Category Archives for "Shoulder Pain"

Frozen Shoulder

Mark: Hi, it's Mark from top local. I'm here with Wil Seto of Insync Physio in Vancouver. One of Vancouver's top rated physiotherapy clinics, many time winners of best physios in Vancouver. And today we're going to talk about frozen shoulder. How are you doing Wil? 

Wil: Yeah, I'm doing great. Thanks.

Mark: So frozen shoulder, what is it?  What the heck is this anyway? 

Wil:  So the technical term for frozen shoulder is adhesive capsulitis. So what it is is it's basically a progression of like a restricted movement in your shoulder joint. So what we call the glenohumeral joint in terms of its range of motion, that's primarily what it is.

And it's really tough to really determine what causes it, but essentially going back to what it is, you have this permanent scarring or this fibrotic scarring that actually occurs. And there's this sort of a neuralpathic and sort of a vasal motor or vascular process that occurs within the shoulder that just can't be really explained yet and what causes that. 

So there's that sort of neurological aspect that really still you know, causes a lot of questions as to where does it come from? And really the other aspect of this too, is that what we're looking at is the side effects of that. You know, so as you get all this fibrotic scarring and all this permanent scarring into the shoulder and the shoulder joint and the rotator cuff area, then you're getting a lot of those effects in terms of the function of that rotator cuff and what that means essentially.

So this isn't something that necessarily appears from a fall or an injury necessarily. This could be just an over use thing. How does it present?

That's a really great question. So in the research and also just with my experience, you know, working with people and seeing this condition, it seems like 70%, first of all, like, you know, we're looking at prevalence, 70% of people that actually get frozen shoulder are usually females.

So when you're talking about what this whole condition is, then it sort of points to the whole. Is there a hormonal aspect of this. And then, you know, what's going on with that. And then also the found that you know, if you're between ages 35 to 65, then you're also at more increased risk of getting this as well.

And it seems like generally speaking, you know, like it's in 2 to 5% of the population. And so when you talking about how does this actually happen? Like, does it occur from overuse or is it a traumatic injury? Well I think when you talk about sort of the primary part of what frozen shoulder is, the onset of it is usually something that's without any known cause.

They call it idiopathic. Where there really isn't any reason. And they still don't even know, what it is exactly that causes this. And the jury is still out on that. Now, when do you start to look at, what we talked about secondary causes, you know, like where you're talking about, oh, is it an overuse thing? Is it like traumatic? 

Yeah. So it can actually occur alongside with things like trauma, so a surgical event. So you get an operation like for your shoulder for something else, and then you develop a frozen shoulder. And you can also have other things like overuse is another good example. Or falling on the shoulder you have an injury?  So those are definitely factors. 

And then there's also like within those sort of secondary factors, you have like other things too. There's systemic. So if you have diabetes, like diabetes mellitus, which is basically type two diabetes, then you can actually have an increased chance of getting this. So this sort of circles back to, is this a hormonal thing . Is this a neuroendocrine thing? 

 And then there's also extrinsic factors like is this like someone that has cardiopulmonary disease or you know, someone that has like a cervical disc issue, like post breast cancer, a meniscectomy and all that stuff. So that goes in line with the surgical. 

And then there's intrinsic factors, which we talked a little bit briefly about like rotator cuff pathologies. And then people that have had like you know, things around there too, or maybe like overuse and then maybe around that shoulder, not exactly in that shoulder joint, but like the AC joint, which is the acromioclavicular joint. So there's all these different things involved. 

Mark: In other words, to sum all that up, the shoulder is really complicated and it can go south in immense amount of ways, basically. Surprise. 

Wil: Yeah, it is. But the shoulder joint is just, is such a beautiful, like marvel of a joint, it's just amazing. 

Mark: So when you're going to treat this, what's your kind of first step? How do you diagnose it and how do you go about then doing a course of treatment? 

Wil: Yeah. That's a really good question too. And so actually funny enough, I was actually just In the process of treating someone that has frozen shoulder and there's specific assessment criteria that they fall in line with like being diagnosed as having frozen shoulder.

And so this particular patient of mine, she's an accountant and relatively fit, 41 year old accountant and she fell in that first primary category. Unknown reason. She didn't fall on it. Nothing really happened. Relatively fit. She fits in that age range and it was like classic range of motion limitation.

And so what I looked at was definitely wanting to improve that range of motion and also looking at how her actual, when we talked about intrinsic factors, how her rotator cuff has been affected by it. You know, and obviously, for someone like her who, you know has been really scared to use it.

Now starting to reactivate that part of the shoulder, the rotator cuff. So we actually started off you know, some simple stuff. Just working on her mobility and then an activation of that rotator cuff. And then we started doing some more specific stuff like neural muscular reactivation. Hands-on stuff with her that actually really started making a lot of progress. The other thing that we were also doing as well was a little bit of dry needling and IMS to kind of help that whole process of the muscles that are just sort of like this, which is essentially responding to a lot of stuff that's happening in the capsule of the shoulder.

