Don’t Get into Deep Water with Swimming InjuriesSwimming is one of the most popular sports in the world. We swim in the sea, pools, lakes, streams, rivers and even ponds. And given 70% of the Earth’s surface is water, we’re not short of opportunities. And while swimming is considered a ‘low-impact’ sport due to the fact that the water supports a large percentage of, more than 84% of regular swimmers suffer from some type of overuse type injury caused by swimming. Why? The main reason is the high repetition number and forceful nature of the shoulder revolutions which takes our shoulder joint through its full range of motion (which is one of the greatest of all our joints), against resistance, over and over again. And as 50-90% of the power generated to propel you forward comes from the shoulders, you can see why they are the most frequently injured joint. However, swimming also puts stress on your back, to hold you level in the water; on the neck when raising your head out of the water to breathe and if you favour breaststroke as a stroke, there’s added pressure from the unnatural twisting motion on the knees. So, despite it seeming to be a low-impact sport, swimming actually carries a surprisingly high risk of injury. Let’s take a look at those injuries, why they happen and what you can do about them. Swimming injuries generally stem from two sources, and often these sources will combine:
- Muscle imbalances
- Stroke technique issues
Feeling The Pinch?
The Stubborn Shoulder Impingement SyndromeDo 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 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.
• Correct your posture: think tall all the time, avoid sitting and holding your head up with your hands. • Consider your ergonomics especially your computer set up and how you use your digital devices. In particular, avoid a forward chin position and sustained head and neck rotation. • Learn to breathe properly: gentle breathing in and out through the nose with movement occurring at the solar plexus not in the shoulder region. Breathing should be silent and invisible. You should feel the sides of your chest wall expanding as you breathe in, not your shoulders rising or your belly expanding. • Manage your stress levels, you may need to start a meditation practice. There are many great apps (e.g.- head space, smiling mind etc) to help you get started. This is particularly important if you clench or grind your teeth. • Get adequate sleep. Aim to sleep with your head in a neutral position not rotated or side flexed. Aim for an absolute minimum of 8 hours every night. • Eat clean food: avoid processed food, excess alcohol and coffee. Eat plenty of vegetables! • Drink a lot of water (at least 33ml per kg of body weight / day) add an extra 250ml for every caffeinated drink (such as coffee) you have. • Avoid carrying anything other than a very light bag on your shoulder • Avoid extending the head / looking up for long periods • Watch the position of your head while exercising – ensure you maintain a neutral head position, (i.e. – not look up or around). • Do not over do it when exercising particularly when using your arms and upper body.
Chronic PainPain is NORMAL. It is the body’s way of alerting us to what it thinks is DANGER. The interesting thing about pain is that we don’t actually experience pain until our brain interprets a signal from the body as being pain. It is important to accept that YOUR PAIN IS REAL – IT IS NOT IN YOUR HEAD!! There are many things that contribute toward the brain signalling pain: Thoughts Fears Past experiences Family issues; My mother has cancer could this be what is happening to me?, Who will look after the family? Work issues; Will I have to have time off? , How much money will I lose? Anxiety/stress can increase the sensitivity of the nervous system Exercise can help turn down pain signals by releasing chemicals that help to quieten the nervous system. All of these things make a difference as to whether or not your brain will interpret the signals from the body as pain. The important thing to understand is that the brain can still signal pain long after the original injury in the tissues has healed. When you initially have an injury, signals are sent to the brain to alert it to danger. The brain then interprets the signal, remember factors mentioned above will play a role in the brain interpreting the signal, and this is where the pain experience starts. This is all necessary so that you don’t go and do anything which may injure you further. However these messages can persist and lead to chronic pain.
Chronic pain is when you continue to experience pain long after the original injury has healedThis is due to central sensitisation. This is when the brain sends chemicals to the spinal cord to meet the signals coming from the tissues. These chemicals can be excitatory, which means they multiply the signals coming from the tissues and therefore send a much stronger signal to the brain then the original signal from the tissues. The brain can also send messages to the tissues to release more inflammatory substances – the body thinks it can heals faster this way, but doesn’t know when to turn off this inflammatory process. This type of inflammation is not helped by medication and explains why there can still be inflammation present many months later. This causes the nerves to become hypersensitive and send earlier and more signals to the brain, again this is an over sensitivity of the nervous system. Over time, the cycle continues which results in increasing sensitivity of the brain and therefore more and more pain. Pain can become a habit – your body anticipates and remembers it and it takes very little to trigger it, sometimes when things are really bad even thinking about moving can trigger the pain. The brain has lost its ability to differentiate between painful and non painful input, so just to be safe it triggers everything as pain. The brain has also lost its ability to distinguish between body parts so you may find your pain spreading or moving. The good news here is there is no damage in the tissues causing the pain, it is just that the brain is so used to feeling the pain that it continues to signal even though the damage has healed. It is the sensitivity of the nervous system that is causing this. The important things to understand is that PAIN DOES NOT EQUAL DAMAGE!! The solution is to make the brain understand that there is no longer any damage in the tissues and it is time to desensitise. We can do this through a graduated return to normal activity.
TAKE CONTROL1. Any new injury or disease requires a prompt medical examination. 2. Understand any prescribed help. Ask for appropriate scientific evidence supporting what is offered to you. 3. Make goals that both you and your clinician understand. Aim for physical, social and work goals, which allow your progress to be measured.
