Running a Marathon? Consider Pre and Post Event Massage

Posted on September 12, 2024

Running a Marathon? Consider Pre and Post Event Massage

Participating in a marathon is a significant physical challenge, and preparing both mentally and physically is essential for success. One key element to consider in your training routine is incorporating pre- and post-event massage. These massages not only enhance performance but also aid in recovery, ensuring that your body can handle the rigorous demands of the race.

What is Pre and Post Event Massage?

Pre- and post-event massage refers to targeted massage sessions before and after a race or athletic event. The techniques used in these massages differ from standard sessions, with specific goals designed to prepare the body beforehand and assist in recovery afterward.

What to Expect from a Pre Event Massage?

A pre-event massage is intended to prepare your soft tissue for the upcoming marathon. Unlike regular deep tissue massages, the goal is not to address ongoing issues or focus on injury rehabilitation. Instead, the therapist aims to loosen muscles, improve blood flow, and enhance flexibility, all critical factors for peak performance.

This type of massage is generally lighter in pressure and fast-paced, ensuring muscles are not overworked before the event. Overexerting the muscles during this massage can lead to fatigue or even injury, which is counterproductive right before a marathon. It is recommended to schedule your pre-event massage within 24 hours of the race to maximise its benefits. This timing helps ensure that your muscles are primed but not fatigued by more intense work, such as a deep tissue session.

What to Expect from a Post Event Massage?

After completing the marathon, a post-event massage can play a crucial role in your recovery process. The goal of this massage is to aid the muscles in returning to their pre-event state by addressing inflammation, tension, and stiffness. The massage focuses on lighter pressure, which facilitates recovery rather than adding strain to already tired muscles.

Techniques such as lymphatic drainage are often used during post-event massages. Lymphatic drainage helps to flush out waste products, such as lactic acid, which can accumulate in the muscles during intense activity. This is important because lactic acid buildup can lead to muscle stiffness and discomfort if not properly cleared out. Another commonly used technique is myofascial release, which helps release muscle tension and reduces inflammation.

A post-event massage also helps prevent DOMS (Delayed Onset Muscle Soreness), a condition many marathon runners experience due to the strenuous nature of the race. This soreness usually peaks within 24-48 hours after the event and can be debilitating. A well-timed massage, typically within 30 minutes to 48 hours after the marathon, can significantly reduce the severity of DOMS, promoting faster recovery.

Mental Readiness is Key

While much of the focus of pre- and post-event massage is on physical preparation and recovery, mental readiness is just as important. Preparing for a marathon can be mentally draining, and it’s crucial to align your mental focus with your physical capabilities. A good massage therapist will not only work on your muscles but also support your mental state, ensuring you feel motivated, confident, and focused before the race.

Post-event, the therapist can help you reflect on your achievement and maintain a positive mindset, helping you feel accomplished and ready for future races. Marathon running is a massive accomplishment, and celebrating your success is an important part of the recovery process.

Conclusion

Incorporating pre- and post-event massages into your marathon training routine can provide numerous benefits for both your body and mind. By preparing your muscles effectively before the race and supporting their recovery afterward, these massages help optimise your performance and minimise post-race soreness. So, whether you’re a seasoned marathon runner or tackling your first race, consider adding these massages to your training strategy—your body will thank you!

For further information about our event massage services or to make a booking please contact us today.

Should I Cold Plunge Before or After a Workout?

Posted on September 8, 2024

Should I Cold Plunge Before or After a Workout?

Cold water immersion, often referred to as a “cold plunge,” has grown in popularity, with many athletes and fitness enthusiasts embracing it for its numerous health benefits. Known for its potential to reduce muscle soreness, boost mental health, and improve factors such as blood pressure and body fat levels, cold plunging is often hailed as a powerful recovery tool. But when should you incorporate a cold plunge into your workout routine—before or after exercise?

The Benefits of Cold Water Therapy

Cold water therapy offers several benefits, especially in the realm of sports and recovery. Athletes commonly use it to reduce muscle damage and delayed onset muscle soreness (DOMS) after intense workouts. The cold temperature constricts blood vessels and reduces inflammation, helping muscles recover faster by flushing out waste products such as lactic acid.

Beyond physical recovery, cold plunging has also been shown to support mental health. The shock of cold water can trigger the release of endorphins and adrenaline, which can reduce stress and improve mood. Regular cold immersion may also help regulate blood pressure, improve circulation, and even reduce body fat.

Cold Plunging After a Workout: A Double-Edged Sword

Given these benefits, it might seem like a no-brainer to hop into a cold plunge after every workout to speed up recovery. However, the science behind cold plunging post-workout suggests a more nuanced approach.

While cold plunging reduces muscle inflammation and soreness, it can also interfere with a crucial aspect of strength training—muscle growth. During exercise, muscle fibers undergo microscopic damage, and the body’s inflammatory response triggers the healing process. This inflammation is necessary for muscle repair and growth, known as hypertrophy.

When you cold plunge immediately after a workout, you reduce the inflammation needed for this process, which could slow down muscle growth. Studies show that while athletes who regularly use cold plunges still see muscle growth, the gains are not as significant compared to those who avoid cold plunging after strength training.

Cold Plunging Before a Workout

Cold plunging before a workout can offer a different set of benefits. Some people find that a quick cold plunge before exercising improves alertness, sharpens focus, and provides an energy boost. The cold water can wake up the nervous system, making you feel more refreshed and ready to tackle your workout.

However, there are potential downsides to cold plunging before exercise. The body’s muscles may stiffen after exposure to cold temperatures, potentially reducing flexibility and mobility. If your workout requires a lot of dynamic movements, or if you’re lifting heavy weights, a pre-workout cold plunge might not be the best option as it could limit your range of motion or even increase the risk of injury.

So, Should You Cold Plunge Before or After?

The answer depends on your fitness goals and current needs:

For muscle growth and strength: If your primary goal is to build muscle, avoid cold plunging right after workouts. The reduction in inflammation could hinder the hypertrophic process and slow down your muscle gains.
For fast recovery: If you’re preparing for a sports tournament, race, or multiple events in a short time, cold plunging after workouts can speed up recovery, reduce soreness, and help you perform at your best in a short time frame.
For mental and physical refreshment: A cold plunge before a workout may provide an energising boost and improve mental focus, making it a good option for those seeking a fresh start to their exercise routine.

Conclusion

Cold plunges offer numerous benefits, but timing is key. If muscle growth is your primary goal, save your cold plunges for non-training days or use them strategically to enhance recovery between competitive events. Always listen to your body and consider your unique fitness goals before incorporating cold water therapy into your routine. And, if you have underlying health conditions, consult your doctor before starting any form of cold immersion therapy.

For further help with your training, and or recovery contact our amazing Sports Therapists and Personal Trainers at 0330 043 2501, info@livewellhealth.co.uk or contact us through our website.

What is Tennis Elbow?

Posted on August 4, 2024

What is Tennis Elbow?

Tennis elbow, officially termed lateral epicondylitis, affects more than just athletes. This prevalent condition involves pain and inflammation in the tendons that link the forearm muscles to the outer part of the elbow.

Repetitive actions such as gripping, twisting, and lifting can often cause this ailment. Activities like going to your local gym, painting, carpentry, and even typing may trigger these motions, leading to small tears in the tendons. Consequently, this results in inflammation and discomfort on the elbow’s exterior, which can intensify with continued use. Symptoms may also include forearm weakness, reduced grip strength, elbow stiffness, and pain extending down the arm.

