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Knee pain when climbing stairs: what may be behind it and when to seek help

2 October 2026 Magazine 0 Comments

Going up or down stairs is an everyday action, but when your knee hurts it can become the hardest part of the day. Some people feel a sharp pain on the first step, others only notice discomfort on the way down, and others need to hold the handrail even though walking on level ground causes no problems.

Knee pain on stairs does not, by itself, point to a diagnosis. It can be influenced by tolerance to load, muscle strength, mobility and the way movement is controlled. In some cases, joint or tendon conditions also play a part and require a specific assessment.

Noticing when the symptom appears and how it changes over time helps distinguish a passing discomfort from a problem for which it is useful to seek an assessment.

On a step, the knee has to bend more than it does when walking on level ground. The thigh and hip muscles have to control body weight as the foot moves to the next step.

This control is particularly noticeable when going down: the leg has to lower the body without letting it drop. If a joint or tissue is sensitive to load, discomfort may show up precisely here, even when a walk causes no symptoms.

The difference between walking and taking the stairs is therefore useful information, not proof that the problem is serious.

The height of the steps and your speed also change the demands. Hurrying down a steep staircase is not the same as calmly taking a few low steps: describing the actual situation makes the symptom easier to understand.

Pain felt at the front of the knee or around the kneecap may be associated with a patellofemoral problem. Stairs, squats or getting up from a chair are movements that can sometimes make it more noticeable.

The location of the pain alone, however, is not enough to establish its cause. It is important to consider how long the symptom has been present, which activities increase it and how the knee, hip and foot move. A sudden change in training or everyday activities can also alter tolerance to load.

The aim of the assessment is not to look for one 'wrong' position, but to understand which factors really matter for that person.

If the pain began after returning to running, using more stairs than usual or increasing exercise, it may help to trace that change. This is not to avoid those activities for good, but to find a progression the knee can tolerate.

Not all pain on stairs is felt at the front. Some people feel it on the inner or outer side; others describe a deeper pain that is hard to locate.

Its location can guide the questions asked during an assessment, but on its own it cannot distinguish a tendon problem from one involving the tissues around the joint or the joint itself. Swelling, possible injuries, stiffness, a feeling that the knee may give way and limits on everyday movement also matter.

That is why two people who point to the same painful spot may need very different approaches.

When you step up, the thigh and hip muscles help support your body. When you step down, they have to control the movement gradually. If this ability has decreased, the knee may have to handle a load that it currently finds difficult to tolerate.

Strength can decline after a period of inactivity, an injury or simply weeks of avoiding stairs for fear of pain. Balance and coordination can also affect how you negotiate a step.

This does not mean that every case of pain is due to 'weak' muscles. It means that strength and control are worth checking alongside the other elements of the clinical history.

If swelling accompanies the pain, the knee may not bend as easily. Going up, and especially down, stairs then becomes more tiring because the movement requires more bending than may be needed on level ground.

Stiffness can be temporary after unusual exertion, but it must be interpreted in context. A mild feeling of tightness that improves within a few days is different from a joint that is very swollen, hot, locked or difficult to bear weight on.

If the changes are significant or persistent, it is better to seek healthcare advice than to force the movement.

This detail may seem minor, but it shows how the knee responds to different demands. Some people feel pain while pushing themselves up; others mainly feel it while controlling the descent.

It can help to notice whether the discomfort starts after just a few steps or only after several flights, whether using the handrail changes it and whether slowing down helps. The next day matters too: an activity that seems tolerable can lead to increased symptoms in the following hours.

These observations help the physiotherapist identify a realistic starting point for recovery, without turning every step into a test that must be passed at all costs.

Alternating feet on each step or taking one step at a time are also strategies that may change how tiring the stairs feel. They can be useful for a while as you work towards taking the stairs the way you want to.

When pain is intense, temporarily using fewer flights of stairs or holding the handrail may be reasonable. Avoiding all movement for weeks, however, is not always helpful: the ability to cope with that load may decline further.

It is usually more sensible to adjust activity according to how the knee responds. You can start with a manageable number of steps, move at a slower pace and alternate demanding activity with recovery.

Progression depends on the cause of the pain and the individual situation. If the knee becomes markedly worse, swells or cannot bear weight, stop and seek an assessment.

A physiotherapy assessment does not simply look at the knee while it is still. It may include joint mobility, lower-limb strength, balance and how the person climbs, descends or gets up from a chair.

The physiotherapist also considers usual activities, recent changes in load and any known conditions. On that basis, they may suggest progressive exercises, strategies to manage pain and a gradual return to activities that are currently difficult.

If signs emerge that require further investigation, care must be coordinated with a doctor. Physiotherapy does not replace a diagnosis when one is needed.

The choice of exercises depends on what the person can do today: some begin with simple movements and light loads, while others can already work on steps, balance and sporting activities. The response in the following hours guides adjustments.

Knee pain after a significant injury, a deformed or very swollen joint, or an inability to put weight on the leg or move the knee calls for prompt medical assessment. A fever together with a hot, red knee also needs urgent attention.

If the pain is less intense but keeps returning, increases over time or limits everyday activities, there is no need to wait until it becomes unbearable. An assessment can clarify how to manage the load and whether further investigations are needed.

The goal is not merely to get through one flight of stairs without pain once. It is to do so with safer movement and an ability that lasts in everyday life.

For some people, the focus is on restoring mobility; for others, on strength, balance or managing an activity that increased too quickly. These aspects often overlap.

If knee pain on stairs continues to affect your days, an assessment may help you understand what is contributing to it and where to start, with gradual goals suited to your situation.

After a fall, an older person can lose confidence even without being hurt: why does it happen?

25 September 2026 Magazine 0 Comments

A fall does not necessarily have to cause a fracture or an obvious injury to leave its mark. An older person who falls, even without any significant injury, may in the following days start to move more cautiously, avoid certain activities and feel less steady when walking. It can happen at home, on the stairs, outdoors or simply while getting around during the day. The reason is not always physical: often the fear of falling again comes into play, gradually changing the way the person moves.

