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Shoulder Pain and Treatment

Shoulder Pain

Shoulder pain is a common problem for many people.  It can happen to people of all ages from children to the elderly.  The pain can be very severe and cause a lot of limitations with work and activity.  Shoulder pain is one of the top 5 reasons why people seek out physiotherapy and massage treatments.

What Causes Shoulder Pain?

There are several reasons why people suffer from shoulder pain.

Trauma

Any type of direct or indirect trauma can produce shoulder pain if the arm and/or shoulder is involved

Shoulder trauma

    • Motor vehicle accidents
    • Falls
    • Sports injuries
    • Violent incidents

Poor office ergonomics

Many people who work in offices spend majority of their time sitting  in front of a computer for long periods of time.  Additionally, many offices do not always provide optimal ergonomic setups for their staff.  Over time, as a result, this may lead to the development of pain and stiffness in the shoulder.

Examples of poor ergonomics include:

    • poor desk and screen height
    • poor positioning of the keyboard and mouse
    • inadequate chair height and support

Poor workplace ergonomics

Poor day to day posture

Shoulder pain related to posture usually develops over time with certain habits.  For the most part, some of these habits we just adopt over time.  For instance, examples include looking at our phones for long periods of time or spending hours playing video games.  In other words, shoulder pain can develop from poor posture if we do not make an effort to be more active during our day.

Repetitive activities

Many people perform tasks that are repetitive at work and/or home.  For instance,  overhead lifting, sorting on an assembly line and typing are examples of repetitive activities.  These repetitive activities can certainly take their toll if it has been going on for a long period of time.  Therefore, if the shoulder is not strong enough to support the work that it’s having to do, then injury may occur.

Repetitive lifting

Consequently, it is not uncommon for people who do a lot of repetitive manual labour to hurt their shoulder at work.  In Ontario, if workplaces are registered with the WSIB or the Workplace Safety & Insurance Board, they may qualify to get physiotherapy treatment.

Congenital or Developmental changes

Some people are born with a unique bone structure that may place them at increased risk of injury. For example, if the acromion of the shoulder blade has a hooked shape, there is more potential for a rotator cuff injury.  Similarly, your genetics may influence the shape of your bones in the shoulder.  This may lead to an increased risk of shoulder pain as a result.

Some Basic Shoulder Anatomy

Having some knowledge of basic shoulder anatomy will help with understanding why shoulder pain develops.  The shoulder joint is quite complex.  Specifically, there are a lot of structures that attach to or present around the shoulder.  For example, these structures include tendons, ligaments, bursae, cartilage and the joint capsule. Furthermore, the shoulder joint is held together by mostly soft tissues without a lot of bony protection.  This setup specifically allows for a lot of movement.  However, as a result there is less stability through the area.

What structures makes up the shoulder joint?

The shoulder is made of 4 separate joints that work together to allow function:

  • Glenohumeral (GH) joint – this is a ball and socket joint and is where majority of our arm movement happens. The socket is made up by part of the shoulder blade and the ball is made up of the humerus, which is the long bone of the upper arm.
  • Acromioclavicular (AC) joint – joint between the acromion of the shoulder blade and the collar bone.
  • Sternoclavicular (SC) joint – joint between chest bone and the collar bone.
  • Scapulothoracic joint – the joint between the shoulder blade and the ribs at the back of the chest.

Why is the shoulder joint prone to pain?

The shoulder is held together by many soft tissues including ligaments, muscles and tendons.   Other important anatomical structures include the joint capsule surrounding the ball and socket joint and the subacromial and subdeltoid bursae.  The function of the joint capsule is to protect the joint and produce a lubricating fluid.  The bursae are small fluid-filled sacs that act as a cushion between the bone and other moving parts.

What are some of the injuries that can happen to the shoulder?