What is tennis elbow

To diagnose tennis elbow, a physical examination is typically performed alongside a review of your medical history and activities. Imaging tests might be used to exclude other potential conditions but in the main a sports therapist, physiotherapist or doctor can accurately diagnose this condition.

Treatment aims to alleviate pain, reduce inflammation, and facilitate healing. This can involve rest, ice application, specific physical therapy exercises, bracing, over-the-counter pain relievers, or sometimes corticosteroid injections. In general we see huge improvements in the condition through a well strategised and dianamic recoveyr and rehabilitation regime.

Preventing tennis elbow is crucial, particularly if your job or hobbies involves repetitive arm movements. It is important to warm up before engaging in such activities, maintain proper form, take regular breaks, strengthen forearm muscles, and use ergonomic tools when necessary.

If you think you might have tennis elbow, it’s important to consult a healthcare provider for a precise diagnosis and tailored treatment plan. With prompt intervention and appropriate care, you can effectively manage the condition and resume your regular activities. If you would like to read more about the condition, we have written an article that goes into much more detail which can be found here.

Alternatively if you would like to book one of our sports therapists or physiotherapists to conduct a thorough in person review, treatment and then provide you with the exercises to rehabilitate this condition then please either make a booking through our online booking system or contact us directly.

Nerve Impingement

Posted on July 1, 2024

Nerve impingement, also known as nerve compression or pinched nerve, is a condition in which a nerve is compressed or constricted, leading to pain, weakness, numbness, or tingling sensations in the affected area. This can occur in various parts of the body, including the neck, back, arms, and legs.
The pathology of nerve impingement involves pressure or constriction on the nerve, which can be caused by a variety of factors, such as injury, repetitive motions, poor posture, or degenerative conditions like arthritis. This pressure can lead to irritation and inflammation of the nerve, which can cause pain and other symptoms.
The occurrence of nerve impingement is quite common, especially as people age and degenerative changes occur in the spine. It can also be seen in people who perform repetitive motions or maintain poor posture for extended periods of time. Additionally, nerve impingement can result from injuries, such as whiplash or a herniated disc, or from conditions such as carpal tunnel syndrome or sciatica.

Anatomy

The human nervous system is comprised of a complex network of nerves that run throughout the body, transmitting signals between the brain and various tissues and organs. Nerves are made up of axons, which carry electrical signals, and are surrounded by a layer of protective tissue called myelin. Nerves can be affected by a variety of factors, including compression, entrapment, inflammation, and injury.

Symptoms

The symptoms of nerve impingement can vary depending on the location and severity of the impingement. Common symptoms may include pain, numbness, tingling, burning, or a feeling of pins and needles. In severe cases, nerve impingement can lead to muscle weakness, loss of sensation, and difficulty with movement.

Causes

Nerve impingement can be caused by a variety of factors, including physical trauma, repetitive motions, poor posture, and underlying medical conditions such as arthritis, diabetes, and nerve disorders. Other common causes of nerve impingement include spinal stenosis, herniated discs, and degenerative conditions such as spinal cord injuries.

People who are at a higher risk of developing nerve impingement include:

Individuals with certain medical conditions such as diabetes, arthritis, or other conditions that can cause nerve damage or inflammation.
Athletes and physically active individuals who engage in repetitive motions, such as running, cycling, or weightlifting, which can put stress on the nerves.
People who have a sedentary lifestyle and spend long hours sitting or working in positions that can put pressure on the nerves, such as office workers or truck drivers.
Individuals with a family history of nerve impingement, as this may suggest a genetic predisposition to the condition.
People who have suffered a previous injury, such as a fracture or dislocation, that may have damaged the nerves.

Diagnosis

The diagnosis of nerve impingement is typically based on a review of medical history, a physical examination, and diagnostic imaging tests such as MRI or CT scans. Nerve conduction studies and electromyography (EMG) tests can also be used to help diagnose nerve impingement and determine the severity of the injury.

It is important to note that while anyone can develop nerve impingement, early detection and proper treatment can greatly reduce the risk of developing long-term complications and help ensure a full recovery.

Treatment

Here are some of the treatment options for nerve impingement:

Rest: Resting the affected area can help reduce inflammation and give the nerve time to heal. You may need to avoid activities that aggravate your symptoms, such as heavy lifting, repetitive motions, or prolonged sitting or standing.

Physical therapy: Physical therapy can help improve your strength, flexibility, and posture, which can relieve pressure on the affected nerve. Your physical therapist may recommend exercises, stretches, or other techniques to help alleviate your symptoms.

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce inflammation and relieve pain associated with nerve impingement. In some cases, corticosteroids may be prescribed to reduce inflammation and alleviate symptoms.

Injections: In some cases, injections of corticosteroids or other medications may be given directly into the affected area to reduce inflammation and alleviate symptoms.

Surgery: If conservative treatments are not effective, or if nerve impingement is causing significant weakness or loss of function, surgery may be recommended. The type of surgery will depend on the location and severity of the compression and may involve removing bone or tissue to relieve pressure on the affected nerve.

Lifestyle changes: Making lifestyle changes can help prevent or alleviate nerve impingement. This may include maintaining good posture, staying active, avoiding repetitive motions, and avoiding activities that put excessive strain on your nerves.

Exercises

Exercises to help relieve nerve impingement and prevent further damage may include:

Stretching: Gentle stretching exercises can help relieve pressure on the nerves and improve flexibility in the affected area.
Strengthening exercises: Targeting the muscles surrounding the affected nerve can help relieve pressure and prevent further damage.
Posture correction: Paying attention to posture and correcting any imbalances can help reduce stress on the nerves.
Aerobic exercises: Engaging in low-impact aerobic activities, such as swimming or walking, can help improve blood flow to the affected area and promote healing.
Yoga or Pilates: Gentle yoga or Pilates can help improve flexibility and strengthen the muscles surrounding the affected nerve.

It is important to consult with a doctor or physical therapist before beginning any exercise program, as they can help determine which exercises are best for your individual needs and ensure proper form and technique.

Prevention

Maintain Correct Posture:

Be mindful of your posture, especially when sitting or standing for long periods. Maintain a neutral spine position to reduce unnecessary stress on the spine and nerves.

Ergonomics:

Ensure that your workspace, whether at a desk or using electronic devices, is ergonomically designed to support good posture. Use supportive chairs, maintain eye-level screens, and take regular breaks to avoid prolonged periods of the same position.

Regular Exercise:

Engage in regular physical activity to strengthen the muscles that support the spine. Focus on exercises that promote core strength and flexibility, as a strong and flexible spine is less prone to nerve compression.

Correct Lifting Techniques:

When lifting objects, use proper lifting techniques to avoid putting excessive strain on the spine. Bend at the knees, keep the back straight, and lift with the legs rather than the back.

Weight Management:

Maintain a healthy weight to reduce the load on the spine. Excess body weight can contribute to conditions like herniated discs and spinal stenosis, increasing the risk of nerve impingement.

Stay Hydrated:

Hydration is essential for maintaining the elasticity of spinal discs. Dehydration can contribute to disc degeneration, which may increase the risk of nerve compression.

Avoid Repetitive Stress:

Be mindful of repetitive movements or activities that can strain specific nerves. If your work or hobbies involve repetitive motions, take breaks and incorporate stretching exercises to reduce the risk of overuse injuries.

