Client Corner | LiveWell Health

Rotator Cuff Strain

Posted on June 3, 2024

In the rotator cuff region there are four muscles, tendons and ligaments, surrounding the shoulder which provide added stability to the shoulder joint. This structure helps to keep the bone securely placed into the socket. Injury to the rotator cuffs can cause an ache like pain in the shoulder. This may lead to a feeling of muscle weakness and inability to lift the shoulder above the head.

Rotator cuff injuries are most commonly presented in people regularly exposed to overhead movements, such as painters, carpenters and builders. Individuals who suffer from this injury can usually manage their symptoms, through sports massage and specific exercises focusing on the rotator cuff muscle region. However, if not treated correctly, further injury to the area may occur such as a complete tear, which may result in surgery.

Anatomy

The rotator cuffs are made up by four muscles, these are the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles aid in keeping the upper arm and shoulder into the socket with stability. They also each allow specific movements at the shoulder joint. The group of four muscles all originate within the shoulder blade, but all insert into different portions of the upper arm bone.

Supraspinatus: This muscle originates at the supraspinous fossa; the muscle belly passes laterally over the acromion process and inserts into the greater tubercle of the humerus bone. This muscle allows the first 15 degree’s movement of abduction, after this the deltoid and trapezius muscles will then allow further motion.

Infraspinatus: The origin of the infraspinatus is the infraspinatus fossa, and the insertion is also the greater tubercle of the humerus. The motion created by this muscle is lateral rotation of the shoulder, moving the arm away from the centreline of the body.

Teres Minor: A small narrow muscle on the back of the shoulder blade which sits underneath the infraspinatus. The origin is the lateral boarder of the scapula. This muscle contributes to external rotation of the arm of the body.

Subscapularis: This rotator cuff is the strongest and largest out of the three listed above. This muscle originates at the subscapularis fossa and inserts into the lesser tubercle of the humerus. The subscapularis allows greater motion at the shoulder and mainly aids in allowing medial rotation of the arm.

Symptoms

Common symptoms of possible rotator cuff strain include:

Dull ache
Difficulty lifting arm over head
Weakness around the shoulder
Disturbed sleep
The constant need to use self-myofascial techniques

Causes

There are a few common risk factors of why rotator strain may occur:

Family History: There may be family history of rotator cuff injuries which may make certain family members more prone to having the injury than others.
The type of job you do: Individuals who work in construction or manual labour who have repetitive overhead movement of the shoulder could damage the rotator cuff overtime.
Age: As you get older joints and muscles become weaker, meaning you may be more prone to injury overtime.

Diagnosis

To diagnose a rotator cuff strain a physical examination will be carried out by a doctor or a physiotherapist. Firstly, they may ask about your day-to-day activities which may determine the seriousness of the injury. The doctor will test the range of movement at the shoulder by getting you to perform movements such as flexion, extension, abduction, adduction and medial and lateral rotation. This will allow the doctor to determine if it is actually rotator cuff strain or whether it may be other conditions such as impingement or tendinitis.

Imaging scans such as X-Ray’s may also be used to see if there is any abnormal bone growth within the joint, which may be causing the pain.

Treatment

Treatments for rotator cuff injuries can be non-surgical or surgical. Tendinitis may occur over time from the repetitive strain placed around the joint, so it is important to treat the affected area.

Apply a cold compress/ ice to the effected area to reduce swelling
Heat packs can be used to reduce swelling
Resting the affected area
Inflammatory medication such as ibuprofen and naproxen
Reduce the amount of repetitive movement to the joint
Don’t lift the arm overhead

Exercises

1. Doorway Stretch
- Purpose: Stretches the chest and shoulder muscles, helping to alleviate tension and improve flexibility in the shoulder joint.
- How to Perform:
  - Stand in a doorway and place your arms on the door frame with elbows at 90 degrees and your hands slightly above head level.
  - Step forward with one foot, gently leaning into the doorway until you feel a stretch in the front of your shoulders and chest.
  - Hold for 20-30 seconds and relax.
2. External Rotation with Weight
- Purpose: Strengthen the rotator cuff muscles, particularly the infraspinatus and teres minor, which are responsible for external rotation of the shoulder.
- How to Perform:
  - Lie on your side with your elbow bent at 90 degrees, holding a light weight in the top hand.
  - Keep your elbow close to your body and rotate your forearm upward, lifting the weight.
  - Slowly lower the weight back down and repeat before switching sides.
3. High to Low Rows with Resistance Band
- Purpose: Strengthen the muscles of the upper back and shoulder, improving stability and support for the rotator cuff.
- How to Perform:
  - Anchor a resistance band above shoulder height.
  - Hold the band with both hands and step back to create tension.
  - Pull the band down and back toward your hips, squeezing your shoulder blades together.
  - Slowly return to the starting position and repeat.
4. Reverse Fly’s
- Purpose: Target the posterior deltoids and the upper back muscles, which help support and stabilise the shoulder joint.
- How to Perform:
  - Stand with feet hip-width apart and a slight bend in your knees, holding a light weight in each hand.
  - Bend forward at the hips with your back flat and arms hanging down.
  - Raise your arms out to the sides until they’re level with your shoulders, squeezing your shoulder blades together.
  - Lower your arms back down and repeat.
5. Lawn Mower Pull with Resistance Band
- Purpose: Strengthen the shoulder and back muscles, mimicking the movement of starting a lawn mower, which engages the rotator cuff.
- How to Perform:
  - Anchor a resistance band at ground level.
  - Stand with one foot forward and grab the band with the opposite hand.
  - Pull the band up and back diagonally, rotating your torso and mimicking the motion of starting a lawn mower.
  - Slowly return to the starting position and repeat before switching sides.
6. Isometric Internal Rotation
- Purpose: Strengthen the subscapularis muscle of the rotator cuff without moving the shoulder, which is helpful when active movement is painful.
- How to Perform:
  - Stand next to a wall with your elbow bent at 90 degrees, holding a small towel or cushion between your forearm and the wall.
  - Press your forearm into the wall, engaging the internal rotators of the shoulder.
  - Hold the tension for 10-15 seconds, then relax and repeat.
7. Isometric External Rotation
- Purpose: Strengthen the external rotators (infraspinatus and teres minor) of the rotator cuff without movement, useful for stabilising the shoulder.
- How to Perform:
  - Stand next to a wall with your elbow bent at 90 degrees, this time with the back of your hand pressing against the wall.
  - Push your hand outward into the wall, engaging the external rotators.
  - Hold the tension for 10-15 seconds, then relax and repeat.

