Viewing posts categorised under: Physiotherapy

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-2021-104686

Lateral 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?

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.

Why can neck pain cause vertigo, dizziness and/or headaches

There have many different hypotheses for this conundrum over the past few decades. Few have stood the test of scientific rigor. Below are a few that have:

1) Proprioception. This occurs more often in acute traumas like whiplash from car accidents. Where the damage in a joint or tissue can lead to abnormal afferent input into the vestibular nucleus. In turn disturbing vestibular input. In normal terms it kinks the balance link between the inner ear, brain and muscles. This is times by 10 due to the fact we have significantly more proprioceptors in the upper cervical joints then any other joint in your body.

2) Sympathetic dysfunction. Your sympathetic part of your autonomic nervous system controls the survival mechanism of our body hence the "fight or flight". When damage occurs to your cervical spine it may stimulate sympathetic nerve fibres changing blood volume in the vestibular arteries supplying the brain stem. Hence constricting blood vessels in the vertebro-basilar system resulting in dizziness and/or vertigo. We have many of these sympathetic nerve plexuses around our spinal column.

3) An obstruction in the vertebral artery. A stenotic obstruction in this artery can lead to all of the above symptoms. Neck rotation can block this artery leading to VBI (vertebral artery insufficiency).

4) Cervicogenic vertigo associated with chronic migraines. The trigeminal nerve which is one of the cranil nerves has reciprocal connections to the vestibular nuclei. The trigeminal nerve innervates a lot of the upper cervical area in which could be an explanation to the symptoms stated above

The secret of sleep

Good quality sleep is vital for a healthy happy life. It enhances our energy, makes us feel more alive and has an important impact on our experience of pain. But so many of us struggle to fall asleep or find ourselves waking up during the night.

When we sleep our bodies are able to restore and repair themselves. One of the great ways our body does this is by secreting collagen in the first few hours of sleep. Collagen repairs and protects cells thereby allowing our entire body to have a better chance at healing. Another important substance released during sleep is melatonin. This is released in the last few hours of sleep when rapid eye movement (REM) sleep kicks in. Melatonin is an antioxidant that enhances our sleep cycle to give our cells plenty of time to repair, rebuild and regenerate. These healthy, happy cells are then better able to combat injuries, inflammation and other causes of pain in our body. On top of that if we are well rested then our mood improves thereby improving our resilience to pain.

Busy lives can make it difficult to get this good quality sleep. We are often staying up longer as well as worrying about lots of things. This extra stress increases our levels of cortisol. Cortisol is a stimulant for the nervous system and makes it difficult for us to wind down. To help combat this we need to ensure adequate GABA is being released in the evening. GABA is a neurotransmitter that helps to slow the nervous system down. To help our body produce more GABA we can take the following supplements.

-Magnesium: a muscle relaxant that helps increase GABA levels

-B6: helps convert glutamate into GABA

-Zinc: a requirement to activate B6

-Prebiotics: to help increase good bacteria in the gut to allow better absorption of nutrients

On top of balancing the body's hormones there are other important things we can be doing to help our sleep. Try some of these tips:

-Switch off your phone

-Avoid screens in the hour before you go to bed

-Keep to a bedtime routine

-Keep the hour before bed the same every night

-Avoid heavy foods and drinks

-Try not to drink caffeine after 4 pm, or alcohol at night

-Do not eat heavy meals in the 2 hours before bedtime

-Try not to nap more than 20 minutes in a day

-Use meditation apps

-Ensure you are getting enough exercise throughout the week as exercise enhances the time spent in deep sleep

-Practice relaxing breathing and yoga prior to bed

If you feel tension in your body or particular areas of tightness and discomfort then have a chat with your physiotherapist. They can assess for the problematic muscles and provide you with gentle exercises to help release this tension prior to bedtime. You may also find it useful to get guidance on good breathing habits. Your physiotherapist can teach you to activate the correct breathing muscles allowing you to access the benefits of breathing techniques.

Cricket Season!