Surprisingly so I've been seeing her since October. And surprisingly you know, within the first three sessions and she was seeing me once a week, her range of motion was like less than 25%. And her strength was so weak. She wasn't even using it. Within the first three sessions, three weeks of coming in to see me, we got her range of motion to over, definitely over 50% close to like 65-70% kind of thing.

And then, so that was like back in October. And then now you know, she still comes in once a week and we're at like 90% range of motion and she wants to have that last little bit, like she's like we can do it. And typically with the prognosis of a frozen shoulder, they do consider it self limiting, it can last up to two years. Is sort of the prognosis on a medical indicator.  

Mark: So when people get this, this is the typical thing that doesn't, they don't want to use it. It hurts a lot. They don't want to move it and they can't really sleep on that shoulder too. Is that right?

Wil:  Yeah, definitely. That is another big symptom of it as well. And that's all coincided with the fact that as it gets stiffer and then things get in this chronic inflammatory process, that's producing more and more scar tissue. And what ends up happening is a part of their psychology is affected too, and they don't want to use it. And then as we go through the rehab with them and we help them with that, they build that confidence. And they start to realize that as the range is getting better, we also have to retrain the neural muscular activation patterns to be able to help reinforce that mobility gain as well.

So that's actually really, really important in this whole process. And I think this goes back in line with talking about, you know, the side effects of frozen shoulder, I guess, or the secondary effects, which is basically the rotator cuff stuff and the really stiff shoulder. 

Mark: So would you say that's a more typical response then at about three, four months of pretty steady work on it can get somebody back to 90% mobility and a lot less pain and issues with their shoulder?

Wil: Yeah, I would say like just recently with this particular individual and also a couple of others that have had worked with that, that seems to be what I'm finding and what we're finding in our group. Whereas you know, I've seen people that have suffered with frozen shoulder and didn't want to do anything about it because they've, you know, they've consulted Doctor Google, or even their family doctor even have said, yeah, you know, it'll be self-limiting within two or three years. But then, you know, they'll come in two years later and they're still right. You know, really super stiff and that's obviously a lot tougher to deal with because the other thing that I didn't actually mention was that she had been suffering with a frozen shoulder since last March at the start of the pandemic. And I think a lot of it was maybe she started to do more computer work at home and all those effects of what we've been experiencing with the pandemic. 

The other really interesting fact that we found, a group of clinicians and also sports medicine doctors and rehab specialists in Australia have found that if this is a true frozen shoulder and you catch it within the first three months of its onset, doing a specific type of injection has been really helpful to help with that. But that's actually very key to be able to diagnose it within the first three months because the effectiveness of that injection is no longer as effective. So it starts to get less and less. 

Mark: And you work a lot with sports medicine doctors. You guys co help each other basically. They refer patients to you. You refer patients back to them based on what their needs are. Is that right? 

Wil: Yeah, for sure, definitely my experience and our experience as a group, we have worked with a lot with sport medicine doctors. And currently right now we actually have sort of a specific sport medicine doctor that we can actually do direct referrals to without having to have a referral from a family physician. You know, and I know that with this time of the pandemic, it's really changed how things have been operating with the healthcare system. And this has been an example of being able to help our patients and our clients be able to get moving better the way that they want to again.

Mark:  Anything else you'd like to say about frozen shoulder? 

 Wil: Well I think it's a really tough thing to wrap your head around when you think you have it. I think honestly, like as much as you consult Dr. Google and family physicians like you know, they're great. I have some really good family physicians that we work with, like our group works with. But sometimes they're just not as knowledgeable cause it is like this orthopedic type of condition, but it's got a medical aspect to it as well. But they don't really know the rehab side of it as as much and we try to work with them and help family physicians. But I guess my biggest take home is like, if you're not really sure if this is what it is and you have stuff going on, get it checked out. You know, general rule of thumb is that if you have stuff going on and if it's like severe enough to even give you pain, like without using it, if it's not going away within like the first week or even two weeks, get it checked out. Get it checked out and at least figure out what's going on. Have a register physiotherapist take a look at it. And really you know, someone that has a little bit of a specialty in orthopedics and even in sports to be able to really ascertain, a little bit more and help you with your specific issue with that. 

Mark: So bottom line don't suffer. If you've got a shore shoulder, sore shoulder, you want to give Insync Physio a call. If you're in Vancouver, in the Cambie, King Ed area, anywhere in that general vicinity, you can call them at (604) 566-9716 to book your appointment. Or if you're in North Burnaby, the North Burnaby office is at (604) 298-4878.

Get yourself looked after, get on the path to healing, and you're going to feel a heck of a lot better really fast. And you can check out the website insyncphysio.com. We've got dozens and dozens and dozens of videos on there on all kinds of exercises and stuff. If you want to try and play doctor yourself, you can, don't recommend it. The faster way is to get in and get a professional helping you. Diagnosing and giving you hands on treatment that will make you feel better. Thanks Wil. 

