Physio | LiveWell Health

Tension Headaches

Posted on June 10, 2024

Tension headaches are the most common type of headache and are caused by muscle tension. Symptoms are often characterised as a dull ache or the feeling of pressure on both sides of the head and are sometimes associated with upper neck pain.

Anatomy

The suboccipital muscles, sternocleidomastoid muscles and trapezius muscles run from the base of the skull, the upper neck and the shoulders. When these muscles become tight and contracted, they may compress the nerves or blood vessels in the head and neck, increasing the pressure. This can result in a dull aching pain in the head and upper neck. This increased pressure may also cause referred pain in which there may be pain around the forehead, temples and eyes.

Symptoms

The symptoms of Tension Headaches can in extreme cases be debilitating. Some of the symptoms can include:

Pain on both sides of the head
Dull aching head pain
Feeling of built up pressure in the head
Tightness across forehead
Neck ache/pain
Tenderness of the scalp, neck and shoulders

Causes

The specific causes of tension headaches are still unclear. Tension headaches are caused by tight, contracted neck muscles and are commonly linked to stress, poor posture, head injury and anxiety. Tension headaches are often linked to running in families and are more common in females.

Diagnosis

Tension headaches are diagnosed by reported symptoms. A full medical exam including other tests may be ran by the GP to rule out any other conditions. Tension headaches can be diagnosed by a discussion with a healthcare professional regarding experienced symptoms.

Treatment

Over the counter painkillers may help relieve pain caused by a tension headache. Heatpacks and gentle stretching may also help relieve symptoms. In some cases stronger medication may be prescribed by the GP for chronic tension headaches.

Sports therapy, physiotherapy and massages can be an excellent treatment for tension headaches. The treatment of the underlying muscle tightness can relieve pressure and consequently reduce symptoms. Treatment sessions may include massage, stretching and mobilisation as well as postural strengthening and advice and education to help reduce symptoms and pain experienced.

Exercises

1. Chin Tucks

Purpose: Strengthen the deep neck flexor muscles and improve posture, which can relieve tension in the neck and reduce headache symptoms.
How to Perform:
- Sit or stand with your back straight.
- Gently tuck your chin toward your chest, as if making a double chin, while keeping your eyes forward.
- Hold the position for 3-5 seconds, then relax.
- Repeat for 20-30 repetitions.

2. Cervical Rotation Stretch

Purpose: Increase flexibility and reduce muscle tension in the neck, which can help alleviate tension headaches.
How to Perform:
- Sit or stand with your back straight.
- Slowly turn your head to one side as far as comfortable, keeping your chin level.
- Hold the stretch for 20 seconds, then return to the centre.
- Repeat on the other side, performing 3 stretches per side.

3. Upper Trapezius Stretch

Purpose: Stretch and relax the upper trapezius muscles, which often become tight and contribute to tension headaches.
How to Perform:
- Sit or stand with your back straight.
- Gently tilt your head to one side, bringing your ear toward your shoulder, while keeping your shoulders relaxed.
- Use your hand to gently increase the stretch by pulling your head closer to your shoulder.
- Hold for 20 seconds, then switch sides. Perform 3 stretches per side.

4. Scapula Pinches

Purpose: Strengthen the muscles between the shoulder blades, improving posture and reducing tension in the upper back and neck.
How to Perform:
- Sit or stand with your arms at your sides.
- Squeeze your shoulder blades together as if trying to pinch something between them.
- Hold the squeeze for a moment, then relax.
- Perform 3 sets of 10-20 repetitions.

Prevention

Due to the nature of our lives and the fact tension headaches can come on through a variety of issues. Some of which are part of our day to day life, such as looking down to your phone, working at a computer/desk, performing certain exercises at gym or just generally feeling stressed from work/life etc.

The good news is with the stretches above, if done regularly, it can prevent the onset of tension headaches. Regular deep tissue massages can also help and trying to take time to de-stress and in some cases meditation/yoga type exercises will also help.

It is important, to slow down and take time for yourself.

If you feel like you are struggling with tension headaches and would like some more advice then please contact us directly, alternatively if you feel a professional massage will help then please make a booking today.

ACL Rupture

Posted on June 10, 2024

Anterior cruciate ligament (ACL) is one of the most injured area of the lower body. The ACL is a strong band of tissue that connects your femur to your tibia. These injuries are mainly common in people who partake in sporting activities such as running, football basketball and netball. This is due to the sports involving a lot of pressure onto the knee, with quick agility movements and changing direction suddenly.

