working from home

Are you spending more time on your laptop in the comfort of your home? Many of us now do. With social and physical distancing rules in place, you may be working and studying from home.
You probably know that slouching for long periods of time can hurt your neck. It can cause shoulders to feel pain too. When you slouch, you curve your midback, placing your shoulder blades further apart and causing your shoulders to rotate in. This can create pain by putting your rotator cuff muscles on stretch. It can also lead to compression of your rotator cuff tendons, causing pain and inflammation of the tendons with movement.
That doesn’t sound good, but what can you do to avoid this?
  • as difficult as it is, do NOT use your laptop on the couch or in bed
  • invest a bit of time to set up a proper home work station
  • if you can, use a docking station and have a separate keyboard, screen and mouse
  • if you don’t have a separate screen, then place your laptop up to your eye level and use a separate keyboard and mouse so that you’re not hunching over, looking down and having your forearms unsupported
  • if you must use your laptop, as its name indicates, on your “lap”, then place a cushion underneath it, tilt the screen back to avoid looking down and support your arms with pillows under your elbows
  • take stretch breaks every 30 minutes
If changing your home work station isn’t enough to resolve your symptoms, our team of physiotherapists is also working from home and can help you. A virtual assessment respects social distancing and can get you back on track. Contact the clinic for more information!

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Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

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Choosing the right back for you and your child shouldn’t be based on what looks good.  An appropriately sized back pack can prevent shoulder, neck and back pain. Click on the video to find out more. 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

 

Anatomy of the Shoulder

Your shoulder joint is where the upper arm (humerus) and the shoulder blade (scapula) connect.  It is a mobile joint covered in an loose tissue known as capsule.  Capsule is a common feature in most of our joints.  The capsule of the shoulder is a dense, fibrous connective tissue that attaches to the bones close to the joint surface.  The capsule seals the joint space and helps in stabilizing the joint from excessive amounts of movement.  The laxity in the capsule also allow for the movement of the humeral head within the joint as we move our arm.

 

Frozen shoulder

In cases of frozen shoulder, medically known as adhesive capsulitis, a thickening occurs of the usually loose joint capsule.  Over time this leads to a stiffening of the capsule and loss of range of motion of your shoulder.  Frozen shoulders are often categorized as primary or secondary frozen shoulders.

Primary frozen shoulders occur when no cause can be linked to the development of a frozen shoulder.

Secondary frozen shoulders develop when other factors play a role in the development of frozen shoulder. These can include intrinsic factors such as if you’ve had a shoulder fracture, rotator cuff pathology or labral injury and extrinsic causes such as if you’ve had a stroke.  Systemic causes include if you have other conditions such as diabetes and thyroid conditions.

Despite this categorization of frozen shoulder, the cause of frozen shoulder is not known.

Stages of a Frozen

If you have a frozen shoulder, your symptoms will tend to follow a pattern as your symptoms progress and resolve.

 

Frozen Shoulder Stage 1

This is the pre-adhesive stage and this stage typically occurs for the first 3 months.   Your symptoms are characterized by pain at the end range of shoulder movements and high levels of discomfort. In this stage the minimal loss of range of motion may seem consistent with a tendinopathy presentation, however elevated pain levels are noted. You may have tried stretching your shoulder to reduce symptoms but noticed that stretching felt worse.

Frozen Shoulder Stage 2

This stage is commonly known as the freezing stage.  In this stage you are noticing increased pain levels and gradual loss of range of motion of the shoulder in all directions.  Scar tissue is beginning to appear in your shoulder capsule.  This stage can last up to 6 months.

Frozen Shoulder Stage 3

This stage is the frozen stage and is usually characterized by a reduction in your pain but the inability to fully move your arm.  At this point your primary complaint is the inability to move your shoulder.  Scar tissue is more mature at this stage and is limiting most movements of your shoulder. This stage can last up to 6 months.

Frozen Shoulder Stage 4

This is the thawing stage.  At this stage your range of motion is continuing to slowly improve. This stage can last up to 9 months.

