Rehab

frozen shoulder

Frozen Shoulder

Frozen Shoulder 632 335 Ace Health Centre

The Frozen Shoulder

Adhesive capsulitis (aka frozen shoulder, painful stiff shoulder or periarthritis) is a self-limiting condition where the bones, tendons or ligaments cause pain on movement. Frozen shoulder later progresses too restricted active AND passive glenohumeral ROM. There is disagreement whether it stems from an inflammatory, fibrosing or algoneurodystrophic (a form of complex regional pain syndrome without demonstrable nerve lesions) conditions.
Frozen shoulder can affect the antero-superior joint capsule, axillary recess and the coracohumeral ligament. Common findings may include a small joint with loss of axillary fold, tight anterior capsule, and synovitis but no adhesions. The space surrounding the GHJ has been suspected to reduce from 15-35 cubic centimetres to 5-6cm.

Ethology of frozen shoulder

Frozen shoulder is classified as either primary (idiopathic onset) or secondary (a direct cause). Secondary onsets could include:
  • systemic (diabetes/metabolic conditions/hypothyroidism)
  • extrinsic (CVA, Parkinson’s, direct trauma)
  • intrinsic (rotator cuff/other shoulder muscle pathologies) factors of origin
It is also known as the 50 year old shoulder since it is much more prevalent in this age group. It is especially common in females over the age of 40 and those who are recovering from a mastectomy are at greater risk.
Frozen shoulder can be challenging to differentiate in the early stages from other shoulder pathologies. One of the main presenting factors is loss of external rotation. Restrictions in a capsular pattern present as ER limitations > Abd limitations > IR limitations. Patients may also complain of difficulties with dressing, overhead activities, grooming. Symptoms may also worsen at night.
The time frame for recovery varies greatly from 6 months to 11 years which could be spontaneous complete recovery or nearly-complete. Most tend to resolve around 3 years. Unfortunately, some patients’ symptoms may never fully resolve (estimated to be around 15%).

The three overlapping phases include:

1. Acute/freezing/painful phase: sharp pain with sleep interruptions – 2-9months
2. Adhesive/frozen/stiffening phase: pain decreases lingering at end ROM, ROM decreases in a capsular pattern – 4-12months
3. Resolution/thawing phase: spontaneous improvement in ROM – 5-24months Physical exam is usually sufficient to diagnose frozen shoulder, however X-rays, US or MRI can help rule out other issues.
A definitive treatment for frozen shoulder remains unclear, however, daily HEP along with an exercise therapy program and patient education are key to aid in the patient’s rehabilitation. It is key to manage your patient’s expectations to allow for a successful recovery. PNF has been found to be effective at decreasing pain and increasing ROM/function. MWMs may be helpful and superior than stretching alone during the second stiffening phase.
During the third phase of frozen shoulder rehab , strengthening should be increased with stretching being increased in frequency and duration but at the same intensity. The strongest evidence supports manual therapy and exercise in adjunct to corticosteroid injection.
For the ultimate frozen shoulder rehab contact us today.
unstable shoulder

Unstable shoulder

Unstable shoulder 774 619 Ace Health Centre

The Unstable Shoulder

There is new classification surrounding an unstable shoulder. Based on the Stanmore classification of shoulder instability there are 3 types:
Polar type I (structural instability), Polar type II (Atraumatic instability), and Polar type III (Neurological dysfunction/muscle patterning). This can be simplified to Born loose, Torn loose, Worn Loose.

Polar Type I:

The Unstable shoulder may present with general rotator cuff weakness, and positive apprehension test, while also showing deficits particularly in subscapularis with a lift-off test. As this type begins to progress a patients shoulder may exhibit increased scapular dysfunction, and abnormal muscle activation. Imaging should only be used when there is suspected structural instability, with arthroscopy being useful to pinpoint areas causing instability.

Polar Type II:

May present with increased capsular laxity, excessive ER, a sulcus sign, and potentially GIRD. Abnormal anterior translation may be present due to laxity, scapular dyskinesia, muscle imbalance, and congenital labral pathology.