Build your Glutes! Show off that bum…

Posted on June 3, 2024

It is vital for individuals to have strong glutes and incorporate strengthening exercises into training programmes. Strong glute muscles ensure the correct pelvic alignment and can help reduce lower back pain. Also reducing injuries sustained to the hip, knee and ankle joints. Strong glutes aid in balance, improved posture, single leg limb support and reduced back pain when lifting heavy weights.

Anatomy

The gluteal region is an anatomical area located posteriorly to the pelvic bone at the proximal end of the femur. The muscles in this region move the lower limb at the hip joint. The main glute muscles are glute maximus, medius and minus.

Glute Maximus – This muscle is the biggest out of all the glutes. It is the most superficial and makes up most of the shape of the glutes on the body. This muscle helps perform extension and lateral rotation of the hip.

Glute Medius – This muscle lies between the maximus and the minus. Movements such as abduction and medial rotation occur here.

Glute Minus – The minus is the smallest and deepest of the superficial glute muscles. This also helps movements such as abduction and medial rotation. When in movement this muscle helps secure the pelvis, preventing any pelvic drop.

Importance of Glute Strengthening

1. Strong Glutes help prevent injuries – It is so important to have strong glute muscles and muscles surrounding the hip as this will add support to the lower back, knees and ankles. This is due to the alignment of the body being in the correct positioning and reducing the amount of stress on certain joints in the body.

2. Enhanced Athletic performance – Basic movements such as jumping, running, driving and twisting are all performed through the hips and legs. This aids an athlete performance by increasing their agility levels and strength when carrying out the movements.

3. Improved posture and balance – Having strong Glute muscles will improve your posture and balance within the body. When the hip, glutes and core are stable it will reduce the amount dysfunctional movements in the body. When the hips are aligned, it will keep the neck shoulders and back in a further stable position, improving posture.

Glute Activation & Exercises

Firstly, to activate the glutes you need to stretch. The main area that needs to be stretched is the hip flexors. Stretches such as a kneeling lunges and banded split squats could be really helpful to loosen up the area.

A few glute bridges can be performed to start the activation of the glutes, these exercises will get the glutes warmed up, ready then for people to move onto the heavier weights. This is so important because you do not want to go in straight away with the heavy weights, as this could cause injury and strain to the glute muscles.

Here is a list of exercises that could be used for glute activation:

Exercises

1. Donkey Kicks
- Purpose: Target the gluteus maximus, helping to build strength and size in the largest muscle of the glutes.
- How to Perform:
  - Start on all fours with your hands under your shoulders and knees under your hips.
  - Keeping your knee bent at 90 degrees, lift one leg toward the ceiling, engaging your glutes to push your foot upward.
  - Lower the leg back to the starting position without touching the floor, and repeat before switching sides.
2. Fire Hydrants
- Purpose: Focus on the gluteus medius and minimus, helping to build the upper and side parts of the glutes for a more rounded appearance.
- How to Perform:
  - Begin on all fours, similar to donkey kicks.
  - Keeping your knee bent, lift one leg out to the side, aiming to get it parallel to the floor while keeping your hips stable.
  - Lower back down and repeat before switching to the other side.
3. Lateral Walks
- Purpose: Strengthen the gluteus medius and minimus, which are crucial for hip stability and creates a more balanced, rounded glute shape.
- How to Perform:
  - Place a resistance band around your thighs, just above the knees, or around your ankles for more difficulty.
  - Stand with feet hip-width apart, slightly bent knees, and a slight forward lean.
  - Step sideways, keeping tension on the band, and bring the other foot in without fully touching them together.
  - Take a few steps in one direction, then reverse.
4. Glute Bridge with Abduction
- Purpose: Combines the standard glute bridge with abduction to target the entire gluteal muscle group, enhancing growth and strength.
- How to Perform:
  - Lie on your back with knees bent and feet flat on the floor, hip-width apart.
  - Place a resistance band around your thighs, just above the knees.
  - Lift your hips into a bridge position, and at the top, push your knees outward against the resistance band (abduction).
  - Bring your knees back together, lower your hips, and repeat.
5. Clams
- Purpose: Specifically target the gluteus medius and minimus, which helps to build side glute muscles and improves hip stability.
- How to Perform:
  - Lie on your side with your legs stacked and knees bent at 90 degrees.
  - Keep your feet together as you lift the top knee, opening your legs like a clam shell, while keeping your hips stable.
  - Lower the knee back down and repeat before switching sides.
6. Plank Jacks with Resistance Band
- Purpose: Engage the glutes dynamically, along with the core, by combining the traditional plank with lateral leg movements against resistance.
- How to Perform:
  - Start in a plank position with your hands under your shoulders and a resistance band around your ankles.
  - While holding the plank, jump your feet out to the sides, keeping tension in the band, and then jump them back together.
  - Maintain a strong core and keep your hips level throughout the movement.

The glutes play a vital role in a huge majority of bodily moves, helps with core strength and is one of the most active muscles in the body. If you think you need help with your butt, then contact one of our fitness advisors or personal trainers today.

The Role of Carbohydrates during Exercise

Posted on June 3, 2024

Carbohydrates play a key role within physical activity by providing energy to the body, brain and muscles. Athletes or anyone taking part in any physical activity needs to ensure they are consuming a large amount of carbohydrates within their diets. If someone does not consume enough carbs it is likely that performance levels and recovery may become impaired.