Regular Stretching:

Include regular stretching exercises in your routine to maintain flexibility and prevent muscle imbalances. Focus on stretches that target the muscles around the spine, including the neck, back, and hips.

Quit Smoking:

Smoking has been associated with increased disc degeneration and reduced blood flow to spinal structures. Quitting smoking can contribute to overall spine health.

Proper Nutrition:

Maintain a balanced diet rich in essential nutrients, as proper nutrition supports the health of spinal structures. Calcium and vitamin D are particularly important for bone health.

Regular Check-ups:

Schedule regular check-ups with your healthcare provider to monitor your spine health. Early detection and management of spinal conditions can help prevent the progression to nerve impingement.

Patellofemoral Syndrome (PFS)

Posted on July 1, 2024

Patellofemoral Syndrome (PFS), also known as anterior knee pain, is a condition characterized by irritation or damage to the posterior surface of the patella, the kneecap. This syndrome encompasses a spectrum of severity, ranging from mild dysfunction to more serious and chronic issues. The pain originates from the patellofemoral joint or nearby soft tissues. While previously referred to as anterior knee pain, discomfort associated with PFS can be experienced throughout various regions of the knee.

Patellofemoral Syndrome (PFS)

Anatomically, PFS involves the patellofemoral joint, one of the two major joints in the knee. The patella sits within the femoral groove, and if it is displaced, its sharp undersurface may compress against one side of the femoral groove. The patella is connected to the quadriceps muscle tendon and the patellar ligament, playing a crucial role in knee function.

Anatomy

Patellofemoral Syndrome (PFS) involves the patellofemoral joint, which is a crucial component of the knee anatomy. Here’s a more detailed exploration of the relevant anatomical features associated with PFS:

Patellofemoral Joint: The patellofemoral joint is the articulation between the patella (kneecap) and the femur (thigh bone). This joint allows for smooth movement of the patella as the knee flexes and extends.

Patella (Kneecap): The patella is a sesamoid bone embedded in the tendon of the quadriceps muscle. It plays a vital role in the biomechanics of the knee by providing leverage for the quadriceps and protecting the underlying joint surfaces.

Quadriceps Tendon: The quadriceps tendon attaches the quadriceps muscles (rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius) to the patella. This tendon is essential for the extension of the knee.

Patellar Ligament: The patellar ligament continues from the patella and attaches to the tibial tuberosity on the tibia. This ligament is a continuation of the quadriceps tendon and is involved in knee extension.

Femur: The femur is the long bone of the thigh and forms the upper part of the knee joint. The patella glides in the femoral groove during knee movement.

Femoral Groove: The femoral groove is a groove or channel on the femur where the patella moves as the knee flexes and extends. Any deviation in the alignment of the patella within this groove can contribute to PFS.

Quadriceps Vastus Medialis Obliquus (VMO): The VMO is a specific part of the quadriceps muscle located on the inner side of the thigh. It plays a crucial role in stabilizing the patella and preventing lateral displacement.

Meniscus: The menisci (medial and lateral) are crescent-shaped cartilaginous structures located between the femur and tibia. They contribute to shock absorption and load distribution within the knee joint.

Ligaments:

Ligaments around the knee contribute to stability:

Medial Collateral Ligament (MCL): Stabilizes the inner side of the knee.
Lateral Collateral Ligament (LCL): Stabilizes the outer side of the knee.
Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL):

Cruciate ligaments within the joint that control anterior and posterior movement.

Understanding the specific anatomy involved in PFS is crucial for recognizing factors that may contribute to the development of this syndrome. Issues such as malalignment, muscle imbalances, or abnormal patellar tracking can disrupt the normal function of the patellofemoral joint, leading to pain and dysfunction. Proper diagnosis and treatment often involve addressing these anatomical aspects through targeted interventions such as physical therapy, strengthening exercises, and biomechanical assessments.

Symptoms

Patellofemoral syndrome, also known as patellofemoral pain syndrome (PFPS), is a condition characterized by pain in the front of the knee, around the patella (kneecap) and the surrounding area. It is a common cause of knee pain, especially among athletes and individuals engaged in activities that involve repetitive knee motion. The symptoms may include:

• Pain around the kneecap: The primary symptom is usually a dull, aching pain in the front of the knee, especially around or behind the patella. The pain may be aggravated by activities such as climbing stairs, sitting for long periods with the knee bent, or engaging in activities that stress the knee joint.

• Pain during or after activities: Pain may increase during activities that involve bending the knee, such as running, jumping, squatting, or sitting with the knee bent for an extended period.

• Crepitus or grinding sensation: Some individuals with patellofemoral syndrome may experience a grating or grinding sensation (crepitus) when moving the knee.

• Swelling and inflammation: The knee may exhibit signs of swelling or puffiness around the patella.

• Instability or weakness in the knee: Weakness or a feeling of instability in the knee can be present, making it challenging to perform certain activities.

• Pain when sitting for prolonged periods: Individuals with patellofemoral syndrome may experience discomfort when sitting for extended periods, especially with the knee bent, such as during long car rides or at a desk.

It’s important to note that the symptoms of patellofemoral syndrome can vary from person to person, and the severity of symptoms may fluctuate over time. If you suspect you have patellofemoral syndrome or are experiencing persistent knee pain, it is advisable to consult with a healthcare professional, such as a doctor or physical therapist, for an accurate diagnosis and appropriate management plan. Treatment often involves addressing contributing factors, such as muscle imbalances, and implementing exercises and strategies to improve knee function and reduce pain.

Causes

The exact cause of patellofemoral syndrome (PFPS) can be multifactorial, and it often results from a combination of various factors. Some common causes and contributing factors to the development of PFPS include:

• Overuse or Excessive Training: Activities that involve repetitive knee motion, such as running, jumping, or squatting, can lead to overuse of the patellofemoral joint, contributing to the development of PFPS.

• Muscle Imbalances: Weakness or imbalance in the muscles around the knee, particularly the quadriceps (front thigh muscles) and the muscles that make up the hip, can affect the alignment of the patella within its groove. This imbalance may lead to increased stress on the patellofemoral joint.

• Poor Biomechanics: Abnormalities in the way the lower limb moves, such as issues with foot pronation (rolling inward) or supination (rolling outward), can affect the alignment of the patella and contribute to PFPS.

• Flat Feet or Overpronation: Individuals with flat feet or excessive pronation may have altered biomechanics that can lead to increased stress on the patellofemoral joint.

• Malalignment of the Patella: Anatomical factors, such as a misalignment of the patella within its groove, may contribute to PFPS. This can be influenced by factors like the shape and structure of the knee joint.

• Trauma or Injury: Direct trauma to the kneecap or the surrounding structures can contribute to the development of PFPS.

• Tightness or Weakness in the Hamstrings: Imbalances between the quadriceps and hamstring muscles can affect knee joint mechanics, potentially contributing to PFPS.

• Improper Footwear: Wearing shoes that do not provide proper support or that exacerbate biomechanical issues can contribute to PFPS.

• Joint Laxity: Some individuals may have increased joint laxity, which can affect the stability of the patellofemoral joint.

• Changes in Physical Activity: Sudden increases in intensity, duration, or frequency of physical activity can contribute to the development of PFPS.

It’s important to note that these factors alone are not necessarily the only cause, and often, a combination of them may contribute to the development of patellofemoral syndrome. Additionally, individual variations in anatomy and biomechanics can play a role.