Normally people will know instantly when they have injured the ACL as you will hear a loud popping sound, the knee will suddenly feel weak and painful, unable to put any weight onto the joint. It is important that you seek medical care as soon as possible when this occurs and go and see a doctor for a medical examination.

Anatomy

The ACL ligament is a band of connective tissue which passes from the femur to the tibia bones. The origin of the ACL is the posteromedial corner of the medial aspect of the lateral femoral condyle and inserts into the intercondylar notch of the tibia. The ACL is an important ligament as it provides stability to the knee by preventing the tibia from sliding Infront of the femur.

The main two components of the ACL are the anteromedial and posterolateral bundles, thee insert into the tibial plateau. When the knee is in extension the posterolateral bundle is very tight and the anterolateral bundle is laxed, when the knee is then flexed the ACL changes its positioning causing the AMB to allowing the ligaments to hold more anterior tibial load. When this area is injured, it can be hard for the joint to hold its normal function.

Injury to ligaments is usually graded on a severity scale:

Grade 1: The ligament is mildly damaged and has been slightly stretched but will still be able to keep the knee stable.

Grade 2: The ligament will be stretched to a point where it becomes loose, commonly known as a partial tear.

Grade 3: This is usually known as a full rupture/ tear of the ligament where it has been split, leaving the joint unstable. A grade 3 tear is so common with the anterior cruciate ligament.

Symptoms

Common signs and symptoms of ACL injuries are:

Loud popping of the knee
Pain when walking/ inability to walk
Instability
Difficulty putting weight on the knee joint
Excessive swelling
Constant pain

Causes

There are a number of things that can cause these injuries, usually, but not always, around sports. Such as:

Sudden change in direction.
Planting the foot into the ground whist twisting the leg.
Landing awkwardly from a jump.
Someone else may cause the injury.
Sudden jolt/ stop causing too much pressure onto the knee ligament.

Diagnosis

For the diagnosis of ACL injury your doctor will check your knee for swelling and tenderness, comparing your injured knee to your uninjured knee. The doctor may also move your knee into a variety of positions to assess range of motion and overall function of the joint testing for stability and strength.

Some scans such as an MRI may be used, however a Rupture is easily diagnosed through sight and various movement tests as described above.

Treatment

Once the ACL has encountered a complete rupture, the main treatment to fix this would be surgery. The main focus will be on rebuilding the ACL, this will consist of a complete restructure of the ligament. The doctor will replace the ligament with tissue graft of a tendon, by doing this it allows the graft to act as added support for a new ligament to grow onto.

Other options such as physiotherapy would be recommended to help strengthen and help support the knee joint to get back to its normal function. Exercises and rehabilitation programmes should only be completed once swelling has reduced. Wearing a brace may also be helpful to reduce instability of the knee joint, as well as crutches to take pressure of the knee when walking.

Exercises

Once the rupture has been treated through surgery there is a long road of rehabilitation ahead. Please seek a professional consultation with a registered sports therapist or physiotherapist to get a detailed plan. In the interim, the below exercises can help stregnthen and get you back on the road.

Heel Slides

Purpose: Improve knee range of motion and flexibility after an ACL injury.
How to Perform:
- Lie on your back with your legs straight.
- Slowly slide the heel of the affected leg toward your buttocks by bending your knee as much as possible without pain.
- Hold the position briefly, then slowly slide the heel back to the starting position.

Isometric Quad Contractions

Purpose: Strengthen the quadriceps muscles without moving the knee joint, which is important for stabilizing the knee after an ACL rupture.
How to Perform:
- Sit with your leg straight out in front of you.
- Tighten your quadriceps (the muscles on the front of your thigh) by pressing the back of your knee down into the floor.
- Hold the contraction for 5-10 seconds, then relax and repeat.

Prone Knee Flexion

Purpose: Improve knee flexion and strength in the hamstrings, which are important for knee stability.
How to Perform:
- Lie face down with your legs straight.
- Slowly bend the knee of your affected leg, bringing your heel toward your buttocks.
- Hold briefly at the top, then slowly lower your leg back down.

Heel Raises

Purpose: Strengthen the calf muscles, which support the knee and improve overall leg stability.
How to Perform:
- Stand with your feet shoulder-width apart, using a chair or wall for balance.
- Slowly lift your heels off the ground, rising onto the balls of your feet.
- Hold for a moment at the top, then slowly lower your heels back down.