Summer is on its way, which means so is the emergence of the iconic Aussie summer sport cricket. You will even see our Senior Physio / resident athlete Kai Allison playing for the Pottsville cricket club this summer! The demands of the sport of cricket can be variable depending on whether the player involved is a speed or spin bowler, and whether they field infield or outfield. For those who are bowling fast or consistently throwing from the boundary, the forces needed from their shoulders to generate speed on the ball are very high and with repetition this can lead to injury if the players shoulder musculature isn’t ready for the task. That is common sense, right?! To do difficult tasks with your shoulders they need to be strong. What is not common sense is the impact that the players ability to create forces through their lower body and trunk will have on their ability to bowl or throw with speed. With specific training of stepping patterns and trunk rotation patterning and strength, we can significantly reduce the risks of shoulder injuries in the overhead throwing athlete as well as improve performance. Studies published by Oyama et. al (2009) and Richardson et. al (2015) showed that with poor control of stepping patterns and trunk rotation sequences there is an increase in electromyographic activity in the muscles of the rotator cuff and all of the stabilisers of the shoulder blade, as well as an increased external rotation range of motion in the cocking phase of the throw. That is technical talk to say that the amount of force going through your shoulder muscles is increased and the positions that your have to get into to achieve force in the throw are more precarious if you don’t have good control of your trunk and stepping patterns. The other way to look at the information from the studies above is that we are able to reduce the forces through our rotator cuff (deep shoulder muscles) by adding rotation and stepping patterns which is great for injury prevention and performance, but it also suggests that if we are trying to specifically drive rotator cuff and scapular adaptation from our training, then we need to train them in isolation. So the take away from the above info is that for building strong and resilient shoulders in the overhead athlete we need to be training both isolated rotator cuff / scapular muscle strengthening AND full body stepping + trunk rotation + shoulder rotation strength and patterning. The other major aspect of maintaining shoulder health is throwing athletes is the ability to control acceleration and deceleration of our upper limb at the start/end of the throw. This wont just happen by itself with regular strength exercises, we need to be specific with our training. That’s a lot of information about WHAT to do, so lets go through some examples of HOW to go about it. The following exercises are a non-exhaustive example program of some ways to target the goals above (I will put a video of these on our Instagram and Facebook in case the photos and explanation don’t make sense).

Band / Cable shoulder internal & external rotations

With these exercises we need to be working on strength through range of our shoulder joint, and to be more specific to the throwing motion they need to be completed in a range of different shoulder positions. The classic position for these is elbow by your side with the rotation, but that alone wont drive change in a throw. Other suitable positions to work on these rotations include 90degress of glenohumeral abduction, and also in 90degress of glenohumeral flexion + neutral horizontal adduction (see the pictures and these positions will make a lot more sense). These will be good at building general rotator cuff strength and can be great as a warm-up exercise.

Weighted Ball accelerations/ decelerations

This exercise is a little trickier to complete solo and is best done in pairs (unless you’re really tricky and bounce the ball from a wall). One person in the pair is doing the acceleration/deceleration exercises and the other is being an assistant and throwing the ball into the right place to catch. I like to do these in a kneeling lunge position, however you can do them in sitting or standing too. The assistant will throw the weighted ball to the athlete at just above shoulder height, and the athlete’s goal is to catch, control and recoil the ball back to their partner.

Single and double hand Palloff press

Despite looking very similar, the outcome and goals of these exercises is quite variable. I have put them together in this program as I like to complete them in a superset with both exercises. The amount of external load being used will be significantly less for the single hand compared to the double. The goal of the single hand version is to be active through the muscles in the back of your shoulder/ shoulder blade while your arm is in a position out in front, whereas the double hand version becomes an anti-rotation exercise for the muscles of your trunk. While being less specific to the throwing motion, these are both great for learning to activate and control the muscles needed in the throwing pattern. When done well, it will look like you aren’t doing much, as the goal is to only move from the shoulders and limit movement from the rest of your body.

