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.
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
Prevent an Injury and PainIf we can identify parts of the body that are tight, weak and dysfunctional, then by re-correcting these areas then we can prevent an injury from occurring in the first place. A functional Screen will tell us (and therefore you) what level of risk you have of sustaining an injury. If an injury has already occurred (even if it is subtle) then quite often it will cause us to compensate in some way. This can then increase our risk of having ANOTHER injury occur. All of a sudden we “feel like we are falling apart” and it takes us much longer to recover.
Why do you love Pilates? I love Pilates because it is a form of exercise that can be modified to suit ANYONE. The layers of challenge you can add are endless. I also love that age is no barrier, it's the practice that counts! What's the best thing about being a physio? Being able to help people reach the goals that are most important to them. No matter how big or small, it's really rewarding to be a part of that journey. I also love that physio can take you in so many directions. From the clinic to the sports field, the possibilities are endless! Why work at Pottsville and Cabarita Physiotherapy ? I grew up in Cabarita, so it's nice to be able to come back to my roots. It's an amazing community with a great coastal vibe and being so close to the beach is always a plus. But, most importantly, the team is amazing! Best relaxation tip? A nice long walk along the beach followed by some guided meditation. There is nothing better. Best lifestyle tip? Find something you love and do it consistently. Challenge yourself in some way each and every day. Favourite activity? Doing some high intensity interval training or boxing. It gets the heart racing and the sweat pouring. It's even better when you have some amazing people to work out with. Favourite recipe? Tacos. Need I say more? A special mention to Kai's choc chip oatmeal cookies. If you haven't tried them, you should! A typical Sunday... A nice long sleep in followed by a Pilates workout. I then like to go to one of my favourite cafes on the Coast and enjoy multiple coffees and a delicious brunch. You might catch me running around the rugby league scene in the afternoon. That's my other passion!
Let massage help you through the winter SeasonFor most of us winter means hot drinks, extra layers of clothing, more hours spent in doors and therefore less physical activity and for some a case of the winter blues as the sun sets earlier and the air gets cooler. The good news is that massage therapy can be a great tool to help you through the season.
The benefits of massage in winter:
It will boost you immune system:The winter months can often bring an influx of colds and flu's, so it’s extra important to have a healthy functioning immune system to fight off these viruses. Being less active in the winter months can also mean poorer lymphatic flow, which means less circulation of the body’s white blood cells. White blood cells are what help your body fight away infections and disease. Studies have shown that massage encourages the flow of your lymphatic system, and therefore white blood cells. The more white blood cells circulating, the stronger your immune system and the less likely you are to get a cold/flu this winter!
It will encourage circulation:In cold weather muscles contract to conserve heat, which constricts blood flow and therefore delivers less oxygen and nutrients to our muscles. This also makes it more difficult for cellular waste and toxin removal. This restriction of blood flow decreases muscle health and function, and at times causes aches and stiffness. Luckily the soft tissue manipulation that is used in massage therapy is a brilliant way to increase circulation and improve your health.
It will keep away those winter blues:For some the colder weather can bring upon stress or feelings of being ‘low’ or ‘under the weather’. One of the beauties about massage is that it releases serotonin and endorphin's, which are hormones that relieve stress/sadness and make you naturally feel happy.
Don’t let the winter blues get you down this season, feel good and get a massage today!
The popularity of golf has increased substantially over the past few years with an estimated 55 million players worldwide. With increased accessibility and participation rates, the sport of golf offers up a diversity of player profiles, ages and levels of experience. Golf is generally considered to be a moderate risk activity with respect to the development of injury. Up to 80% of all golfing injures are due to overuse with the remainder resulting from trauma or contact. The most common areas for injuries in golfers include:
Low back and trunkInjuries represent the highest incidence of injury affecting up to 1/3 of golfers. Due to the increased rotational forces placed on the spine during the golf swing and the asymmetric nature of the swing, the back is subject to increased forces and potential for injury.
Upper limb injuries are far more common than lower limb injuries.
- Shoulder injuries are usually related to overuse and are due primarily to increased rotary forces (internal and external rotation) at the beginning and at the end of the swing. Common injuries include rotator cuff pathology, AC joint pain and shoulder instability.
- Elbows are the second most frequently injured area. Overuse injuries to the tendons of the medial epicondyle (golfer’s elbow) and lateral epicondyle or (tennis elbow) are common. Interestingly, tennis elbow is 5 times more common than golfer’s elbow among amateur players - likely a result of poor biomechanics such as over-swinging.
- Wrist and hand injuries can result from blunt force with the ground or overuse. Fractures, subluxations and tenosynovitis are most commonly seen.
Lower limb injuries are much less frequent and can be attributed to both the swing as well as the walking loads between holes.
- Hip injuries are often a result of the increased rotational forces placed on the hip during the swing. Soft tissue injuries to the groin and gluteals have been noted, as well as trochanteric bursitis.
- Knee pain is often associated with meniscal injury due to the twisting moments placed on the knee during the swing. Osteoarthritis of the knee can also be aggravated during the swing or when walking.
- Foot and Ankle pain are less common, with ankle sprains and plantar fasciopathy of note.
- The main risk factor associated with injury is a lower handicap (increased proficiency) likely due to the increased hours spent training and playing golf – think overuse and/or over training.
- An age of >50 years old was also observed as in increased risk factor, primarily due to the physiological changes associated with ageing.
- Other factors increasing risk of injury include lack of warming-up, reduced mobility/flexibility and poor physical conditioning.
- Muscular imbalances have also been shown to increase injury risk, particularly during intense play or with high practice hours.
- Collision injuries are most commonly related to contact with golf balls and clubs and in some instances, the golf-cart!
- Poor swing mechanics and incorrect grip and set-up.
- Evidence exists for the implementation of a holistic training program to reduce golf-related injuries.
- Flexibility with specific focus on the shoulder and hip (particularly the hip flexors);
- Mobility particularly of the thoracic spine;
- Core stability to support the large rotational forces of the spine during swing;
- Balance to provide a solid foundation for the swing;
- Resistance exercises with particular focus on large muscle groups and scapular stabilisers.
- An adequate warm-up prior to commencing play e.g. dynamic stretching including trunk rotations and knees to chest.
- Assessment and correction of any muscular asymmetries or range of motion deficits;
- Optimisation of swing biomechanics by a golfing coach.