Half Squats

Purpose: Build strength in the quadriceps, hamstrings, and glutes, which are crucial for knee support without putting excessive strain on the joint.
How to Perform:
- Stand with feet shoulder-width apart.
- Slowly lower your body by bending your knees, keeping your back straight, until your thighs are about halfway to parallel with the floor.
- Push through your heels to stand back up.

One Leg Stands and Hold

Purpose: Improve balance, stability, and strength in the supporting muscles around the knee.
How to Perform:
- Stand on one leg, using a wall or chair for balance if necessary.
- Hold the position for 20-30 seconds, keeping your knee slightly bent, then switch to the other leg.

Isometric Knee Flexion and Extension

Purpose: Strengthen the muscles around the knee without joint movement, which is beneficial for maintaining strength after an ACL rupture.
How to Perform:
- Sit with your knee slightly bent.
- For flexion, press your heel into the floor as if trying to bend your knee further, but without actually moving it.
- For extension, try to straighten your knee by tightening your quadriceps, pressing the back of your knee down into the floor.
- Hold each contraction for 5-10 seconds, then relax and repeat.

Resist Knee Bike Upright

Purpose: Improve range of motion and strength in the knee using a stationary bike, while also providing a low-impact cardiovascular workout.
How to Perform:
- Sit on a stationary bike with the seat adjusted so that your knees are slightly bent at the bottom of the pedal stroke.
- Start with light resistance and pedal smoothly, gradually increasing resistance as tolerated to challenge your knee muscles.
- Aim for 10-20 minutes, depending on your comfort and fitness level.

An ACL rupture can be life changing and as such the rehabilitation back to full fitness can be a long, hard road. If you need help with an ACL issue then please contact a member of our team and make a booking with one of our physiotherapists or sports therapists.

Plantar Fasciitis

Posted on June 3, 2024

In the bottom of the foot there is a thick fibrous tissue known as the plantar fascia. The plantar fascia provides stability for the foot and also works as a shock absorber. Injury to the plantar fascia can lead to an aching sensation on the bottom of the foot when walking, especially after long periods of rest. The term plantar fasciitis refers to inflammation on the sole of the foot.

Plantar fascia injuries are most common in individuals who do lots of exercise such as running, jumping and dancing, involving lots of impact on the bottom of the feet. Treatment methods such as massage and rest can help alleviate the painful symptoms. Painful symptoms may ease on their own but if they still remain after 2 weeks, consult a professional.

Anatomy

The plantar fascia is a long, thick fibrous tissue connecting to the calcaneus (heel bone of the ankle) it runs along the bottom of the foot and divides into five digital bands, along the heads of the metatarsals (toes). It covers the sole of the foot.

The function of plantar fascia is to provide support to the foot when standing and shock absorption when running.

Inflammation or degeneration of the tendon where the fascia originates can cause heel pain.

Symptoms

The symptoms of plantar fasciitis will be aggravated by continuing activity on the sole of the foot such as walking/running and will get worse over time. Some of the symptoms of plantar fasciitis include:

Pain on the bottom of the foot, around the heel and the arch (main symptom)
May be tenderness/pain under sole of foot and under heel when pressing in
Eases pain when exercising, but painful once rest
Difficult to raise toes off floor
Pain occurred gradually
Pain worse first thing in morning/when walking after long periods of rest
Pain eases off only to return later
Pain directly under the heel
Flat or overpronated feet
Tight calves

Causes

Plantar fasciitis is directly caused by damage to the plantar fascia running along the sole of the foot.

Some examples of causes/links consist of:

- Overuse
- Recently started exercising on hard surfaces
- Exercising with a tight calf or heel
- Overstretch the sole of your foot during exercise
- Recently started doing a lot more running, walking or standing up
- More common in sports involving running, dancing or jumping
- Foot biomechanics
- Overpronation (foot rolling in/flattening too much when running or walking which stretches plantar fascia more than normal)
- High arch – unable to absorb as much shock so increased strain on plantar fascia
- Footwear – very flat and unsupportive shoes increase likelihood of developing plantar fasciitis
- Bodyweight – overweight individuals or those that do lots of heavy lifting causes increased load on feet increasing chances of developing heel pain

Flexibility – if have tightness in the calves or plantar fascia this can alter the biomechanics in the foot causing strain on the fascia

Diagnosis

During your visit to your local GP or Sports Therapist / Physiotherapist, they will assess..

