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Shoulder, Injury, Fitness, Rotator Cuff

Have I Got a frozen Shoulder? Or is it a Rotator Cuff?

Have I Got a frozen Shoulder? Or is it a Rotator Cuff? – Physiotherapy

Frozen shoulders can be a complicated and very frustrating issue. Typically they can last for up to 18 months. The shoulder becomes very inactive and day to day function is compromised. It is not a common presentation in the clinic here. Often people are concerned they have developed a frozen shoulder. However it is more frequently an issue to do with rotator cuff damage, or a type of shoulder impingement, or both of these together.

What is Frozen shoulder?

Frozen shoulder is medically termed as ‘adhesive capsulitis’. Fibrous adhesions start to develop within the shoulder joint and ultimately surround the shoulder capsule. The capsule itself becomes very inflamed – hence the ‘itis’ on the end of the word capsule. The result is significantly reduced shoulder function. Certain movements can cause sharp pain and as result the patient begins to move the joint less and less. It is best treated with injection therapy, some physiotherapy (aiming to preserve some range of motion), and in more acute cases there is surgical intervention. In the case of surgery the shoulder joint is manipulated under anaesthetic to restore greater movement. Although surgical intervention naturally cannot have a guaranteed success rate, it can provide a degree of improvement in the extremely frozen shoulder.

What is the Rotator Cuff?

The rotator cuff is a grouping of soft tissue structures that protect and strengthen the shoulder joint. It is comprised of muscles and tendons including the Supraspinatus, Subscapularis, infraspinatus and Teres Minor. These surround and attach into various parts of the shoulder joint and the shoulder blade. The cuff gives stability in particular, however it is vulnerable to damage as we get older.

How the shoulder joint moves

The shoulder is a relatively vulnerable joint compared to some other major joints within the body. It moves in multiple directions – as opposed to the hip or knee. There is a higher incidence of shoulder dislocation for example, because of this greater level of movement. Essentially the joint moves in multiple directions; forwards,backwards, sideways and in a rotational fashion.

Some typical Examples

The majority of shoulder issues presenting in clinic here in Rathmines relate to the rotator cuff as opposed to a frozen shoulder. Very often our clients are unaware how the issue might have developed, as it can be a very innocuous incident which causes the initial damage. Some typical examples such as starting a lawn mower, pulling a heavy suitcase or simply out walking the dog on a lead can cause an initial tear to a tendon and the issue slowly escalates from there.

What we do to treat the issue

We do an initial assessment of the joint to find out what the specific issue is. We use a number of orthopaedic examination tests to get an accurate diagnosis, without need for MRI referral. Once we have a solid diagnosis, we then work on restoring range of motion to the damaged joint. We simultaneously work on improving stability and strength. Don’t worry, there’s not too much hardship and homework – we send on video exercises to our clients so they can work away on their own schedule as suitable.

 

To schedule an appointment with one of our Physiotherapists, jump straight to our booking system here or call 01 4964002.

 

Physiotherapy Services, Dublin 6

Jordi Murphy joins a very undesirable club – the ACL club

The ACL Club

Ireland’s incredible victory last Saturday came with a hefty price tag for one of the Warriors that ultimately slayed the New Zealand team. An ACL Injury.

I winced as I saw Jordi’s knee buckle. His attempt to chase down a quick line out throw by the Kiwis ended with a nasty rotation.

To the casual observer, this was an innocuous slip. In the world of sports medicine and Chartered Physiotherapy the alarm bells were ringing!

The pitch side medical team probably knew this was an ACL (Anterior Cruciate Ligament) injury if they saw the mechanism of injury. Foot planted combined with an awkward rotation meant that the incredible force an athlete like Murphy can produce exceeded the ability of the ligament to withstand it.

Physiotherapy Dublin 6

Jordi Murphy feeling the intense pain from the knee ligament injury sustained on Sat evening

The ultimate effect is a tear of the ligament and effectively an unstable knee.

An image of the knee (from behind) with the knee ligaments still intact

An image of the knee (from behind) with the knee ligaments still intact

Ligament Tear

As the physios rushed on, they are probably asking Jordi for any tell tale signs to confirm what they intuitively know. Did you hear a pop (a nice way of asking have the bones in the knee smacked loudly together?) Where are you sore? – Normally everywhere!

So what’s happening in the initial few minutes of this injury in the majority of ACL injuries?

Extremely painful usually only for a few minutes. This is followed by a Large swelling as the knee joint fills with blood from the ligament tear.

There are some clinical tests that can be performed on the pitch in the first few minutes. These will assist a diagnosis and give the medical team a very good idea of the extent of the damage.

It’s highly likely that Jordi had rapid access to an MRI scan in the US – possibly in the Soldier Field stadium. This produces a superb image of the joint and will provide lots of information on any damage to other structures in the knee.

Jordi will need an ACL reconstruction. We’re fortunate in Ireland to have several outstanding knee surgeons to perform this work. That’s only the start of the journey. All good surgeons will emphasise to their patient that the rehab post surgery is crucial in a full recovery and return to sport.

Physiotherapy

The role of an experienced chartered physiotherapist becomes essential in the daily routine of recovery. Knowing what to do and when to do it is critical in protecting the repair and building strength in the surrounding knee muscles.

Jordi has a long road ahead of 9-12 months of hard work post surgery. He will do very well as everything is in his favour – age, background, fitness, attitude & motivation to name a few ingredients.

