What is Sever’s Disease?

Sever’s Disease (calcaneal apophysitis) is an inflammation of the growth plate in the heel of growing children due to the pulling of the Achilles tendon.

Sever’s disease is a common sports injury in adolescents between the ages of 8 and 14 years.

It is characterised by pain in the heel region, most often during and after activity.

What are the risk factors for Sever’s Disease?

The primary causes of Sever’s Disease are flat feet (pronated foot type), tight calf muscles, growth spurts, increased or altered training load, inappropriate footwear, football boots and hard playing surfaces.

How Can Physiotherapy Help?

Our therapists at PhysioMotion address any bio-mechanical issues to ensure optimal outcomes for our clients.

We also advise on appropriate footwear for all sports including running.

Detailed assessments of your body type, running style, volume of exercise and any injuries will be reviewed when making the appropriate choice of footwear.

Treatment for Sever’s Disease

Once a full assessment and diagnosis has been made by our Physiotherapist, resolution of pain is most often achieved through a combination of treatment modalities.

Usually, Sever’s Disease often resolves when the growth plate closes as adolescents mature or by reducing activity. However, to minimise pain and prevent its recurrence, the following regime is recommended:

Ice / heat therapy

Apply ice for 10-15 minutes to the painful area using a damp towel to protect the skin from an ice burn. Wait 5 minutes. Apply a heat pack for 10-15 minutes as above. Recommended twice daily.

Exercise program

Compliance with the exercise program prescribed by your therapist e.g., calf stretches. Each program will be customised for your body to specifically target your causative factors as prescribed by your therapist.

Anti-inflammatory gel

For adolescents over the age of 12, application of an anti-inflammatory gel such as Voltaren Emulgel to the affected area (first 2 weeks of treatment only).

Rest & activity modification

Footwear modification

• Shoes with a heel elevation of approximately 2cm will be more comfortable when acute

• Flexibility at the toe box of the shoe

• Heel raisers or orthoses (orthotics)

• Minimise barefoot walking that causes pain

Our steps to managing acute injuries

The following recommendations apply to injuries in areas such as the hamstring or groin. Please check with your physiotherapist for a specific treatment plan.

Immediately after the injury takes place

1. Prevent further injury by limiting over-stretching or bearing weight

2. Reduce inflammation and swelling through
   RICE – Rest, Ice, Compress, Elevate

After 24 hours

Take anti-inflammatory medications after the first 24 hours.
Why? Inflammation is an important part of the healing process as it triggers the body’s cellular healing response. However, prolonged inflammation and swelling for more than 24 hour’s delays healing.

Week 1 Post Injury

Manual therapy will involve soft tissue efflourage

After 1-2 Weeks

Manual therapy using deeper muscular release techniques to assist in stimulating tissue healing through:

• Increased circulation to the site of injury

• Desensitisation of nerve endings to reduce pain

• Stretching of scar tissue as a result of healing

At Week 2-4

Begin a strengthening program to address intrinsic muscle weakness and prevent any further loss of muscle function. The program will be progressed dependent on your specific activity requirements.

This is a high-level approach and may not suit all injuries. We recommend working with a physiotherapist for an approach that is tailored to you and your injury,

Hamstring & Groin Muscles

Pain and tightness in the hamstring and groin muscle (muscles at the back and inside aspect of your upper thigh respectively) are common complaints particularly in a sporting population.

It ranges from chronic overuse and tightness in runners to acute strains in more dynamic sports such as football especially whilst kicking a ball, deep lunges required in hockey, rugby or netball.

To enable peak performance, whether at amateur or elite level, understanding the mechanism of injury and how it can be treated will allow you to return to optimal health.

Anatomy of the Hamstrings & Groin Muscles

The hamstring muscles are made up of three muscles (semimembranosus, semitendinosus and biceps femoris) that originate from your ischial tuberosity (base of your pelvic bone) extending down the back of your thigh and attach to the tibia and fibula (lower leg bones). Their action is to bend the knee and extend the hip.