- - History- how long the pain has been occurring for and when its most painful
  - Physical examination- check for tenderness in foot, pain during palpation
  - Gait analysis- analysing feet and how they function when walking and running- if overpronate or feet flatten

Treatment

Aims to decrease pain and inflammation, identify and correct possible causes, improve flexibility, gradually increase strength and return to full fitness levels.

Rest- rest from activities causing the pain reduces initial pain and inflammation
Massage – can help stretch and relax the plantar fascia. Massage also helps to stimulate blood flow and loosen tight tissues underneath the foot which cause pain
Stretches – for calf muscles and plantar fascia
Night splint – compliments plantar fasciitis exercises by preventing the tissues from tightening up overnight. Wearing a night splint is more effective than stretching exercises alone.
Taping- supports the arch of the foot and reduces strain on the plantar fascia
Shock Wave Therapy – method of therapeutic treatment for soft tissue injuries- works by passing shock waves into the tissues
Ultrasound – transmits high frequency sound waves into the tissues- has a micro massage effect and can reduce pain and inflammation
Footwear – wear comfortable trainers with good cushioning- avoid hard, flat soles
Cold therapy – ice massage or application of an ice pack for 10 minutes every hour for the first day- reduce to 3-5 times a day as symptoms ease
Medication – doctor may prescribe NSAID’s (Nonsteroidal anti-inflammatory drugs) e.g. ibuprofen in the early stages – always check with a doctor before taking any medication
Orthotics (shoe insoles) – for overpronated feet if feet roll in or overpronate it can cause strain on the foot should be worn at all times, not just when training
Surgery – rarely needed but is used when all other treatments haven’t helped.

Exercises

The best way to treat plantar fasciitis is firstly to rest. If pain allows, some stretching exercises can help improve symptom’s and alleviate some pain.

Foot rolling – rolling the foot over a round object such as a ball, weights bar, rolling pin or can of soup can stretch the plantar fascia. Roll the foot repeatedly over the object, applying increasing downward pressure. You can also apply an object that can be cooled in the freezer (bottle or metal can) to apply cold therapy at the same time – 10 minutes per day until walking in the mornings is pain-free.
Calf stretches – stand facing a wall with one foot in front of the other, the front knee slightly bent, and the back leg straight. Keep both heels on the ground and lean into the wall, feeling a stretch in the calf of the straight leg. Hold for 20-30 seconds, then switch legs and repeat.
Soleus stretch – Stand in the same position as the calf stretch, with one foot in front of the other. This time bend both knees while keeping both heels on the ground. Lean into the wall, feeling a stretch in the lower part of the back calf. Hold for 20-30 seconds, then switch legs and repeat.
Stretching on a step – stand with toes on step and heels off the back, lower heels down below the level of the step until a stretch is felt- hold for 15-20 seconds- further stretches calves and Achilles
Towel Scrunch – While sitting, place a towel on the floor with your foot on top of it. Try scrunching up a towel with your toes like you are trying to pick it up off the floor

No running!

Try to maintain fitness by swimming or cycling & you can begin to start walking again when there has been no pain for at least a week, slowly increase the distance and speed.

Prevention

Stretching – make sure to keep up the stretching of the lower body to prevent strain on the fascia
Footwear and Insoles – try to wear shoes that are supportive for the sole of the foot and absorb shock with cushioning
Ease into more intense exercise gradually – start by walking and gradually increase the amount as time goes on, then eventually ease back into running when pain is eliminated
Keep a healthy lifestyle and your weight under control as excess weight can increase the amount of stress on the foot

Frozen Shoulder

Posted on June 3, 2024

Frozen shoulder (also known as adhesive capsulitis or periarthritis) is used to describe the condition where the glenohumeral joint of the shoulder is stiff and painful. It occurs in about 2-5% of the general population, with a higher prevalence among elderly individuals and those with diabetes. Frozen shoulder is a benign and self limiting condition, usually lasting for 1-3 years, in 20-50% of patients the stiffness and pain only partially resolve, which leads to long lasting effects of shoulder mobility impairment and reduction in sleep quality. Commonly patients who suffer persistent symptoms (over 4-5 years) only suffer mild long term effects.