  • Sprains/Strains of any of the muscles, tendons and ligaments
  • Tears/Ruptures of any of the muscles, tendons and ligaments
  • Tendonitis/Tendinosis
  • Fractures
  • Bursitis
  • Dislocations
  • Adhesive Capsulitis or Frozen Shoulder
  • Osteoarthritis
  • Nerve entrapments/injuries

Signs and Symptoms of Shoulder Injuries

  • Pain
  • Swelling
  • Restricted range of motion
  • Weakness
  • Instability
  • Bony deformities

Healing Times for Shoulder Injuries

The healing time for shoulder injuries will vary depending on the injury.  Most simple sprains and strains will take anywhere from 6-8 weeks to get better.  On the other hand, other types of injuries may need more time to recover.  For example, muscle or tendon tears can take 6-12 months to improve.  And similarly, frozen shoulders can take well over 1 year to improve.  Therefore, the timeline for healing really depends on the nature of the injury.  Additionally, there are a lot of individual differences in healing time even for similar injuries.  Some of these factors include:

  • Age
  • Level of fitness and/or mobility
  • Commitment to treatment
  • Consistency of doing home exercise program
  • Ability to modify workplace or home environment to allow for optimal treatment response
  • Presence of other injuries
  • Amount of time that they injury/pain has been present

Treatment for Shoulder Pain

The treatment for shoulder pain will depend on the type of injury and the structure(s) that has been injured. Most importantly, it is important to understand that the shoulder is made up of 4 different joints.  Additionally, these 4 joints are all interconnected with each other.  Therefore, treatments needs to target the whole shoulder complex and not just the individual structures involved.  Consequently, this will allow the shoulder to return to its full potential and reduce the risk of re-injury.

The main goals of any shoulder pain treatment will be to:

  • Reduce pain
  • Regain full range of motion
  • Regain strength and stability
  • Return to pre-injury activities

What is the typical treatment for shoulder pain?

Treatment for shoulder pain usually has multiple components.  The Registered Physiotherapist will start with a thorough assessment.  Firstly, this allows them to identify the source of the shoulder pain.  Secondly, based on the assessment, the physiotherapist is able to provide the most appropriate treatment.  Specifically, examples of physiotherapy treatment can typically include:

  • Manual therapy
    • soft tissue work
    • mobilizations
    • assisted stretching of the shoulder and associated areas

  • Modalities – these are usually used in the acute phase for pain relief
    • Ultrasound
    • Laser
    • IFC or TENS
    • Acupuncture
    • Heat/Ice
  • Exercises
    • Range of motion and strengthening exercises that are specific to the injury
    • It is important that the patient completes the prescribed exercises on a regular basis at home.  Firstly, this allows the patient to make the necessary changes with movement and strength.  More importantly, however this allows the patient to be independent and provide self treatment on a daily basis.

  • Education
    • Explanation of the condition
    • Rationale for the treatment choices
    • Do’s and don’ts to help the injury along

In conclusion, shoulder pain can be quite debilitating for many people.  Therefore, it is important to seek out a registered physiotherapist for assessment and treatment sooner than later.  Similarly to most other injuries, the longer an injury is left untreated, the more chronic it becomes.  Consequently, this makes it more difficult to resolve in a timely manner.  Call PhysioNow today to get treatment for your shoulder injury.  Our experienced physiotherapists and massage therapists in Mississauga, Etobicoke and Oakville will help you recover!

Neck Pain Treatment

Neck Pain Treatment

Neck Pain Treatment

Pain in your neck can happen for several different reason  . Neck Pain Treatment can help get you back on your feet quickly.  It can happen suddenly from an accident or fall.  Even sleeping in an awkward position can cause neck pain. Other times it can build up over several months or even years and gradually get worse. And sometimes, it may seem like there is no reason and you just wake up one day with neck pain.

