Osteoarthritis (OA) is the commonest joint degeneration condition in the world, resulting in huge amounts of pain and suffering, work loss, expense and disability. Ageing of western developed populations, soon to be followed by some developing countries such as China, will place an increasing burden on medical services as the occurrence of OA rises steadily with age. There will be an increasing need to provide medical and physiotherapy treatment for OA over the next 50 years and for many thousands of people this will involve joint replacement.

Knee injuries and the management of post-operative knee conditions require physios to apply cold therapy to the joints to control knee effusions and pain. This is difficult to do with traditional methods but the Aircast Cryocuff is a flexible and efficient device to achieve effective cryotherapy and compression.

Ankle impingement is a condition whereby the patient suffers from a restriction in their ankle movement due either to a bony or soft tissue problem. The typical causes of this condition are usually irritation of the capsule or synovial membrane of the ankle secondary to a single or a repeated series of accidents or incidents. Ankle sprains, especially if repetitive, can lead to chronic pain and impingement syndromes. This gives the patient continual pain on weightbearing and limits their mobility and sporting activities. Estimates vary but 10% of people suffering ankle sprains may develop some degree of impingement.

The complicated anatomy of the foot is targeted at generating propulsive force for running and walking and at coping with the body weight. The ankle mortise holds the talus firmly and it sits at the top of the main long ways arch of the foot. The medial or longitudinal foot arch is the biggest one, this takes the standing, and moving loads of the body with the spring ligament absorbing and releasing some of the energy involved. The outside, lateral arch is much smaller as is the arch across the front of the foot between the fifth and first metatarsal heads.

The menisci (often called cartilages) and the main joint surfaces of the knee can be made more vulnerable to injury and damage if knee control is not good enough to prevent unplanned joint movements. Meniscal function is partly to control movement of the femoral condyles into particular paths, centring them on the upper shin bone plateau. Without the guiding help the large and strong condyles can catch the edges of the menisci as they roll across the tibial plateau and so cause tears or other damage to the menisci.

The knee joint is a hinge joint as is the elbow but has a complex hinging action. At the end of the thigh bone is the expanded area known as the femoral condyles, with a similar area on the upper part of the shin bone (the condyles of the tibia), making up the knee. The fibula is a smaller bone on the outside of the shin but not part of the knee joint and does not bear significant weight, functioning as an area of attachment for the ankle, foot and toe muscles. The knee divides the leg by its hinge, functioning to allow the delivery of high levels of muscular propulsive force, to enable shortening of the limb during gait and to bend the knee in sitting and other resting postures.

A normal joint exhibits accessory movements which are small sliding and gliding motions inside the joint, occurring during movement but a person is incapable of performing them in isolation. They are very important in joint function and should they be reduced or lost this will impact on the ability to use the joint and could cause pain. Because the hip joint is stable and very deep it is not obvious there is much in the way of accessory movement. The main one is a downwards and upward movement of the head in and out of the socket.

The hips are ball and socket joints between the legs and the pelvic part of the trunk. The joint consists of a rounded ball (the femoral head) which fits into the reciprocally rounded socket (the acetabulum) which is quite deep and envelops most of the head. It is a large joint, the surfaces mirror each other well and it is stable. The articular cartilage of the hip is a shiny, friction-free material which aids the easy movement of the joint even under load, and is vital to normal functioning of the hip. The cartilage is thickest where weight bearing occurs most commonly, at the uppermost point of the head and the socket.

The ankle is often classified as a mortise joint and is a very special joint due to its position in the body. The ankle hinge performs forwards and backwards movement during gait and confers stability so that we can balance during motion and on rough surfaces. The lower leg is connected to the foot by the ankle and this permits the body weight to be transmitted across the joint to the propulsion unit which is the foot. Most of the upper part of the joint consists of the tibia with a small contribution made by the fibula on the lateral side.

Most pain is related to injury or tissue damage and the treatment is relatively straightforward in theory: the tissue at fault is searched for and investigated, a cause is found and the treatment is aimed at improving the underlying abnormality. This is the medical model of disease and injury and it works exceptionally well, diagnosing our fractured leg, pneumonia, arthritic joint or heart attack and then treating it so the problem is solved. The difficulty starts with the many pain conditions which dont fit into this model and which are not well diagnosed or treated by medical doctors.