SPORT blog

ELBOW INJURIES - Olecranon Bursitis (Students Elbow)

The Olecranon is the top part of the Ulna bone in the foream. It is the bony part that you lean on at the back of the elbow. A Bursa is a small sac that houses some fluid. This fluid is very similar to fluid in other joints called Synovial Fluid. There are several bursae found around the body, and there is one found over the Olecranon in the elbow. The purpose of the bursae is to give smooth movement between the bones that stick out.

Bursitis means inflammation of the bursa. Olecranon Bursitis is the most common bursa to become inflamed. Inflammation can be caused by a bleeding into the bursa, or repeated loading of the elbow, which will cause swelling and extra fluid to form.

Causes

1) A repeated, but mild injury, is the most common cause. A prime example of this is leaning on your elbows constantly which causes friction and a mild injury over the Olcranon. It is commonly given the name ‘Students Elbow’, because of people leaning on their elbows while studying. It could also be given the name ‘Miners Elbow’, or ‘Plumbers Elbow’, due to crawling alot on your elbows. 2) An accidental blow to the area, or a fall onto the elbows, could set off an inflammation response. 3) Generalised Arthritis could cause one or more bursae to become inflamed, but not usually in the case of Olecranon Bursitis. 4) Infection of a bursa could occur if there is a cut in the skin over the bursa which in turn could cause bacteria. 5) There are a few cases that can occur for no apparent reason at all. But in my experience, there is always an underlying problem, maybe a forgotten mild injury.

Symptoms

1) Pain is felt at rest and with movement. 2) Swelling and tenderness occur over the tip or the elbow after bleeding into the bursa usually following forms of impact. Sometimes the skin is also broken. 3) Small blood clots can form in the bursa which can cause an irritation in surrounding tissues. Inflammation is likely and an outpouring of fluid. 4) When there is inflammation of the bursa, or if it has been under prolonged pressure, it becomes swelled with fluid and the overlying skin becomes red and tender to touch. The swelling could extend into the forearm. 5) Mobility is limited in the elbow joint.

Olecranon Bursitis (Students Elbow)

Treatment

1) You may need no treatment at all. Just a small swelling is very common, and will often clear by itself. If there is a small amount of fluid left after the inflammation has gone then this can be left alone. A large amount of fluid left can look unsightly. Basically, in this case, rest until symptoms have gone. 2) The doctor may drain the blood and fluid by puncturing the bursa, this is called Aspiration. Sometimes the fluid can build up again even after being drained. In this case it is wise to wear an elbow support for compression from our Online Sports Shop at Serious About Sport, this will make sure it doesn’t happen again.

Vulkan Elbow 3mm

Elbow Support

3) The doctor may give a local steroid injection when inflammation will not go. 4) Surgery may be needed to remove the bursa, if it has been affected by repeated inflammation especially if loose bodies or adhesions are present. It is done Arthroscopically (keyhole). 5) Antibiotics will be needed if the cause of bursitis is infection.

To protect the elbow from excessive friction and rubbing to prevent further bouts of Bursitis, it may be wise to elbow pads, especially if you are to lean on your elbows while working.

July 17, 2009 at 3:08 pm · Filed under Sports Injuries

ELBOW INJURIES - Tennis Elbow

Tennis is played by all age groups. Tennis Elbow is the name of a painful condition which affects the outside of the elbow. It is very common in people aged between 35-55. Depending on how bad the symptoms are, can take from 2 months to 2 years to fully heal. Tennis Elbow is also known by its medical term Lateral Epicondylitis, and affects the outside of the elbow bone called the Lateral Epicondyle. The problem is caused by damage to a tendon. This tendon joins the Extensor Muscles of the forearm to the upper arm bone, the (Humerus). The tendon is called the Common Extensor Tendon.

Illustration showing the elbow joint

The Elbow Joint

The tendon can be damaged by lifting something very heavy which can cause the tendon to tear. The most common cause is Overuse. This overuse can cause tiny tears in the tendon.

Causes

If you were to play tennis 3 times a week, but you hadn’t played for some time, this is a prime example of overuse that could cause Tennis Elbow. This is not the only way that you could develope Tennis Elbow. There are varied and different activities that would involve repeated hand, wrist and forearm movements, that could well be the cause. Here are just a few:

1) Using a computer mouse with bad arm and neck posture. 2) Using a computer keyboard. 3) Using any equipment that vibrates such as a strimmer. 4) Using scissors or shears. 5) All gardening. 6) Manual repetitive work involving twisting and lifting the wrist. This could include plumbing, bricklaying and using a screwdriver. 7) Playing a musical instrument like a violin.

Symptoms

1) The main symptoms are pain and tenderness on the outside of the elbow (lateral part), and also the muscles on top of the forearm. It is more common that Tennis Elbow will affect the arm of your more dominant hand, the arm you use the most. The symptoms will develope gradually, and the pain may go away after a day or two. Obviously, if you repeat the activity that triggered the pain, it will get worse because you will damage the tendon even more. The pain could become constant and in some cases can affect your sleep. 2) A weakness in the wrist could cause problems in carrying out simple movements or tasks, such as lifting a plate or a cup of tea, opening a door handle, wringing out a wet cloth, or even shaking hands. 3) A tender point can be found by pressure caused over the Lateral Epicondyle, see above. 4) Pain will occur over the Lateral Epicondyle when your hand is Dorsiflexed (flexed), at the wrist against resistance.