The hip adductor muscles that make up the groin consist of the adductor brevis, adductor longus, adductor magnus, gracilis, and pectineus.

These groin muscles adduct the thigh (bring the femur and knee closer to the midline). The groin muscles are often injured with activities requiring cutting motions (side to side) or when kicking a ball.

Three grades of injuries:

Grade I

• Less than 10% of the muscle bulk (muscle fibres) are torn

• Cramping, tightening and / or sharp pain in the muscle during or after activity

• Mild pain and tenderness at the site of injury

• Minimal loss of strength and range of movement

• Recovery time approximately 2 weeks, but full tissue healing will take 6 weeks.

Grade II

• Pain at the site of the tear at the time of injury and subsequently during normal daily activities such as walking and during sport.

• Sporting capabilities will be limited

• Loss of strength and range of motion at affected joints e.g., limited knee extension and hip flexion ranges

• 10-50% of muscle fibres torn

• Recovery time approximately 4-6 weeks

Grade III

• Acute intense pain at the site of the muscle tear at the time of injury

• Significant loss of functional use, inability to weight bear fully or bend the ankle

• More than 50-100% of muscle fibres torn. If there is a complete tear of the muscle fibres, this will be referred to as a rupture

• Healing times for a grade III tear will vary depending on the level of dysfunction and may require a specialist orthopaedic review. In some cases, surgery may be required to suture the muscle to regain full function. Further investigation such as an MRI (magnetic resonance image) scan maybe required.

What are the Causes of Hamstrings & Groin Injuries?

There are varying factors as to why hamstring & groin strains occur. Some of the contributing factors are:

• Asymmetry in strength and control of any region in the musculoskeletal system especially the synergy of muscle action between the hamstrings / groin and the gluteal, calf’s and quadriceps muscles

• Weak abdominal and trunk core muscle control

• Tightness in the hip flexor and quadriceps muscles

• Poor biomechanics in your sport leading to improper techniques.

How Can Physiotherapy Help?

At PhysioMotion, our Physiotherapists will perform a comprehensive assessment to diagnose the grade of the injury and start a progressive treatment protocol to expedite recovery and return to sport. Early intervention is highly recommended to prevent any further injury and unwanted compensatory mechanisms in other regions of the body.

Accurate diagnostic skills from our therapists at PhysioMotion will also differentiate whether you have a hamstring or groin strain rather than referred pain such as sciatica or a hernia that may present as groin pain.

As an addition to therapeutic care, we recommend acute injury management and rehabilitation.

The Achilles Tendon

Tightness and pain at the back of the heel and lower calf is a common problem particularly amongst the sporting population. The causes are often multifactorial, but the latest evidence based research suggests particular treatment protocols are more effective than others.

What is a Tendon?

Tendons connect muscles to bones to assist movement

Due to its physiology, it acts to store and transmit energy to create movement and power

It is relatively inelastic and is susceptible to injury due to large forces that it must transmit e.g., the Achilles tendon can sustain up to ten times your body weight during running and jumping activities.

What are the Signs and Symptoms of an Achilles Tendinopathy?

Pain and tightness – in the achilles either at its’ attachment at the heel bone, or in the mid portion often with bands of thickening in the tendon

Early Pain – Pain is usually worse when the muscles and tendon are not warmed up e.g., arising from bed in the morning

Pain & tightness as activity increases – Depending on its severity, pain and tightness may lessen as you warm up, but if more serious, will gradually worsen again as activity increases. It will often be stiff and painful after activity or sport

Inflamation – In acute cases, the Achilles tendon will be inflamed and swelling may be present. In chronic cases, the tendon may be thickened.

What Are the Causes of Achilles Injuries?

Achilles tendinopathies are often multifactorial in cause, but definite features are asymmetrical and / or excessive loading on the tendon due to poor biomechanics in any region of the musculoskeletal system.

