762info@manchesterhipclinic.comSpire Hospital, 170 Barlow Moor Road, Didsbury, Manchester M20 2AF

What is Clinical Pilates?

Clinical Pilates is a Physiotherapy led functional and dynamic exercise programme focused on retraining normal patterns of movement from a central stable core. This rehabilitation method is particularly effective in correcting the biomechanical imbalances around the hip, lumbar spine and pelvis through exercises that isolate the proximal hip and core muscles. Strengthening these deep stability muscles can help to correct muscle imbalance and improve hip joint function.

Clinical Pilates is different to other physiotherapy rehabilitation exercises because it concentrates specifically on “centering”  which refers to activating the deep abdominal muscles, back muscles and pelvic floor in unison, while keeping the lower back in a neutral spine position. This restores the natural curves of the spine and improves body awareness by training the centre to remain active throughout the duration of the Pilates movements.

The Clinical Pilates concept of strength training is that there are different components which make up a functional core:-

Supportive Core

(Transversus Abdominus, Pelvic Floor, Multifidus, Diaphragm)


Strength Core

(Latissimus Dorsi, Serratus Anterior, Obliques, Rectus Abdominus, Quadratus Lumborum, Gluteals, Thoroco-lumbar fascia)



(Arms, legs)


Functional Core

Centering activates the supportive core. The controlled movements activate the strength core and the movements incorporate actions of the extremities which facilitates an effective method of core strengthening.

Alongside functional core strengthening, Clinical Pilates exercises also follow the APPI (Australian Physiotherapy & Pilates Institute) principles which include:-

  • Concentration
  • Breathing
  • Centering
  • Control
  • Precision
  • Flowing movement
  • Integrated movement patterns
  • Routine

These are all aspects which make Clinical Pilates a valuable method of strengthening.

Why Clinical Pilates for hip rehabilitation?

Every exercise in the Clinical Pilates repertoire has a particular movement focus. For example, some exercises focus on controlled strength, rotary stability, abdominal strengthening, gluteal strengthening or limb dissociation. These concentrated movements are the foundation of early stage rehabilitation from hip injury or surgery, allowing Physiotherapists to prescribe patient-centred, individualised Pilates exercises.

Basic level Clinical Pilates exercises are often included in a thorough Physiotherapy assessment. These movements allow Physiotherapists to identify biomechanical imbalances and movement dysfunction. This facilitates the prescription of specific exercises to correct movement dysfunction and reduce hip symptoms to aid recovery.

Clinical Pilates can also help to prevent hip injury. . .

Commonly Clinical Pilates is used as a rehabilitation method in Physiotherapy for hip pain, hip dysfunction or following hip surgery. However, it is also a popular and effective method of injury prevention or prehabilitation.

Regular participation in Clinical Pilates classes will maintain and continually improve strength around the proximal hip and core muscles. This means the development of muscle imbalance, movement dysfunction or overloading leading to hip pain are less likely.

This is particularly relevant for the sporting or athletic population. A recent research study proved that a 6 week course of Clinical Pilates classes can improve functional movement and reduce the risk of injury in recreational runners (Laws et al, 2017).

Additional benefits of Clinical Pilates

Alongside improvements in core stability, flexibility and strength, Clinical Pilates has other health benefits including stress management, breathing control and relaxation.

Clinical Pilates exercises can be performed in 1:1 sessions or small group classes led by an experienced and fully qualified Physiotherapist to aid recovery from hip surgery or injury.

Anna Laws


Spire Manchester


What are stem cells?
Stem cells are perhaps Nature’s best-kept secret. These cells, which are found in multicellular organisms, such as humans, not only have the ability to divide (mitosis) but also to form various structures such as cartilage, bone and many more. The process is called ‘differentiation’.

What types of stem cell are there?
There are two basic forms of stem cell – the embryonic stem cell and adult stem cell. Adult stem cells, which are also known as mesenchymal stem cells or MSCs are of great interest to researchers, scientists and surgeons alike. MSCs are free of the controversy that surrounds the embryonic stem cells and yet have the potential to form new tissues. At The Manchester Hip Clinic we use the MSCs. This gives us the ability to repair and regenerate tissues such as cartilage and bone more effectively.

