One of the first questions any patient asks when obtaining an injury is ‘how long until it gets better’... If only an answer were simple.
Unfortunately, when it comes to the shoulder joint, the answer isn’t straightforward at all because your shoulder is one of the most complicated joints in your body.
To achieve the wide range of movement that the shoulder provides, it requires a combination of muscles from body to shoulder blade (scapula), body to arm bone (humerus) and shoulder blade to arm bone. Due to this complexity, it is one of the most susceptible joints in the body to injury.
The shoulder is made up of three bones, the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). There are joints between the clavicle and scapula and between the scapula and humerus.
The stability of the shoulder is predominantly controlled by four muscles, commonly known as the rotator cuff. They are tasked with keeping the joint properly centred and located.
- Teres Minor
Common Shoulder Problems
The most common shoulder injuries are:
- Rotator cuff tears/tendonitis
- Frozen Shoulder
Rotator Cuff Tears
The rotator cuff muscles and tendons are an important part of the shoulder and are tasked with keeping the bones of the joint together across its wide range of motion. Rotator cuff tears account for more than 50% of shoulder injuries and are most common in people who repeatedly perform overhead motions. Thus athletes involved in sports such as swimming, racquet sports and weight lifting, which all require repetitive overhead movement, are particularly prone to injury.
Typical symptoms of a rotator cuff tear will be pain at night disturbing your sleep, and probably some lessening of pain during the day, although any overhead movement or even reaching behind your back is likely to be painful. You will also probably experience weakness in the affected arm. If left untreated, the pain will most likely increase over time.
Keen athletes may be tempted to continue in their favourite sport, in the hope that the pain will recede, but this will most likely aggravate the situation and, over time, may make the condition worse. If you suspect a rotator cuff tear, it is strongly advised to seek help from a qualified physiotherapist or sports therapist as soon as possible, as some conditions, such as a full-thickness supraspinatus tear, can become irreversible if left too long.
Rotator cuff tendons can become trapped between a bony projection of the shoulder blade called the acromion and the top of the humerus (arm bone). Particularly prone is the supraspinatus tendon, this muscle is responsible for moving the top of the arm sideways from the body for about the first 15 degrees of arm movement.
Impingement problems can be caused by a number of factors, including:
- Loss of scapula – humeral rhythm
- Nerve interference or injury from the neck to the shoulder, causing abnormal movement of the shoulder
- Poor posture
- Tears and inflammation of tendons
Recent dislocation, sudden injury or overuse can each cause shoulder instability. The head of the upper arm bone can glide out of the shoulder socket (glenoid). This can occur when the capsule and ligaments that have the role of stabilising the shoulder in the socket have not healed properly and remain stretched making them too loose to keep the shoulder stabilised. This can result in repeated dislocations.
It is, therefore important to seek treatment. Rehabilitation and soft tissue work can be provided by qualified physiotherapists or sports therapists to help strengthen the muscles and ligaments and help to gain stability around the shoulder joint once more. It is advisable to seek help sooner rather than later.
This condition, medically described as adhesive capsulitis, can literally develop overnight. The capsule of the joint becomes inflamed and stiff, resulting in restricted movement. Eventually, the shoulder ‘freezes’ and becomes immobile for a few months to a year.
However, a frozen shoulder does typically progress in three main stages:
- Freezing stage- any movement of your shoulder causes pain, and your shoulder's range of motion starts to become limited.
- Frozen stage- pain may begin to diminish during this stage. However, your shoulder becomes stiffer and moving it becomes more difficult.
- Thawing stage- The range of motion in your shoulder begins to improve.
A bursa is a fluid-filled sac that act as a cushion to stop friction between the muscles and bones as they glide over on another. You have several in your shoulder, one being one of the largest in the body which is located towards the top of the arm.
After an excessive repetitive motion of the shoulder, the bursas can inflame and swell. The pain is normally a gradual onset located on the outside of the shoulder which can spread down the arm. It can become more aggravated when lying on the shoulder or if you’re using your shoulder anywhere from 60-90 degrees up and outwards.
When treating Bursitis, the aim is to control the inflammation. If you don’t seek help, often the pain will become worse and become impinged.
This is when the normally smooth cartilage that covers the ball and socket joint diminishes after constant friction leaving bone to grind against bone. It develops slowly and the pain worsens over time, normally after chronic wear and tear or work injuries. Symptoms may include swelling, pain, and stiffness.
Osteoarthritis is a chronic problem which cannot be resolved, but the symptoms of the condition are amenable to pain-reducing treatment.
