Physiotherapy for Shoulder Pain

Suffering from a sore or stiff shoulder?

By Sam Davison, Principal Physiotherapist

Every time you reach up to grab something – a book from a library shelf or a coffee cup from your kitchen – you get a shooting pain in your shoulder. No amount of heat gels or ice packs have solved the problem. You need professional help.

The shoulder is inherently a very mobile joint – perhaps one of the most mobile – and it requires good control and muscle function to swing in all directions and generate significant power. Given the number of muscles, tendons, ligaments and bones that work for this to happen, shoulder dysfunction and pain can occur for many reasons. In some cases, shoulder pain can be referred from other sources such as the neck or upper back and although less likely, even the heart. Problems in the shoulder can occur with everyday wear and tear, overuse or an isolated injury.

But there is good news. In almost all cases, Physiotherapy can help ease symptoms and get your back to do things you love. A Physiotherapy assessment will allow your treating practitioner to pin point the source of your pain as well as identify the cause of your shoulder problem.

Common conditions we treat are:

Rotator cuff injuries
Tendinopathies
ACJ injuries
Dislocations
Instability
Post-Op surgical repairs
Fractures

How can Barangaroo Physio help you?

We listen to you, letting you tell your story and the main difficulty you’re experiencing. We then have a look, work out what the problem is, make a plan and treat the underlying cause. Whilst we are at it, we also work with you, using various tricks and tools to make sure it never happens again.

If you’re unsure how our Physios can help, give us a call and one of our team will be in touch soon.

May 15, 2018July 16, 2018

We floss our teeth, so why don’t we floss our joints and muscles?

VOODOO FLOSSING

By Nathanael (Nate) Chan, Physiotherapist

Voodoo flossing is a manual therapy technique utilising a compressive force aimed to improve joint range of motion and improve muscle length. The current body of research is of a low quality with inconsistent findings. There are no negative effects on performance, however it should be used with caution.

There exact physiological process is unknown, but there are a few theories explaining it’s purpose and function.

1. Improve muscle length through gliding

Through the compressive wrap/floss it aims to pin the muscle down in one position, as we move the muscles and joints through range of movement (e.g. squat), it will in turn lengthen the muscle itself and break up any fascial adhesions.

2. Compression

Compression is a reduction in volume, in this instance created via wrap/floss around the body part (e.g. ankle or calf). As a result, it restricts blood flow causing an acute physiological response to the body part. After removing the wrap/floss a new blood supply permeates the area and flushes out the lactic acid to promote healing to the specified body part.

3. Distraction Force

A common technique used in manual therapy, the floss creates more space for the joint capsule to roll and glide (e.g. ankle for squatting). Thus, increasing the range of motion.

Overall it suggests it will improve range of motion, prevent injuries and enhance your athletic performance!

April 30, 2018July 20, 2018

The Gold Coast 2018 Commonwealth Games (GC2018)

THE LARGEST SPORTING EVENT FOR AUSTRALIA IN THE PAST DECADE.

By Nathanael (Nate) Chan, Physiotherapist

Over the summer thousands and thousands of people flooded the streets of Gold Coast creating an experience like no other. The games provided the Gold Coast city its largest sporting event ever.

A total of over 6,000 athletes and team officials across 70 nations and territories, including 15,000 passionate and friendly volunteers converged in this sunshine city.

As an aspiring educator and advocate of health in the form of a physiotherapist (allied health care practitioner) this opportunities to experience and contribute to the working together as a healthcare allowed me to gain a different perspective from the different health disciplines (Sports Doctors, Sports Physiotherapist, Sports Massage Therapist, Nurses and Athletic Trainers). Most importantly gaining an insight into an athlete’s psychological state of mind pre and post event, often coming and going in a blink of an eye (10seconds for those 100m sprinters). This informal research I conducted whilst working at the Games allows us physiotherapists, and the healthcare team to continually advance, and provide an athlete-centric holistic care to achieve the best possible outcome.

Outside of work, I enjoyed the energy and vibe this event created! The famous quote by Dennis Brown, ‘Every day you learn something new’ became a definite theme through this experience. I learnt many things through engaging conversations with my colleagues and athletes. However, learning about each of the Commonwealth nations/territories, and their culture/languages was truly insightful. At night the city woke up from its sleep with many spectators, athletes, coaches and volunteers converging to view the festivals held each night spread across different locations in the Gold Coast.

