Shoulders
Do you lie awake at night with an aching shoulder? Do you feel sharp grabs of pain while reaching up into the cupboard or into the back seat of your car? Did your shoulder pain start one day without any injury that you can remember? Shoulder pain can keep us awake at night and limit our day-to-day activities – even the most basic ones like washing our hair or getting dressed. In this article we are going to talk about how shoulder problems can start and what there is to do about it.
First let’s talk about what is inside your shoulder. The shoulder is what we call a ‘ball and socket’ joint. This means that the top of the upper arm bone has a ‘ball’ like surface, and this ball connects with the concave surface of the shoulder blade, similar to a golf ball sitting on a tee. This type of joint (like your hip joint) is build for maximum mobility. Having so much mobility is a good thing because it allows our shoulder and arm to reach in all different directions. However, this excess mobility can also predispose the shoulder to injury.
Almost everyone has heard of the rotator cuff. The rotator cuff is a group of 4 muscles responsible for protecting the shoulder. These are often the muscles that are injured in the shoulder because they can become pinched inside the joint (referred to as ‘impingement’). The rotator cuff muscles work alongside the muscles of your shoulder blade to ensure that the ball is always positioned in the centre of the socket so as to avoid pinching, inflammation and pain. Impingement can occur if any of these shoulder muscles become tight or weak or if the neck and upper back are too stiff to allow for proper arm movement.
People that spend a large portion of their days sitting often become very weak in their shoulder blade muscles while at the same time also becoming tight in their chest, upper back and neck. Others spend a lot of their workday doing repetitive movements with their arm that also can create irritation and muscle imbalances in the shoulder. At night many of us tend to lay on our ‘favourite’ side while sleeping which squeezes the blood out of the shoulder thus causing further irritation and preventing recovery from the strain during the day.
If you start to have shoulder pain the best strategy is to avoid the movement that is creating the pain and to ice the shoulder for 15 minutes 2-3 times per day for the initial 3 days (after 3 days switch to heat for 20 mins, 2-3 times per day to increase blood flow/healing). Make sure to continue to move the shoulder in motions that don’t hurt in order to prevent your shoulder from getting stiff. Also try as best as you can to not sleep on the painful shoulder at night in order to allow healing.
If the pain does not subside within a week it is advisable to see your health care professional so that the specific reason for the shoulder pain can be diagnosed. In physiotherapy, pain control and stretching out tight muscles are usually the initial goals. Treatment then fairly quickly progresses to focusing on strengthening specific muscles as well as increasing overall flexibility. Often the conversation of prevention will focus on daily stretching or Yoga as well as emphasizing good posture while sitting.
I hope that you have learned a little bit about how the shoulder works and what can cause shoulder pain. If you are starting to have nagging shoulder pain or tightness, remember that it is much easier to deal now then ‘down the road’. Happy spring (summer) everyone!
Back
The Latest on Lower Back Pain
With all of this mild weather we have been experiencing in the Okanagan it really does feel like spring is just around the corner. I’m sure many of you have started to do some work in your yards in preparation for the gardening season. Each year during the start of spring there is something that comes along with the longer days and warmer temperatures: lower back injuries.
So what can we do to avoid hurting our backs?
A recent study published in the Journal of Arthritis Care and Research looked at just shy of a thousand patients over the age of 18. They found 8 different risk factors for lower back pain. In order of highest to lowest risk the 8 factors were: distraction during a task, manual tasks involving awkward postures, manual tasks involving objects not close to the body, manual tasks involving people or animals, manual tasks involving unstable or unbalanced objects, manual tasks involving heavy loads, moderate or vigorous physical activity, fatigue/tiredness. Being fatigued tripled the odds of suffering a lower back injury, while distraction increased the risk by 25 times! So based on this recent information when you are getting outside to do your yard work or gardening this spring make sure to remember this list and try to avoid these risk factors. Take frequent breaks during your day to avoid fatigue. When lifting, bring objects close to your body and focus on what you are doing to avoid distraction. When lifting, bend at your hips and knees (sticking the butt out) while keeping a straight spine to minimize dangerous pressure on the spinal discs and joints. As well, a recent study done at the University of Sydney in Australia found that almost half of the lower back injuries they looked at occurred in the morning between 8 and 11 am. The cause is yet unknown but it is thought that it may be due to the fact that your spinal discs fill with fluid overnight, making them more susceptible to pressure in the first few hours of your day. It makes sense then to take your time in the morning when possible and make sure your muscles and joints are warmed up before jumping right into your ‘spring cleaning’. Of course we don’t live in a perfect world where we can always completely avoid risk of injury. But keeping some of these latest study results in mind I hope that you can stay healthy during this upcoming spring season.