Wrist is Dorsiflexed Against Resistance

This is a sure way of diagnosing Tennis Elbow. 5) There is also another good diagnosis test called the ‘Positive Middle Finger Test’. When the middle finger is extended against resistance, there will again be pain over the lateral elbow.

Treatment

The first thing to do is to reduce the pain and inflammation by applying ice for 2-3 days, 3 times a day, for about 15 minutes each time, remembering not to apply direct to the skin, but on a damp cloth. There is no need for elevation and compression as swelling is not a problem.

You should rest actively, meaning rest the injured area and try to avoid movements that trigger the pain, but you should continue with activities like running or cycling, in other words, conditioning exercises.

Once the injury has started to improve, you could start applying local heat and using a heat retainer such as one of our Vulcan Elbow Supports from our Online Sports Shop, Serious About Sport, which will help to heal the injured tissue quicker.

You can also try treating with ice massage and then alternating with heat treatment. Taping the wrist to support the elbow joint under load is also very helpful and effective in some patients. Another effective use is a brace which can be used to reduce the load on extensor muscles. You should apply this when the arm is relaxed and kept in position until the rehab period is over. Thyse are my preferred methods of treatment, but on occassions you may need to take anti-inflammatory medications, or need to have local steroid injections in persistent cases. In extreme cases surgery may be needed. Hopefully it will never come to that.

Vulkan Neoprene Elbow Support

Price - £14.99 Tennis Elbow Brace

Exercise and Rehabilitation

I would advise stretching the extensor muscles of the forearm. This will give a full ROM, and align the tissues for repair.

1) Your first stretch should be first to extend your arm out straight, palm face down. Then pull your hand upwards towards your forearm, and hold , in a relaxed stretch not a painful one, for 20-30 seconds. 2) Your second stretch is the reverse of this. You will pull your hand downwards towards the underside of your forearm, and hold for 20-30 seconds in a relaxed stretch. If it is painful then keep your arm bent during the stretch.

By doing these stretches regularly, you will soon show good signs of improvement, and resistance exercises can then start for strengthening. Any weight should be light at first, and you may need to use resistance bands before going to dumbells. You could try wrist curls, that work the underside of the forearms and the tops of the forearms. If you hold a light dumbell in each hand while sitting down. Put your bent arms on your thighs with your wrists hanging over the end of your knees. You can try this first with your palms up which will work the underside of the forearms, and then with palms down to work the top of the forearms. Just curl the weights upwards at the wrist then slowly lower. You should do 3-4 sets of 25 repetitions for each set of exercises. When this becomes easy to perform, the weight should be raised by 2 kilogrammes.

Another exercise is to hold a tennis ball in the palm of your hand and squeeze and hold the squeeze for a second each time. Do this 10 times and twice daily.

Healing

Tennis Elbow is self limitating, which means at some point it will heal. Sometimes, and most of the time, it will heal very quickly. But sometimes symtoms will persist and may last from 2 weeks to 2 years, especially if the patient continues to load the arm and does not seek advice. Any strenuous activity can resume when the arm is fully mobile, has normal strength, and is pain-free.

If surgery has taken place, then you will need to wait 8-10 weeks before resuming any tennis again.

July 11, 2009 at 2:30 pm · Filed under Sports Injuries

SHOULDER & UPPER ARM INJURIES - Deltoid Muscle Strain/Rupture

Tears of the Deltoid Muscle do not occur very often, but do occur in handball and volleyball players, Amercan footballers, weightlifters and wrestlers. In most cases the muscle is damaged by direct impact, but can also be injured by overuse. The tear actually affects a small part of the muscle. This will make it difficult to raise the arm upwards.

The Deltoid Muscle Strain is located at the big muscle on the shoulder. There are 3 parts to the muscle: the front (anterior), middle and back (posterior). The muscle helps to lift the arm sideways (abduction). The front part helps to lift the arm forwards (flexion) and the back part helps to lift the arm up backwards (extension).

Deltoid Muscle

Symtoms for Deltoid Muscle Strain

1) A sudden sharp pain in the muscle at the back of the shoulder. 2) Pain when lifting arms from the side out and backwards against resistance, when keeping the arm straight (extension). 3) Pain when lifting the arm from the side up sideways against resistance (abduction). 4) Swelling and tenderness at the site of the muscle tear.

Grade 1 Strain

1) Tightness in the muscle. 2) The patient may be able to use their arms as per normal and do press-ups. 3) There probably won’t be mach swelling. 4) There also won’t be alot of pain when the patient is asked to lift the arm up sideways or to the front or back of the body.

Grade 1 Treatment

1) For the first 48hrs apply ice, 15 minutes each time, but not directly to the skin, wrap in a wet cloth. 2) Stretch the back of the shoulder if no pain is felt.

