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What should I avoid if I have shoulder bursitis?
What is shoulder bursitis?
Within our shoulder we have multiple bursa, which are little sacs of fluid that help to reduce any friction between the tendons and bones within the joint. However, if our shoulder is in a position for a prolonged time that is irritating the bursa (e.g. painting a house) or if we injure any of the muscles, tendons and ligaments within our shoulder, fluid can accumulate within the bursa, causing bursitis! Like if we had a blister on the back of our heel (sac of fluid) and we wore shoes that kept rubbing against it, its going to inflame the blister and make it bigger and more sensitive.
3 main activities to avoid:
1. Avoid sleeping on the affected shoulder
- When we sleep on our affected shoulder, you will be placing more pressure directly onto the bursa that is inflamed. In turn, this will not allow the bursa to settle and will continue to compress it, causing more pain and inflammation in the region.
- Instead, try to sleep on your back or on the other side, propping your sore shoulder up with a pillow to avoid rolling onto the sore side.
2. Avoid repetitive overhead & across body activities
- We need to give the bursa time to settle, and avoid doing any activities that will put our shoulder into an impinging position. Continuing to repetitively use our arm overhead or across the body will continue to irritate the bursa and not let it settle. Activities such as cleaning high windows, painting high ceilings, sweeping, vacuuming, placing objects on high shelves for a prolonged time, should try to be avoided.
3. Avoid long lever lifting
- Long lever lifting is when we lift an object or small weight with a straight elbow. As the arm will be in an elongated position, it will increase the load that is placed on the shoulder joint. In turn, this will place more pressure on the bursa if the muscles aren’t strong enough to help support the joint.
- Instead, bring the object closer to you and lift it with a bent elbow to reduce the amount of load going through the shoulder
If you continue to have pain after avoiding the aggravating activities, manual therapy and specific exercise prescription from a Physiotherapist will help to improve your range of motion and build strength within the shoulder will help relieve bursitis pain.
What should I avoid if I have shoulder bursitis?
Link to Tayla's Chat on Facebook Keep moving with kneecap pain
Pain in the front of the knee, around the kneecap can be a common issue in people presenting to Physiotherapy. This issue can be caused by an irritation of the patellofemoral joint, the joint between your kneecap and the base of your thigh bone. Often pain can occur in this joint when running, walking up or down stairs or during other exercise such as squatting. Pain in this area often relates to pressure on the kneecap as it articulates with the bottom of your thigh bone – your femur. The force on this joint is mainly influenced by two things: the amount of force being produced by the quadriceps muscles on the top of your thigh, and the amount of knee bend or flexion that occurs when the joint is under load.
Here are a few strategies you could implement to reduce your patellofemoral pain whilst continuing to exercise:
- Choose exercise activities that gradually expose the knee to greater stresses.
There is a systematic review by Hart et al. (2022) that has looked at the average reaction force that different activities place on the patellofemoral joint in healthy individuals.
Walking: 0.9x body weight
Descending stairs: 2.8x body weight
Ascending stairs: 3.8x body weight
Running: 5.2x body weight
Squatting: 1 – 18x body
Looking at these averages, a good way to try and reduce the load on the patellofemoral joint could be to target start with a low loading exercise such as walking and gradually progress to stairs and then running. As you can see, there is a very large variability in the loads that are placed on the knee during squatting movements. Therefore, if you can minimise the amount of knee bend during your squats, you may be able to reduce your knee pain.
- Modify your current exercise program to reduce the stress on the knee joint.
We know that the joint reaction force will increase with greater knee bend. Choosing squat variations that limit your knee from bending more than 90 degrees could allow you to maintain lower body strength whilst reducing your pain. Choosing exercises that are double-legged rather than single-legged may reduce the tendency of your knee to track inwards, which may help to settle your patellofemoral pain.
If you are a runner, increasing your step rate may help you to settle your knee pain and keep you running. If you keep the same running pace, an increased step rate will reduce your stride length, which reduces the amount of knee bend through the weight-bearing portion of the running cycle. This can then reduce the reaction force in the patellofemoral joint, and it will be easier to maintain better alignment through your hips to avoid a scissoring pattern.
Then once symptoms have settled you can begin gradually re-expose the knee to more loads over time so that it can get used to it. As with many areas of the body, this advice is generalised and may not be affective for individuals with varied anatomy and movement patterns. Try a few of these strategies, and if you’re still having issues with your knee pain, we’d be happy to help you here at the clinic.