Polar Type III:

Will present with large muscle activation occurring (Lat Dorsi, Pec Mj, Ant Delt, and Infraspinatus) while other rotator cuff muscles may be suppressed.

What can you do for an unstable shoulder?

Imaging can be used on the unstable shoulder using X-ray at first to gain an insight into the structural damage done and the position of joint. CT and MRI can be used when diagnoses is still unclear and soft tissue imaging could be of greater benefit.
Each polar type causes different mechanisms for instability and pain. It can be helpful to classify patients to better manage symptoms and create the appropriate exercise program. Physiotherapy can be beneficial to help manage symptoms and limit risk of dislocations.
Each program should be tailored to each patient, however early stages should start with regaining ROM, with AAROM or PROM to help normalise the movement. While Isometrics can be used to help with muscle activation, and proprioception (hands on table) to help with joint stability.
Once joint stability has been restored the patient can progress. Progression is to include increased strengthening within varying ranges, and stabilisation exercises (wall ball, wall push ups).
The Unstable shoulder final stage of rehab can include a progressed exercise program. This includes plyometric work and increased dynamic movements and stability work, along with return to sport/work activities.
Why do I have neck pain?

Why do I have neck pain?

Why do I have neck pain? 1280 500 Ace Health Centre

Why do I have neck pain?

Why do I have neck pain? Sometimes there can be no direct cause / incidence of why you have neck pain. Maybe you simply woke up in the morning and thought you slept in a funny position. Perhaps you twisted your neck too quickly to look at something. You might’ve bumped your head or jolted your shoulder during a scrimmage. Maybe you were in a car accident. Or simply, your neck pain just randomly began.

What symptoms Will I Get

Symptoms can vary greatly from person to person. Each person’s experience will be different. But could include one or several of the following:

  • Headaches
  • Dizziness
  • Lightheadedness
  • Nausea
  • Sharp shooting pain
  • Constant achy pain
  • Limited neck movement
  • Tight muscles around the neck/shoulder
  • Radiating pain down the arm
  • Tingly sensations or pins and needles
Factors contributing to the risk of getting neck pain include:
  • Poor posture
  • Anxiety
  • Sporting activities
  • Occupational activities
  • Depression
  • Previous neck injury
  • Age
Did you know that people that office workers have the highest risk and incidence of developing neck pain?
Specific factors for office workers that may increase your risk include:
  • High job strain
  • Long sitting hours
  • Less physical activity
  • Poor postures
  • Low social and work support
  • Job insecurity
  • Poor computer workstation layout

Why do I have neck pain? Physiotherapy Can tell you


Seeing a physiotherapist can help get rid of your neck pain by offering several pain-relieving modalities.

This could include:

  • Activity modifications
  • Advice and education regarding posture and sitting habits
  • Shoulder/head positional changes
  • Neck strengthening and endurance exercises
  • Taping techniques
  • Massage
  • Manual therapy
  • Functional training for neck/shoulder/trunk
  • Dry needling
  • Tailored therapeutic exercises
Your individualized physiotherapy treatment may encompass some or all of the above treatment options. It also depends on how long you have had the symptoms. The less time you’ve had your pain for, the quicker the recovery. Although this timeframe can vary, it is important to seek assistance sooner rather than later. That way, you can get back to doing what you need to do pain-free. Come speak to one of your physiotherapists today to address all your neck needs and concerns.
heel pain in runners

heel pain in runners

heel pain in runners 505 344 Ace Health Centre

The Top 5 Exercises for Heel Pain in Runners

The top 5 exercises for heel pain in runners will be discussed in this blog.
The exercises will help improve muscle strength and promote flexibility in the foot and leg muscles. Ultimately it will allow you to get back to running faster and free from pain.

Exercises for Heel Pain in Runners

1. Plantar fascia stretch – 

This stretch will relieve the tension in the plantar fascia. In sitting with the injured foot resting on the other leg, bend the ankle and toes up as shown in the picture. Hold for 10 seconds and repeat 10 times, do this 3 times per day.