What are carbohydrates?

Carbohydrates are one of the main three macronutrients we need to consume every day, together with protein and good fats. The main three types of carbohydrates are starch, fibre and sugar. Starch carbohydrates are more so known as complex carbs, these are food types such as potatoes, corn and starchy vegetables. Natural and added sugar foods are known as simple carbs, these can be found in food and drinks such as milk, honey, sweets, sugary drinks and syrups.

Why do we need carbohydrates and how does it aid in exercise performance?

It is imperative to our bodies that we consume carbohydrates. Carbohydrates are stored in the muscles and liver as glycogen. Carbohydrates are one of the main sources of energy for our body to function, carbs are broken down and digested into a small molecule called glucose. This is used for fuel and is stored within muscles. The glucose energy molecule aids in delaying the onset of fatigue and help with muscular endurance. Carbohydrates also aid in muscular growth alongside protein and fats (macronutrients) which is so important to athletes to grow in their athletic
performance. Glycogen stores can be limited, so if a person is training and partaking in high intense physical activity, our bodies will need carbohydrate stores to fuel the body, ensuring an individual has increased energy levels. Glycogen is the main source of energy for quick bursts of physical activity and exercise, this keeps people motivated and full of energy. If these stores are low during exercise a person may become fatigued very quickly, lacking overall energy and unable to perform at the best of your ability at the highest standard. It is so important for a person to consume the right amount of carbohydrates to aid in exercise performance. If you are a person who is active and performs the recommended amount of exercise per week, healthy eating and carbohydrate intake is a necessity. Carbohydrate intake doesn’t have to always be food intake, you could have energy drinks and carbohydrate supplements (especially if you are trying to control weight).

Good sources of carbohydrates

Quinoa, Wheat, Pasta, Rice
Oats, yoghurt
Banana
Potatoes / Bread
Apples
Carrots
Corn
Whole grains
Vegetables

As you can see carbohydrates are a key compenent of any diet or nutrition plan. We should not be cutting food groups out of our nutrition plans as they all plan a significant role! So if you are in need of support or advice by qualified nutritionists who won’t feed you down the wrong path, then contact us today for more information.

How important is Protein?

Posted on June 3, 2024

Protein is one of the three main macronutrients needed to fuel the human body, meaning your daily calorie intake should consist of 10%-35%. The rest of our intake is made up of the other two macros carbohydrates & fats, as well as micronutrients such as vitamins & minerals. However, unlike the other two marcos your body does not store protein, which is why it is essential in your diet especially when trying to build muscle.

What is Protein?

Protein is made up of a long chain of amino acids & are considered to be the “building block” of a cell. Every cell contains protein but the role of each cell differs depending on the arrangement of the amino acids within it. They are essential for the structure & function of the tissues in the body. Some of these roles include:

Building structures in the body
Helping to produce antibodies to fight off illness or infection
Repairing of cells & creating new ones
Carrying oxygen throughout the body
Aiding digestion

Another key role for protein is the production of muscle mass. Simply eating protein won’t help to gain muscle but this combined with weight/fitness training & a balanced diet should do the trick. As we all know fitness training is essential for muscle growth, stimulating & even slightly damaging the muscle allows it to grow back bigger & stronger. How? Well, during exercise you create micro tears within the muscle, your body then breaks down the protein you have consumed to repair these tears. In order to do this, the broken down protein fills the tear creating new muscle fibres & therefore healing the muscle while increasing the muscle mass

How much do you need in your diet?

Daily protein intake tends to vary depending on an individual’s caloric needs. The average advised calorie intake is 2000 calories per day for women & 2500 for men. Each gram of protein contains 4 calories, indicating that the average woman should consume a minimum of 50g per day & men should aim for at least 62.5g per day. However, what is the average person? Every individual is different which means so is there daily calorie intake. If you’re not too sure what your daily calorie intake is then you can work it out another way. It is recommended in people aged 19-50 that you should consume 0.75g of protein per kilogram of body weight per day. But when exercising with the aim of growing muscle, the Journal of Sport Science suggests upping this to 1.3-1.8g of protein per kilogram of body weight.

How does protein help me to keep fit?

As well as being great for muscle growth & repair, protein has many other benefits that help us to keep fit & healthy. These include;

Speeding up recovery rate after exercising
Reduces muscle loss
Helps to maintain a healthy weight
Prevents binge eating

High protein diets are often advised for people trying to lose weight, as protein combined with fibre helps to keep you fuller for longer.

Good Sources of Protein

When talking about protein most people think of meat, however there are many different types of food that contain lots of protein. Below are some examples of high protein foods:

Fish
Poultry
Lean Beef
Tofu
Eggs
Nuts
Seeds

Overall, whether you are trying to keep your body functioning at it’s best, to gain muscle mass, or loose weight, protein is an essential part of your diet. If you feel you would like to speak to one of our nutritionists then please contact us today.

Hip Labrum Impingement

Posted on June 3, 2024

Hip labrum impingement may occur when the ball and socket joint is unable to move smoothly within the joint. It is more frequently known as Femoral acetabular impingement (FAI). The ball and socket joint are lined with a layer of cartilage that assists in cushioning the femur bone into the socket, which allows free movement no grinding or rubbing within the joint, resulting in no pain. It is also lined with a ridge of cartilage called the labrum, this will keep the femoral head in its place inside the hip socket enabling extra stability.

Anatomy

The hip is a synovial joint more so known as a ball and socket joint. The ball of the joint is the femoral head (the upper part of the femur) more commonly known as the thigh bone. Within the socket is the acetabulum which is surrounded by the pelvis, this makes up the joint.

The surface of the ball and socket is protected by articular cartilage. This enables the bones in and around the joint to glide easily when performing everyday movements such as walking. The cartilage also helps prevent any friction around the surface of the joint avoiding any sort of impingement. Another feature around the joint is the hip labrum. This fibrocartilage labrum is found within the acetabulum, this enables stability to the joint as the hip has a large range of motion in movements such as flexion, extension, abduction, adduction and rotation.