Diagnosis

Diagnosing patellofemoral syndrome (PFPS) typically involves a comprehensive evaluation by a healthcare professional. This may include a thorough medical history, a physical examination, and in some cases, imaging studies. Here is an overview of the diagnostic process for PFPS:

• Your doctor or physical therapist will start by asking about your symptoms, including the nature and location of the knee pain, factors that aggravate or alleviate the pain, and any relevant medical history or previous injuries.

• A physical examination will be conducted to assess various aspects of your knee function. This may involve how you walk, assessing the alignment of your lower limbs, and checking for signs of muscle imbalances or weakness. The healthcare provider may also perform specific manoeuvres to reproduce or exacerbate your symptoms.

• Your healthcare provider may palpate (feel) around various structures around the knee, including the patella, to identify areas of tenderness or swelling.

• The range of motion of the knee joint will be assessed, and strength testing of the muscles around the knee, especially the quadriceps and hamstrings, may be conducted.

• Functional tests, such as evaluating your ability to perform specific movements like squatting or climbing stairs, may be used to assess how your knee functions during activities that can aggravate PFPS.

• While the diagnosis of PFPS is often based on clinical evaluation, imaging such as X-rays or MRIs (Magnetic Resonance Imaging) may be ordered to rule out other structural issues and to assess the alignment of the patella and the condition of the surrounding structures.

It’s important to note that the diagnosis of PFPS is often one of exclusion, meaning other knee pain causing factors will be ruled out first.

Treatment

The treatment of patellofemoral syndrome (PFPS) usually involves a combination of conservative measures aimed at reducing pain, improving knee function, and addressing underlying contributing factors. Here are common treatment approaches:

Rest from activities that exacerbate symptoms can help reduce inflammation and pain.

Modifying or temporarily avoiding activities that involve repetitive knee motion, such as running or jumping, may be beneficial.

A physical therapist can design a specific exercise program to strengthen the muscles around the knee, particularly the quadriceps and hip muscles. These can be physiotherapists, sports therapists or personal trainers.

Stretching exercises to improve flexibility in the muscles and tissues around the knee.

Sports Massage or Deep Tissue Massage performed by a qualified therapist who has level 4 or above.

Patellar taping or bracing may be used to help stabilize the patella.

Orthotics and Footwear:

Custom orthotics or supportive footwear may be recommended to address issues related to foot pronation or other biomechanical factors.

Over-the-counter pain medications, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended for pain relief.

Ice application can help reduce inflammation. Applying an ice pack to the affected area for about 15-20 minutes at a time can be effective.

Guidance on modifying activities or exercises to reduce stress on the patellofemoral joint.

Evaluation of gait and lower limb biomechanics to identify and address any issues contributing to PFPS.

Maintaining a healthy body weight can help reduce stress on the knee joints.

In some cases, a healthcare provider may recommend corticosteroid injections to reduce inflammation and pain. However, these are typically used judiciously due to potential side effects.

Surgery is rarely the first-line treatment for PFPS. However, in cases where conservative measures are not effective, surgical options such as arthroscopy may be considered. This might involve procedures to address structural issues or correct biomechanical problems.

It’s important to note that the effectiveness of treatment can vary from person to person, and a tailored approach is often necessary. It’s recommended to consult with a healthcare professional, such as an orthopaedic specialist or physical therapist, to determine the most appropriate treatment plan based on individual circumstances. Additionally, early intervention and adherence to recommended exercises and modifications are crucial for successful management of PFPS.

Exercises

Exercise is a key component of the treatment plan for patellofemoral syndrome (PFPS). The goal of exercises is to strengthen the muscles around the knee, improve flexibility, and address any muscle imbalances or weaknesses that may be contributing to the pain. Here are some exercises that are commonly recommended for individuals with PFPS. However, it’s crucial to consult with a healthcare professional or a physical therapist before starting any new exercise program, as the specific exercises should be tailored to individual needs and capabilities.

Quad Sets:

Sit or lie down with your leg extended.

Tighten the muscles on the top of your thigh and push the back of your knee into the surface you’re sitting or lying on.

Hold for a few seconds, then relax.

Repeat for several sets.

Straight Leg Raises:

Lie on your back with one leg straight and the other bent.

Lift the straight leg a few inches off the ground and hold for a few seconds.

Slowly lower the leg back down.

Repeat for several sets on each leg.

Wall Sits:

Stand with your back against a wall and slide down into a sitting position, as if you were sitting in an imaginary chair.

Hold the position for 20-30 seconds.

Stand back up and repeat for several sets.

Step-Ups:

Use a sturdy step or platform.

Step up onto the platform with one foot, then bring the other foot up.

Step back down, leading with the same foot.

Repeat for several sets, alternating legs.

Clamshell Exercise:

Lie on your side with your hips and knees bent at a 90-degree angle.

Keeping your feet together, lift the top knee while keeping the feet together.

Lower the knee back down.

Repeat for several sets on each side.

Lateral Leg Raises:

Lie on your side with the bottom leg bent slightly for support.

Lift the top leg to the side, keeping it straight.

Lower the leg back down.

Repeat for several sets on each side.

Hamstring Stretch:

Sit on the floor with one leg extended and the other bent so that the sole of your foot is against the inner thigh of the extended leg.

Reach toward the toes of the extended leg while keeping your back straight.

Hold the stretch for 20-30 seconds and then switch legs.

Calf Stretch:

Stand facing a wall with your hands on the wall at shoulder height.

Step one foot back and press the heel into the floor.

Hold the stretch for 20-30 seconds and then switch legs.

Remember to start slowly and gradually increase the intensity and duration of exercises. If you experience increased pain or discomfort during any exercise, it’s important to stop and consult with your healthcare provider or physical therapist. Additionally, consistency is key, and performing these exercises regularly as part of a comprehensive rehabilitation program can contribute to improved outcomes for individuals with PFPS.

Prevention

While not all cases of patellofemoral syndrome (PFPS) can be entirely prevented, there are several strategies and lifestyle modifications that can help reduce the risk of developing or exacerbating the condition. Here are some preventive measures:

Strengthening:

Regularly incorporate exercises that focus on strengthening the muscles around the knee, especially the quadriceps, hamstrings, and hip muscles. Strong muscles provide better support to the knee joint.

Flexibility:

Include stretching exercises to maintain flexibility in the muscles and tissues around the knee. This can help prevent muscle imbalances and improve joint function.

Warm-up and Cool Down:

Always warm up before engaging in physical activities or sports. A proper warm-up prepares the muscles and joints for the stresses of exercise. Similarly, cool down with stretching exercises to help prevent stiffness.

Gradual Progression:

Avoid sudden increases in the intensity, duration, or frequency of physical activities. Gradual progression allows your body to adapt to new demands, reducing the risk of overuse injuries like PFPS.

Well Fitted Footwear:

Wear supportive footwear that is appropriate for your activity. Shoes with good arch support and shock absorption can help maintain proper biomechanics and reduce stress on the knee joint.

Maintaining a Healthy Weight:

Excess body weight can contribute to increased stress on the knee joints. Maintaining a healthy weight through a balanced diet and regular exercise can reduce the risk of PFPS.

Biomechanical Assessment:

If you have concerns about your gait or lower limb biomechanics, consider consulting with a healthcare professional or a physical therapist for a biomechanical assessment. Addressing any abnormalities early on can help prevent future issues.

Cross-Training:

Engage in a variety of physical activities to avoid overuse of specific muscle groups or joints. Cross-training can help distribute the workload and reduce the risk of repetitive strain injuries.