It is precisely at this stage that rehabilitation for older people can become important. The aim is not only to recover from any physical limitations, but to prevent fear from leading the person to move less and less, with a resulting loss of strength, balance and independence.

In other words, a fall that appears to have had no consequences can set off a mechanism that deserves attention.

After a fall it is normal to be more careful for a few days.

The problem arises when caution gradually turns into giving things up.

Someone who used to go out for a walk may start to avoid going out alone. Some people stop using the stairs, move around only by holding on to the furniture, or ask family members to accompany them even for activities they were doing on their own until recently.

In other cases the change is less obvious.

The person keeps walking, but more slowly, with shorter steps, constantly looking at the floor or stiffening the body for fear of losing their balance again.

These behaviours may seem simply a natural consequence of age, but sometimes they appeared precisely after a fall.

And it is important to notice.

The fear of falling can create a kind of vicious circle.

After the episode the person feels less steady and, to protect themselves, moves less. By moving less, however, they use their muscles less and give balance and coordination less stimulation.

Over time they may therefore genuinely feel weaker.

This further increases the feeling of insecurity and leads them to avoid even more activities.

The mechanism can be summed up like this:

fall → fear → less movement → loss of strength and confidence → even more fear of falling.

This is why the best solution is not always simply to tell an older person to “be careful”.

Safety also depends on the ability to keep moving.

Everyday movement plays a very important role in maintaining physical abilities.

Getting up from a chair, walking, climbing a few steps, changing direction or getting around outdoors are all actions that require a combination of strength, balance, coordination and body control.

When these activities are gradually dropped, the abilities needed to perform them can decline too.

It is a process that can become particularly evident in older people, especially if reduced strength, joint problems, balance difficulties or long periods of inactivity were already present before the fall.

Rehabilitation for older people therefore aims to maintain or regain precisely those abilities that make it possible to face daily life with greater confidence.

Before talking about recovery, it is important to understand how the fall happened.

Slipping on a wet floor is not the same as suddenly losing your balance while walking normally.

Likewise, tripping over a rug is a different situation from a fall accompanied by dizziness, loss of consciousness or sudden weakness.

For this reason, especially when the cause of the fall is unclear or when episodes recur, it is advisable to discuss it with a doctor.

An assessment can be even more important if, after the fall, there is significant pain, difficulty putting weight on a limb, confusion, persistent dizziness, loss of consciousness or other new symptoms.

Physiotherapy can work on movement abilities, but it is just as important to understand whether medical factors contributed to the episode.

A physiotherapy assessment is not only about the part of the body that may have been affected by the fall.

It can be useful to observe how the person gets up from a chair, how they walk, how they change direction and how steady they are when they have to deal with small obstacles or shift their weight from one leg to the other.

Other aspects may also be considered, such as:

lower limb strength;
static and dynamic balance;
joint mobility;
walking speed and steadiness;
ability to stand up and sit down;
coordination;
any need to use a mobility aid.

Another important element is understanding which activities the person has stopped doing since the fall.

Sometimes it is these very changes that reveal more about the problem than the pain does.

Telling someone who is afraid of falling to go straight back to their previous activities is rarely enough.

Confidence has to be rebuilt gradually.

A programme can begin with simple, controlled movements: standing up and sitting down, holding a stable position, shifting weight, taking small steps in different directions.

Activities closer to everyday life can then be introduced, such as walking on different surfaces, turning round, reaching for an object or tackling a few steps.

The difficulty is increased gradually according to the person's abilities.

The aim is not to put the older person to the test, but to let them experience movement again under controlled conditions.

Every activity regained can help to rebuild confidence.

When an older person falls, it is also useful to look at the environment they live in.

Loose rugs, electrical cables, poor lighting, objects left in walkways or unsuitable footwear can increase the risk of tripping.

This does not mean turning the home into a place free of every obstacle.

It means identifying some avoidable risks without unnecessarily limiting the person's independence.

The possible use of a walking stick or a walking frame should also be properly assessed. An aid can increase safety when it is indicated, but it must be suited to the person and used correctly.

After a fall, family members too can understandably become more protective.

“Wait, I'll do it”, “Don't go out on your own”, “Don't use the stairs any more” are phrases that come from the wish to avoid another accident.

But taking over completely from the person can, in some cases, increase inactivity even further.

It is often more helpful to find a balance between protection and independence.

If an activity is still possible safely, continuing to do it can be an important part of recovery.

The aim is not to ignore the risk, but to prevent fear from ending up eliminating movements the person is still perfectly able to perform.

Rehabilitation for older people can be considered when, after a fall, changes appear such as greater unsteadiness when walking, going out less, difficulty getting up, loss of balance or gradually giving up normal activities.

It can also be helpful when the person says they are fine but family members notice that they are moving differently from before.

Acting at this stage makes it possible to work not only on strength, but also on confidence in movement.

And this is often the most important aspect of all.

After a fall with no serious consequences it is easy to think the problem is over the moment the pain goes away.

That is not always the case.

The fear of falling can continue to affect the person for much longer than the initial injury and, if it leads them to move progressively less, it can affect balance and independence.

Noticing these changes makes it possible to act before they become habits that are hard to change.

Recovery therefore means not only avoiding another fall, but feeling confident enough again to keep walking, going out, getting up, moving and taking part in normal daily activities.

Because, especially as we get older, keeping moving means keeping an important part of our independence.

Shoulder pain at night: why can it hurt just when you are in bed?

16 September 2026 Magazine 0 Comments

Shoulder pain at night is a very common complaint and can affect people of very different ages and habits: those who work long hours at the computer, those who do manual work, those who play sport, but also those who have had no obvious injury. It can appear when you lie down, wake you during the night or make it difficult to find a comfortable position.

