Return to Sports  & Nutrition

                               Dr. Vijay Bathina

                     Chief Consultant- Sports Physio

                                Return To Play

Return to play refers to the point in recovery from an injury when a person is able to go back to playing sports or participate in an activity at a preinjury level.

No one likes to be sidelined with an injury. One of the goals of sports medicine is to try to get an athlete back into action as soon as possible. Returning too soon, before adequate healing or recovery has taken place, can put you at risk for reinjury and possibly an even longer down time.

With the right game plan for sports injuries—from early diagnosis and treatment to full functional rehabilitation—you can often safely accelerate your return to play.

A Lesson From the Pros

Why does it seem that professional athletes return to play so much faster than the average person or athlete? Professional athletes are usually in tremendous physical condition at the time of injury. This fitness level helps them in many ways. Studies have shown that good conditioning can not only prevent injuries, it can also lessen the severity of an injury and speed recovery.

Professional athletes also get prompt treatment when an injury occurs, and this lessens the acute phase of the injury. Early treatment means that there is less swelling, stiffness, and loss of muscle tone. In addition, professional athletes work extremely hard with a physical therapist and/or certified athletic trainer during their recovery.

Many professional athletes bring to their recovery what they bring to their sport—a positive attitude. Although you may not have access to the same resources that professional athletes have, you can harness the power of a positive attitude for your own benefit during recovery.

Tips From the Pros to Speed Your Recovery

• Maintain balanced physical conditioning
• Make sure that injuries are recognized early and treated promptly
• Participate in a full functional rehabilitation program
• Stay fit while injured
• Keep a positive, upbeat mental attitude

Your Recovery Plan

Phases

Recovery from an injury involves a series of logical steps from the time of the injury until you are able to be back on the field or court. Each step should be outlined and monitored by your physician and physical therapist.

During the acute phase of injury, the focus should be on minimizing swelling. This involves the RICE formula (Rest, Ice, Compression, and Elevation), along with a limitation of activities. Depending on the type and severity of your injury, treatment may also involve surgery, bracing, or even casting.

During the acute period, it is very important to maintain overall conditioning while the injury heals. Creative techniques can be used to safely work around the injury. For example, a runner with a leg injury can often run in water or use a stationary bicycle to maintain conditioning. Even if one leg is in a cast, the rest of the body can be exercised by performing strength-training exercises. Do not wait until your injury is healed to get back into shape.

In the next phase of recovery, you should work on regaining full motion and strength of the injured limb or joint. Your physician, therapist, or certified athletic trainer will outline an exact plan. For most injuries, gentle protective range-of-motion exercises can be started almost immediately. Muscle tone can be maintained with the use of electrical stimulation or simple strengthening exercises.

When strength returns to normal, functional drills can be started. For lower extremity injuries, this may include brisk walking, jumping rope, hopping, or light jogging. For upper extremity injuries, light throwing or easy ground strokes can be performed. Specific exercises for balance and agility can bring back the coordination that may have been lost in the injury.

Once you have progressed with motion, strength, endurance, and agility, and are tolerating functional drills, you can try higher levels of sport-specific movement patterns. This is monitored by your physical therapist or certified athletic trainer. You may find that tape, braces, or supports help during this transition time.
Only when you are practicing hard without significant difficulty, and the healing has progressed to the point where the likelihood of injury or harm is low, are you ready to return to play. During these final phases of recovery, you should be closely monitored. Special attention should be given to adequate warm up prior to the activity and icing after the activity.

A Word Of Caution

Following the rational progression of recovery not only lessens the chance of reinjury but also assures that you will be able to perform at your best when you return to play. All too often, athletes think they are ready to return as soon as the limp or the swelling subsides. They may feel good, but they are probably only 70% to 75% recovered. This invites reinjury.

Sports medicine experts are working on methods to help athletes get close to 100% recovery as quickly as safety allows. There is often tremendous pressure to get the athlete back as soon as possible, but the athlete's health and safety must be placed above all other concerns.