Neck Pain Treatment:  Possible symptoms you may feel

  • The way you feel the pain can also vary depending on how the  injury happened.
  • Some neck injuries will have just pain as the symptom.
  • Other neck injuries will include pain but also have weakness and pins and needles as well.
  • Sometimes you will have pain that is just in the neck itself. In other cases, pain is felt more in the arms or hands.  When this happens,  you might not think that there is anything wrong with your neck at all.
  • Neck pain Treatment can be difficult mostly because it can be difficult to properly diagnose. It is important to find an experienced Registered physiotherapist to make sure that appropriate treatment is received.

See this link for possible causes of Neck Pain.

Neck pain Treatment options:

There can be a variety of treatment options that can be successful at managing neck pain.

  • Modalities such as heat and IFC/TENS can help with reducing pain temporarily.
  • Manual treatment techniques like soft tissue work and mobilizations help with improving mobility and reducing stiffness and tissue tension.
  • Doing the appropriate exercises will also help stretch and strengthen the affected areas.
  • Acupuncture is another modality that can help with reducing pain and improving stiffness.
  • Massage therapy is another treatment approach that can greatly alleviate pain and stiffness and help further the patient’s recovery.
  • Ultimately, there are a variety of treatment options available to treat neck pain. It is up the treating therapist and their expertise to determine the best treatment approach to correct the pain and achieve the patient’s goals.

Neck pain can be very painful  and really affect a your quality of life. It is important to seek help as soon as possible so that the pain and limitations can be addressed and recovery can be achieved quickly!

Call PhysioNow today to get started!

Acupuncture: Neck pain

Acupuncture: Neck pain

Acupuncture: Neck pain

Almost everyone will experience some sort of neck pain or stiffness during their lifetime. However, certain occupations appear to be predisposed to neck symptoms.  Acupuncture: Neck pain may be able to help.

Manual laborers, for instance, have more symptoms than office workers.  The type of work seems to affect the risk. A person’s age and a history of twisting and bending during work can also contribute.

Studies have shown acupuncture: Neck Pain to be effective in relieving certain types of neck pain.  This is especially true for neck pain  caused by whiplash. Some studies suggest acupuncture can treat degenerative neck disorders such as ankylosing spondylosis and cervical spondylosis.  In many cases, acupuncture: Neck pain has worked for patients whose conditions could not be solved using conventional approaches.

¬ Mechanism of action of Acupuncture: Neck pain

  • Release of opioid peptides.Opioids are naturally occurring chemicals in the brain that have apain killing effect. The release of these opioids plays a large role in the reduction of pain. There has been lots of evidence to show that acupuncture stimulates the central nervous system.  This causes the release of these pain killing chemicals.
  • Alteration in the secretion of neurotransmitters and neurohormones.Acupuncture is said to activate the hypothalamus and pituitary glands. This changes the release of these chemicals. These particular chemicals play a direct role in the feeling of pain. It also affects the activity of an organ . Evidence has shown that acupuncture alters this secretion in a manner that reduces pain.
  • Stimulation of electromagnetic points on the body. The 2,000 points of the body that acupuncture focuses on are thought to be special conductors of electromagnetic signals. Stimulation of these areas is believed to start the flow of endorphins—the body’s natural painkillers.¬ Indications for Acupuncture: Neck pain
    • Sudden Force/Automobile Accident
    • Degenerative Disc Disease
    • Overuse/Improper Use
    • Osteoporosis
    • Neck Strain
    • Degenerative Arthritis
    • Whiplash
    • Muscle Tension or Spasm
    • Bone Spur
    • Herniated or Protruding Disk
    • Pinched Nerve
    • Ligament/Muscle Tears
    • Cervical Spondylosis
    • Ankylosing Spondylosis

    ¬ Contraindications of Acupuncture: Neck pain

    There are very few situations where acupuncture is not advised:

    • When someone has a hemophilic condition
    • When a  patient is pregnant – certain acupuncture points and needle manipulations should not be used during pregnancy
    • If a patient has a severe psychotic condition or is under the influence of drugs or alcohol

    Check out this link for a bit more information about the use of Acupuncture: Neck pain.

