Shah Punwar Orthopaedics is happy to offer patients a new practice location at the BMI The Sloane Hospital in Beckenham. Our Kent Orthopaedic Clinic will start offering appointments from Wednesday 14th April. Please book via the BMI booking line on 0808 273 6283 or it’s now possible to book your appointment with Mr Shah Punwar online via the BMI booking system:


The anterior cruciate ligament (ACL) is a ligament in the knee, which joins the femur (upper leg bone) with the tibia (lower leg bone) and its function is to keep the knee stable. ACL tears are common amongst sportspeople, both professional and amateur.

ACL injuries generally occur when the knee is bent backward, or twisted. This can happen when you change direction quickly, land from a jump or slow down from running, all of which are common in pivoting activities like football, rugby or skiing.

There are of course other, non-sports-related ways to injure your ACL. Other common causes are falling off a ladder or missing a step on the stairs.

Mr Shah Punwar is highly experienced in treating ACL tears and has an excellent track record, but what can you do to increase the chance of your surgery’s success?

Recuperation from ACL injuries

The journey to recovery from an ACL tear can be a long one and there is a serious risk of re-injury if a structured rehabilitation programme is not followed closely, particularly among athletes.

Surgery to repair an ACL tear can help you to return to your previous athletic form. However for contact sports, a delay in returning to the playing field of at least nine months can prevent re-injury.

One particular study showed that for every month that a return to full play was delayed, post surgery, the risk of reinjury was reduced by 51%.


Physiotherapy forms a crucial part of the recovery process after surgery on an ACL tear. Any athlete will know that it is important to warm up your muscles prior to commencing a sporting activity.

Physiotherapy performs this same function, but on a more gradual, long-term basis. This allows an injured body part to fully recover and regain strength before it is called back into action again.

The idea of fitting regular physiotherapy sessions into your schedule might seem too much to contemplate. But a recent study published in the British Medical Journal (BMJ) showed that even minimal physiotherapy can be effective in aiding recovery from ACL surgery.

We would always recommend however that a full physiotherapy programme is adhered to for optimal results.

Pre-operative physiotherapy

A growing body of evidence suggests that having physiotherapy before your surgery leads to a beneficial outcome. Indeed some patients may be able to avoid surgery altogether by following a good physiotherapy programme.

One study, published in the American Journal of Sports Medicine, found that patients who received pre-operative physiotherapy had better functional outcomes for the knee, with the benefits lasting for over two years after surgery.

Some components of a physiotherapy programme before ACL surgery might be:

  • Exercises to improve strength in the hamstring and quadriceps
  • Treatment to control swelling in the knee joint
  • Balance exercises
  • Neuromuscular training – this involves learning how best to jump and land in order to protect your knee

Pre-op physiotherapy is known as ‘prehabilitation’ and, combined with good post-operative physiotherapy and a delayed return to sport, is the best way of achieving a full recovery with reduced risk of re-injury.

For more information on ACL surgery or to book an appointment, please contact us by calling 0808 273 6283.

The maxim ‘no pain, no gain’ has just been reinforced by the publication of a recent Canadian osteoarthritis study, published in Osteoarthritis and Cartilage, the official journal of the Osteoarthritis Research Society International. The study has shown that working through any initial pain caused by exercise will pay off in the end as pain levels will decrease.

Osteoarthritis is the most common form of arthritis and can affect any joint in the body, although the large weight-bearing joints such as the knees are particularly susceptible. It occurs when the cartilage that protects and cushions the ends of your bones wears down, causing pain and stiffness. It’s thought that 8.5 million people suffer from osteoarthritis in the UK.

The study, from researchers at Western University’s Wolf Orthopaedic Biomechanics Laboratory (WOBL), found that rather than giving up exercise when it hurts, persistence pays off.

“You really shouldn’t be afraid of exercise. We know it can sometimes hurt when you move a joint with OA, but as long as you’re careful about it and take a break when you have substantial amounts of pain, it’s actually better for you to keep exercising,” said Trevor Birmingham, a physical therapy professor at Western who is also Canada Research Chair in Musculoskeletal Rehabilitation.

A 12-week neuromuscular exercise programme was devised for knee arthritis patients. During the supervised therapy sessions, participants were questioned about their perceived exertion and pain levels.

Rather than aerobic or strength training, neuromuscular exercise focuses on postural control and balance. For example, ensuring your knee is in the correction position while performing the various exercises.

Listening to your body

With any exercise programme it is essential that you listen to your body. Patients on the Western study knew to expect there would likely be some pain experienced at the start of the exercise programme but that this should subside. However, if the pain went above a certain threshold then the exercises would be modified.