Causes

Common causes of hip impingement are triggered by the femoral head being covered too much by the hip socket. Repetitive grinding at this joint leads to cartilage and labral damage, causing the feeling of impingement.

Other factors that may affect an individual to suffer with labrum impingement could be that individual may have been born with a structurally abnormal ball and socket joint. Also, movements that involve repetition of the leg moving into excessive range of motion may aid in the injury of hip labrum impingement.

Symptoms

Some common Hip Labrum impingement symptoms are as follows:

Stiffness in the hip or groin region
Reduced flexibility
Pain when performing exercise such as running, jumping movements and walking
Groin area pain, especially after the hip is placed into flexion
Pain in surrounding areas such as lower back and the groin
Pain in the hip even when resting

Causes

When you go to visit your doctor/ health care professional about hip complications they may talk about two main types of hip impingement:

Cam impingement
Pincer impingement

Cam impingement “occurs because the ball-shaped end of the femur (femoral head) is not perfectly rounded. This interferes with the femoral head’s ability to move smoothly within the hip socket”.

Pincer impingement “involves excessive coverage of the femoral head by the acetabulum. With hip flexion motion, the neck of the femur bone “bumps” or impinges on the rim of the deep socket. This results in cartilage and labral damage”.

Unfortunately, both these two types can happen at the same time, more so known as combined impingement. Which may cause an individual to experience a lot of pain and discomfort.

Diagnosis

The diagnosis of hip impingement will be given by a doctor based on how you describe your symptoms and after performing a physical examination of the hip.

A passive motion special test that is commonly used for hip impingement is called the FADIR (flexion, adduction and internal rotation). This is where the patient will lie in supine position (on their back) with the legs relaxed, then the doctor will carry out the test:

The affected leg will be raised so that the knee and hip are at a 90-degree angle
The doctor will support the knee and ankle and gently push the entire leg across the midline portion of the patient’s body moving into adduction
Then whilst keeping the knee in position, the doctor would move the foot and lower calf away from the body into abduction

People who are suffering with hip impingement would feel pain during stage 3 of the test, however it may be hard to differentiate between each injury as someone not suffering with impingement may still feel pain, so it is always important to test the unfaceted side for a comparison.

Some imagining tests may also be performed such as:

X-Ray – The X-Ray screening may show an irregular shape of the femur bone at the top of the thigh or too much bone around the rim of the hip socket, thus causing the impingement
MRI Scans – This may pick up wear and tear of the cartilage which runs along the hip labrum
CT scans may also be performed

Treatment

Non-Surgical Management

Activity Modification:

Advise the patient to avoid activities that exacerbate symptoms, such as deep squats, prolonged sitting, or high-impact sports.

Physical Therapy:

Stretching Exercises: Focus on stretching the hip flexors, hamstrings, and quadriceps to improve flexibility.
Strengthening Exercises: Emphasise strengthening the gluteal muscles, core, and hip stabilisers to support joint function and reduce stress on the hip.
Manual Therapy: Incorporate techniques such as joint mobilizations and soft tissue massage to reduce pain and improve range of motion. A deep tissue massage or sports massage may be a good option.

Medications:

NSAIDs: Prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and alleviate pain.
Pain Relievers: Recommend acetaminophen for additional pain management if needed.

Injections:

Corticosteroid Injections: Administer corticosteroid injections into the hip joint to reduce inflammation and provide temporary pain relief.

Surgical Interventions

Indications for Surgery:Consider surgery if the patient experiences persistent pain and functional limitations despite exhaustive non-surgical treatments.

Arthroscopic Surgery:
- Debridement: Remove bone spurs, damaged cartilage, or any other impinging structures to alleviate pain and improve hip function.
- Labral Repair: Repair any torn labrum to restore joint stability and function.

Post-Surgical Rehabilitation:
- Early Mobilisation: Initiate gentle range-of-motion exercises soon after surgery to prevent stiffness.
- Progressive Strengthening: Gradually introduce strengthening exercises as healing progresses, focusing on restoring hip strength and stability.
- Functional Training: Incorporate functional and sport-specific training to facilitate a return to normal activities and athletic pursuits.

Exercises

- 1. Hip Flexor Stretches
  - Purpose: Stretch the muscles at the front of the hip to reduce tightness and relieve pressure on the hip joint, which can help alleviate impingement symptoms.
  - How to Perform:
    - Kneel on one knee with the other foot in front, forming a 90-degree angle at both knees.
    - Gently push your hips forward while keeping your back straight until you feel a stretch in the front of your hip.
    - Hold for 20-30 seconds and switch sides.
  2. Piriformis Stretches
  - Purpose: The piriformis muscle, located in the buttocks, can become tight and exacerbate hip issues. Stretching it helps improve flexibility and reduce pressure on the hip joint.
  - How to Perform:
    - Lie on your back with knees bent.
    - Cross one ankle over the opposite knee.
    - Pull the uncrossed thigh toward your chest until you feel a stretch in the buttock of the crossed leg.
    - Hold for 20-30 seconds and switch sides.
  3. Isometric Hip Raises in Abduction
  - Purpose: Strengthen the hip muscles, particularly the abductors, without moving the joint, which is beneficial when movement causes pain.
  - How to Perform:
    - Lie on your back with your knees bent and feet flat on the ground.
    - Place a resistance band around your thighs just above the knees.
    - Gently push your knees apart against the band without lifting your hips.
    - Hold the tension for 10-15 seconds, relax, and repeat.
  4. Glute Bridge
  - Purpose: Strengthens the gluteal muscles and stabilizes the hip, which can reduce stress on the hip joint and support recovery from impingement.
  - How to Perform:
    - Lie on your back with knees bent and feet flat on the floor, hip-width apart.
    - Press your feet into the ground and lift your hips toward the ceiling, squeezing your glutes.
    - Hold at the top for a few seconds before slowly lowering back down.
  5. Single Leg Bridge
  - Purpose: This variation of the glute bridge further challenges the glute and core muscles, improving stability and strength on one side of the body at a time.
  - How to Perform:
    - Begin in the same position as the glute bridge.
    - Lift one leg off the ground, keeping it straight, and then lift your hips using the strength of the supporting leg.
    - Hold at the top, then lower and repeat before switching legs.
  6. Straight Leg Raises (Can Also Use Resistance Band)
  - Purpose: Strengthen the quadriceps and hip flexors without putting undue stress on the hip joint, helping to maintain stability and reduce symptoms.
  - How to Perform:
    - Lie on your back with one leg straight and the other bent.
    - Keeping the straight leg’s foot flexed, slowly lift it toward the ceiling to about a 45-degree angle.
    - Lower the leg slowly and repeat. You can add a resistance band around your ankles for added difficulty.
  Prevention