A systematic recovery plan is successfully used every day, at all levels of play, from the recreational athlete to the elite professional or Olympic athlete.

                           Sports Nutrition 

                             Varsha Raju

                         Sports Nutritionist

Athletes who want a winning edge need the right nutrition. When you give your body the right fuel by drinking enough water and eating a balanced diet, you will make the most of your athletic talents and gain more strength, power, and endurance when you train.

This article contains some general sports nutrition guidelines. To achieve top performance, your diet should be based on a variety of factors including your age, weight, physical condition, and the type of exercise you are doing. Consult your doctor for individualized sports nutrition advice.

Hydration

Water is the most important nutrient for athletes. Water comprises about 60% of body weight and is essential for almost every bodily function. Because your body cannot make or store water, you must replace the water that you lose in your urine and sweat.

Everyone should drink at least two quarts (64 oz.) of water each day—and athletes need even more. To stay hydrated and avoid overheating, drink plenty of fluids before, during, and after sports or exercise. When you work out or compete, especially in hot weather, try to replace the amount of water you lose in sweat by drinking the same amount of fluid.

Stay hydrated by drinking plenty of fluids before, during, and after exercise.

Drinking cool water is the best way to keep hydrated during workouts or events that last an hour or less. Sports drinks made up of 6% to 10% carbohydrates can help you stay hydrated during longer events. Most sports drinks should be diluted with approximately 50% water.

Because thirst is not a reliable way to tell if you need water, be sure to drink even if you are not thirsty. You will not start feeling thirsty until you have already lost about 2% of your body weight—enough to hurt performance. Also, if you stop drinking water as soon as your thirst is satisfied you will get only about half the amount you really need.

The following tips will help you stay hydrated:

• Drink small amounts of water frequently rather than large amounts less often.
• Drink cool beverages to lower your core body temperature and reduce sweating.
• Track your sweat loss by weighing yourself both before and after exercise. For every pound lost through sweat, drink 16 to 24 oz. of water. Your body weight should be back to normal before your next workout.
• Pay attention to the amount and color of your urine. A large volume of clear urine is a sign that you are well-hydrated. Smaller amounts or dark yellow urine can indicate dehydration.

Fuel Sources

A balanced diet is another key to sports nutrition. Eating the right combination of fuel (calories) from carbohydrates, proteins, and fats will give you energy for top performance.

Carbohydrates

Carbohydrates—the most important source of fuel—should provide about 60% to 70% of your daily calories. Carbohydrates are found in many foods, including:

• Fruits
• Vegetables
• Pasta
• Bread
• Cereal
• Rice

Eating fruit, or another food high in carbohydrates, will help you maintain energy during competition.

Your body converts the sugars and starches in carbohydrates into energy (glucose) or stores it in your liver and muscle tissues (glycogen). This gives you endurance and power for high-intensity, short-duration activities.
If your body runs out of carbohydrate fuel during exercise it will burn fat and protein for energy—causing your performance level to drop. This may happen if you start exercising without enough stored muscle glycogen or if you exercise intensely for longer than an hour without eating more carbohydrates. It may also happen if you do multiple repetitions of high-intensity, short-duration exercises or if you participate in multiple events or training sessions in a single day.
The following tips will help you maintain carbohydrate fuel so that you can stay energized and perform at your best:

• Start your exercise or competition with glycogen-loaded muscles by eating carbohydrates for at least several days before the event.
• To replenish energy and delay fatigue, eat additional carbohydrates when you exercise or compete for longer than one hour.