Reference:
Hart, H. F., Patterson, B. E., Crossley, K. M., Culvenor, A. G., Khan, M. C. M., King, M. G., & Sritharan, P. (2022). May the force be with you: understanding how patellofemoral joint reaction force compares across different activities and physical interventions—a systematic review and meta-analysis. British Journal of Sports Medicine, 56(9), 521–530. https://doi.org/10.1136/bjsports-2021-104686Lateral hip pain
Pain on the outside of the hip is a common complaint especially for those who have shifted towards an increase in their physical activity or ceased physical activity leading to a stress to the tendons that surround the hip.
Some times this pain can also be a result from an inflamed bursa in the hip but it is important to note that there is often an issue with the glute tendon itself and so this muscle and tendon also needs to be addressed in order to restore pain free movement.
To help manage this pain it is important to reduce compressive loads on the outside of the hip, so try to avoid sleeping on that side or crossing your legs, as this stretches and puts pressure on these structures. If you do sleep on your side, place a pillow between your knees. Also try to avoid stretching out the glutes as this also puts compressive pressure on the area of pain. Until you build more strength around the hip, it is best to reduce walking up hills and stairs. Putting an ice pack or frozen peas right over the widest part of the hip is helpful to reduce the pain.
A really helpful exercise in the early management of this pain is a simple exercise using a belt or a tied up scarf around your thighs. You can do this in sitting or laying on your back with the feet on the bed and the knees bent up. Once you have the belt around your thighs, simply press the affected side into the belt and hold. This is called an isometric exercise, where you switch on a muscle and keep it switched on so as to stimulate blood flow and it is also a really good way to desensitize the area of pain. It is a gentle way to begin activating these glute muscles so that you can then progress slowly with more challenging glute exercises once the pain settles more and more.
Be patient with yourself, lateral hip pain can be tricky and can sometimes take a while to get on top of. There are other treatments that can help, such as shockwave therapy and corticosteroids injection but as this pain is often a result of an issue in your glute tendon, it is important that you rebuild the strength and control around your hips.
Tennis Elbow - Why is my elbow hurting?
Lateral epicondylitis (also known as Tennis elbow), is considered an overload injury of the extensor tendons of the forearm where they attach at the lateral epicondyle. It affects up to 3% of the population, and symptoms may persist for up to 1 year in 20% of people. Up to 17% of workers within the highly repetitive hand task industries such as factory workers, admin workers and tradesman, experience lateral epicondylitis.
What does it feel like?
Lateral elbow pain presents as pain and tenderness over the outside of the elbow when doing activities such as:
- Writing or typing on the computer
- Lifting an object (even as light as a sheet of paper)
- Opening the car door or those horrible pasta sauce jars
The pain may build up over a few weeks to become a burning sensation, and cause swelling of the area, stiffness, or weakness in the forearm.
Is it from playing too much tennis?
It can be, but it is categorised as an overload injury. Overload injuries tend to occur after a minor or sometimes unrecognised trauma to the extensor muscles of the forearm. Despite the commonly known title of tennis elbow, tennis is a direct cause in only 5% of people.
How should I manage this injury?
Modify and lower the load going through the extensor tendons. However, make sure not to completely rest the tendon for prolonged time (e.g., resting completely for 10 weeks, and returning to the activity with pain remaining). Throughout the course of the tendon injury, it is essential to continually modify the load because as the tendon heals, it will gradually be able to handle more load and you will be able to do more things with less pain.
Some “handy” tips on how to reduce the load through your elbow include:
- Doing your best to avoid repetitive tasks
- Use the unaffected hand
- Adjusting your work environment (e.g. height of work chair)
- Wearing a brace to disperse load from tendon]
Exercises that specifically load the tendon gradually have been shown to have improved long-term outcomes. The aim is to progressively increase the load as the tendon heals within pain free limits. These exercises are to be best prescribed to you by your Physiotherapist.
Will cortisone injections give me a quick fix?
Cortisone injections have been proven to reduce pain and improve function in the short term, the quick fix of 6 weeks. However, it does have the highest rate of
re-occurrence and repeated cortisone injections will increase the risk of surgery. With Physiotherapy intervention where patients are educated about their pathology, given advice on medication, braces and how to deload the tendon, people will get out of pain faster and experience less pain over the duration of their recovery.