The problem shows up above all during the night or in the early hours of the morning, often when the shoulder stays in the same position for a long time. It may be due to overload, joint stiffness, irritation of the tendons, changes in the rotator cuff or other conditions involving the shoulder and the surrounding tissues.

Understanding where it hurts, when it appears, which movements bring it on and why it gets worse in certain positions is important in order to tell a temporary discomfort from a situation that deserves a more thorough assessment.

During the day the shoulder is almost always moving. Even without realising it, we constantly change position, move the arm, alter how it is supported and spread the load.

At night exactly the opposite happens.

We can stay in the same position for a long time and, if we lie on the painful side, we increase the direct pressure on the tissues of the shoulder. In some conditions this can make an irritation that is already present more noticeable.

Sleeping on the opposite side does not necessarily solve the problem either. The arm of the painful shoulder can in fact fall forwards, keeping the joint in an uncomfortable position for several hours.

The silence and the absence of daily activities can also make the pain easier to perceive. During the day our attention is spread over many things; when we are in bed, a discomfort that previously seemed bearable can become much harder to ignore.

Among the structures most frequently involved in shoulder problems are the tendons of the rotator cuff, a group of muscles and tendons that contributes to the stability and movement of the joint.

When one or more of these tendons are irritated or overloaded, the pain can appear above all when lifting the arm, putting the hand behind the back or performing movements above the head.

In some cases the discomfort becomes particularly noticeable during the night.

This does not automatically mean that there is a serious injury. Tendinopathies, tissue irritation and changes in load can produce similar symptoms without necessarily being associated with severe structural damage.

This is why the symptom must always be interpreted in the overall context.

Position can play a role, but it is rarely the only explanation.

Sleeping directly on the painful shoulder can increase compression and make the discomfort more intense. Some people find relief by sleeping on their back with the arm lightly supported by a pillow.

Others are better off on the opposite side, keeping a pillow in front of the body and resting the painful arm on it.

There is, however, no universally correct position.

If the pain appears every night, changes according to the movements made during the day or is accompanied by an obvious reduction in mobility, simply changing the way you sleep may not be enough.

Another element to consider is what happens in the preceding hours.

Work that requires repetitive movements, overhead activities, intense training sessions or exercises performed with heavy loads can increase the stress on the tissues of the shoulder.

The problem may not be particularly obvious during the activity and instead appear several hours later.

A typical example is someone who spends a day doing manual work, gardening, DIY or exercises at the gym and then notices an increase in pain once lying down.

In these cases it becomes important to assess not only the painful spot, but also the way the load was distributed over the course of the day.

Not all night-time pain is linked to the tendons.

In some people the shoulder becomes progressively stiffer and everyday movements begin to shrink. Getting dressed, reaching for an object up high or putting the hand behind the back can become more and more difficult.

When mobility decreases significantly and night pain is severe, it is worth looking into the situation more closely.

One of the conditions that can present in this way is adhesive capsulitis, commonly known as “frozen shoulder”, but a diagnosis cannot be made on the basis of night pain alone.

The important feature to observe is the association between pain and progressive loss of movement.

The area where the pain is felt does not always coincide with the origin of the problem.

The cervical spine, for example, can cause symptoms that spread towards the shoulder, arm or shoulder blade.

In these cases there may also be tingling, changes in sensation, discomfort that varies with neck movements or pain that extends further down the arm.

A proper assessment also serves to distinguish a mainly joint or muscle problem of the shoulder from a disorder involving other structures.

It is one of the reasons why the simple question “where does it hurt?” is often not enough.

Even before talking about treatment, it can be useful to pay attention to a few details.

Does the pain appear only when you sleep on the affected side? Does it wake you even when you are on your back? Can you lift the arm normally during the day? Do you have difficulty getting dressed? Did the pain start after an unusual activity or did it appear gradually?

How things develop over time also counts.

A discomfort that appears after intense activity and gradually improves over the following days is different from a pain that keeps increasing for weeks.

Noting these elements down can make it much easier to understand the problem during a later assessment.

Shoulder physiotherapy starts first of all from an assessment of movement.

The physiotherapist can look at mobility, strength, control of the shoulder blade, any movements that cause pain and activities that prove more difficult.

Treatment is not necessarily the same for everyone.

Depending on the situation it may include exercises to regain mobility, progressive work on strength, load management and strategies to temporarily modify some activities that aggravate the symptom.

Manual therapy can also be used when indicated, but it rarely represents the whole programme on its own.

The aim is not simply to “make the pain go away”, but to gradually bring the shoulder back to tolerating the movements and activities of daily life.

Complete rest for long periods is not always the best solution.

If every movement is avoided for fear of pain, the shoulder can become progressively stiffer and some activities can prove even more difficult.

At the same time, continuing to carry out exactly the same activities that caused the overload can keep the irritation going.

The best approach is often somewhere in between: temporarily reducing the movements that aggravate the problem most, while maintaining a level of movement compatible with the symptoms.

Progression must be gradual.

Shoulder pain at night should not automatically cause concern, but some signs deserve a medical assessment.

It is important to look into it further if the pain appears after a significant injury, if you can no longer lift the arm, if there is sudden weakness, fever, obvious swelling or very intense pain that keeps getting worse.

Persistent pain that does not change over time and regularly disturbs sleep should also be assessed.

The same attention is needed when shoulder pain is associated with unusual symptoms such as difficulty breathing, chest pain or general malaise: in these cases you should see a doctor promptly.

Changing pillow, altering your position or avoiding sleeping on the painful side can help reduce the discomfort, especially in the early stages.

But when the problem keeps coming back, the more useful question is not only “how can I sleep without pain?”, but “why does my shoulder keep hurting?”.

Observing how the joint moves, which activities increase the symptoms and whether there are limitations in strength or mobility makes it possible to tackle the problem more precisely.

Night pain is in fact a symptom, not a diagnosis. Understanding its context is the first step towards using the shoulder with greater freedom again and, above all, towards being able to sleep once more without spending the night searching for the least painful position.