Wil: Thank you, Mark.

Shoulder Rotator Cuff Injuries – Bicep Curls

Hold a dumbbell in each hand. To target the biceps specifically begin with the palms facing the midline of your body. Lift the weight and turn your palm facing upwards, or into supination position, as you flex the arm keeping the elbow pointed down. Then lower the weight back down reversing the motion to the original start position. Perform 3 sets of 10 reps on each side.

When done correctly this exercise helps with the recovery & rehab of your rotator cuff injuries. The biceps muscle helps to facilitate support and stability to the dynamic nature of the rotator cuff strength in the shoulder.

If you have any pain or are unsure about the exercise please consult your local Physiotherapist before continuing. 

Shoulder Injuries – Scapula Strengthening Row Level 2

This rowing progression exercise is a great way to build more rhomboid scapular muscles to help you rehab your shoulder injury.

Using a looped band, make sure it’s anchored to a sturdy object. Wrap the first band around yourself & it should be around your shoulder blades and in line with the back of your shoulder and armpit. Then have a second band anchored & hold that second band in your hands.

 Ensure you have your arms on the inside of the first band. With your knees slightly bent, begin to row or pull your shoulders and elbows back. Focus on pulling your shoulders and shoulder blades back against the resistance of the band. Repeat this for 10 repetitions doing 3 sets daily. 

Shoulder Injuries – Scapula Strengthening Row Level 1

Whether having a minor shoulder injury or something more severe this exercise is a great way to isolate the rhomboid scapular muscles to help you with your rehab.

Using a looped band, make sure it’s anchored to a sturdy object. Then wrap the band around yourself, the band should be around your shoulder blades and in line with the back of your shoulder and armpit. Ensure you have your arms on the inside of the band.

With your knees slightly bent, begin to row or pull your shoulders and elbows back. Focus on pulling your shoulders and shoulder blades back against the resistance of the band. Repeat this for 10 repetitions doing 3 sets daily. 

Shoulder Impingement Wil Seto

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio. He's the owner. He's the professional. He's the one of the top rated physiotherapists in Vancouver year after year after year as voted by his customers. And Insync is one of the top physiotherapy clinics. We're going to talk about shoulder impingement today. How are you doing Wil? 

Wil: Yeah, I'm doing well. Thanks for having me on, so yeah, shoulder impingement. Well what is it, first of all? So it's like saying like I have shoulder pain, you know, you don't really know, you can Google it, you know, consult Dr. Google, and then they'll give you the definition of what it is. Basically it's like when you have the structures in your rotator cuff and read that sort of bony area getting impinged basically. And, so really, when you look at what that means, it's when you have a lot of imbalance happening in through there.

So, I'm thinking about a specific client who happens to be another rock climber. And she's pretty avid rock climber. She's a boulderer. And, and it wasn't a particularly one incident that happened, she came into the clinic and she was just saying like, yeah, I just noticed gradually my shoulder was starting to get more sore.

And I mean, she was still climbing at the time. And she's a pretty high level, like recreational climber, like doing things that are pretty advanced on a recreational level. And, so anyway, she presented with these symptoms. And, first of all, like, you know, we got also clear other things just to make sure that it's not coming from the neck and all that stuff, because we want to make sure that there's not, you know, issues in terms of radiating down from spinal nerves and all that stuff. So that's a clear little test that I do. 

And then the other thing is really, now that we start to look at, okay, is it really coming from the shoulder? Okay, well, what's causing it. And so there could be many different things causing it, and it could be an underlying, actual pathology or issue with the rotator cuff itself.

So you can get an injury in the rotator cuff without a traumatic injury. And how that looks is that if you have a lot of imbalances there to begin with or if you're doing something, a sport, or even it doesn't even have to be a sport, it can be like, you're a painter and you're an electrician. You're doing stuff overhead all the time. And you're always going to put a lot of stress in your rotator cuff. And so what happens when you do a lot of that stuff overhead, or if you're sleeping on it a lot, you're decreasing the blood flow to the area, and then you're also straining it and stressing it all the time.

So you can have micro strains that happen. So then with the micro strains, then it causes the integrity of that area to be less strong. And then you can have sort of this gradual thing happening, where then you get the muscle imbalances with whatever sport or activity that you're doing that also ended up, you know, causing you to compensate and you start to use those as your strategies for how you use that shoulder. 

So ultimately with this person, She presented with a lot of that cause she liked to do specific types that we call problems in the gym and she was a bowler primarily. And so with her doing these types of specific problems, you know, meant that she was always using these type of muscles.

And also in climbing, you do tend to use a lot more of your lats and teres and so the posterior chain. And so she was very imbalanced there to begin with. So when I did assess her, I was pretty confident that her issue was just a pure impingement thing that it wasn't from like a micro strain of the rotator cuff, because there was specific things that we did that helped me identify that.

And so basically first treatment, we addressed the issues that I thought was causing this and then, gave her some exercises and did the manual therapy to really help guide the shoulder and facilitate a process that was able to bring things back into more normal alignment and better movement.

