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.

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

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.

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.

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

The Tibia and Fibula, (lower leg bones), are common sites of stress fractures arising from alot of constant and repeated running.  Most causes of this type of injury are the skeleton system being out of alignment, running gait changes, leg length difference, poor running conditions, previous injury, and hard, uneven surfaces.  Woman seem to suffer more commonly from this injury more than men.

Lower Leg Factures of the Tibia and Fibula

The injury usually happens 2-3 inches above the medial malleolus (bony piece on the inside of the ankle), on the tibia.

Symptoms and Diagnosis

1)  Pain is felt on the lower third of the tibia, usually after running long distances.  2)  Tenderness and swelling over the site of the fracture.  3)  Pain when you press into the skin.  4)  An MRI can verify the stress fracture.

Treatment

1)  Rest for about 8 weeks and avoid painful activities.  Use ice treatment for any swelling  2)  Crutches can be used at early stages of the injury, especially if pain on weightbearing.  3)  Consult you physical therapist on why the injury happened in the first place.  You will need a professional  diagnosis.  4)  You could maintain fitness levels by swimming, running in water, or supervised weight-training.  5)  Treatment can also be combined with mild electrical stimulation.

Electrical Stimulation to Lower Leg

Medial Tibial Stress Syndrome or Shin Splints,  is a very common complaint with runners and other athletes.  It is common because athletes tend to change from one type of surface to another, change their type of shoes, alter their techniques or carry out concentrated training on hard surfaces.  This injury is usually triggered by long distance running with the constant landing on the hard surface.  It is also mostly with the type of runners that run with forefoot strides or with feet pointing outwards and over pronated runners.

Shin Splints

Symptoms 

1)  There is tenderness over the medial part of the tibia (inside of the shin).  It is normally local but can spread down the shin, and is worse over the lower half.  2)  Swelling can be seen and felt.  3)  The pain will stop with rest but will start up again when the activity is commenced.  4)  Pain is felt when your toes and ankle are plantar flexed (bent upwards).  5)  There is tenderness in the lower half of the tibia and sometimes lumps and bumps can be felt along it’s edge.  6)  If symptoms have persisted for a while, then an X-ray is needed to rule out a stress fracture.

Treatment

1)  Training should be suspended and the patient should rest immediately, so that the injury can heal.  The pain is a warning to stop what you are doing.  2)  Cold therapy asap, with an ice pack wrapped in a towel 2-3 times a day, for about 10 minutes each time, for 2 days.  This will reduce any swelling and inflammation.  3)  Training should not commence until there is no pain under load and any tenderness over the tibia is gone.  4)  Fitness levels can be maintained with non weight-bearing exercises such as swimming or cycling.  Bear in mind, if you are cycling, the pedal should be held under the heel rather than the front of the foot.  5)  Alternating heat and cooling treatment can be very effective, and also the use of our Serious About Sport heat retainer/support from our Online Sports Shop is helpful.

Calf/Shin Heat Retainer

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Prevention

1)  When changing your running surface, the change should be gradual and your training intensity should be the same.  2)  Wear the right clothing and equipment.  Your running shoes should be chosen to suit the surface.  3)  Orthotics may be needed.  4)  Also your running technique should be changed to suit each surface.  5)  Warm up and stretch thoroughly.

A return to your sport should be possible within 2-4 months in most cases.  This means a gradual increase of activity and listening to your physiotherapist.  If your prescribed treatment  doesn’t relieve the pain within 2 weeks, then a stress fracture should be suspected.

Patellofemoral injuries are a common problem in all age groups.  The cause of this pain is very complicated and not well known.  Because of this, the correct diagnosis must be formed and carried out, otherwise the treatment could be wrong and will not work.

Function

With a normal patella it is a wedge shape and has a crest in the centre.  Of all the joints, the patella has the thickest cartilage.  The patella slides or tracks in the groove in the end of the femur (thigh bone), when flexing or extending (bending of the knee).

Patella                                                            Patellofemoral Syndrome

Symptoms

1)  Pain occurs in the knee joint and behind the patella during any load bearing and sitting with a bent knee.  2)  Pain is made worse with walking and running going up hills and stairs but especially going down hills.  3)  When getting up from a seated to a standing position pain and stiffness can be felt.  4)  Pain problems are made worse when squatting.  5)  Tenderness can be felt on the medial (inside) and the lateral (outside) faces, and around the patella.  6)  Sometimes a slight swelling will be noticed in the knee joint.  7)  When flexion or extension of the knee is carried out, crepitus or creaking can be felt or even heard behind the patella.  8)  Sitting for long periods is uncomfortable, known as (the theatre or movie sign).

Causes

1)  Overloading - repeated weight-bearing such as running and other sports.  Bending the knee causes pressure between the patella and the femur.  2)  Over-pronating feet - flat feet will eventually cause more stress in the knee joint.  3)  Muscle imbalance - If the outer muscles of the quadriceps are stronger than the inner muscles, this will case patella tracking.  This could also be caused by an overtight iliotibial band ITB.  4)  Q-angle - known as the femoral angle.  Some people have a large Q-angle and may be seen as knock-kneed.  The patella is forced to the outside of the knee when the patients leg is straitened, and causes stress under the patella aswell.

Patella Tracking to the outer edge                                               Q- angle

Prevention and Treatment

1)  Rest from painful activities.  2)  RICE (rest, ice, compression, elevation).  You should rest until there is no pain, this is very important.  Compress with a  Serious About Sport knee support/heat retainer from our Online Sports Shop.  Use one with a hole for patella support.  Also taping can be very helpful.

3)  Exercise for the quadriceps and hamstring muscles, especially the vastus medialis.  4)  Stretching the quads. and hams. is very important.  5)  You will need to see a physical therapist who will advise on treatment and rehabilitation.

80% of patients, providing they strictly adhere to the professional advice given by the therapist, usually improve over a period of 6 months. I always stress to my patients that this injury will take time to heal.

Knee Free Support

In certain cases it may be necessary to operate if the symtoms have continued for a long time.  There are more than 100 surgical procedures for the treatment of patellofemoral disorders.  There are many different misalignments.