Every shoulder injury will present differently, and everyone’s perception of improvement will be different too. For example, one patient may be over the moon for gaining an extra 10 degrees in pain-free shoulder motion. Whereas the next will be happy only when gaining their full range of motion back.
Many biological, psychological, and social factors are involved during the recovery process after a shoulder injury.
If you are suffering from shoulder pain, we can help
Call 01889 881488 Now
Jean, Erica & Charlotte will be happy to help
Like a traditional massage, sports massage more intensely manipulates the soft tissues and tendons. In addition, the masseuse uses more strength to purge the muscles, which helps to loosen and condition the essential structural integrity. As a result, you are less likely to become injured during sports or physical activity.
Sports massage also helps to promote blood flow, which can aid healing and recovery after intensive exercise, which is why you will often find sports massage administered before and after races at running clubs.
What are the common areas for sports massage?
- Typical sports massages include legs used by runners, athletes, hockey, cricket, and rugby players.
- As well as the common sports previously mentioned, Netball and Tennis are also popular with shoulder and lower back sports massage therapies.
- The lower back is also a widespread complaint from horse riders, and we have seen jockeys from all over the world.
What is a sports massage therapist?
A sports massage therapist administers the massage, 'a masseuse', and is often referred to as a therapist as this serves a purpose and not just for pleasure. Sports massage has more medical benefits than other massages which are for relaxation and wellbeing.
What is a sports massage like?
A sports massage is slightly more aggressive than a typical massage, so it can be somewhat uncomfortable initially; however, your therapist will discuss this with you throughout so that it is tolerable. The fact it is more aggressive should not put you off because the effectiveness of the sports massage is driven by the pressure placed on the soft tissues.
There are many reasons that sports massage is so good for you and keeps you injury-free. This article covers some of the reasons sports massage is good for you.
What is sports massage good for?
- It is good for legs, shoulders, lower back, knees, calves, and neck.
- It is good for keeping your joints stable and loose, reducing the risk of sports injuries.
- It is ideal for those who are physically active, runners and hikers.
- It is good for people who have previous injuries to stave off issues resurfacing.
How can Nicky Snazell Pain Relief Clinic help?
Pain relief clinic is here to help; you will see one of our very experienced team. From there, we will discuss your specific needs and then complete your wellness programme. Nicky and the Pain Relief Clinic look forward to welcoming you aboard. If you are a first-time client, then please use the contact form; if you are an existing patient, you can use the online booking form.
Rotator Cuff Physiotherapy
Many have heard of the rotator cuff in the shoulder and, not surprisingly, believe it to be a single part of the shoulder. The rotator cuff is, in fact, a group of four muscles that work together to provide dynamic stability of the shoulder joint, helping to control the joint during rotation:
- Teres Minor
The Supraspinatus is a small muscle which you can feel above the bony ridge on the back of your shoulder blade (scapula). It attaches to the top of the arm bone (humerus), just below the shoulder joint. The task of this muscle is to move the arm sideways away from the body for the first 15 degrees. After that other muscles take over most of the load, it is an area of the should that can be torn and is popular for 'Rotator Cuff Physiotherapy'
The Infraspinatus is a thick triangular muscle, which occupies the main part of the sculptured dent in the back of the shoulder blade, below the bony ridge. As one of the four muscles of the rotator cuff, the main function of the infraspinatus is to turn the arm out as in the backhand in tennis and stabilise the shoulder joint.
The Subscapularis is a large triangular muscle at the front of the shoulder blade, between the shoulder blade and the rib cage. It attaches to the top of the arm bone (humerus) and into the front of the shoulder capsule. Its role is to turn the arm in.
The Teres Minor muscle sits below the Infraspinatus. It is quite a small rounded muscle and its primary task is to stop the arm moving up when it is moved out sideways (abducted). It also helps the Infraspinatus turn the arm out.
TREATMENTS FOR ROTATOR CUFF TENDINITIS
Rotator cuff tendinitis describes the inflammatory response of one or more of the four rotator cuff tendons, due to impingement or overuse, and leading to more and more micro-trauma that can then lead to a tendon rupture and will require Rotator Cuff Physiotherapy.
The inflamed thickening of the tendons often causes the rotator cuff tendons to become trapped under the acromion (the bony projection of the shoulder blade over the shoulder joint) – like a carpet stuck under a door – causing sub-acromial impingement. Failure to heal then leads to further damage. Early treatment of tendinitis, therefore, is necessary in order to prevent the development of more chronic and serious conditions.