Anatomy

The hallmark pain and stiffness are caused by the formation of adhesions or scar tissue in the glenohumeral (GH) joint. The GH joint is a ball and socket joint between the scapula and humerus, connecting the upper arm to the trunk. Under normal conditions this joint is one of the most mobile in the human body, allowing for a large range of motion in multiple planes. In the case of frozen shoulder the adhesions limit this range of motion and make movement painful.

Symptoms

There are 4 recognised clinical stages of the condition:

Painful stage- moderate pain and reduction of movement lasting less than 3 months
Freezing stage- severe pain and reduction of movement lasting 3-9 months
Frozen stage- pain may be present but stiffness predominates lasting 10-14 months
Thawing stage- minimal pain and gradual improvement in movement lasting 14-24 months

Causes

The cause of frozen shoulder is still unclear. Historically researchers into the aetiology of the condition have shown that it is characterised by a thickened, tight capsule with chronic inflammatory cells and fibroblasts found in the joint capsule. It can occur as a primary idiopathic condition or secondary to medical conditions or trauma.

Diagnosis

Frozen shoulder is diagnosed by testing positive to three characteristics:

Insidious onset of severe pain over a period of months, night time pain is a common feature
Shoulder stiffness with markedly reduced external rotation
Negative radiographic findings

Some patients describe the pain as a deep ache, poorly localised and non specific without any point of tenderness. In others it presents as a pain which refers to the deltoid origin and radiates down to the bicep area. Manual testing will often return normal rotator cuff strength but a greatly reduced passive and active range of motion.

In some cases laboratory tests may be carried out to identify or rule out underlying conditions. Radiographs of the shoulder will also return normal with a patient suffering from frozen shoulder, but may be carried out to exclude conditions such as shoulder dislocation, GH arthritis or calcific tendinopathy.

Treatment

There is no universally accepted intervention which is viewed as the most effective treatment for restoring motion and reducing pain.

Non-surgical or conservative management is preferred with most patients improving in 6-18 months. This includes analgesics, oral steroids, physical therapies and supra-scapula nerve block. Physical therapy, from a sports massage and remedial therapist or physiotherapist, has traditionally been the first choice of treatment for frozen shoulder. The therapist can work to reduce pain, mobilise the joint and provide the patient with a supervised stretching and strength maintenance programme.

Exercises

Exercises should be carried out under the direction of a qualified therapist and vary according to the stage of the condition.

Early Freezing Stage: Gentle and Short Duration Stretches
1. Pendulum Exercises
  - Purpose: Promote gentle movement in the shoulder joint, reducing stiffness without causing pain.
  - How to Perform:
    - Lean forward with your unaffected arm supported on a table or chair.
    - Let your affected arm hang down loosely.
    - Gently swing your arm in small circles, or forward and back, using your body to initiate the motion.
    - Perform for 1-2 minutes, gradually increasing the range of motion as tolerated.
2. Passive External Rotation
  - Purpose: Maintain range of motion by gently stretching the external rotators of the shoulder.
  - How to Perform:
    - Lie on your back with your arm close to your side and elbow bent at 90 degrees.
    - Use your unaffected hand to gently push your affected arm outward, rotating it externally.
    - Hold for 10-15 seconds, then relax and repeat, avoiding any pain.
3. Supine Passive Forward Elevation
  - Purpose: Improve shoulder mobility by gently stretching the shoulder in a pain-free range.
  - How to Perform:
    - Lie on your back with your affected arm by your side.
    - Use your unaffected hand to slowly lift your affected arm overhead, keeping it straight.
    - Hold at the top for a few seconds, then slowly lower it back down.
    - Repeat, ensuring the movement remains gentle and within a comfortable range.
Later Frozen Stage: Strengthening Exercises
1. Isometric External Shoulder Rotation
  - Purpose: Strengthen the shoulder’s external rotators, stabilising the joint without moving it.
  - How to Perform:
    - Stand with your elbow bent at 90 degrees, and press the back of your hand against a wall or door frame.
    - Push outward against the wall without moving your arm, holding the tension for 10-15 seconds.
    - Relax and repeat, ensuring no pain occurs during the exercise.
2. Posterior Capsular Stretching
  - Purpose: Stretch the tight posterior capsule of the shoulder, improving internal rotation and overall flexibility.
  - How to Perform:
    - Bring your affected arm across your body at shoulder height.
    - Use your other hand to gently pull your arm closer to your chest, stretching the back of your shoulder.
    - Hold the stretch for 20-30 seconds, then release and repeat.
Thawing Stage: Combined Strength and Stretching Exercises
1. Combined Strength and Stretching Exercises
  - Purpose: Enhance overall shoulder function by combining strengthening with stretching, gradually increasing range of motion and strength.
  - How to Perform:
    - Incorporate exercises like active external rotations, shoulder abduction, and flexion against light resistance bands or weights.
    - Alternate between strengthening movements and stretching exercises like doorway stretches or wall slides.
    - Increase the frequency and intensity as tolerated, aiming for 2-3 times daily.