Swiss Ball DeadBug

The target of this exercise is to learn/practice simultaneous activation of the muscles that we will use in the trunk rotation to create momentum before we get to the shoulder rotation. We need to be pressing downwards into the swiss ball with our arms and upwards with our thighs, then maintain this contraction as we take away the opposite hand and leg. The remaining contact points will ensure that we are active through the hip flexors on one side, through the trunk/abs to the opposite shoulder. This is exactly the force transfer we need when patterning our throwing.

Cable weighted step & rotate

In the deadbug we have worked on activation, now this is putting activity into motion. Start slow and work on the step into the activation pattern created in the deadbug, then following through with the hands. This exercise can be completed slowly with moderate resistance for motor patterning, or with lighter weights and more speed to be more specific to the true throw. As mentioned earlier, this is a sample program of some of the many appropriate ways to achieve the goals mentioned in the first part of the blog. As every person/athlete is individual, their program should reflect this so if you need assistance or help with any of the above exercises, or others you are doing in your strength work don’t hesitate to contact us for assistance.

Feeling The Pinch?

The Stubborn Shoulder Impingement Syndrome

Do you get a sharp, debilitating pain in your shoulder when you are performing tasks like brushing your hair, putting on certain clothes or showering? During these movements, where you raise your arm out to the side and then upwards over your head, do you alternate between no pain and pain? For example, during the first part of the moment you don’t feel any pain, and then suddenly your shoulder “catches” and there is sharp pain, followed by no pain again as you continue to move your arm upwards. These are all signs of a condition called Shoulder Impingement Syndrome (SIS), where the tendons of the rotator cuff muscles that stabilise your shoulder get trapped as they pass through the shoulder joint in a narrow bony space called the sub-acromial space. Impingement means to impact or encroach on bone, and repeated pinching and irritation of these tendons and the bursa (the padding under the shoulder bone) can lead to injury and pain. Shoulder complaints are the third most common musculoskeletal problem after back and neck disorders. The highest incidence is in women and people aged 45–64 years. Of all shoulder disorders, shoulder impingement syndrome (SIS) accounts for 36%, making it the most common shoulder injury. You shouldn’t experience impingement with normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen, a condition called rotator cuff tendonitis. Likewise, if the bursa becomes inflamed, you could develop shoulder bursitis. You can experience these conditions either on their own, or at the same time. The injury can vary from mild tendon inflammation (tendonitis), bursitis (inflamed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness tendon tears, which may require surgery. Over time the tendons can thicken due to repeated irritation, perpetuating the problem as the thicker tendons battle to glide through the narrow bony sub-acromial space. The tendons can even degenerate and change in microscopic structure, with decreased circulation within the tendon resulting in a chronic tendonosis.

What Causes Shoulder Impingement?

Generally, SIS is caused by repeated, overhead movement of your arm into the “impingement zone,” causing the rotator cuff to contact the outer tip of the shoulder blade (acromion). When this repeatedly occurs, the swollen tendon is trapped and pinched under the acromion. The condition is frequently called Swimmer’s Shoulder or Thrower’s Shoulder, since the injury occurs from repetitive overhead activities. Injury could also stem from simple home chores, like hanging washing on the line or a repetitive activity at work. In other cases, it can be caused by traumatic injury, like a fall. Shoulder impingement has primary (structural) and secondary (posture & movement related) causes: Primary Rotator Cuff Impingement is due to a structural narrowing in the space where the tendons glide. Osteoarthritis, for example, can cause the growth of bony spurs, which narrow the space. With a smaller space, you are more likely to squash and irritate the underlying soft tissues (tendons and bursa). Secondary Rotator Cuff Impingement is due to an instability in the shoulder girdle. This means that there is a combination of excessive joint movement, ligament laxity and muscle weakness around the shoulder joint. Poor stabilisation of the shoulder blade by the surrounding muscles changes the physical position of the bones in the shoulder, which in turn increases the risk of tendon impingement. Other causes can include weakening of the rotator cuff tendons due to overuse, for example in throwing and swimming, or muscle imbalances between the shoulder muscles. In summary, impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity. When your rotator cuff fails to work normally, it is unable to prevent the head of the humerus (upper arm) from riding up into the shoulder space, causing the bursa or tendons to be squashed. Failure to properly treat this instability causes the injury to recur. Poor technique or bad training habits such as training too hard is also a common cause of overuse injuries. Over time pain can cause further dysfunction by altering your shoulder movement patterns which may lead to a frozen shoulder. For this reason, it is vitally important that shoulder impingement syndrome is rested and treated as soon as possible to avoid longer term damage and joint deterioration.