2. Calf stretch – 

Tightness in the calf muscle can make the pain from plantar fasciitis worse.  Stretching the calf muscle can help ease the pain. Stand near a wall with one foot in front of the other, front knee slightly bent. Keep your back leg straight, heel on the ground, and lean toward the wall. Feel the stretch along the calf of your back leg. Hold the stretch for 30 seconds, repeat 10 times 1-2 times a day.

3. Rolling stretch – 

Place a round object like a golf ball or trigger point massage ball under the arch of the foot. Rollback and forth for 2 minutes. Repeat 2-3 times throughout the day.

4. Modified calf raises –

Of the top 5 exercises for heel pain in runners, this one is definitely the most challenging. Its best done barefoot.With a rolled-up towel under the toes. Push up into a calf raise, hold at the top, then slowly lower down. The speed should be 3 seconds up, 2-second hold at the top, 3 seconds lowering. Do 3 sets of 12 reps on each leg. If too painful or difficult, start on 2 legs and gradually progress under the guidance of a Podiatrist or Physiotherapist.

5. Short foot exercise –

The short foot exercise can be a little tricky but with the help of a Physiotherapist or Podiatrist, it can be mastered. The idea is to shorten the foot by contracting the small muscles in the foot to raise the arch.Sit in a chair barefoot and form a 90-degree angle at the knee and ankle. Try to shorten the foot by bringing the ball of the foot towards your heel, doming the arch of the foot. Do one foot at a time and try to avoid scrunching up the toes. Hold for 10 seconds then relax and repeat 10-12 times. Practice throughout the day, you can even do it sitting at your desk.

Conclusion

Combine the top 5 exercises for heel pain in runners with an appropriate level of activity that doesn’t aggravate symptoms. Choose suitable footwear and consider foot orthotics to help the pain settle. Contact us for more information and a consult with our podiatrist

Futsal injury prevention and treatment

Futsal injury prevention and treatment

Futsal injury prevention and treatment 1280 720 Ace Health Centre

Futsal injury prevention and treatment

In this blog we talk about Futsal injury prevention and treatment. Playing soccer / football can be a great activity for all ages, but like any other sport there is always an associated risk of injury. There are some injuries that are more evident in younger players such as Osgoode-schlatters or Severs, while in older players we might see more ACL, meniscus or concussion type injuries. Some common injuries are:

  • Stress fractures
  • Growing pain such as Osgoode-schlatters and Severs
  • Sprained ankles
  • Muscle strain or tears
  • Injured tendons for example Tendinopathy
  • Knee injuries such as ACL, MCL, PCL, LCL, Meniscus injury, Patellofemoral pain syndrome
  • Concussion
  • Shin splints
  • Foot injuries

Out of these there are 4 that stand out more than others.

Most common Injuries

  1. Shin splints – This is the overuse of the muscles along the inside of the leg. It can be related to flat feet and pronation, sudden increase in exercise, poor running posture and weakness.
  2. Ankle sprains – Its easy to sprain an ankle especially in futsal. Fast side to side movements. this can be related to foot posture, flexability and poor balance. This is the most common futsal injury.
  3. ACL injuryACL stands for Anterior cruciate ligament. This ligament is in the knee joint. It gets put under high stress during turning and pivoting. This is why its such a highly injured area.
  4. Hamstring strain – Your hamstring is placed under high stress during most activities. Jumping, running, stopping. This must be rehabilitated properly post injury due to its high load job.

CLICK HERE to find out what signs and symptoms to look for and if you potentially have an injury. 

CLICK HERE to find out the most common futsal and football injuries a podiatrist treats

Futsal injury prevention and treatment is important for every part of the body. Every injury will cause some sort of disruption to the athletes level of performance. At Ace we want to keep you on the court/field performing at your very best. See one of our health professionals to prevent injury or return to your best post injury and at a high level of performance. We are able to provide proper advice and education to better understand your injury as well as provide proper rehab exercises and make shoe recommendations.

 

Contact us today for an appointment. Call us on 5572 6222 or click this link to go to our contact page.

Rotator Cuff Injury

Rotator Cuff Injury

Rotator Cuff Injury 1500 750 Ace Health Centre

Rotator Cuff Injury

What is the Rotator Cuff?

