When is Shoulder Pain not Shoulder Pain

I have been treating a client for the past 2 weeks who came to me be complaining of left shoulder pain. It all started two weeks ago when she lifted a heavy bucket off a table. The client reported that the pain got worse towards the end of the day and was aggravated when she lies on her shoulder. She was also saying the pain was referring into her first 3 fingers in the form of pins and needles and some numbness. The pain was not improving with rest....scalene-muscles-trigger-points

On examination she had pain on moving her shoulder and when she flexed, side bent and rotated her neck to the left.  She also had very tight muscles in her neck, among other positive tests which were all consistent with a neck injury.

In particular her Scalene muscle was very tight and when i pressed on it it caused the same referral pain into her fingers. The Scalene muscles are located in the neck and attaches to the ribs, they assists with breathing and side bending the Neck. As per the image below, evidence shows that tight scalene muscles can refer pain down the arm to the fingers.

My initial treatment involved soft tissue massage to the neck and shoulder muscles, some gentle mobilisation to the neck and shoulder region. I also used Dry Needling on the upper traps and to the scalene muscle, this was all supported with Kinesio taping to the shoulder to help improve posture. I also prescribed some exercises to help improve her posture and strengthen the scalene muscle.

On her 2nd appointment she reported just slight numbness in her index finger, she could now lie on the shoulder and movement was pain free.

I repeated a similar treatment and gave some progressive exercises... She cancelled her 3rd appointment as her symptoms had resolved fully.


Neck Pain and Deep Neck Flexors

Neck Pain and Deep Neck Flexor Exercises, Range of Motion Physical Therapy Clinic Dublin

I see a lot of clients suffering from acute or chronic neck pain. Some of the incidents of acute neck pain are caused by whiplash injuries and more subtle injuries such as lifting objects incorrectly or jarring neck muscles.

Clients who suffer a whiplash injury and do not seek treatment can suffer from Chronic Neck Pain later in life, due to weakness and imbalance of the neck muscles.

Chronic neck pain can also be caused by poor posture, a number of clients suffer from Forward Head Posture (FHP) and Rounded Shoulders. Forward head posture is as a result of the deep neck flexor muscles at the front of your neck becoming tight, while the posterior cervical muscles at the back of the neck are shorten and weakened, causing the head to be pulled forward. Typically this posture is accompanied by rounded shoulders, placing further pull and tightness on the shoulders and upper back (Upper Cross Syndrome).

Deep Neck FlexorWhen treating this type of neck pain it is important to focus on the deep Neck Painneck flexor muscles (DNF); include the longus capitus and colli, while also looking to release the sternocleidomastoid with the posterior cervical muscles.

In order to ensure muscle balance between the anterior and posterior aspect of the neck it is important to have sufficient motor control of the two groups of muscles.

These two exercises have been identified as the best early stage exercises to help recruit and strengthen the DNF while also helping to lengthen the posterior cervicals.

Chin TuckExercise 1: Chin TuckChin Tuck for Neck Pain

This exercises is best started lying down with your knees bent up.
In order to complete the exercise simply draw your chin down towards the floor, causing a slight nod of the head.
Hold for 5 – 10 secs and repeat 5 – 10 times, twice a day.

Head liftExercise 2: Head liftNeck Exercise

This exercise is a slight progression from the chin tuck.
In the same starting position, simply lift your head of the floor 3-4″
Hold for a couple of seconds and repeat 10 times
Both these exercise help build strength and endurance and enable you to switch on and gain control of the muscle groups. These exercises would also be accompanied by some shoulder exercises, such as scapula pinches to assist with the stabilisation of the neck.

These exercises should be performed pain free, if they cause any pain stop the exercise and contact a Range of Motion Physical Therapy Lucan Dublin for further assistance.

 


running marathon

Marathon Running Injury

Running Injuries at Range of Motion Physical Therapy Dublin 

So I am finally catching up with myself after a very busy October, I reckon I did over 30 sports massages in the two weeks leading up to the marathon. Again well done to all of those who completed the marathon and some great times.