Treatment can include: first and foremost scapula re-education exercises, postural exercises to lessen the impingement, gentle shoulder mobilisations and massage, aided by local electrotherapies, such as laser, pulsed shortwave, shockwave and deep oscillation. Specific rehab exercises can help guide you back to full fitness.
Welcome back to the new series of articles about physiotherapy and common injuries and pathologies seen by physiotherapists. Last time we took a brief look at one of the most common musculo-skeletal conditions that a physiotherapist will encounter – tennis elbow (also known as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia). This article will now look at the anatomy of the elbow and the muscles connected to it in detail so that we can have a good idea of what is hurting or being injured in tennis elbow and can maybe start to have an idea of what causes it.
The elbow is an amazing piece of biomechanical design and is comprised of 3 bones – the humerus which is the upper arm bone and two bones in the forearm called the radius and ulna. The radius runs from the elbow to the thumb and the ulna starts at the bony prominence on the back of your elbow (olecranon process) and runs down to the wrist. To make it easy to remember which bone is which, when I was a student I used to repeat “the ulna is underneath the radius”. Simple I know but effective nonetheless when you are a physio student desperately trying to cram in your anatomical knowledge.
Now as we are looking at tennis elbow we are not going to look or worry too much about the actual elbow joint itself except to say that it has two ways of movement – flexion and extension (basically straightening and bending) and pronation and supination (pronation is rotating the hand palm down and supination palm up). It may seem strange that in a condition called tennis elbow we will be ignoring the elbow joint itself but hopefully the reason why will become clear soon.
The key part of the elbow in tennis elbow that we really need to examine is the lateral epicondyle – this is the point where all of the wrist extensors and finger extensors start from and is the point at which pain is felt in tennis elbow, it is also called the common extensor origin (for reasons which will become apparent soon) and is the site of attachment for the common extensor tendon. Pain here is the cardinal sign for tennis elbow that all physiotherapists look for.
Running from the lateral epicondyle and the common extensor origin are all of the muscles that extend the wrist and the fingers – extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor indicis and extensor digiti minimi. Two other muscles have attachments at the lateral epicondyle – supinator and anconeus. All of these muscles merge together here to form what is known as the common extensor tendon which then attaches to the lateral epicondyle. So it is fairly obvious that this common extensor origin is an important point in wrist and finger extension and may well be a likely site of injury that physiotherapists will need to examine.
Before moving on it is worth considering the actions of a couple of these muscles in more detail extensor carpi radialis brevis and extensor carpi ulnaris have an important synergistic role in stabilising the wrist – they both act at the same time in concert with their flexor brothers (flexor carpi ulnaris and flexor carpi radialis) to prevent side to side movement at the wrist (ulnar and radial deviation). The two extensors also act together at the same time you grip an object to hold the wrist in extension a bit and prevent the finger flexors from flexing the wrist. In fact studies have shown that extensor carpi radialis brevis is the tendon most commonly injured in tennis elbow and the most common point that it is injured at is the common extensor tendon.
So hopefully from the above brief anatomy lesson we can now see that any extension or even flexion of the wrist is going to put a large amount of stress through the common extensor tendon and in turn if this tendon receives any injury we are likely to feel pain at the lateral epicondyle – which is where patients with tennis elbow will normally describe to their physiotherapist that they feel pain when they pick things up.
The next article will look at the physiology and some of the reasons why tendons get injured and why tennis elbow can often become chronic and last for a long time.
This will be the first blog post in an upcoming series about physiotherapy and common pathologies or injuries seen by physiotherapists. We will be examining in detail the causes and nature of various pathologies, who they affect, treatment options, self-management and how physiotherapy can help. The first pathology that I would like to deal with is an extremely common but frustrating and painful condition called tennis elbow that as a physiotherapist I encounter regularly in practice.
Tennis elbow has several other more complicated sounding names such as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia. All of which basically try to describe the fact that the pain people feel is at the outside (lateral) bony bit of the elbow (epicondyle). The pain normally comes on when picking up heavy objects, twisting items such as screwdrivers and can be quite sharp and uncomfortable.
