The Shoulder and Physiotherapy
December 2, 2008 | Leave a Comment
The gleno-humeral joint, known in lay terms as the shoulder, is a vital part of the links in the upper limb and responsible for our ability to place our hands where we can see them to perform activities. Because flexibility is a prime requirement the shoulder is a less stable joint with moderate muscle power and a large range of motion. It is described as a “soft tissue joint”, implying that the joint’s functional ability is dependent on its soft and not its hard components. Physiotherapists are closely involved in treating and rehabilitating the shoulder, dealing with the muscles, ligaments and tendons.
The gleno-humeral joint is made up of the ball of the humerus and the socket of the shoulder blade which is called the glenoid surface. The top of the arm bone, the humeral head, is large and carries many of the tendon insertions for the stability and movement of the shoulder. The socket or glenoid is a relatively small and shallow socket for the large ball but is deepened slightly by a fibrocartilage rim called the glenoid labrum. Above the shoulder is the acromio-clavicular joint, a joint between the outer end of the collar bone and part of the shoulder blade, a stabilizing strut for arm movement.
A great many muscles act on the shoulder joint and on the other joints in the shoulder girdle, the acromioclavicular, sternoclavicular and scapulothoracic joints. The glenohumeral and scapulothoracic joints are acted upon by the major stabilisers and movers in the area, varying from power muscles which allow forceful work to stability muscles such as serratus anterior and the rotator cuff to smaller movement muscles such as deltoid. The muscles must keep the relationship between the shoulder blade and the thorax and ribcage steady and under control for the glenohumeral joint to also enjoy stability and precise movement.
The rotator cuff is a group of four small muscles which originate from the scapula and insert around the ball of the humeral head, the teres minor, subscapularis, infraspinatus and supraspinatus. The cuff tendons form a sheet around the ball of the arm bone and allow forces to be exerted on the humeral head by the shoulder girdle muscles. If the rotator cuff is not functioning normally the more powerful muscles tend to make the humeral head slide upwards on the socket, interfering with normal function and making a person unable to lift their arm up above their head.
As a person ages, the rotator cuff develops degenerative changes in its tendinous structures, causing small tears in the tendons which can enlarge until there is no continuity between the muscles and their attachments. This leads to loss of normal shoulder movement and can be very painful but is not always so and “Grey hair equals cuff tear” is a common saying. Physios work at rotator cuff strengthening, whilst in massive tears the main shoulder muscles can be progressively strengthened to improve function. Surgery is possible for massive, moderate and small rotator cuff tears and physiotherapists manage the post-operative protocols.
The shoulder joint is not typically affected by OA (osteoarthritis) but when it is physiotherapists treat arthritic shoulders by joint mobilisations, muscle strengthening and ranges of motion. Once physio has nothing else to offer, total shoulder replacement is one of the further options, with various surgical techniques involving replacing the humeral ball and the scapular socket either anatomically or in reverse. The shoulder is often called a “soft-tissue joint” as the soft tissues, their strength and balance, are vital to the function of the joint. Post-operative physio management is essential as the correct protocol must be closely followed to ensure success.
Physiotherapists treat many other types of shoulder problems such as impingement, tendinitis, hypermobility, abnormal muscle patterning, fractures and dislocations. Impingement is treated by strengthening the rotator cuff or by subacromial injection or acromioplasty operation, where the end of the acromion can be excised. Tendinitis is treated by direct treatment of the tendon and graded strengthening and hypermobility by stability work and accepting the limitations dictated by the condition. Abnormal muscle patterning is managed by teaching normal patterns functionally and fractures and dislocations by the protocols laid down by the surgeons and trauma physiotherapists.
Physiotherapy Treatment of Shoulder Fractures
November 30, 2008 | Leave a Comment
Humeral fractures occur commonly with up to five percent of all fractures falling into this category, eighty percent of humeral fractures being minimally displaced or undisplaced. Osteoporosis is a contributing factor in many of these fractures and a fracture of the forearm on the same side is a typical presentation. Nerve or arterial damage from the fracture is an important consideration but not common. Typical sites of fractures are the top of the arm (neck of humerus - “shoulder fracture”) and the middle of the shaft of the humerus.
Humeral fractures are typically caused by a fall on the arm, force being transmitted from the elbow or hand or by a fall onto the side of the upper arm. The upper arm is the site of attachment of many of the arm muscles and the pull these exert at the time of injury can displace the fracture. Older people are more susceptible to these fractures with a typical age of around 65 being the peak occurrence, while if this fracture occurs in young people it is due to road accidents or sporting injuries.
