Rotator Cuff Injuries

The shoulder is a complex ball-and-socket joint, which is able to move in many different planes. It is, therefore, susceptible to numerous injuries, two common types being injuries to the rotator cuff and impingement syndrome. In this blog, I will discuss rotator cuff injuries; in the next blog, I will discuss impingement syndrome.

The rotator cuff is made up of four muscles that surround the shoulder joint, providing stability to the joint. These muscles are supraspinatis, infraspinatus, teres minor and subscapularis. Chronic tears of these muscles can be caused by repetitive microtrauma to the muscles as a result of overuse.

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Prevalence

Partial tears are more commonly seen in younger individuals, whereas complete tears are usually seen in adults over 30 years of age. The risk of a complete tear increases with age. Partial tears are treated conservatively, whereas complete tears may require surgical treatment.

Symptoms

·         Dull ache deep in the shoulder joint

·         Pain in the shoulder joint that can wake one when lying on the affected side

·         Difficulty with actions such as combing ones hair and putting on a jacket

·         Weakness in the arm and shoulder may also be present

Causes

·         Traumatic injury, such as a fall

·         Lifting something that is too heavy for the muscles to cope with

·         Repetitive overhead movements, such as swimming, bowling and serving in tennis

·         Bone spurs, causing rubbing of the tendons

Risk Factors

·         Age – the risk of developing a rotator cuff injury increases with age

·         Sporting activities requiring repetitive overhead movements, such as swimming, bowling and serving in tennis, increase the risk of developing a rotator cuff injury

·         Jobs that require repetitive overhead movements, such as construction jobs, increase the risk for rotator cuff injuries

Management

Conservative treatment is usually adequate to treat a rotator cuff injury:

·         Rest, ice and non-steroidal anti-inflammatory drugs

·         Physiotherapy to reduce inflammation and increase range of movement

·         Biokinetic therapy to improve muscle strength and stability around the joint

Surgical treatment may be required in the case of a complete tear.

References

Foundations of Athletic Training: Prevention, Assessment and Management

http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/basics/definition/CON-20031421

Newsflash!!

Please note that I am moving premises.

As of 1 August 2014, Nicole Lay Biokineticist will be practicing at:

95 Boeing Road East

Bedfordview (entrance on Marais Street)

Tel: 011 454 0232

Achilles Tendinitis

With the Comrades Marathon taking place on Sunday, I thought it appropriate to look at another injury that commonly affects runners, namely Achilles tendinitis, or inflammation of the Achilles tendon. This is the most common type of tendinitis, affecting the Achilles tendon, which connects the two main calf muscles to the back of the heel.

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Risk Factors

The following factors may increase one’s chances of developing Achilles tendinitis:

·         Tight and weak calf muscles

·         Foot deformities affecting the alignment of the foot

·         A recent change in running shoes or surface

·         A sudden increase in training intensity, either distance, speed or hill work

Due to its position in the body, the Achilles tendon bears a significant amount of force, subjecting it to injuries such as rupture and tendinitis.

Signs and Symptoms

Acute signs and symptoms include the following:

·         Burning or aching in the back of the heel

·         Increased pain when stretching the calf muscles or rising up onto ones toes

·         Tenderness to the touch on the Achilles tendon itself

Chronic signs and symptoms include:

·         Pain that is exacerbated by exercise

·         Pain that becomes constant

·         A thickened tendon

·         Pain only on the back outer part of the heel

·         Muscle spasms and tightness, combined with reduced flexibility in the calf muscles

·         Radiographs may show bony deformities and calcifications

Management

Acute treatment includes ice, non-steroidal anti-inflammatory drugs and activity modification. Complete rest for up to three weeks may be necessary in more severe cases. Surgery may be necessary in chronic cases where conservative treatment does not alleviate symptoms.

An appropriate stretching and strengthening programme is essential to prevent recurrence of this injury. Once the acute pain has subsided, consult a Biokineticist to assist you with this programme.