Good Technique:

Ensure proper technique when participating in sports or exercises. Improper form can contribute to increased stress on the knee joint and may lead to overuse injuries.

Listen to Your Body:

Pay attention to any signs of pain or discomfort during physical activities. If you experience persistent knee pain, consult with a healthcare professional for evaluation and appropriate management.

It’s important to note that individual factors, such as anatomy and genetics, can also influence the risk of developing PFPS. While these preventive measures can help reduce the risk, there is no one-size-fits-all approach. If you have concerns about your knee health or are experiencing persistent pain, it is advisable to consult with a healthcare professional for personalized guidance and recommendations.

If you believe you may be suffering with PFS then please contact a member of our physiotherapy or sports therapy team.

Hip Arthritis

Posted on July 1, 2024

Osteoarthritis / Arthritis is a degenerative disease where cartilage in the joints of the body get worn down eventually leaving the bone exposed causing endless amount of pain who anyone who suffers with it. Normal or “healthy” cartilage acts as support in the joint, which allows the bone to run smoothly, when damaged it becomes rough causing discomfort for many people.

Anatomy

The hip is a ball and socket joint and is one of the largest joints in the body. The acetabulum is a part of the pelvis bone which allows the head of the femur to move freely in the socket.

Articular cartilage is a slippery substance which covers the joint, this helps protect and allows free unpainful movement in the ball and socket. Within the hip synovium can be found, this also helps lubricate the joint to allow the hip to function properly.

A person who is suffering with arthritis of the hip will have cartilage that is worn down and will not be producing enough fluid to allow the free movement. This will lead to the bone rubbing against another bone creating discomfort and pain for an individual.

Hip Arthritis

Symptoms

Stiffness around the hip joint
Flare ups when walking, running or performing exercise
Pain when resting
Daily discomfort and ongoing pain in the joint
Stiffness in the groin, thigh and glutes when walking
Swelling around the hip
Grinding sensation in the joint when moving

Causes

Arthritis is more common as you get older
Family history is a common factor of hip arthritis
Individuals who are more overweight often show on going signs of arthritis
An injury to the hip and overuse may lead to the long-term effects of arthritis

Diagnosis

A full physical examination will be carried out by a doctor to determine the severity of your condition.

The doctor will carry out special tests specific for the hip to see what movements create the most pain and discomfort. The professional will need to know information such as when the pain first started to occur, how if effects your sleep and how it affects your day-to-day life and activities.

Special tests that are used for the diagnosis of hip arthritis are Trendelenburg test, supine (leg length test) and gait test.

Treatment

Non- surgical treatment that may be effective to help reduce the pain from arthritis are as follows:

One of the most successful forms of treatment is to have a deep tissue or sports massage. The reason for this is to lengthen the muscles, relax the muscles around the Hip such as the Glutes etc in order to alleviate some of the pressure in the joint.
Ensuring you rest enough when the hip joint is in any pain to reduce irritating the arthritis
Preform non-weight baring exercises such as swimming or a gentle cycle to reduce any added pressure onto the hip, this allows the hip to still have good range of motion and keeps the joint functioning
Make sure you are getting enough sleep and resting the hip
Try eating a healthier balanced diet, this will help with weight loss and reduce the amount of stress placed onto the joints
Use over the counter treatment such as deep freeze which may help reduce pain and swelling around the joint

If the pain is ongoing, it is worth speaking to your doctor who may suggest surgery as a last resort. This would mean you would undergo a hip replacement, where you would then follow an 8–12-week rehabilitation programme.

Exercises

These exercises should be performed in sets and reps, it is best to speak to a doctor or physiotherapist to find out the recommended amount suitable for you:

1. Seated Hip Flexion

Purpose: Improve hip flexor strength and maintain mobility in the hip joint, which can help alleviate stiffness and pain from arthritis.
How to Perform:
- Sit on a chair with your feet flat on the floor.
- Lift one knee toward your chest while keeping your back straight.
- Lower your leg back down slowly and repeat with the other leg.

2. Sit to Stand

Purpose: Strengthen the muscles around the hip joint, particularly the quadriceps and glutes, to improve stability and reduce pain from hip arthritis.
How to Perform:
- Sit on a chair with your feet hip-width apart and your hands on your thighs or crossed in front of you.
- Lean slightly forward and push through your heels to stand up, using your leg muscles rather than your arms.
- Slowly lower yourself back down to the chair and repeat.

3. Kneeling Hip Flexor Stretch

Purpose: Stretch the hip flexors, which can become tight and contribute to pain and reduced mobility in people with hip arthritis.
How to Perform:
- Kneel on one knee with the other foot in front of you, forming a 90-degree angle at both knees.
- Gently push your hips forward, stretching the front of your hip on the kneeling side.
- Hold the stretch for 20-30 seconds, then switch legs and repeat.

4. Hip Abduction in Supine Position

Purpose: Strengthen the hip abductors, particularly the gluteus medius, which helps support and stabilise the hip joint.
How to Perform:
- Lie on your back with your legs straight and slightly apart.
- Keeping your leg straight, slowly slide one leg out to the side as far as comfortable, then return it to the starting position.
- Repeat with the other leg.

5. Hip Extension

Purpose: Strengthen the glutes and hamstrings, improving hip stability and reducing pain from arthritis.
How to Perform:
- Stand with your feet hip-width apart and hold onto a sturdy surface for balance.
- Keeping your leg straight, slowly lift one leg backward, squeezing your glutes.
- Lower the leg back down slowly and repeat with the other leg.

6. Glute Bridges

Purpose: Strengthen the glutes and lower back muscles, providing better support for the hip joint and reducing arthritis symptoms.
How to Perform:
- Lie on your back with your knees bent and feet flat on the floor, hip-width apart.
- Lift your hips toward the ceiling, squeezing your glutes and keeping your body in a straight line from shoulders to knees.
- Hold for a few seconds at the top, then slowly lower your hips back down.

7. Body Weight Squat

- Purpose: Strengthen the quadriceps, hamstrings, and glutes, which helps support and stabilise the hip joint.
- How to Perform:
  - Stand with your feet shoulder-width apart.
  - Slowly lower your body by bending your knees and hips, keeping your back straight and your weight on your heels.
  - Lower as far as comfortable, then push through your heels to stand back up

Prevention

Prevention of hip arthritis involves making lifestyle changes and taking steps to reduce your risk of developing the condition. Here are some tips for preventing hip arthritis:

Maintain a healthy weight: Being overweight or obese puts additional stress on your hip joint, increasing your risk of developing arthritis.
Exercise regularly: Regular exercise can help improve your joint health, flexibility, and strength.
Avoid overuse injuries: Repeated stress on the hip joint can lead to arthritis over time.
Use proper technique: When performing physical activities or exercises, use proper technique
Wear appropriate footwear

Avoid sitting for long periods: Sitting for extended periods can increase the pressure on your hips.

Manage other health conditions: Certain health conditions, such as diabetes or rheumatoid arthritis, can increase your risk of developing hip arthritis. Work with your healthcare provider to manage these conditions and reduce your risk.

By making these lifestyle changes and taking steps to reduce your risk of developing hip arthritis, you can help protect your hip joints and maintain good overall health.

If you are suffering with Hip Arthritis and would like to Make a booking or speak with one of our Phsyiotherapists or Sports Therapists then please contact us today.