Back of Shoulder Stretch

3) Strengthen the shoulder muscles.

4) You can also come and see me John Stangroom, and I will advise on treatment and rehab + use sports massage techniques to speed up recovery, or use ultrasound and electrical stimulation treatment.

Grade 2 Strain

1) The patient will probablly not be able to use the arm properly or do press-ups. 2) There may be twinges of pain during activity. 3) May be, or notice swelling. 4) Pressing into the muscle causes pain. 5) Also lifting the arm to the front, side or back, causes pain.

Grade 2 Treament

1) Ice as mentioned above and rest. 2) Consult an injury specialist who will advise on treatment and rehab. 3) You could also use a heat retaining shoulder support from our Online Sports Shop at Serious About Sport.

Serious about Sport Vulcan Shoulder Support £29.99

Grade 3 Strain

1) The patient may not be able to move their arm. 2) They will be in severe pain. 3) They will have alot of swelling that will appear immediately. 4) By contracting the muscle may cause a bulge to appear and be very painful. 5) Could take 3-12 weeks to totally go.

Grade 3 Treatment

Same treatment as at Grade 2 Strain above, but may need surgery only if necessary though.

July 4, 2009 at 12:49 pm · Filed under Sports Injuries

SHOULDER & UPPER ARM INJURIES - Tear of the Long Tendon of the Biceps

The biceps muscle is located in the front of your upper arm. It helps you to bend your arm at the elbow and also to rotate your arm. It’s other function is to stabilise the shoulder.

Tendons are used to attach muscles to the bone. The biceps tendon attaches the biceps muscle to the bones in the shoulder and in the elbow. The upper end of the biceps muscle has 2 tendons (Long Head, and Short Head) that attach to bones in the shoulder. The long head attaches to the top of the shoulder socket (Glenoid). The short head attaches to the shoulder blade (Coracoid Process).

1) ulna
2) humerus
3) radius
4) biceps brachii tendon
5) short head of biceps tendon
6) scapula
7) coracoid process
8) acromion process
9) biceps brachii
10) long head of biceps tendon

Biceps Tendon tears can be either partial or complete. I find that torn tendons normally begin as a fraying of the tendon. The damage gets worse and the tendon can completely tear, sometimes by lifting a heavy object. Normally it is the Long /Tendon of the Biceps that is injured, because it is more vulnerable as it runs through the shoulder joint to attach into the socket. Because the Biceps has 2 attachments at the shoulder, the short head rarely tears, so people can still use their biceps if the long head does completely tear.

Causes

There are 2 main causes of Biceps Tendon tears, injury and overuse.

Injury - Falling hard on an outstretched arm, or lifting something that is too heavy, could cause a tear in your Biceps Tendon.

Overuse - Alot of tears are due to wear and tear and fraying of the tendon. This fraying will happen slowly over time, especially as we get older. It gets worse with overuse, which in this case, is a constant shoulder movement again and again. Overuse can cause different shoulder problems, e.g. rotator cuff injuries, shoulder impingement and tendonitis. This will put more stress and strain on the Biceps Tendon, which will weaken or even tear it.

Other factors to take in to account for tendon tears are 1) Age. The older we get the more wear and tear we will have on the tendon than in younger people. 2) Heavy Overhead Activities. Tears are seen in gymnasts, tennis players, badminton players, wrestlers, rowers, javelin throwers and especially weightlifters. Too much loading on weightlifting is a typical example of this risk. Many jobs also require heavy overhead lifting which puts wear and tear on the tendons. 3) Smoking. Using nicotine can affect nutrition in the tendons. 4) Corticosteroid Injections. This type of medication has been shown to increase muscle and tendon weakness.

Symptoms

1) There is a sudden sharp pain in the upper arm and anterior (front) of the shoulder. 2) You sometimes will get a popping or snapping sound. 3) Swelling can be seen over the front part of the upper arm. 4) The biceps muscle will cramp with hard use of the arm. 5) Could sometimes see bruising from the middle of the upper arm to the elbow. 6) In early stages you will not be able to contract the muscle against a resistance. 7) Strength will be effected when the elbow joint is flexed and the forearm is twisted, hand palm up. 8) A slow contraction of the biceps will show a more prominent swelling than that of the normal biceps of the healthy arm. The muscle will not be able to flex the elbow jointfully.



Treatment

My initial treatment would be Ice treatment, 15-20 minutes a time, at least 3 times a day, for a few days. Ice packs can be purchased from our Online Sports Shop, Serious About Sport. Do not apply ice directly to the skin.

Rest as much as possible, and certainly avoid heavy lifting and overhead activities. This will relieve pain and limit swelling. Using a sling may be recommended for a short time.

I would advise flexibility and strength exercises and design and monitor a rehabilitation programme appropriate to the injury and the patients sport.

The doctor may prescribe nonsteroidal anti-inflammatory medications like ibuprofen, aspirin or naproxen to reduce pain and swelling.