A forceful incident is normally required to fracture the humerus and if there is no history of this the physician will suspect a cause such as cancer. The physio examination will show significant pain on attempted movement of the shoulder or elbow, reduced movement of the shoulder, widespread bruising or swelling in the whole arm and in shaft fractures some arm shortening is possible. Checking for nerve damage is important as the radial nerve can be injured especially in shaft fractures, impairing control of wrist and thumb muscles.
Management of Arm Fractures
Acutely the patient is kept still and given adequate analgesia to relieve the initial pain. Fractures of the upper part of the arm bone can mostly be managed without operation if there is little or no displacement but rotator cuff injury could occur if the greater tuberosity is fractured, especially if it is displaced any distance, great force was involved or the patient is older. A collar and cuff sling allows upper humeral fractures to traction themselves straight and in line, while shaft fractures can be braced but are difficult to control.
Displaced three or four part fractures typically require surgery, referred to as ORIF (open reduction internal fixation) and this is more likely in younger people. Older people may have a poorer result in terms of pain and movement so may have surgical replacement of the head of the arm bone. Plating and nailing is usually unnecessary for shaft fractures as they heal well normally. The side effects of humeral fractures include nerve injury in shaft fractures, adhesive capsulitis and avascular necrosis of the head of the humerus. Healing occurs in six or eight weeks and older people may never regain full movement of the shoulder.
Physiotherapy for Shoulder Fractures
Initially the physio assesses the arm, asking the patient about their pain level as this varies greatly, examining the swelling and bruising of the arm. The physiotherapist then checks the available range of movement of the shoulder, elbow, forearm and hand. Any muscle weakness and sensory loss is noted as this may denote nerve damage. If not operated on, a sling is continued with and if the fracture is not too painful or severe, early exercises are started by the physiotherapist. Pendular exercises, with the patient bending over at the waist, are important in the early stages as they allow movement of the shoulder joint without much force.
Three weeks after the fracture bone healing will be well under way so the physiotherapist will instruct the patient in auto-assisted exercises, using the other arm, to help reduce stress on the injury. Unassisted exercises are the next step as the arm becomes stronger, to practice lateral and medial rotation and flexion. At six weeks the bone will be clinically sound so the physio can progress to more vigorous movements with resistance and gentle end-range stretching. Joint mobilisations can be useful to free up the sliding and gliding movements of the joint and strengthening and joint range work continued with Theraband.
Ridding Your Back of Pain Caused From Stress
October 8, 2008 | Leave a Comment
The answer to that question is yes. Stress cause back pain can be found in the lower and upper back and can be experienced by anyone. The back and stress have a mutually unbeneficial relationship. It’s kind of like the relationship between a cough you have with a chest cold. Stress cause back pain can bring you to your knees and strikes when least expected. Stress cause back pain is not any fun but can be prevented in many instances.
The television program Sex and the City had a good example of stress cause back pain in on of their programs. The lawyer, Miranda, had a huge argument with her friend Charlotte while on the phone. The stress that fight caused hit her like a ton of bricks in the neck. Before it was over she was on the bathroom floor hugging her rug for all there was in her. Stress cause back pain can hit anywhere in the back but before all is said and done you will feel that pain throughout the entire body.
Saying No Might Be The Answer
It’s never too late to prevent stress cause back pain. How easy is it? For some very and for others it can be a struggle. The only way to prevent stress cause back pain is to remove the stress in your life and in your body. Learning to deal with the stressful events in your life will help prevent stress cause back pain from occurring. If while trying to learn to prevent stress cause back pain, you are currently suffering, there is help. Many insurance companies will cover a massage therapist or a chiropractor if stress cause back pain has been diagnosed. Both can be a great help in relieving stress cause back pain. If the pain is over the edge you may need to visit both to get the effective relief.
The chiropractor may also be able to assist you in learning a few helpful back pain exercises to work out the built up tension in your muscle tissue. A deep tissue massage would not only release the stress that is stored up in your muscles, but is also a great way to pamper yourself. Being good to your body like that is one very good way to eliminate extra stress in your life.
