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Clavicle Fracture, Frozen Shoulder, General Category, Rotator Cuff tear, Shoulder Dislocation, Shoulder Injuries, Shoulder pain, Sports Injuries

Shoulder Pain and Treatment

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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!

Erin Mills Physionow, Exercise, General Category, Lorne Park PhysioNow, Low back Pain, Manual Therapy, Mechanical Diagnosis and Therapy, neck pain, Neck strain, PhysioNow, Physiotherapy Mississauga, Posture

Posture

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IS POOR POSTURE THE CAUSE OF YOUR PAIN?

Did you know that current research suggests 80% individuals will experience back pain at some time in their lives? There are several causes that can lead to back pain-degenerative changes, herniated discs, poor posture, pulled/torn muscle /ligament around the spine, kidney stones or many other pathological causes. Of all these various causes, there is one thing that can be controlled and taken care of by you-POSTURE!

 

WHAT EXACTLY IS A POOR POSTURE?

Any position that places our spine in unnatural curves (most often a C shape) instead of the normal S shape curve is a poor posture (see picture below). S shaped curve allows for equal weight distribution as well as flexibility of the spine. Poor posture is known to affect not just the spine but also the surrounding ligaments and muscles. Prolonged poor postures lead to a lot of pressure on these surrounding tissues thus increasing the damage and pain.

Posture. Physiotherapy Mississauga

Good-Posture-vs-Poor-Posture

FACTORS CONTRIBUTING TO POOR POSTURE:

Improper workstation design :

Could be a wrong chair, monitor height or distance of yourself and the monitor. Lack of enough breaks specially in a desk job also contribute to poor posture in the long run.

Repetitive movements/postures as a part of work/occupation:

Bending repeatedly and working.

Lifestyle:

Current technology has made people to bend down and look into their electronic devices for several hours every day. High heels, sitting with the wallet in the back pocket and heavy bags/purses also lead to malalignment of the spine.

Muscle imbalance:

Due to certain sports that we play or our basic posture leading to weakness in some groups and tightness in others thus affecting the curve.

Poor core stability and strength

Age:

As age advances, it leads to lesser flexibility and strength. If we keep thinking that doing exercises will cause more discomfort than what we currently have, the muscles become weaker and weaker and without enough muscle strength, the spine cannot stand erect

Habit:

The habit of poor posture is very difficult to change like sitting slouched on a couch for several hours or just slouch sitting or standing in day to day activities. Sure, everyone loves to sit in a relaxed position but, if you do not make the effort of trying to change it, it will keep creating more and more problems for the body.

 

EFFECTS OF BAD POSTURE:

Since childhood we have been asked to sit straight or stand tall and not slouch. Mostly everyone did that as a compulsion and rather grudgingly. However, it has many important reasons instead of it just being better for our appearance!

Back pain:

That is the most obvious one! Poor posture leads to stretching of the muscles of the back and the surrounding structures thus making them weak which in turn reduces the support it gives to the spine – taking us back to poor posture! As it becomes more of a chronic habit, you then have to take care of your posture and make your muscles stronger as well.

Neck pain, headaches and jaw pain:

Sometimes when there is no trauma or injury to your jaw and it starts clicking, popping, paining or going into spasm. There is a possibility it might be coming due to malalignment of the neck. A forward head posture has been known to cause jaw pain and headaches.

Hip, knee and foot pain:

Yes, the body is a closely connected structure. Any malalignment or change at one point like the foot or knee does affect the spine and leads to pain and vice versa.

Gastrointestinal system problems:

A slouched position/poor posture may compress the internal organs of the abdomen. It also affects the movement of the intestines thus leading to numerous gastrointestinal troubles like acid reflux or constipation. Over time it can also affect the metabolism and the way food is processed in the body.

Psychosocial impact:

In general, a person with a good upright posture seems more approachable and confident compared to the one who is slouching. This in turn leads to less motivation or mood issues in social situations. It has also been known to cause more fatigue and sleep problems as the body has to work harder and spend more energy to maintain itself when it is clearly not aligned well.

 

WHAT CAN YOU DO TO FIX A BAD POSTURE?

