Energize Sports Massage

Feeling the Pinch?

The Stubborn Shoulder Impingement Syndrome

Do you get a sharp, debilitating pain in your shoulder when you are performing tasks like brushing your hair, putting on certain clothes or showering? During these movements, where you raise your arm out to the side and then upwards over your head, do you alternate between no pain and pain? For example, during the first part of the moment you don’t feel any pain, and then suddenly your shoulder “catches” and there is sharp pain, followed by no pain again as you continue to move your arm upwards.

These are all signs of a condition called Shoulder Impingement Syndrome (SIS), where the tendons of the rotator cuff muscles that stabilise your shoulder get trapped as they pass through the shoulder joint in a narrow bony space called the sub-acromial space. Impingement means to impact or encroach on bone, and repeated pinching and irritation of these tendons and the bursa (the padding under the shoulder bone) can lead to injury and pain.    

Shoulder complaints are the third most common musculoskeletal problem after back and neck disorders. The highest incidence is in women and people aged 45–64 years. Of all shoulder disorders, shoulder impingement syndrome (SIS) accounts for 36%, making it the most common shoulder injury.

You shouldn’t experience impingement with normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen, a condition called rotator cuff tendonitis. Likewise, if the bursa becomes inflamed, you could develop shoulder bursitis. You can experience these conditions either on their own, or at the same time.

The injury can vary from mild tendon inflammation (tendonitis), bursitis (inflamed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness tendon tears, which may require surgery. Over time the tendons can thicken due to repeated irritation, perpetuating the problem as the thicker tendons battle to glide through the narrow bony sub-acromial space. The tendons can even degenerate and change in microscopic structure, with decreased circulation within the tendon resulting in a chronic tendonosis.

What Causes Shoulder Impingement?

Generally, SIS is caused by repeated, overhead movement of your arm into the “impingement zone,” causing the rotator cuff to contact the outer tip of the shoulder blade (acromion). When this repeatedly occurs, the swollen tendon is trapped and pinched under the acromion. The condition is frequently called Swimmer’s Shoulder or Thrower’s Shoulder, since the injury occurs from repetitive overhead activities. Injury could also stem from simple home chores, like hanging washing on the line or a repetitive activity at work. In other cases, it can be caused by traumatic injury, like a fall.

Shoulder impingement has primary (structural) and secondary (posture & movement related) causes:

Primary Rotator Cuff Impingement is due to a structural narrowing in the space where the tendons glide. Osteoarthritis, for example, can cause the growth of bony spurs, which narrow the space. With a smaller space, you are more likely to squash and irritate the underlying soft tissues (tendons and bursa).

Secondary Rotator Cuff Impingement is due to an instability in the shoulder girdle. This means that there is a combination of excessive joint movement, ligament laxity and muscle weakness around the shoulder joint. Poor stabilisation of the shoulder blade by the surrounding muscles changes the physical position of the bones in the shoulder, which in turn increases the risk of tendon impingement. Other causes can include weakening of the rotator cuff tendons due to overuse, for example in throwing and swimming, or muscle imbalances between the shoulder muscles.

In summary, impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity.

When your rotator cuff fails to work normally, it is unable to prevent the head of the humerus (upper arm) from riding up into the shoulder space, causing the bursa or tendons to be squashed. Failure to properly treat this instability causes the injury to recur. Poor technique or bad training habits such as training too hard is also a common cause of overuse injuries.  

Over time pain can cause further dysfunction by altering your shoulder movement patterns which may lead to a frozen shoulder. For this reason, it is vitally important that shoulder impingement syndrome is rested and treated as soon as possible to avoid longer term damage and joint deterioration.

What are the Symptoms of Shoulder Impingement?

Commonly rotator cuff impingement has the following symptoms:

▪   An arc of shoulder pain approximately when your arm is at shoulder height and/or when your arm is overhead

▪   Shoulder pain that can extend from the top of the shoulder down the arm to the elbow

▪   Pain when lying on the sore shoulder, night pain and disturbed sleep

▪   Shoulder pain at rest as your condition worsens

▪   Muscle weakness or pain when attempting to reach or lift

▪   Pain when putting your hand behind your back or head

▪   Pain reaching for the seat-belt, or out of the car window for a parking ticket

Who Suffers Shoulder Impingement?

Impingement syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height also increase the risk of rotator cuff impingement.

How is Shoulder Impingement Diagnosed?

Shoulder impingement can be diagnosed by your physical therapist using some specific manual tests. An ultrasound scan may be useful to detect any associated injuries such as shoulder bursitis, rotator cuff tears, calcific tendonitis or shoulder tendinopathies. An x-ray can be used to see any bony spurs that may have formed and narrowed the sub-acromial space.

What does the Treatment Involve?