MSCs can be found at various locations in the body, including bone marrow, adipose tissue (fat) and peripheral blood. We favour the use of marrow-based or peripheral blood stem cells.

Where do the cells come from that are used in stem cell therapy?
At The Manchester Hip Clinic the stem cells are harvested autologously – directly from the patients. Consequently, there is no risk of disease transmission, rejection or ethical controversy that can exist using cells from an unrelated donor. All of us have a supply of MSCs in various tissues and these can be harvested using specialised techniques.

Where can stem cells be used?
By their very nature, stem cells can be used in a variety of different situations to help in the repair and regeneration of damaged tissues and structures. In joint preservation, one role of stem cells is in the possible treatment of arthritis of the hip and knee joints. This can potentially be accomplished by regeneration of cartilage (gristle). In simple terms, the gristle on the joint surface is the barrier to arthritis. Once this layer is damaged, the joint is likely to progress to frank arthritis, which presents as pain, stiffness and loss of function. Stem cell therapy may be used in an attempt to encourage regeneration of this gristle layer. The procedure is designed to help preserve the natural hip and knee joints and perhaps to delay or prevent the need for more major operations such as replacement of the hip or knee joint.

Another area of particular interest for stem cell therapy in the hip and knee is to help with the regeneration of dead bone. In a condition called avascular necrosis, or AVN, there is death of a segment of the bone near the joint.  This can sometimes progress onwards to become severe arthritis.  Early reports of the use of stem cells to regenerate bone in AVN are encouraging.

There are many other reasons why stem cells might be used.  These techniques may be relevant to different patients and are employed as required.

What does the procedure involve?
The procedure is in the form of arthroscopy (keyhole surgery) of the hip. Patients often ask whether stem cell therapy involves surgery on two separate occasions.  For the techniques that we use, only a single operation is normally required. Most hip arthroscopy patients will have one night’s stay in hospital.  Once the patient is under anaesthestic, an aspirate of their blood and/or marrow is taken with a special needle. In order to harvest the stem cells, the aspirate is then processed in the operating theatre, while the patient is still asleep,. At the same time the keyhole operation (arthroscopy) is commenced to access the hip.  The surgeon uses specialist arthroscopy techniques to prepare the tissue bed so that it is ready to receive the stem cells.  The harvested stem cells, alongside a suitable scaffold, are then injected through the same keyholes that are routinely used for the arthroscopy.

What are the side effects?
Any surgical intervention carries a degree of risk however the surgical procedures used for stem cell therapy are the same as those for routine hip arthroscopy operations.  There is a theoretical risk of infection, but this is low and surgery is in any event covered by antibiotic treatment.  As for the stem cells, these are derived from the patient’s own blood or marrow, so there is no risk of rejection or disease transmission.

What is the evidence for stem cell therapy?
Stem cell therapy is a relatively new procedure.  However, it has created so much interest worldwide that extensive research has been taking place in this field. Animal and human studies have been published that have suggested a safe and favourable response to stem cell therapy in hips, knees and even ankles.  Our practice routinely collects data on all patients who undergo surgical treatment under our care; assessment questionnaires are periodically sent to those who have undergone surgery.  This is an invaluable source of information that helps us to inform our patients, publish in the literature, and to train others who are interested in the techniques we undertake.


They say prevention is better than cure and that is certainly true in hips! Having said that you can’t change your genetics. Some people have a certain shape to their hip which seems to predispose to the development of arthritis. These ‘CAM’ and ‘Pincer’ shaped hips predispose to pinching (impingement) of the hip against its socket, leading to damaged cartilage and eventually arthritis. Hip Arthroscopy surgery can be used to reshape the hip and may prevent early arthritis progressing to advanced stages.

The most important modifiable risk factors for arthritis is your weight and activity level. Being even slightly overweight leads to increased load on the hip joint. Over time the hip can be squashed down and change shape permanently. The increased angle leads to more pinching and the hip wears down more quickly. Losing weight can slow the whole process down. Other people have illnesses in childhood such as Hip Dysplasia (the hip and socket are too shallow, having not formed properly), Perthes disease (the blood supply to the hip gets cut off in childhood), or Slipped capital femoral epiphysis (the growth plate of the bone slips out of place). All of these conditions need to be spotted in childhood so something can be done about it and potentially prevent adult hip osteoarthritis.