Non-optimal movement strategies anywhere in the body can cause compensatory movement patterns in the lower limbs placing excessive, and usually repetitive strain on the Achilles tendon.

Other factors that contribute to Achilles injuries are:

• Any sport that requires repetitive motions placing high loads on the Achilles e.g., running

• Excessive loading from increased training intensity or inappropriate exercise regimes

• Insufficient rest periods between training sessions e.g., resistance training causes a normal degree of tendon damage that would undergo repair in 36-48 hours, but if similar training is performed again within this time repeatedly, it will lead to degenerative changes in the tendon

• Tight calf muscles e.g., from inappropriate footwear such as high heels

• Poor biomechanics of the foot, ankle, knee, hip or pelvic girdle

• Although tendons require load, too much or too little load e.g., plaster cast of the ankle will create tendon pathology

• Insufficient core trunk and global muscle strength leading to overuse of lower limb muscles

• Bone spurs that cause friction to the tendon

• Advancing age reduces the tensile strength of tendons making them susceptible to injury.

How Can Physiotherapy Help?

Healing and recovery times for Achilles problems vary largely depending on the cause and the severity of tissue damage. However, if the primary cause is diagnosed and addressed quickly, then the body’s natural healing processes will occur and you will have significant improvement within days, but full tissue healing usually takes six weeks or more.

Plantar fasciitis is a common cause of pain in the heel at the sole of your foot. It is often throbbing pain, tender and warm on palpation, which indicates that it is inflamed.

Usually, it is most uncomfortable on first arising from bed in the morning, prolonged periods of walking / running or moving again immediately after a period of inactivity.

The plantar fascia is sheet of soft tissue similar to a ligament that runs from the heel to the base of the toes that supports the arch of the foot and p

Do Heel Spurs Cause Plantar Fasciitis?

Up to half of all patients with plantar fasciitis have a heel spur – they are a sign of plantar fasciitis; not a cause. The spur is due to the body’s healing response to the chronic micro tears of the fascia at its’ heel attachment. Scar tissue is laid down to repair this damage and calcifies over time eventually enlarging the attachment site that can be then seen as a spur.

What Causes Plantar Fasciitis?

During our gait cycle when the foot flattens (pronates) as we place weight onto it, the arch elongates and places a tensile (stretching) load on the plantar fascia – a normal movement pattern. However, poor biomechanics such as excessive pronation of the foot will result in over stretching of the fascia particularly at its’ attachment at the heel, which leads to inflammation and pain.

Non-optimal biomechanics in the foot is often associated with other musculoskeletal asymmetries in other regions of the body causing the foot to compensate as a result. Other causes of plantar fasciitis include tightness in the calf muscles, recent significant weight gain, increased activity levels or a new sport, inappropriate footwear and a loss of the protective fat pad cushion on the bottom of the heel associated with ageing.

Treatment will involve manual ‘hands on’ joint corrections, soft tissue release, acupuncture and dry needling techniques, and an individualized exercise program

How is Plantar Fasciitis Treated?

Once a full assessment and diagnosis has been made by a Physiotherapist, resolution of pain is most often achieved through a combination of treatment modalities. To minimise pain and prevent its recurrence, the following regime is recommended:

Rest & modification: Rest and activity modification as advised by your Podiatrist or Physiotherapist

Ice: Apply ice for 10-15 minutes to the painful area using a damp towel to protect the skin from an ice burn. Recommended 2-3 times daily.

Exercise program: Compliance with the exercise program prescribed by your therapist e.g., plantar fascia and calf stretches. Each program will be customised for your body to specifically target your causative factors as prescribed by your podiatrist.