 

Risk factors for Developing a Frozen Shoulder

The cause of frozen shoulder is not yet known. Research does show that frozen shoulder is more common in women than in men. Frozen shoulder is thought to affect 2-5% of the general population and is more common between the ages of 40-65 and in 14% of cases can occur on both sides at the same time.

Several factors have been shown that can increase your risk of developing a frozen shoulder.  If you have the following conditions you are more likely to develop a frozen shoulder

  • Diabetes
  • Thyroid disease
  • Auto immune disorders
  • Shoulder trauma
  • Heart attack
  • Immobilization of the shoulder

Having had a frozen shoulder of one arm increases your chance of developing frozen shoulder on the opposite side by between 5-34%.

 

Treatment of Frozen Shoulder

The treatment for frozen shoulder depends on the stage that you are in, so it is important for other shoulder pain conditions including impingement, arthritis and tendinopathy to be ruled out by your physiotherapist. Imaging studies such as X-Rays, ultrasound and MRI are not required to diagnose your frozen shoulder.

In early stages treatment will often include education on frozen shoulder and pain management strategies.  These may include techniques performed in the clinic such as acupuncture or the use of therapeutic modalaties.  Your physiotherapist may prescribe range of motion exercises to encourage movement without aggravating symptoms.  Aggressive stretching and strengthening exercises at this stage will only increase the pain and will not necessarily resolve your symptoms faster.

In later stages of frozen shoulder your physiotherapist may use manual therapy techniques to loosen your shoulder capsule.  If your pain is persisting in these later stages, your physiotherapist will communicate with your doctor, as the use of a cortisone injection may be indicated.  Clinical techniques are complemented by target exercises to improve your movement.  Shoulder strengthening exercises to reduce pain with activities are prescribed. Unresolved capsule restrictions can lead to impingement pain of the shoulder and neck pain.

Unsure where to start?  Or are you looking for a second opinion for persistent shoulder pain? Contact us for a consultation to help you get back on track with your health and fitness goals.

 

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Family Physiotherapy, assessing and treating persistent injuries and pains for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, contact the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

References

  1. Kelley M, Shaffer M, Kuhn J, Michener L, Seitz A, UHL T, Godges J, McClure P “Shoulder Pain and Mobility Deficits: ADhesive Capsulitis” Journal of Orthopaedic Sports Physiotherapy 2013

 

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

 

Shoulder pain

By Peter Poon, PT

 

Have you ever experienced jabbing pain in the front of shoulder when reaching up, out or across your body?  Interestingly, between 7%-34% of adults have shoulder pain at some point in their lives and the level of discomfort can range from annoying to debilitating (Diercks et al., 2014).

Shoulder impingement and pain syndromes

The above pain pattern can be a symptom of SAPS or Subacromial Pain Syndrome. SAPS is defined as all non traumatic, usually unilateral, shoulder problems that cause pain, localized around the acromion (top part of shoulder), often worsening during or subsequent to lifting of the arm (Diercks et al., 2014). The above scenarios fall under the external impingement subtype, which include compression or abrasion of muscle under subacromial space. People with impingement type pain often have altered shoulder blade movements as well. If left untreated, it will lead to more severe rotator cuff diseases.

 

Anatomy of the shoulder girdle complex

The shoulder refers to the union between scapula (shoulder blade), humerus, clavicle (collar bone) and its ligaments plus overlying muscles.

 

Here are some important bits you need to know:

  1. The humeral head – This is the top portion of the bone in your upper arm. Normally it should stay snugly fit centered into its socket, the glenoid fossa
  2. Acromion, Coracoid and Coracoacromial ligament – These structures sit above the humeral head and provide a small space aptly named the subacromial space.
  3. Supraspinatus Tendon (part of the rotator cuff), long head of the biceps tendon and a bursa – These structures sit between the humerus and the subacromial space.  These are the structures that get impinged upon with this syndrome.
  4. Shoulder muscles important for normal shoulder movement: deltoid, biceps, rotator cuff muscles
  5. Scapular muscles important for normal shoulder movement: (upper/mid/lower) trapezius, serratus anterior and pectoralis muscle group