  • Avoid prolonged sustained positions. Make sure you take frequent breaks, if possible, try getting up from your chair after every 30-45 minutes .
  • Get into the habit of sitting well- always sit with your buttocks touching the back of the chair. This, in turn, will promote an erect posture and your back will get enough support
  • While you are standing try to distribute your weight evenly on both legs and do not lean on one side.
  • Use a backpack instead of a one sided bag if it is heavy so there is equal weight distribution on the shoulders. While sitting remove the wallet from the back pocket
  • Do a chin tuck- if you have a poking chin and rounded shoulders, straighten your upper back and do a chin tuck and repeat it 10 times. You should also stretch your chest muscles if you have rounded shoulders
  • If you have to use the phone for a long time, try holding it with your hand. You can also use a hands-free device instead of cradling it with your shoulder

 

HOW DOES PHYSIOTHERAPY HELP TO SOLVE POSTURE RELATED PROBLEMS?

Physiotherapists can help you by assessing exactly where your problem begins and then helping you to understand and modify habits that lead to bad posture. There are also various other treatments like manual therapy, taping and exercises that are aimed at stretching the tight muscles and strengthening the weaker muscles around the spine. They can also advice you regarding your work station modifications, if required.

 

PhysioNow

If you or anyone you know has posture related aches and pains or wants to get an assessment done to find out more about how you can improve your posture, call us today for an appointment!

 

 

Erin Mills PhysioNow, Erin Mills Physiotherapy Ltd., General Category, Headaches: Neck Pain, Neck pain Treatment Mississauga, PhysioNow, Physiotherapist Etobicoke, Physiotherapist Mississauga, Physiotherapy Mississauga, Vestibular Rehabilitation

Neck related dizziness

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Neck related dizziness

Neck related or cervicogenic dizziness is one of the common causes of dizziness and affects 45-80% population. However, while treating the symptoms of being dizzy/light-headed, this diagnosis is commonly missed.

How can it come from the neck?

Nerves from the upper part of the neck connect with the vestibular system(area of the brain responsible for balance). As a result, any injury or impairment in the upper neck like car accident (whiplash), abnormal posture or any inflammatory condition could eventually lead to disturbance in the vestibular system. This, in turn, leads to dizziness.

How to know if your dizziness is related to your neck?

  • If you are experiencing lightheadedness, unsteadiness, feeling imbalanced and above all, feeling like your external environment is spinning
  • Moreover, if your symptoms comes with moving the head quickly in any direction, during sitting or standing up
  • Further, if you are experiencing headache and neck pain
  • In addition, you have a history of neck injury due to a car accident or neck pain due to abnormal posture

Diagnosis:

There is no specific test with good evidence for cervicogenic dizziness. However,  there are tests that will help you rule out other causes of dizziness. This, in turn will help in concluding that cervical spine is the cause for your symptoms.

How could physiotherapy help you with dizziness?

First of all, there will be a comprehensive assessment of your symptoms. Then, the physiotherapist designs a treatment plan incorporating manual therapy , exercises, education and other modalities like acupuncture. Consequently, it will help treat the neck as well as the vestibular system.

Physiotherapy Treatment Etobicoke

Neck related dizziness

Prognosis:

Cervicogenic dizziness usually has good prognosis. It usually resolves with the treatment of neck and the vestibular system. About 75% of patients have reported significant improvement in their symptoms.

Are you experiencing any of these symptoms? Our Vestibular physiotherapists specialize in treating this. Book an appointment today at one of our clinics! We will do an assessment and help you get better.

Accident Rehabilitation, Accident Rehabilitation Etobicoke, Accident Rehabilitation Long Branch, Accident Rehabilitation Lorne Park, Accident Rehabilitation Mississauga, ACL REHAB, acupuncture, Applewood Physionow, Concussion, Custom Knee Bracing, Custom orthotics, Erin Mills Physionow, Erin Mills PhysioNow, Erin Mills Physiotherapy Ltd., Etobicoke Physiotherapy, General Category, Knee Pain, Long Branch PhysioNow Ltd., Long Branch Physiotherapy, Lorne Park PhysioNow, Low back Pain, Massage Therapy Services Mississauga, Motor Vehicle Accidents, neck pain, Neck pain Treatment Mississauga, Pelvic Health, PhysioNow, Physiotherapist Etobicoke, Physiotherapist Mississauga, Physiotherapy, physiotherapy Etobicoke, Physiotherapy Etobicoke, Physiotherapy Mississauga, Pregnancy Mississauga, Registered Massage therapist Mississauga, Registered Massage Therapy Lorne Park PhysioNow, Registered Massage therapy Mississauga, Registered Physiotherapist Mississauga, Registered Physiotherapy Mississauga, Sports Injuries, Sports Physiotherapy, Sports Taping, Vestibular Rehabilitation

Physiotherapy Mississauga

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Physiotherapy Mississauga

Why choose PhysioNow for Physiotherapy Mississauga?