Healing

If surgery is not needed, then strength and mobility exercises can start as soon as the pain begins to go away. After some treatment there may be some weakness.

If surgery is carried out, R.O.M. (range of motion) exercises can start within 1-2 weeks. Conditioning exercises that do not include the upper arm, can start early. You can gradually increase the strength training a few weeks later. Any contact sports should be avoided for at least 2-3 months.

June 25, 2009 at 12:21 pm · Filed under Sports Injuries

SHOULDER & UPPER ARM INJURIES - Clavicular Fracture

Broken Collarbone

The Clavicle (collarbone), is the bone over the top of the chest between the breastbone (sternum) and the shoulder blade (scapula). It is easy to feel as it is one of the only bones that is not covered by muscle but most of it is only covered by the skin.

Clavicle Fractures are very common. The broken collarbone can occur in babies, during birth coming down the birth canal, in children because the clavicle hasn’t fully developed until late teens, in athletes because of being hit or falling, and in general many types of accidents and falls.

Clavicle Fractures are a very common injury, and they can occur in different ways. Normally patients will have fallen on an outstretched hand, or have fallen and hit the outside of the shoulder. The clavicle can also fracture from a direct hit.

Falling on an Outstretched Hand

Symptoms

Most of the time the patient will have shoulder pain, and find moving the shoulder very difficult. There will be swelling and bruising around the broken bone, and once the swelling has gone down, you will be able to feel, and sometimes see, the fracture through the skin. There will be a sharp pain when any movement is made, and the patient might experience a dull to extreme aching around the clavicle area and the associated muscles. Sometimes you might suffer nausea, dizziness, and/or spotted vision from the pain.

At the doctors or hospital, an X-ray will show the fracture. An examination will also be carried out to make sure the nerves and blood vessels are not damaged. It is very rare for them to be damaged, but it has been known to happen. It is always worth checking as a matter of course.

X-ray of broken Left Collarbone

Treatment

It is normal to start with R.I.C.E. therapy. Rest the injured shoulder as much as possible. Ice with cold packs applied to the shoulder for 15 minutes and every 2 hours. Compress the affected area with a special splint called a figure-of-eight splint or sling. This brace is wrapped around the shoulders to keep them back and in position. You can also ues a shoulder strap, from our Online Sports Shop at Serious About Sport, to support the shoulder. Elevation of the shoulder or affected arm.

Figure-of-Eight Brace                                        Shoulder Strap. Fits either R or L shoulder

                                                                     joint. Unrestricted arm movement. £29.99

Non Steroidal Anti Inflammatory Drugs (NSAID’s), such as Ibuprofen or Naproxen, may be prescribed to reduce inflammation and any discomfort. After a few days to weeks, pain and swelling will begin to go away and the bone starts to heal. The physical therapy and strength training can now commence to increase tendon and muscle strength. Clavical Fractures normally completely heal within 12 weeks, and the pain goes away after 2 weeks. Patients are usually back to their sports activities within 12 weeks especially younger patients. Once recovered, a patient may notice a bump over where the fracture was. This could last for months or longer. This is normal, do not worry.

June 20, 2009 at 3:38 pm · Filed under Sports Injuries

SHOULDER & UPPER ARM INJURIES - Acromioclavicular (AC) Joint Seperation

AC Joint

Seperation of the AC Joint is quite a common injury in contact or collision sports or throwing sports and overhead strength training for the upper body. These shoulder injuries account for 3% of all shoulder injuries and 40% of shoulder sports injuries. Athletes in their 20’s and 30’s are more affected and men are injured more than women.

The shoulder joint is made up of a junction of 3 bones; the collarbone (Clavicle), the shoulder blade (Scapula) and the upper arm bone (Humerus). The clavicle and scapula form to make the socket of the joint, and the round head of the humerus fits into this socket. The end of the scapula, that joins to the clavicle, is called the Acromion. This small AC joint is, average size 9MM x 19mm, has a Fibro Cartilage to each of it’s surfaces, and a Fibrocartilage Disc which helps to absorb any compression forces.

To stabilise the Acromioclavicular Joint, the body relies on primary muscles, the Anterior Deltoid which comes from the clavicle, and the Trapezius muscle that comes from the acromion.

There is also stability provided by the Ligaments, called the Acromioclavicular Ligaments. They run between the clavicle and acromion and further strengthening is provided by the Coracoclavicular Ligaments that run between the clavicle and the coracoid part or the scapula.

Types of Injury

An athlete or person that suffers an Acromioclavicular injury will normally inform you of either one of two types of injury, Direct or Indirect.

Direct Force: This is where the athlete or person falls on to the point of the shoulder with the arm at the side (adducted). This force will drive the acromion downwards and inwards (medially). 70% of these joint injuries are usually of these direct force type.

Indirect Force: This is where the athlete or person falls onto an outstretched arm. This force will go through to the head of the humerus on to the acromion. In this case the acromioclavicular ligament could rupture and the coracoclavicular ligament could stretch.

There are 6 grades to this type of injury, these are

1) A sprain of the acromioclavicular ligament, that will cause pain over the AC joint, with mild pain and tenderness when moving the shoulder.

