Shoulder Injury?? Specialist Physiotherapist Tony Gill shares his wisdom

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Shoulder pain is one of the most common musckuloskeletal problems in the human body after Back pain. Millions  of pounds are lost in the UK each year to sickness and time off work due to shoulder pain. Our Bristol Physiotherapy Clinic is lucky enough to have its own dedicated shoulder specialist who is able to assess diagnose and treat your problem. Tony Gill is not only a shoulder specialist but also a qualified diagnostic ultrasonographer and injection therapist. This means as well as this specialist service our Bristol Physio Clinic has onsite diagnostic ultrasound, guided ultrasound injections and excellent links to all the top shoulder specialist surgeons in Bristol to fast-track your care if appropriate.

Common problems include;

Shoulder Impingement and Sub-Acromial pain

Frozen Shoulder or Adhesive Capsulitis

Rotator Cuff tear

Shoulder Instability/ Dislocation

Acromio-Clavicular shoulder pain and dysfunction

 

Click HERE for more information on each Injury.

If your shoulder is giving you pain or dysfunction then use the  Contact Form or call us on 0117 923 7506 to book a session.

Shoulder Diagnosis By Tony Gill

Common Shoulder Injuries by Tony Gill

 Shoulder Pain, Shoulder Problems and Shoulder Dysfunction

bristol-physio-portrait-tony-gill

Shoulder Impingement

Shoulder-impingement

The most common of shoulder problems, this is a symptom not a diagnosis as lots of separate conditions cause impingement.

Overuse, trauma, rotator cuff weakness or rotator cuff tear all cause Impingement.

Symptoms: Pain raising the arm above horizontal or above the head. A weak shoulder with power movements like throwing  can be painful to lie on but usually has a good hand behind the back movement.

Treatment: Manual therapy to treat tight painful muscles and joints. Specific exercise to retrain the Rotator Cuff to optimise the shoulder control. Exercise and posture work to maximise the trunk and Scapula control which are the base the shoulder works from.

 

Frozen Shoulder

adhesive capslitisAlso known as Adhesive Capsulitis this is a condition that usually occurs in our late 40’s to 60’s and has genetic links. Early diagnosis is crucial as treatment is far more effective in the first 6 weeks and we strongly recommend an early Steroid injection as this condition can last anywhere between 6 months and 3 years. In the initial stages inappropriate therapy can actually prolong the condition and lead to more pain and dysfunction and why it is important to be seen by a specialist who can recognise this condition and arrange the most effective treatment.
This condition usually has 3 stages. The initial painful stiffening freezing phase.  The less painful but stuck frozen phase and finally the improving thawing phase.

Symptoms: Shoulder begins to stiffen and has reduced movements behind the back and out to the side, painful to lie on and severe pain with reaching out movements or jerk movements.

Treatment:  Early Treatment usually involves discussion regarding a capsular Steroid injection which we are able to perform in clinic with discussion with your G.P.
We then treat the associated cervical and myofascial symptoms with a care not to flare the shoulder and worsen or prolong the problem.

 

Rotator Cuff Tear

cuff

Under the age of 30 these are rare and usually involve a high impact trauma. As we age and
get closer to 50-60 years even small forces can cause a tear in an already worn tendon.

Symptoms: They give similar symptoms as shoulder impingement. When the symptoms are more severe we are unable to move the arm away from the body with any power, but might be able to move it with the other arm. This indicates the stability muscles may be torn.

Treatment: Treatment depends on accurate diagnosis highlighting why suspected tears should be seen by a specialist. If a large tear is suspected this should be referred for investigation and a shoulder surgeons opinion. We have excellent links to surgeons in the area and can have you seen rapidly when required.
Smaller tears can be optimised with therapy and even larger tears that are non operable can be treated effectively with specialist physiotherapy.

 

Shoulder Instability

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Shoulder Instability is a big group of problems including Dislocation, Labral tear, Hyper-mobility laxity, Muscle patterning,  Subluxations. 

Symptoms: This is too big a group to discuss in a simple page but if you have dislocated your shoulder and continue to have problems, feel the shoulder keeps popping out or almost popping out or is weak after a trauma then it should have a specialist assessment from a shoulder therapist or surgeon.

