Shoulder pain is very common affecting up to 70% of the population in their lifetime (1). The shoulder 'complex' is aptly named as it can be a challenging area of the body to rehabilitate effectively. The shoulder complex includes the shoulder blade (scapula), clavicle (collar bone) and humerus (arm bone) which form the ball and socket joint and the AC joint (joining the clavicle to the scapula). Its muscle connections are extensive, connecting the shoulder complex to the upper back, the chest wall, the low back and the upper arm. In sport and activities such as lifting, these muscular connections are important for developing force.
The shoulder joint is also the most mobile joint in the body. With extra mobility comes the need for stability and the shoulder has both passive stabilising structures (bony fit and ligaments) and dynamic muscular stabilisers which need to work optimally for pain-free function. Often patients complaining of shoulder pain state that their shoulder 'just started hurting' for no apparent reason. Whilst some shoulder pain can be caused by trauma or a definite injury 'event' eg a footy tackle; more often the cause is not so clear cut. In these instances there is often an acute overload of the shoulder structures - examples we have encountered over the years include doing too much overtime in a heavy manual job, lifting weights at the gym with incorrect technique, digging trenches, playing a tennis tournament or swimming long distances in rough open water. Whatever the cause of your shoulder pain, it can be rehabilitated. There are many possible 'diagnoses' for shoulder pain including rotator cuff tendinopathy or tears, bursitis, AC joint inflammation or injury, instability, capsulitis, osteoarthritis, biceps tendon injury and labral tears. Many people with pain-free shoulders have evidence of the above problems on MRI scans (2). In otherwords, "clinical symptoms may not match radiological findings" at the shoulder joint (2). With shoulder pain it is important to "treat the patient not the scan". This is good news for patients with shoulder pain as most can be treated conservatively with physiotherapy led rehabilitation without medical interventions such as injection therapy or surgery. The Physio4athletes approach to treating shoulder pain includes both passive and active components. Passive treatment refers to what the physiotherapist does to alleviate your shoulder pain and enable better movement such as soft tissue therapy techniques (3), dry needling and joint mobilisation. Passive treatments will assist in the short term. However active treatment methods are the mainstay of shoulder rehabilitation and refer to the shoulder exercises you are prescribed ie what you do for yourself. It is essential to complete the exercise program for symptom relief and prevention of recurrence. At Physio4athletes our 45 minute appointments enable us time to thoroughly assess your shoulder pain, provide manual therapy and prescribe appropriate exercises to improve your rotator cuff function, scapular control and shoulder strength. We are familiar with treating athletes who rely on their shoulders for their sports performance, having treated many elite swimmers and tennis players in the clinic and at international competitions. As such, we have rehabilitated many challenging shoulder pain presentations over the years. If you have any questions regarding your shoulder pain please do not hesitate to contact us The Physio4athletes team. References: 1. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks, Cadogan et al; BMC Musculoskelet Disord. 2011; 12: 119. 2,. Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. Gill et al; Int J Rheum Dis. 2014 Nov;17(8):863-71. 3. Effectiveness of massage therapy for shoulder pain: a systematic review and meta-analysis. Young-Ran Yeun, PhD1; J Phys Ther Sci. 2017 May; 29(5): 936–940.
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12/2/2020 should i get my "ankle sprain" checked??Ankle sprains are very common and are usually (but not always) caused by an inversion injury involving uncontrolled "rolling" of the ankle outwards. An example of when this may happen is landing from a jump onto an uneven surface such as an opponent's foot; or stepping down onto uneven pavement. Usually the ankle ligaments are torn or overstretched, however bony fractures and joint cartilage injuries can also occur. Physiotherapists can assess and refer for an X-Ray, if required, based on the examination findings. Ankle injuries are usually very painful in the short term and a significant minority of ankle sprains cause ongoing problems (hence this post).
A physiotherapist can assess your ankle injury and the extent of ligament tearing, if any, and diagnose any bony or cartilage injury early. An easy to follow rehabilitation program can be prescribed to manage pain, regain mobility, strength and, most importantly, functional ankle control for your sport or general activities. Preventive measures can be put in place, such as learning how to tape the ankle(s) or wearing braces during sport to prevent re-injury. 18/10/2019 0 Comments HOW WILL YOU BE ACTIVE THIS WEEKEND?Here are some top 5 tips to staying healthy and injury free throughout the season...... 1. Be smart about increasing your load. If you haven’t played much tennis over the colder months make sure you slowly re introduce tennis to your schedule. A sudden increase in load is highly associated with injury rates, so add sessions back into your schedule gradually, with a day or two break between them. There is a long season ahead of you, make sure you last right through!