2) A widening of the AC joint with a raising of the end of the clavicle. Can be severe pain near the AC Joint and moving the shoulder is restricted.

3) Dislocation of the AC Joint with a forward movement of the clavicle. The Coracoclavicular ligaments ( above), are partially torn, and the upper shoulder looks depressed. The clavicle can be free floating and could lift the skin. There is severe pain and tenderness over the joint.

4) The AC Joint is dislocated, with the clavicle displaced into or through the Trapezius muscle. The Coracoclavicular ligaments are completely torn. The findings are similar to Grade 3 but there is more pain present.

5) Tearing of the Acromioclavicular ligaments aswell as the Coracoclavicular ligaments. The clavicle and scapula are completely out of alignment. Again the same findings as Grade 3 but much more pain and the skin could be penetrated. This injury is rarely seen in athletes.

6) Both sets of ligaments are completely torn, with joint dislocated and complete mis-alignment of clavicle and acromion. The shoulder looks a lot flatter. Thi type of injury is very rare in athletes due to the amount of force needed to produce this dislocation. There could also be associated fractures aswell.

Treatment

I would prescribe early mobility exercises, especially in Grade 1-3 injuries. I would also use a bandage to help get the clavicle back into position. I would recommend surgery for Grade 4-6 injuries. With the treatment of Grade 3 injuries I would suggest non surgery with early mobility exercises. In young athletes in sports with overhead activities, I would suggest a surgical approach, as this injury is very likely to occur again. In most cases early treatment is recommended with resistance exercises as soon as possible.

Rehabilitation

If you don’t need surgery, then I would start you on range-of-motion (ROM) exercisesas pain eases. A strength programme will follow this, with exercises that keep the arm below shoulder level are started. This will then progress to strength exercises for the rotator cuff and shoulder blade muscles. In a lot of cases the pain will go within 3 weeks. To recover fully, could take up to 6 weeks for Grade 2 injuries and up to 12 weeks for Grade 3 injuries.

After Surgery

You may have to wear a sling or support to protect the shoulder for a few days. My first few treatments would be focused on controlling the pain and swelling from the surgery. After 4 weeks I would start ROM exercises, passive exercises. These are exercises where I move the shoulder joint, but the muscles stay relaxed, basically I would do all the work. I would also teach the patient how to performpassive exercises at home. After 6-8 weeks I would start active therapy, this would allow the ligaments to heal. Active ROM exercises help to regain shoulder movement using your own muscles. These exercise work the muscles without straining the shoulder joint. After 3 months I would start the patient on more active strengthening. This would involve improving strength and control of the Rotator Cuff muscles, and muscles around the shoulder blade. Recovery from surgery can take time. You must be patient and stick to my programme. The exercises are designed to work the shoulder as in normal daily tasks and activities. Finally I would educate the patient on ways to avoid future problems.

June 19, 2009 at 4:34 pm · Filed under Sports Injuries

SHOULDER & UPPER ARM INJURIES - Frozen Shoulder (Adhesive Capsulitis)

Frozen Shoulder is a very common condition which will affect your ability to move your shoulder. Eventually it will cause pain and stiffness and also reduce the normal movement in the joint. In certain patients, it can stop movement in the shoulder completely. Normally, only one shoulder will be affected, but in roughly one in five patients it will spread to the other shoulder. In nearly all cases, Frozen Shoulder will happen to people aged between 40 and 60, but more common in women than men. The cause of Frozen Shoulder is not really understood, but is usually most common to people who have Diabetes, or Heart Disease. But it is not linked to Arthritis, and it does not affect any other joint. There are various types of treatment, which are, Painkillers, Physiotherapy, and in certain cases Surgery may be needed. Recovery is very slow, and can last for several years, but most people will eventually get back full movement in their shoulder.

Shoulder Joint

Symptoms

Frozen shoulder is very painful. There is stiffness in the shoulder joint that just doesn’t go away, so it makes it so difficult for you to perform a normal range of shoulder joint movements. You will probably find it very hard to perform daily tasks like dressing yourself, driving and even sleeping comfortably. You may find that you are unable to move the joint at all, hence this gives it it’s name Frozen Shoulder.

There are 3 stages to Frozen Shoulder, and the symptoms will change very slowly. The whole process, from onset to cure, can last months and even years, and symptoms are different from person to person.

These 3 stages are: Stage 1 - Freezing Stage - This could last from 2-9 months. The first sympton is usually pain, then stiffness and a limitting of ROM (Range Of Movement) will slowly build up. The pain is worse at night, especially when lying on the affected side: Stage 2 - Frozen Stage - This could last from 4-12 months. The pain gets easier, but the stiffness and the limiting of ROM are still there and get worse. This stage affects all shoulder movements, but especially a rotation of the arm outwards is severely affected. You will also experience a muscle wastage around the shoulder because the muscles simply are not being used: Stage 3 - Thawing Stage - This could last from 5-24 months. The stiffness will gradually go, and movement will gradually return to hopefully normal, or near normal.