All in all, it is enlightening experience that I would recommend to all. Share the Dream!

March 20, 2018July 16, 2018

Chronic Exertional Compartment Syndrome

Chronic Compartment Syndrome (CECS) is a painful, chronic exercise-induced musculosketal problem in the affected limb. It is widely under recognised and often misdiagnosed as shin splints in the lower leg or as general muscle tightness from pushing too hard in the gym. Because the symptoms could be explained by a number of factors, formal diagnosis and relevant imaging can sometimes take time.

Typical Signs and Symptoms:

Aching, tightness, swelling, cramping in the affected limb which can be progressively debilitating
Pins and needles or numbness
Can occur in one limb or both (more common)
Pain typically induced by exercise and typically worsened with increased intensity, distance or time
Pain subsidises within minutes of finishing activity

Causes:
When there is increased muscle pressure in a particular muscle compartment during and after exercise
Primarily affects the lower legs and is more commonly seen in the front and side of the shin bone where the compartments sit in a tighter space.
When exercises, blood flow increases to the working muscles to improve their capacity, but if the muscle does not expand then the pressure builds up within the compartment and causes severe pain

Risk Factors:

Age – Although anybody can develop this problem, the condition is more common in athletes under the age of 30 years
Exercise – Repetitive impact activities such as running, soccer, walking and jumping
Over training – Increasing the duration or intensity of training can increase symptoms significantly

Diagnosis:

Suspected with a good history and thorough clinical examination
If CESC is suspected then referral to a Sports and exercise Physician is advised to discuss the relevant imaging required
Diagnosis is confirmed when the pressure within the compartment exceeds normal limits. A pressure test is required for this,

Treatment Options:
Non Operative – Symptoms can be well managed and greatly relieved with activity modification, relative test, optimal biomechanics and compression. However, given the pathophysiology, if an individual wants to maintain a high level of intensive activity and CECS is confirmed on pressure testing then referral to a surgeon is advised
Operative – The operation required for relief is known as a fasciotomy whereby the surgeon divides the outer layer of the muscle (fascia) to relieve pressure.

It is important to note that chronic exertional compartment syndrome is not a life-threatening condition. It is different from an acute episode of compartment syndrome which is considered a medical emergency.

January 31, 2018July 16, 2018

7 Fact or Fiction Remedies for Plantar Fasciitis

By Russel Rubin, Principal Podiatrist

Picking Up Marbles With Your Toes

It makes sense that strengthening your feet might help reduce and prevent foot pain, but here’s an exercise you may not have heard of: picking up small marbles with your toes!

How it works: Sit in a chair with your feet out in front of you. Scatter marbles on the floor by your feet, and place a water glass a few inches in front. Pick up the marbles with your toes, and place them in the glass.

What it’s supposed to do: This exercise strengthens the muscles of your feet, creating better stabilization of the plantar fascia ligament, and improving your gait.

Covering Your Feet With Cabbage

It’s no joke – some people recommend the topical use of cabbage to reduce heel pain caused by plantar fasciitis.

How it works: Soften a few cabbage leaves (preferably red) over a low flame so that they do not break as you form them to your feet. Secure the leaves into place with gauze or a bandage, and allow it to sit overnight. Some people recommend pouring honey on the cabbage leaves before fastening them.

What it’s supposed to do: Cabbage contains a pigment called anthocyanin, which may help to reduce joint pain and inflammation.

Soaking Your Feet in Vinegar

Apple cider vinegar is a common home remedy for a wide variety of ailments – including plantar fasciitis.

How it works: Mix one cup of apple cider vinegar and 6 cups of warm water in a tub or container. Submerge aching feet and soak for 30 minutes.

What it’s supposed to do: Apple cider vinegar is rich in minerals and nutrients, including magnesium which can be absorbed through the skin.

Rubbing Mustard Oil on Your Feet

Massage is often recommended to temporarily relieve plantar fasciitis pain, but some people claim that using warm mustard oil makes your massage even more effective.

How it works: Warm a teaspoon of mustard oil my microwaving for a few seconds, and massage it into the sole and heel of your foot in a circular motion.

