Category Archives for "Shoulder Pain"

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.

Shoulder Rotator Cuff Related Injuries – Lev Scapula Muscle Stretch

To stretch out the right Levator Scapula muscle, bring your left hand back and behind your head with the pads of your fingertips on the first two vertebrae of your neck. Then, place your right hand behind sliding it down your neck keeping that elbow pointing up.

Look with your eyes to a spot down on the left side of the floor. With your left hand, gently pull the right side of the neck and head away from your right shoulder until you feel a stretch barrier on the right side. Hold the stretch for 30 seconds and repeat it for 3 sets on both sides.

This is a great way to improve mobility in your shoulder in order to help facilitate a better recovery for your rotator cuff related injury. If you’re unsure about the exercise or have any uncertainty about where you’re at with your shoulder, consult your local Physiotherapist before continuing. 

Shoulder Rotator Cuff Strain Injury – Side Plank Scissors on Hand

Lie down on your side, with your feet stacked on top of each other and your hand supporting your body weight. Keep your low back straight, butt tucked in and pull your inner core muscles inward below your belly button.

Lift your hip up off the ground and raise your top arm upwards pointing your hand to the top. Raise the top leg up towards the ceiling and back down again ten times before lowering your hip back down to the ground to rest for 10 seconds. Repeat this movement pattern for 10 repetitions in total doing 3 sets per day on each side.

This exercise will build more strength in your rotator cuff in conjunction with your shoulder blade (scapula) muscles.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your shoulder, consult your local Physiotherapist before continuing. 

Shoulder Rotator Cuff Strain Injury – Side Plank on Hand

Lie down on your side, with your feet stacked on top of one another and your hand supporting your body weight. Keep your low back straight and butt tucked in and pull your inner core muscles inward below your belly button.

Lift your hip up off the ground and raise your top arm upwards pointing your hand to the top. Hold this for 10 seconds and then come back down to rest for 10 seconds. Repeat this for 10 repetitions in total doing 3 sets per day on each side.

This exercise will help you build more coordinated strength in your rotator cuff in conjunction with your shoulder blade or scapula muscles.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your shoulder, consult your local Physiotherapist before continuing. 

Shoulder Rotator Cuff Strain Injury – Side Plank Scissors on Forearm

Lie down on your side, with your feet stacked on top of each other with your forearm supporting your body weight. Keep your low back straight, butt tucked in and pull your inner core muscles inward below your belly button.

Lift your hip up off the ground and raise your top arm upwards pointing your hand to the top. Raise the top leg up towards the ceiling and back down again ten times before lowering your hip back down to the ground to rest for 10 seconds. Repeat this movement pattern for 10 repetitions in total doing 3 sets per day on each side.

This exercise will build more strength in your rotator cuff in conjunction with your shoulder blade (scapula) muscles.

If you're unsure about the exercise or have any uncertainty about where you're at with the recovery of your shoulder, consult your local Physiotherapist before continuing.

Shoulder Rotator Cuff Strain Injury – Side Plank on Forearm

Lie down on your side, with your feet stacked on top of one another with your forearm supporting your body weight. Keep your low back straight and butt tucked in and pull your inner core muscles inward below your belly button.

Lift your hip up off the ground and raise your top arm upwards pointing your hand to the top. Hold this for 10 seconds and then come back down to rest for 10 seconds. Repeat this for 10 repetitions in total doing 3 sets per day on each side.

This simple exercise will begin to build the coordinated strength of your rotator cuff in conjunction with your shoulder blade muscles.

If you're unsure about the exercise or have any uncertainty about where you're at with the recovery of your shoulder, consult your local Physiotherapist before continuing.

Shoulder Rotator Cuff Strain Injuries – Cross Body Arm Pulls

Secure a resistance band to something solid, like the leg of your couch or the leg of your bed on the opposite side below you.

Maintain neutral spine posture with your inner core below your belly button engaged. Then, take up the slack with your right hand at the start position by your opposite hip. Pull the band up and across your body leading with your elbow and then rotate the arm upwards so that the fist is pointing up to the ceiling.

It’s important to maintain control of the movement of your arm and have your shoulder and arm be at a ninety degree angle at the end of the movement. Slowly return the arm back to the start position with control. Repeat this for ten to fifteen repetitions, doing 3 sets on each side.

This is a multidirectional strength exercise aimed at targeting the major rotator cuff muscles like the supraspinatus, infraspinatus and teres major in combination with the scapular muscles to help build increased neuromuscular strength and coordination in the shoulder complex after an injury. 

Shoulder Rotator Cuff Strain Injuries – Side-Planks on Elbow Level 2

To fully rehab the rotator cuff after an injury, it’s ideal to strengthen the shoulder blade muscles as well.

Start by positioning yourself side lying on the affected side. If it’s your left shoulder then position your left forearm on the ground with your low back and legs straight, feet together and your inner core muscles engaged below your belly button.

Keep your low back flat and your body in a straight line as you lift your left hip off the ground so your body weight is supported by your arm, shoulder and foot. Then raise your right arm straight up pointing your hand to the ceiling and lower it back down.

Do this arm motion for ten repetitions for a total of ten sets, twice per day. 

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