Early hip OA is much easier to fix than advanced OA. Sometimes X-rays can miss the early features, MRI or CT scans are more reliable. If you are sure that you have hip or groin pain, but the X-ray is normal, you will need to speak to your doctor about a specialist opinion or scan.

Sometimes a steroid injection done under X-ray guidance can give temporary relief, and provide clarification around whether pain in the groin or buttock area is truly coming from the hip joint, however, they generally wear off after 2-3 months, so it is not a long-term option. Other substances such as hyaluronic acid (an artificial version of your natural joint fluid) and PRP are also being used but need to be further evaluated to see if they have long-term benefit.

It is important to do regular strengthening exercise (such as core stability and pilates) and maintain a healthy weight, if hip pain is becoming intrusive, ask to see one of our specialists.

Dr Leon Creaney


Who does this effect?
This condition occurs when there is degeneration in the hip causing damage to the joint surface (figures 1 and 2). There are numerous different causes but the most common is osteoarthritis. However, it can occur earlier due to abnormalities within the hip. This may be due to a previous injury, childhood hip disease, femero-acetabular impingement (A misshapen hip that catches and causes damage to the hip joint) or problems with the blood supply to the hip.

How does it present?
Commonly, this causes groin pain often going down the thigh to the knee. The hip is stiff, and the patient walks with a limp. As arthritis becomes more widespread and severe, the pain becomes more constant, it may occur at night and be associated with increased stiffness, decreased mobility and ability to exercise.

What investigations do you need?
X-rays of the hip to confirm the diagnosis are taken as standard. More complex scans such as CT or Magnetic Resonance may be needed to pin down the diagnosis and help surgical planning.

Non-surgical Treatment
To begin with, simple measures are tried such as painkillers, weight loss and activity modification. Oral supplements such as glucosamine and chondroitin may benefit some patients, especially with early arthritis. Injections such as steroid, hyaluronic acid or PRP may be used to either confirm the source of the pain (e.g. if the patient also has back pain) or in those patients who are not ready for a joint replacement.

When a patient has severe arthritis and painkillers no longer control the pain, hip joint replacement is advised. This has the benefit of relieving the pain and allowing the patient to return to a near normal level of activity.

In simple terms, the ball of the hip is removed and the thigh bone is prepared before the metal stem is inserted. The pelvic cup is then prepared and the artificial cup is inserted and held using either bone cement or an artificial coating that bonds directly to the surrounding bone surface (figures 3,4 and 5).

There are different forms of hip replacement and each one has a role to play depending on the patient’s age and activity level. Younger (<70) and more active patients, will have implants where the cup liner is made of a wear resistant plastic and the ball of the hip will be made of ceramic, which is very smooth, hard wearing and produces less wear debris than traditional implants.

In general, a hip replacement is a safe and reliable operation. The vast majority of patients are either pain-free following the surgery or have a significant improvement in their symptoms, returning to a level of activity that has not been possible for some time.

Approximately, 5% of patients will develop a post-operative complication. The most important of these are a deep infection, hip dislocation, leg lengthening, nerve and blood vessel injury, blood clots, fracture, future need for revision and medical complications such as stroke or heart attack. Great care is taken to minimize these risks including the use of antibiotics and blood thinning drugs around the time of the operation. Using information from The National Joint Register, we know that in general (if a proven combination of implants is used), approx. 95% of hip replacements will still be functioning well at 14 years although this drops in patients less than 55 years old to 93% at 10 years, due to their higher activity level. Patients tend to remain in a hospital for between 2 and 4 days.
It is important to undergo a focused rehab program both before and after surgery, focusing on hip strength and core stability as this will help patients to return to activity sooner. Patients should be able to return to a wide range of sports after surgery including cycling, swimming, tennis and skiing.