What is Clinical Pilates and why has it made such an Impact?Clinical Pilates has been shown to reduce the onset, persistence and recurrence of pain by addressing the neuromuscular dysfunction it is associated with. Clinical Pilates is largely concerned with training local spinal and pelvic stabilising muscles to work efficiently throughout functional activity. It is particularly important in the rehabilitation of spinal pain amongst other motor control problems and is associated to what researcher’s term “specific stabilisation exercises” or “motor control exercise”. With the latest research emerging, evidence-based Physiotherapists have re-evaluated their management of low back pain with a shift towards this type of exercise rather than focus on strength and endurance, which is perhaps more appropriate in the advanced stages of rehabilitation. CLINICAL PILATES involves the following components which are particularly helpful to aid in the rehabilitation of low back pain:
- Teaches co-activation of Transversus Abdominis (TA), Pelvic Floor (PF) and Multifidus (MF) muscles
- Teaches correct muscle activation patterns
- Trains local and global stability systems
- Trains neutral stability before end range stability
- Progresses static stability to dynamic
- Direction specific
Osteoarthritis and supplementsOsteoarthritis is a common inflammatory condition characterised by joint pain. See below example. Osteoarthritis affects 2.1 million Australians. The prevalence is higher in women and joint symptoms are experienced by more than 25% of people aged 65 years or older. Osteoarthritis is particularly burdensome, on individuals and on the healthcare system and is the main reason for knee replacement surgery. This is of great concern considering the projected rise in the aging population. In recent years, omega 3 fatty acids (from fish oil), glucosamine and chondroiten have increased in popularity. Research into these and osteoarthritis is showing some promising results, however more research is still needed. Should you take these supplements if you have Osteoarthritis?? You can as there is some worthwhile evidence but it should form only a small part of your management plan. Score your pain on a scale of 1-10 before taking the supplement, then after 3-6 months score your pain again to see if there has been any change. If you are taking chondroitin it is recommended that you take a supplement containing 800mg such as BioOrganics glucosamine 750g and chondroitin 400mg. There is much stronger evidence to show that dietary induced weight loss (>10% of body weight) and physical exercise such as strength training and aerobic exercise can have a moderate to large improvement in pain, function and quality of life. In addition, learning effective pain – coping skills have been shown to have positive outcomes not only for pain but also for function, stiffness and disability.
What is World Osteoporosis Day?World Osteoporosis Day takes place every year on October 20th, launching a year-long campaign dedicated to raising global awareness of the prevention, diagnosis and treatment of osteoporosis and metabolic bone disease.
In Australia an estimated 1.2 million people have osteoporosis and a further 6.3 million have low bone density.The disease is most common on the older population with 66% of adults over 50 suffering Poor bone health can lead to minimal trauma fractures such as a minor bump or fall The most common fracture sites include: hip, wrist, spine arms and ribs Physiotherapists understand the impact of a fracture on a patient, seeing how disruptive they can be for day to day tasks and quality of life, slowing the road to recovery. Fracture prevention is complicated but studies have shown we can reduce re-fracture rates by up to 80%. We can devise strength and balance programs specific to you type of fracture, age and level of function which result in improved mobility strength and physical performance A new online tool will assist you and your Physio. Visit http://www.knowyourbones.org.au/ Australia’s first bone health self assessment. The assessment provides a general risk summary report.
Upper Crossed Syndrome
What is it? And how can Remedial Massage help?Upper Crossed Syndrome (UCS) is an extremely common musculoskeletal imbalance of the upper body. It is usually caused by poor posture or repetitive tasks in prolonged standing or sitting positions. As a consequence certain muscles become chronically tight, while others become long and weak. This muscular imbalance results in rounded shoulders/upper back, winging/tipping shoulder blades, and a forward head position with a poking out chin. The muscles affected in this common syndrome are the Pectoralis Major and Minor muscles in the chest, the Sub-Occipital muscles at the base of the skull and Upper Trapezius and Levator Scapulae in the upper shoulder/neck which all become overactive, short and tight. This excessive shortening of muscles causes an imbalance between muscles groups. Muscles such as Mid-Lower Trapezius, Rhomboids and Serratus Anterior of the upper back and the deep cervical flexors in the neck therefore become underactive, long and weak. The musculoskeletal imbalances of UCS can result in an array of pain or discomfort presentations. For example mid- upper back pain/tightness, neck pain/tightness, headaches, or pins and needles down the arms, just to name a few. Also overtime if untreated, these muscular imbalances can affect the position of the skeletal system leading to other chronic conditions such as shoulder instability, shoulder impingement and shoulder bursitis. Luckily Remedial Massage and correctly prescribed exercises can dramatically help with this condition. Remedial Therapists can use their skills in soft tissue work to release the tight, short and overactive muscles, and can give simple homework stretches/exercises. This is extremely important for while these large powerful muscles such as the Pecs or Upper traps remain tight, it is very challenging to properly strengthen the weak muscle groups. Remedial Therapists can also use techniques to stimulate the long, weak and underactive muscles encouraging them to activate and strengthen. Remedial Massage can be used as an effective complementary treatment for UCS, alongside Physiotherapy allowing the exercises prescribed by Physios to be most effective. If you feel like you relate to any of these symptoms, don’t wait, find the time to care for yourself and book some Remedial treatment today so you can move and feel your best!
Why get a functional Screen?Firstly to properly answer this question we must ask ourselves …
…. WHAT IS A FUNCTIONAL SCREEN?A functional Screen is a test (or group of tests) that assesses mobility and stability throughout the body. This will identify areas of the body that may be tight, weak or dysfunctional. It identifies asymmetries within the body. The measures obtained are compared to norms so that you know exactly where you sit in regards to others (certain variables such as height and age are taken into account)
Here at Pottsville and Cabarita Physiotherapy some of the Functional Screening tools we use include;
- FMS (Functional Movement Screen)
- SFMA (Selective Functional Movement Assessment)
- Y balance (Upper limb / lower limb balance and Stability)
- Treadmill Running assessment (With video analysis)
- Posture Assessment (Using the latest app)
This moves us on to the next question…… Why should we get a Functional Screen?
PREVENT an INJURY & PAIN