- - When exercising avoid placing full body weight onto your hip when the legs are positioned in excessive range of motion
  - Do daily stretches morning and night
  - Always rest when needed
  - Perform rehabilitation exercises given by a physiotherapist

If you feel you may have this condition / injury and would like it assessed by a professional our team of sports therapists and physiotherapists can help. Alternatively you can speak to your doctor. Either way please contact us for further information alternatively please make a booking directly online.

Winging Scapula

Posted on June 3, 2024

Scapula winging is a condition that affects the shoulder blades, the shoulder blade bones should usually lay flat against the back of the body. Scapula winging occurs when a person suffers with shoulder problems, causing the shoulder blades to stick out abnormally. The condition of scapula winging is quite rare but some individuals may suffer really bad from the condition and need effective treatment.

The main muscle involved in the cause of scapula winging is the serratus anterior. This muscle originates from the ribs 1-8 and attaches to the anterior surface of the scapula, which pulls the muscle against the ribcage. The long thoracic nerve is stimulated by the serratus anterior, when or if this nerve becomes injured the scapula will be affected as it jolts back adding more force onto the arm. Injuries to the shoulder may affect this nerve causing inflammation and added pressure onto the nerve, consequently triggering the onset of scapula winging.

Anatomy

The scapula more commonly known as the shoulder blade articulates with the humerus at the glenohumeral joint. The scapula has three surfaces: the costal, lateral and posterior.

Costal Surface

The anterior surface of the scapula faces the ribcage. This is where the subscapularis originates (one of the rotator cuff muscles). The coracoid process also originates here which lies underneath the clavicle allowing the pectoralis minor, coracobrachialis and bicep brachii to attach at this region.

Lateral Surface

The lateral surface faces the humerus bone. This is where the glenohumeral joint is situated, the main bones around this area are the glenoid fossa, supraglenoid tubercle and infraglenoid tubercle.

Posterior Surface

The posterior surface of the scapula is the site of the majority of the rotator cuff muscles. These include the Infraspinous fossa and the Supraspinous fossa.

All 3 surfaces of the scapula are important to know to locate the site of pain/ discomfort and understand what is causing the winging.

Symptoms

Scapula winging symptoms may differ as it depends where the location of the muscle or nerve damage is situated. Scapula winging is commonly presented by the shoulder blade sticking out from the back uncharacteristically. This may affect a person from even doing everyday things such as sitting down on a chair that has a hard back or even carrying bags that have straps.

Common symptoms of scapula winging are shown as:

Shoulder blades sticking out
Pain into the neck, shoulders and arms
Weakened muscles surrounding the shoulder blade
Tiredness and exhaustion when performing simple tasks
Pain and discomfort around the area
Inability to lift arms over the head
Sagging of the scapula

Causes

Scapula winging Is triggered by an individual sustaining a severe injury to any muscles that control the scapula. The serratus anterior is one of the main muscles that enables a person to lift the arm above shoulder level, therefore when this is injured it can cause many problems within the shoulder region.

The main causes of scapula winging are:

- Nerve damage to the long thoracic nerve
- Serratus anterior weakness
- Weakness in the rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis)
- Compression on the dorsal scapula nerve (controls the Rhomboid muscles)
- Weakness in the trapezius

Diagnosis

Firstly, for the diagnosis of scapula winging your doctor will look at the shoulder blades for any clear obvious signs of winging. Some patient’s scapula bone may be more visible than others and have distinct scapula winging. The doctor may also ask you to perform arm/ shoulder movements to examine the range of movement and stability at the joint.

One of the main tests that are used to aid in the diagnosis of scapula winging is the serratus anterior test. This is where the patient is asked to face a wall, standing about two feet from the wall and then push against the wall with flat palms at waist level. This test is carried out to identify if any damage is done to the thoracic nerve causing the scapula to wing.

Treatment

Treatment for winging scapula is dependent on which muscles or nerve is causing the issue. There are two types of treatment surgical and non-surgical.

Non-surgical treatment (Scapula Winging)

Physical therapy/ Rehabilitation
Stretching exercises
Strengthening exercises given by a physiotherapist
Wearing a brace/ sling to support the arm and shoulder
Sports massage therapy
Muscle relaxants/ anti-inflammatory drugs

Surgical treatment (Scapula Winging)

One surgical treatment for scapula winging is nerve and muscle transfers. This is a process which involves moving a part of the nerve and muscle to a different portion of the body, this mainly focuses on the neck, shoulder, back and chest areas.

Static stabilization is another form of treatment used to prevent scapula winging, however there is a risk with this treatment that it may return. This procedure uses a sling to attach the scapula to the ribs to add extra stability to the shoulder blade.

Exercises

When performing these exercises aim to do 3 rounds of 15 sets for each exercise. Make sure they are slow and controlled so that it is solely focusing on strengthening the weakened muscles:

Scapula retraction
External Rotation
Horizontal Row
Standard press ups
Press up on knees (easier version)
Angel wings exercise

Prevention

Prevention for scapula winging may not always be possible, however there are procedures you can complete to reduce the risk:

Perform exercises to help with posture
Try and maintain correct posture positioning
Don’t carry anything to heavy on the shoulders and back
Do not lift heavy weights at the gym that could cause more damage to the shoulder
Strengthen the muscles in the neck and shoulders
Perform rehabilitation exercises given by a physiotherapist or doctor
Avoid constant repetitive shoulder/ arm movements
Rest when needed

If you want to discuss this concern with our specialists then please contact us or make a booking.