It was almost night and day. Like she came back to see me the following week. And she reported something like, yeah, it was getting like a three to four out of pain, you know? And it was only coming on right after climbing. And then she's like, yeah, I had no pain whatsoever. But then the thing for me that I was looking for on the second session was how was her strength now?

How was she able to now like maintain this because that's really key. Because I see this kind of stuff and my goal to help her is to not just take away that pain off the first session and be like, Oh wow. You're like, that's like magic. And I'm like, well, no, it's not magic. It's actually, you know, this is what's going on.

And so I really educated her and you know what that means because then, as I helped her in the second session, then I have to give her things that work on the areas that she doesn't know where she's weak. Because there was a lot of areas that she was not recognizing that she needed to actually strengthen in her core stability related to the stabilizing muscles of her scapular and her actual whole shoulder complex.

So, I started progressing her strengthening and her core stability program in a way to really benefited her. And I think she came in for a followup session to progress those exercises. And she didn't have any problems. And then because she's in the climbing community and I'm a rock climber myself, she reached out to me and she hadn't been having any more trouble.

And so that's the kind of thing what I typically see with a shoulder impingement, that's not involving anything more sinister. 

Mark: So without that initial shock traumatic injury, this is just an over use or imbalanced problem basically, it's fairly simple to look after if it's addressed in a timely manner.

Wil: Yeah, exactly. And that's totally bang on. With her, she was just not, actually it's funny, because she was just not even stretching after sessions and she had been pushing the grade a little bit more. And so there's always these little indicators of how it started. And then once it's there and you know, they're like, Oh, well I tried to look up stuff to stretch and then you kind of hit a point of no return where you, you can if it's just tight, but then, you know, sometimes it's hit and miss. So it's tricky that way. 

Mark: If you want to get better fast, if you want an expert help on how to do it, give Insync Physio call. You can reach them in Vancouver, (604) 566-9716. They'll get you feeling better. Or in North Burnaby, (604) 298-4878. Got a call and book ahead. They're busy all the time. Check out the website if you want to book online, makes it easy, insyncphysio.com. They'll get you feeling better and moving well and doing all the activities that you want to pursue in your life. Thanks. Wil. 

Wil: Thanks Mark.

Biceps Strain

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. One of the best physiotherapists in Vancouver, many times as voted by his customers as one of the top physios. And we're going to talk about bicep strength today. How are you doing Wil? 

Wil: Hey, Mark thanks, I'm doing really well. I appreciate the shout out. So yeah, we'll talk about bicep strains today. There's a couple of different areas that you can actually strain it.

So this one particular person, he was a really avid rock climber and he was in his late twenties  when you know, had the injury. And it was actually a rock climbing injury where he ended up hyperextending his arm. And, he basically straightened his long head on his biceps.

And that's typically the, like for the biceps, the one that you tend to actually strain because you actually have two, that's why it's called biceps. You have the long head and the short head. And he strained it, at the actual point where it attaches to the shoulder, which is called the origin point.

And, you can also get issues happening, kind of more towards the elbow, which is called the insertion point of the long head of the biceps and your short head also attaches on there too. But with this one in particular, it was a traumatic injury. And, it looked like it was also a few other things going on too.

So when you have this kind of an injury where, especially with this mechanism, with this particular person, you know, he ended up hyperextending because he broke off the hold with his right arm and he held on with his left and it ended up hyper extending that left.

He had this pain that was ongoing. For probably a good two or three months until he actually had some proper physio. And so basically when we went through the process of looking at what was happening, one of the things that you have to consider, especially pain in the shoulder, you have to actually look at the shoulder and assess that and see what was going on because the long head of the biceps actually attaches close to the rotator cuff and sort of like, helps and assists with rotator cuff function. And so we had to clear all that stuff first and then really start to differentiate and look at okay, yeah so is it just the biceps tendon and is it just that area?

And the other thing was also looking at other components because with the long head biceps injury, with this type of mechanism, you can also injure the capsule because that's where the biceps long head attaches and also the cartilage. 

So there's a specific term that we use in the physio world called the SLAP lesion. So SLAP is just an acronym for a superior labral anterior posterior injury. And so that involves like the long head of the biceps. And so the speer capsule, interior aspect of that whole area, and the labral is basically the cartilage.

And so, this person came in, like two, three months after the injury and was only able to move their arm about around this high. And they were actually getting some physio somewhere else and it just wasn't really helping. I think what I was assessing too was also the whole shoulder. The whole shoulder and everything, what was going on and I realized that, you know, we had to actually address all the stuff that was going on. And so, the long head of the biceps was definitely the main thing in question. And as we sort of started treating him and it started progressing, a little bit by little bit, and it was getting better actually within the first two weeks. I had made a suggestion and I said, because of the mechanism of injury and what I thought was going on, which was this SLAP lesion, that we get an MRI. \

And interestingly enough, they were able to get an MRI set for like three months pretty quickly after they saw me. But then, we actually got full range back within like a month. And so a month of working on this issue of not being able to fully flex and come out this way and he had full flection and also behind the back motion. So there's range of motion was like 100% after four weeks. We also worked on the strength and surprisingly six weeks later got him back rock climbing.