 

Efficient movement of the shoulder

While it may look like reaching up consists of the head of the humerus rolling upwards within the socket, the scapula and the clavicle actually plays an immensely important role in helping us reach. While the humerus rolls within the socket, the scapula upwardly rotates, posteriorly tilts, and the clavicle posteriorly rotates. Furthermore, shoulder girdle muscles (rotator cuff, trapezius, serratus anterior, pectoralis and biceps) have coordinated contraction and relaxation to help us with reaching. Certain muscle tendons will need to cross under the subacromial space in order to complete the motion.

Muscle imbalances and impingement pain

As mentioned above, patients with impingement pain often have different shoulder blade movements. Part of the problem can be due to the scapular muscles controlling the movement.  These include an overactive upper fibers of trapezius, tightness in the pectoralis and/or weakness in the serratus anterior.  Not only do changes within the scapular muscles cause changes to the movement of the scapula, they can also alter the orientation of the humeral head in its socket, thus decreasing the subacromial space during shoulder movement.  This can lead to compression of the rotator cuff tendons, bursa and the biceps tendon resulting in tendon pain.

 

Risk Factors for impingement pain

There are many common factors that influence the scapular muscles and can increase the chance of developing shoulder impingement syndrome.

Muscle timing issues

Full flexibility of the joints may be present, however there can be a problem where the muscles are not firing in the proper sequence.  This can be a result of muscle weakness or muscles that are too short and overpowering or too long and functioning as weak muscles.

Thoracic and cervical posture

Postural problems that affect the neck and thoracic spine can result in changes in the length/tension of muscles surrounding the spine.  This change in starting posture can affect the efficiency of scapular muscles.

Age and hand dominance

As we get older, our dominant hand’s shoulder girdle complex may also undergo degenerative changes which could increase the chances of developing SAPS.

Occupation

Jobs that require heavy labour and/or repetitive movements can predispose individuals to repetitive strain injuries in the shoulder girdle or scapular muscles, which can also lead to SAPS. Furthermore, sedentary workers could be at risk of developing SAPS if their desk is not setup ergonomically. Simple changes can be done to help alleviate these problems.

Previous traumas or injuries

Certain shoulder girdle injuries (ie. frozen shoulder, fractures and dislocations) can cause stiffness in the shoulder joint and its surrounding ligaments/capsules, which will have detrimental consequences to the efficiency of the scapular muscles.

Anatomical differences in the shape of the acromion

There are 3 common varieties of acromions found in the population. Certain types of acromions will decrease the subacromial space and may increase the chances developing SAPS.

What can be done?

Luckily, research has shown conservative treatments have favourable results in combating impingement type pain. Rehab professionals can help to identify underlying sources of why your shoulder isn’t moving the way it should. Part of the assessment should include a detailed history pertaining to previous injuries, medical conditions, occupation and social factors; followed by a careful analysis on how you move your shoulders.  A physiotherapist would then be able to offer a series of exercises to help restore the movement pattern. Often, this will be enough to reduce the initial pain. As your symptoms reduce, it will be important to address the next areas of mobility restrictions, postural changes or muscle imbalances that may have caused the initial symptoms in the first place.  Making positive changes in predisposing factors to injury will help prevent future re-injury.  Some of the possible interventions could include body weight exercises, flexibility programs and/or lifestyle modifications.

 

Not Sure Where to start?

You’re not alone. There are a number of risk factors that can prevent “traditional” shoulder and posture programs from succeeding.  Our physiotherapists and massage therapists have the experience and training to evaluate and diagnose your current status and the tools to get you started and progressing towards better health.  Contact us to get started on your goals!