Hamstring Tear – Grade 1 and 2

Posted on July 1, 2024

Hamstring tear is an injury to a muscle at the back of the thigh, that is caused by a rapid extensive contraction or a violent stretch of the hamstring muscle group, causing high mechanical stress. They account for up to 29% of lower limb injuries in sport, due to the involvement of high speeds such as sprinting and football, however older age can increase the risk due to a loss of flexibility.

Some experiences of hamstring tears involve pain and tenderness, with limited range of motion, where others experience additional symptoms, such as swelling or a ‘popping’ or tearing sensation.

Grade 1 and 2 hamstring tears can heal within 3 to 8 weeks, however can take months to heal depending on the severity of symptoms.

Hamstring Tear – Grade 1 and 2

Anatomy

The hamstrings are a group of three muscles: semitendinosus, semimembranosus, and bicep femoris (long head), that predominantly acts to flex and extend the knee.

Most hamstring tears occur in the central part of the muscle, or where the muscle fibres and tendon fibres intersect (MTJ). Tendons can tear away from a small bone fragment (ischial tuberosity), that typically occur at the proximal origin (top) of the hamstring, however, can occur from the distal origin (bottom), although less common.

Hamstring Tear - Grade 1 and 2

Symptoms

Sudden and sharp pain
Tenderness
A “popping sensation” at the time of injury
Swelling and bruising (or discolouration) in the first few hours and days
Weakness and a loss of strength in the leg

Causes

Overload of the hamstrings typically the cause of hamstring tears, that occurs when the muscle is stretches beyond its limit or challenged with sudden load, typically during an eccentric contraction. Previous hamstring injuries can increase the risk of developing a tear, particularly if the body is compensating for another limb injury, or if there is muscle weakness and a lack of flexibility.

Diagnosis

Physical examinations are often performed, such as palpation to pinpoint the area of the hamstring tear, however precise location may be difficult to determine without medical imaging.

Other physical examinations involve performing various movement to evaluate strength and range of motion, to determine the severity or the classification (grade 1 to 3) according to the pain and physical limitations.

Neurological examination may be performed to assess the sciatic nerve, to check any entrapment or irritation in healing scar tissue. Imaging such X-rays and MRI may be advised in severe cases, to detect the location of the tear and the extent of the injury, however for grade 1 and 2 tears, only physical examination if typically required.

Treatment

There are 3 phases of treatment to aid recovery and function of the hamstring injury (grade 1 and 2):

Phase 1 (inflammation phase) -Exercises and excessive stretching should be avoided, to control pain and help scar tissue develop. At the phase, crutches may be required to reduce weight bearing and facilitate recovery. You may want to use cold and heat therapy (contrast bathe) as well as gentle massage.

Phase 2 (reparative phase) – Exercises are introduced to try and regain full range of motion. Progressions of more challenging exercises are included in this stage, however, should be performed tolerably and pain-free. Such exercises could include hamstring curls, hip extension (with added resistance band for progression), hamstring wall stretch, and single leg balance.

Phase 3 (remodelling phase) – specific to patients playing sport to allow return to sport, and their level of function. This phase is specific to the patient, where sport or activity-specific drills such as agility are advised to promote tissue remodelling, or drills involving quick movements such as plyometric exercises.

Exercises

Hamstring stretch: Sit on the floor with your legs straight out in front of you. Lean forward, reaching your hands towards your toes until you feel a stretch in your hamstrings. Hold for 30 seconds and repeat 3 times.
Hamstring curl: Stand facing a wall or chair, with your feet shoulder-width apart. Lift one foot towards your buttocks, keeping your knee bent. Lower your foot and repeat for 10-15 repetitions on each leg.
Deadlift: Stand with your feet shoulder-width apart, holding a barbell or dumbbells in front of your thighs. Hinge forward from your hips, keeping your back straight, and lower the weights towards the floor. Return to the starting position and repeat for 10-15 repetitions.
Romanian deadlift: Stand with your feet shoulder-width apart, holding a barbell or dumbbells in front of your thighs. Hinge forward from your hips, keeping your back straight, and lower the weights towards the floor. Keep your knees slightly bent and your hips back as you lower the weight. Return to the starting position and repeat for 10-15 repetitions.
Glute bridge: Lie on your back with your knees bent and your feet flat on the floor. Lift your hips towards the ceiling, squeezing your glutes at the top. Lower your hips and repeat for 10-15 repetitions. This exercise strengthens the glutes and hamstrings.

Prevention

Warm-up properly: Warming up properly before any physical activity is essential to prevent hamstring tears. It increases blood flow to the muscles, making them more pliable and less prone to injury.
Stretch regularly: Regular stretching, especially before and after exercise, can help prevent hamstring tears. Incorporate stretching exercises such as hamstring stretches, quadriceps stretches, and hip flexor stretches into your routine.
Build strength gradually: Gradually increasing the intensity and duration of your exercise routine can help prevent overloading the hamstrings. Focus on building strength in the hamstrings and surrounding muscles to improve overall stability and reduce your risk of injury.
Use proper technique: Using proper technique when performing exercises that involve the hamstrings, such as running and weightlifting, can help prevent hamstring tears. Avoid over-striding, sudden changes of direction, and landing heavily on your heels.
Wear appropriate footwear: Wearing appropriate footwear that provides adequate support can help prevent hamstring tears. Choose shoes that fit well and have good shock absorption.

If you are interested in finding out how livewell and our team of physiotherapists, sports therapists and massage therapists can help you in your recovery from your Hamstring tear, then please either book a consultation or contact us today.

Calf Tear

Posted on July 1, 2024

Calf Tear

Calf tears are a relatively common injury that occurs in people of all ages and activity levels. It is estimated that up to 18% of all sports injuries involve the calf muscles, making it one of the most injured areas in the lower leg.

Calf tears are more common in people who engage in sports or activities that involve repetitive or explosive movements of the lower legs, such as running, jumping, or dancing. These activities can put a significant amount of stress on the calf muscles, making them more susceptible to injury.

Calf tears are classified into three grades based on the severity of the injury. Grade 1 tears involve minor damage to the muscle fibers, while grade 2 tears involve a partial tear of the muscle. Grade 3 tears are the most severe and involve a complete tear of the muscle.

While calf tears can be painful and limit mobility, they generally heal well with proper treatment and rehabilitation. It is important to seek medical attention if you suspect a calf tear or if you experience persistent pain or swelling in the calf muscle. With proper care, most people are able to return to their normal activities within a few weeks to a few months.

Anatomy

The calf muscle is made up of two muscles: the gastrocnemius and the soleus. The gastrocnemius is the larger of the two muscles and is responsible for flexing the ankle and knee. The soleus is located underneath the gastrocnemius and is responsible for plantar flexion of the ankle.

Symptoms

The symptoms of a calf tear can vary depending on the severity of the injury. The following are some common symptoms of calf tears grade 1 and 2:

Mild to moderate pain in the calf muscle
Swelling and tenderness in the affected area
Difficulty in walking or standing on the affected leg
Stiffness and limited range of motion in the ankle and foot
A popping or snapping sensation at the time of injury

Causes

Calf tears can be caused by a sudden or forceful movement, such as pushing off or jumping, which puts excessive strain on the calf muscle. The following are some common causes of calf tears:

Overuse or repetitive strain on the calf muscle
Sudden movements or changes in direction
Inadequate warm-up before exercise or sports activities
Poor flexibility or strength in the calf muscles
Foot and ankle problems, such as flat feet or ankle instability

Diagnosis

A calf tear can be diagnosed through a physical examination by a healthcare professional. Imaging tests, such as an ultrasound or MRI, may be ordered to confirm the diagnosis and to determine the extent of the injury.