Prevention

As the aetiology of the condition is still unknown advising on how to prevent an incidence of the condition is difficult. Research has suggested that prolonged immobilisation or limited use of the shoulder joint may contribute to the likelihood of developing frozen shoulder. With this in mind regular balanced exercise and stretching can help to maintain the structural support and mobility of the GH joint.

Temporomandibular Disorders (TMD)

Posted on June 3, 2024

Temporomandibular disorders (TMD) are conditions which affect the movement of the jaw. They are sometimes referred to as TMJ disorder or TMJD. It can cause facial pain, tenderness and difficulty moving the joint. TMD is believed to affect up to 15% of adults, with peak incidence at 20 to 40 years of age, more commonly found in women. TMD is treatable, but can have many different causes which can make diagnosis a challenge. Once diagnosed most patients can be successfully treated at home using methods such as reducing stress and changing posture.

Anatomy

TMD refers to a group of disorders affecting the Temporomandibular Joint (TMJ).

This joint connects your lower jaw (mandible) to your skull. It is located bilaterally (on both sides of your head) just in front of your ears. The function of this joint is to open and close your mouth, allowing you to eat and speak.

The TMJ is a hinge joint which allows for precise and complex movements of the jaw.

Symptoms

The symptoms typically present, either on one or both sides of the face:

Pain in the face or neck
Limited jaw range of motion and/or locking of the joint
Stiffness in the jaw muscles
Clicking or popping from the TMJ area
Malocclusion (a shift in jaw position)

Causes

There is no single specific cause for TMD, but some conditions are believed to contribute to developing a disorder. These include arthritis, joint erosion, clenching or grinding of the teeth, congenital structural jaw problems and trauma to the jaw. It is also thought that prolonged stress and poor posture which puts extra strain on the muscles of the face and neck are associated to the development of TMD.

Diagnosis

There is no standard test for TMD, you may be referred to an ENT specialist for a diagnosis. They may physically examine your jaw for swelling or tenderness and possibly carry out and X ray, CT scan or MRI to assess the structure of your jaw.

Treatment

Most TMD patients are treated conservatively, using pain medication, ice to reduce pain and swelling and reducing jaw movements by eating soft foods and avoiding chewing gum.

Many find that physiotherapy or sports massage therapy can support treatment for TMD. Your therapist can manipulate the muscles surrounding your jaw and neck, thereby relieving the tension in your TMJ. They can also provide you with exercises the stretch the muscles around your jaw, optimising joint movement. As stress and upper body posture is believed to be a contributing factor in TMD you may find that regular massage treatments can help you to manage your condition.

In extreme cases your GP or ENT specialist may advise corrective dental treatment if this bite alignment is an issue or arthrocentesis if fluid and debris needs to be cleared from the joint.

Exercises

There are many different exercises which can be used to help TMD. Your Physiotherapist or Sports Massage Therapist will be in a better position to advise which are best for you, but here are a few examples that they may ask you to carry out.

Goldfish Exercise:

Press your tongue to the roof of your mouth. Then place one index finger on your left TMJ and the other index finger on your chin. Apply light pressure on each finger, drop your chin so that your mouth opens, but tongue stays in contact with the roof of your mouth. Repeat with the right TMJ.

Chin Tucks:

Stand or sit tall then bring your head backwards, tucking your chin in towards your chest. Keep your head straight, it might help to focus on a point or object straight in front of you.

Jaw Stabilisation:

Keep your jaw in a neutral position and then partially open it, about the width of the top of your thumb. Apply gentle pressure with your hand, first on the left then right then at the bottom of your jaw. Resist the pressure to keep your jaw stationary.

Prevention

As TMD have no specific cause it can be difficult to prevent their occurrence. You may find it helpful to use a mouth guard at night or use muscle relaxants (under the supervision of your GP) if you are prone to teeth grinding. Physio or sports massage therapy can help to optimise your posture and avoid excess pressure on your TMJ. It is also advisable to reduce, or manage, stress levels and anxiety. This can be achieved through regular exercise, massage treatments, diet and counselling.