Proteins

Proteins should provide about 12% to 15% of your daily calories. Proteins are found in many foods, including:

• Meat
• Fish
• Poultry
• Eggs
• Beans
• Nuts
• Dairy products

Proteins give your body the power to build new tissues and fluids among other functions. Your body cannot store extra protein so it burns it for energy or converts it to fat. The amount of protein you need depends, in part, on your:

Good sources of protein include meat, cheese, eggs, and nuts

• Level of fitness. Physically active people need more protein than those who do not exercise. You also need more protein when you start an exercise program.
• Exercise type, intensity, and duration.Endurance athletes often burn protein for fuel, as do bodybuilders and other athletes who perform intense strength-building activities.
• Total daily calories. Your body burns more protein if you do not consume enough calories to maintain your body weight. This can happen if you eat too little or exercise too much.
• Carbohydrate intake. Your body may use protein for energy if you exercise with low levels of muscle glycogen or if you do repeated training sessions without eating more carbohydrates. When you start with enough muscle glycogen, protein supplies about 5% of your energy; otherwise, it may supply up to 10%.

Fats

Fats should provide no more than 20% to 30% of your daily calories. Saturated fats come from animal-based foods, such as meats, eggs, milk, and cheese. Unsaturated fats are found in vegetable products such as corn oil.

Your body needs small amounts of fat for certain critical functions and as an alternative energy source to glucose. Eating too much fat, however, is associated with heart disease, some cancers, and other major health problems. Also, if you are eating too much fat, it probably means that you are not eating enough carbohydrates.
How your body uses fat for energy depends on the intensity and duration of exercise. For example, when you rest or exercise at low to moderate intensity, fat is the primary fuel source. As you increase the intensity of your exercise your body uses more carbohydrates for fuel. If your body uses up its glycogen supply and you continue exercising you will burn fat for energy, decreasing the intensity of your exercise.

Nutrition before Competition

What you eat several days before an endurance activity affects performance. The food you eat on the morning of a sports competition can ward off hunger, keep blood sugar levels adequate, and aid hydration. Try to avoid eating high-protein or high-fat foods on the day of an event since this can put stress on your kidneys and take a long time to digest.

To perform at your highest level, follow these general nutrition guidelines before an event:

• Eat a meal high in carbohydrates.
• Eat solid foods 3 to 4 hours before an event. Drink liquids 2 to 3 hours before an event.
• Choose easily digestible foods, rather than fried or high-fat foods.
• Avoid sugary foods and drinks within one hour of the event.
• Drink enough fluids to ensure hydration. A good guideline to follow is: Drink 20 oz. of water 1 to 2 hours before exercise and an additional 10 to 15 oz. within 15 to 30 minutes of the event. Replenishing fluids lost to sweat is the primary concern during an athletic event. Drink 3 to 6 ounces of water or diluted sports drink every 10 to 20 minutes throughout competition.

Carbohydrate Loading

To avoid running out of carbohydrates for energy, some endurance athletes—including long-distance runners, swimmers, and bicyclists—load their muscles with glycogen. To do this they eat extra carbohydrates and exercise to energy depletion several days before an event. To "carbohydrate load" before an event:

• First, exercise to muscle fatigue. Your workout must be identical to the upcoming event to deplete the right muscles.
• Next, eat a high-carbohydrate diet (70% to 80% carbohydrates, 10% to 15% protein, and 10% to15% fat), and do little or no exercise for three days before the event.

Some endurance athletes believe that following this carbohydrate-loading regimen will ensure that muscles loaded with unused glycogen will be available to work for longer periods of time during competition. Consult your doctor for advice before trying a carbohydrate-loading diet.

VERTIGO (BPPV)

                                                     
                           

                                                             Vertigo (BPPV)



What is vertigo?

Vertigo is a type of dizziness. It is described as a ‘spinning’ sensation in the head and is usually brought on by sudden changes in position. Some people say it feels like standing still in a spinning room. You may feel like you are going to fall over.

While there are some serious causes of vertigo, in most cases it is not a serious condition and usually gets better with time.

 What causes vertigo?

The most common cause of vertigo is called benign positional paroxysmal vertigo or BPPV.

BPPV happens when tiny particles in the balance centre of the inner ear are disturbed, usually by sudden movement. This causes the spinning sensation. It is a common problem that can affect people of all ages.