Menopause and physical activity: why loss of strength is not inevitable

28 August 2026 Magazine 0 Comments

Menopause brings real physiological changes, but progressively losing strength and physical capacity is not an inevitable consequence. Between the ages of 45 and 60, many women begin to notice differences that previously seemed minor: recovering after physical effort may take longer, certain movements may feel less easy, and everyday activities that had never been a problem can become more demanding.

At this stage, movement becomes even more important. The goal is not simply to "stay active", but to provide muscles and bones with sufficient stimuli to preserve their capabilities. Walking, cycling or swimming are useful activities, but when it comes to muscle strength during menopause, another often overlooked element should also be considered: resistance training.

A properly designed programme can help preserve strength, independence and confidence in movement. Physiotherapy and therapeutic exercise can become valuable tools, especially when pain, previous injuries or long periods of inactivity make it difficult to know where to start.

As we age, muscle mass and strength tend to gradually decrease. The menopausal transition can contribute to this process through hormonal changes, together with other factors such as physical activity levels, nutrition, sleep quality and lifestyle.

This does not mean that after menopause muscles stop responding to training.

Muscle tissue retains its ability to adapt to stimuli. When subjected to appropriate exercises that progressively become more challenging, it can continue to develop strength and improve its function.

The real difference is therefore also determined by what we ask the body to do. If muscular stimuli become progressively lower over the years, the loss of capacity may accelerate. If, on the other hand, the body continues to receive appropriate loads, there is considerable potential to maintain and improve physical performance.

A woman may walk every day, go hiking at weekends and lead an active lifestyle while still not providing her muscles with enough stimulus to increase their strength.

Aerobic activity remains important for general health, but it has different objectives from resistance training.

To work on muscle strength during menopause, muscles need to be asked to progressively produce greater amounts of force. This can be achieved using weights, resistance bands, machines or appropriately adapted bodyweight exercises.

This does not necessarily mean lifting extremely heavy loads. It means using resistance that is sufficiently challenging in relation to individual abilities and adjusting it over time as the body adapts.

Strength training is not only useful for sport.

Getting up from a chair, climbing stairs, carrying shopping bags, moving an object, walking on uneven ground or getting up from the floor all require muscular capacity.

When available strength decreases, these activities require an increasingly large percentage of a person's resources. A simple movement can therefore gradually become more demanding.

Having a good strength reserve means being able to manage everyday life with greater capacity. It also means continuing to enjoy the activities you love without perceiving every physical effort as something to avoid.

The goal of exercise is not to pursue an aesthetic ideal, but to maintain a capable body.

Menopause is a stage during which bone health also deserves particular attention. The reduction in oestrogen levels can contribute to a decrease in bone mineral density and, in some people, increase the risk of osteoporosis over time.

Physical exercise is one of the useful tools for supporting musculoskeletal health.

Resistance exercises and weight-bearing activities produce mechanical stimuli that affect not only the muscles but also the bones. The programme must naturally be adapted to the individual's situation, especially in the presence of diagnosed osteoporosis, previous fractures or other clinical conditions.

Training more does not automatically mean training better: the choice of exercises, intensity and progression are what make the difference.

Lower back pain, knee discomfort, joint stiffness or shoulder problems can lead people to progressively reduce their physical activity.

This is understandable, but avoiding all movement risks creating an unfavourable cycle: you move less, lose strength, certain activities become more difficult and, as a result, you move even less.

The presence of pain does not necessarily mean that exercise must be stopped. It is often possible to modify movements, loads and ranges of motion in order to continue training in a way that is compatible with the situation.

A physiotherapy assessment can be particularly useful when you are unsure which exercises to choose or are concerned that movement could make the problem worse.

An effective programme should not be a standard sequence that is identical for everyone.

Age, training experience, any existing medical conditions, pain, goals and starting level can significantly change the way the programme should be structured.

A programme may begin with relatively simple movements and progress towards more demanding exercises. Adapted squats, lower-limb exercises, pushing and pulling movements, calf exercises and balance exercises can be combined in different ways.

The central principle is progression: when an exercise becomes easy to manage, the stimulus needs to evolve.

It is this transition that transforms simply "being active" into genuine muscle strength training during menopause.

One of the most limiting beliefs is that if you have never done strength exercises before, starting after the age of 50 will make little difference.

This is not the case.

Training can also be introduced for people who have spent many years without structured physical activity. Naturally, the starting point will be different from that of a woman who already trains regularly, but the principle remains the same: provide an appropriate stimulus and increase it gradually.

There is no need to make up for years of inactivity in just a few weeks. Trying to do so can actually unnecessarily increase fatigue and the risk of overload.

Consistency matters far more than rushing.

There is no single amount that is appropriate for everyone. Frequency and intensity depend on the initial condition, individual goals and other activities performed during the week.

An effective programme must also allow sufficient time for recovery. Training consistently does not mean working the same muscle groups every day.

It is useful to observe how the body responds in the hours and days that follow: normal muscle fatigue is different from increasing pain or symptoms that persist and limit activities.

Progression should follow the individual's ability to adapt, not a rigid schedule.

At TI-FISIO in Mendrisio, strength training starts from the person's actual abilities, not from their chronological age or a pre-designed programme.

The assessment makes it possible to identify any limitations and establish a practical starting point. The programme may then include:

assessment of strength and mobility;
resistance exercises adapted to the individual's level;
balance and movement control exercises;
gradual progression of loads;
adaptation of exercises in the presence of pain;
restoration of function after periods of inactivity or previous injuries.

Physiotherapy therefore becomes a tool for building capacity, not simply for treating a symptom. The goal is to progressively make the person more independent and confident in physical activity.

Menopause represents a period of change, not a boundary beyond which a progressive loss of physical abilities must be passively accepted.

Training the muscles means investing in the ability to continue walking, travelling, practising sport, managing everyday activities and maintaining independence over the years.

Muscle strength during menopause can be trained with programmes designed around the individual's starting level and progressively adapted over time. Even those who have never performed resistance exercises can start, provided they do so according to criteria appropriate to their individual condition.