Lumbar Disc Herniation

Posted on June 3, 2024

A herniated disc, also known as a slipped or bulging disc, is a relatively common pathology often occurring in people aged 30 to 50. The intervertebral discs play a crucial role in the spine acting as a shock absorber between the vertebrae, as well as allowing for a wide range of movement. Disc herniation refers to a condition in which the spinal discs become damaged & encroach on the nerve roots branching off the spinal cord. This can happen anywhere along the spinal column but often occurs in the cervical or lumbar region, due to the wide range of movement in these areas causing more wear & tear on the discs. For most people a slipped disc is extremely painful due to the nerve compression, however some people don’t even feel that it has happened.

Anatomy

The Spinal column is made up of 24 individual interlocking bones known as vertebrae. These vertebrae are split into 3 different sections consisting of 7 Cervical, 12 Thoracic & 5 Lumbar, followed by the Sacrum & Coccyx. Even though the vertebrae in each section look different they all have the same functional components; the body for load bearing, the vertebral foramen to protect the spinal cord & the transverse processes for ligament attachment. In between these vertebrae the intervertebral discs are found, protecting the bones by absorbing shock from body weight, trauma & daily activities such as walking, lifting or twisting.

Spinal discs are made up of 2 parts, a soft gel-like inner portion called the nucleus pulposus & a tough outer ring known as the annulus fibrosus. The nucleus pulposus, mainly consisting of water plus loose networks of collagen fibers, is where shock absorption primarily takes place. Surrounding this inner core, the annulus fibrosus is composed of tough ligamentous fibers which protect the nucleus pulposus, as well as securely connecting the vertebrae above and below the intervertebral disc.

Causes

A herniated disc occurs when excess pressure is placed on the disc causing the annulus fibrosus to become weak. This weakness can then cause bulging, cracking or ruptures within the annulus fibrosus allowing the nucleus pulposus being able to “leak” through & compress against the nearby nerve roots. The result, intense pain in the lower back followed by shooting pains into the buttock & down the leg.

The main factors that can increase the risk of a herniated disc are:

Age – Over time the intervertebral discs naturally start to lose the fluid which normally allows them to stay pliable and spongy between the vertebrae, this is known as disc degeneration. This dehydration of the discs causes them to become stiff and unable to withstand strenuous compression, leaving the annulus fibrosus more susceptible to bulging or rupturing even from the slightest of movements.

Lifting heavy objects repetitively or incorrectly – Lifting heavy objects can place excessive strain on the lower back which can cause a herniated disc. Especially when they are lifted without correct technique, predominantly using your back muscles instead of your legs to lift combined with a twisting motion overstress the discs increasing risk of herniation. If you have a physically demanding job, the repetitive nature of the role can also increase the risk and your placing this strain on the disc over and over.

Obesity – Excess weight increases the stress on the lumbar spine making individuals who are overweight more likely to herniate a disc.

Smoking – Experts suggest that putting nicotine into your system limits the blood flow to the discs causing them to break down quicker, speeding up degeneration therefore increasing the risk of herniation.

Trauma – The least common cause of disc herniation is trauma, a serious fall or accident can lead to this pathology but is less common than the other factors.

While all these factors can increase the risk of lumbar disc herniation anyone at any time could herniate a disc.

Symptoms

Signs & Symptoms tend to vary depending on where the herniated disc is situated & the level of herniation. Typically only affecting one side of the body, symptoms can range from moderate lower back pain to extreme pain & numbness going all the way down the leg.

Lower back pain
Pain often down one leg from the buttock into the thigh & calf.
Numbness, tingling or burning sensations due to nerve compression
Pain that worsens at night
Pain that worsens with certain movements such bending or sitting
Muscle weakness
Sciatic pain
Difficulty lifting the foot (Foot Drop)
Pain when standing from a seated position

Pain normally eases within six weeks, but during this short duration pain can be severe making daily activities difficult to participate in. However not all herniated discs can cause symptoms, as the herniation may not be compressing on a nerve & therefore not radiating any pain.

