Autumn is coming – Time for reflection…Oh, and clearing the garden.

June 2, 2015

A few days ago I decided (on the spur of the moment), to take down a Magnolia tree that was shading the house. To be frank, the real reason is that it was giving the local squirrel population a convenient bridge to my roof space and therefore extending my ongoing battle with there smart little beggars!

However, the point of this reflective post is that I did EXACTLY the opposite of the advice I give to my patients! With frowning solemnity, I tell them how silly it would be to treat ANY physical activity differently to the way that we should approach exercise and movement. This of course includes gardening, especially the , “I was only moving a large pot/I was only felling a tree/I was only double-digging the potato plot ready for next season”, comments that I smugly listen to and gently shake my head sadly at.

I made the decision (good, as I had been putting it off for a while), leapt to my feet and gathered the tools I’d need (pretty good, as this shows planning and commitment), fired up the chainsaw and plunged in (really not so good, as I’d done no physical preparation and hadn’t got proper eye protection), and then spent several hours turning a perfectly good tree into fuel for the open fire and a huge pile of debris that I couldn’t be bothered to take to the dump because my back hurt, my shoulders were knackered and my quads were shaking from spending too much time terrified up a ladder!

What lesson should I draw from this? The most practical answer to that is probably go to work and earn the money to employ a professional (but then would he arm up either?). What should I and you and, indeed a professional tree surgeon, have done?

The image to the right might be one answer, but I think we can take a more pragmatic approach and

SUDDEN-ONSET WRIST PAIN

September 29, 2011

Wrist pain is common. Wrist pain starts for many reasons including trauma, overuse and disease, but I think we often overlook its importance when there isn’t an obvious injury like a fall. The emphasis for many sports and fitness enthusiasts, both consumers and providers, is on the bigger, perhaps more impressive structures.
Sure, there are many articles on the web about grip strength, and forearm strength, but what I see as missing from many of these articles and blogs is any attention to the ‘non-muscular’ structures, like tendons and fascial integrity of the retinacula. These connecting structures that provide stability and ‘packaging’ for the mobile structures like joints and muscles have an unglamorous image.
Wrist pain is amazingly frustrating to anyone who suffers from it, but especially to the active and fit because it inhibits or prevents almost every they do, from dressing to lifting their favourite weight to leaning on the wrist to perform a press-up or sprint start.
One common problem is strain of the ulnar collateral ligament (often called the styloid ligament),  on the outer (ulnar), side of the wrist. It usually starts after overuse or strain of the wrist, perhaps as when over-stretching the grip and especially when cocking the wrist sideways.
You will note that Matt’s wrist, although subject to the stress of an off-centre 44kg load, remains aligned with his forearm and is not deviating to either side.
So, why does this ligament give so much trouble. It is small, short and rather insignificant looking.
The styloid ligament is a rounded cord, attached above to the end of the styloid process of the ulna, and dividing below into two fasciculi, one of which is attached to the medial side of the triquetral bone, the other to the pisiform and flexor retinaculum.
In other words, from the end of the outer forearm bone to two of the wrist bones and some fascia.
So why does it matter if it small, short and insignificant? Well, small doesn’t just have to beautiful. It can be functional and vital as well (and I did say insignificant looking!). The answer is in its role in stabilising for the wrist, prevention of excessive radial deviation  and helps in the limiting over flexing of the wrist. (Remember it is blended with the flexor retinaculum).
In anatomical terms it is very complex and forms part of the triangular fibrocartilage complex. In functional terms, the TFCC forms a cushion for the end of the ulnar bone and is a major stabiliser of the wrist.
So what happens when you stuff it up?
First, there is pain, particularly on wrist flexion and ulnar and radial deviation (sideways motion). Extension tends to feel sore and compressive rather than sharp, like the other movements.
Second, swelling and sometimes heat is seen over the outer side of the wrist. The whole wrist, hand and even forearm may feel stiff and ‘full’, as if pumped up, but not in a healthful way!
Third, you may find it confusing; overall grip might feel reasonable, but pinching index and thumb together can be really sharp. There may well be lots of clicking across the joint, especially if you twist the wrist. It is not necessarily painful, but a bit disturbing. The elbow may well click also.
Fourth, painkillers may not be all that effective and finding a comfy position is hard to achieve.
All these features and no doubt many others, are ‘normal’ for sprains and strains. They are however a message not to plough on regardless. Symptoms should be settling over a matter of days as long as you use common sense practice – any longer than a week, the suspicion must be that it is more than a sprain.
Self treatment includes the old faithful’s of R.I.C.E or Rest, Ice, Compression and Elevation. The example on the right is a bit extreme (I’m sure you will be a lot neater), but you get the idea.
Keep the joints moving with plenty of articulation WITHOUT LOAD, strip out any trigger points you may have in your forearms with a TPT ball (I recommend the one from this link), or just deep thumb pressure assuming you haven’t rogered the other wrist as well.
Slowly reintroduce exercise with some gentle weight bearing, perhaps with the wrist strapped initially and do take your time. It is worth remembering that ligaments do not have a good elastic limit, like muscle and tendon fibres.
The relevance of that is that if you overstretch a ligament badly, continue to over-stretch it or ignoring these injuries, they will become less and less competent. And we don’t want that do we?
Keep well and strong. Contact me here if there are any questions arising from this brief offering.
Andrew