Achilles Tendinitis

Posted on June 3, 2024

Achilles tendinitis may occur when overuse or to much strain is placed onto the tendon in the ankle region. The Achilles tendon is situated at the heel of the foot and connects the lower leg muscles of the calf to the heel bone of the ankle.

This pathology is mainly sustained by people who do a lot of running and high intensity exercises. Individuals who may have amplified the time and intensity of their runs, thus potentially leading to Achilles tendinitis. This injury could also occur with a lot of people who play sports such as tennis, netball or basketball, due to the fast pace and explosive movements, causing added pressure onto the ankle joint. If not treated correctly Achilles tendinitis could lead to further complications such as tendon tears or ruptures, which may require surgical repair.

Anatomy

The Achilles tendon, also known as the calcaneal tendon is situated at the back of the ankle. It is a hard band of fibrous tissue that attaches the calf muscles to the calcaneus (heel bone of the ankle). The Achilles tendon is also the largest and strongest in the body.

The two calf muscles; the gastrocnemius and soleus form into one band of tissue, which becomes the Achilles tendon at the lowest point of the calf. A bursa (small sac of fluid) covers the Achilles tendon to help support and protect the area.

When we flex the calf muscles the Achilles tendon pulls onto the heel. This enables us to perform day to day movements such as walking, running and standing on our tip toes. So, it is important to be safe when exercising ensuring the area is protected. The tendon has a limited amount of blood supply, so when we place the tendon under strain or tension it can be more susceptible to injury.

Causes

The main causes for Achilles tendinitis are from repetitive stress and tension placed onto the tendon, it is not usually related to one specific injury cause. Too much pressure on our bodies sometimes can be harmful and extra care should be taken whenever performing any sporting event or exercise activities. Here are some causes of Achilles tendinitis:

Tightness in calf muscles
Sudden increase in intensity of exercise
Longer duration of exercise
Unexpected bone growth

Symptoms

Common signs and symptoms of Achilles tendinitis are as follows:

Stiffness at the back of the ankle first thing when you wake up
Pain along the back of the tendon
Sharp pain along the back of the foot
Feels different e.g., thicker or tighter
Lack of range of movement
Severe pain after exercising
Swelling around the tendon

When exercising or walking and you feel or hear a loud popping noise, you should see your doctor immediately. As it is highly likely that you may have torn/ ruptured the tendon and will need medical attention.

Diagnosis

If you feel you are suffering with Achilles tendinitis, then it is best you go and see your doctor. The health care professional will palpate (feel) the area to determine the site of pain tenderness and swelling. The doctor will also complete a physical examination assessing flexibility, alignment, reflexes and range of movement around the effected area.

Special imaging test may also be used such as:

X-Rays
Magnetic Resonance imagining (MRI)
Ultrasound

Treatment

Now days there are many treatment theories available for Achilles tendinitis. These could be home treatments, anti-inflammatory medication or surgery.

Use the RICE acronym- Rest, Ice, Compress and Elevate the area of injury
Reduce physical activity until swelling and pain has reduced
Ice the area after exercising when pain has occurred
Anti- inflammatory drugs such as aspirin or ibuprofen (however this may just mask the pain)
See a sports therapist / physiotherapist for rehabilitation exercises and stretches
Wear protective equipment such as a brace to prevent heel movement
See a sports therapist and get a sports massage to ease the tension from the calves and plantar on the achilles tendon.

Exercises

Here are a few exercises which may aid in preventing Achilles tendinitis:

Calf Raises on Floor
- Stand with feet hip-width apart.
- Slowly lift your heels off the ground, then lower them back down. This strengthens the calf muscles and tendon.
Single Leg Calf Raises
- Stand on one leg.
- Lift your heel off the ground, then slowly lower it. This targets each calf individually and enhances strength and stability.
Calf Raises on Elevated Bench
- Stand with the balls of your feet on the edge of a step or bench.
- Rise onto your toes, then lower your heels below the step level. This increases the stretch and strengthens the calf muscles more effectively.
Lunge Calf Stretch
- Step one foot forward into a lunge position, keeping the back leg straight and heel on the ground.
- Push your hips forward to stretch the calf muscle of the back leg.
Resistance Band Calf Stretch
- Sit with your leg extended and a resistance band looped around the ball of your foot.
- Pull the band towards you while keeping your leg straight to stretch the calf muscle.
Resisted Plantarflexion
- Sit with your foot flexed and a resistance band around the ball of your foot.
- Push your foot down against the band, then slowly return to the starting position. This strengthens the calf muscles and tendon.
Walking on Tip Toes
- Walk around on your tiptoes for a few minutes. This exercise helps to improve calf strength and flexibility.

Prevention

It may not be possible to full prevent Achilles tendinitis from occurring, however you can incorporate certain measures to reduce the risk factors:

Don’t over do exercise, make sure to have rest days and include full warm ups before exercising
Increase intensity levels of exercise progressively
Make sure you are wearing the correct footwear
Stretch daily, and even more importantly before and after exercising
Perform specific exercises to strengthen the calf muscles
Complete non weight bearing exercise such as swimming to reduce pressure onto the Achilles tendon.

If you think you may have achilles tendinitis or would like to find out if you have it, please contact a member of our team today or make a booking online.

Exercise and Type 2 Diabetes

Posted on June 3, 2024

How can exercise help with Type 2 Diabetes?

Type 2 diabetes is a condition that affects the level of sugar in the blood, but can easily be managed with the correct medication accompanied with a healthy diet & exercise. A healthy diet is a great way of managing your blood sugar level, as well as aiding in controlling your weight & improving overall mood. Being type 2 diabetic doesn’t restrict what foods you can and can’t eat but limiting certain foods such as sugar, fats & salt can definitely help.

