Shoulder Pain

Pain Triggers – Shoulder Rides

 

shoulderride2

 

Most parents know kids can cause pain… literally. Lifting and carrying children can result in stress and strain on the parent’s body, back, shoulders and neck. The shoulder ride is a typical suspect. Despite being great fun for the child, it can quite literally be a pain in the neck for the parent as sometimes it is just quicker and easier to pick up a child when walking a long distance.

So how can a parent minimise the stress and strain on their own bodies?

  • If you absolutely insist on lifting a child up onto your shoulders, try having them stand on a higher (make sure it is safe!) surface such as a table, so that they are at the correct height. Remember its always much better to lift with your legs, rather than your back and this is no different
  • There are carrying devices on the market to assist in carrying children on the back or shoulders. These devices are potentially a safer option for the parent, and avoids the child needing to use a tight grip on the neck or head to hold on.
  • If carrying a baby or infant in the arms be conscious of alternating sides regularly to avoid overloading on one side only.
  • Limit the amount of time or the regularity of shoulder rides.
  • Know when to say no. Don’t attempt it if you are tired, or sore.
  • Know your limits. At some point in time your child will be simply too big to carry. Try and explain to them that it is no longer safe to keep carrying them.
  • Learn a few smart stretches to help keep you limber. Your friendly physiotherapist can guide you, or help you out if you’ve already suffered the effects before reading this advice.shoulder-rides

 

If you suffer from neck or back, it is best to commence neck treatment straight away.  Your physiotherapist has numerous tricks that can help to quickly relieve your neck pain and muscle spasm.

If you have had neck pain or stiffness for a month or more, your GP may be able to refer you to a physiotherapist in Sydney as long-term stiffness can be treated effectively at any time.

If you are not sure what to do, please contact Sydney Physio Solutions for advice or to make an appointment with one of our neck physiotherapists.

Pain Triggers – Laptop Bags

laptop-bagsCarrying a heavy laptop bag can be a common cause of lots of joint issues including neck, shoulder, lower back or forearm pain. Laptops and all the paperwork that comes along with them often weigh more than we think and can cause significant postural asymmetries and abnormal joint loading – especially if we carry them for long periods and always on the same side.

Another common culprit is us females popping our heavy laptops and papers into our shoulder handbags – not only is this bad for our shoulder and neck but also bad for our bags!  

Consequently consider using a wheeled or rolling laptop bag and swapping arms regularly backpackto help keep these aches and pains at bay. A rucksack bag rather than an over the shoulder or carrying case is also better option.

So ladies for those of you going against these recommendations its a good excuse to go shopping – happy bag hunting! 

laptop-bag

 

If you suffer from shoulder pain or neck pain, it is advisable to start shoulder treatment straight away.  Your physiotherapist has numerous tricks that can help to quickly relieve your shoulder pain and muscle spasm.

If you have had shoulder pain or stiffness for a month or more, your GP may be able to refer you to a physiotherapist in Sydney as long-term shoulder stiffness can be treated effectively at any time.

If you are not sure what to do, please contact Sydney Physio Solutions for advice or to make an appointment with one of our shoulder physiotherapists.

Sleep Habits

Physios are often asked about the best position to sleep in, and what is the best mattress or pillow to use. Unsurprisingly, there is no one answer. However, sleep is obviously a crucial time to allow the body and mind to recuperate. Here are a couple of tips that I often advise.

dog upside down

In patients with low back pain, especially if it is one sided and referring into the leg, I advise them to sleep with their sore side up and a pillow/s between the knee to unload the spine. This also works very well for hip pain, particularly bursitis, as it removes the tension of the leg from the hip.

Mattresses are often a great source of contention. The main advice that I give to patients is to make sure they feel comfortable and supported and check that they are not waking up in a valley in the morning! This would indicate that it may be time for a new mattress. This is where you need to have a trade-off between feeling comfortable but also supported. When patients are deliberating between a slightly softer or firmer mattress I generally recommend the firmer mattress as they tend to soften over time anyway.