 Activities that bring on a dizzy spell can vary.
 They often involve moving your head into a certain position suddenly, such as:
 • looking up
• lying on one ear
 • rolling over in bed
• getting out of bed
• bending over.

There are other causes of vertigo, including head injuries (such as a knock to the head), stroke, circulation problems, infections, inner ear disorders, and the degeneration of inner ear structures. For some people the cause may not be found.

What are the symptoms?
 • Dizziness – this begins seconds after a certain head movement and lasts less than a minute.

 • Feeling light-headed.
• Balance problems.
• Nausea – feeling like you are going to vomit. These symptoms usually get better once you are in a different position. Pain, ringing in the ears (tinnitus) or deafness is not common.

If you have more serious symptoms – speech difficulty, double vision, unsteady walking, difficulty swallowing, altered strength or feeling in your legs or arms, ringing in your ears or deafness – you should seek medical help.

Treatment Vertigo often gets better by itself. Many people improve without treatment. If BPPV is an ongoing problem then your doctor may offer options.



Brandt-Daroff exercises

The Brandt-Daroff exercises are thought to disperse any tiny particles away from the balance centre in your ear, therefore getting rid of the cause of your dizziness. You may be anxious that the exercises will bring back your symptoms. This is normal. However, the exercises will only work if you feel dizzy as you do them. The dizziness will get less with time. 1. Sit on the edge of the bed. Turn your head 45 degrees (look to the left). Lie down quickly on the right side. Ensure the back of the head rests on the bed. Wait 20–30 seconds or until the dizziness stops. 2. Sit upright. Wait 20–30 seconds for any dizziness to settle. 3. Repeat on the other side. Turn the head slightly to the right before lying down quickly on the left side. 4. Do five times on each side (takes about 10 minutes).

         CHONDROMALACIA PATELLAE

What is Chondromalacia patellae?



Chondromalacia literally means "softening of the cartilage", and Patellae means "the knee-cap". So Chondromalacia patellae means "softening of the articular cartilage of the knee-cap." The articular cartilage is the cartilage lining under the knee-cap that articulates with the knee joint. Under normal circumstances, it is smooth and shiny, so that it glides smoothly along the articular groove of the femur as the knee bends. When it "softens", it may break down, causing irregularities along the undersurface of the patella.


The patella (kneecap) is normally pulled over the end of the femur in a straight line by the quadriceps (thigh) muscle. Patients with chondromalacia patella frequently have abnormal patellar "tracking" toward the lateral (outer) side of the femur.

This slightly off-kilter pathway allows the undersurface of the patella to grate along the femur, causing chronic inflammation and pain. Certain individuals are predisposed to develop chondromalacia patella: females, knock-kneed or flat-footed runners, or those with an unusually shaped patella undersurface




What are the symptoms?




The typical patient is a teenage girl complaining of pain in the front of her knee around the knee-cap. She may also have pain that is deep-seated that may radiate to the back of the knee. The pain comes and goes, but usually with squatting, kneeling, and negotiating steps, especially going down the stairs. She may be engaged in strenuous sports, but experiences pain with repeated bending of the knees. Although girls are more often affected, boys can have this problem too.






At this stage, there is no breakdown of the articular cartilage of the patella yet, and is totally reversible. In fact, many doctors may not use the term "chondromalacia patellae" at this stage, because there is no actual softening or breakdown of the cartilage. A more appropriate diagnosis would be "Anterior knee pain syndrome" or "Patellofemoral stress syndrome". In fact, in the majority of patients, the pain comes and goes for a few years until growth is complete. At that point, the pain goes away permanently. In others, the pain gets increasingly worse during the teenage years, the articular cartilage of the patella may actually break down, and medical or surgical treatment may be necessary.