If you want to start strength training, resume physical activity after a period of inactivity or are experiencing pain and are unsure which exercises are most suitable, contact TI-FISIO in Mendrisio. A physiotherapy assessment can help you build a personalised, progressive and sustainable programme, turning movement into a practical resource for staying strong and active over time.

Surgical scars and movement: what can happen months after surgery

21 August 2026 Magazine 0 Comments

After surgery, attention is inevitably focused on the first few weeks: the wound needs to heal, the pain needs to decrease and normal activities need to be gradually resumed. When the skin appears healed and the scar becomes less visible, it is easy to think that the recovery process is also complete. This is not always the case.

A scar continues to change for months. The tissues undergo a remodelling process that can affect elasticity, sensitivity and their ability to glide over the underlying layers. In some people, everything progresses without any particular consequences; in others, stiffness, discomfort during certain movements or a feeling of tension in the operated area may persist.

Post-operative scars should therefore not automatically be considered problematic, but neither should they be assessed solely on their appearance. When they interfere with movement or are associated with persistent symptoms, a physiotherapy assessment can help determine what is actually happening.

The visible part is only one of the elements involved in healing. Surgery can affect several layers of tissue, and each one must go through its own repair process.

During healing, the body produces new connective tissue to restore continuity in the affected area. In the early stages, this tissue has different characteristics from the original tissue and subsequently continues to organise and mature.

This is why a scar may appear closed externally while the tissues are still changing their characteristics.

This does not necessarily result in a limitation. Many scars develop without causing any problems. However, when gliding between the different tissue layers is reduced, some movements may feel less free or may be accompanied by tension.

One of the sensations most frequently described after surgery is a feeling of tightness in the area during movement.

This can occur, for example, after abdominal surgery when fully extending the body, after knee surgery during flexion or near the shoulder when raising the arm overhead.

This sensation does not necessarily mean that the scar is causing damage. It may be related to the characteristics of the scar tissue, local sensitivity, a temporary reduction in movement or simply the fact that the area is not yet being loaded in the same way as before surgery.

A thorough assessment is useful precisely to distinguish a normal stage of recovery from a limitation that may benefit from treatment.

During the first few weeks after surgery, there are specific precautions established by the surgeon and healthcare team. Once this phase has passed, movement is generally reintroduced progressively.

Recovery, however, does not end when a person is able to walk, work or carry out everyday activities again.

A person may regain good independence and only realise months later that certain movements remain difficult. The problem may become apparent when returning to the gym, resuming a sport, lifting a weight or trying to achieve a range of motion that was not necessary in everyday life.

It is at these moments that post-operative scars may become relevant again, particularly when greater demands are placed on the operated area.

Not all the effects associated with a scar involve mobility.

After surgery, changes in sensitivity may occur in the surrounding area. Some people report reduced skin sensitivity, while others experience tingling, burning, itching or particular discomfort when the area comes into contact with clothing or objects.

These sensations may also be related to the involvement of small superficial nerve structures during surgery and their subsequent healing.

In many cases, sensitivity gradually changes over time. However, when the problem persists, increases or limits everyday activities, it is useful to discuss it with a professional to determine whether further investigation or specific rehabilitation may be necessary.

When discussing scars, the word "adhesion" is often used to explain any sensation of stiffness or pain.

This is an oversimplification that is not particularly helpful.

Adhesions between tissues can indeed develop after surgery, but not every symptom can automatically be attributed to the scar. Pain may also be influenced by reduced strength following a period of inactivity, joint mobility, tissue sensitivity and the way a person has resumed using the operated area.

Attributing everything to the scar risks overlooking other important aspects of recovery.

Physiotherapy should therefore begin with function: which movements are difficult? When does the pain occur? How much load can the area tolerate? What has changed compared with before surgery?

There is no rule stating that all post-operative scars need to be treated.

However, an assessment may be useful when, some time after surgery, there is:

tension that limits certain movements;
pain during specific activities;
persistent local sensitivity;
difficulty fully recovering mobility;
a feeling of stiffness in the operated area;
difficulty returning to sport or physical activity;
fear of loading or moving the affected area again.

The appropriate time for an assessment also depends on the type of surgery and the instructions provided by the surgeon. Respecting the biological healing process always remains a priority.

The treatment of post-operative scars is sometimes reduced to the concept of scar massage. Rehabilitation can be much broader than this.

When indicated, the physiotherapist may work on local mobility and tissue gliding, but must also assess what happens during movement.

The rehabilitation programme may include:

progressive mobilisation of the area;
work on sensitivity;
restoration of range of motion;
strengthening exercises;
gradual exposure to movements that cause tension;
progressive loading based on everyday or sporting activities.

The goal is not to make the scar "perfect", but to restore function so that the person can move without avoidable limitations.

After surgery, it is normal to protect the operated area. The problem arises when this caution continues even after medical restrictions have been lifted.

Avoiding a movement for months because of the fear that it might "open" or damage the scar can contribute to a loss of strength and mobility. Returning to movement must, of course, respect the type of surgery and medical advice, but once clearance has been given, it is important to progressively rebuild confidence.

Physiotherapy can also support this stage by gradually increasing the difficulty of exercises and showing the person what their body is once again capable of doing.

At TI-FISIO in Lugano, the scar is assessed as part of the overall recovery process following surgery. The assessment does not focus solely on the mark on the skin: mobility, sensitivity, strength, quality of movement and the activities the person wishes to resume are also considered.

Based on the assessment, the rehabilitation programme may include:

✔️ manual techniques when appropriate;

✔️ progressive restoration of mobility;

✔️ personalised therapeutic exercise;

✔️ work on sensitivity and confidence in movement;

✔️ progression towards everyday, work-related or sporting activities.

The scar is therefore considered for what it actually represents: one part of a system that needs to regain the ability to move, adapt and tolerate load.

