Rotator Cuff Physiotherapy
Many have heard of the rotator cuff in the shoulder and, not surprisingly, believe it to be a single part of the shoulder. The rotator cuff is, in fact, a group of four muscles that work together to provide dynamic stability of the shoulder joint, helping to control the joint during rotation:
- Teres Minor
The Supraspinatus is a small muscle which you can feel above the bony ridge on the back of your shoulder blade (scapula). It attaches to the top of the arm bone (humerus), just below the shoulder joint. The task of this muscle is to move the arm sideways away from the body for the first 15 degrees. After that other muscles take over most of the load, it is an area of the should that can be torn and is popular for ‘Rotator Cuff Physiotherapy’
The Infraspinatus is a thick triangular muscle, which occupies the main part of the sculptured dent in the back of the shoulder blade, below the bony ridge. As one of the four muscles of the rotator cuff, the main function of the infraspinatus is to turn the arm out as in the backhand in tennis and stabilise the shoulder joint.
The Subscapularis is a large triangular muscle at the front of the shoulder blade, between the shoulder blade and the rib cage. It attaches to the top of the arm bone (humerus) and into the front of the shoulder capsule. Its role is to turn the arm in.
The Teres Minor muscle sits below the Infraspinatus. It is quite a small rounded muscle and its primary task is to stop the arm moving up when it is moved out sideways (abducted). It also helps the Infraspinatus turn the arm out.
TREATMENTS FOR ROTATOR CUFF TENDINITIS
Rotator cuff tendinitis describes the inflammatory response of one or more of the four rotator cuff tendons, due to impingement or overuse, and leading to more and more micro-trauma that can then lead to a tendon rupture and will require Rotator Cuff Physiotherapy.
The inflamed thickening of the tendons often causes the rotator cuff tendons to become trapped under the acromion (the bony projection of the shoulder blade over the shoulder joint) – like a carpet stuck under a door – causing sub-acromial impingement. Failure to heal then leads to further damage. Early treatment of tendinitis, therefore, is necessary in order to prevent the development of more chronic and serious conditions.
Treatment can include: first and foremost scapula re-education exercises, postural exercises to lessen the impingement, gentle shoulder mobilisations and massage, aided by local electrotherapies, such as laser, pulsed shortwave, shockwave and deep oscillation. Specific rehab exercises can help guide you back to full fitness.
Marathon Performance for the Lullaby Trust
Lorna Hopkin from Brocton, Stafford is elated to have completed Sunday’s gruelling 26.3 mile Virgin London Marathon. Lorna a Marketing Manager at Tamworth based Summit Systems, and her brother Gavin Aiken, ran on behalf of the Lullaby Trust, supporting families effected by Sudden Infant Death Syndrome. The duo chose the charity following the tragic loss of Lorna’s son Leo to SIDs last year aged just 5 weeks. They have raised an incredible £8,500 for the charity with donations still flowing. Please see Just Giving Site.
“We are absolutely amazed by the generosity of everybody more than doubling our fundraising target. The marathon was incredibly hard but I felt I had no choice but to complete it for Leo and everyone who put their faith into us. There were more than a few tears shed by the whole family at the end. We hope the money provides beneficial support to families enduring the pain of SIDS.”
Lorna found the challenge harder than anticipated after a back injury earlier in the week left her unable to walk properly. After some impromptu advice she managed to get an appointment at Nicky Snazell’s Pain Relief Clinic, where her pelvis was assessed and the muscular spasm treated accordingly. Lorna says:
“When I arrived I found that a friend who worked there, Erica Byrnes, had already paid for my treatment in support of the cause which was so incredibly kind it brought a tear to my eye. The service was fantastic and I left renewed.”
“On race day, I was still experiencing some back pain as expected, but knowing the underlying cause was gone, I decided to attempt the race. The first few miles were really painful, then it settled down and my toe took over. By mile 15 my toe was in agony so I stopped a few times then eventually took my shoe off to reveal a hole in my sock strangling my toe!! Thankfully once moved pain relief was immediate and I was able to continue”.
“The Lullaby Trust had cheering stations at mile 9 and 19 which kept me going. I had a mini breakdown at mile 23 but accepting sweets of strangers got me going again. Seeing the London Eye and Big Ben, and hundreds of people shouting my name and cheering made the last mile amazing.
“Passing through the finish line and feeling the weight of the medal around my neck was one of the best feelings ever.
“I then had to get across London to the Lullaby Trust after party. I felt like a celebrity with people high fiving me, giving up seats on the tube and asking questions. The after party was great too with a much needed shower and sharing stories with other families effected by SIDS.