Pile_of_pillows

When it comes to neck pain and pillows, I advise patients to select a pillow that maintains a neutral neck position. If you are unsure of what a neutral position is then you may want to consult your physio. The pillow chosen will vary depending on whether the person is a stomach/back/side sleeper, but it will also vary based on the person’s size and natural spinal curvature.

In general, side sleepers will probably need a high profile pillow, whereas back sleepers will likely only need a low profile pillow or sometimes no pillow at all (or a rolled up towel behind the neck).

When a patient is suffering from acute neck pain and finding it difficult to find a position of comfort, I generally recommend lying on your back with a McKenzie cervical roll under the neck. This usually keeps the neck in a minimally stressful position. If the patient also has associated arm pain, then I may advise them to have a pillow under their arm to support it and take the weight of the arm off the neck.

Workstation Position

The goal of ergonomics is to make work more comfortable and to improve both health and productivity. Many ergonomic problems can be fixed by rearranging, adjusting or modifying existing furniture and tools, so don’t be in too much of a rush to go out and purchase the next great ergonomic “THING”.

We know that sitting for long periods can have negative consequences for our health, and that regular breaks along with standing for part of your day can help to prevent and relieve aches and pains when they occur. However, often sitting cannot be avoided, at which times it is important to ensure that your office chair is set-up to provide optimal support for your back.

desk_ergonomics

Steps for setting up your workspace:

Adjust the chair height so that your elbows are at desktop level (roll your shoulders back and relax them first).

Sit fully back into your chair, adjust the seat back for good lower back support, use a lumbar roll if the back of the chair does not support your lower back.

If your chair seat has a tilt feature, set it so that you are comfortably supported.

If your feet don’t comfortably reach the floor or there is pressure on the backs of your legs, use a footrest.

Locate your monitor so the top third of the viewing area is at or below eye level. Use monitor stand if required. As long as you can clearly view the screen contents there is no specific distance that you need to be from the monitor.

With elbows at the desk level, ensure that your wrists are straight. Use wrist rest if required, and if you have armrests try to adjust them so they support your arms without beings too high or too low.

Position the mouse as close as is practical to the keyboard, so that both elbows are directly under the shoulders while working. If this is not possible you may need to consider purchasing a mini keyboard.

To reduce stress on the neck when working from paper documents, a document holder can be placed between the keyboard and monitor.

Always either put the phone on loudspeaker (depending on your office environment) or use a phone headset if you need to use the computer while talking on the phone, this will help avoid neck and shoulder strain.

Use your mouse pad or another soft surface to pad the edge of your desk. Avoid pressing your hands or forearms against any desk edge.

Adjust screen brightness and contrast for clear comfortable viewing, and clean the screen regularly. Also remember the 20-20-20 rule: look away from the monitor every 20 minutes to a distance of 20 metres for 20 seconds. This helps avoid eye strain.

Finally and very importantly remember to take breaks regularly preferably every 45 minutes to an hour for 1 or 2minutes. Go get a glass of water talk to a colleague etc.

Exercises To Manage Shoulder Pain

This month I wanted to share with you some shoulder rehabilitation exercise options. This is tricky as there are so many potential problems which can occur with this complex joint; but here are a few of my top favs!

The rotator cuff is imperative for the stability and optimal functioning of our shoulder joint. The core role of our rotator cuff is to stabilise the ball within the socket during all movements.

 

  • Starting Position :
  • Draw the ball of the shoulder joint into the socket centrally and maintain this position throughout. Remember they are relatively quite small muscles so start with a light weight to ensure we are not compensating with other larger and more superficial muscles.
Rotator Cuff Exercise 1

Rotator Cuff Exercise 1

Rotator Cuff Exercise 2

Rotator Cuff Exercise 2

 

 

 

 

 

Serratus anterior is another key muscle whose role is to stabilise the scapular (shoulder blade) and ensure correct positioning of the joint socket.