Having a scar months or years after surgery is normal. What deserves attention is the possible presence of pain, stiffness or limitations that continue to interfere with the activities a person wants to perform.

Even when surgery took place a long time ago, it may still be useful to determine whether there is room for improvement in function. The problem does not always depend directly on the scar, and an individual assessment is precisely what helps avoid oversimplified interpretations.

If you have one of the post-operative scars that continues to be associated with tension, pain or difficulty with movement, contact TI-FISIO in Lugano. The team can assess your situation and, when indicated, develop a personalised physiotherapy programme to help you regain mobility, strength and greater confidence in the activities you want to return to.

Shoulder pain during active vacations: paddle, swimming, and beach volleyball under observation

10 August 2026 Magazine 0 Comments

Summer is the time of year when many people rediscover the pleasure of outdoor sports. Some take advantage of their holidays to go swimming, others try paddleboarding for the first time, while others spend entire days playing beach volleyball with friends and family. These activities encourage movement and well-being, but they can also place stress on one of the most complex joints in the human body: the shoulder.

It is not uncommon for discomfort to appear after just a few days of holiday, particularly during overhead movements, along with pain when lifting the arm or a feeling of stiffness that makes even simple movements difficult. In most cases, these symptoms are not the result of a sudden injury, but rather a combination of repetitive movements, unfamiliar loads and physical preparation that may not always be adequate.

Taking action at the first signs can often prevent minor discomfort from developing into a more persistent problem. In these cases, a shoulder physiotherapy programme can help identify the causes of the pain, restore joint function and allow you to return to your activities safely.

The shoulder has a wide range of motion that allows it to perform many different movements. This characteristic is an advantage in sports activities, but it also makes the joint particularly sensitive to overload.

During paddleboarding, swimming or beach volleyball, the arm performs hundreds of repetitive movements above head level. Muscles, tendons and joint structures must therefore work in perfect synergy to maintain stability and precision.

When the load increases suddenly or the muscles are not sufficiently prepared, pain, stiffness and loss of strength may occur.

In recent years, paddleboarding has become increasingly popular, especially during the summer season.

Many people start practising it while on holiday, spending long periods on the water without any specific preparation.

The continuous paddling movement places considerable demands on the shoulder, particularly during acceleration and changes of direction.

Poor technique or increasing the amount of time spent on the water too quickly can contribute to discomfort that tends to worsen day after day.

Swimming is often recommended as a beneficial activity for the joints, but this does not mean that it is completely risk-free.

Different swimming strokes involve repetitive movements that continuously engage the shoulder. If technique is incorrect or training volume increases too quickly, tendons and muscles may become overloaded.

Pain frequently occurs during the recovery phase, when the arm moves out of the water, or during overhead movements, but it may also develop in the hours following training.

In many cases, it is not necessary to stop the activity completely. A physiotherapy assessment can help identify the cause of the problem and manage the load in the most appropriate way.

When shoulder pain occurs, many people immediately think of tendinitis.

In reality, there can be several different causes.

Sometimes the problem is related to reduced joint mobility, while in other cases it may be associated with weakness of the rotator cuff muscles or suboptimal control of the shoulder blade during movement.

Suddenly increasing the number of training sessions or returning to a sport after many months of inactivity can also contribute to the onset of symptoms.

For this reason, identifying the actual source of the pain before beginning any treatment is essential.

Many problems can be prevented by following a few simple precautions.

Among the most important are:

gradually increasing the amount of time dedicated to sports activities;
always performing an adequate warm-up;
avoiding concentrating many hours of sport into just a few days;
alternating training days with adequate recovery;
stopping the activity if the pain tends to increase.

Small changes in sporting habits can significantly reduce the risk of overload.

At TI-FISIO in Lugano, every shoulder physiotherapy programme begins with a thorough assessment to understand the actual source of the pain.

The assessment does not focus solely on the joint, but also considers how the muscles, shoulder blade and spine work during movement.

The rehabilitation programme is tailored to the individual's needs and may include:

✔️ functional assessment of the shoulder;

✔️ personalised therapeutic exercises;

✔️ manual therapy when indicated;

✔️ restoration of mobility;

✔️ gradual return to sports activities.

The goal is not only to reduce pain, but also to enable the person to return to paddleboarding, swimming, beach volleyball or any other activity with greater safety and a lower risk of recurrence.

Holidays are the ideal time to enjoy sports and physical activity, but listening to your body's signals is essential to prevent minor discomfort from interfering with the pleasure of being active.

If the pain persists or tends to recur, a shoulder physiotherapy programme can help you gradually restore mobility, strength and function through a personalised approach.

The TI-FISIO team in Lugano is available to assess your condition and guide you through a rehabilitation programme tailored to your needs, with the aim of helping you return to sport safely without giving up the activities you love.

Returning to sport after an injury: why rushing is your worst enemy

5 August 2026 Magazine 0 Comments

For people who practise sport, being forced to stop because of an injury is often one of the most difficult situations to accept. After days or weeks away from training, the desire to return can easily take over. This is an understandable reaction: sport is not only physical activity, but also a source of wellbeing, social interaction and personal motivation.

However, this very impatience can become the main obstacle to recovery. Returning to training too early, before fully regaining strength, movement control and the ability to tolerate physical loads, significantly increases the risk of reinjury.

In recent years, the concept of returning to sport has changed considerably. In the past, the disappearance of pain was often the main criterion considered. Today, however, several different factors are assessed to determine whether the body is genuinely ready to resume physical activity safely.

Understanding these principles helps prevent mistakes that could compromise weeks of rehabilitation and allows athletes to return to sport with greater confidence.

One of the most common mistakes is believing that the absence of pain means that the injury has completely healed.

In reality, pain is only one of the factors that must be assessed.

A person may no longer experience discomfort during everyday activities but may still have weaker muscles, less stable joints or altered movement patterns. Under these conditions, the injured tissue may not yet be ready to tolerate the demands of the chosen sport.

For this reason, returning to sport should never be based exclusively on how you feel at a particular moment, but on a complete functional assessment.