There are many structures that can be injured in shoulder impingement syndrome. How the impingement occurred is the most important question to answer. This is especially important if the onset was gradual, since your static and dynamic posture, muscle strength, and flexibility all have important roles to play. Your rotator cuff is an important group of muscles that control and stabilise the shoulder joint. It is essential the muscles around the thoracic spine and shoulder blade are also assessed and treated as these too work together with the entire shoulder girdle.

To effectively rehabilitate this injury and prevent recurrence, you need to work through specific stages with your therapist. 

These stages may include:

1.       Early Injury: Protection, Pain Relief & Anti-inflammatory Treatment

2.      Regain Full Shoulder Range of Motion

3.       Restore Scapular Control and Scapulohumeral Rhythm

4.      Restore Normal Neck-Scapulo-Thoracic-Shoulder Function, including posture correction

5.       Restore Rotator Cuff Strength

6.      Restore High Speed, Power, Proprioception and Agility Exercises

7.       Return to Sport or Work

The early stages of treatment will involve manual therapy, including massage to relieve pain and release tight structures as well as mobilisation techniques to restore normal shoulder movement. Strapping/taping has been shown to be helpful in reducing pain as well as ultrasound and laser therapy. As you move through the other stages of treatment your therapist will prescribe rehabilitation exercises specific to your shoulder, posture, sport and/or work demands.  

Corticosteroid injections can be useful in the initial pain relieving stage if conservative (non-surgical) methods fail to reduce the pain and inflammation. It is important to note that once your pain settles, it is important to assess your strength, flexibility, neck and thoracic spine involvement to ensure that your shoulder impingement does not return once your injection has worn off.

 

Some shoulder impingements will respond positively and quickly to treatment; however many others can be incredibly stubborn and frustrating, taking between 3-6 months to resolve. There is no specific time frame for when to progress from each stage to the next. It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. For more specific advice about your shoulder impingement, contact your local physical therapist.

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for specialist medical advice in each individual case.

Posted 2 days ago
<p>I<b>f you want to be the best you have to learn from the best.</b></p><p>Looking forward to another high class workshop with Paula Clayton on Achilles tendinopathy & Plantarfasciopathy the complete solution.. </p><p>Paula worked as a senior performance therapist for the English Institute of Sport and British Athletics between 2003 and 2014. She has travelled extensively to Olympic Games (Athens, Beijing & London), Commonwealth Games, World and European Championships with GB track and field as part of the medical team during this time.</p><p>Prior to 2003 Paula worked in Premiership and Championship football for 4 years. She has taught on two sports therapy degree programmes, delivered sessions to MSc students and sports medicine students, written a number of articles and has an MSc in Physiotherapy and an MSc in Sports Injury Management. Paula also delivers soft tissue master-classes to senior physiotherapists and soft tissue therapists within premiership and championship football clubs, National Governing Bodies and to soft tissue therapists nationally and internationally through her company <a href="http://www.stt4performance.com/">www.stt4performance.com</a>.</p><p>The workshop is to be held on the 23rd June 2018 at the London School of Osteopathy,12 Grange Road, London SE1 3BE</p>

If you want to be the best you have to learn from the best.

Looking forward to another high class workshop with Paula Clayton on Achilles tendinopathy & Plantarfasciopathy the complete solution.. 

Paula worked as a senior performance therapist for the English Institute of Sport and British Athletics between 2003 and 2014. She has travelled extensively to Olympic Games (Athens, Beijing & London), Commonwealth Games, World and European Championships with GB track and field as part of the medical team during this time.

Prior to 2003 Paula worked in Premiership and Championship football for 4 years. She has taught on two sports therapy degree programmes, delivered sessions to MSc students and sports medicine students, written a number of articles and has an MSc in Physiotherapy and an MSc in Sports Injury Management. Paula also delivers soft tissue master-classes to senior physiotherapists and soft tissue therapists within premiership and championship football clubs, National Governing Bodies and to soft tissue therapists nationally and internationally through her company www.stt4performance.com.

The workshop is to be held on the 23rd June 2018 at the London School of Osteopathy,12 Grange Road, London SE1 3BE

Posted 4 weeks ago

Upper Cross Syndrome

A common complaint linked to the modern lifestyle

Upper-Crossed Syndrome is a tightness of the upper trapezius and levator scapular on the dorsal side (back) which crosses with tightness of the pectoral major and minor on the front of the chest. Weakness of the deep cervical flexors in the neck cross with weakness of the middle and lower trapezius. This pattern of imbalance often causes joint dysfunction. Specific postural  changes are seen with upper crossed syndrome, including forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders and rotation and abduction of the scapula.