 

Family Physiotherapy, assessing and treating sports injuries for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

References

Ludewig, P.M. & Braman J.P. (2011). Shoulder impingement: Biomechanical considerations in rehabilitation. Manual Therapy, 16, 33 – 39

Diercks, R., Bron, C., Dorrestijn, O., Meskers, C., Naber, R., de Ruiter, T.,  Willems, J., Winters, J., & Van der Woude, H.J. (2014). Guideline for diagnosis and treatment of subacromial pain syndrome, Acta Orthopaedica, 85:3, 314-322

 

 

Contact Us

Located in Thornhill we are conveniently located near Markham, Richmond Hill and North York.

2300 John Street Unit #7 Thornhill, Ontario

Contact Us Today

 

 

 

 

 

 

Sports injuries series: pitching and arm pain

By Darryl Viegas, PT

Injury and Sports Physiotherapy

Sports injuries vary in severity as well as their underlying causes. One of the most common non traumatic sports injuries that we see in the clinic is shoulder and elbow pain in baseball players, especially pitchers. In major league baseball there have been a few notable names of the home team over the past few years with missed starts due to shoulder fatigue, elbow pain, low back pain, latissimus dorsi strains and shoulder pain requiring various treatments from rest to physiotherapy to cortisone shots. At a professional level one often hears of pitch counts and a gradual increase in a young pitchers workload in an attempt to prevent this type of sports injury. However clinically we also see these problems in the amateur, weekend warrior and young sports enthusiasts.

Phases of the overhand pitch

Throwing involves more than just the muscles of the shoulder.  Pitching is more than just throwing hard.

Pitching can be considered as 6 phases of motion that simplistically link the pitcher’s arm to their shoulder girdle, trunk, hips and legs.  The connections between these areas allow for efficient storage of energy during the first 3 phases, release of energy rapidly in the 4th phase and the slowing down of momentum in the final two stages.

Phases of the pitching motion
Phases of the pitching motion

The ability to consistently perform the movements influences the ability to consistently locate a pitch and efficiently generate and absorb the Pitching and the kinetic chainrequired forces.  Restrictions in range of motion and strength of the hip, pelvis and trunk muscles will require greater deceleration forces at the shoulder and elbow.  For example, restricted hip range of motion of the front leg during the stride phase affects foot placement as the lead leg contact the ground.  This can cause a greater cross body movement of the pitch requiring greater force absorption through the trunk muscles.  This impairs accuracy and endurance.  A lead leg that opens up too much at foot contact increases the load on the shoulder muscles and elbow as does biomechanical changes that cause an increase in sideways leaning (Solomito 2015).  If left unresolved overloading of the shoulder or elbow musculature can lead to overuse injuries including tendinopathies.

Assessment of a pitcher without pain

Evaluation of a pitcher should not just occur with the onset of pain.  Often before arm symptoms develop changes in velocity, location and symptoms in other areas of the body will present.  These can be more easily worked on before pain symptoms develop.  One recommendation is that evaluation should be done before the start of the season and in high level athletes there should be periodic reassessment during the season (Limpisvasti 2007).

Assessing a pitcher with pain

Assessment of a pitcher with shoulder or elbow pain starts with assessing the painful regions. Diagnosing the pain will in many ways determine the prognosis and whether time off from sport is required. Appropriately diagnosing also influences what conditioning exercises can be done to more rapidly return to sport. and appropriately managing the local joint, tendon or ligament pain and muscular imbalances.

Additionally, a detailed biomechanics evaluation of non painful areas is essential to determining the underlying causes of the problems. These include mobility and strength measures of the shoulder, shoulder blade, spinal mobility, dynamic strength, lower extremity mobility and strength and core strength in order to correct muscle imbalances exercises often start as isolation movements to repattern movements.  However, as with any athletic injury, the exercises need to progress towards functional applications and sport specific conditions.

The Family Physiotherapy Approach

At Family physiotherapy our team of physiotherapists and massage therapists work as a team to find the pain and treat the underlying problems that are preventing you from achieving your athletic goals.  If pain has been interfering with your season or if you noticed arm fatigue, back soreness, leg symptoms or inconsistencies in your pitching then make the call to see one of our therapists to get you back to where you want to be!

 

 

Family Physiotherapy serving the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.