It is one of the most common musculo-skeletal conditions that a physiotherapist will see and affects approximately 3 – 11/1000 patients per annum (Dingenmanse et al 2012). It is thought to occur in 1.4% of the population (Shiri et al 2006), now these do not sound like huge numbers but when you consider the size of the UK population (roughly 60 million) then 1.4% of the whole population is a lot of people! It is 7 – 9 times more common than the next most common elbow injury: golfer’s elbow (medial epicondylitis) (Walz et al 2010) and causes prolonged time off work especially in chronic sufferers (Walker-Bone et al 2012). Numerous studies have shown that it is associated with handling tools and repetitive twisting and lifting actions of the forearm (Van Rijn et al 2009) basically meaning that if you are an electrician, carpenter, manual labourer or a housewife then you are at an increased risk of developing the condition.
So… what causes it? Well that is a common question for physiotherapists and seemingly a simple question. Unfortunately it is a complicated answer and will need us to look in some detail at both the anatomy of the elbow and physiology of tendons. Which will be covered in the next blog post.
Dingenmanse R., Randsdorp M., Koes B., Huisstede B. (2012) Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review British Journal of Sports Medicine Published Online
Shiri R., Viikari-Juntura E., Varonen H., Heliovaara M. (2006) Prevalence and determinants of lateral and medial epicondylitis: a population study. American Journal of Epidemiology 164 (11): 1065 – 1074
Van Rijn R., Huisstede B., Koes B., Burdorf A. (2009) Associations between work-related factors and specific disorders at the elbow: a systematic literature review Rheumatology 48: 528 – 536
Walker-Bone K., Palmer K., Reading I., Coggon D., Cooper C. (2012) Occupation and epicondylitis: a population-based study. Rheumatology (Oxford) 51 (2): 305 – 310
Walz D., Newman J., Konin G., Ross G. (2010) Epicondylitis: Pathogenesis,
Imaging, and Treatment Radiographics 30 (1): 167 – 185
Unless you fall off, cycling is a sport that causes very little, if any impact injury and is relatively body-friendly. On the road, there’s no impact to jar your joints as you would find in running. In mountain bike riding, although there is still no direct impact there is an element of vibrational force depending upon the type of terrain you ride. Like any endurance sport however, cycling can produce a catalogue of niggling aches and pains, which unless diagnosed and properly treated can often lead to something more serious.
If you are a regular cyclist, maybe training for you first charity ride or even a sportive, it is important that you know how to spot the signs of an injury and that you get the correct treatment and advice to correct any problems.
When you start to increase the amount of riding you do you will be adding stresses and strains on your body. You might be tempted to ignore slight niggles and stick to you training programme at all costs. BEWARE. Riding through the pain is very likely to turn what may be a minor problem into a major one.
If you get injured, take it seriously. Take some time off the bike or adapt your training regime but do not ignore it. If the problem does not ease after rest, it is wise to be assessed by a physio or sports injury therapist. Whatever you do, don’t ignore a potential injury when it’s still in the niggle stage.
Other than the obvious ﬂesh wounds and trauma caused by falling off there are the less impressive but no less painful sprains and strains caused by overtraining/overuse injuries often resulting from biomechanical stress caused by muscle imbalances or incorrect bike setup.
One of the most common injuries reported by cyclists is pain in/around the kneecap. This is often likely to be an overuse injury. Patellofemoral pain syndrome or Chondromalacia patellae are two possible causes and are usually found because of tightness or weakness in associated muscles that causes unwanted movement of the kneecap (patella) as you pedal. If the patella rubs on the bones behind it, this can irritate and inﬂame the cartilage at the back of the cap causing pain.
Similar symptoms can be caused by your illiotibial (IT) band becoming tight and pulling the kneecap out of line causing it to rub against underlying bones. If you consider the repetitive nature of the pedalling action – up to 5,000 pedal revolutions an hour – it’s no surprise that a problem like this can quickly escalate into a clinical injury.
The stabilising muscles of your hip/pelvis play a big part in preventing your knees rolling inwards, and can be weakened by an over tight IT band. This is one factor that may lead to a number of painful problems, including medial knee pain, anterior knee pain and even lower back pain, in cyclists and also runners.
A number of issues can give rise to hip pain one of the most common is Piriformis syndrome. This is often caused by overtraining (particularly if there is a muscle imbalance) and by overworking the gluteus maximus muscles in your buttocks. If overstressed and tight, the piriformis can put pressure on the sciatic nerve, causing pain or numbness down the back of the leg or in the hip and is a common cause of sciatica.
Pain caused by neck hyperextension can be exacerbated by positional issues on the bike combined with lack of ﬂexibility and core strength. The deep muscle of the neck ( ﬂexors/extensors) help to hold your head up, when they become weak it is left to the trapezius and other muscle groups to support your head as you lean forward. When these muscles get fatigued, you can get the aches and pains in the back and sides of your neck.