Orthotics: The use of heel raisers or orthoses (orthotics) if needed

Footwear modification: Footwear modification as suggested by your therapist:

• Shoes with a heel elevation of approximately 2cm preferably with a cushioned sole during acute phases

• Footwear able to accommodate orthotics if needed

• Minimise barefoot walking

The ankle joint is a hinge joint that is formed by the talus, tibia and fibula bones. The major ligaments of the ankleare: the large medial deltoid or medial collateral ligament (MCL), the lateral collateral ligaments (LCL) and the ligaments between the tibia and fibula bones (tibio-fibula syndesmosis).

The surface of the bones inside the ankle joint is covered by cartilage, which absorbs shock and provides a smooth, gliding surface for joint movement.

acuum- like seal and increases the stability of the hip joint.

Common Ankle Injuries

Acute injuries to the ankle usually occurs in sports, either contact or non-contact that require twisting movements and sudden changes of direction, especially sports such as football, basketball, netball and hockey. Injuries range from mild with minimal damage to severe where ligaments can be ruptured, or bones fractured. Pain, bruising, or swelling may be present.

Ankle Sprains & Fractures

An ankle sprain occurs when a ligament within the ankle is over stretched or torn. Typically, the ankle is rolled outwards (LCL sprain) and less commonly, rolled inwards (MCL sprain). When a sprain is severe, it can cause a fracture of the fibula that can vary from a chip of bone to a displaced fracture requiring surgical intervention.

Symptoms vary depending upon the grade (I, II, or III) of the sprain and the specific ligament that is injured. The morbidity and management will vary depending on the severity of the ligaments injured and whether there are other associated fractures. Common symptoms of ankle sprains include:

• Pain and swelling – Both will vary depending on the grade of sprain. Pain may be dull for mild sprains and sharper with more severe sprains.

• Limited mobility

• Popping noise – You may hear an audible popping or snapping sound at the time of injury. It may indicate that one or more ligaments were torn, suggesting a more serious (Grade III) sprain.

• Inability to weight bear

• Bruising – May indicate a more serious sprain (Grade II-III)

Below is a classification of the grade and the severity of ligament injury:

Grade I: Usually minor with minimal impact on most activities and usually recovers in 1-3 weeks.

Grade II: Moderate to significant impact on activities associated with pain and usually recovers in 3-6 weeks

Grade III: Complete tear associated with significant morbidity. May take 6-12 weeks to recover. May be associated with a bone fracture that will range from conservative management to surgical intervention. If fractures are suspected, further investigation such as x-rays or MRI’s will be required.

Effective early management of ankle sprains is crucial in preventing re-occurrences and undesired compensatory patterns elsewhere in the musculoskeletal system. Often, mis-managed ankle sprains are the beginnings of other issues such as lower back pain and muscular imbalances.

Talar Dome Injuries

The talar dome is the upper surface of the calcaneus bone (heel bone). A talar dome injury occurs with damage to the cartilage and sometimes underlying bone of the talus. Injuries can be traumatic e.g., an ankle sprain or chronic from repetitive inappropriate loading on the bone.

Persistent pain from an ankle sprain or from poor loading at the front and deep in the joint must be checked for a talar dome fracture. Undiagnosed & inappropriate management can cause chronic pain.

Signs and symptoms

• Deep ankle pain: usually at the front of the ankle especially when weight bearing.

• Aggravating activities: activities with pivoting; prolonged weight bearing especially on hard uneven surfaces; going up and down hills or steps; jumping

• Ankle joint: swelling, stiffness & tender to touch

How Does Physiotherapy Help?

At PhysioMotion, our Physiotherapists will perform a comprehensive assessment to diagnose your injury and start a progressive treatment protocol to expedite recovery. Early intervention is highly recommended to prevent further injury and unwanted compensatory mechanisms in other regions of the body.

Any one of these can be the source of knee pain, but two very common types of non-traumatic knee problems are patellofemoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS). Acute knee sprains involve ligamentous and / or meniscus tears, although meniscus tears can be non-traumatic degenerative tears.