• Over 16 years of providing top rated Physiotherapy Mississauga
There are 4 convenient locations- Erin Mills, Applewood, Lorne Park and Long Branch

• Awards/nominations? PhysioNow: nominated for a Top Choice Award in 2020.

• A team of highly qualified physiotherapists and massage therapists

All of our physiotherapists and massage therapists have several years of experience in their field and are registered in good standing with the College of Physiotherapy and Massage Therapy.

• Services we offer

Services are provided for all ages and for a variety of conditions. For instance,  our therapists are specialized in several areas including manual therapy, acupuncture, vestibular rehabilitation, concussion , sports injuries, pelvic health and soft tissue techniques.

Physiotherapy Mississauga

Lower Back Pain Treatments

Physiotherapy Mississauga

Donjoy Defiance ACL Repair Brace

Physiotherapy Mississauga

Return To Sport After ACL Ligament Repair

In addition, we  do custom orthotics and braces.  For your convenience, we are currently also offering our physiotherapy services virtually .

• Direct billing available

In addition, Direct billing is available to most of the insurance companies so it is convenient for you.  For instance, we also deal with third party insurers like MVA and WSIB.

• Flexible hours and free parking available

Above all, we are open for extended hours ( ) to help you at a time that is best for you.

What to expect at Physiotherapy Mississauga?

First, you have an assessment with our physiotherapist.  They will do a full check up of the problem area .

Next, the physiotherapist will then prescribe a treatment plan especially for you.

Further, they can also help you understand more about your condition.

We will answer your questions .

Lastly, changes may be made  in your daily routine.

As a result, this will  help you to get better faster.

COVID considerations: We take excellent precautions!

 

• Providing a face mask and use of 70% alcohol hand sanitizer for each patient upon arrival into the clinic

• Installation of sneeze guards at the front desk

• In addition, Sanitization of treatment beds after before each patient use

• Disinfecting commonly touched surfaces between every patient

• Switching out pillowcases with each patient use

• All staff will wear a gown and mask and wash hands between each patient contact

  • Social distancing throughout the clinic.
  • Lastly, no visitors are sitting in reception

If you are in need of Physiotherapy or Massage Therapy, Contact PhysioNow today.

Kevin Durant
Achilles Rupture, General Category

Kevin Durant

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What happened to Kevin Durant?

Kevin Durant originally injured his calf in early May during the second round of playoff games.  The injury had been labeled a ‘calf injury’ and Durant has not been able to play for over 30 days.  After doing a shoot around with the team, the Warriors made the decision to allow Durant to play for Game 5.  Durant came out strong, scoring 11 points in 12 minutes of play. But things changed as he tried to do a crossover move and had to fall to the floor on the sidelines.  He was grabbing onto his lower right calf, more towards his Achilles tendon. In conclusion, from the replays, it looked like he may have torn his Achilles tendon.

What is the difference between a calf strain and an Achilles tendon tear?

  • Kevin Durant’s injury

Calf Strain : Did Kevin Durant have this injury?

It is possible that Kevin Durant had a calf strain to start.

The bulk of the calf is made up of 9 different muscles.  Three muscles work together to produce a downward movement of the foot. These 3 muscles attach themselves into the heel bone:

  • Gastrocnemius
  • Soleus
  • Plantaris

Other Muscles of the calf/ foot

The other 6 muscles cause knee, toe and foot movements in different directions.  These muscles are located deeper in the calf area. However, these muscles travel around the sides of the ankle and attach to different parts of the foot and toes.  These muscles are:

  • Popliteus
  • Flexor digitorum longus
  • Flexor hallucis longus
  • Tibialis posterior
  • Peroneal longus
  • Peroneal brevis

Sometimes injuries are labelled incorrectly.  Pain in the calf region is attributed to the first three muscles.  However, a calf strain could involve any one of the 9 muscles mentioned above.  As a result, it is up to the health professional to correctly identify which of the muscles are involved in the strain.

Severity of Calf Strain: What Grade did Kevin Durant have?

