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.
Top 5 Health Benefits of surfing by Ann HawkinsWhat’s better way than relaxing on the beach, basking in the sun and enjoying some great fun activities for recreation! Even better, if these fun activities along with some tremendous health benefits. One such amazing water fun activity as well as sport is surfing. The number of surfers have been steadily increasing everywhere. There are about 23 million surfers worldwide and about 17,36,000 surfers in U.S alone, as per Statistic Brain. Surfing is a great water sport. All you have to do is- hop on your surfboard, learn some know-hows and indulge in this amazing water sport. Let us look at some amazing health benefits that it offers along with the fun.
- Surfing helps in boosting the cardiovascular health:
- Surfing helps in reducing stress:
- Surfing helps in improving flexibility:
- Surfing helps in toning the muscles:
- Surfing helps to be motivated:
Common Surfing Injuries - AnklesAnkles are one of the most common joints injured whilst surfing and having adequate ankle mobility and stability are very important for surfing performance. Research has found ankle injuries to be increasingly prevalent, particularly amongst competitive surfers due to the demands of aerial surfing and other progressive manouveres. Important elements of the prevention of ankle injuries include having adequate ankle range of movement. Having good ankle range of motion helps to protect the ankle against injury sustained from forceful landings, and also assists in the prevention of other lower limb injuries such as knee and hip conditions.
How do I improve my ankle mobility?There are many ways to increase ankle mobility, stretching is a simple solution that will help with this and lead to increases in ankle mobility.
Soleus stretch: keeping your heel planted, try and touch your front knee to the wall.
Gastrocnemius stretch: hold your leg straight behind you and lunge forward.
Ankle StabilityAnkle stability is another important aspect of the prevention of ankle injuries. Proprioception describes the awareness of where the body is in space and is an important aspect of the stability of a joint. Ways to train ankle proprioception include training on unstable surfaces such as the surf set or bosu ball. Other functional ways to increase ankle stability include practicing tasks like landing onto unstable surfaces and maintaining adequate lower limb strength. Our surf performance Pilates classes focus specifically on training specific movement patterns and functional strength training to match the requirements needed whilst surfing. We integrate dynamic movement patterns and proprioceptive training tasks to increase balance, core stability and help to increase surfing performance and decrease risk of injury. To find out more about our surf performance classes, visit our website CLICK HERE you can book online or call us on (02) 6676 4000. http://pottsvillephysio.com.au/services-pilates-fitness-programs/
As Father’s day approaches we have taken time to reflect on the influences that our Father's have had on us.
Dan,Matt, Joel and Kai have been interviewed, below are their responses:
DanThe 3 things you love about being a father; 1. Being able to watch your children grow and develop into their own personalities 2. It gives you the privilege of being able to see the world again through a child's eyes. Kids teach us to see the beauty in little day to day things that often we forgot to notice in our busy lives 3. I also love being able to share things that I love with my children. I get more joy out of seeing them catch a great wave or make it to the top of a mountain hike than I would if I was doing it myself
MattThe most Important things my father taught me... How to drive, swim, tumble turn in the ocean and how to not catch any fish What it would mean to be a father.. Being a father (especially for the first born) would undoubtedly be the highlight of a man's life What is your favourite tradition with my Father? Growing up it was the New Year's Test at the Sydney Cricket Ground. Favourite activity to do with my Father Favourite activity is to be out in the ocean with Dad watching him negotiate the waves on his standup paddle board What is your Dad's favorite story about you as a Child? Favourite story would be about how I was running and jumping out of the cot by the age of about one. . Who are some other important Men in my life to recognise on Father's Day? Fred Hollows / My Granddad
JoelThe most Important things my father taught me... Patience If things don't make you happy don't do them Go with the flow What is your favourite tradition with your Father? Surfing and going to Farmers market in Bellingen Favourite activity to do with your Father ? Surfing and laughing with him as he goes over the falls How would you describe your Father in 3 words Classic Aussie Larrikin What is your Dad's favorite story about you as a Child? Hiding behind his leg because I was shy Who are some other important Men you would like to recognise on Father's Day? Huey ~ God of waves Poseidon ~ God of water
There are many different ways to train for surfing, each one with it’s own strengths and limitations. Surfing is a challenging sport that incorporates a number of physical skills and abilities. Much of the training for surfing has previously involved isolated movements and lacked specificity and functional relevance to the sport. People in the past have said that surfing itself is the best form of training, due largely to the difficulty in replicating the demands of surfing on dry land. Whilst nothing will ever replicate the same thrill, uncertainty and excitement unique to surfing, the surfset is a way to increase the functionality of training for surfing. The surfset is specifically designed for surfing training and can be seen as a more functional approach to training for surfers, as it enables replication of the movements and perturbation challenges inherent in surfing. The surfset consists of a modified surfboard set upon unstable surface, which creates a functional platform to replicate the dynamic integration of body systems required in surfing. The surfset is designed to engage the core and stabilising muscles, through challenging the body in a dynamic environment. Exercising on the surfset is a full-body approach to training, moving away from training in isolated and non-functional ways. Training in this way helps to develop functional movements sequences and functional muscle activation patterns specific to surfing, resulting in improved function and surfing performance. Workouts on the surfset can be specifically designed to develop aspects of surfing performance such as aerobic fitness, along with muscular strength, power, endurance in addition to balance and coordination. Workouts can also be designed to isolate specific movement sequences in surfing such as the pop up and allows replication of the dynamic balance and proprioceptive demands of surfing. In addition to being a challenging full body workout, exercising on the surfset is also a fun, engaging and unique way to exercise.