What are the Symptoms of Shoulder Impingement?

Commonly rotator cuff impingement has the following symptoms:

An arc of shoulder pain approximately when your arm is at shoulder height and/or when your arm is overhead
Shoulder pain that can extend from the top of the shoulder down the arm to the elbow
Pain when lying on the sore shoulder, night pain and disturbed sleep
Shoulder pain at rest as your condition worsens
Muscle weakness or pain when attempting to reach or lift
Pain when putting your hand behind your back or head
Pain reaching for the seat-belt, or out of the car window for a parking ticket

Who Suffers Shoulder Impingement?

Impingement syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height also increase the risk of rotator cuff impingement.

How is Shoulder Impingement Diagnosed?

Shoulder impingement can be diagnosed by your physical therapist using some specific manual tests. An ultrasound scan may be useful to detect any associated injuries such as shoulder bursitis, rotator cuff tears, calcific tendonitis or shoulder tendinopathies. An x-ray can be used to see any bony spurs that may have formed and narrowed the sub-acromial space.

What does the Treatment Involve?

There are many structures that can be injured in shoulder impingement syndrome. How the impingement occurred is the most important question to answer. This is especially important if the onset was gradual, since your static and dynamic posture, muscle strength, and flexibility all have important roles to play. Your rotator cuff is an important group of muscles that control and stabilise the shoulder joint. It is essential the muscles around the thoracic spine and shoulder blade are also assessed and treated as these too work together with the entire shoulder girdle.

To effectively rehabilitate this injury and prevent recurrence, you need to work through specific stages with your therapist.

These stages may include:

Early Injury: Protection, Pain Relief & Anti-inflammatory Treatment
Regain Full Shoulder Range of Motion
Restore Scapular Control and Scapulohumeral Rhythm
Restore Normal Neck-Scapulo-Thoracic-Shoulder Function, including posture correction
Restore Rotator Cuff Strength
Restore High Speed, Power, Proprioception and Agility Exercises
Return to Sport or Work

The early stages of treatment will involve manual therapy, including massage to relieve pain and release tight structures as well as mobilisation techniques to restore normal shoulder movement. Strapping/taping has been shown to be helpful in reducing pain as well as ultrasound and laser therapy. As you move through the other stages of treatment your therapist will prescribe rehabilitation exercises specific to your shoulder, posture, sport and/or work demands. Corticosteroid injections can be useful in the initial pain relieving stage if conservative (non-surgical) methods fail to reduce the pain and inflammation. It is important to note that once your pain settles, it is important to assess your strength, flexibility, neck and thoracic spine involvement to ensure that your shoulder impingement does not return once your injection has worn off. Some shoulder impingements will respond positively and quickly to treatment; however many others can be incredibly stubborn and frustrating, taking between 3-6 months to resolve. There is no specific time frame for when to progress from each stage to the next. It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. For more specific advice about your shoulder impingement, contact Pottsville and Cabarita Physio on 6676 4000 or 6676 4577 The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case.

WHAT IS AN ANKLE SPRAIN?

An ankle sprain is a stretch or tear in one or more of the lateral (outside) ligaments of the ankle. Ankle ligaments are slightly elastic bands of tissue that keep the ankle bones in place. Because the ankle is responsible for both weight-bearing and mobility, it is particularly susceptible to injury. The relatively small joint has to withstand large forces exerted when walking, running and jumping, especially if the surface is uneven. Most ankle sprains happen when the ankle twists or rolls suddenly, usually a rapid and uncontrolled movement. The most common injuries happen when the foot rolls onto the outside of the ankle, straining the outside ligaments of the ankle joint. Symptoms of a sprained ankle include; pain, tenderness and swelling, bruising, trouble moving the ankle, and sometimes an inability to put your full weight on the ankle.