    ¬ Types of application of Acupuncture: Neck pain

    • Basic needlingNeedles are inserted to a depth of 4–25 mm and left in place for a period of time (from a few seconds to many minutes). There are often 6–12 needles (and sometimes more) inserted at different acupoints at the same time. The sensation is often described as a tingling or dull ache at the entry point. Many people say they feel very relaxed or sleepy, and some report increased energy levels afterwards.
    • Electro acupuncture (EA)A tiny focused electric current is applied to the skin at the acupoints or can be applied to the needle itself.

    If you would like to meet with a Registered Physiotherapist that is trained to do Acupuncture: Neck Pain,   please call PhysioNow today! Our experienced physiotherapists would be happy to help !

Peroneal tendinopathy

Peroneal tendinopathy

Peroneal tendinopathy

Peroneal tendinopathy or peroneal tendonitis is characterized by an aching pain and swelling in the perineal tendons. These are located in the lower, outside portion of the ankle. A tendon is soft-tissue that attaches a muscle to a bone. The muscles involved in this condition are the 2 peroneal muscles in the lower leg, called the peroneus longus and the peroneus brevis.

Anatomy

?There are two peroneal tendons that run along the back of the fibula. The first is called the peroneus brevis. The term “brevis” implies short.  It is called this because it has a shorter muscle and starts lower in the leg. It then runs down around the back of the bone called the fibula on the outside of the leg and connects to the side of the foot.  The peroneus longus takes its name because it has a longer course. It starts higher on the leg and runs all the way underneath the foot to connect on the other side of the foot. Both tendons, however, share the major job of turning the ankle to the outside. The tendons are held in a groove behind the back of the fibula bone.

Causes of Peroneal Tendonitis

  • A sudden increase in weight bearing activities, particularly walking, running or jumping
  • Inadequate or unsupportive footwear
  • Muscle imbalances of the lower limb
    Poor lower limb biomechanics
  • Incomplete rehabilitation following an acute ankle injury, such as an ankle sprain

Symptoms of Peroneal Tendinopathy

  • Gradual worsening pain over the outside of the ankle
  • Pain during and/or after weight bearing activities
    Pain with turning the foot in and/or out
  • Instability around the ankle when weight bearing

Diagnosis

A full examination from a physiotherapist can be all thats needed to diagnose peroneal tendonitis
Patients with this condition usually experience pain behind the outside ankle during activities putting stress on the perineal tendons. Pain can also be noticed following these activities or following a rest period. This may be noticed especially upon waking in the morning. There may be swelling when the injury first happens. There will also be pain when testing resisted foot movements.  Stretches into various positions of the foot inversion, and resisted movements can cause pain behind the outside ankle.
Diagnosis may be confirmed with an MRI scan or ultrasound investigation
a diagnostic Ultrasound may be used for detecting all types of peroneal injuries.

What else could it be?:

Symptoms of peroneal tendinopathy mimic various other conditions of the ankle joint. So, before diagnosing peroneal tendinopathy we should rule out other possible injuries by doing the following tests:
Ankle Sprain: ligament testing by the Physiotherapist
Ankle fractures: special tests by the Physiotherapist
Os trigonum syndrome: MRI, physiotherapy testing
Chronical lateral ankle pain with other cause: MRI
Longitudinal peroneal tendon tear: MRI
Peroneal subluxation: ultrasonography, CT, MRI or peroneal tenography
Flexor Hallucis longus tendon injury

Physiotherapy rehabilitation

Treatment for peroneal tendonitis includes a program of stretching, strengthening, mobilisation and manipulation. It also includes proprioceptive exercises, icing, ankle bracing or k-taping during contact sports. If symptoms are severe, a cast or ROM boot immobilization may be worn for 10-20 days. After symptoms resolve, you will begin a progressive rehabilitation programme along with a gradual increase to full activity.