Causes

It is thought, but not quite clear, that Frozen Shoulder occurs when there is a thickening and swelling of the flexible tissue that surrounds your shoulder joint. The tissue is called a capsule. The shoulder is a ball and socket type joint, where the end of your upper arm (the humerus) sits in the socket of your shoulder blade (the scapula). The shoulder capsule will be fully stretched when you hold your arms above your head, and will hang down when your arm is lowered. If you have a Frozen Shoulder, it is thought that the joint capsule becomes inflamed, and then bands of scar tissue form in the joint capsule. This causes them to thicken, swell and tighten. Therefore there is less space for your upper arm bone in the joint, so that any movement will be stiff and painful.

                Frozen Shoulder

Again, it is not fully understood exactly why Frozen Shoulder occurs, and in a lot of cases it is not possible to find the cause. There are other risk factors that may go towards developing a Frozen Shoulder.

The main factor could be from a Shoulder Injury i.e. a broken bone (fracture), or after having Surgery to the shouler area. This might be because you are keeping your arm and shoulder still for long periods at a time when you need to recover, and this might cause the joint capsule to tighten up because it is not being used.

Another factor might be Diabetes. If you have Diabetes, you are 2-4 more times likely to suffer from Frozen Shoulder than someone that isn’t diabetic. Again the reason for this isn’t known. You are also more likely to get it in both shoulders, and for it to be a lot more severe.

There are other health conditions that increase the chance of developing Frozen Shoulder, which are Heart or Lung Disease, Overactive Thyroid Gland, Parkinson’s Disease, or if you have had a stroke.

Treatment

Treatment for Frozen Shoulder will vary depending on how far, at what stage it is at and how painful and stiff the joint is. If I were treating the shoulder, my aim would be to keep the joint as mobile as possible and as pain free as possible while the shoulder healed. Your G.P. might refer you to a physiotherapist, who would as I would, keep the joint mobile and flexible through different techniques.

The following may help ease and prevent the symptoms:

Anti-inflammatory Painkillers - These could be Ibuprofen, Diclofenac, Naproxen, Paracetamol and Codeine. These drugs would be prescribed to ease the pain. One of these may be OK, but there may be side-effects associated with them. You should always read the leaflet that comes with the packet for any side-effects.

Shoulder Exercises - It is very important to keep the joint as mobile as possible with gentle, regular exercises. If you do not use your shoulder the muscles will waste away and make any stiffness much worse. You must try and use your shoulder as much as is possible. If your shoulder is very stiff, then exercise could be very painful. Also a heat retainer shoulder support from our Online Sports Shop, Serious About Sport, would help to keep the shoulder warm and could aid recovery. Your G.P. or I could give you exercises which would not cause you any further damage to your shoulder. You could also have shoulder manipulation under a local anaesthetic where your shoulder is gently moved and stretched while you are asleep.

Shoulder Strap Price : £29.99

Corticosteroid Injections - Painkillers may not be enough to control severe pain, therefore you may be able to have steroid injections in and around your shoulder joint. These help to reduce inflammation, swelling and pain. They can be very effective at relieving the symptoms for several weeks at a time, certainly at stage 1 (Freezing Stage). This is not a cure, as the symptoms normally tend to gradually come back, but patients like the relief it brings. Too many of these injections can actually damage your shoulder, so you may only be able to have treatment once or twice.

Transcutaneous Electrical Nerve Stimulation (TENS) - Tens is a type of physiotherapy which can ease the pain of Frozen Shoulder. It numbs the nerve endings in your spinal cord that control pain, so you cannot feel it any longer. It is done by putting small electrical pads (electrodes) on to your skin over the shoulder, this will give small electrical pulses from the TENS machine. A physio will control the strength of the pulses and how long the treatment lasts.

Nerve Block - A specialist may use this type of treatment. This involves an injection to block the nerves that send pain messages from the shoulder. But like a steroid injection, it only eases pain for a while, it is not a cure.

Hydrodistension - This is another technique that a specialist will use. This is a treatment where the shoulder joint space is expanded (distended) by injecting a liquid, sometimes a dye, or saline (salt water) mixed with a steroid, into the painful shoulder. This has been shown to improve symptoms in a number of cases.

Surgery - If all or any of the above treatments fail to improve the shoulder. then you may be referred for surgery. The surgeon will remove any bands of scar tissue that might have formed in the shoulder capsule, and this will really improve the symptoms as much as an 8-10 chance. The operation is called an Arthroscopic Capsular Release. It involves keyhole surgery where by the surgeon will make an incision (cut), about 1cm long. Then a probe will be used to open up the shoulder capsule and release it. Physiotherapy will be neede after the operation to regain full ROM (range of movement). Because of the great results, it will become more widely used.