Is there any evidence for exercising with the surfset?Completing exercises such as squats on unstable surfaces such as a surfset has been found to increase core muscle activation, along with an increase in lower limb muscle activity, making this type of training particularly effective and functional for this population (Nairn, Sutherland & Drake, 2017). Specific benefits of surfset training can also be related to common injuries in surfing. Ankle injuries and sprains are one of the most common injuries in surfing and training on the surfset can be targeted specifically to rehabilitate functional stability, range of movement, balance and proprioception for these injuries (Nathanson, Haynes & Galanis, 2002).
To summarise, the benefits of training on the surfset include:
- Increased dynamic balance
- Improved core stability
- Greater lower limb joint proprioception
- Development and refinement of surf specific movement patterns
- Increases in muscular power, strength and endurance
- Greater aerobic fitness
Why do you love Pilates? Pilates for me, is the most important and effective form of exercise you can do. It’s the only form of exercise I’ve ever done that feels like every single repetition you do is doing you good. Pilates helped me to become active again after 3 years of not being able to run due to back pain and I’ve seen it help so many other people with injuries to be pain free and achieve their goals. I love the challenge of Pilates and the dynamic nature of the exercise, there are so many ways to push yourself and improve your fitness, strength and core stability. What is the best thing about being a Physiotherapist? The best thing about being a Physiotherapist is being able to help people in need and have a positive impact on someone’s life. It’s awesome to be able to help people understand what is causing their pain and particularly when someone has that light bulb moment when they understand exactly what is going on with their body. It’s also great to be able to meet a wide range of people and to help people achieve their goals. Why work at Pottsville and Cabarita Physio? Pottsville and Cabarita physio is a great place to work, full of like-minded people all striving to do their best for their clients and help people on their journey from pain to performance. There are some really great, experienced physios who are fantastic to learn from as well as a great work environment that encourages personal development and excellence. It’s such a supportive and positive atmosphere and really enjoyable to be a part of. Best relaxation tip Best relaxation tip would be to find something that takes your mind off everything and allows you to relax and unwind and to incorporate it into your daily routine. It may be something simple as reading a book or watching a movie, anything that averts your attention and enables you to escape and relax. Exercise would be my other big suggestion. Running always helps me to relieve stress and eliminate my anxiety. You might not want to push yourself to go for a run or go do some Pilates at the end of a big day, but you’ll always feel much better after having done it. I think that having that surge of activity and pushing yourself to exercise always enables you to relax much more afterwards. Best lifestyle tip Find your own form of personal expression. I think It’s important to invest your time and energy into things that allow you to express your feelings and passions and who you are as a person. It can be as simple as practising a sport or hobby, or planting a garden but I think its great to have a creative outlet or something to channel your energy into in a positive way. I also think it’s extremely important to have a consistent exercise routine. I think the importance of exercise is still underrated, and its critical to exercise every day and you’ll feel much better for doing it, and will be much healthier and happier in the long run. Favourite activity For me, I love to surf. It’s been something I’ve done my whole life since I was a little kid. I’ve always loved the challenge and unpredictable nature of surfing, there are so many variables and every session and wave is different to the next. There’s nothing that can come close to the exhilaration and adrenaline felt when you pull into a big barrel, or land a trick you’ve been trying for ages, or just do a really big turn. It can be frustrating at times but I love the challenge and will always be drawn back to the ocean and the anticipation of the next wave. Favourite Recipe Something sweet for sure. I’ve got a very big sweet tooth and love a spot of baking. Favourite recipe would have to be gooey chocolate brownies with raspberry sorbet. Not great for the waistline, but so, so good. A typical Sunday A typical Sunday would involve a nice long sleep in, followed by a big breakfast whilst catching up with the news of the day. Then I’ll head out for a surf and hopefully spend most of the day bobbing around in the ocean getting some waves. I’ll spend the rest of the afternoon cooking up something for dinner and then might enjoy a sneaky glass of white wine while I watch some TV or a movie. Not the most exciting routine, but a nice way to finish the week and get ready for the week ahead.