Other treatment options you can try including Acupuncture, Extra-corporeal Shock Wave Therapy, orthoses/braces, manipulation and exercise and mobilisation.
Take home message!
- Tennis elbow is an OVERLOAD injury.
- Don’t do nothing. Learn how to modify your daily tasks to avoid overloading the wrist extensor muscles
- Cortisone injections may be good for a quick fix, but think long term
If you are suffering from tennis elbow and would like to learn how to manage this injury appropriately, visit your local Physiotherapist. You can also visit our YouTube channel to view a video I have created to provide a few exercises to get you started.
Exercise Guidelines
Many clients ask how much exercise should I be doing? It is a question that is often asked and not many people seem to be able to answer.
In many cases, injuries are caused by deconditioning and muscle atrophy, which leads to problems with pain and loss of physical function. It is important that people get sufficient exercise to maintain their level of function and current fitness levels, however it is important that people know how much activity they should be doing.
General Exercise Guidelines
The Australian Government department of health states that adults between the ages of 18-64 should accumulate a total of 300minutes of vigorous exercise per week, including completing specific muscle strengthening exercise on 2days. For people aged 65 years + it is recommended that people complete 30 minutes of moderate intensity exercise every day.
What is vigorous exercise?
Vigorous exercise is counted as exercise where you are breathing hard and fast, with a moderate increase in your heart rate.
What is moderate intensity exercise?
Moderate-intensity aerobic activity means you're working hard enough to raise your heart rate and break a sweat. One way to tell if you're working at a moderate intensity is if you can still talk but you can't sing the words to a song.
Is walking enough?
People often ask if walking is enough. If you are walking at a moderate intensity as described above, for 30 minutes per day, then you should be meeting recommended exercise guidelines for people aged 65 +. However, if your physio advises strengthening a muscle group or area, then walking is not sufficient.
How to build strength?
https://www.youtube.com/watch?v=2tM1LFFxeKg
Strength is often recommended to rehabilitate an injury and protect an area of the body. Strength is built by placing the tissue under stress so that you are causing microscopic damage to the tissue. Once this damage occurs, the body will heal the area, making it stronger and able to withstand greater stresses in future. Our bodies have adapted to be able to cope with the demands of everyday activities, so it is important that when strengthening a muscle you are placing it under sufficient loads that are greater than what the body typically experiences.
If you are not meeting the recommended exercise guidelines including 2 sessions of muscle strengthening per week, you may be vulnerable to muscle loss or atrophy, and may be developing a greater risk of injury.
In summary, completing adequate levels of activity are important for maintaining physical functional and limiting the effects of injury. Physiotherapists are experts in instructing people on how to exercise in the presence of injury or pain. If you are unable to meet your activity levels due to injury, then ask the physio how to work around the injury whilst we help the body to heal.
Remedial massage
The intention in remedial massage is to ‘remedy’ the body. This style of massage holistically looks at the entire body, with its focus being treating pain, structural dysfunctions and helping in injury rehabilitation.
Remedial massage therapists use assessments and tests to find out what structures are causing your pain or your postural dysfunction. Usually muscular pain such as low back pain, is caused by either weak muscles, overactive muscles or compensating muscles. Once the remedial therapist has found the cause of your pain/discomfort, the massage will then be focused around treating the muscles that are causing the pain in your body. Therefore remedial massage is specifically tailored to each individual unlike most relaxation massages.
A remedial massage will involve a variety of techniques, targeting specific muscle groups. Some techniques include trigger point therapy, PNF stretching, Myofascial release and muscle stripping. The pressure in remedial massage can be at times deeper than in relaxation massage, but always working in what is tolerable for the client.
People who will benefit from a remedial massage include anyone who is experiencing muscle tension, or anyone experiencing acute or chronic pain, some examples being low back or neck pain. Like relaxation massage remedial massage is also beneficial at stimulating blood flow throughout the body and assisting in toxin removal.
Although remedial massage may not be considered as relaxing at a relaxation massage, it’s still very effecting at calming the mind and body. Especially seems as remedial massage treatments can take away your musculoskeletal pain, which has a direct effect on your mental and emotional state.