June 10, 2009 at 9:26 pm · Filed under Sports Injuries

RUNNING INJURIES - Foot - Plantar Fasciitis

Plantar Fascia is a thick band of tissue, like a tendon. It starts at your heel and goes along the bottom of your foot. It is attached to each one of the bones which go to form the ball of your foot. The plantar fascia acts like a rubber band between the heel and the ball of the foot, and this in turn forms the arch in the foot. In my experience it goes to say that if this thick band is short, you will have a high arch. If the band is long, you will have a low arch or flat feet. The pad of fat in your heel covers the plantar fascia, which helps absorb the shock of walking or running. If the plantar fascia is damaged, this could be a cause of heel pain.

Causes

Most of the time Plantar Fasciitis leads to heel pain, heel spurs, and/or arch pain. It is the over-stretching of the Plantar Fascia that will lead to inflammation and discomfort which can be caused by the following: 1) Over-pronation (flat feet) which ends up with the arch collapsing on weight-bearing: 2) A foot with a really high arch: 3) A sudden increase in your physical activities: 4) Too much weight on the foot usually due to obesity or pregnancy: 5) Badly fitting footwear: 6) Tight calf muscles and Achilles Tendons.

The main cause of Plantar Fasciitis is over-pronation (flat feet). It occurs when you are walking, your arch collapses on weight-bearing and the plantar fascia is stretched away from the heel bone. Pain is felt on the bottom of your foot where the heel and arch meet, probably on the inside of your foot. It is worse first thing in the morning or after a long rest. This is because at rest the plantar fascia contracts back to it’s original shape. As the day goes on the fascia will be stretched and the pain may go away.

Treatment

Plantar Fasciitis is an inflammation and the best way to treat it is to first find out the cause of the inflammation. The most important advice I would give is to allow for plenty of rest to take the strain off of the plantar fascia. This gives the tissues time to heal. In a lot of cases the foot will be over-pronated, and in the case of runners, the inner arch of the foot will role over too much during the run. This will lead to tightness in the Achilles Tendon which increases the strain on the Plantar Fascia. You can obtain insoles that can support the inner arch of the foot, which will help a great deal.

Orthotics with Arch Support

While the Plantar Fascia is still painful, ice treatment is very effective, (never apply ice directly to the skin). Use an ice pack from your friendly online sports shop, Serious About Sport. You can always obtain anti-inflammatories prescribed by your doctor. When the pain has gone away, stretching the Plantar Fascia is very effective. You can do this by pulling your toes up towards your shin and holding that stretch for 20-30 seconds. This will encourage the tissues back to their correct length, and help with the healing process. A more effective way of stretching the Plantar Fascia is by wearing a Night Splint, as it implies, it is worn while you sleep. This can reduce the symptoms in 80% of cases, and moreso when taking the first few steps in the morning.

Plantar Fascia Stretch

Plantar Fascia Night Splint

Taping is also very effective for Plantar Fasciitis. The tape supports the fascia and takes some of the strain away that aggravates the injury. If there is no tape available, then an Air Heel can be a good substitute. This will take out some of the strain from the Achlles Tendon and the Plantar Fascia.

Taping for Plantar Fasciitis

In 95% of cases the Plantar Fasciitis will settle. In severe cases, where the pain is affecting normal walking, then you may have to undergo an injection of corticosteroid and local anaesthetic. This could be very helpful, but following this, rest for a few days is advisable.

If Plantar Fasciitis just does not go, then Surgery may have to be considered. With this treament, it may include the removal of bony spurs from the heel bone, or a fascia release. These types of treatment need to be avoided as later problems could arrise such as nerve damage and even changes to the mechanics of your foot.

Bony Growth (Heel Spur)

There is a modern treatment out called Needle Fasciotomy. This is done using guided ultrasound. A needle is inserted into the Plantar Fascia and moved back and forwards. This will disrupt the hard fibrous tissue that was caused by the excessive inflammation. This is done using an ultrasound scanner, so there is alot less chance of any surgery complications. By breaking up the tight, hard, fibrous tissue, this will relieve the strain on the Plantar Fascia and healing can take place.

Prevention

Bad footwear is usually blamed, or involved, for going some way to causing Plantar Fasciitis. Your shoes should give you enough support for your feet. Footwear that is not fit for purpose could increase the strain on the Fascia and cause inflammation. You can also use insoles to support the arch on the inner side of the foot to help with severe pronation. These will relieve the stress on the Plantar Fascia and Achilles Tendon.

June 5, 2009 at 10:15 pm · Filed under Sports Injuries

RUNNING INJURIES - Ankle - Achilles Tendonitis

About 11% of all running injuries are due to Achilles Tendonitis. The Achilles Tendon is the largest tendon in the body, and probably the most vulnerable. It joins the Gasrocnemius (calf) and the Soleus muscles of the lower leg to the heel of the foot. The Gasrocnemius muscle crosses the knee, the ankle and the subtalar joints which can create tension and stress in the Achilles Tendon. Tendons are very strong but not very flexible, so they will only stretch so far before they become inflamed and tear or rupture.

Symptoms

Acute symptoms - 1) When exercising, the tendon will be painful. The pain will come on gradually with a lot of exercise and on rest will go away: 2) Swelling over the Achilles Tendon: 3) Redness over the skin: 4) If you press your fingers into it, and move your foot, you may feel a creaking. If acute Achilles Tedonitis isn’t properly treated, then it may develop into chronic Achilles Tendonitis. This is difficult to treat especially in older people who will suffer more often. The pains experienced at the acute stage should disappear after a warm-up but come back when training has stopped. Eventually the injury will get worse untill you cannot run anymore.