Mark: So there you go. If you need some help with your shoulders, your biceps you've injured yourself. It could be rock climbing. It could be throwing baseballs. It could be many of the things we use our shoulders for many different actions, the guys to see our Insync Physio. You can reach them in Vancouver at (604) 566-9716. Or in North Burnaby, (604) 298-4878. Check out the website insyncphysio.com. You can book online there. You can pick the physio you want to see. Wil's in real demand so it might take a while to see him, but he is one of the very best in Vancouver. And thanks a lot Wil.

Wil:  Thanks Mark. And oh, one more thing to add I almost forgot that he did get that MRI scan done, and it did show a long head biceps tear along with a superior interior capsule tear and some cartilage damage. 

Mark: But he's all good now and back climbing. 

Wil: All good. Now and back climbing. 100%.

Rotator Cuff Injury

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. One of the best physiotherapy shops in Vancouver, multiple time winners of best physiotherapists in Vancouver and their star, their owner, Wil Seto who's many times voted the best physio in Vancouver as voted by his customers. And we're going to talk about a real common issue, traumatic rotator cuff injuries. Wil how are you doing? 

Wil: Yeah. Hi Mark. I'm doing great. Thanks for having me on today. So yeah, rotator cuff injury. So when we talk about rotator cuff traumatic injuries, they can obviously be quite worrisome and when you have that happen, you're kind of left wondering, you know, like what should I really do about it? 

Mark: So just for those who might not know, rotator cuff, that's a real common term we heard about it in baseball. What is the rotator cuff? 

Wil: Yeah excellent question. So we like to refer to it as like a rotator cuff interval, but to keep it simple, like when we think of rotator cuff, it's primarily composed of four muscles and tendons that attach onto the arm or in the shoulder joint.

And, so, you know, I don't want to complicate it too much, but basically the names of them, there's four of them and have your supraspinatus, infraspinatus, teres minor and subscapularis. So you have the four rotator cuff muscles that basically, what they do, is they act like a suspension bridge. So if you think of like, you have those four muscles and they, create this like ability to stabilize your shoulder because your shoulder has this 360 degrees of motion and movement, right. So that's the primary function. Then you also have your capsule and your ligaments that are intimately connected with that.

Mark: So when you injure your rotator cuff, you basically you've hurt your shoulder, doing something with your arm and shoulder, basically. 

Wil: Yeah, exactly. So I see this a lot and you know, many different sports, but one in particular, who was a gentleman that, had a fall from skiing. And I mean, he's quite an athletic gentleman to begin with and he does rock climbing, but his specific thing that he did, he actually fell down skiing like from last year. And it really struck me because I remember like he came in and, you know, he did have some limited range of motion and he definitely was, a kind of person that was very functional to begin with. you know, like right after the injury.

And so he really wanted to get better at fast. He was always pushing it. There are specific tests that we do to really pinpoint and really isolate, okay you know what part of the rotator cuff? And so when we looked at his shoulder, you know, definitely had  all the compensation issues already right away, that was going on, like just, you know, his lats and his pecs were kicking in. And so certain muscle imbalances were already there. Whether they were preexisting, but definitely I think it was because of the injury. And, ultimately, what we wanted to do, is we wanted to do more of the conservative measure in terms of taking them through the physio portion of it and looking at range of motion, getting his motion back, looking at getting his strength. And really starting to hone in on activation of that rotator cuff. 

Talked about the rotator cuff is, if you think of the four of them, it's like a suspension bridge. And when one of them is injured, then now you have this imbalance, so then now it poles differently and so we want to try and get that other one that's been injured to heal and to kind of get that working properly. And then all the other ones sort of follow suit as well. And then kind of just be able to provide this what you call dynamic stability in that whole shoulder joint. Because the shoulder, what makes it really unique is that, like I was saying, it provides you this 360 degrees of movement.

If you can imagine like a baseball, you know, sitting on a golf tee, right. And then you have all this cartilage that, kind of makes it a little bit deeper. So the bowl, but then it needs to be stabilized by muscle because it's not like your elbow or your knee where you have a stop right there where you can, you know, be able to limit your range. And that's why it's more like the 360 degrees type of motion. 

And then there's a lot of other factors to consider with regards to, you know, looking at the muscle control round the whole shoulder blade. So if you have, all this compensation going on, when you have an injury, then you have to address that. So we won't try and normalize that. 

So, basically the first three or four sessions, we really, we looked at normalizing things and then trying to get the motion back and get the activation patterns. And quite honestly, if things weren't progressing well or they're progressing quite slowly, then I would refer over to a specialist like one of our sports medicine physicians that we have in the back of our pocket, so to speak who really likes to take on clients of ours and we can get them in to see them pretty quickly. And so that's a real benefit to be able to do that, because then they're able to get through the process and I communicate with them. I work with the sports medicine physician to be able to expedite certain things and to look at, you know, do we need to get a scan, like an MRI or something like that. 