 

References

Chu, Jayabalan, Kibler, Press “The kinetic chain revisited: New concepts on throwing mechanics and injuries” American Academy of Physical Medicine and Rehabilitation 2016

Limpisvasti, ElAttrache, Jobe “Understanding shoulder and elbow injuries in baseball” Journal of the American Academy of Orthopaedic Surgeons 2007

Solomito, Garibay, Woods “Lateral trunk lean in pitchers affects both ball velocity and upper extremity joint moments” American Journal of Sports Medicine 2015

 

 

 

 

 

 

What is Shockwave?

generating-a-pressure-wave-300x188

 

 

 

 

 

 

 

Extracorporeal shockwave therapy (ESWT) uses acoustic pulses to help to improve tissue healing and reduce pain. Pressure waves inside the shockwave unit are generated inside the unit balistically.   Compressed air rapidly speeds up a projectile in the transmitter of the unit.  The projectile is abruptly stopped by hitting the transducer head and the pressure wave is transmitted into the tissue using a water based gel.  Within the target tissue the mechanical energy is converted to chemical energy.

 

How does Shockwave help?

 

The common treatment sites treated by shockwave are the tendons.  In several areas of the body including the hips, knees, ankles, shoulders and elbows, these tendons do not have a good local blood supply.  Over time micro trauma, small injuries without proper healing, can create a situation where the accumulated failed healing can result in pain.  Research has shown that these tendinopathies areas do not respond well to techniques such as cortisone and anti inflammatory medication.  When the target tissue is the tendon research has shown that energy produced by the shockwave unit during a treatment session affects the tendon at the cellular level.  Through a chain of events at the cellular level, there is an increase in production of structural protein of the connective tissue known as collagen.   Circulatory changes also occur resulting in improved blood flow to the area.  This is dependent on the frequency used during the session as well as the intensity of the treatment waves.

 

What can I expect from a shockwave session?

Your physiotherapist will localize the area to be treated using a thorough assessment to determine if it is appropriate for you.  A water based gel is used to conduct the pressure wave into the tissue and is not moved around to the same extent as an ultrasound head.  Once the shockwave treatment has begun you will hear the noise of the projectile striking the transducer at a frequency determined by your therapist to maximize benefits and minimize discomfort.  Since pressure waves are being used there can be mild discomfort that is felt during the treatment session however this is usually temporary.  Your physiotherapist may increase the intensity of the shockwave slightly if the session is being tolerated well but will ask you before this is done.  The shockwave treatment is generally complete after a few minutes after which your physiotherapist will utilize other techniques to address movement or strength imbalances that may have contributed to the pain.  You may notice a slight discomfort or occasional reddening of the areas treated after the shockwave session.  You will be able to return to work and even continue with sports after the session, however for a few conditions you may be asked to refrain from certain aggravating movements.  Most conditions require between 3 to 8 treatment sessions usually spaced five to ten days apart.  There can be immediate changes in pain after the session; however tissue regeneration will take time.

Conditions that can benefit from Shockwave

Studies have shown shockwave to be a beneficial treatment approach for a variety of orthopaedic conditions including:

  • Tennis elbow
  • Calcific tendinitis of the rotator cuff
  • Achilles pain
  • Hip pain
  • Patellar tendinitis
  • Achilles Tendinopathy
  • Muscle pain
  • Myofascial pain and more

For more information or to determine if shockwave is appropriate for your condition talk to one of the physiotherapists at Family Physiotherapy.

 

The physiotherapists at Family Physiotherapy are trained in the safe use of Shockwave for orthopaedic conditions. We serve the areas of Thornhill, Markham, Vaughan and Toronto

 

References

Mani-Babu S., Morrissey D., Waugh C., Screen H., Barton C. “The Effectiveness of Extracorporeal Shock Wave Therapy in Lower Limb Tendinopathy” The American Journal of Sports Medicine 43 2014

Speed, C.  “A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence” British Journal of Sports Medicine 48 2014

Dreisilker, U. “Enthesopathies” Shockwave Therapy in Practice 2010