Chronic symptoms - are very similar to acute symptoms as well as 1) Pain along the tendon and stiffness to the tendon especially in the morning: 2) You may be able to feel lumps or nodules in the Achilles Tendon at about 2cm above the heel: 3) There will be pain in the tendon when walking up hills or stairs: 4) Chronic Tendonitis is a long term condition and may be quite persistent.

Causes

1) This is an overuse injury, and is normally caused by doing too much too soon in training: 2) Running up hills too much will cause the tendon to fatigue and will become inflamed: 3) People that have overpronated feet or rolling in of the foot, can put more strain on the Achilles Tendon. When the foot rolls in or flattens, the lower leg will rotate and turn inwards. This will twist the tendon and place stresses along the length of the tendon: 4) Women wearing high-heels will shorten the tendon, and if you place a demand on the tendon, such as a 5 mile run in flat shoes, then this will place excessive strain on the tendon and make it stretch further than is capable.

Treatment

Prevention is the best treatment for Achilles Tendonitis. You should stretch the Achilles Tendon before training and especially at the start of the day. This will help keep flexibility in the ankle joint. Any problems with the mechanics of the foot can be fixed with orthotic. You could possibly use heel lifts, heel cups, arch supports or purpose made orthotics to suit.



      Achilles Tendon Stretch   Orthotic with Arch Support

Other treatments are 1) Resting the Achilles Tendon will allow the inflammation to cease and go away so that healing can take place. The patient will need to have a substantial period of rest for the Tendonitis to subside. 2) A heel wedge could be put into the shoe to lessen the stress on the Achilles Tendon. It should be placed in any shoes that you wear untill pain goes away completely. 3) Putting ice on the area affected can encourage blood flow to the area and in turn lessen the pain that comes with inflammation. You could apply ice after training and through the day for the first 48 hours, and more if required. See ice packs on our Online Sports Shop at Serious About Sport. 4) There is a whole list of non-steroidal anti-inflammatory medications. These are Ibuprofen, Motrin, Naprosyn, Celebrex and many others. These medications will improve and lessen he pain and swelling. You will need to speak to your doctor before taking any of these medications. 5) Lastly you could come and see me, and I would advise a stretching and rehabilitation programme to help with flexibility of the Achilles Tendon.

I would not advise on Cortisone injections to be used on patients with Achilles Tendonitis, as it has been shown that the Achilles Tendon has ruptured due to the injections.

June 3, 2009 at 10:10 pm · Filed under Sports Injuries

RUNNING INJURIES - Ankle - Sprain

A sprain is an injury to a ligament. The function of a ligament is to help hold the joints together. They are thick bands of tissue that join bone to bone. A sprain to the ankle is the most common type of soft tissue injury. The severity of a sprain is graded into: Grade 1 - Mild stretching of the ligament without joint instability: Grade 2 - Partial rupture (tear) of the ligament but without causing instability to the joint: Grade 3 - Complete rupture (tear) of the ligament with instability of the joint.

The ankle joint

Symptoms

1) Sometimes a snapping or popping sound on spraining the ankle as a ligament is torn or bone cracked: 2) Sprain is painful and gets worse on moving the ankle, and with a severe sprain you would not be able to put any weight on the leg: 3) May have swelling or bruising and the swelling could happen soon after the injury, whereas bruising may take up to 24 hours to develop. The swelling will restrict you from moving your foot, which is a form of protection against further injury:

Seek further advice if your ankle is extremely painful or swollen after 2-4 weeks, if you can’t put any weight on the affected leg, or there is an obvious change in the shape of your ankle.

Causes

1) The most common is an inversion sprain, when your ankle turns inwards. It is an overstretching of the ligaments on the outside of the ankle: 2) Sprains are also common in sports involving running and jumping, landing from a jump, or fast changes in direction (football, basketball, volleyball, badminton, squash, netball): 3) Walking on irregular surfaces: 4) The slipping of your foot off the edge of the curb: 5) Twisting your ankle while climbing the stairs, and 6) Wearing high-heels and losing your balance.

Treatment

1) Apply ice straight away or as soon as you possibly can: 2) If the ankle injury is severe, you may need X-rays to determine the correct treatment: 3) R.I.C.E. (Rest, Ice, Compression - with one of our Online Sportshop Ankle Supports at Serious About Sport, Elevation) treatment therapy should be used in every case, and should surfice in 70% of cases: 4) Recovery time is normally between 3-7 weeks, but the swelling may persist for a few months: 5) Surgery may be needed in very severe cases, where tendons need repairing around the ankle joint: 6) Orthotics or insoles may help to stabilise and control and to stop further occurrences of ankle sprain.

Ankle Support

£14.99

Ankle Strap

£25.99

May 30, 2009 at 12:16 pm · Filed under Sports Injuries

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