References

Foundations of Athletic Training: Prevention, Assessment and Management.

Fibromyalgia and Exercise

Fibromyalgia (FM) is a complex, multidimensional, rheumatological disorder. It is the third most common rheumatological disorder in the United States. It affects both men and women; however, a higher prevalence is seen in women, with 80% of people affected being women between the ages of 20 and 55 years.

FM is characterized by the presence of chronic pain and tenderness at specific anatomical sites, known as “tender points”. Other symptoms may include:

·         Sleep disturbance

·         Chronic fatigue

·         Morning stiffness

·         Paresthesia (tingling sensation) in the hands and feet

·         Enhanced perception of physical exertion

·         Depression

·         Anxiety

As a result of these symptoms, those affected with FM may also suffer from:

·         Impaired functional ability

·         Low self-esteem

·         Poor physical fitness

·         Social isolation

·         Poor quality of life

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The exact cause of FM is as yet unknown; however, the following factors are believed to increase the risk of developing FM:

·         Muscle abnormalities

·         Neuroendocrine and autonomic system regulation disorders

·         Genetic predisposition

Due to the multidimensional nature of FM, a multidisciplinary approach to the management of FM patients has been shown to provide the best results. This includes appropriate medications to manage symptoms, client education, cognitive behavioural therapy, hypnosis, acupuncture, and an appropriate exercise programme.

People with FM will reap the same benefits of exercise that individuals without FM receive; however, the main goal of a regular exercise programme for individuals with FM is to restore and maintain functional ability. The benefits of exercise that are more specific to those with FM include the following:

·         Reduced number of tender points

·         Reduced pain at the tender points

·         Decreased general pain

·         Improved sleep and therefore less fatigue

·         Improved self-esteem

·         More frequent and meaningful social interactions

·         Improved functional ability

Because of their symptoms, people with FM often become sedentary and, therefore, very deconditioned. They often complain of morning stiffness, exaggerated delayed-onset muscle soreness, poor recovery from exercise, and difficulty using their arms when elevated above their shoulders. High-impact, vigorous activities are also not well-tolerated. Therefore, low- to moderate-intensity aerobic activity is recommended for people with FM. One must begin the exercise programme slowly and progression should be slow and controlled. Supervised exercise therapy sessions with a biokineticist will ensure appropriate progression and will potentially increase exercise adherence.

References

ACSM’s Exercise Management for Person’s with Chronic Diseases and Disabilities

Shin Splints

Medically know as Medial Tibial Stress Syndrome (MTSS), shin splints are an overuse injury of the lower leg, which causes pain and inflammation along the tibial bone in the shin, as a result of small tears in the muscles attaching to the shin bone.

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Causes

Shin splints are most commonly related to running activities. A change in running surface, speed, distance, technique, stretching or footwear may contribute to the development of pain.

Signs and Symptoms

·         Dull pain which occurs along the shin bone (tibia) at any stage during physical activity

·         Pain may occasionally be sharp and penetrating

·         Pain is usually relieved with rest, but can recur hours after physical activity has stopped

·         In beginners, pain may be caused by doing too much too quickly

·         In more experienced runners, pain may be caused by mechanical abnormalities in the runner’s technique

·         Pain is aggravated by actively pointing the toes

Treatment

·         Rest is essential to relieve pain – at least 5-7 days

·         Ice, compression, elevation and non-steroidal anti-inflammatory drugs may be useful to relieve acute symptoms of pain and inflammation

·         See a physician to rule out any other conditions, such as a stress fracture or compartment syndrome

·         Re-evaluate any contributing factors, such as running surface and footwear

·         See a podiatrist to assess any foot abnormalities

·         See a biokineticist to assess your running technique and correct any weaknesses contributing to the problem – appropriate stretching and strengthening exercises for the lower leg will probably need to be done

References

Foundations of Athletic Training: Prevention, Assessment and Management.