A Rotator Cuff Injury is very common. The rotator cuff is a key group of four muscles that support the shoulder joint. These four muscles allow you to perform all sorts of movements like reaching, twisting, and raising your arm. The rotator cuff muscles attach to bones of the shoulder. These bones include your collar bone on the front, your arm (humerus) bone on the side, and the shoulder blade (scapula) on the back.

Without these bones and attaching muscles, your shoulder would not be able to perform any movements. They make activities seem easy like brushing your hair, getting dressed, lifting, and carrying heavy objects.

What is a Rotator Cuff Injury?

An injury to any one of these four supporting shoulder muscles can occur. Usually, they are from a direct traumatic incident to the shoulder. They can also develop over time from general wear and tear. Injury to the rotator cuff muscles may result in some degree of tearing or inflammation of the muscle. One of the rotator cuff muscles called the supraspinatus is the most common muscle to be injured. This muscle helps lift your arm up to the side. The degree of injury and symptoms can vary greatly depending on several factors.

These include:

  • Age (risk increases with age, especially over the age of 60)
  • Occupation (repetitive arm movements increase the risk)
  • Family history
  • The location of the injury
  • History of trauma
  • The size of the potential tear to the muscle
It is interesting to note, some symptoms of your shoulder pain do not necessarily correspond with the injury severity. In other words, imaging may report a larger tear but you do not report having much pain. It’s important to be aware that this is very common. Your physiotherapist can help guide and treat your specific symptoms and concerns.

What is the treatment?

Physiotherapists can perform special and functional tests to diagnose and treat your injury. Manual therapy, specific exercises, and activity modifications can help regain the stability and strength of your shoulder and relieve your pain.
If you have any questions or concerns about your shoulder feel free to contact your physiotherapist at Ace Health Centre today.
ACL  knee ligament injuries

ACL  knee ligament injuries

ACL  knee ligament injuries 765 402 Ace Health Centre

ACL  knee ligament injuries

A common injury athletes fear is ACL  knee ligament injuries. Why is this though? You may hear announcers talk about an athlete’s rehab journey after they have returned. You may even hear them talk about how bad it will be if it was the ACL that was injured on the play. So why is it that this particular injury is feared more than others?

Purpose of the ACL knee ligament

Like all ligaments, the ACL’s job is to maintain efficient movement within the knee. The ACL helps stabilize the knee and prevents the shin from sliding forward. It does this by attaching from the posterior aspect of the thigh bone (femur) to the anterior portion of the shin bone (tibia). The ACL does not work alone though. There are several other ligaments that surround the knee to help stabilize it. These include the MCL, PCL, and LCL. Along with the combination of ligaments, the muscles surrounding the knee also help the knee move and stabilize.

Mechanism of Injury

For the most part, we will see ACL injuries from athletes involved in contact sports, or sports with a quick change in directions. Depending on the severity, the injury can be classified under grade 1, 2, or 3. Grade 1 injuries can be described as mild, painful with minimal stretching/tearing of ligament fibers. The next is Grade 2 injuries can be described as moderate. It can be painful with up to 50% of ligament fibers torn. And finally, Grade 3 injuries can be described as severe. It may or may not be painful, and complete rupture of the ligament fibers.

Although grade 1 and 2 injuries are not as severe, we can still see recovery times lasting up to 12 weeks. But how do you tell the difference between the grade of injury? While a proper assessment by a health professional can determine this. Athletes will have an idea of when a grade 3 injury has occurred as there will be a popping sound.

Recovery

Now to discuss the injury we all fear as athletes. Grade 3 ACL injury. Grade 3 injuries differ to the grade 1 and 2 injury for recovery as the ligament has been ruptured. This means that most athletes will opt for surgery. ACL reconstruction is a surgery performed to replace the ruptured ligament with a hamstring tendon or patella tendon. So we have a replacement ligament, but why does it take so long for athletes to return to sport? The tendon is not built the same way a ligament is but can adapt to do the job. This takes time for the adaption to take place. The recovery for this can last around 9 months for a full return to sport (sometimes longer).