The use of a biomechanical ankle platform (BAPS), deep tissue friction massage, ultrasound electric stimulation can also be included in the physiotherapy
Also, shock wave therapy (ESWT), acupuncture is used to treat tendinopathy. But there is only limited evidence from studies for these treatments.
There is evidence for using manual therapy, specifically the lateral calcaneal glide.

If you have any further queries please call PhysioNow. Our experienced physiotherapists would be happy to help you. Call Today to get started 289-724-0448.!

De Quervain’s Disease

De Quervain’s Disease/ Texting thumb.

De Quervain's Disease

De Quervain’s Disease

De Quervain’s Disease or nowadays known as texting thumb is a painful inflammation of tendons in the thumb that extend to the wrist. The rubbing of the inflamed tendon against the canal it passes through causes pain at the base of the thumb and into the lower arm. It is commonly seen in females over 40 years of age.

Causes of De Quervain’s Disease

1. Simple strain injury to the tendon.
2. Repetitive motion injury. Workers who perform rapid repetitive activities involving pinching, grasping, pulling or pushing are at increased risk. Specific activities including intensive mousing, trackball use, and typing. Other activities including bowling, golf, fly-fishing, piano-playing, sewing, and knitting can also cause De Quervain’s Disease.
3. Frequent causes of De Quervain’s Disease include stresses such as lifting young children into car seats, lifting heavy grocery bags by the loops, and lifting gardening pots .
4. De Quervain’s Disease often occurs during and after pregnancy. Factors may include hormonal changes, fluid retention and more lifting.
5. Rheumatoid arthritis.

De Quervain's Disease

De Quervain’s Disease/ Texting Thumb

Onset and Symptoms of De Quervain’s Disease

Onset can be gradual or sudden. Pain is felt along the back of the thumb. There can be Pain directly over the thumb tendons, and pain may travel into the thumb or up the forearm. The bottom of the thumb or the side of the wrist might also be sore or swollen.
It may be hard and painful. Symptoms may get worse when the thumb is moved, particularly when pinching or grasping things. Some people also have swelling and pain on the side of the wrist at the base of the thumb. The back of the thumb and index finger may also feel numb. People might experience a funny sound like a squeak, crackle, snap, or creak when they move the wrist or thumb.
If the condition is not well addressed, the pain can spread up your forearm or down into your thumb.

How is De Quervain’s Disease diagnosed?

De Quervain’s Disease is diagnosed based on history and physical examination. X-rays, or ultrasound may be used to rule out other causes of pain.The Physiotherapist may use special tests to help diagnose De Quervain’s. More information can be found here.

Physiotherapy Treatment

Your Physiotherapist will likely recommend that you wear a specific wrist splint with a thumb spica for 4 to 6 weeks . PhysioNow carries these wrist splints in stock. You’ll also need to stop doing activities that worsen the condition.

Wrist brace with thumb spica

De Quervain’s Disease

The physiotherapist after a thorough assessment could choose different therapy approaches to help with the swelling, pain, and function.
These treatments may include Ultrasound, K-taping, acupuncture, and manual therapy. Other Physiotherapy treatments may include specific exercises focusing on range of motion, strength, and flexibility. These would be given for a safe and effective return back to function.

Recovery times vary depending on your age, general health, and how long you’ve had the symptoms.
If your disease has developed gradually, it’s often tougher to treat. So, it may take you longer to get relief. Your doctor may give you anti-inflammatory medication, or may inject the area with steroids to curb pain and swelling.

In our experience at PhysioNow, more than 99% of people with De Quervain’s Disease get better with Physiotherapy treatment provided. If however, you are one of the outliers, your doctor may recommend surgery. The operation would release the tendon’s tight covering so that the tendon could move smoothly. It’s an outpatient procedure, which means you go home afterward. Your doctor will recommend physiotherapy after surgery which includes an exercise program to strengthen your thumb and wrist.

If you or someone you know suffers from De Quervain’s Disease, please call us today. Our skilled Physiotherapists can Help!