In general, a calf strain is caused by overstretching or tearing of the calf muscles.  This type of injury can occur suddenly or over time. The severity of the strain is graded by the amount of muscle damage that has occurred:

  • Grade 1
    • Mild or partial stretch or tearing of a few muscle fibres
    • The muscle may be tender and painful
    • Strength and function are maintained
  • Grade 2
    • Moderate stretching or tearing of a greater percentage of muscle fibres
    • A snapping or pulling sensation may be felt at the time of the injury
    • More tenderness and pain
    • There may be some visible bruising
    • Loss of strength and function
  • Lastly, Grade 3
    • Severe tear of the muscle fibres, commonly a complete rupture
    • A ‘popping’ sound may be heard of felt at the time of the injury
    • There is definite bruising and sometimes there is a visible ‘dent’ in the muscle
    • Severe loss of strength and function

Signs and Symptoms of a Calf Strain

  • A snap, pull or “pop” felt or heard at the time of injury
  • Pain and weakness in the calf area
  • Swelling in the calf area
  • Tightness
  • Bruising
  • Weakness in the calf when doing any weight bearing activities
  • Limping when walking

What is the usual Physiotherapy treatment for a calf strain?

Treatment for a calf strain is like that of any other muscle in the body.  The goals of the treatment include:

  • Reducing pain
  • Improving range of motion of the knee and ankle
  • Improving the strength
  • Speeding up recovery time
  • Returning to activities
  • Preventing re-injury

How long does it take to recover from a calf strain?

The length of time for recovery from a calf strain injury depends on the severity of the injury.  On average:

  • Grade 1: 10-12 days
  • Grade 2: 4-6 weeks
  • Lastly, Grade 3: 6 months after surgery

Achilles Tendon Rupture : Kevin Durant’s final injury

The gastrocnemius, soleus and plantaris muscles unite to form the Achilles tendon.  The tendon is a tough band of tissue that connects these three calf muscles to the heel bone.  When the calf muscles contract, the Achilles tendon is tightened and pulls the heel. As a result, the action allows the foot to be pointed down.  A complete tear of this tendon is called an Achilles tendon rupture.

Signs and symptoms of Achilles Tendon Rupture

  • Sudden and severe pain at the back of the ankle or calf
  • Sound of a loud pop or snap
  • Immediate swelling and weakness
  • Visible bruising and possible denting in the tendon

Treatment options for Kevin Durant’s Achilles Tendon Rupture

  • Non-surgical treatment
    • Rest
    • Crutches
    • Ice
    • Pain medication
    • Immobilisation for the first few weeks with a walking boot and heel wedges
    • Recovery may take longer but risks of surgery are avoided
  • Surgical Treatment

The choice between surgical or non-surgical treatment depends on different factors. A patient’s age, activity level and severity of the injury all play a factor.  In general, younger and more active people, especially athletes, choose surgical repair. In contrast, older and more sedentary individuals usually choose the non-surgical pathway.  In either option, rehabilitation is a lengthy and difficult process to make sure full function is returned.

So, what happened to Kevin Durant?

The Kevin Durant was out for over a month with an initial calf strain.  Due to the amount of time that he was out of the game, it’s likely that he had a grade II strain of his calf.  As a result, his return to the game resulted in a complete Achilles tendon rupture. In review, it makes you wonder whether he was physically able to return to play.  Did he have enough time for recovery from his initial injury to withstand the demands of the game?

Basketball is a sport that has a lot of pivoting, stop and go movements and bursts of high intensity activity.  In conclusion, it is possible to say that judging from how soon into the game the injury happened, that Kevin Durant was likely not fully recovered.

Professional Sports: Decisions for return to play. Should Kevin Durant have returned to play in Game 5?

However, in professional sports, there is a lot of pressure from all fronts to get a star player back in the game.  The team was down 3-1 and having Durant back in the game boosted their confidence and morale. As a result, the fans wanted the Warriors to win.  The organization wanted the team to hold on to their title again. In addition, Kevin Durant himself probably felt terrible that he wasn’t able to play and support his team.  As a result, all of these pressures likely led to the decision for him to play.

Unfortunately, our bodies are not always able to function like we want them to. In Durant’s case, his return to the game led to an even more serious injury, which required surgery.  In conclusion, after surgery he will have to endure a lengthy process of physical therapy and will likely be out for the entire next season.

Return to Play Decisions

This is an excellent example of the importance of return to play decisions.  Regardless of the sport and regardless of the injury, it is vital that the health and well being of the athlete is the top priority.  In conclusion, returning to play too soon isn’t worth risking a more serious injury. Lastly, a more serious injury can affect the athlete’s future participation in the sport.

Physiotherapy Treatment options for Achilles Rupture

If you or someone you know has experienced calf pain or an achilles rupture, our Physiotherapists at PhysioNow are here to help! We have treated many patients with exactly these injuries. Call today to get started on your treatment and get back in the game!