Womens Health
This one’s for the ladies.
Ladies, have you notice the increase in the number of bladder leakage commercials on TV these days? Brands like Poise and Always have caught on that there are a large number of women who experience bladder leakage on a daily basis. These commercials are great in one aspect because they open up doors for women to have conversations. This is important because these issues may be embarrassing to discuss with friends and therefore are often sealed behind tight lips or talked about only in doctors’ offices. The downside to these commercials is that they make you feel like a pad is the best way your bladder leakage can be addressed. Many women who have bladder leakage do not seek information regarding the underlying cause, the type of bladder leakage they have or additions ways it can be addressed.
To fill in some of the gaps – there are essentially three types of bladder leakage. First there is stress incontinence (loss of bladder control). This type usually occurs because the pressure exerted on the pelvic floor is too forceful for weakened muscles during a cough, sneeze, laugh or any event that increases intra-abdominal pressure.
The second type of incontinence is called urge incontinence. This type of leakage is usually behaviour driven and occurs because of toileting cues and conditioning surrounding your learned habits. For example, you just pulled into your drive way – before you pulled up there was no urge to go to the bathroom. However, now that you are in the driveway you are frantically rummaging through your purse to grab your keys, you found them. Now, to make it to the front door you waddle the whole way there because all you can think about is emptying your bladder and by the time you get the lock open you may have already leaked before you made it to the toilet.
The final type of incontinence is called mixed and is a combination of stress and urge. In addition to using these products there are other ways to treat bladder leakage. One of the treatments for stress incontinence comes from gaining body awareness and control of your pelvic floor muscles and retraining them to turn on before a cough and sneeze. The treatment for urge incontinence involves behavioural retraining surrounding your current toileting habits.
Now that you are aware there are more options, perhaps it’s time for you to take control of your leakage and contact a physiotherapist who treats women’s health in an effort to reduce or eliminate leakage.
IMS
Intramuscular Stimulation (IMS)
Intramuscular Stimulation (IMS): What is it and how can it help get rid of your chronic pain?
In this article I am going to focus on the treatment of chronic muscle and nerve pain and why it can be so difficult to find a solution for this type of pain. It is estimated that over one third of the adult population in North America suffers from chronic pain. That is a staggering statistic! This means that 1 of out of every third person out on the street is dealing with ongoing daily pain. Research shows that suicide is nine times more prevalent in people with chronic pain than with depression and it is estimated that in the United States, chronic pain affects more people than diabetes, cancer and heart disease combined.
So is chronic muscle and nerve pain so common? To understand this question we have to look at the gradual process that happens to all of our bodies to some degree over many years. As harsh as it sounds, the reality is that as we age our bodies are slowly ‘rotting’. By the time we reach our 50’s and 60’s we will all get some amount of arthritis in our spine. How fast we ‘rot‘ depends on a variety of factors including our overall fitness levels, nutrition, the types of jobs we do, family genetics and any traumatic injuries we sustain along the way ie. motor vehicle accidents. As the arthritis in the spine progresses, the nerves that exit the small spaces between each spinal bone (vertebrae) start to become irritated. In response to this irritation, the muscles that these nerves supply then start to form tight bands. These bands are the ‘knots’ you feel when you rub sore muscles. The muscle bands not only cause pain but they also begin to pull at joints and tendons as well as compress the already sensitive nerves at the spine. These tight bands often do not respond to traditional treatment approaches such as stretching, massage and spinal manipulation.
A form of treatment that has been gaining popularity in the last 5 to 10 years for chronic muscle and nerve pain is Intramuscular Stimulation (IMS). This treatment technique was developed by a Doctor in Vancouver by the name of Dr. Chan Gunn. Dr. Gunn developed this technique while working with people who were injured on the job and whose pain was not going away with traditional treatment approaches. What he found in these patients was that by stimulating their tight muscles with an acupuncture needle, the pain very often significantly improved or in many cases disappeared.