Treatment: This depends on the diagnosis but with stable Labral tears, laxity without trauma or hyper-mobility, very specialist exercise and therapy is required. This can get very complex and usually the area we shoulder specialist therapists spend a great deal of time rehabilitating. For the dislocation group it is very important we make sure there is no structural damage and we usually organise specific scans or investigations and/or shoulder surgeon advise to ensure you have the best treatment.

 

Postural Shoulder Pain

posterior shoulder

This is becoming far more prevalent with the use of laptops, mobile phones, Ipads and general reduced extension or upright activities in our lives.

Symptoms: Pain in the epaulette area and scapula and upper back region. Can be worse with static sitting postures and also give us pain in the neck area.

Treatment: Its unrealistic to think any therapist can fully cure this without addressing the postural issues. Treating this effectively requires your full effort to work on posture changes, exercise to stabilise and give more power to your upper trunk plus awareness of the bad habits that are adding to the problem. A good therapist will spend time identifying these as well as giving specific exercise and lifestyle changes. We also use manual techniques to change the joint stiffness, muscle tightness and pain.

 

A/C joint (Acromio/Clavicular Joint) pain

ac-joint-arthosis

I see many of these and when we are young it is usually from trauma even from a fall on an outstretched hand as well as impact to the shoulder. These are often missed as a source of continual shoulder pain post road traffic accident (RTA) form the seatbelt.
As we age usually 40 years onwards this joint can become slightly degenerative and give pain.

Symptoms: Pain on top of the shoulder you can usually put one finger on. Painful with across body movements and end of range high arc movements.

Treatment: As a shoulder specialist who is able to treat with steroid injection as well as physiotherapy, my treatment of choice tends to be a steroid in the vast majority of these as it seems to be the most effective treatment I can offer. I also settle them with manual therapy and acupuncture. If the pain is not settling I do not think it is fair to continue to treat you if it is not improving the problem.

Keen for Winter Cycling Training?

Simon Shepherd
Simon Shepherd

Cross training for cyclists by Simon Shepherd

Remind you of anything:

“New Year, New Goals, New Kit and clothing you want to try out on the bike…But oh look its winter out there, damn. Oh well I’ll go tomorrow!!”

Wrong answer.

Lets be honest no-one really likes getting on the bike for a 3-4 hour training ride when all around you the rain is coming in horizontally and the trees are blowing over at 90 degrees. Kind of takes the fun and beauty out of cycling.

Winter cycling

Now lets face facts, its not all about the bike after all, there are other activities we as cyclists can and should engage in to benefit us as the cycling season approaches. Strength and conditioning work is as equally important as getting the miles under your belt. As cyclists we work in a linear motion often for hours on end, day after day, week after week. lots of repetitive movements in one plane. Trouble is, we are made of bones, joints, ligaments, tendons, muscles; and not forgetting our nervous system, all of which helps us through 3 dimensions in our everyday function and activity. It is therefore important that we make ourselves fit for purpose in a 3 dimensional way.

Core strength

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Ah yes the old ‘core strength’.  A group of muscles including Rectus Abdominus, Transverse Abdominus, Mulitifidus, Internal and External obliques, Erector Spinals, Gluts to name a few.

So what I hear you say??

Well it’s these muscles that need to be strong and fit for purpose to help avoid predisposition to injury and support ourselves whilst we hold our linear static postures for 3-4 hour plus rides. Its these muscles that when strong, fit and efficient help our pedaling become more efficient, help our handling and control of the bike improve and make the sport we all love become much more enjoyable!

Ideas to help train the core:

Firstly keep it simple! The harder and more complicated you make your training regime the more likely the chance of bad form, bad training and potential risk of injury. Aim for 2 sets of 12 to 15 reps initially, 3 times a week, aiming to progress onto 3 sets, then sets with load (weights).  Its also important to stop exercising when your form has gone, or indeed if you feel pain. It is all about quality not quantity after all.

Some simple exercises to consider in your core sessions:
Plank

Side plank

Lunges

Squats

Press ups

For further ideas feel free to have a look at our YouTube Channel. There you will find a plethora of wonderful exercises. My personal favorite being The Founder.

[youtube]https://www.youtube.com/watch?v=rY5qxNxhIqU[/youtube]

Good luck, and remember consistency pays off.

See you on the road

Simon