Shoulder Impingement and the Rotator Cuff

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xray imageWhat is the rotator cuff?
The rotator cuff muscles consist of 4 small muscles that work together to keep the shoulder joint centred – supraspinatus (most commonly associated with a rotator cuff tear); infraspinatus and teres minor (the external rotators); and subscapularis (the internal rotator and least understood but arguably the most important).

Why is it important?
Imagine the shoulder joint as a golf ball sitting on a golf tee. It requires the small rotator cuff muscles closest to the joint to stabilise it so the larger muscles can move the arm efficiently.

What is shoulder impingement?
Impingement is the most common pathology seen in the shoulder, which involves the tendons and other soft tissues get squished under the acromion (a bony arch forming a roof above the shoulder joint).

How do we manage it?
The management largely depends on the cause. Often a muscle imbalance is created by repetitive use of the arm over shoulder height (throwers or swimming). The muscle imbalance can be associated with the scapula (resulting in scapula winging or lack of rotation control) which requires specific exercise to stabilise the shoulder blade region.

Additionally a muscle imbalance of the rotator cuff can be created by the pain associated with impingement symptoms. This can be identified via a physical assessment of active movement control versus passive range available and if clinically relevant to the symptoms will result in improvement within a 2 week period. Occasionally the acromion is shaped in a hook fashion which increases the chance of impingement and this can require surgery (acromioplasty) to shave away and make more space in the area.

The concept that muscle imbalance and fatigue can lead to shoulder impingement has been validated over the years, and supports the use of rotator cuff strengthening exercises as an effective treatment for shoulder impingement.

 

 

Eccentric exercise for the achilles tendon

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calf muscle and achilles tendonExercise for the achilles tendon is most commonly done via eccentric exercise which involves contracting a muscle as it lengthens. The opposite is termed a concentric contraction where the muscle shortens as it contracts. The force generated during an eccentric exercise is higher than a concentric contraction. The subsequent loading of a tendon occurring with an eccentric contraction is the basis for the Alfredson protocol of Achilles tendon rehabilitation.

An example of an eccentric contraction is for the calf muscle and achilles tendon complex. If you stand with both forefeet on a step and push up onto your toes, a concentric contraction results where the muscles shorten as they contract. If you then lift one foot off the ground and lower yourself down on the other foot, an eccentric contraction occurs with the muscle contracting but lengthening at the same time. Higher force is generated in the Achilles tendon during this movement which is the basis for the Alfredson protocol. Repeated loading of the tendon via this exercise results in the tendon being able to tolerate higher loads. Not all achilles tendon problems are suited to this approach. A good place to start is an individual assessment by a NU Moves physiotherapist. 

Don’t Be Limited By Your Tendons: Achilles Tendonitis

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achilles tendon physio newcastle

Achilles tendonitis … if you have suffered from it you know how much it can limit you with everyday life activity. The actual diagnosis is now termed ‘tendinopathy’ rather than tendonitis as recent evidence has found there is not an actual inflammatory process within the tendon. Regardless of the name, it refers to pain located usually up to 5cm up from the back of the heel. There are several different types of Achilles tendinopathy so if you suspect you have this problem it is a good idea to get a physiotherapist to confirm the diagnosis and type of presenting problem.

The good news is simple inexpensive treatment is available and quite effective in getting you active again. We commonly recommend 3 strategies that help:

  1. Despite the lack of bleeding or inflammatory cells present in a tendinopathy, applying ice safely to the local area still does provide benefit to many people. Simple things can be beneficial even if the understanding of why isn’t so simple. Put simply the benefit of ice is to reduce pain which assists beneficial exercise to be undertaken.
  2. Relative rest is also advised when managing tendon pain. This doesn’t mean complete rest from the aggravating activity but usually a reduction in the task that aggravates the pain.
  3. Active exercise based rehabilitation is the key to regaining strength and reducing pain with everyday life and exercise. This involves gentle and progressive loading exercises for your Achilles’ tendon known as the Alfredson protocol. The exercise is a type of eccentric exercise that is optimally performed with knees straight and knees bent and involves 3 sets of 15 repetitions of each. There may be soreness or pain that can last for a day, but the soreness should reduce as you progress the exercises over the course of weeks. Working with your physio will guide how much soreness is OK and when the protocol should be modified.
  4. To compliment these 3 treatments we also provide stability exercises for the core and legs muscles to compliment the Achilles exercises. For example, a lack of strength at the hip can increase the requirements and load on the calf and Achilles region. A more comprehensive and effective program will find any such imbalances and help if the goal is regular or more intensive exercise. To learn more, read our What is Eccentric Exercise? article.

If you have an achilles problem, start with a physio assessment and ask if the Alfredson protocol is appropriate for you.

Physiotherapy massage and manual treatment

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We frequently get asked the question, “Do we do massage?”

NU Moves physiotherapists use manual therapy within most of our treatments. But what is manual therapy? Manual therapy includes massage, joint mobilisation, joint manipulation, and myofascial stretching. The appropriate treatment will be used after careful assessment. These are skilled, specific hands-on techniques that can all be effectively used to assist recovery, prevent injury, help keep you active, and make you feel better.

massage

1. Sports Massage

This massage is for the active individual who is seeking to maintain and optimise their physical potential. The purpose of this massage is to alleviate tension which builds up in the body’s soft tissues during physical activity. Sports massage can prepare you for sport and assist in your recover after sport. However, it is best used as a preventative treatment to control muscle tension and prevent injury.