So the key to addressing this chronic pain process is to release the muscle tension. In an IMS treatment, when the needle enters the taut band the muscle will ‘grab’ the needle and a deep, cramping sensation is felt. Once the muscle grabs it then typically will ‘reset’ itself and begin to relax. When the tight muscle relaxes, a decrease in pain should follow. IMS is now being recognized and used by physiotherapists and doctors around the world to treat chronic pain of musculoskeletal origin. If you are suffering from ongoing muscle or nerve pain and haven’t had success with traditional types of treatment, IMS may be worth trying. For more information about IMS visit:www.istop.org
Physio Articles
The phrase “no pain, no gain” would probably be the leading misconception about pain that I hear – live by this slogan at your own risk. Why? Because first and foremost, pain is a protector. Pain is a wonderful and fascinating perception that helps to keep us out of danger. I can certainly sympathise that when you’re experiencing persistent or intense pain, its hard to see it as “wonderful” or “fascinating” but it truly is a remarkable defence mechanism that we possess.
When you step on a nail, twist your knee or tweak your back, what comes to your defence first? The simple answer is pain. It’s your first warning of actual or even potential tissue damage. Yes, that’s correct – “potential” tissue damage, meaning your body is smart enough to tell you to withdraw from danger before the damage is done. Wow! When tissue damage does occur, such as a strained ligament, tendon or muscle, your body sends all its best healing products to the area in the form of ‘inflammation’. The brilliance of inflammation is that it increases the sensitivity of the danger detectors (receptors) in the damaged area, which send more danger messages to the brain where they are processed and a pain experience can result. What do you think of that? Essentially, your body doesn’t just heal you with inflammation but it also tells you about it through the feeling of pain as a way of changing your behavior, allowing the area to rest and heal more effectively.
If you understand that the experience of pain is a critical response when the body feels threatened or in danger, then you will see how the slogan “no pain, no gain” will quickly lead you astray. Instead, us ‘pain geeks’ like to encourage the slogan – “know pain or no gain”, meaning that if you understand why you are experiencing pain and what it means, you are more likely to adopt the appropriate behaviour to encourage recovery.
The story of pain can get rather complex but equally as fascinating. Like any of our body systems, our defence systems can sometimes get a bit carried away and malfunction. This is often the case in the event of persistent pain – a story that will have to wait for another time. Until then, remember “know pain or no gain”.
Shoulders
With the May-long weekend marking the unofficial start of summer, and the weather quickly heating up, many people are hitting up the lake to take their swimming practices outdoors. Like any sport, aches and pains can occur in swimming, with shoulder pain being the most common complaint. The term swimmer’s shoulder is used to describe painful shoulder overuse conditions that occur in the sport.
The shoulder is a ball-and-socket type of joint, which allows for a large amount of motion. This excessive mobility is balanced by surrounding tissues to make it more stable. Included in the structures that help stabilize the shoulder is a fibrous capsule that surrounds the head of the humerus (the arm bone), as well as the rotator cuff. Four muscles make up the rotator cuff, and serve to keep the humerus properly placed in the joint. The bony structure that you can feel on the top of your shoulder is called the acromion, where impingement can occur.
Many movements occur at the shoulder during swimming, a lot of which is overhead. Different swimming strokes involve different patterns of motion, but all have some combination of rotation, circumduction and scapular movements. These positions can put the swimmer at risk of impingement, especially if the biomechanics are off.
Injuries to the shoulder complex from swimming are typically microtrauma: small injuries over time from the repetitive activity rather than a macrotrauma from a one-time incident. There are many factors that can contribute to injury, typically described as intrinsic and extrinsic.
Intrinsic factors can include the positioning of the joint itself; if the capsule surrounding the joint is tight at the back, it pushes the humerus forward, increasing the likelihood of impingement of the tissues under the acromion, and placing more stress on the tendons of surrounding muscles. Opposite of that would be if the joint is lax, which creates more demand on the rotator cuff muscles to provide stability. Another intrinsic factor is posture, with rounded shoulders and an increased forward bend in the upper back being common amongst swimmers. This lengthens and weakens muscles that stabilize the scapulae, can contribute to a tight posterior capsule in the shoulder, and decreased mobility in the spine.
Extrinsic factors are related to the use of your shoulder: overuse (your training schedule), misuse (swimming form), abuse (too strong of demand placed on your shoulder), and disuse (time off from training).