Diagnosis

If you believe this is a pathology you may be suffering with you should consult with a healthcare professional so they can conduct a thorough assessment. They will ask about your symptoms, medical history & when/how the pain started. After this a physical exam would be performed to find the source of the pain and discomfort. They will also assess your muscular strength and discover what movements trigger the pain. A herniated disc may be suspected if pain starts in the lower back and is then accompanied by radiating pain down the leg. In order to confirm this more tests can be performed, these include:

Straight Leg Raise Test – While lying on your back & keeping your legs straight, your healthcare professional will slowly raise your affected leg until symptoms occur. If pain is felt during 30 to 70 degrees of hip flexion this indicates lumbar disc herniation. If you have a herniated disc compressing on a nerve, this particular movement recreates symptoms by increasing this compression therefore resulting in a positive test. You will also be asked if any numbness or tingling is felt down the leg while completing this movement.

MRI (Magnetic Resonance Imaging) – This type of scan usually provides the most accurate imaging of a herniated disc, as it shows the disc, surrounding soft tissue & nerve roots. This allows your healthcare professional to actually see where the herniation has occurred & which nerves are being impinged.

X-Ray – These aren’t often used to diagnose herniated discs as the soft tissues structures of the discs & nerves are hard to capture. However, X-Rays are used to rule out any other causes of the pain such as a fracture or bone spur, a tumor or spinal alignment issues.

Your healthcare professional can then put all this information together to diagnose the cause of your pain & discomfort. However, during the initial assessment, if no serious signs of a herniated disc are found then imaging scans may not be provided at this point. As some professionals prefer to wait & see if symptoms ease on their own within the six weeks.

Treatment

Treatment for a herniated disc can range from minimal pain management to surgical treatment. In most cases lumbar disc herniation often resolves from minimal treatment within six weeks. Your GP may prescribe painkillers or muscle relaxants to relieve short term pain and also refer you to a Physiotherapist/Sports Therapist. Your therapist will then provide you with stretches and exercises for the back and surrounding areas.

When slipping a disc, or with any injury in fact, initial response is to decrease the pain that you are in, ways to do this include:

Rest – Bed rest is ok at first when pain is severe, however this should be limited to a couple of days as any longer than this can cause muscles to become stiff and weak. Heavy lifting & intense exercise however should be avoided for the first six weeks.

Ice – Applying ice after initial injury can help to ease pain by reducing inflammation & muscle spasms associated with disc herniation.

Pain Medications – Over the counter painkillers can help to treat pain & inflammation. Also your GP may prescribe muscle relaxants if spasms get particularly bad.

Heat Therapy – Applying heat to the area after the first 48 hours, with a hot water bottle or by having a nice bath, can help to relax the muscles surrounding the injured area & reduce muscle pain & spasms.

Hot & Cold Therapy – Some individuals find maximum relief from using a mixture of hot and cold treatment. For example, applying ice for 10 minutes, immediately followed by a heat pack or hot water bottle for 10 & repeat.

After this you can start to consider more long term solutions for the pathology, this options include:

Strengthening Exercises

Spinal Manipulations

Epidural Injections

Acupuncture

Massage Therapy

If symptoms do not improve after these treatments & persist longer than six weeks, surgery is then sometimes considered.

Exercises

Provided are some exercises that can help lumbar disc herniation:

Back Extension – Lie on your front with your forearms and palms flat on the floor. Slowly lift your upper body up off the floor and hold for up to 30 seconds, aim for 10 reps.
Glute Max Stretch – Lie on your back with your knees bent, life one leg off the ground and place the outside of the ankle joint over the opposite knee. Hold the knee of the lifted leg and pull the leg in towards the body and hopefully you should be able to feel the stretch in the buttock region. Hold stretch for up to 30 seconds and try to treat 3 times on each leg.
Pelvic Tilts – While lying on your back, place your hands on your hips & roll your pelvis back & forth along the ground. Aim for 10 sets of 3 reps
Superman – On your hands and knees slowly lift and straighten your opposite arm and leg. Aim to complete 10 sets of 3 reps.

While completing exercises if any pain or discomfort is felt then stop immediately and rest instead.

Prevention

It isn’t always possible to prevent herniating a disc but here are some steps you can take to reduce your risk.

Strengthening exercises – Increasing your core strength can help to stabilise and support the spine, decreasing the stress placed on your discs.

Maintain good posture – Sitting up straight and keeping your back aligned reduces the pressure placed on the discs.

Lose weight – If you are classed as overweight losing excess weight can help to reduce wear and tear on your discs as the load being placed on them will be less.

Correct lifting techniques – Make sure when you are lifting heavy objects that you are doing it correctly, bend and lift from your legs not your waist.

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.

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.

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