Common Knee Injuries

Acute injuries to the knee can cause considerable disability and time off sport. Commonly, it occurs in sports, either contact or non-contact that require twisting movements and sudden changes of direction, especially sports such as football, basketball, netball and hockey. Injuries range from mild with minimal damage to severe where ligaments can be ruptured, meniscus torn or bones fractured. Pain, bruising, or swelling may be present and can develop within minutes of the injury.

Knee Sprains- ACL, PCL, MCL & LCL

A knee sprain occurs when a ligament within the knee is stretched or torn. Symptoms vary depending upon the grade (I, II, or III) of the sprain and the specific ligament that is injured – ACL, PCL, MCL or LCL. The morbidity and management will vary depending on which of these ligaments is injured.

Common symptoms of knee sprains include:

• Pain and swelling – Both will vary depending on the grade of sprain. Pain may be dull for mild sprains and sharper with more severe sprains.

• Limited mobility

• Popping noise – You may hear an audible popping or snapping sound at the time of injury. It may indicate that one or more ligaments were torn, suggesting a more serious (Grade III) sprain.

• Inability to weight bear

• Buckling of the knee – Weight bearing may result in giving way of the knee due to ligamentous laxity e.g., an ACL injury may cause the knee to buckle forwards.

• Bruising – May indicate a more serious sprain (Grade II-III)

Below is a classification of the grade and the severity of ligament injury.

Grade I: Usually minor with minimal impact on most activities and usually recovers in 1-3 weeks.

Grade II: Moderate to significant impact on activities associated with pain and usually recovers in 3-6 weeks

Grade III: Complete tear associated with significant morbidity. May take 6-12 weeks to recover.

MCL, LCL and PCL tears (Grade I-III) are mostly conservatively managed and make a full functional recovery.

A grade III ACL tear will require surgery and up to six months of rehabilitation post- surgery.

Meniscus Injuries

Meniscus tears are common in contact sports like football as well as non-contact sports requiring jumping and cutting such as soccer. They can happen with sudden changes of direction and often at the same time as other knee injuries, e.g., an ACL injury. Older athletes are more at risk because the meniscus weakens with age, whereby 40% of people 65 years or older suffer from meniscus damage. There are two different types of meniscal tears:

Acute tears

These are commonly due to trauma or sports involving twisting motions. Acute tears have different shapes (horizontal, vertical, radial, oblique and complex). Surgery is sometimes indicated.

Chronic tears

These result from chronic asymmetrical loading in the knee joint causing the meniscus to be worn. Surgery is sometimes indicated if conservative management is ineffective.

Common Knee Pain Syndromes

Patellofemoral Pain Syndrome

PFPS also known as ‘runner’s knee’, is discomfort often associated with crepitus (crackling sounds) at the front of the knee arising from the mal-tracking of the patella in its femoral groove (area where the knee cap moves). Poor biomechanics in the patella femoral joint (PFJ) wears down the cartilage that lines both these structures thereby causing pain.

PFPS Signs and Symptoms:

• Common in both athletes and non-athletes, but more so in teenagers, and women more than men.

• Non-traumatic onset, often gradual, but can arise from a single event

• Pain with knee flexion (bending) positions / activities e.g., sitting, steps, cycling, running

• Factors that contribute to higher incidence of PFPS can be the shape and size of the patella and muscle imbalance in the leg placing asymmetrical loads on the PFJ

Up to 25% of the population will suffer knee pain and of these, 50% will be PFPS. Either PFPS or ITBS (see below) can cause mild discomfort to severe pain and effective treatment aimed at the cause of the dysfunction is extremely successful at returning you to your sport.

Iliotibial Band Syndrome

ITBS occurs when there is pain on the lateral aspect (outside area) of the knee. It is a non-traumatic overuse injury common in athletes caused by the iliotibial band (tendon like structure) rubbing against the lateral epicondyle of the knee (bony prominence) resulting in inflammation, swelling and pain of the iliotibial band.