Orthopaedic surgeon Mr Shah Punwar explains to his patients that there is much evidence that moderate exercise and even running is good for osteoarthritis, contrary to what used to be taught.

A 2013 study that compared the effects of running vs walking, found that running significantly reduced the risk of requiring a hip replacement, in part due to its weight loss benefits.

For more advice on management of osteoarthritis, call 0808 163 1268 to arrange a consultation with Mr Shah Punwar.

If it wasn’t enough to contend with Coronavirus this winter, anyone suffering from arthritis knows that the colder months can worsen joint pain and stiffness. There have been a number of studies that have tried to explain why some people seem to suffer more through the winter.

Arthritis and cold weather

One explanation is that a drop in barometric pressure which occurs when temperatures change can cause the expansion and contraction of the tendons, muscles and bones, resulting in increased pain in our joints. Scar tissue can also react in the same way so anyone who has damaged their knees or hips might suffer when it’s cold.

It’s also thought that a change in temperature could increase the thickness of the synovial fluid that lines our joints. Synovial fluid acts as the body’s shock absorber, but this thickening could make the joints stiffer.

Inflammation is also a factor as genes that promote inflammation proliferate in winter. Another argument is that our pain receptors are more sensitive during cold weather. Researchers at Manchester University recently used a smartphone app to track how people responded to different weather fronts and found that arthritis sufferers are 20% more likely to experience pain on days that are windy.

Separate to a physical link between winter and arthritis, it may also be that when it is colder, we are less likely to be active and therefore experience more stiffness and, as a result, increased pain. Less daylight hours and poor weather can make us more prone to anxiety and lower mood levels and less able to cope with joint-related pain.

Tips on managing knee or hip pain during winter

  • Keep your joints warm by wearing thermals or layers of clothing
  • Taking a warm bath or shower, hot water bottles or electric blankets could help ease pain and stiffness
  • Getting plenty of sleep although joint pain often can affect sleep patterns and you should speak to your GP if this is the case
  • Stay as active as you can as it can help alleviate pain and improve your circulation and also helps to keep excess weight off your affected joints

If your pain continues to worsen or is not alleviated by any of the measures you adopt, arranging a consultation with an orthopaedic consultant to discuss your treatment options, both non-operative and surgical, is advisable. Call 0808 163 1268 to arrange your consultation with Mr Shah Punwar.

Hip replacement surgery can often seem daunting, but the benefits of increased mobility, and absence of pain and discomfort, usually outweighs any concerns for those suffering from hip arthritis. Now, another benefit can be added to the list; according to a new article in the Journal of the American Academy of Orthopaedic Surgeons, patients that underwent a total hip replacement experienced a ‘significantly lower number of falls post-op than those who did not have the surgery’.

Total hip replacement and fall risk

Researchers used a New York database of nearly 500,000 arthritis patients. These patients had either had total hip or total knee replacements, and their fall rates were compared to those who didn’t have surgery.

Cases were tracked for up to two years after the procedure and then compared to arthritis sufferers that had not undergone surgery. It was found that those who had a total joint replacement were far less likely to fall.

Lead author of the study and orthopaedic surgeon Dr Ran Schwarzkopf explains why joint deterioration can increase the risk of falling: “As the wear and tear increases, patients lose their range of motion. They cannot turn their toes as easily, flex their hips or lift their legs high enough to avoid obstacles due to physical limitations as well as pain, resulting in falls and fragility fractures.”

The increase in range in motion and agility is a factor. Mentally, patients who have undergone a hip or knee replacement also experience less fear of falling and this, in turn, leads to more confidence in their everyday movements.

Hip replacement benefits

The secondary benefits of hip replacement and increased mobility are well documented. Previous studies have found that patients who underwent a total hip replacement had a reduced risk of heart failure, diabetes and depression. In 2018, a Swedish study found that hip replacement surgery not only improved quality of life, but also increased life expectancy, compared to the general population.

For more information on joint arthritis and the treatment options, both surgical and non-invasive, call us on 0808 163 1268 to arrange a consultation with Mr Shah Punwar.

Our National Health Service has had to rise to the challenge of the COVID pandemic by redesigning its services to cope with the onslaught of patients. As a result of these decisions, though, there have been many unintended effects in terms of access to acute care, diagnostics and planned surgery.

In fact, COVID has been described as a ‘wrecking ball’ through NHS waiting times and we have had warnings from hospital trusts that it may be up to two years before patients are seen for non-urgent care. These longer waits are already having a profound and negative impact on patients’ lives. Patients that are waiting for these procedures that are deemed non-urgent, such as knee or hip replacements, will be suffering increasing pain, lack of mobility and reduced quality of life.