HOW LONG DOES IT TAKE TO HEAL?

Most people recover completely from mild sprains within two to six weeks. More severe sprains can take up to six months before you can return to full activity, or sport. Once a significant sprain occurs, without good rehabilitation the joint may never be as strong as it was before the injury. It is not surprising therefore that many people have a history of repeated ankle sprains. With the correct rehabilitation however, you can help your ankle become even stronger than it was before the injury.

WHAT CAN BE DONE?

Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to inflammation, part of the natural healing process. However, the body tends to overreact to sudden traumatic injury and as a result excess inflammatory fluid accumulates which can result in ‘scar’ tissue production. Too much scar tissue may prevent normal function with reduced flexibility and increased risk of re-injury. It is important to get medical advice to gain a positive diagnosis and

ADVICE HANDOUT

Follow the PRICE guidelines immediately after injury and for at least 3 days afterwards before doing anything else. Your local physio therapist as well as most massage therapists can assist you with this: PROTECT - Protect the injured tissue from undue stress and avoid ALL movements in the same direction as when the injury occurred. REST – Unload the joint (take the weight off it) as much as you can in the first 72 hours after injury. Try and avoid walking on the joint as much as possible. ICE – Ice is an amazing natural healer and a great short-term pain reducer. It is also believed to have a beneficial effect in reducing swelling and promoting healing. The optimal amount of time to apply ice is around 10-15 minutes in bony areas such as the ankle. It can be applied as often as desired to achieve pain relief, ideally every 1-2 hours. COMPRESSION - This is advised for the first 72 hours, but only while your foot isn’t elevated. The compression can be firm if it doesn’t cause pins and needles or any loss of feeling around the joint. ELEVATION - Reduces the flow of blood to the area which helps reduce swelling. Elevation is recommended in the first 72 hours after injury. However, remove any compression while your foot is elevated unless you are wearing just a light compression bandage. When following PRICE it is also important to avoid HARM, hence the saying: ‘Give PRICE and avoid HARM’. HARM is an acronym for Heat, Alcohol, Running, Massage. Following this acute management phase, your physical therapist will start some ‘hands-on’ treatment to mobilise and strengthen the joint. This phase of treatment is crucial to ensure you return to full function and prevent future injury. Adequate preparation for activity is key and weight-bearing should progress gently. Drastic changes in activity level and performing unpractised skills expose your ankle to re-injury. Gradually build up your fitness level. Your ankle, and the rest of your body, will thank you for it! WHY IMMEDIATE TREATMENT IS IMPORTANT The success of injury healing can be boosted by appropriate, effective and timely action particularly in the early stages of an injury (ie. the first 72 hours). Any ‘soft-tissue’ is subject to injury including ligaments (which join bones to bones), tendons (which join muscles to bones) and to muscles themselves. The immediate reaction of the body to injury is similar irrespective of the soft tissue structure and is known as an inflammatory reaction. Injuries can be caused by overstretching, bruising or crushing. A strain describes overstretching of a muscle, while a sprain describes overstretching of a ligament or tendon. THE INFLAMMATORY REACTION Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to the four main signs of inflammation:

Heat – chemicals released from the damaged tissue causes dilation of surrounding blood vessels to bring healing agents to the area. The result is more blood and therefore heat
Redness – is due to the increase in blood to the area
Pain – is caused by the chemicals released from the injured tissues as well as the increased tissue pressure from the fluid acting on nearby nerve endings
Swelling – is the result of this accumulation of extra fluid.

This inflammatory reaction is necessary as it is part of the natural healing process. However the body tends to overreact to sudden traumatic injury and as a result more inflammatory fluid accumulates than is necessary for healing. This fluid contains a protein that turns into replacement ‘scar’ tissue. If too much can form it may prevent the structure returning to normal function with reduced flexibility and increased risk of re-injury.