Causes

When driving passed a bus stop I am invariably greeted by the sight of a succession of people with heads bent forward and rounded shoulders gazing into their phones. I see plenty of potential future clients. Adopt this posture frequently and for long enough and your body will adapt to what you are asking it to do. The rhomboids, middle and lower trapezius become long, weak and stretched with the pectorals becoming short and tight. We are physically designed as hunter gathers and not meant to be sitting at a computer desk of driving for 7 hours a day. 

What to do about it.

If your job means you have to sit at a desk everyday then its something you don’t have much choice in doing. But all is not lost. A strategy of massage, stretching and strengthening is the answer. Soft tissue work can bring immediate relief to a condition that often leads to headaches, discomfort in the upper back and sleepless nights. I also provide my clients with a suitable exercise program via the website Rehabmypatient.com. 

The aim is to strengthen those muscle groups that have become long, weak and stretched. As well as strengthening the weak muscle groups the aim is to also reverse the clients posture at least a couple of times a day. What I mean by this is that if for instance you are sitting at the wheel of a car for hours per day you are sitting in a state of spinal flexion( bending forward) for hours at a time. To counter this then the client needs to adopt a posture of thoracic extension to be included in their exercise program. The soft tissue work and stretching  resolve the other problems of short tight pectorals etc.and also help with the discomfort of the weakened muscles that have in effect, become locked long and weak (rhomboids, lower and mid traps). 

So there you have it. It is a problem that tends to develop over a period of time which is why I see it as a problem of future epidemic proportions in the younger generation in particular who spend a lot of time on mobile phones, gaming etc.  

Posted 4 weeks ago

What is Sports Massage?

Therapy for sports and occupational injuries.

In order to understand the what exactly sports massage is and its benefits, one must first have an understanding of what is meant by this type of alternative therapy. It is important to understand that “Sports Massage” is not necessarily also just another name for” Deep Tissue massage”, which is simply applying more pressure. This type of therapy is more about understanding all the different layers of tissue in the body, and working with and through those layers to relax, lengthen, and release holding patterns in the body.

It is also important to note that a sports massage is not just for sports people. More than half of my clients come to me with work related / occupational related problems.

Sports Massage is also about working with the myofascial system and trigger points. The myofascial system is made up of a web of connective tissue that both wraps around the muscles and compartmentalizes the body. Muscles are made up of many layers of tissue. The place where muscle contraction occurs in the muscle fiber is called a sarcomere. These are microscopic units and it takes millions of them to contract for even the smallest movement.

A trigger point can be described as a hypersensitive nodule located in the myofascial / muscle tissue. A trigger point occurs when these sarcomeres are over stimulated and are unable to release their contracted state. The result is an interruption of blood flow to the immediate area, which in turn causes oxygen starvation and an accumulation of metabolic waste products (carbon dioxide and lactic acid). This trigger point then sends out pain signals to the brain, which causes one to rest the muscle and avoid using it. This in turn causes the muscle to shorten and tighten up. Symptoms manifested by myofascial trigger points can include muscle weakness, stiffness, edema (swelling), postural distortions, dizziness, and referred pain, meaning signals are getting confused in the body. Trigger points can also compress nearby nerves causing burning, tingling, and numbness in the areas served by the nerve. If left untreated, this often results in increased stress and anxiety for the individual, and more often than not causes lost time from work and other activities.

When you come in for sports massage, the therapist works through those layers of muscle tissue to seek out the trigger points, and works through the layers of fascia to find those “knots” and holding patterns in the myofascial system. By working systematically through the muscle layers the trigger points and myofascial holding patterns are released. This allows fresh oxygenated blood to flow back into the tissues that have been ischemic or oxygen deprived, providing much needed nutrients to the area.

Sports massage has a lot to offer for the individual suffering with back pain, neck pain, leg pain, and or arm pain and problems associated with muscle strain and overuse. It also helps one to decrease symptoms of anxiety and stress through pain reduction and relaxation.

Hopefully this gives you a better understanding of this type of alternative therapy and what it is all about. It is also important to remember that massage like most other aspects of holistic therapy is very individualistic. Everyone has different pressure needs when they come in. Some people feel they have to have a lot of pressure in order to get a really good massage and for them that is a good thing. Others come in and have massive knots but can’t tolerate much pressure at all either because they have never been worked on before or have not been worked on in a long time, or it is just simply too painful. Often people have the misconception that it should be a painful and hard massage, but if you are on a massage table just trying to endure the therapy for an hour, chances are your muscles are only tensing up more. I have found that most trigger points can be successfully eliminated without excruciating pain. It may take a little more time and effort, but it usually can be done. Its a case of getting regular feedback from my clients during the treatment and working within the individuals tolerance. When the muscles can get to a more relaxed state, it makes it much easier to get the “knots” out, and nothing so greatly effects a person’s well being as that healing touch.

Posted 5 weeks ago