So it, it happened to be that this person needed that, you know, his progress was really slow and it turned out that he had a full on thickness tear. It was like a pretty large, like more than three quarters of his rotator cuff was torn. And so they decided to operate because it was, you know, definitely the weakness part of it. That's where you really find, you know, that this dysfunction, he wasn't complaining of pain very much other than the fact when it limited his motion. But the reason why he couldn't go all the way up was because when we tested him and obviously the strength was really poor. 

So, he ended up getting somehow fast tracked when we got them to see the sports medicine physician. He had surgery. And so the surgery was the thing that he elected to do because he's very active and he wanted to be able to rock climb and ski and all that stuff. And that was actually a year ago. 

So, you know, and I've seen him since, and he's actually back rock climbing and skiing again without any problems, but that's been a full year of rehab for his surgery. So it's been really a success story in that way.

Mark: So if you fallen on yourself and you find that you got a lot of pain in your shoulder, if you've injured it playing some sport or recreational activity, or it could even happen in a car accident. The guys to see are Insync Physio, they're experts at getting you back moving properly in your life. Reach them at their Vancouver office (604) 566-9716 or in North Burnaby, (604) 298-4878. If you want to book online, you can do that at their website insyncphysio.com. It's really simple to use, and it will get you able to pick whichever physiotherapists you want to see. Thanks a lot Wil. 

Wil: Thanks Mark.

Simon Kelly – Shoulder Dislocation

Mark: Hi, it's Mark from top Local. I'm here with Simon Kelly of Insync Physio in Vancouver. One of Vancouver's best physiotherapy clinics, many time winners of best physio therapy clinic in Vancouver as voted by their customers. And Simon's a physiotherapist there. He's actually from Ireland of all places originally so, love the accent, love what he's got to say. He's an expert at getting you feeling better. And we're going to talk about shoulder dislocation today. A really painful subject. What was going on with this client Simon? 

Simon: Cheers Mark, thanks for having me again. This client was a snowboarder, a 30 year old. He came in, I think it was two weeks after the injury. Had lots of shoulder pain was sort of cradling his arm across the chest kind of like in a sling position. And his wrist was kind of hanging down like so. Pretty limp. 

And so we had a discussion what happened obviously? So he was snowboarding, so it was pretty traumatic. He said his shorter dislocates pretty frequently. I think he said  like anywhere between 20 and 25 occasions in his lifetime, but generally it just goes back in and he started rehabs himself he says. But this time was a little bit different because he had like no use of his wrist. That's why his wrist was hanging down like so. A lot of the nerves that supply those muscles had been damaged, which was kind of a new presentation to him. 

So he was pretty worried when I first saw him actually. So we went through this objective that was pretty important stuff to know. And there definitely was some nerve damage. I had to clear the neck first because sometimes the nerve roots come from the neck, so the neck seem to be intact.

But we have a lot of nerves that pass through our top of our shoulder. You call your brachial plexus. And before they go under the clavicle on top of the first rib, and they can sometimes do damage going down into the arm and into the forearm and into the wrist. So first protocol for him was actually to send him for an X Ray and make sure he hadn't fractured the top of the humerus. Because one of the nerves, the radial nerve, brings the wrist up. So it extends the wrist. In other words, that's why his wrist was down. So I was hoping that he had fractured the top of his arm. 

Good news for him, that differential diagnosis was ruled out because he didn't have any fractures. No Hill-Sachs fractures is a fracture in the humerous and no humerous fracture in a different part of the humerour. So that was all good. In theory, we should of probably sent him for a MRI at that moment, but it was going to take a long time and he just wanted to start rehab. So we got right into it basically. 

So, first protocol was to really get his nerves firing up again. We done that by putting on electrical muscle stimulation. It's called EMS kind of like jumping a car is the analogy I would use. We're just kind of getting electrical nerve impulses firing from the muscles to the brain. In other words, to get this wrist moving. So, like he also had no triceps, so he couldn't extend his arm above his head, which means against gravity. So very, very weak at that moment in time. So then we just started firing up with the electrical muscle stimulation and got it working. And then his wrist started to come back moving again which was fantastic. 

So most of the work early on was getting his nervous system back working, I suppose the wiring from his brain to his forearm. And then rest of the treatment was really just stability in the shoulder. And he had to avoid the high-five position initially because the shoulder can come out forwards. So we avoided that initially, but then we do eventually have to go into that as the weeks progress, because he clearly has to use his arm in functional positioning if he wants to go back snowboarding again. 

So we did rehab. We got him back. I did send them to a neurologist just to be extra safe a few weeks in just to be sure to the nerves weren't completely damaged. And he said it's all okay. It should come back in three to six months, which it did. And he was back on the slopes within five or six months after that injury.