High-heeled shoes to be careful chondromalacia patella

In order to build their own more perfect proportion, like women wearing high heels, will feel that the recent knee pain and the time will be good and bad, such as the shares are facing a similar situation to pay special attention and care suffering from chondromalacia patella. Patella that the so-called ordinary people to his knees, was inverted triangle, is located femur (thigh) and tibia (leg), the patella in the day-to-day activities of the whole range of up to 7 centimeters mobile, and therefore if the long-term bear the weight of pressure, and by external forces Wear effects will feel pain in the knee and activities will be restricted.

It is characterized by the use of when a patient to the patellofemoral joint will have a wide range of knee pain before the phenomenon, which especially in the up and down stairs, running, or kneeling when it is aggravated. Patients usually describe the former will have a wide range of knee soreness, and this pain will be after the sedentary, stair climbing, mountain climbing, jumping or squatting more obvious after a long time.

Many female friends, accustomed to wearing high heels to go out, up and down stairs in high-heeled shoes to wear when the surface of the patella in fact suffered by the forces of body weight can reach 7 to 9 times. "Chondromalacia patella" their symptoms and general osteoarthritis similar because of cartilage bone loss caused by gum sulfide, out-patient generally nothing more than common causes of any of the following four kinds of circumstances ︰

(1) wider pelvis.
(2) deviate from the patellar position.
(3) 4 thigh gravis or too tight.
(4) have been knee injury.
Regarding the treatment of minor symptoms can by straight leg lift movement to enhance the quadriceps, and shares in the power of oblique in order to stabilize the patella, so that the patella to return to its normal position. In severe cases, symptoms when conservative treatment fails, it is necessary to consider surgical treatment, surgical methods, including joint lateral ligament relaxation techniques, soft tissue reinforcement, and even Osteotomy to make the activities of the patella in his knee only to maintain a normal track. Chondromalacia patella as a result of knee joints in patients with tight lateral organizations should do patella joint mobilization and deep massage, and then a special medical tape affixed to the knee to correct patellar position, the patient must follow the guidance of physiotherapists do four triceps exercise training and knee proprioceptive training.




Physiotherapy Treatment Protocol


Rehabilitation Philosophy Physical therapy is often recommended for treatment of pain and dysfunction associated with patellofemoral syndrome and chondromalacia of the patella. The physical therapist will evaluate the patient’s mobility, flexibility and strength with the purpose of determining the underlying cause of the abnormal stress on the patella.
The patient will be counseled on which activities he or she can safely continue and which should be avoided.
The physical therapist will teach the patient the proper exercises to reduce patellofemoral stress. In most cases this will include strengthening muscles about the hip and knee that are weak and stretching ones that are tight.


Rehabilitation **


The following is an outlined progression for rehab. Advancement from phase to phase as well as specific exercises performed should be based on each individual patient’s case and sound clinical judgment by the rehab professional.




** Phase 1 (Acute Phase) Goals Control Pain and Inflammation Begin Pain Free Flexibility Exercises Establish Quadriceps Activation Establish Pain Free Knee ROM Recommended Exercises Cycle with Minimal Resistance (if pain free) Range of Motion and Flexibility Heel Slides (in pain free arc) Lower Extremity Stretching (based on individual assessment) Rectus Femoris IT Band Hamstring Hip Rotators Gastroc Quad Sets (intensity and flexion angle guided by pain) Strength Guidelines Perform range of motion exercises daily. Do 2-3 sets of 15-20 Reps. Perform stretching program daily. Hold stretches for 30 seconds and perform 2-3 repetitions of each.




Phase 2 (Sub-acute Phase A) Goals Continued Protection of Injured Joint Continue to Improve Flexibility Begin to Strengthen Areas of Weakness/Instability Recommended Exercises Cycle (slow progression of resistance) Range of Motion and Flexibility Continue Flexibility From Phase 1 Begin Open Chain Strengthening (based on strength assessment) Strength Knee Extension (SAQ, If painful use LAQ in painfree arc) Straight Leg Raise Hip Abduction Hip Extensors Hip External Rotators Hamstring Curls Guidelines Perform stretching program daily. Hold stretches for 30 seconds and perform 2-3 repetitions of each. Cardio program should be performed no more that 3-5 times a week for 20-35 minutes. Perform strengthening exercises daily. Do 2-3 sets of 15-20 Reps.
