Visit arthritis solution for more information

A great overview by Mike Kennedy

As a sports physiotherapist I work in a number of diverse settings which gives me access to a wide range of clients from the elite professional footballer to the office worker who is a keen triathlete at the weekends. For each client the need is the same “how can I get the most out of my body following injury in order to improve my performance.” Pain at the hip and groin region particularly can be very debilitating for the athlete, quite often it is very poorly understood area and as a consequence the problem can become chronic and result in an extended period on the sideline’s.

Diagnostics & Collaborative working
Diagnostics play an important role as the hip and groin is a very complex area and problems can be difficult to diagnose. Orthopaedic consultant opinion together with radiographic imaging and specialist reporting is important in pinning down the correct diagnosis. A collaborative approach in assessment from leading specialists in Sports Medicine and the Sports Physiotherapist is the most effective route in treating the athlete in terms of getting them back to action as soon as is safely possible and providing a solution to ensure their long term fitness.

Focused & Progressive Rehabilitation
First of all it is important to educate the athlete about their injury, the mechanism of injury often involving video analysis and the rehabilitation plan that will allow them to return to sport and avoid any injury reoccurrence. It requires a ‘buy in’ from both the therapist and the athlete to commit to a rehabilitation programme which will allow them to return to full fitness.
Hip and groin injury can be multifactorial in nature but it is important to focus targeted rehabilitation at the region initially and then progress to more dynamic loading as symptoms improve. I have found the following progressive stages of rehabilitation to be most effective within the sporting population:

  • Intersegmental control and strength (such as a deadlift or double leg squat)
  • Linear mechanics and running load (such as barbell/overhead running and leg change drills)
  • Multidirectional mechanics and sprinting (such as a lateral shuffle or Zig Zag cutting)

Within these 3 phases the therapist encourages correct execution in technique and correct lumbo-pelvic form. Furthermore, a gradual increase in load progression, speed intensity and multi-directional movement patterns is also encouraged. Other treatment methods may also be incorporated if deemed necessary, such as improving the mobility of the lower extremities and spine with manual therapy and sports yoga, application of strength and conditioning principles, Shockwave therapy and clinical Pilates.

It is also important to keep the athlete focused and interested within rehabilitation. In order to achieve this outcome the therapist must make rehab specific to their sport; jointly develop drills with the athlete to mirror scenarios encountered within a game situation and make rehab proprioceptively demanding in order to retrain reaction timing and load response.

Profiling & injury prevention
There is now a growing trend towards profiling of the athlete to highlight any injury risk factors and movement dysfunction that may predispose the athlete to injury.
A specific screening tool devised by the therapist specific to the demands of the sport and/or the athletes overall physical capabilities is generally used twice a year in both a squad environment or on an individual basis to measure athletic performance. The screen may broadly include the following battery of tests:

  • Range of motion eg. Shoulder mobility
  • Strength testing eg. Adductor Squeeze test
  • Balance testing eg. Single leg landing
  • Work Capacity testing eg. Push up to failure
  • Movement Patten analysis eg. Squat form
  • Outcome measure eg. Triple hop for distance

Data produced from the screen allows us to flag up any potential weaknesses that could be a contributing factor to injury and have an adverse effect on overall physical performance.
In order to nullify these weaknesses the athlete who presents as a high injury risk is given outlined bespoke action points to work on and then they are assessed more regularly, every few months throughout the year on key tests relevant to their profiling findings. This detailed monitoring allows us to prevent potential injury occurrence in key area’s such as the hip and groin and ensures the athlete remains fit, strong and pain free in order to achieve optimal performance.

Mike Kennedy MSc BSc (Hons) MHCPC MCSP MACPSEM

Manchester United Football Club Academy Physiotherapist
Lead Physiotherapist, Mike Kennedy Chartered Physiotherapy & Pilates
Highly Specialist Musculoskeletal & Sports Physiotherapist, Spire Perform Manchester
Consultant Physiotherapist to the Professional Footballers’ Association (PFA)
Associate Research Physiotherapist to the FASHIoN trial – Studying Hip Impingement

You can find more information on the services Mike provides at the following web resources:
Wigan Physiotherapy
Spire Healthcare

The Manchester Hip Clinic is committed to helping all kinds of people with hip problems to be free from pain and often to resume near-normal levels of physical activity – even those who may have thought that such relief would never be possible.

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