However, I did say to him based on the 20 dislocations that he did that previously, that he might want to go and see an orthopedic specialist just because . It was pretty stable when I left him, but I really wanted him to get it checked out even further, just to be sure. He may need surgery at some point in the future, but he really wasn't a big fan of going under the knife.

So that's kind of where I left him. We definitely stabilized and it was definitely pretty good when I left but I would have liked another opinion from a specialist. Which is what he was going to do. 

Mark: So would that be because the ligaments have been stretched or /and tendons have been stretched too far?

Absolutely Mark. Like when, like someone who's dislocated his shoulder that many times. You know, it's highly likely that it's going to kind of continue to dislocate unless you get a surgery. So those ligaments and tendons are going to be overstretched. It's going to be too lax in your shoulder and it's going to continue to fall.

And in his case, he was actually starting to damage some of his nervous system. So that was something I really wanted to get across to him, even though he was young and a 30 year old male, and he was clearly an adrenaline junkie. He wanted to get back on the mountains. I had to give them that information, expert advice to be like, look I think you still need to see an orthopedic surgeon just to tighten up their shoulder and you might be looking at surgery. In your own best interest, if you want to stay on just slopes for the coming few years. 

Is there any, ongoing protocol that you would have recommended to him to try and help with that? 

Simon:  Absolutely Mark. Yeah. I would've of given him a huge amount, not a huge amount, but a couple of very important exercises to kind of standardize the shoulder. Sometimes we do closed kinetic chain exercises like wall pushups the where hand is actually fixed. That's a bit safer because the bottom of the hand is fixed. And then we do open kinetic chain, which is when your hand is free in space like mine. But I would have been going into this position eventually, which we were doing actually and he was coping pretty, pretty well. 

It's just on this occasion based on his history, clinically, he seemed pretty stable, but just that many dislocations. For me, I was like, maybe he needs to see a specialist too at the end. But yeah, for sure, we gave him lots of stuff to work on in his own time. Which he should be doing actually every couple of weeks for numerous months after that, based on his history.

Yeah because if he's snowboarding, he's probably going to fall again. He's probably going to fall on his shoulder one way or another, whether it's with his arm outstretched or just directly on the shoulder and that ballistic impact. Could easily, if it's loose already, it's going to dislocate it again. Right?

Absolutely. Like he kind of appeared to think it was kind of okay, because it just kept relocating, but I was trying to tell him that you can't just continue to go on like this forever. But I liked his enthusiasm and his positivity. Is probably why he got better so well but, same time he may have been looking at surgery at some point. And that was my opinion when he left.

But very interesting case with the nerves and that in his arm. Seeing him progress against gravity was pretty, pretty interesting. And it can come back. That's what I would like to get across with this video. Pretty scary when you're in your wrist is hanging down like that. And you're wondering, is it severed or is it ever going to come back. Nerves usually regrow one millimetre a day, when they're damaged. So it can grow back in other words, we just have to make sure it grows back correctly, and you get all the movement back into your arm. 

Mark: There you go. If you need some help with your shoulders. Got shoulder issues and you don't want to be 80 years old and still have, you can't sleep on your side because your shoulder is so buggered from not looking after it. The guys to see Insync Physio, give Simon Kelly a call. You can reach him at the Vancouver Cambie Street office (604) 566-9716. Check it out. If you want to book insyncphysio.com. You can book for both Vancouver and the Burnaby office, or if you're in Burnaby, give them a call there at (604) 298-4878. Call. Get in there. Get after it. Get looked after sooner rather than later, so that you can enjoy the rest of your life. Thanks Simon. 

Cheers, Mark. Thanks very much. See you soon.

Shoulder Strain Injuries – Biceps Strain Rehabilitation

Hi everyone!!! It’s Wil Seto here from INSYNC PHYSIO Sports and Orthopaedic Rehab clinics, with two locations, one in Central Vancouver and one in North Burnaby BC. I’m going to talk about a type of shoulder strain and shoulder injury that involves the biceps today.

What usually goes on with a biceps injury? Your biceps muscle is made up of 2 muscles… hence “biceps”. A few things can occur.

Number 1, you can strain or pull the tendon of the long head of your biceps at the shoulder or the biceps tendon down by your elbow. You can also have what’s called Tendinopathy of the long head of the tendon at the shoulder or elbow. If it’s a minor strain or a Tendinopathy, strengthening the tendon is one of the best things you can do for it.

Here’s an exercise you can start off with. This focuses on the strengthening and rehabilitation of the tendon by performing eccentric contractions. If the left is the affected side, assist shoulder flexion with the elbow flexed all the way up with a resistance band for your non affected arm.

Then using only your affected side, slowly lower the arm and straighten the elbow with constant resistance throughout until you reach the start position again. Repeat this for 10 repetitions doing 3 sets 2x daily.

If you’re unsure about the exercise or have any uncertainty about what you’re doing, consult your local Physiotherapist before continuing.