To maximize your season, it is worthwhile to assess your shoulder mechanics, preferably before injury occurs to be preventative. Any impairments should be addressed, which can include mobilizing stiff or tight structures, strengthening the rotator cuff and other supporting musculature, and improving technique. Be cautious of overtraining – don’t increase your distance, intensity or frequency of training too quickly. Give yourself adequate time to make strength and endurance gains, as well as time to recover.
Consulting your physiotherapists to address shoulder and posture impairments, and a coach to look at your form, can help keep you swimming strong this summer.
Sports
Attention Curlers!
The curling season has now come to an end, and most of us won’t step onto the ice again until fall. If you spent any part of the past season haunted by joint or muscle pain, this is the perfect time to do something about it. Absolutely every professional athlete knows that the off-season is the time to rebuild strength and recover from injury. Whatever your age and physical activity level, this same principle applies to you.
Curlers are most likely to experience pain in their shoulders, back or knees. This pain is most likely to affect either the delivery phase or the sweeping phase of the game. Sometimes it can take hours or even days after playing for the pain to subside, or it may lead to the use of pain medications. Pain is a big deal because it can stop your muscles from generating power and can affect your enjoyment of the game. Unfortunately, if not properly addressed, this pain can go on for years, getting worse and worse until it eventually leads to retirement from the sport.
Many of the aches and pains that we experience as curlers originate from a common source: muscle imbalance around the legs, back and shoulders. By building strength and flexibility in our muscles, it’s possible to achieve a consistent, balanced delivery and powerful sweeping. For example, a powerful push from the hack uses the strength in your quads while effective sweeping requires strong deltoids and latissimus dorsi. Conversely, weakness in your quads or tightness in the hip flexors will prevent you from getting low enough to be balanced and effective in your delivery.
The solution to this problem must include building strength and lengthening tight muscles. Since this takes time to do, it can be difficult to achieve during the curling season. A proper, targeted stretching and strengthening program, provided by your Physical Therapist, during the off season will make you a better shot maker while at the same time eliminate distracting aches and pains. By consulting with your Physical Therapist early in the off season, you’ll be giving yourself the best chance to return to the ice in the fall as a stronger and more comfortable athlete.
Rob Heimbach is a registered physiotherapist and associate at Sun City Physiotherapy’s Glenmore location. He can be contacted at glenmore@suncityphysiotherapy.com.
Hips and Knees
Your Hips: The ‘Core’ of the Problem?
I think most of us by now have heard about the importance of strengthening your ‘core’. But did you know that the most important part of your core for preventing hip, knee, and ankle injuries are your hip muscles? Your hip muscles or ‘glutes’ are the largest group of muscles in your lower body and are a part of your core that are often much weaker than they should be.
So what exactly are the hip muscles responsible for? Strong hip muscles keep your spine, pelvis, knees and ankles in alignment. If your glute muscles aren’t strong enough your hips rotate and drop, your knees move inward and your feet flatten (pronation). All of these motions create more strain on the joints, ligaments and tendons of your lower body. This excessive strain often leads to injury and persistent pain. Achilles tendinosis, patellofemoral knee pain, iliotibial band (ITB) syndrome, and piriformis syndrome are all common injuries linked to weak hip muscles. Research is also showing that hip weakness is a major risk factor for non-contact ACL (knee ligament) injuries.
So why do our hip muscles become weak in the first place and what can we do about it? The latest research done by Dr. Powers who is a physiotherapist in Los Angeles, shows that our brains have only a very small area dedicated to controlling the hip muscles. It is unclear why this is the case but it may explain why the majority of us don’t naturally use our hip muscles during activities such as: running, walking and hiking. The good news is that the same research shows that exercise can change the way our brains work.
In the study, patients that took part in specific hip strengthening exercises, actually showed changes in brain function. The areas on the brain controlling the hip muscles became larger after only a week of exercise! This is important because the larger the area of your brain dedicated to a certain muscle group is, the easier it is to ‘turn on’ and strengthen that muscle. Keep in mind though, these strengthening exercises need to be done for a minimum of 3 months in order to get significant strength improvements in the muscle.