Everyone needs a good stretch .. here are some stretches for Surfing, Skiing, Hockey... any twisting sport!
- Perform each of the stretches shown on the video
- Hold stretches for 20 - 30 seconds.
- Hold stretches only to the point of tension (you should not feel pain).
- Repeat stretches on muscle groups that are especially tight.
Being out at the sea, riding the mountainous waves, listening to the surf pounding in your ear can be an exhilarating experience. That, together with advances in surfboard technology, has made surfing an increasingly popular sport. However, it can be hazardous especially if you are starting out or if you are not physically fit. Even seasoned surfers may push their skills to the limit by tackling bigger waves and making daring manoeuvres that can land them into difficulty. Many people are injured while surfing. Some common surfing injuries are: Lacerations and/or contusions Cuts and bruises to the head, legs and feet can result from coming into contact either with their own or another surfer's board, the ocean floor, rock or debris. Sprains and strains involving the lumbar (lower back) or cervical (neck) regions, the shoulder and ankle are also common. Fractures Fractures to the head, ribs and shoulder may occur as the surfer comes into contact with a reef, rock or the ocean floor. In some cases the nose or teeth may be broken. Ear and eye damage The surfer's ears and eyes are also subjected to injury from direct trauma or from the UV rays of the sun reflecting on the water. A "wipe-out" may also perforate the eardrum. Over time, surfers can develop bony growths within the outer ear, a condition known as surfer's ear that leads to deafness. Overuse injuries Overuse injuries take place as a result of paddling for prolonged periods face down on the board. The shoulder, neck and back are most affected. Surfing injuries can be prevented with the use of protective equipment. Nose guards attached to the front of the board can prevent injury if you come into contact with the board. Helmets are necessary when surfing over large waves or reefs; wet suits worn for warmth will guard against cuts from fins, and hoods can protect your ears during a wipe-out. Booties are worn for warmth by some surfers and these can also protect the feet from cuts. Anyone wanting to engage in this sport should be a strong swimmer, be physically fit and have a good understanding of what surfing entails before getting into the water. A physiotherapy program can help prepare the beginner for his new sport. If you have suffered injury, your physiotherapist will work on balance, flexibility, proprioception (sense of your own body position and orientation) and strength. Range of motion particularly in the legs and core muscles and shoulder will help. This, together with use of protective gear, will help you make a safe return to surfing.
Here are some of the more common workout excuses we hear and what to do about them
- No time: we all have the same hours in the day so how do some people (even the busy ones) find time to exercise and others don’t – the answer lies in what you prioritise. Do you waste time on social media, watching TV or surfing the net? You don’t need to allocate massive blocks of time just 20 minutes will do. Exercise must become a non negotiable entry in your diary preferable every day but at least a few times each week. We always have time for what we WANT to do.
- I am too tired: often people feel more energised after exercise due to the release of endorphins and increased circulation so sometimes it is worth just getting started, tell yourself you will just do 5 minutes then see how you are feeling, most of the time you will keep going and feel great afterward. You may also need to look at your sleeping patterns and go to bed earlier if you are planning to exercise early in the morning. If you feel you are chronically tired (all the time) you may need to speak to your GP and get some blood tests – if this is you start with restorative exercise like gentle Yoga, Pilates or Walking.
- The weather isn’t suitable: if you are an outdoor exerciser find an indoor option for bad weather days: skipping, dancing, stream a yoga class, or do a few bodyweight exercises like push ups, squats and lunges.
- It’s too hard: working hard does get results but it is a good idea to start gently and gradually build up the intensity as your body strengthens, find a qualified coach in your chosen area to help you work at the correct level.
- I forgot my gym gear / togs / sneakers....: organisation is key, pack your exercise gear the night before or have a spare set in the car just in case.
- I can’t escape the kids: so exercise with them: a walk to the park, jump on the trampoline, dancing, skating, bike riding, scootering..........
- I am too old: there is exercise for everyone. You may not want to join the gym but what about walking, gardening, lawn bowls or Pilates (we have a few people in their 90’s doing Pilates with us)
- I am not good enough: I hear this so often – but you have to start somewhere. We offer personalised programs from the most basic to the most advanced so there is a program for everyone no matter what your condition.