Adam Mann Rotator Cuff Tear

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann of Insync Physio in Vancouver. They are multiple award winning Best Physiotherapists in Vancouver. If you want to get better, these are the guys to see, and we're going to talk about a rotator cuff tear. How are you doing Adam? 

Adam: Doing well. Good to see a Mark.

Mark: So what was going on with this client, we're going to tell a little bit of a history of a client. They came in with a rotator cuff. What did you see? 

Adam: Yeah, so this guy was a middle-age plumber. And so he used his right arm a whole bunch just to tighten valves and all sorts of stuff in sort of really tight spots.

So he's always kind of reaching under and kind of doing some end range motions, a lot of twisting motions. So he had pretty debilitating shoulder pain and it was going on for almost three to four months. And it was on the front part of his arm right here. And he felt like his arm was painful. It was weak and it had limited range of motion. And it's this guy's livelihood. So he definitely needed his arm to be rock solid. 

So eventually we assessed him and we decided that he had a rotator cuff tear. 

Mark: So how did that present? Like what other issues was he having other than just the pain that of maybe trying to do, you know, look after plum juice, but what else was happening with in his life?

Adam: So, you know, he had a lot of pain when he was sleeping. That was a big part of it. So when he's sleeping on that side, or even on the other side, and his arm was in a non ideal position, you would just feel that kind of achy pain. He also would feel a pinch as soon as he kind of was reaching overhead past 90 degrees and almost any motion. And sometimes the pain would actually radiate a little bit to the back. 

Mark: So how do you assess and treat this condition? 

Adam: So shoulders are really interesting to treat. So typically when we do a shoulder assessment, we go in and we look at the neck range of motion. And we look at the shoulder range of motion, and then we also look at the shoulder blade. And so here's a shoulder blade here that I have, and there's 17 muscles that attach to the shoulder plate. And some of them go all the way up to the neck wrap around to the front of the arm and the rotator cuff in particular, its job is to stabilize this ball and socket joint. So as he's moving his arm through different ranges of motion, it sort of adds a bit of compression onto the joint so that he can move above 90 and do something, those extreme motions.

But the way that we look at it is we will take a look at the neck. We'll make sure that we'll look at the posture. That's actually a really big part of it because a lot of times the tendon that was compressed, if the shoulder is in a forward posture position, this tendon here is the one that he damaged, it's called the superspinatus.

So in certain positions, it can get compressed when you're in a bad posture position. So we could confirm some of that with do some strength testing and orthopedic testing, and basically a cluster of different tests that show that it was a rotator cuff tear. And so that's how we kind of assess it.

Mark: And so then how do you move into treatment of that, given that it's a tendon and it's within a joint that he's going to be using a lot. 

Adam: In terms of treatment again, because there's so many different factors in the shoulder. I always like to start with posture.

So we really try to get that shoulder blade into a better position. And we do that by treating a bit of the neck where we open up the neck. We make sure that the back muscles bring the shoulder blade into an ideal position are working. And then we add in a gradual strengthening program of the shoulder and we start in pain-free ranges.

So we might start below 90 at first, and then we'll slowly creep up to higher motions or end range motions. Once we have more real estate that's pain-free inside of that joint for the person to move. 

Mark: So that sounds like a very holistic kind of body approach. What can you tell me more about that? How does that work? 

Adam: Yeah, so in general, the way I treat and the way I look at a person is force goes to the area of least resistance. And so if it's going into this muscle here, it's probably due to a dysfunction of where that shoulder is sitting. And so if we can get that shoulder into a better position, we're gonna have lasting outcomes.

And the problem with rotator cuff tears is that 50% shoulder pain tends to come back. So when we are treating this, I kind of set realistic expectations with the client where we can get you pain-free and we can probably get you full range of motion back, but you do need you to keep up with some of the exercises that we give you. Not all of the exercises, but some of them, you know, once a week, like you can miss a couple of days here and there for sure, but I wouldn't miss a couple of weeks.

Mark: And so that kind of falls onto the next question. Would this just go away all by itself?

Adam: A lot of research shows that this doesn't necessarily go away. It does come back a fair bit. And in general, working on posture is quite healthy. We want to get people moving well for long periods of time.

And so, it would probably ebb and flow, but the shoulder would still be weak. We actually do need to strengthen the muscle and the tendon that was compressed, in order to get full function back. And there was a bit of research that shows if you don't rehab it and get it stronger, it will actually lead to arthritis inside of the joint and stuff like that later on. And some other outcomes that we don't want.

Mark: So there you go, if you've got pain in your shoulders and you want it fixed and you want it to not come back and continually make your sleeping really difficult. I've been through this. This is not fun at all. And I was treated at Insync and it made a heck of a difference and it will work for you. You can reach them. Insyncphysio.com to book online.

You can talk to Adam in Vancouver office at (604) 566-9716 to book and get him to look after your shoulders for good. So that you can live out the rest of your days with healthy, loose shoulders. Thanks Adam. 

Adam: Awesome, Mark. Glad to hear that your shoulder's moving better. Good chatting with you.

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