What it’s supposed to do: By doing a warm mustard oil massage you will help the muscles of your feet relax and bring blood flow to the area. Like apple cider vinegar, mustard oil has magnesium, and it is also said to have anti-inflammatory properties.

Using Aloe Vera Topically or Internally

Aloe vera seems to be growing in popularity as a cure-all and superfood (or super drink in some cases). Research seems to support some of it’s benefits, including its antioxidant and antibacterial properties, and benefits to the skin.

How it works: Aloe vera can be consumed or massaged into the skin topically.

What it’s supposed to do: Aloe vera contains mucopolysaccharides, which have anti-inflammatory properties.

Herbal Treatments

Herbal treatments are widely used, so it is no surprise that its believed these can also cure or alleviate symptoms of Plantar fasciitis. Turmeric, Horsetail, Feverfew, Willow, Ginger, Bromelain, Green tea, Calendula, Meadowsweet, Arnica, Chamomile and Tea Tree.

How it works: A variety of herbs taken either internally or externally.

What it’s supposed to do: Reduce inflammation and swelling, and alleviate pain.

Putting an onion in your sock overnight.

Yes, you read that right. Putting an onion in your sock overnight apparently helps lessen the pain of Plantar fasciitis.

How it works: Sleeping with an onion in your sock overnight.

What it’s supposed to do: Who knows? Maybe the compression of the socks overnight helps with the pain, but it could be the onion.

Will any of these wacky home treatments magically cure your plantar fasciitis? Probably not – but if you have struggled to find a solution that works, they may be worth a shot!

January 17, 2018April 23, 2018

Shoulder Pain – Who and What are the Rotator Cuff?

Most people will have only heard of the rotator cuff when they were told they have a rotator cuff strain or tear. Rotator cuff injuries occur more often in people who provide repetitive overhead movements for example, swimmers, painters and tennis players.

But what does the Rotator cuff mean? Where is it and what does it do?

As a whole the rotator cuff is made up of 4 muscles and tendons that help provide strength and stability to the shoulder during movement. These muscles are located around the shoulder blade and form a cuff around the shoulder joint and attach onto the top of the long arm bone.

Each muscle is used in a variety of upper limb movements including reaching, tucking a shirt in behind and raising the arm to the side. They are pivotal to almost every movement of the shoulder joint. A balance of muscle strength and muscle flexibility is essential to the normal functioning of the shoulder and the entire shoulder girdle.

The 4 Rotator Cuff Muscles

Supraspinatus
Infraspinatus
Subscapularis
Teres Minor

As the shoulder joint has poor bony stability (hence why it is so mobile), it means our muscles are more vulnerable to injury.

Common injuries include:

Tendonopathy – this is often caused by a number of different mechanisms but perhaps the most common is due to an increase in the load and force on the tendon. Other factors such as anatomical varients of the shoulder blade, muscle shortening or altered shoulder / scapula mechanics which all place more load on the cuff tendons and increase the risk of tendonopathy.
Tear – These can either occur as a result of worsening tendonopathy (degeneration) or as a result of more significant trauma e.g following a fall, fracture or shoulder dislocation.

Diagnosis

Most diagnoses can be established from clinical history and examination. By observing shoulder movements and testing the individual muscles of a shoulder – Physiotherapists and Doctors can confirm rotator cuff injury. Occasionally an XR maybe required to look at the anatomy of the shoulder. When there is a more severe injury, or a number of muscles / tendons injured then the most effective scan is an MRI.

Treatment Options

The good news is that the majority of rotator cuff injuries can be successfully treated conservatively / non-operatively with Physiotherapy.

Normalising the shoulder mechanics by correcting muscle imbalances and control accompanied with activity modification will provide the biggest amount of relief.

This alongside anti-inflammatory medications, ice and taping can all facilitate recovery from these injuries.

If you have been experiencing shoulder pain during your gym workouts or have been noticing a painful shoulder at night time, get it checked out. Often some simple corrective exercises can keep you working at your best without causing further injury.

December 31, 2017July 20, 2018

Sitting is the new smoking

Orange is the new black / Sitting is the new smoking

Is Sitting really that bad for you?! Are standing desks worth it?

It is not uncommon to read public health articles in the news and wonder if there’s any truth behind the story or is it all just being blown out of proportion?