The term Return To Play refers to the process that accompanies an athlete from the end of the acute phase of an injury through to a complete return to sporting activity.

It is not a single moment, but a gradual process involving several stages.

Recovery generally includes:

resuming normal daily activities;
restoring mobility;
rebuilding strength;
returning to progressive training;
resuming full training sessions;
returning to competition.

Skipping any of these stages increases the risk that the body may not yet be ready to cope with the physical demands of the sport.

There is no single rehabilitation protocol that is suitable for everyone.

A runner’s return to sport will be different from that of a footballer, tennis player or cyclist.

Each discipline involves specific movements, different speeds, changes of direction, jumps, physical contact or repetitive actions.

Even two people with the same injury may therefore follow different rehabilitation programmes, depending on the sport they practise, their activity level and their personal goals.

This is one of the reasons why standardised programmes are rarely the best option.

Losing some strength during a period of inactivity is normal.

Even a few weeks away from training can reduce muscular capacity, affecting joint stability, balance and movement control.

Restoring strength is essential before returning to sport.

Simply comparing the injured limb with the healthy one is not always sufficient. In some cases, it is also necessary to assess movement quality, physical endurance and the ability to produce force in situations that reflect the demands of the sport.

Another very common mistake is attempting to make up for lost time by completing several training sessions within just a few days.

After an injury, tissues need time to gradually adapt to physical loads again. Increasing the intensity, duration or frequency of training too quickly can expose muscles, tendons and joints to stresses that exceed their actual capacity.

Returning to sport should follow a progression based on the individual’s characteristics and the body’s response to different forms of exercise, rather than being driven solely by enthusiasm to resume training.

Recovering from an injury also involves an emotional component that is often underestimated.

Many athletes are afraid of repeating the same movement that caused the injury. Others feel completely recovered too early and increase their training load without taking the necessary precautions.

Both attitudes can negatively affect recovery.

Confidence in one’s own body is therefore another important criterion when returning to sport, alongside physical and functional factors.

Many recurrent injuries are not caused by the severity of the initial injury, but by suboptimal management of the recovery process.

The most common mistakes include:

stopping physiotherapy as soon as the pain decreases;
skipping certain stages of rehabilitation;
immediately resuming the usual training routine;
comparing your recovery time with that of other athletes;
neglecting strength and injury-prevention exercises.

Every person recovers at a different pace. Trying to speed up the process rarely brings benefits and increases the risk of having to start again from the beginning.

Today, the decision to resume sporting activity is not based on a single parameter.

The physiotherapist takes several factors into consideration, including:

movement quality;
muscular strength;
balance and neuromuscular control;
joint mobility;
load tolerance;
confidence when performing sport-specific movements.

Considering all these elements together makes it possible to determine whether the body is genuinely ready to meet the demands of the chosen sport.

At TI-FISIO in Mendrisio, the return to sport is planned through a personalised programme whose sole objective is not simply the disappearance of pain, but the complete restoration of function.

Every rehabilitation programme begins with a thorough assessment and is adapted to the sport practised, the athlete’s level and the goals they wish to achieve.

During the rehabilitation process, key aspects are monitored, including:

✔️ joint mobility;

✔️ muscular strength;

✔️ movement control;

✔️ load tolerance;

✔️ recovery of sport-specific movements.

The aim is to enable a gradual return to training, minimising the risk of reinjury as much as possible and promoting stable, long-term recovery.

Every injury is part of an athlete’s sporting journey, but it does not have to become a permanent obstacle. Taking the appropriate amount of time to recover means investing in both your health and your future performance.

If you are currently preparing to return to sport after an injury or would like to recover safely before resuming training, the TI-FISIO team in Mendrisio is available to support you. Through a thorough physiotherapy assessment and a personalised programme, you can return to your chosen activity with greater safety, confidence and awareness, reducing the risk of reinjury and rediscovering the pleasure of practising the sport you love.

Cyclist’s knee: the 5 mistakes that cause pain during long rides

22 July 2026 Magazine 0 Comments

Knee pain rarely begins without a reason. In most cyclists, it is the result of small mistakes that gradually accumulate, ride after ride, until they develop into a genuine overload injury. A saddle positioned just a few millimetres too high, a sudden increase in mileage, insufficient recovery or inadequate muscle preparation can alter the way the knee works while pedalling. The result? What initially feels like minor discomfort can develop into a problem that limits training and compromises the entire season.

Understanding the causes of knee pain in cycling makes it possible to take action before the condition becomes chronic and to return to cycling with greater safety and awareness.

Every pedal stroke requires a precise and repetitive movement of the hip, knee and ankle. During a ride lasting several hours, the knee performs thousands of cycles of flexion and extension, continuously distributing the forces generated by pedalling.

When biomechanics are correct and the training load is well managed, the joint is generally able to tolerate these movements without difficulty. However, when one or more factors fall out of balance, the knee becomes the structure that absorbs most of the mechanical stress.

Knee pain is rarely caused by a single factor. More often, it results from the combination of several elements that, over time, progressively increase the overload on the joint.

Not all knee pain presents in the same way.

Some cyclists experience discomfort at the front of the kneecap, while others feel it on the outer side, inner side, or at the back of the knee. The moment when the pain appears can also provide important clues.

Symptoms may occur:

after many kilometres;
during climbs;
when increasing the pace;
the day after training;
after several consecutive rides.

Waiting until the pain becomes severe is one of the most common mistakes. Taking action in the early stages often allows for a faster recovery and helps avoid long periods away from cycling.

When it comes to knee pain in cycling, the first factor to consider is always your position on the bike.

A saddle that is too low increases knee flexion throughout the pedal stroke, while a saddle that is too high can cause compensatory pelvic movements and increase strain on muscles and tendons.

Even small errors in saddle setback or cleat positioning can alter the distribution of forces. After just a few dozen pedal strokes, these changes are almost imperceptible; after thousands of repetitions, however, they can contribute to significant overload.