Unfortunately, the timing of your joint replacement procedure is essential. In January, an American study found that most knee OA sufferers wait too long before they opt for a knee replacement. Researchers at Northwestern University concluded that when patients wait too long, they lose more function and can’t be as active, leading to weight gain, depression and other health issues. Surgery may not also be as successful at a later stage and they lag behind in optimal results.

Self pay joint replacements

The pre-COVID state-of-affairs was far from perfect. For several years now, waiting lists for planned care have grown and waiting times have increased and it has been driving patients to explore self-pay options. According to healthcare analysts LaingBuisson, there was a 7.4% growth in self-paying patients between 2014 and 2018.

While NHS wait times are cited as the ‘key driver’ in this trend, there are other factors. Private care should mean you are at less risk of cancelled or moved operations and the impact that can have on your employment. Same day surgery and enhanced recovery are more likely to be options. The relative cost of private surgery has also become more affordable.

At the beginning of this year LaingBuisson forecast the market will continue to grow to £1.3bn by 2021, figures which are surely being readjusted to take in the impact of COVID. If you want more information on our self-pay joint replacements, call us on 0808 163 1268 to arrange a consultation with Mr Shah Punwar.

The elite athletes competing in the Winter Olympics will be focused on staying fit and avoiding injuries. Although traumatic injuries such as knee ligament ruptures receive a lot of attention, there are a number of lesser known conditions that cause leg pain in athletes at all levels. Shin splints is a general term used to describe exercise-induced pain in the front of the lower legs, or shins.

As well as general considerations, such as the the type of surface you run on and the footwear you use, there are many specific causes of exercise induced leg pain.

Some of the more common ones are outlined below:

Tibial Stress Fractures

These are incomplete cracks in the tibia where repetitive loading has overcome the ability of the bone to resist it. They may occur more frequently in specific sports such as long-distance runners.

Medial Tibial Stress Syndrome

This is a common cause of shin splints. Pain is usually felt in the lower, inner aspect of the shin secondary to repetitive stress and subsequent periosteal (the outer layer of bone) stimulation and inflammation.

Muscle strain

Muscle fibres may be damaged by over-stretching; the most likely site being at the front of the shin. Symptoms are acute pain within the muscle at the site of the tear. The area may also be swollen and warm.


This is where microtears in a tendon cause inflammation in the surrounding tissue It is an overuse injury, generally caused by excessive repetitive movements, particularly over-stretching and loading of a muscle. Pain occurs mainly at the start of and after exercise.

Chronic exertional compartment syndrome

This overuse condition, caused by tight fascia (connective tissue) around the muscles, produces symptoms during and for about 15 minutes after training. Typical post-exercise examination findings include tightness in the back of the lower leg and paraesthesia (pins and needles). Pain is often described as cramping. There may also be associated muscle tears.

Nerve entrapment syndromes

Peripheral nerves can become trapped leading to symptoms in the affected nerve distribution. This is particularly common when nerves run in confined spaces and can occur due to local trauma. Patients often describe the pain as sharp and shooting. Specific examples of sporting nerve entrapments include the ilio-inguinal nerve (hockey player’s groin) and the medial plantar nerve (jogger’s foot).

Essentially many of these conditions are caused by overuse. It is therefore important not to try to ‘run through the pain’, undertake a period of rest, and seek expert advice where appropriate.

We all know what it is like to knock into something and bruise ourselves. But whilst simple soft tissue bruises will usually improve over 1-2 weeks, bruising to the bone can often take a lot longer to recover from.

The term itself is often misleading. Whilst it is possible to cause bleeding under the thick layer of tissue covering bones (periosteum) it is also possible to cause microfractures to the internal structure of bones without causing an outer break or fracture.

These true bone bruises can only be seen on magnetic resonance imaging (MRI) scans and show up as areas of ‘high signal’ meaning fluid. The fluid comes from bleeding from the damaged bone fibres. Bone bruises seen on MRI indicate that quite a severe injury has been sustained and in the context of knee injuries often go with ligament damage such as anterior cruciate ligament (ACL) ruptures.

This type of bone injury is often found in athletes who participate in martial arts, where it is normal to block an incoming attack with the use of your arms and legs. Internal bone bruises do not need any specific treatment but will affect rehabilitation and recovery from injuries.

For further information on bone bruises, call us on 0808 163 1268 to arrange a consultation with Mr Shah Punwar.

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