Like so many others before him – Conor McGregor, Peter O’Mahony, Luke Fitzgerald to name a few. Jordi is now a member of the dreaded ACL club. But he will bounce back like the others all managed so successfully.

Personal Health Physiotherapy, Dublin 6

Director of Physiotherapy – Ronan Fallon

 

For a Physiotherapy consultation with Personal Health’s Director of Physiotherapy, Ronan Fallon – Ring 01 4964002

USAIN BOLT – THE RACE FOR OLYMPIC FITNESS!! by Ronan Fallon

USAIN BOLT – THE RACE FOR OLYMPIC FITNESS!!!

Last week in Jamaica, Usain Bolt pulled out of the national finals following a second night of discomfort in his hamstring muscle. The diagnosis is a Grade 1 muscle tear. This is potentially a big problem as he needs to qualify for the Olympic Games on the 22nd of July in London. 

Usain Bolt Running out of Time, Ronan Fallon, Physiotherapy, Personal Health, D6

Will he run out of time??

Firstly, what is a Grade 1 muscle tear? Put simply, muscle injuries are clinically graded on a scale of 1-3 with 1 being the least serious and 3 being a severe rupture.

If you are dealing with an Olympic athlete, he will probably undergo an MRI to confirm what the medical team already know from their clinical examination of the presenting problem. 

Secondly, what happens next? There is a battery of treatments that an Olympic athlete will receive. Usain Bolt has flown to Germany to see a specialist for further treatment. Ultimately, these treatments are designed to speed up the healing process. These can vary depending on all sorts of issues, mainly money! However, Mother Nature’s physiological healing timeframes need to be acknowledged and respected.

Medical team, Usain Bolt, Personal Health,Ronan Fallon, Physiotherapy, Personal Health, D6

 

Muscle is like a Rope!

A reasonable analogy is that the fibres in Muscle tissue are similar to the strands of a rope. Once an injury has occurred, then the amazing human healing cycle begins. This can take weeks to fully return to somewhere close to the pre-injury condition.

Here’s the problem, the Hamstring muscle has to be fully healed and strong before you even attempt to put it through the most severe test which is flat out sprinting. 

Usain Bolt of Jamaica starts in the men's 200 metres heats during the world athletics championships at the Olympic stadium in Berlin, August 18, 2009. REUTERS/Dominic Ebenbichler (GERMANY)Ronan Fallon, Physiotherapy, Personal Health, D6

I am sure that Usain is being managed extremely carefully as the medical and physiotherapy team attempt to combine the tricky task of accelerating healing and loading appropriately in an effort to prepare for the ultimate test on the 22nd of July.

Elite athletes such as Usain Bolt are obviously supreme physical specimens. This generally helps shave a few days of the well-known recovery timeframes. Also, access to medical and physiotherapy services which will be babysitting him 24 hours a day is also a bonus. 

Usain Bolt, Bubble wrap, Personal Health,Ronan Fallon, Physiotherapy, Personal Health, D6

Bearing all this in mind, and considering that he is the fastest man on the planet. I am confident that he will get through the qualification stages even if he is not 100% fit. 

If you are an Olympic athlete, recreational runner or 5-a-side player, all muscle injuries are very well understood. Chartered Physiotherapy will help with grading and managing recovery.

Football, Physio, sport, Physiotherapy, Fitness

Will Jonathan Walters be fit for Saturday ? by Ronan Fallon

Well is he going to be fit to continue?

Last night’s match in Paris saw the boys in green put in a great performance on the European stage. It’s fair to say that we could have easily taken all three points. Unfortunately, this result did have an impact on Jonathan Walters.

It is well known that he has been struggling with an Achilles tendon problem for the last few weeks. The Achilles tendon is the common tendon from the calf muscles into the heel bone.
It is a notoriously tricky problem for anyone from an international footballer to a mid-week 5-a-side social footballer or tag rugby player. As such, it was not a good sign that Jonathan Walters reported last night that he was struggling with this issue from the very first minute!

Achilles tendon
As you can see from the image, pretty much all activity on the football pitch requires load to go from the calf muscle and through your Achilles tendon. This allows the athlete to propel forward to run & jump.

 

MANAGEMENT

Chartered Physiotherapy Dublin 6

Decisions Decisions…..

There is no doubt that the Irish medical team are using all of the resources at their disposal in an effort to get Jonathan fit for Saturday. This is a very quick turnaround for an injured achilles such as this one.
I suspect that they will be using a battery of treatments including anti-inflammatories, Icing, Soft tissue for the calf muscles and most importantly rest.
The crucial component in this management strategy is controlling loading. Thai is the weight that he takes through that inflamed tendon. He should be on crutches for 48 hours. This would allow the Achilles to recover without the stress of his bodyweight on every step.

Medical Team

This is a tricky conundrum for the medical team today. How long can they afford to rest Jonathan from team training in preparation for the Belgium match? Martin O’Neill and his team will have  already discussed this and may have even made a decision on ruling him out.
It’s very difficult to see how Jonathan Walters will be fit for Saturday. An MRI scan will show the true extent of the damage. As a result all we can work off are the soundbites from Management and player alike.

In conclusion, we’re all hoping for a speedy recovery and that his removal from the game early might just give him a chance for the big game on Saturday.

COYBIG !

Ronan