“Running the London Marathon has been one of the hardest but best experiences of my life. I am delighted to have been able to raise so much money in Leo’s memory and it was wonderful to feel him smiling down from heaven on me for the day.”
Traffic light approach to health, what do I mean ?Traffic Light Approach to Health
At my clinic, I always ask my patients to fill in a questionnaire about their
current health, and their answers are incredibly useful in letting me see
where they need to improve their mindset, their nutrition, their fitness and
their lifestyle. I call it the traffic light approach to health because we analyse
these areas by saying whether the patient is green (good), amber (room for
improvement) or red (poor). These are your fitness keys, and they will tell
you where you need to improve. With this in mind, I have developed four
questionnaires – one for each key – and have placed them in the appendix
of this book. If you want to get the most out of this book, I urge you to
complete the questionnaire at the start of each chapter, and again after
you’ve absorbed the knowledge and implemented some of my suggested
changes into your life. Soon, you should start to see your traffic light scores
changing from red or amber to green on all counts. When this happens, you
are likely to be at your optimal health for your age, which means you’ll be
giving yourself the best possible chance if a disease or injury should occur.
So, to those therapists and doctors who want to go beyond their specific
training and look at the synergy of everything they know in order to create
their own map, here is mine.
If you don’t want to commit to a new, healthy you, then now is probably a
good time to leave my blogs. If, however, you desire to work towards a healthy, fit,
pain-free body, here we go. It’s time to take your health into your own hands
and get rid of all the pain that has been holding you back
Welcome back to the new series of articles about physiotherapy and common injuries and pathologies seen by physiotherapists. Last time we took a brief look at one of the most common musculo-skeletal conditions that a physiotherapist will encounter – tennis elbow (also known as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia). This article will now look at the anatomy of the elbow and the muscles connected to it in detail so that we can have a good idea of what is hurting or being injured in tennis elbow and can maybe start to have an idea of what causes it.
The elbow is an amazing piece of biomechanical design and is comprised of 3 bones – the humerus which is the upper arm bone and two bones in the forearm called the radius and ulna. The radius runs from the elbow to the thumb and the ulna starts at the bony prominence on the back of your elbow (olecranon process) and runs down to the wrist. To make it easy to remember which bone is which, when I was a student I used to repeat “the ulna is underneath the radius”. Simple I know but effective nonetheless when you are a physio student desperately trying to cram in your anatomical knowledge.
Now as we are looking at tennis elbow we are not going to look or worry too much about the actual elbow joint itself except to say that it has two ways of movement – flexion and extension (basically straightening and bending) and pronation and supination (pronation is rotating the hand palm down and supination palm up). It may seem strange that in a condition called tennis elbow we will be ignoring the elbow joint itself but hopefully the reason why will become clear soon.
The key part of the elbow in tennis elbow that we really need to examine is the lateral epicondyle – this is the point where all of the wrist extensors and finger extensors start from and is the point at which pain is felt in tennis elbow, it is also called the common extensor origin (for reasons which will become apparent soon) and is the site of attachment for the common extensor tendon. Pain here is the cardinal sign for tennis elbow that all physiotherapists look for.
Running from the lateral epicondyle and the common extensor origin are all of the muscles that extend the wrist and the fingers – extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor indicis and extensor digiti minimi. Two other muscles have attachments at the lateral epicondyle – supinator and anconeus. All of these muscles merge together here to form what is known as the common extensor tendon which then attaches to the lateral epicondyle. So it is fairly obvious that this common extensor origin is an important point in wrist and finger extension and may well be a likely site of injury that physiotherapists will need to examine.
Before moving on it is worth considering the actions of a couple of these muscles in more detail extensor carpi radialis brevis and extensor carpi ulnaris have an important synergistic role in stabilising the wrist – they both act at the same time in concert with their flexor brothers (flexor carpi ulnaris and flexor carpi radialis) to prevent side to side movement at the wrist (ulnar and radial deviation). The two extensors also act together at the same time you grip an object to hold the wrist in extension a bit and prevent the finger flexors from flexing the wrist. In fact studies have shown that extensor carpi radialis brevis is the tendon most commonly injured in tennis elbow and the most common point that it is injured at is the common extensor tendon.
So hopefully from the above brief anatomy lesson we can now see that any extension or even flexion of the wrist is going to put a large amount of stress through the common extensor tendon and in turn if this tendon receives any injury we are likely to feel pain at the lateral epicondyle – which is where patients with tennis elbow will normally describe to their physiotherapist that they feel pain when they pick things up.