• ITBS occurs in 5-15% of runners

• Most frequent in athletes performing repetitive knee flexion / extension motions e.g., cyclists and runners

• Pain may not occur immediately during activity, but may intensify over time.

What are the Causes of PFPS & ITBS?

PFPS and ITBS are often multifactorial in cause, but definite features are asymmetrical and / or excessive loading on the PFJ or ITB due to poor biomechanics in any region of the musculoskeletal system. Non-optimal movement strategies anywhere in the body can cause compensatory movement patterns in the lower limbs placing excessive and usually repetitive strain on these areas.

Other factors that contribute to PFPS and ITBS are:

• Excessive loading from increased training intensity or inappropriate exercise regimes especially with repeated knee flexion/extension motions

• Poor biomechanics of the foot, ankle, knee, hip or pelvic girdle

• Insufficient core trunk and global muscle strength leading to overuse and an imbalance of lower limb muscles especially weak hip abductors (gluteal muscles).

How Can PhysioMotion Help You?

Physiotherapy management of PFPS and ITBS is commonly treated at PhysioMotion. In addition to our treatment principles for joint pain treatment will involve manual ‘hands on’ joint corrections, soft tissue release, acupuncture and dry needling techniques, and an individualized exercise program including abdominal / trunk core stability with real time ultrasound imaging and stability retraining.

For knee sprains and meniscus tears, our Physiotherapists will perform a comprehensive assessment to diagnose the severity of the injury and start a progressive treatment protocol to expedite recovery using our treatment principles for joint pain. Early intervention is highly recommended to prevent further damage and unwanted compensatory mechanisms in other regions of the body.

Once a definitive diagnosis has been made, initial treatment will be aimed at reducing pain, swelling and subsequent morbidity. For optimal healing and prevention of further injury, the most progressive post-surgical protocols will be used during your rehabilitation. In non- surgical cases, a whole body individualized biomechanical assessment will be performed to ascertain why you were predisposed to such a knee injury.

The hip joint is a ball and socket synovial joint, formed by pelvic acetabulum (the socket), the labrum (cartilage rim) and the head of the femur (the ball). It forms a connection from the lower limb to the pelvic girdle, and is thus designed for stability and weight-bearing.

Femoral-Acetabular Impingement (FAI) Syndrome & Labral Tears

FAI occurs when normal movement of the hip joint is restricted due to excessive bone growth on either the socket or the femur. This is caused by increased contact between the bones. Over time, this may cause labral tears, degeneration of the cartilage and bone spurs leading to osteoarthritis. Pain often occurs in the front aspect of the hip, but also in the groin or thigh and specifically when the hip is brought into flexion, adduction and internal rotation. FAI may also be present in asymptomatic patients.

A labral tear of the hip occurs when the labrum (cartilage rim of the socket) becomes detached or degenerates. The labrum cushions impact in the hip, provides a vacuum- like seal and increases the stability of the hip joint.

What are the Symptoms of FAI & Labral Tears?

FAI’s are often associated with labral tears, but often, labral tears are present without a FAI. They both present with similar symptoms and a differential diagnosis is important in receiving appropriate management. Symptoms for both FAI and labral tears include:

• Hip or groin pain with prolonged sitting, stairs, squatting & pivoting / accelerating sports

• Pain in the thigh, groin, back or buttock

• Stiffness, restricted range, clicking, catching and giving way may be reported

• Pain with side lying on the painful hip

Three types of FAI: CAM-flattening of the femoral neck and head; Pincer-bone spurs on the socket; and Mixed-combination of pincer and CAM.

What are the Causes of FAI & Labral Tears?

The underlying causes of both FAI and labral tears are ineffective biomechanical loading through the hip joint associated with non-optimal neuromuscular activation patterns.

This will present as asymmetrical strength and tone in the hip and trunk muscles. Specifically, the gluteals, deep hip, abdominal wall and spinal muscles.