  • Starting Position:

    Standing facing a wall and lean forwards onto forearms. Allow your body to sink between your shoulders so that your chest moves towards the wall

  • Procedure:

    Push away from the wall by rounding out your shoulders. Keep deep neck flexors on (neck lengthened). Shift body weight onto left/right arm and the lift the opposite arm out to side.

    Below Tanya is activating serratus whilst maintaining an isometric contraction of her posterior rotator cuff. Ensure you are not fixing through your chest muscle (pectorals) during this ex. If unsure have it reviewed by your physiotherapist.

Serratus Anterior

Serratus Anterior

Levator scapulae, rhomboids and pectorals are three muscle groups which commonly become tight with shoulder pain. See how to stretch these out below.

Levator Scapular

Levator Scapular

Levator scapulae

  • Starting Position: Reach the left hand over the head to hold the back of the head on the left side
  • Procedure: Turn head into slight right rotation.

Gently draw head down towards left arm-pit, feeling stretch in upper shoulder muscle on right side

                                                

Rhomboids

Rhomboids 

 

Rhomboids:

 

 

 

 

                                                        

Pectorals

Pectorals

Pectorals:  

  • Starting Position: Standing in a doorway with right arm up against door frame. Elbow bent at 90 degrees
  • Procedure: Turn body to the left while gently lifting chest.
  • Feel stretch in right side of chest wall.

Shoulder Pain in World Cup Cricket

Shoulder injuries in fast bowlers are surprisingly not as common as you might think. Tim Southee, the New Zealand opening bowler, recently picked up a shoulder injury after being hit by a wayward ball during fielding practice. Luckily enough for the Kiwis, he recovered in time for the recent win against Australia in the world cup.

tim southee

He is not the first bowler to pick up an injury from a “friendly fire” type incident involving a stray cricket ball in practice. Glenn McGrath missed the opening test of the 2005 Ashes series against England at Lords (the series the Aussies later went on to lose!) after standing on a ball and twisting his ankle.

glenn mcgrath

One thing we are unlikely to see this world cup is an English player injuring their shoulder from picking up the trophy too quickly! However, I would say there is a significantly increased risk of an Englishman (they could actually be Irish or South African if in the England team!) developing an overuse type injury from throwing the ball back to the bowler from the boundary!

Englands-captain-Paul-Collingwood-holds-the-trophy-as-they-celebrate-victory-over-Australia-in-the-2010-Twenty20-Cricket-World-Cup-Final

 

If you suffer from shoulder pain please get in touch with the team at Sydney Physio Solutions to make an appointment to see one of our shoulder specialists.

Shoulder Rehab Exercises Using Pilates

Pilates can be an interesting and fun way to rehab your shoulder.

My favourite Pilates shoulder rehab exercises are:

  1. Book Openings:

This exercise aims at increasing upper back range of motion in a gentle way

Book Openings 1                                                                                 to

Book Openings 2

  1. Superman in kneeling: this exercise works the shoulder blade stabilisers on the arm pushing the ground away. You can also add a leg lift simultaneously to increase the demand on the core and train your posterior oblique sling system.

 

or

Both of these shoulder rehabd exercises are commonly used in our Mat classes here at Sydney Physio Solutions.

If you would like to join a Pilates class to assist with your shoulder rehab, check our website or call 9252 5770.

Shoulder Pain and Body Posture

Lets face it – shoulder pain and desk jobs go hand in hand! If you spend several hours a day working on a computer, you may unconsciously find yourself adopting poor postural habits such as hunching over your keyboard. This position is usually a sign that you have a tight chest and a weak upper back.

Over time, this type of bad body posture can contribute to you developing a rounded upper back, a condition called kyphosis, which can cause shoulder pain and upper back stiffness and pain.

upper crossed

In the Physio world we often see this ‘upper-crossed’ pattern of poor posture that you can see in the above picture.

So rather than getting ‘upper-tight’ (and uptight) about it – do some shoulder exercise to correct it! Stretches for the chest and upper trapezius in the upper back &  neck will allow your shoulders to come back and be better centred in the joint.