Treatment

The treatment for a calf tear grade 1 or 2 (related article) generally includes the following:

Rest: The affected leg should be rested to allow the muscle to heal.
Ice: Applying ice to the affected area can help reduce pain and swelling.
Compression: Compression with a bandage or brace can help reduce swelling and provide support to the affected area.
Elevation: Elevating the affected leg can help reduce swelling and promote healing.
Pain medication: Over-the-counter pain medications may be used to help manage pain.

Exercises

After the initial healing period, the following exercises may be prescribed to help improve range of motion and strength in the calf muscle:

Calf stretches: Stretching the calf muscle can help improve flexibility and reduce the risk of future injury. Stand facing a wall with your hands on the wall and your feet shoulder-width apart. Step back with your affected leg, keeping your heel on the ground. Lean forward into the wall until you feel a stretch in your calf. Hold for 30 seconds and repeat on the other leg.
Calf raises: This exercise helps strengthen the calf muscle. Stand with your feet shoulder-width apart and rise up on your toes, lifting your heels off the ground. Hold for a few seconds and then lower your heels back down. Repeat for 10-15 repetitions.
Single leg balance: This exercise helps improve balance and stability in the affected leg. Stand on your affected leg and lift your other leg off the ground. Hold for 30 seconds and repeat on the other leg.

Prevention

To prevent calf tears, it is important to take the following measures:

Warm-up: Always warm up before engaging in exercise or sports activities. A proper warm-up can help prepare your muscles for activity and reduce the risk of injury.
Stretching: Regular stretching of the calf muscles can help improve flexibility and reduce the risk of tears. Incorporate calf stretches into your warm-up routine and stretch after exercise.
Proper footwear: Choose appropriate footwear that provides adequate support and cushioning for your feet and ankles. Replace worn-out shoes regularly.
Gradual progression: If you are new to a sport or activity, start slowly and gradually increase the intensity and duration of your workouts. This can help prevent overuse injuries.
Strengthening exercises: Regularly performing exercises that strengthen the calf muscles can help prevent tears. Examples include calf raises and resistance band exercises.

By following these preventive measures, you can significantly reduce your risk of calf tears and other lower leg injuries. If you do experience pain or discomfort in your calf muscles, it is important to seek medical attention before continuing with exercise or sports activities.

Rotator Cuff Injury

Posted on June 17, 2024

Rotator Cuff Injury

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 injury:

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 injury 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 injury 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 injury 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

Doorway Stretch: Stand facing an open doorway with your hands placed on the door frame at shoulder height. Step one foot forward and gently lean forward, feeling a stretch in your chest and shoulders. Hold the stretch for 20-30 seconds before releasing. Repeat the stretch with the other foot forward.
External rotation with weight: Hold a dumbbell or weight plate in one hand and stand with your elbow bent at 90 degrees and your upper arm against your side. Rotate your arm outwards, away from your body, while keeping your elbow tucked in. Slowly return to the starting position and repeat for 8-12 repetitions before switching arms.
High to low rows with resistance band: Attach a resistance band to a sturdy anchor point at chest height. Stand facing the anchor point with the band in both hands. Pull the band towards your chest, keeping your elbows tucked in and your shoulders down. Slowly release the band back to the starting position and repeat for 8-12 repetitions.
Reverse fly’s: Hold a dumbbell or weight plate in each hand and bend forward at the waist, keeping your back straight. Extend your arms out to the sides, keeping them parallel to the floor. Squeeze your shoulder blades together as you bring the weights up towards your body, then slowly release back to the starting position. Repeat for 8-12 repetitions.
Lawn mower pull with resistance band: Attach a resistance band to a low anchor point and stand with your side to the anchor point. Hold the band in one hand with your arm extended towards the anchor point. Pull the band towards your chest, keeping your elbow bent and your shoulder blade squeezed down and back. Slowly release back to the starting position and repeat for 8-12 repetitions before switching sides.
Isometric internal rotation: Stand with your elbow bent at 90 degrees and your upper arm against your side. Place a rolled up towel or small ball between your elbow and your side. Squeeze your elbow into your side, holding the contraction for 10-15 seconds before releasing. Repeat for 2-3 sets of 10-15 repetitions.
Isometric external rotation: Stand with your elbow bent at 90 degrees and your upper arm against your side. Hold a resistance band in both hands, with one end of the band anchored to a sturdy object. Rotate your arm outwards, away from your body, while keeping your elbow tucked in. Hold the contraction for 10-15 seconds before releasing. Repeat for 2-3 sets of 10-15 repetitions before switching arms.

Prevention

Strengthen the rotator cuff muscles: Exercises that target the rotator cuff muscles can help to build strength and stability in the shoulder joint. Examples of such exercises include external rotation with a resistance band, internal rotation with a light weight, and scapular stabilization exercises.
Warm up properly: Before engaging in any activities that involve overhead arm movements, it is important to warm up the shoulder joint with dynamic stretches and exercises. This can help to increase blood flow to the muscles and reduce the risk of injury.
Practice good technique: When engaging in activities that involve overhead arm movements, it is important to use proper technique and form. This can help to reduce stress on the rotator cuff muscles and tendons and minimize the risk of injury.
Use proper equipment: Using equipment that is properly fitted and designed for the activity can help to reduce the risk of rotator cuff injuries. For example, using a tennis racket with a larger grip or wearing properly fitting swim goggles can reduce the stress on the shoulder joint.
Rest and recover: Resting and allowing the shoulder joint to recover after activity is important for preventing overuse injuries. Avoiding overuse and engaging in activities that strengthen and stretch the shoulder muscles can help to prevent rotator cuff injuries.

How We Can Help

We understand that dealing with a rotator cuff injury can be a challenging and painful experience. As healthcare professionals, we are dedicated to helping you manage your symptoms and regain full function of your shoulder joint.

We are pleased to offer you our services in massage therapy and sports therapy, both of which can be highly effective in treating rotator cuff injuries. Our trained and experienced therapists can work with you to reduce pain and inflammation, improve range of motion, correct muscle imbalances, and provide advice on injury prevention.

Our services are tailored to meet your individual needs and goals, and we will work with you to develop a treatment plan that is effective and manageable for you. We believe in a collaborative approach to healthcare, and we may work in conjunction with other healthcare professionals, such as physiotherapists or orthopedic specialists, to ensure that you receive the best possible care.

We take pride in providing our patients with high-quality, compassionate care, and we are committed to helping you achieve optimal health and well-being. If you are interested in learning more about our physiotherapy and sports therapy services, or if you would like to schedule an appointment, please do not hesitate to contact us.

Glenohumeral Joint Instability

Posted on June 17, 2024

Glenohumeral Joint Instability

The glenohumeral joint (GH) is a ball and socket joint that includes a complex, dynamic, articulation between the proximal humerus (“ball”) and the glenoid (“socket”) of the scapula. The static and dynamic stabilizing structures allow for extreme range of motion in multiple planes, that predisposes the joint to instability events. Shoulder instability often occurs when the capsule (lining of the shoulder joint), ligaments, or labrum becomes stretched, torn, or detached from the glenoid, commonly after shoulder trauma or repetitive motion. A genetic condition can also cause looseness and weakness in the joint. Exercise programs that aim to strengthen the rotator cuff and scapular muscles are often the primary treatment for instability, where full range of motion usually returns after 6-8 weeks.