Gentle Shoulder Rehab: Just A Suggestion

November 24, 2009

Filed under: AB'S PERSONAL VIEWS,SPORTS INJURIES,UPPER LIMB — Andy Bellamy @ 12:00 pm

There is an old saying that suggests that there are many ways to skin a cat. Just so, and there are also many ways to stretch and rehab any joint, including the shoulder.

I sometimes feel that there is a gap in the way that we as therapists and trainers handle the recovery and rehabilitation phase of shoulder injury; that the categories are sub-divided too starkly into black and white, passive and active, low-stress mobilising and strength building. It seems to me that we should more often look at what the individual needs and build in an intermediate phase, where act as guide but let the injured individual be inventive and therefore participatory in their own recovery. They improve faster as a result. Encourage them to clean windows, polish floors, bounce balls against a wall – all low, (or at least controllable), effort activities that help to distract from the discomfort but also gives a sense of achievement.

This is not revolutionary thinking by any means as business management techniques are always telling us that if the employee ‘buys in’, then productivity and contentment rise! Why should patients and sports people be any different?

Each individual is just that, individual, and has different physical structure, varying levels of physical activity, abilities, age, expectations and needs. It seems intuitive, therefore, that while those who are professionals endeavour to tailor recovery regimes, that they should, in part at least, be led by the recipient.

I am a great fan of The Rotater and, increasingly, of Kettlebell workouts, but they have very different ‘points of entry’ in the timeline of recovery – the Rotater can be used fairly early in the recovery phase – gently at first, ramping up the intensity as pain reduces and range of motion increases and until it becomes an integral part of any workout, prehab or sporting event. Kettlebell is fantastic as a total body workout that is low impact and wonderful as shoulder mobiliser, BUT is only appropriate rather further down the recovery road!

The following video tries to outline a fairly ‘loose’ approach to mobilising the shoulder – be inventive, work within your means to start with, gradually increasing range and intensity, trust your therapist or trainer, but trust yourself as well.

As with all advice on medical conditions, check with your doctor, osteopath, physiotherapist, chiropractor or trainer before embarking on any new regime.

Shoulder Dislocation

October 28, 2009

Filed under: UPPER LIMB — Tags: , , , , — Andy Bellamy @ 5:12 pm

What is a dislocation? Everyone knows, right? A true dislocation of a joint requires the complete separation of the two sides of a joint. What is often called a dislocation is actually a sub-luxation, or partial separation – they still hurt and do damage, but tend to recover faster.

This is an example of a shoulder dislocation. It is of a rare type, inferior, (or downwards into the armpit), and is caused by hyperabduction and makes up only 1% to 2% of all dislocations. This is a Luxatio erecta type.

1_16.12.08 A&E

So, if it is so rare, why does it matter? Well, it is rare overall, but is relatively common in sporting people who fall!  Mountain biking, moto-X, soccer goalkeeping, equestrian sports and skateboarding.

If YOU end up in the emergency room with your arm stuck above your head, the chances are that they will not have seen it. The key to relocating this joint is to dislocate it again first…..FORWARD, creating an ANTERIOR dislocation, then a more normal reduction to its proper position.