Following surgery the new ligament will be limited in the movement it is allowed to prevent re-rupture. During this time we may lose muscle mass, and strength in the operated leg. Along with the surgeon’s protocol for exercises, it is important to work with a physiotherapist. A physiotherapist can safely manage exercises, and progress exercises to provide optimal recovery. As we start to feel better, less pain, and stronger we may think we are ready for a return to sport. However, returning too early can increase our risk of re-rupture.

From this understanding, it is important to work with surgeons, doctors, coaches, and physiotherapists to help design a return to sport plan.

Time for bone to heal?

How long for a bone to heal?

How long for a bone to heal? 600 449 Ace Health Centre

How long for a bone to heal?

Time for bone to heal? So, you’ve just broken a bone. Not only having to deal with the pain associated with it, you have to wear a cast and potentially may need surgery. We are given general time frames as to when the bone will heal. But what does this process entail and why are we told 6-8 weeks for bone healing? Bone healing occurs over 5 phases. Initially we will see tissue destruction and haematoma formation (blood clot). Followed by inflammation. Soft bone formation. Hard bone formation, and finally a remodelling phase.

Haematoma formation and inflammation

Within the first week following a broken bone the body will respond by creating a blood clot. This is to provide the bone with increased blood supply and nutrients. Within the blood other responses occur to help begin clearing out dead bone fragments. As well we will see growth factors influence the bone to begin bone healing. Furthermore we will also see increased formation of blood vessels within the blood clot to help supply the area with the needed nutrients.  Similar to tissue healing this is the beginning of the healing phase, and starts from the beginning of injury and may overlap with the next stages of recovery.  This phase can last up to a week before moving on to the next phase.

Soft and hard bone formation

Now following the initial phase and the cleaning of dead bone fragments, the body will begin to form a connection between the two bone ends.  It does this by creating a soft bone made of cartilage in order to help stabilise the break.  From this increased stability the bone is able to continue with the healing process, and will continue to use the methods used in phase one and two to progress to a healthy bone.  As the process continues the soft or cartilaginous bone shifts to a harder bone (trabecular).  This bone will now be evident on imaging and appear swollen with respect to the rest of the bone.  These phases of the healing process can last up to 3 months.  Within this stage you may be given the all clear from your doctor to remove any casts and begin using the affected area again.

Remodelling phase of bone healing

Within the remodelling phase you may have been given the go ahead from your doctor already to start using the area again in a safe manner.  This phase can be simply put as a use it to improve it principle.  As bone is formed around the injury, it constantly reshapes itself to provide more support where its needed.  This phase can last up to 2 years.  This length of time will not prevent you from doing the things you enjoy. Although it is important to understand that although we are back to activity, the bone is still recovering.

It is important to note that with bone healing you should always listen to the advice of your doctor as to when you can return to activity.  Furthermore, it is important to work with physiotherapists to help prevent other complications. Complications may arise, as well as maintain movement in the surrounding areas.

 

Following this a physiotherapist can begin to progress exercises to further strengthen the area and mobility following the prolonged time of inactivity. Contact us today and see how we can help you.

How long until I recover from an injury?

How long until I recover from an injury?

How long until I recover from an injury? 700 400 Ace Health Centre

How long until I recover from an injury?

How long until I recover from an injury?

As we touched on last week, how long until I recover can vary depending on structures involved. This week we will focus on the healing time of soft tissues (muscles, tendons, and ligaments). Soft tissue repair can be broken down to 3 phases: Inflammation, Repair, and Remodelling phase. Each phase holds its own importance in recovery, as well as its own time frame.

Inflammation Phase

As a lot of us may have experienced when we first get hurt is swelling or bruising around the area. Some of the signs that may signal the beginning of inflammation is: Heat, Redness, Swelling, Pain, Loss of Function.

So we might ask what is the point of this and how long will it last?