What is degenerative disc disease
Degenerative disc disease is commonly seen in lower back and neck CT’s and MRI’s. It is a radiological term used for explaining anatomical changes in a disc rather then a pathology. Having this in mind when degenerative disc disease is coupled with pain it is most commonly due to issues with surrounding structures e.g. weakness and/or stiffness. Having degenerative disc disease does not always mean that it is causing pain output. Weaknesses of surrounding structures can lead to shear, compressive or tensile forces which make the more vulnerable discs stress.
The protocols to then treat a painful back with a history of degenerative discs is to make sure surrounding structures are strong and supple. This will take away the forces on the vulnerable discs. It does not mean though that those discs will heal it only means a better managed pain state. These discs will always be structurally vulnerable due to their lifetime of stressors.
Do not wrap yourself in bubble wrap to avoid this natural wearing of discs as it will most likely happen quicker. Be aware of remaining constantly active throughout your lifetime and treat your body with the respect it deserves.
Lateral Hip Pain
Have you recently started to get pain in the side of your hip? Has it been there before and then come back again? Have you had corticosteroid injections that have relieved pain temporarily or not at all? If so, read the blog below to help you get on-top of your stubborn hip pain and start the pathway back to performance.
Lateral hip pain can be referred to as Greater Trochanteric Pain Syndrome, Trochanteric Bursitis, Glute Medius Tendinopathy or Hip Bursitis. All these terms are used to describe pain inside the hip and buttock region, on the bony part on the side of your hip (greater trochanter) and sometimes down the outside of the thigh. The hip pain can be aggravated by sitting cross-legged, prolonged walking, prolonged sitting, climbing stairs/hills and lying on the painful hip.
Ultrasound imaging of lateral hip pain often illustrates inflammation or thickening of the trochanteric bursa or ‘bursitis’. A bursa is a small fluid-filled sac that provides a cushion between bones and tendons throughout the body to minimise friction. You may have been given a corticosteroid injection into your bursa to ease this inflammation.
These injections can be effective in reducing your pain, but this may only be short-lasting!
Often trochanteric bursitis is a secondary reaction to a Gluteus Medius/Minimus tendinopathy or weakness in this hip muscle group. Dysfunction in these muscles can increase the compression force on the bursa and tendons. Prolonged and repeated compression of these structures without suitable exercise and lifestyle modifications can cause thickening and inflammation of the bursa, and potentially tendon degeneration.
Benefits of Gardening
Whether you’re growing fruit and veggies, flowers or succulents, getting your green thumb on can have a surprising number of health benefits for you and your family.
Stay fit and active in the garden
Depending on the size of your garden, maintaining it can be also be a great way to be physically active. This could be as strenuous as mowing the lawn, or as gentle as getting a good stretch and practice stabilising yourself while kneeling, sitting or reaching.
In fact, gardening is a recommended activity as it can encourage the use of many motor skills, improve endurance and strength and keep you moving.
Eat your greens
Do you have a picky eater at your dinner table? Kids who are picky eaters may be keener to try new foods that they’ve helped to grow. Watching the plants sprout and grow and waiting until fruit and veggies are ripe and ready to eat can help build their enthusiasm and excitement about healthy foods.
The effect works on everyone, not just those with hard-to-please tastes. Growing your own fruit, vegetables and herbs will encourage you to eat seasonally, add more variety to your diet, encourage you to prepare homemade healthy dishes and learn to appreciate fresh produce.
Understand seasonality
These days, we can buy pretty much any fruit and vegetable we want from the supermarket, at any time of year. But eating seasonally has important benefits for our bodies.
Different fruits and vegetables are “in-season” at different times throughout the year. For example, asparagus and apricots grow in spring and summer, while Brussels sprouts get going in winter. Eating seasonally can keep healthy eating exciting by encouraging you to try new recipes using in-season produce. You will also get a wider variety of different coloured produce, providing nutritious vitamins and minerals in your diet throughout the year as the produce you eat changes with the seasons.
Find out what’s in season at different times of the year in Queensland using the Healthier. Happier. Fruit and Veggie Seasonality Charts [PDF 369KB] and ask about the ideal planting times for your area at your local garden centre or nursery.
Relax and meditate
Gardening is also a great way to relax, providing opportunities to still the mind and get away from the busyness of everyday life. There is even evidence to suggest that gardening can help ease symptoms of mental illnesses like depression and anxiety.