Other causes are:

• Structural abnormalities – congenital hip problems causes wear and tear of the labrum leading to FAI

• Trauma – Injury in contact sports or dislocation e.g., a car accident

• Repetitive Motions – Sports such as running; twisting and pivoting sports such as golf, ballet, hockey, hockey, softball.

How Does Physiotherapy Help?

At PhysioMotion, our Physiotherapists will perform a comprehensive assessment to diagnose your injury and start a progressive treatment protocol to expedite recovery. Counselling whether surgical or non-surgical options are considered based on the most up to date medical research.

Effective early management of hip pain related to FAI & labral tears are crucial in preventing osteoarthritis and undesired compensatory patterns elsewhere in the musculoskeletal system.

Shoulder pain and stiffness is a common complaint amongst both athletic populations and sedentary groups. In particular, it occurs with sporting activities requiring overhead arm positions or throwing actions such as tennis, cricket, baseball, golf, badminton, swimming, resistance training, and basketball. Trauma in contact sports such as rugby is also frequent. However, shoulder problems also arise frequently in a sedentary population due to poor postures. In all of these cases, the most common injury is known as ‘shoulder impingement’ associated with a ‘rotator cuff tendonitis’.

Shoulder Impingement & Rotator Cuff Tendonitis

The rotator cuff is made up of four muscles that help move and stabilize the shoulder joint (supraspintaus, infraspinatus, trees minor & subscapularis). Damage to any, or all of the four muscles and the ligaments that attach these muscles to bone can occur because of acute injury, chronic overuse, or ageing. This damage can cause significant pain and disability associated with stiffness and dysfunction.

The shoulder is a ball-socket joint that allows the arm to move in many directions. It is made up of the humeral head (the upper end of the bone of the upper arm) fitting into the glenoid fossa of the scapula (shoulder blade). The humeral head is kept in place by the joint capsule, glenoid labrum (thick cartilage around the socket) and the rotator cuff muscles. The rotator cuff muscles are the dynamic stabilizers and movers of the shoulder joint and adjust the position of the shoulder girdle during arm movement.

Shoulder impingement refers to the rotator cuff tendons or the surrounding soft tissue being impinged or compressed as they pass through bony structures of the shoulder. Rotator cuff tendonitis refers to the inflammation of these tendons due to any trauma or injury.

What Are the Signs & Symptoms of Shoulder Impingement & Rotator Cuff Tendonitis?

• A deep ache in the shoulder that may radiate to the outside upper arm over the deltoid muscle

• Sharp catching pain or gradual increasing pain

• Pain on movements involving elevation and often worse above shoulder height

• Pain at night particularly when side lying

• Weakness when using the arm

• May lead to a chronic rotator cuff tear

What Are the Causes?

The causes for both of these conditions are:

• Acute strains of the rotator cuff from trauma or injury leads to inflammation & swelling that reduces space for the tendons to move

• Chronic repetitive sporting or functional activities

• Asymmetry in other regions of the body placing excessive loads on the shoulder girdle

• Ageing results in a decrease blood supply to the rotator cuff tendons

• Bony spurs at the acromio-clavicular joint (tip of the shoulder).

How Does Physiotherapy Help?

At PhysioMotion, our Physiotherapists will perform a comprehensive assessment to diagnose the cause of your shoulder problem and start a progressive treatment protocol to expedite recovery for a return to sport and function. Early intervention is highly recommended to prevent

In addition to our treatment principles for joint pain, our Physiotherapists will look at symptom modification techniques to immediately address acute pain. This will include assessing the biomechanics of the thorax, shoulder girdle, neck and all other relevant regions of the body. In addition, we will address any weakness, instability or muscular imbalance to prevent recurrence.

If the problem stemmed from a sporting activity, then analysis of your sporting technique will be conducted.

Surgery is not usually indicated with shoulder impingement and rotator cuff tendonitis, but your Physiotherapist will recommend further investigation if required.