Here we explore the story, the research and what us health professionals think.

(You might want to stand up for this!!)

Your chair is not out to kill you. It’s not necessarily all about the sitting itself but more the problems associated with inactivity. We all know that there are several risk factors for heart disease including family history, high blood pressure, obesity, cholesterol, diabetes and being physically inactive – whilst the action of sitting won’t necessarily cause you harm, it’s the periods of inactivity.
Knowing the risks and implementing strategies is useful, if your job largely involves desk based work, get up and about on your way home, at the weekends and use your lunch breaks effectively.

Sitting and low back pain. The discs between our vertebrae are compressed in certain positions. The lumbar vertebrae more so when you’re sitting or in flexion. We all have a flexion capacity. If you are sitting all day long, don’t go to the gym and continue to do sit ups or activities where you load in flexion, modify to increase your flexion tolerance and reduce your risk of low back pain.
- - Use a lumbar roll in your chair to support your spine, limit your sitting to a maximum of 30mins and don’t slump over your laptop on the couch!
Don’t just stand there like a lemon. Standing all day equally isn’t the answer either. No posture is good enough to be maintained for lengthy periods of time without variation. It’s important to distribute loads equally through your body.
- - Rest your feet and legs for short periods. Change your postures. Start by sitting for an hour, standing for a couple of hours and repeat.

As health professionals we recommend the use of a height adjustable standing desk that allows you to easily switch between the two. It’s a cost-effective solution to all of the above problems for those of you working in an office environment.

If you have any questions or concerns about your back, your posture or your ergonomic set-up, just ask us! We’d be more than happy to assess and advise.

December 9, 2017July 20, 2018

Stay Fit When You Hit The Slopes

Are you hitting the ski slopes and haven’t prepared properly?

A week of skiing involves at least 5 hours of exercise everyday as well as continuous squatting, pivoting, turning, bouncing and occasional falling. These factors plus fast speed, obstacles, jumping and undulating ground, it’s no wonder snow fields are risk factors for injury.

Whether your skiing, boarding or skating – these sports require huge levels of endurance and lower limb strength so be prepared. You wouldn’t take part in a marathon with no training so skiing shouldn’t be any different.

We know from studies that Hip strength is crucial to reducing knee injury risk and this is vital when skiing. Not only do you need strength to stabilise on a moving surface but you also need this strength to keep you going all day long.

Here at Barangaroo Orthopaedic & Sports Injury Clinic, we believe in injury prevention and with only 8 weeks to go until prime snow fall we want you to be ready to make the most of the time you have on your ski’s / board.

It is never too late to strengthen up your muscles to decrease your risk of soft tissue damage.

Here are our top five exercises to get you ready:

1-Hip Extensions on a Swiss Ball

2-Lateral Banded Resistance

3-BOSU Squat Holds

4-Single Leg Squats

5-Forward and Lateral Plyometric Jumps

Our Exercise Physiologist Rachael runs “Get fit to Ski” Programs. If you have a trip planned get in touch today on 8599 9811.

December 1, 2017July 20, 2018

Acupuncture v Dry Needling

Acupuncture is an ancient therapy which has been practiced for over 5000 years. The belief is that health relies on a steady flow of “chi” – (The vital flow of energy in all living things) through the body’s energy pathways, known as meridians. These meridians are linked to specific organs such as the heart, spleen and liver and It is thought that problems or pains arise when there is blockage in any of these energy channels.

Whilst Acupuncture and Dry needling both involve the insertion of needles, the theory and clinical reasoning behind the practice is different.

Physiotherapists practice dry needling as it is proven to be an effective way of relieving pain and reducing myofascial tension. Physio’s use needling techniques alongside manual therapy and rehabilitation to correct musculoskeletal dysfunctions.

Physio’s use their knowledge of anatomy to needle specific tight spots or knots within a muscle. The research shows that inserting needles into these points can cause biochemical changes which induce healing properties into the affected tissues.

Some of these points also happen to correspond with some of the traditional acupuncture points.

Dry Needling, can be used effectively for:

Neck tension and headaches
Low Back Pain
Muscle Strains
Ligament injuries
Tennis Elbow
And More….

If you have a pain or muscle imbalance, then dry needling may be of benefit to you.