Add some strengthening work for the deep neck flexors and back muscles and…. voila!!!! Better posture and less shoulder pain.

If you do continue to suffer from shoulder pain contact one of our shoulder specialists who are part of the team at Sydney Physio Solutions.

Shoulder Injuries in Tennis

Shoulder pain & tennis players seem to go together! With the ATP World Tennis circuit well underway, we can almost always guarantee at least 1 of the top 10 Men or Women players will suffer from a shoulder injury. Rafael Nadal, Andy Murray & Novak Djokovic have all had shoulder injuries in the last few years. This is not surprising when you take the age old issue of  training overuse and repetitive stress on the shoulder, and add to that the sheer power of serving up to 200kph on match day.

Rafael Nadal - service

Rafael Nadal – service

Records show that most commonly these players will suffer irritation to the soft tissue structures around the shoulder joint, which can lead to inflammation, shoulder pain, and the inability to play.

For the average Joe, (like me!), tennis shoulder injuries are more likely to occur from poor form (boo!), poor technique, or poor shoulder strength and stability (yikes!).  If in doubt, before dusting off the old racquet it may be worth having a quiet word with your local tennis instructor, or even your physio…..you will thank yourself for it!

Training to be a Desk Worker

desk-worker1

Office workers are the new endurance athlete.

Sounds strange but I think we need to start treating these workers like athletes. Just like we get a myriad of overuse injuries with endurance sports such as marathon running, Ironman, Cycling etc,  sitting at a desk for 8-10 hours a day comes with a whole laundry list of overused muscles and joints and make us much more prone to injuries. Now you may feel like you sustain some of these injuries outside of work for example bending over and tying your shoelaces sending your back into spasm or doing overhead weights leading to shoulder problems.

In reality, the range of motion deficits which are primary contributors to your injury have built up over time with poor posture and lack of daily movement, and then slowly crept into the way you move when exercising or doing any kind of physical tasks around the house.

Here are some things you should be “training” to prevent injuries.

Upper body – specifically shoulders, neck

1.  Pec muscle tightness – These don’t feel tight until you actually have someone palpate or massage them, but this leads to shoulder mechanics issues, and that dreaded tightness in upper back and traps.  I measure shoulder position all the time and the symptomatic side is always way tighter in the chest muscles.  It leads to poor shoulder mechanics and shows up in clinic with  a patient who has hurt their shoulder doing a military press or a sore neck and upper traps area after doing burpees or pushups.

2.  Deep neck flexor weakness – Poking your chin forward all day and not using your deep neck flexors, which are like your core but for the neck, leads to weakness.  This leads to increased load on the discs and facet joints of the neck.  These two structures are a common complaint in clinic.   A lot of evidence in the literature has focused on deep neck flexor strength and shows that it plays a large role in reducing neck pain.

Lower Body – Specifically hip and back

1. Tight hip flexors – if you sit all day with your hips flexed at 90 degrees then your hip flexors are shortened.  Over time they become a real restriction to hip extension. If you are a runner you need good hip extension or you will begin to extend through your lower back. With repetitive back extension plus the load of running you can expect to load the joints poorly and eventually have pain.

2.  Lumbar discs – The pressure on the discs in slumped sitting is enormous and can lead to bulging sometimes even neurological symptoms like pins and needles and numbness or loss of strength.

So as athletes would do, you need to be training your deficiencies. Stretching/massaging/foam rolling the muscles you know are going to be prone to tightness.  Strengthening the muscles prone to weakness.  Here’s a general list of areas to start with ….

Stretch

  • Pectorals
  • Upper Trapezius
  • Levator Scapulae
  • Hip Flexors
  • Quadratus lumborum

Strengthen

  • Deep neck flexors
  • Lower/ mid fibers of trapezius
  • Serratus anterior
  • Core
  • Glute medius

For tailored programs it would be best to consult a professional