Our body uses inflammation to bring in more blood and nutrients to the injured site to help begin the recovery process. The aim of inflammation is to contain and limit the injury. Initiate the repair process and splinting of the injured area. As this can be an uncomfortable feeling, we may think it will never end. However the typical length of this inflammation phase lasts anywhere up to 72 hours. This is not to say that we will have no swelling after 72 hours as we may see some lasting effects.

Repair Phase

When recovering from an injury the repair phase begins by overlapping with the inflammation phase. Within this phase we will see the beginning of scar tissue being formed. This scar tissue is weak and randomly laid down to quickly repair the injured area. Within this phase we will see an increase in movement, and decreased levels of pain. This phase can last anywhere up to 2-6 weeks.

Remodelling phase

The remodelling phase is further broken down to two stages. In the first phase the weaker scar tissue being put down begins to shift toward stronger scar tissue. This first stage takes up to 2 months before shifting to the second stage. Within the second stage the scar tissue is being remodelled.  This remodelling phase can last anywhere from 2-12 months. This scar tissue is remodelled through forces acting on the scar tissue which can consist of exercise, massage, or mobilization of the scar tissue.

From this we can better understand the question of ‘how long until I recover?’ Although we can be pain free within the first few weeks, it is important to know that healing can continue for up to 12 months. This continued healing is to better allow the tissue to return to its optimal level. Contact us now to get your recovery started.

When Can I Return To Sport after an injury?

When Can I Return To Sport after an injury?

When Can I Return To Sport after an injury? 600 400 Ace Health Centre

When Can I Return To Sport after an injury?

As an athlete this is a question you may ask yourself  ‘When Can I Return To Sport after an injury?’ post injury. However the biggest challenge to returning can be an injury that has sidelined you. There are a few factors to consider when planning on returning to sport. These can be: the time since the injury, the type of injury, or the effects of the injury on our body. So how will we know when it is safe to return to sport?

Timing of Injury

As our bodies take the time to properly recover from an injury, it is important to know what this means for our return to sport. Early on following an injury our bodies begin to protect us. It does this by creating inflammation around the area. This so you may noticed an increase in size. Along with this you may find you have less movement in the area. You may even notice a colour change of the skin/bruising. This is the bodies natural protective process which allows more blood flow and nutrients to enter the injured area.

However what a lot of us have probably noticed is that the area becomes a lot more sensitive to touch or movement. This  may cause an increased levels of pain for something that should not hurt. This process of inflammation will typically start within the first 24 hours, and should last about 3 days.

Type of Injury

Now as we let our natural healing process begin with inflammation, the type of injury can have a huge impact as well. Each sport holds its own risks as to what area or structure will be injured. Some sports are more prone to different types on injury. Some are muscle injuries, while others we see ligaments being stretched or torn, and we may even see a bone break. With muscle injuries we can generally see a healing times of 2-4 weeks. This is dependent on the severity of the injury. While when we look at ligaments we may see healing time frames of 6-12 weeks.

However a ligament injury can sideline us for up to 9 months depending on the severity and which ligament. Finally looking at broken bones, healing times can range from 6-8 weeks for minor breaks. This can increase that duration to 30 weeks, depending on the severity.

Lasting effects of the Injury

As athletes, we want to return to sport as fast as possible. This means we may find ourselves asking, “when can I return to sport?” Although we see injury healing times or feel no more pain and think we are ready to return, however that is not true. With any prolonged time off, and potential surgeries or casting of our injuries there are other things to consider before returning. This prolonged time off and lack of use can leave our muscles weak, or our fitness at sub-par levels.

Although we may have met the time frame given to us for our injury to heal, it is important to get our body back to game shape. Returning to game shape is not always about lifting heavy weights and going for runs. It is using every aspect of the game to make our body function at its highest level.  So the question still remains “When Can I Return To Sport after an injury?”

When can I return to sport?

Return to sport is variable for every athlete and injury, it is important to work with coaches, doctors, physiotherapists and anyone else involved to allow the optimal time to recover and return to game shape. Physiotherapists will give you a guideline as to how to progress through activities and exercises. Furthermore they will be able to better understand how the injury happened in the first place and provide a program that will prevent a future repeat of the injury and safely return you to the game you love.

Call us today so we can help you return to your sport!