 2. Deep Tissue Massage

This massage focuses on the deeper layers of muscle tissue. The aim of this massage is to release patterns of tension in the muscles with slow deep strokes through the muscle fibres. A deep tissue massage will loosen muscle tissue, release toxins from the muscles, and assist blood and oxygen to circulate properly.

3. Soft Tissue Massage

This massage involves light to medium pressure aimed at relieving general muscular aches and pain, soreness and tension. It provides the benefits of massage while retaining a relaxing essence.

Book in for a physiotherapy session and discuss manual therapy and massage with your physio. Often a combination of joint and muscle treatments are required to get you moving better and feeling better. The depth of the massage varies to the tolerance and goals of the individual.

Call us at 4921 6879 to book an appointment.

 

 

 

Ergonomics: Getting your study space right

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Ergonomics: Get Your Study Space Right

How do you sit at your computer? Does it ever lead to pain? If you study or work in an office, read on to learn how you can setup your workstation ergonomically. Ergonomics refers to the design or arrangement of a workstation to suit the user.

Commonly affected areas due to poor workstation setup are the shoulders and neck, wrist, and elbows. Practicing good ergonomics can reduce pain and discomfort.

5 Tips to Setup an Ergonomic Workstation

ergonomics_guide

  1. The chair should have a backrest (lumbar support).
  1. Adjust the chair height (desk should be at elbow level when sitting upright).
  1. Use a footstool if feet are off the ground.
  1. Adjust monitor so the top is at eye level.
  1. The keyboard and mouse need to be within reach, keeping elbows by your side. (Don’t reach out.)

  Laptops and tablets don’t allow for good ergonomics because they tend to pull your shoulders and neck downward. The keyboard and screen need to be separated. Get yourself a wireless keyboard and mouse and put the laptop up at the correct height (either on a docking station or even just a stack of books). This will help you maintain good posture.

Try not to sit at your computer desk for long periods of time. Setting up your workstation correctly takes only minutes to do, is not expensive, and means you’ll have a better study or work experience.

Low back pain – Is it in the way you move?

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woman doing fitnessMedical literature places all those with low back pain that have no pain down the legs or other nerve or medical features into one group “non-specific low back pain”. It is a large group (approx 80%) of all people who have low back pain. So how do we best help such a large group of different people with non-specific low back pain? Every person is different in their physical makeup and past experiences.  We cannot separate the ‘who’ you are from the ‘what’ is wrong when answering this question.

 5 areas worth considering when helping someone with non-specific low back pain.

1. How much sitting do you do? As a nation, we are now sitting more than ever before thanks mostly to computers. Remember the message from Dr Mike Evans and his 23 1/2 hrs video! If you haven’t watched it, click here to learn what’s the single best thing we can do for our health.

2. How much movement/exercise do you do? Too much of any position can make us sore, and simply doing something different can offset that. Walking to counteract the sitting can help those who have pain with sitting. If that is you, start a regular walking program.

3. The way you move can predispose you to pain. Dr Peter O’Sullivan is a world leader in researching back pain and remains a practicing physiotherapist in WA. His research looks into sub-classifying mechanical low back pain into which movements increase it and improving how you move to reduce it.

4. Core strength – this actually has the least amount of research behind its benefits. Sometimes strengthening the back and abdominal muscles does work (as evidenced by those doing pilates) but other times it creates pain.

5. Stress levels – this is a common contributor to low back pain. Occasionally it is the main cause of the pain but often being stressed just makes your pain worse. There are lots of resources to help in this area but starting with your GP is a good option.

Management needs to identify and address all of these factors. Get moving if you aren’t already (if the pain allows you). Get out of the chair as much as you can. Look at what movements or postures make the pain worse – that’s where your physio can help the most! Consider your stress levels relative to the pain. Lastly you can start core exercise/pilates if there is no increase in pain – note there are many types of core exercises and choosing the right level and having the correct technique is important. Sometimes it helps because it’s just another method of getting you out of the chair and active.

It’s a lot to consider but if you have back pain that is affecting your life then you need a physiotherapy assessment. We will get you moving in the right way. Let us know if we can help at 4921 6879 or email admin@numovesphysiotherapy.com.au.

Neck Headaches

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neck headache massageHeadaches are often caused by disorders of the neck or physical and emotional tension. For many people, headaches start as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, temples, forehead or behind the eyes. Moving the neck or bending forward for a long time tends to make it worse. This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck or muscles can cause referred pain to your head.

Any of the following points could suggest that your neck may be causing the headache:

  • Does the pain radiate from the back to the front of your head?
  • Headache with dizziness or light-headedness
  • Headache brought on or worsened by neck movement or staying in the same position for a long time
  • Headache which always feels worse on the same side of your head
  • Headache eased by pressure to the base of the skull
  • Headache which persists after your doctor has checked for other causes

Physiotherapy can successfully treat headaches originating from the neck and teach you how to prevent or control the pain naturally. Treatment can include:

  • Mobilisation or manipulation of joints in the neck and thoracic spine
  • Functional and rehabilitative exercises
  • Encouraging normal activity
  • Postural assessment, correction and advice
  • Massage

We particularly focus on identifying what causes the headache, which often leads to successful self-help strategies in preventing or reducing frequency of further headaches.

* Based on an Australian Physiotherapy Association client education article