Physical activity helps to lower your blood sugar level by increasing insulin sensitivity, allowing your muscles to use the glucose (sugar) in the blood for energy. Furthermore, Sheri Colberg-Ochs, founder of the Diabetes Motion, states that physical activity actually helps to lower blood sugar for up to 72 hours. Overall, the NHS recommends you should be aiming for at least 2.5 hours of activity a week, but activity doesn’t always have to mean exercise, this can be anything that causes you to get out of breath. For example, walking slightly faster than normal, going up & down climbing stairs, or even doing some strenuous housework. However, if you are looking to add more exercise into your daily routine the activities below have been found to be beneficial for people with Type 2 diabetes.

Cardio – Exercises such as walking, jogging, cycling or swimming are great cardio workouts. If you’re fairly inactive at the moment going out for a little walk each day will have amazing benefits on your body. As well as helping with insulin sensitivity & blood sugar levels doing cardio will also improve lung health & fitness. Meaning over time you will be able to get a little further or even progress a walk into a fast walk or light jog.
Resistance training – Building muscle mass allows a higher capacity of blood sugar to be stored within the muscle, lowering the amount of sugar in the blood. Therefore helping to manage blood sugar levels while storing energy.
Balance Training – Sometimes type 2 diabetes can lead to loss of sensation in the feet, known as neuropathy. This condition can lead to trips & falls, so improving your balance can help to prevent this. This doesn’t have to be anything strenuous simply standing on one foot for a certain amount of time can help to improve overall balance.

If you are currently quite inactive please make sure to consult with your healthcare professional before adding any intense exercise into your routine. Also make sure to stay hydrated & to keep check of your blood sugar levels before & after exercise.

You can also contact our team to schedule a nutrition consultation with our qualified staff and maybe even discuss some exercise and training with our personal trainers! Contact us for more information and make a booking here.

Digesting Food

Posted on June 3, 2024

How long does it take to digest food?

The amount of time it takes to digest food will always depend on what types of different foods you have eaten. Generally, it takes around 24-72 hours of food to move through your digestive tract. Different factors such as metabolism, gender and whether someone suffers with digestive issues could all contribute to the rate of digestion, either slowing down or speeding up the process.

Food travels fairly quick through a person’s digestive system, the first process may take around 6-8 hours for food to travel from the small intestine to the large intestine. However, once the food has reached the large intestine it can sit there for at least a day to be broken down even more into smaller particles.

The rate of digestion also depends on what foods you may have eaten, for example; fish and meat products can take as long as 2 days to fully digest compared to foods such as fruit and vegetables taking as quick as a day due to being high in fibre. Foods that are high in fibre help the digestive tract course run with added efficiency.

What happens during the digestion process?

The digestive system is made up of five main components:

Mouth
Oesophagus
Stomach
Small Intestine
Large Intestine

Digestion is the process by our bodies which breaks down food, and gives you the main nutrients our bodies need to fully function. Anything else left over becomes a waste product which our bodies remove naturally.

The first process begins with the mouth, as you pass food into the mouth you start to chew the food breaking it down into smaller pieces, this is where your mouth releases saliva. The saliva contains enzymes that breaks down the starch in the food, resulting in the food becoming easier to swallow.
Once you have swallowed the food travels down to the oesophagus. The oesophagus connects your mouth all the way down to the stomach. The oesophageal sphincter opens to allow food to travel and transfer into the stomach.
As soon as the food has entered the stomach, acids that are in the area will break down the food particles even more. This creates partially digested food and gastric juices within the stomach.
When food has entered the small intestine the liver and pancreas also aid in the contribution of breaking down food. The pancreas aids in breaking down fats, carbohydrates and protein. The main three food groups. Other nutrients such as vitamins, fibre and water move through the small intestine wall and into the bloodstream. Then whatever is left over will transpire into the large intestine.
This is the final part of the digestive process where the large intestine will absorb any remaining water and get rid of any nutrients that the body does not need. Turning it into solid waste, where the body will naturally get rid of any of these products, completing the procedure.

Common Digestive System Complications

It is vital to seek help when suffering with any digestive system complications and understand the signs and symptoms. If left for to long other issue may develop and may lead to further serious illness.

Acid reflux- This occurs when the oesophagus sphincter is weakened. Resulting in acid from the stomach to travel back up into the oesophagus, causing a sensation of heartburn.
Food Intolerance- Some digestive issues may have underlying causes of the development in allergies. This is largely triggered by certain food groups/ types not being able to be processed in the body by a certain digestive enzyme.
Irritable Bowel Syndrome (IBS)- Common signs of IBS can be shown as bad stomach cramps, constipation or diarrhoea. These can all be affected by what food type you consume but are commonly cause by food/drinks such as dairy, alcohol, caffeine and gas producing foods.

Weight fluctuation and bloating- Weight loss and weight gain are common indications of digestive issues. If the body is unable to absorb the nutrients it needs from food then this could explain unexpected weight loss. Bloating is also common with conditions such as IBS which may be mistaken for weight gain; however, this is normally just signs of poor digestion. A person may also suffer with slow bowel movements which may contribute to weight gain.

A Few Tips for Better Digestion

- Limit the amount of red meat and processed foods
- Eat more nutritious foods such as fruit and vegetables
- Get plenty of sleep and be in a good sleeping routine
- Exercise daily
- Manage stress levels
- Eat smaller meals more frequently, rather than larger meals

If you feel you want to discuss more about this and in particular your own personal nutrition, our qualified nutritionists can help. Contact us today or make a booking online.

Lateral Ankle Sprain

Posted on June 3, 2024

A lateral ligament sprain within the ankle complex is one of the most frequently injured area within the body, being encountered at 83% in sports such as football and many athletic events.