With the arrival of warmer weather, many cyclists try to make up for the time lost during the winter.

Moving from short rides to much longer routes is one of the most common mistakes.

Muscles, tendons and joints need time to adapt progressively to increased workloads. When distance, intensity or elevation gain increase too quickly, the knee may not yet be ready to cope with the demands.

A gradual progression is often the best form of prevention.

Many people believe that the best way to improve on the bike is simply to ride more.

In reality, muscle strength plays a fundamental role in preventing injuries.

Weak gluteal muscles, poor pelvic control, tight hamstrings or limited ankle mobility can all alter knee movement with every pedal stroke.

Incorporating strength, stability and mobility exercises into your routine helps distribute loads more effectively while improving pedalling efficiency.

One of the riskiest approaches is believing that the pain will simply disappear if you keep training.

At first, discomfort often appears only during longer rides. Over time, it starts to occur earlier and earlier until it is present even during everyday activities.

The longer you wait, the greater the risk that recovery will take more time.

Pain is the body's way of signalling that the load has exceeded the tissues' capacity to adapt. Ignoring it rarely leads to positive outcomes.

When discomfort returns over several consecutive rides, simply reducing your mileage or adjusting your saddle height may not be enough.

A physiotherapy assessment makes it possible to analyse the problem as a whole by evaluating joint mobility, muscle strength, movement control, any compensatory patterns and training load management. The goal is not only to identify the structure causing the pain, but also to understand which factors have led to the overload.

This comprehensive assessment makes it possible to develop a truly personalised rehabilitation programme, avoiding standardised treatments that often fail to address the root cause of the problem.

Once the pain has resolved, it is important not to return immediately to the same training loads that caused the problem.

Some simple habits can make a real difference:

progressively increase mileage and elevation gain;
include strength training throughout the cycling season;
allow adequate recovery between training sessions;
regularly check your bike fit;
listen to your body's signals before the pain becomes persistent.

Prevention remains the most effective way to keep enjoying cycling consistently and pain-free.

Every cyclist has a unique history, a different level of preparation and personal goals that deserve an individualised approach. At TI-FISIO, every treatment begins with a comprehensive assessment that goes beyond the knee and evaluates the entire kinetic chain.

During the assessment, key aspects are evaluated, including:

✔️ hip, knee and ankle mobility;
✔️ muscle strength and motor control;
✔️ any movement compensations;
✔️ training load management;
✔️ factors that may contribute to overload.

Based on these findings, a personalised physiotherapy programme is developed, which may include therapeutic exercise, manual therapy where appropriate, mobility restoration, muscle strengthening and practical advice to help you return to cycling gradually and safely.

Knee pain should never become a barrier to your passion for cycling. Addressing the first symptoms early often allows for a faster recovery, helps avoid long periods away from the bike and reduces the risk of the problem becoming chronic.

If knee pain continues to occur during or after your rides, trust the team at TI-FISIO in Mendrisio. A personalised physiotherapy programme can help identify the underlying cause of the problem, improve your pedalling technique and help you get back on the bike with greater confidence, efficiency and freedom of movement.

Tag: physiotherapy Ticino

Knee pain when climbing stairs: what may be behind it and when to seek help

Why can stairs cause pain when you can walk normally?

Pain at the front of the knee: the role of the kneecap

What if the discomfort is on the side or inside of the knee?

Strength and movement control matter more than you might think

When the knee is stiff or swollen

Does the pain appear going up, going down or both?

Should you avoid stairs altogether?

What physiotherapy assesses for knee pain on stairs

When is it better to seek medical attention?

Getting back to the stairs with more confidence

Contact

Lugano clinic

Mendrisio clinic

After a fall, an older person can lose confidence even without being hurt: why does it happen?

When the fear of falling changes the way you move

Fear of falling and loss of independence: the cycle that can set in

Why stopping moving can make things worse

Not all falls are the same

What is assessed after a fall?

Regaining confidence means taking it step by step

The home environment can make a difference too

The role of the family: helping without taking over completely

When can rehabilitation for older people be helpful?

Getting moving again without letting fear decide

Contact

Lugano branch

Mendrisio branch

Shoulder pain at night: why can it hurt just when you are in bed?

Why can the shoulder hurt more precisely at night?

Shoulder pain at night and the rotator cuff

Can the position you sleep in be to blame?

Daytime overload can make itself felt at night

When shoulder stiffness comes into play

What if the pain did not really start in the shoulder?

What to look out for when the shoulder hurts at night

When physiotherapy for the shoulder can be useful

Keep moving the shoulder or rest it?

When night pain deserves a medical check

Sleeping better is important, but you need to understand why the shoulder hurts

Contact

Lugano branch

Mendrisio branch

What changes in the muscles during menopause

Being active does not necessarily mean training strength

Why strength also matters in everyday life

Muscles and bones: why loading is important for both

Pain should not automatically lead to inactivity

Therapeutic exercise: not simply a list of exercises

It is not too late to start

How much training is needed?

The role of TI-FISIO in Mendrisio

More strength means more freedom to choose

Contact

Lugano branch

Mendrisio branch

A scar is not just what we see on the skin

Why the skin may feel “tight”

Scars and movement: a relationship that changes over time

Pain, sensitivity and unusual sensations

Adhesions exist, but they do not explain every type of pain

When a scar should be assessed

Treating a scar does not simply mean massaging it

Fear of movement can also slow recovery

How TI-FISIO approaches post-operative scars in Lugano

When the scar remains, but movement can still change

Contact

Lugano branch

Mendrisio branch

Why the shoulder is so exposed during summer sports

Paddleboarding: a complete sport that requires control

Swimming: when technique makes the difference

Beach volleyball: jumps, spikes and explosive movements

The first symptoms that should not be underestimated

Why the pain is not always caused by the tendons

How to prevent shoulder pain during the summer

TI-FISIO’s approach to shoulder physiotherapy

Enjoy your summer without limitations

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