Exercise is not only great for stress cause back pain but it’s an important way to help maintain a healthy body in general. You can take that nice leisurely walk in the park or do a full fledge work out. Either way it is a great way to help keep the stress in tow. Yoga is also a great form of exercise to help relax the muscles and remove the stress from your life. Exercise can help to strengthen the muscles and work out the stress that plaque our lives. Stress cause back pain doesn’t have to be a part of your life when saying no to stress.
Getting To Know The Common Causes Of Back Pain
October 1, 2008 | Leave a Comment
What are the common causes of back pain? With the number of people who are living with back pain rising, it’s almost certain that life can be said to be the number one common causes of back pain. Over seventy-five percent of adults will have some sort of back pain. Because we push our bodies beyond in our daily life, with work and play, back pain has almost become an epidemic. Back pain will not discriminate for any reason. This means that more than likely you will have to tolerate back pain at some point in your life.
It seems that no occupation or pastime is safe from the possibility of painful oohs and aahs from bending over for too long, or reaching just a smidge too far during that tennis match. Golfers also complain of jabs and twinges from over swinging. Who knew gold could be so dangerous? There are a few common causes of back pain that all people should be aware of in order to avoid injury to their spine and spinal muscles.
Getting To Know The Back
The only way to really understand the common causes of back pain is to really understand the workings of the back. The back is made up of vertebrae and muscles over thirty of each to be exact. It also consists of nerves, joints, ligaments and disks. It’s not just thrown together; it is a complex mesh of strength that keeps our bodies moving in all directions. If this complicated piece of body equipment is not kept in good working order it is sure to cause pain and discomfort for any one of us.
Muscles can certainly stretch, but this does not make you Mr. Fantastic. One of the most common causes of back pain is muscular or lumbar strain and ligament sprain. Stress can also cause back pain like this, where it feels like a pulled muscle.The best thing to do is to try and relax as much as possible, and also look into scheduling a visit with a chiropractor. Strains and sprains need more TLC than anything else; a lot of rest, an ice pack, and plenty of water to flush out any impurities in your tissue.
Natural age progression of the body can also be common causes of back pain. Things such as arthritis and osteoporosis can affect the back. Arthritis is the disintegration of the ligaments in the joints. Osteoporosis is the loss of calcium in the bones which in turn makes them brittle and easily breakable. Both come as we age and are common causes of back pain that can only be diagnosed by a health care provider. There are treatments available that can help with these common causes of back pain.
Your Back doesn’t like Household Chores
September 20, 2008 | Leave a Comment
Household chores are murder on your back. Twisting, lifting, reaching, bending, repetitive motion are aggravating to a back. I have clients that come to me with their “back out” from anything from plugging in the iron to brushing their teeth. I know you must do these things, but let me share some healthy back tips for getting through those back breaking chores safely.
Counter chores: Like doing dishes, or brushing your teeth. The issue here is counter level. Ideally it should be at belt level. You lean forward, extend your arms out to cut or wash, and this creates a stress on the lower spine area. An easy relief is to just raise up one leg, either on a stool or just open the cabinet and sit your foot on the ledge. And next time you re-do your kitchen cabinets, design them at the proper height: bend your elbows and shrug, the counter should be at the bottom. Safer than platform shoes.
Vacuuming: Unless you have a roomba, you will benefit from learning to vacuum in a manner that your back will tolerate. Instead of pushing and pulling quickly, twisting your back, take your time. Extend your arm and if you take a step forward and back, you can rotate full body. Just be aware of that twisting and extending, and avoid it as you go.
Bathtub: Take off your shoes and climb inside the tub instead of leaning over it. Squat some if you can.
Ceiling painting or fan cleaning: Reaching up over your head will arch your back and strain it unnecessarily. Instead just get out the right ladder, something that minimizes the reaching as much as possible.
Laundry time: Stop carrying the dirty laundry in a basket down a flight of stairs. Many reasons to avoid this: #1 You cannot see your feet and risk falling. Your back will hate you if you do that. #2 Your arms are outstretched increasing your back pressure. #3 You may tend to sway your back, adding undue pressure. Instead, toss them in a bag and let it roll down the stairs. It’s ok to bring the laundry back upstairs in a basket if you must, because it is not as painful falling up the stairs facing them as it is facing down the stairs and falling backward or forward and downward.
How to lift: Nope, I’m not going to say squat. That moves your center of gravity forward, stretching out, straining the back. The healthy way to lift is to actually kneel down, with one knee on the floor and one bent, then raise up strongly.
Just a few adjustments to avoid those chiropractic adjustments.