So if you suffer from ongoing hip, knee or ankle pain, strengthening your hips may be the key to getting over your injury problems. Visit your local physiotherapist and ask for an assessment on your hip strength. If your muscles are weak your physiotherapist will give you the proper home strengthening exercises to address the weakness. Through these exercises you can change your brain to help change your pain.
IMS
Intramuscular Stimulation, or IMS for short, is a technique used by physiotherapists since it was developed in the 1970’s in Vancouver by the pain specialist Dr. Chan Gunn. IMS is a total system for the assessment and treatment of chronic musculoskeletal pain that has a neuropathic cause. It is grounded in western medical science and there is a growing body of evidence to support its efficacy.
Neuropathy refers to when a nerve is not functioning properly once it has exited the spinal cord. Often this occurs without any structural damage to the nerve meaning that x-rays and scans may look normal. Some indicators of neuropathy are pain in the absence of tissue damage, delayed onset of pain after an injury (e.g. in whiplash), and pain that gets worse after doing more activity. There are other specific physical signs that suggest there may be a neuropathic cause to a persons pain too. These signs will be picked up during the assessment and will indicate whether that person is a candidate for IMS treatment.
When nerve conduction is reduced in neuropathy, one of the main results is that the muscles that are supplied by that nerve become tight and shortened. This in itself can cause pain and supersensitivity of the muscle so even light touch to that area can feel very tender. The shortened muscle will also create more stress on the adjoining tendons and joints which can create problems in these structures causing further pain. Some common conditions in which an underlying neuropathy can be a factor are whiplash, chronic low back or neck pain, headaches, tendinitis, shoulder pain, and groin pain.
IMS involves the use of very thin needles which are inserted into the muscles that have been affected by neuropathy. This creates a ‘grasp’ or cramp sensation which causes the muscle to release, which in turn takes the tension off the surrounding structures. In this way supersensitive muscles can be desensitized and the persistent pull of short muscles can be released. When performed well IMS has a remarkable success rate, reducing symptoms in even long term chronic conditions that may have been present for months or even years, giving long lasting and often permanent results.
Sports
If you’re a regular league curler, whether recreational or competitive, then you’re surely familiar with the aches, pains and injuries that go hand-in-hand with the sport. Joints and muscles at the knees, back and shoulders are most vulnerable to injury. The good news is that by taking the following three preventative steps, you can minimize your chances of injury and maximize your enjoyment of curling this season!
Number one on my list is proper equipment. I can guarantee that if you curl long enough you’re going to fall once or twice. Over 90% of curling injuries result from a slip and fall. If you’re on the ice with any regularity, it’s worth ditching the runners in favour of a proper gripper and slider. Beginner curlers and young curlers in particular should also consider wearing a helmet when starting out. Scary fact: when you fall, your head is the body part that’s most likely to hit the ice first!
Number two is a proper warm up. But wait, there’s a twist. You need to actually get WARM. You need to increase your heart rate and body temperature! If you think that I’m stating the obvious, just look around at all of the curlers casually chatting or gently stretching before going on the ice. These activities will only warm you up if you’re doing them on a hot beach or in a hot yoga studio. Start by running on the spot, high-knees, butt-kicks, or doing jumping jacks. Follow that up with some curling-specific stretches including the legs and trunk, and you’ll be ready to hit the ice.
My third and final tip is this: get a qualified coach to take a look at your mechanics. I remember the first time that I saw my delivery and sweeping on camera, I was shocked at how awkward I looked! I’m not saying that you’re in the same boat; you might be perfect. But you may not look as good as you think you do. If you aren’t already getting regular coaching, an instructor can provide you with some insight into your technique. Improving your delivery and sweeping by optimizing the way that you load your joints and muscles will improve your performance and prevent overuse injuries. You’ll play better, and feel better doing it!
Keep these three points in mind and with any luck you’ll make it through the curling season with little to no time missed due to injury! If you do happen to run into any issues along the way, keep in mind that a visit to a physiotherapist can help you to get back on track. Happy curling in 2016!
For more information on curling injuries, prevention and exercise, join us for a free informational talk on Tuesday, January 26th at 6:30 at Sun City’s Glenmore location. Call 250-762-6313 to reserve your seat.
Rob Heimbach is a registered physiotherapist and associate at Sun City Physiotherapy’s Glenmore clinic. He can be contacted at 250-762-6313 or email glenmore@suncityphysiotherapy.com