After knees, the back is probably one of the biggest causes of pain reported by cyclists. Again lack of ﬂexibility and a poor posture/set up are often the cause. The neutral position for the spine in a standing position allows for the curves of the spine to take your bodyweight and for the muscles to be relaxed. Sitting and reaching forward causes tension in some of the muscles of the spine and can stress the joints causing aches and pains particularly in the lower back and across the shoulders. In extreme cases long periods of being in a bent forward position can damage the intervertebral discs causing them to herniate.
Any exercise causes a small amount of inflammation in muscles, due to microscopic amounts of damage. After a long ride it is normal to ache for a day or so as the muscle repairs. This is often referred to as Delayed Onset Muscle Soreness (DOMS)
Numbness, tingling, or pain in your arm, hand, wrist, or little finger is all common symptoms especially following a long ride. Approximately one-third of all bicycling overuse injuries involve the hands. The two most common are handlebar palsy and carpal tunnel syndrome. By making some adjustments to your bike and by wearing some protective equipment, you can help prevent these injuries from occurring.
Ulnar neuropathy (sometimes known as handlebar palsy) is caused by compression of the ulnar nerve at the hand and wrist. The ulnar nerve controls sensation in your ring and little finger and some of the muscular function of your hand. Compression of the ulnar nerve is a common problem for cyclists and is the result of direct pressure on the ulnar nerve from the grip on the handlebars and sometimes overstretching of the nerve when using the drop-down handlebar position for an extended period.
The pressure placed on the ulnar nerve results in numbness and tingling in the ring and little fingers, hand weakness, or a combination of both. Symptoms can take from several days to months to resolve. Rest, stretching exercises, and anti-inflammatory usually help relieve the symptoms. Applying less pressure or weight by adjusting your position will help prevent the condition
Carpal tunnel syndrome
Although it is less common than Ulnar neuropathy, carpal tunnel syndrome (compression of the median nerve) is another overuse injury that cyclists often experience. This often occurs when a cyclist holds the handlebars on top and applies pressure directly on the median nerve. Symptoms include numbness and tingling in the thumb, index, middle, and ring fingers and weakness of the hand. Although pressure from this riding position contributes to the symptoms of carpal tunnel, there can be other causes for hand pain and numbness, therefore, an evaluation for other possible causes should be performed by your health-care professional.
If you think you may have any of these conditions, it would be worth getting in touch with the clinic to make an appointment to have it checked out. Call on 01889 881488 now.
Orthotics, when properly prescribed, can reduce pain and improve athletic performance.
Orthotics are footwear inserts custom designed and made specifically for you to correct imbalances in your body. Such imbalances may
- Cause you pain
- Affect your sporting performance
- Cause potential problems in the future
Orthotics can help correct fallen arches or high arched feet, leg length discrepancies and help resolve ankle pain, knee pain, hip pain, lower back pain, and they even make an impact all the way up the body to the shoulders, neck and jaw. Not surprisingly, for most of us, it is difficult to see that our back pain could be caused by a foot problem, and we will never make this link without assessment.
You may be wondering if you require orthotics or not, or may think that you can buy some insoles from a high street or online shop. It is important to realise such insoles are totally different to prescribed orthotics as they are not specifically designed for your feet and are generally made from a soft, short-lived material. While insoles can be helpful in certain circumstances, most of the time they are offering no relief to your problem and sometimes can make the problem worse.
We all have or own unique foot shape and movement problems. To make this complex structure perform correctly requires an orthotic to be made exactly to your needs. A custom-made orthotic will put your foot in an ideal position at every stage of walking, running and pivoting.
Would I benefit from orthotics, you may be asking yourself? If you fit into one of the groups below, then you will most likely benefit from orthotics:
- You know you have different leg lengths.
- You stand more than 6 hours a day, especially on hard surfaces.
- You are overweight.
- You suffer from arthritis.
- Sports players and runners exert much higher forces and are likelier to have problems.
If you feel you may require orthotics, then we can assess you here at the clinic. This is called a biomechanical assessment, and it involves a mixture of looking at your posture and a variety of special static and dynamic tests. This would include digital foot pressure measurement and looking at you walking on the treadmill. If, during the assessment, we spot any imbalances, then orthotics will most likely be needed.
If you wish to know more or feel that you may benefit from orthotics then feel free to contact us here at the clinic.