For Further Advice & Consultation :Contact


Dr.Vijay Bathina
Chief Physiotherapist
SYNAPSE PHYSIO CARE
09848857464

                                   "TEXT NECK SYNDROME"

HOW TO AVOID 'TEXT NECK'
Courtesy: Physiotherapy Newzealand

Poor posture from staring at your smartphone, or 'text neck' as it's sometimes known, is damaging your spine according to research published in Surgical Technology International.

The research published by Dr Kenneth Hansraj shows as the neck bends forward and down, the weight on the cervical spine begins to increase. At a 15-degree angle, this weight is about 27 pounds, at 30 degrees it’s 40 pounds, at 45 degrees it’s 49 pounds, and at 60 degrees it’s 60 pounds.

According to the research these stresses can lead to early wear-and-tear on the spine, degeneration and even surgery.

Physiotherapy New Zealand President Ian d'Young says imagining more than 25kg hanging around your neck is a powerful example of how much stress you could be putting on your spine with poor posture.

"It's important that we educate people, and particularly children, about how to correctly use these devices. It's not about ditching technology, it's about making sure that we are using it in a way that's not going to set us up for long term health problems."

"Poor posture is not just the result of texting, it could be slouching in front of a computer or the TV."

"Anytime you stay in a fixed posture for too long - such as looking down at a tablet - you are putting those muscles under stress."

Tips for avoiding 'text neck'

Check your posture at regular intervals throughout the day and adjust (there's even smartphone apps that will remind you to check your posture).
Take frequent, regular breaks. Try taking a break every 20 minutes by standing up or even going for a short walk.
Sit up straight when you're using a device.
Hold up the device a little higher so your neck is not on an angle and look down with your eyes rather than your neck.

Stretch - if you're using devices for longer periods of time then try and take regular stretches to break up the time.

For Further Advice & Consultation :Contact

Dr.Vijay Bathina

Chief Physiotherapist

  SYNAPSE PHYSIO CARE

09848857464

Could Your Shoulder Pain Be Sub-acromial Bursitis?

What is Shoulder Bursitis?

Shoulder bursitis is an inflamed shoulder bursa. 

We have several bursa in your shoulder. our bursa is a fluid filled sac that helps to reduce friction in your shoulder spaces.  subacromial bursa is the most commonly inflamed of the shoulder bursa.

Subacromial bursitis is a common cause of shoulder pain that is usually related toshoulder impingement of  bursa between r rotator cuff tendons and bone (acromion). Your subdeltoid bursa is less commonly inflamed shoulder bursa.

More information: What is Bursitis?

What are the Symptoms of Shoulder Bursitis?

Shoulder bursitis commonly presents with the following symptoms:

• Gradual onset of your shoulder symptoms over weeks or months.
• Pain on the outside of your shoulder.
• Pain may spread down your arm towards the elbow or wrist.
• Pain made worse when lying on your affected shoulder.
• Pain made worse when using your arm above your head.
• Painful arc of movement – shoulder pain felt between 60 - 90° of arm moving up and outwards. 
• When your arm is by your side there is minimal pain and above 90° relief of pain.
• Shoulder pain with activities such as washing hair, reaching up to high shelf in the cupboard.

How to Diagnose Shoulder Bursitis

 physiotherapist is able to differentiate shoulder bursitis from a rotator cuff injury using manual tests. Shoulder bursitis commonly co-exists with rotator cuff tears or tendonitis.

Ultrasound scan is often the most helpful test to diagnose subacromial bursitis. Sometimes MRI scan is required to confirm the diagnosis of bursitis of the shoulder.

What Causes Shoulder Bursitis?

Bursitis around the shoulder can be caused by a repeated minor trauma such as overuse of the shoulder joint and muscles or a single more significant trauma such as a fall.