Whether you’re gardening by yourself, or getting the whole family involved, it’s a great way to spend some time outdoors, away from screens and to-do lists, and engage with nature. From repetitive tasks like weeding that provide opportunity for meditation, to practising patience while waiting for plants to grow, gardening is a great exercise for your mind as well as your body.
Breathe easier
Gardening doesn’t have to be an outdoor activity – there are many varieties of plants that can be grown inside, too. As well as making rooms look nice, indoor plants can help improve air quality in enclosed spaces. Some studies also suggest that indoor plants can boost the concentration and focus of office workers.
Not all plants will grow well indoors, so you’ll need to research which varieties will grow well in the lighting and temperature of your room.
Things to keep in mind when starting out
Different fruits and vegetables grow best at different times of the year. The Healthier. Happier. website has articles on what plants to grow during different seasons and a guide to easy grow-your-own healthy foods.
If you’re planting an edible garden, remember that not all plants are safe to eat. Make sure you plant non-toxic varieties, checking at your local garden store if you’re unsure. Don’t use chemical sprays or fertilisers on your edible garden.
Always wear gloves when working with plant material, soil and fertilisers, and be sure to wash your hands when you’re finished. When working outside, remember to be safe in the sun by wearing a broad-brimmed hat and protective clothing, wearing sunglasses, using a broad spectrum SPF 30 or higher sunscreen, working in the shade when possible and drinking plenty of water.
Some councils and community groups offer gardening workshops, or set up community gardening sites, to help locals learn about gardening and growing edible plants. You can also find more information about starting a garden on the Better Health website and from this list of links on the
Healthier.Happier Website
Information care of the QLD Government website
https://www.health.qld.gov.au/news-events/news/health-benefits-of-gardeningTendinopathy
Tendinopathy refers to an unhealthy tendon characterised by overuse and the presence of tiny tears along with the breakdown of collagen fibres and other changes to the intracellular structure of the tendon.
Here are some vital facts to know about tendinopathies.
1) Tendinopathy does not improve with rest. Pain may settle temporarily but returning to activity is often painful again because rest does nothing to increase the tolerance of the tendon to load.
2) There is NO good evidence that these injuries are caused by inflammation. Therefore, anti-inflammatories often have limited effectiveness for these injuries.
3) The main factor for tendinopathy is overuse or simply too much of certain activities. Activities that
require the tendon to store energy such as walking, running, jumping, along with loads that cause compression are the most common causes of tendinopathy. Tendon pain is sometimes caused with only subtle changes in activity.
4) Exercise is the most evidence-based treatment for tendinopathy – tendons need to be loaded progressively so that they can develop greater tolerance to load. In a vast majority of cases tendinopathy will not improve without this.
5) Modifying load is important in settling tendon pain. This often involves reducing tendon load that involves energy storage and compression.
6) Pathology on imaging is NOT equal to pain. This is one of the things that most people have the most difficulty understanding about tendon injuries. You can have severe pathology or tearing of the tendon, but this will not determine the amount of pain you will have or necessarily affect your recovery. Tendon pathology is also common in people without pain,
7) Tendinopathy rarely improves long term with only passive treatments such as corticosteroid injections, massage, acupuncture, dry needling, etc. Exercise is the most important treatment and passive treatments should only be used as adjuncts. There is lots of evidence to support this and if you are interested, more information can be found in the links provided.
8) Exercise needs to be individualised to a person’s pain and presentation. There must be progressive increase in load to enable restoration of function whilst respecting pain.
9) Tendinopathy responds very slowly to exercise. You need to have patience, ensure that exercise is correct and progressed appropriately, and try and resist the common temptation to accept ‘short cuts’ like injections and surgery. There are no short cuts.
References
Abate M, Gravare-Silbernagel K, Siljeholm C, et al.: Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research and Therapy. 2009, 11:235.
Cook J, Purdam C: Is compressive load a factor in the development of tendinopathy? British Journal of Sports Medicine. 2012, 46:163-168.
Littlewood C, Malliaras P, Bateman M, et al.: The central nervous system–An additional consideration in ‘rotator cuff tendinopathy’and a potential basis for understanding response to loaded therapeutic exercise. Manual therapy. 2013.
Malliaras P, Barton CJ, Reeves ND, Langberg H: Achilles and Patellar Tendinopathy Loading Programmes. Sports Medicine. 2013:1-20.
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