The main mechanism of this occurring is when an individual will be placed in excessive inversion and internal rotation of the foot whilst the leg is forced into external rotation. The anterior talo-fibula ligament is thought to be the most susceptible within this Injury.

As soon as athlete or personnel have sustained a lateral ankle injury, mechanical limitations and neuromuscular control of the joint becomes effected, for example; ligamentous tear, reduced strength and loss of balance. Due to these influences effecting the ankle joint, it leads to a 73% chance of recurrent damage and injury within one year, especially if correct and safe rehabilitation is not carried out.

Anatomy

The ankle complex consists of three key joints; these are the talocrural, subtalar and distal tibiofibular. The talocrural joint is known as a hinge joint, movements such as plantarflexion, dorsiflexion, inversion and eversion can be experienced. However due to the fibula being protracted superiorly towards the lateral malleolus compared to the tibia with medial malleolus, eversion movements become restricted. Therefore, implying why inversion injuries may be more frequent in the lateral ankle complex.

Symptoms

A few symptoms of a lateral ankle sprain are as follows:

Tenderness and swelling
Bruising around the ankle joint
Tenderness on palpation around the joint
Unable to place full body weight onto the joint
Restricted range of movement
General pain and discomfort

Causes

A lateral ankle sprain may occur when the ankle joint is forced out of its natural position, causing an overstretch within the ligaments around the joint, therefore resulting in a possible partial tear or complete tear. Some causes may consist of wrongly falling on the ankle causing it to twist. Awkwardly landing from a jump or pivoting. Walking or running on an uneven surface resulting in loss of balance, or another person unintentionally landing onto the ankle during a sporting event.

Diagnosis

An injury to the ankle complex is classified by grades I to III to distinguish the severity of ligamentous damage and indisposition of the sprain. Lateral ankle injuries consist of two types of dysfunction, one being mechanical instability and the other being functional instability.

Both of these elements influence the acute injury, implying that once an individual has sustained a lateral ankle injury, a development of chronic ankle instability may transpire in the near future. The incidence of CAI may be present due to mechanical instability from where ligaments have not healed properly in the ankle region and joint laxity becomes effected.

Specific Tests can also be used to help with the diagnosis of a lateral ankle sprain:

The Anterior Draw test: Tests the ATFL
Talar tilt test: Tests the CFL
Posterior Draw test: Tests the PTFL

Treatment

Treatment for a lateral ankle sprain can vary as it will be dependant on the severity of the injury.

The first step that should be taken 24-72 hours after the injury is sustained would be to reduce the amount of swelling around the joint. An individual should follow the RICE model. Rest, Ice Compress and Elevate. This would include using a cold compress on the ankle and making sure no weight is placed onto the joint.
Soft tissue massage therapy may also be used to assist with the removal of oedema and aid in mild stretching. However, this technique should only be performed once swelling and bruising has reduced around the joint.
Once the ankle can handle some weight being placed onto it, rehabilitation exercises given by a Physiotherapist or doctor should be performed. This will help decrease stiffness around the joint, increase ankle strength and prevent any further complications such as long-term chronic ankle instability issues. These exercises may consist of proprioceptive, strengthening and early motion specific training exercises.

Exercises

Here is a list of exercises specifically for lateral ankle sprain injuries:

Single Leg Squat (with chair support)

Setup: Stand beside a sturdy chair, using it for support if needed.
Execution: Lift one leg off the ground, slightly in front of you. Squat down on the standing leg, ensuring your knee stays aligned with your toes.
Depth: Lower yourself until your thigh is nearly parallel to the floor or as low as comfortable.
Return: Push through your heel to return to the starting position.
Repeat: Complete the desired number of repetitions, then switch legs.

Single Leg Hip Abduction

Starting Position: Stand upright with feet together and hands on your hips or holding onto a support for balance.
Movement: Lift one leg out to the side, keeping it straight and your toes pointing forward.
Height: Raise your leg as high as comfortable without tilting your torso.
Control: Lower your leg back to the starting position slowly.
Repetitions: Perform the exercise for the specified number of reps, then switch sides.

Wobble Board Balance on One Leg

Preparation: Place a wobble board on the floor and stand next to it for support.
Positioning: Step onto the wobble board with one foot, maintaining a slight bend in your standing knee.
Balance: Lift your other foot off the ground and try to balance on the board.
Stabilisation: Use your core and small movements of your standing leg to maintain balance.
Duration: Hold the position for as long as possible, aiming to increase your balance time progressively. Switch legs and repeat.

Standing Single Leg Balance

Start: Stand with feet hip-width apart and arms at your sides.
Lift: Raise one foot off the ground, bending the knee to a comfortable height.
Hold: Maintain your balance on the standing leg, using your arms to help stabilise if necessary.
Duration: Hold the position for a specified amount of time, then switch legs and repeat.
Progression: Increase the challenge by closing your eyes or standing on an unstable surface.

Star Excursion Balance Test

Setup: Place a series of markers or tape lines on the floor in a star pattern, with the centre being your standing point.
Starting Position: Stand on one leg in the centre of the star.
Reach: Extend the other leg to reach toward each marker, touching it lightly with your toe.
Return: Bring the reaching leg back to the centre after each touch.
Sequence: Move systematically around the star, reaching to each marker without losing balance.
Repetitions: Perform the test on both legs, noting the distance reached and maintaining form throughout the exercise.

Prevention

To assist in the prevention of a lateral ankle sprain from reoccurring you should:

Ensure a full warm up and cool down is performed before and after taking part in Sporting events or exercise activities.
Wear the correct footwear that is made for your activity e.g., suitable running trainers when going for a run.
If suffered with an ankle sprain before then use protective equipment such as a brace or tape to add extra support to the ankle.
Perform some form of stability training and balance exercises regularly.
Use strengthening exercises for the ankle joint.
Make sure any rehabilitation strategies are executed and performed daily.

If you believe you have a lateral ankle sprain or at least want to find out, please contact a member of our physiotherapy or sports therapy team or make a booking online for an appointment.

Company

Key Services

Head Office

Socials