In overuse type injuries, bursitis is often associated with impingement and tendonitis(inflammation) of the rotator cuff tendons.

Specifically, the subacromial bursa lies between the coracoacromial ligament and the supraspinatus muscle and helps to reduce friction in this small space under the acromion.

When your arm is at your side the bursa protrudes laterally and is not normally impinged unless it is grossly inflamed.  

When you elevate your arm further out to the side the bursa rolls beneath the bone increasing the impingement. 

When you continue elevate your arm above shoulder height, the bursa rolls clears the impingement zone and your pain eases. However, further impingement may return at the extreme of range when your arm is adjacent to your ear.

What Causes Rotator Cuff Impingement & Bursitis?

Rotator cuff impingement and the bursitis it causes has primary (structural) and secondary (posture & movement related) causes.

Primary Rotator Cuff Impingement – Structural Narrowing

Some of us are born with a smaller sub-acromial space. Conditions such as osteoarthritis can also cause the growth of subacromial bony spurs, which further narrows the space.

Because of this structural narrowing, you are more likely to squash, impinge and irritate the soft tissues in the subacromial space, which results in bursitis or rotator cuff tendonitis.

Secondary Rotator Cuff Impingement – Dynamic Instability

Impingement can occur if you have a dynamically unstable shoulder. This means that there is a combination of excessive joint movement, ligament laxity and muscular weakness around the shoulder joint. This impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity.

In an unstable shoulder, the rotator cuff has to work harder, which can cause injury. An overworking rotator cuff fatigues and eventually becomes inflamed and weakens due to pain inhibition or tendon tears.

When your rotator cuff fails to work normally, it is unable to prevent the head of the humerus (upper arm) from riding up into the subacromial space, causing the bursa or tendons to be squashed. Failure to properly treat this instability causes the injury to recur. Poor technique or bad training habits such as training too hard is also a common cause of overuse injuries, such as bursitis or tendonitis.

Poor Shoulder Blade (Scapular) Stability

Your shoulder blade (scapular) is the base of your shoulder and arm movements.

Poor shoulder blade stability results in tipping and rotation of your scapular, which causes your acromion (bone) to pinch down into the subacromial structures (eg bursa and tendons) causing impingement leading to swelling or tears.

Normal shoulder blade-shoulder movement - known as scapulo-humeral rhythm - is required for a pain-free and powerful shoulder function. Alteration of this movement pattern results in impingement and subsequent injury.

How to Normalise Your Scapulo-Humeral Rhythm

Your physiotherapist is an expert in the assessment and correction of your scapulo-humeral rhythm. Any deficiencies will be an important component of your rehabilitation.

Researchers have identified poor scapulo-humeral rhythm as a major cause of rotator cuff impingement. Plus, they have identified scapular stabilisation exercises as a key ingredient for a successful rehabilitation.

Your physiotherapist will be able to guide you in the appropriate exercises for your shoulder.

Shoulder Bursitis Treatment

Shoulder bursitis is one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport or work too quickly – especially if a thorough rehabilitation program is not completed.

Your rotator cuff is an important group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This prevents injuries such as bursitis,  impingement, subluxations and dislocations.

We also know that your rotator cuff provides subtle glides and slides of the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapular) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.

Did you know that your arm only has one bony joint articulation where your collarbone (clavicle) attaches to the acromion (tip of shoulder blade)? <

The rest of your attachments are muscular, which highlights the importance of retraining and strengthening of your shoulder muscles.

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence – these are:

Phase 1 - Early Injury Protection: Pain Relief & Anti-inflammatory Tips

In the early phase you’ll most likely be unable to fully lift your arm or sleep comfortably. Our first aim is to provide you with some active rest from pain-provoking postures and movements.

This means that you should stop doing the movement or activity that provoked the shoulder pain in the first place and avoid doing anything that causes pain in your shoulder.

You may need to be wear a sling or have your shoulder taped to provide pain relief. In some cases it may mean that you need to sleep relatively upright or with pillow support. Your physiotherapist will guide you.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.