2 Do some cross training to improve your fitness levels. Instead of playing tennis 5 nights a week initially, spend some time early on doing different types of activity in order to build fitness and strength. This can include running, cycling, swimming, boxing or doing an appropriate gym program for your age and activity level. As the season advances you can add in more tennis sessions to your schedule. 3. Follow up on those niggles you had at the end of last season. Did you have an injury at the end of last season that went away when you weren’t playing for the last few months? This may resurface when you start playing again especially if the causing factors are related to poor technique or equipment. Get in touch with a tennis specific health professional who is happy to liaise with your coach, for an assessment, treatment and return to play plan. 4.Get a good body management program going early on. Tennis specific physios can go through a screening process with you to identify any potential areas of concern regarding potential injury. They can then shape a body management program designed specifically to your needs, not only to prevent injury but also to optimise your performance! 5.Changes in technique or equipment – get advice first If you’re really serious about your tennis over the next few months and want to improve your game, make sure you get the best advice available before changing technique or advice. Coaches, and tennis specific health professionals are always happy to liaise with each other and yourself to discuss the safest way to improve your tennis. Remember, changing too many variables at once also contributes to acute increases in load through your body as discussed in tip number 1! 23/9/2019 do you have SWIMMER'S SHOULDER?WHAT CAUSES SWIMMER'S SHOULDER?Swimmer's shoulder is an "umbrella term" for pain that arises in the shoulder area as a result of swim training. Swimming is a unique sport with respect to the demands placed on the shoulders. All swim strokes require extreme shoulder flexibility into positions that are unlike any other athletic activity. Competitive swimmers regularly perform over 2000 arm strokes in a single training session and repeat this 5-10 times each week. The combination of the extreme shoulder flexibility and high repetitive swim training loads means that swimmer's shoulder pain is a common occurrence. Currently, it is thought that the source of pain in most swimming shoulder pain cases is Rotator Cuff tendinopathy. There may be co-existing irritation of the subacromial bursa ("bursitis"). Research in swimmers has shown that the rotator cuff tendons, and nearby bursa, thicken in response to swim training and this process occurs in both painful and pain-free shoulders. In other words, the tendon thickening is a normal adaptation response to swim training. When a swimmer presents with shoulder pain, in the absence of a traumatic injury, it is likely that the rotator cuff tendons have been loaded too quickly, or too much overall and have failed to adequately adapt to/ recover from the training loads; which is is termed 'reactive tendinopathy'. Glenohumeral labral tears, AC joint inflammation and partial rotator cuff tendon tears may be also be evident on MRI imaging in swimmers' shoulders but it is important to note that these findings are not always associated with shoulder pain. Risk FactorsThere are a number of research supported risk factors that may predispose a swimmer to the development of swimmer's shoulder, which include shoulder rotational range of motion variations, rapid change in or excessive swim training loads, rotator cuff strength imbalances and a past history of shoulder pain. Adequate strength and endurance of the rotator cuff and scapula stabilising muscles is essential to maintain a 'healthy shoulder' for the repetitive demands of swimming and a strong 'core' may support swim performance. Swim technique is important as some basic errors can place undesirable loads on the shoulder during training and there has been some published work in this area. Research has shown that the majority of swimmer's shoulder pain occurs during the early pull through or 'catch' phase of all strokes, when the propulsive force is first generated. Specific flexibility in the shoulder, upper back and thoraco-lumbar fascia is required to get the arm in to the correct position for the catch. Likewise good scapula (shoulder blade) control, rotator cuff muscle strength and activation and core rotational control is essential to execute the 'high elbow catch' correctly. It is recommended that treatment specifically addresses an individual swimmer's capacity to execute a good high elbow catch. Currently, there is no evidence that certain swim strokes, gender, side of breathing or hand dominance increase the risk of developing shoulder pain, despite common beliefs. Treatment ApproachThe shoulder joint complex is robust and if prepared and rehabilitated appropriately, swimmers can, and do, enjoy training free of shoulder pain. A thorough physiotherapy assessment is essential to identify and address any shoulder movement and strength impairments and relate these back to correct performance of the swim strokes. Although each case is individual and should be managed as such, management of swimmer's shoulder usually comprises: - Acute pain management of pain including icing and isometric rotator cuff tendon exercise loading protocols. - Strength: Prescription of targeted rotator cuff and scapula stabilising muscle "work hardening" exercises. In most instances a supportive core strengthening program is beneficial. - Flexibility: Restoration of swim specific shoulder and upper back flexibility with manual therapy and a self management program. - Modification of swim training loads: It is very uncommon for a swimmer to be 'out of the water'. There are always skills & drills that can be performed which will maintain swim fitness while the shoulder pain is settling. Re-loading of the shoulder is undertaken in a graduated fashion towards full training. - Analysis of swim stroke technique with the coach if available or by video analysis of a client swimming to identify technique errors that may be overloading the shoulder. - Correction of ineffective shoulder movement patterns such as incorrect high elbow catch muscle activation or poor hip to shoulder 'connection' with targeted exercises. - Self management program: On return to full swim training a maintenance program is prescribed; comprising pre- training activation, strength and mobility exercises; post training soft tissue release and stretches and gym based strength exercises. Physio4athletes...... "swimming physios"At Physio4athletes we have been treating swimmer's shoulder for over 20 years. We treat elite pool and open water swimmers, masters, English channel, recreational swimmers, triathletes and everyone in between. Through our work on pool deck at swim training or travelling to national and international swim events, our conversations with elite coaches and swim biomechanists, we have developed a thorough understanding of the demands of this sport. We provide targeted, swimming-specific rehabilitation for all swimmers with shoulder pain.
For assistance with your swimmer's shoulder injury, please contact us or book online at: www.physio4athletes.com |
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