As well as the usual problems associated with dislocations, (AC joint, nerve and blood vessel damage), the inferior type causes damage to the floor of the armpit and can lead to  concurrent fractures of the upper arm, AC joint, as well as injury to the nerves, (brachial plexus), or specifically to the axillary artery.

Recovery can be slow, even with conventional physical therapies, medication and exercises. You will probably have to start with PASSIVE movements, such as pendulum swinging which you can see if you run the video. Remember that passive means just that – let someone else make the movements for you, (physio,osteopath), or use the weight of a tin of beans or can of coke and your body movements to generate the impetus.

Repeat these exercises several times a day and at every opportunity. If you don’t use the range of motion, you may well lose it! Repeat each direction on movement about 30 to 40 times. ie, 30-40 clockwise, anticlockwise, front-to-back, etc.

Good luck with your rehab and make use of all the tools available to you; information, professional advice, devices like the Rotater and, most of all, use your imagination.

NEW ShoulderCentric SITE & BLOG

September 6, 2009

As a result of my earlier fall and subsequent surgery, I have, (perhaps inevitably), taken a more active interest in shoulder problems than I did before. As a result of using an excellent product for shoulder injury rehabilitation called ‘The Rotater‘,  I had something of a ‘Victor Kiam’ moment and have become exclusive UK distributor for this product.

We don’t normally endorse products so positively, but this thing really does do what it says on the tin. Take a moment and have a look! If you would like to know more, drop in and see us at the clinic or check  these sites;

Main ShoulderCentric Site

The Blog for shoulder exercise and rehab articles.

Facebook Page for general shoulder information:

Scott Welch - Boxer using Rotater

Scott Welch - Champion Boxer using the Rotater

The Rotater is used to enhance the process of rehab after surgery and can also be used to improve shoulder mobility that may help your sporting ambitions. Flexibility and improved range of motion, (ROM), for golf, tennis, rugby, baseball, boxing and goalkeeping can all be helped with its regular use.

Rotater Cuff Injury & Tear

June 17, 2009

WHAT IS THE ROTATOR CUFF?

A group of 4 muscles in each shoulder, named for its vague similarity to a short sleeve shirt cuff. Damage to the cuff may be referred to as rotator or rotater cuff tear, rotater cuff strain or rotator cuff injury.

  • These muscles are the supraspinatus, the infraspinatus, the subscapularis and the teres minor muscles. These muscles start on or under the shoulder blade and their tendons wrap around the shoulder joint and the tendons attach to the humerus, or upper arm bone. Their job is to stabilise the joint while it goes through its many movements.**
  • The most likely point of injury is to the tendons of the muscles and can range from microscopic tears to large holes in the cuff.
  • The supraspinatus tendon is the commonest site of tearing.
  • The size of the tear and the amount of pain suffered does not correlate well. Large tears can be seen on scanning that are symptom-free!
  • Rotater cuff tears can happen at any age and may from sporting activities, such as throwing sports, traumatic injuries like dislocations and fractures, but are most common in older age. Degeneration of the tendons, abrasion under the acromio-clavicular joint, (the bony knob on top of your shoulder) and postural problems, (being increasingly round shouldered), are all causes.

WHAT ARE THE SYMPTOMS?

  • · Pain often starts around the upper, outer arm
  • · Pain gets worse when you lift the arm and try to use it above your head
  • · A painful arc of movement – i.e. lifting the arm, initially without pain, until you get a sharp pain, which you might be able to go through with effort, when it then eases again
  • · Pain when turning the arm out to the side when the elbow is bent, (external rotation)
  • · Waking at night with a dull, persistent ache or just when you are resting
  • · Pain over the front and side of the shoulder when you lean on the arm of a chair
  • · Pain when you push the arm sideways against a resistance (the ‘impingement sign’)
  • · Weakness, especially overhead or out to the side
  • · Poor range of motion – can’t do up bra, reach back pocket, brush hair and so on
  • · Crackling (crepitation) and creaking when you do move

HOW IS THE ROTATER CUFF INJURED?

  • · Shoulder dislocation from sports injuries
  • · Lifting or catching something heavy
  • · Falls on to an outstretched arm
  • · Overuse, especially new activities or sports – perhaps soon after retiring from a sedentary job
  • · Age-related degeneration of the shoulder tendons and impingement, (pinching)
  • · Poor posture, (round-shouldered), which reduces the amount of room under the acromion, especially the supraspinatus muscle (more…)