As you improve, supportive taping will help to both support the injured soft tissue and reduce excessive swelling.

Your physiotherapist will utilise a range of pain relieving techniques including joint mobilisations, massage, acupuncture or dry needling to assist you during this painful phase.

Phase 2: Regain Full Range of Motion

If you protect your injured rotator cuff structures appropriately the injured tissues will heal. Inflamed structures eg (tendonitis, bursitis) will settle when protected from additional damage.

Symptoms related to shoulder bursitis may take several weeks to improve while we await Mother Nature to work her wonders. During this time it is important to create an environment that allows you to return to normal use quickly and prevent a recurrence.

It is important to lengthen and orientate your healing scar tissue via joint mobilisations, massage, shoulder muscle stretches, and light active-assisted and active exercises.

Researchers have concluded that physiotherapist-assisted treatment will improve your range of motion quicker and, in the long-term, improve your functional outcome.

In most cases, you will also have developed short or long-term protective tightness of your joint capsule (usually posterior) and some compensatory muscles. These structures need to be stretched to allow normal movement.

Signs that your have full soft tissue extensibility includes being able to move your shoulder through a full range of motion. In the early stage, this may need to be passively (by someone else) eg your physiotherapist. As you improve you will be able to do this under your own muscle power.

Phase 3: Restore Scapular Control

Your shoulder blade (scapular) is the base of your shoulder and arm movements.

Normal shoulder blade-shoulder movement - known as scapulo-humeral rhythm - is required for a pain-free and powerful shoulder function. Alteration of this movement pattern results in impingement and subsequent injury.

Your physiotherapist is an expert in the assessment and correction of your scapulo-humeral rhythm.

Researchers have identified poor scapulo-humeral rhythm as a major cause of rotator cuff impingement. Any deficiencies will be an important component of your rehabilitation.

Plus, they have identified scapular stabilisation exercises as a key ingredient for a successful rehabilitation.

Your physiotherapist will be able to guide you in the appropriate exercises for your shoulder blade.

Phase 4: Restore Normal Neck-Scapulo-Thoracic-Shoulder Function

You may find it difficult to comprehend, but your neck and upper back (thoracic spine) are very important in the rehabilitation of shoulder pain and injury.

Neck or spine dysfunction can not only refer pain directly to your shoulder, but it can effect a nerve’s electrical energy supplying your muscles causing weakness and altered movement patterns.

Plus, painful spinal structures form poor posture or injury doesn’t provide your shoulder or scapular muscles with a solid pain-free base to act upon.

In most cases, especially chronic shoulders, some treatment directed at your neck or upper back will be required to ease your pain, improve your shoulder movement and stop pain or injury returning.

Phase 5: Restore Rotator Cuff Strength

It may seem odd that you don’t attempt to restore the strength of your rotator cuff until a later stage in the rehabilitation. However, if a structure is injured we need to provide nature with an opportunity to undertake primary healing before we load the structures with anti-gravity and resistance exercises.

Having said that, researchers have discovered the importance of strengthening the rotator cuff muscles in a successful rehabilitation program. These exercises need to be progressed in both load and position to accommodate for which specific rotator cuff tendons are injured and whether or not you have a secondary condition such as bursitis.

Your physiotherapist will happily prescribe the most appropriate program for you.

Phase 6: Restore High Speed, Power, Proprioception & Agility

If your shoulder injury has been caused by sport it is usually during high speed activities, which place enormous forces on your body (contractile and non-contractile), or repetitive actions.

In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Phase 7: Return to Sport or Work

Depending on the demands of your chosen sport or your job, you will require specific sport-specific or work-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport or employment.

Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport or work.

Work-related injuries will often require a discussion between your doctor, rehabilitation counsellor or employer.

The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.

Exercises:

For Further Advice & Consultation :Contact

Dr.Vijay Bathina

Chief Physiotherapist

  SYNAPSE PHYSIO CARE

09848857464