The next article will look at the physiology and some of the reasons why tendons get injured and why tennis elbow can often become chronic and last for a long time.
This will be the first blog post in an upcoming series about physiotherapy and common pathologies or injuries seen by physiotherapists. We will be examining in detail the causes and nature of various pathologies, who they affect, treatment options, self-management and how physiotherapy can help. The first pathology that I would like to deal with is an extremely common but frustrating and painful condition called tennis elbow that as a physiotherapist I encounter regularly in practice.
Tennis elbow has several other more complicated sounding names such as lateral epicondylitis, lateral epicondylosis and lateral epicondylalgia. All of which basically try to describe the fact that the pain people feel is at the outside (lateral) bony bit of the elbow (epicondyle). The pain normally comes on when picking up heavy objects, twisting items such as screwdrivers and can be quite sharp and uncomfortable.
It is one of the most common musculo-skeletal conditions that a physiotherapist will see and affects approximately 3 – 11/1000 patients per annum (Dingenmanse et al 2012). It is thought to occur in 1.4% of the population (Shiri et al 2006), now these do not sound like huge numbers but when you consider the size of the UK population (roughly 60 million) then 1.4% of the whole population is a lot of people! It is 7 – 9 times more common than the next most common elbow injury: golfer’s elbow (medial epicondylitis) (Walz et al 2010) and causes prolonged time off work especially in chronic sufferers (Walker-Bone et al 2012). Numerous studies have shown that it is associated with handling tools and repetitive twisting and lifting actions of the forearm (Van Rijn et al 2009) basically meaning that if you are an electrician, carpenter, manual labourer or a housewife then you are at an increased risk of developing the condition.
So… what causes it? Well that is a common question for physiotherapists and seemingly a simple question. Unfortunately it is a complicated answer and will need us to look in some detail at both the anatomy of the elbow and physiology of tendons. Which will be covered in the next blog post.
Dingenmanse R., Randsdorp M., Koes B., Huisstede B. (2012) Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review British Journal of Sports Medicine Published Online
Shiri R., Viikari-Juntura E., Varonen H., Heliovaara M. (2006) Prevalence and determinants of lateral and medial epicondylitis: a population study. American Journal of Epidemiology 164 (11): 1065 – 1074
Van Rijn R., Huisstede B., Koes B., Burdorf A. (2009) Associations between work-related factors and specific disorders at the elbow: a systematic literature review Rheumatology 48: 528 – 536
Walker-Bone K., Palmer K., Reading I., Coggon D., Cooper C. (2012) Occupation and epicondylitis: a population-based study. Rheumatology (Oxford) 51 (2): 305 – 310
Walz D., Newman J., Konin G., Ross G. (2010) Epicondylitis: Pathogenesis,
Imaging, and Treatment Radiographics 30 (1): 167 – 185
The most important motorbike race of the year to Japanese manufacturers is the Suzuka 8 hour race in Japan. Winning this race is especially important to Honda.
The winners this year were Leon Haslam and Michael Van Der Mark, both of whom recently came to Nicky Snazell’s Pain Relief Clinic for treatment. Michael was able to attend for more sessions of treatment than Leon, and Michaels rapid recovery following a crash at Monza has been commented on by the TV media. Michael broke four bones in his foot and on returning to Holland was advised that all that he could do was rest for 8 weeks.
Fortunately Leon knew of our clinic and he got Michael to fly over for treatment with us and he walking pain free after just 3 treatments and then racing at Donington the following weekend.
There is a good chance that Michael would not have been able to race at Suzuka without our breakthrough technology helping him.
Leon & Michael won the race for Honda with their riding skills, and just a little help from us.
Unless you fall off, cycling is a sport that causes very little, if any impact injury and is relatively body-friendly. On the road, there’s no impact to jar your joints as you would find in running. In mountain bike riding, although there is still no direct impact there is an element of vibrational force depending upon the type of terrain you ride. Like any endurance sport however, cycling can produce a catalogue of niggling aches and pains, which unless diagnosed and properly treated can often lead to something more serious.
If you are a regular cyclist, maybe training for you first charity ride or even a sportive, it is important that you know how to spot the signs of an injury and that you get the correct treatment and advice to correct any problems.
Orthotics when properly prescribed can reduce pain and improve athletic performance.
Cricket injuries will start with the cricket season. Make sure you are properly prepared in order to get the most out of the season.