Anatomy

Structurally a ball and socket joint, that involves the humeral head with the glenoid cavity of the scapula, and it represents the major articulation of the shoulder girdle. The joint capsule and ligaments provide a passive restraint to keep the humeral head compressed against the glenoid. As one of the most mobile joints, the GH joint has stabilising elements, that are divided into static (capsule-labro-ligamentous complex) and active (rotator cuffs and bicep tendons).

Symptoms

The symptoms of Glenohumeral Joint Instability include but may not be limited to:

Pain, tenderness, swelling, and/or bruising.
A loose feeling, or hearing a “pop” in the shoulder joint.
Repeated shoulder dislocation.
Tingling or burning sensation in the lower arm and hand.
Localised numbness of the skin overlying the deltoid muscle.
Decreased range of arm/shoulder motion.

Causes

Glenohumeral joint instability can occur following a traumatic accident such as a fall or collision. It can also occur without significant trauma or injury, which is often genetic from those with hypermobility or connective tissue problems, or from a development of laxity in tissues of the shoulder joint. Other causes can be from repetitive motions, particularly from throwing sports, causing the shoulder to stretch over time, where normal muscle control is lost.

Diagnosis

A physical examination can confirm the impression obtained from the history and help to determine if the shoulder is loose or unstable. Radiographs or imaging, such as X-rays, MRI, or a CT scan can help to provide confirmation of traumatic glenohumeral instability present from the damaged bones, cartilage, and rotator cuff. Mobility may be restricted for two weeks, followed by physical therapy to strengthen the muscles that stabilises the shoulder.

Classifications

Polar Type I (structural instability) – typically present with a positive apprehension (anterior direction) associated with rotator cuff weakness. Posture, single leg balance, and scapula control are often disturbed. Can begin to exhibit signs of poor scapula control, abnormal muscle activation, and altered trunk stability and balance, when moving towards type II and III poles.

Polar Type II – (atraumatic instability) – present with positive anterior apprehension test, with increased laxity and excessive external rotations, and muscular balance

Polar Type III – (neurological dysfunctional or muscle patterning) – shows abnormal activation of large muscles and suppression of the rotator cuff. Mostly occurs with a history of easy shoulder dislocation.

Treatment

Treatment usually begins with physical therapy, designed to strengthen the shoulder, and maintain the joint in position.

Restricting activity that includes overhead motion may be advised to reduce symptoms. Full range of motion usually returns after 6-8 weeks.

If less invasive treatments don’t work, and in severe instances, open surgery is often necessary, where an incision is made over the shoulder and the muscles are moved to access the joint capsule, ligaments, and labrum. After surgery, full recovery often takes 4-6 months, and in some cases up to 12 months. At this stage some deep tissue massage and scar tissue work may be necesary!

Exercises

1. Shoulder Flexion (Lying Down)

Purpose: Improve shoulder mobility and strengthen the muscles involved in flexion, which helps stabilise the shoulder joint.
How to Perform:
- Lie on your back with your arm by your side.
- Hold a light weight or no weight at all, and slowly raise your arm straight up toward the ceiling, keeping your elbow straight.
- Lower your arm back down slowly, and repeat.

2. Shoulder Blade Squeeze

Purpose: Strengthen the scapular stabilisers, particularly the muscles that control the shoulder blades, to improve overall shoulder stability.
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 few seconds, then relax.
- Repeat for the desired number of repetitions.

3. Resisted Rows

Purpose: Strengthen the upper back and shoulder muscles, particularly the rhomboids and middle trapezius, to enhance shoulder stability.
How to Perform:
- Anchor a resistance band at chest height.
- Hold the band with both hands, and step back to create tension.
- Pull the band toward your chest, keeping your elbows close to your sides and squeezing your shoulder blades together.
- Slowly return to the starting position and repeat.

4. Internal Rotator Strengthening Exercise

Purpose: Strengthen the internal rotators (subscapularis) of the shoulder, which are crucial for maintaining joint stability.
How to Perform:
- Attach a resistance band to a sturdy object at waist height.
- Stand with your affected side closest to the band, holding the other end with your elbow bent at 90 degrees.
- Keep your elbow close to your body, and rotate your arm inward against the resistance.
- Slowly return to the starting position and repeat.

5. External Rotator Strengthening Exercise (with Arm Abducted 90°)

Purpose: Target the external rotators (infraspinatus and teres minor) to improve the stability and control of the shoulder joint.
How to Perform:
- Stand or sit with your arm raised to shoulder height and your elbow bent at 90 degrees, holding a resistance band or light weight.
- Rotate your forearm upward, keeping your elbow in line with your shoulder.
- Slowly lower your arm back down to the starting position and repeat.

6. Standing Row (with Resistance Band)

Purpose: Strengthen the muscles that stabilise the shoulder, particularly the upper back and shoulder blade muscles, to improve shoulder joint stability.
How to Perform:
- Anchor a resistance band at chest height.
- Stand facing the band, holding it with both hands.
- Pull the band toward your chest, leading with your elbows and squeezing your shoulder blades together.
- Slowly return to the starting position and repeat.

Prevention

Glenohumeral Joint Instability (GJI) is a condition that occurs when the ball and socket joint of the shoulder become dislocated or partially dislocated due to trauma or other underlying conditions. GJI can result in pain, weakness, and limited range of motion, making it difficult for people to perform their daily activities. In severe cases, surgery may be required to treat the condition. However, prevention is always better than cure, and there are several steps that individuals can take to prevent GJI.

Strengthen the Rotator Cuff Muscles:
The rotator cuff muscles are a group of muscles that attach the shoulder blade to the humerus bone and help stabilize the shoulder joint. Strengthening these muscles can help prevent GJI. Exercises that target the rotator cuff muscles include external and internal rotation exercises, scapular stabilization exercises, and shoulder blade squeezes.

Improve Shoulder Mobility:
Limited shoulder mobility can lead to increased stress on the shoulder joint, which can increase the risk of GJI. Stretching exercises that target the shoulder joint, such as shoulder circles and shoulder flexion stretches, can help improve shoulder mobility and prevent GJI.

Maintain Good Posture:
Poor posture can contribute to shoulder instability and increase the risk of GJI. Individuals should aim to maintain good posture by keeping their shoulders back and down and their chest open. Practicing good posture can help improve shoulder alignment and stability.

Avoid Overuse Injuries:
Overuse injuries can cause wear and tear on the shoulder joint, leading to increased instability and a higher risk of GJI. To avoid overuse injuries, individuals should practice proper form and technique when performing exercises and avoid repetitive overhead movements.

Wear Proper Protective Gear:
Individuals who participate in contact sports or activities that involve the risk of shoulder injuries should wear proper protective gear, such as shoulder pads or braces. Protective gear can help absorb the impact of a fall or collision, reducing the risk of GJI.

In conclusion, preventing GJI requires a combination of strengthening exercises, stretching, good posture, injury prevention strategies, and protective gear. By following these steps, individuals can help reduce the risk of GJI and maintain a healthy and stable shoulder joint. It is important to consult with a healthcare professional before starting any new exercise program or if experiencing any shoulder pain or discomfort. If you are unsure what to do, please contact us and one of our Personal Trainers, Physiotherapists or Sports Therapists can help.

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