I am especially happy with one particularly client who came to me from the local running club. I had seen her with about 5 weeks to go before the marathon for a sports massage and her training was going well for her, building it steady. I received a call from her the following week, she was in a distressed state having injured her lower leg during a training session.

Tibialis AnteriorDuring the assessment it was obvious she had strained her Tibialis Anterior Muscle (Muscle running down the Shin), she reluctantly admitted to trying to do some bare foot running during one of her training runs… Thankfully she has learnt the golden rule when training for a marathon, do not change anything in the final phase of your training plan, be it your foot wear or technique.

In terms of helping her recover from her injury we were under a bit of time pressure, or should I say I was…. Initially it was important for me to manage my clients stress levels and expectations, what is done is done. My first goal was to ensure she stops her long runs and understands that she now needs to focus on resolving her injury.

The simple protocol we followed was initial Rest and Ice with gentle stretching of the muscles of the shin, this was done by having her kneel on the floor with her feet pointing behind her while she sat back on her feet.

Over the cousre of a week the swelling and pain eased so we introduced some thera-band exercises, adding some resisted ankle dorsi-flexion to strengthen the muscle. This was monitored daily and as her pain decreased further we started a walk – run program to prepare her injured muscle to getting back to running.

After approximately 2 half weeks of the walk run program she was back running for 30 minutes slow and easy and feeling much more confident of her chances of making the marathon. On the final days leading up the marathon there was no pain or swelling, we decided she would start the marathon and see how it goes. However if she feels any pain she was to pull up for fear of creating a more serious injury.

I was delighted to hear that her injury held up for the entire marathon and she completed the race without having to stop. I think she has learnt some really good lessons and gained some great experience and is looking forward to her next marathon.

Please contact Range of Motion Physical Therapy Dublin for some great advice on how to manage running injuries or if you are just looking for so on going maintenance sports massages.

 


gluteal muscles

Best Exercises to Strengthen and Stabilise the Glute Muscles

Strengthening Exercises for the Glute Muscles Range of Motion Physical Therapy Dublin

The group of gluteal muscles are made up of the Glute Maximus, Glute Medius and Glute Minimus, collectively these group of muscles Abduct, Extend, Internally & Externally Rotate the hip. The glutes also assist with some additional movements e.g. Trunk Extension, hip flexion in conjunction with the hip flexor, to name a few.

There are also a deeper set of muscles under the larger gluteals, the hip rotators. The hip rotators can also be referred to as the hip stabilisers (like the rotator cuff of the shoulder), the larger gluteal muscles work to move the hip while the smaller hip rotator group help to stabilise the hip during movement.

glumin

One of the main functions of the gluteal muscles is to stabilise the hip as we walk, run and climb stairs. This is done by contracting the gluteal muscles on our stance leg, which works against gravity and maintains a level pelvis, as the opposite leg swings forward.

In the case of someone with weak or misfiring glutes, they may have a trendelemburg gait, or waddle as they walk. This is normally more prevalent in elderly people who have to hike their hip up as they walk to ensure they do not trip or stumble.

weak glutes

Any weakness, muscle imbalance or inhibition of the gluteal muscles can cause a number of additional acute or chronic issues:

  • Hamstring Strain – glute maximus work in conjunction with hamstrings to extend the hip, any imbalance can lead to over loading the hamstrings
  • Low Back Pain – glute maximus works with low back extensors when lifting, any misfiring of the glutes can over load the low back extensors
  • Anterior Hip or Knee Pain – weak glutes can cause increased internal rotation of the leg causing a patella tracking problem. While also causing additional hip wear and tear during hip extension.
  • Lower Body Misalignment – As above weak glutes can cause increased internal rotation of the leg leading to ankle pronation and knee valgus.

By activating the gluteal muscles and strengthening them it will help to correct the muscle firing patterns and enhance the strength and performance of the group of muscles.

The following exercises have been found during EMG studies to be the best all round exercises to isolate and strengthen the gluteal muscles.

Based on EMG studies the following exercises worked the individual glute muscles as below:

Glute Medius:                                                    Glute Maximus:

  • Side Plank                                           Single Leg Deadlift
  • Unilateral Bridge                               Single Leg Squat
  • Lateral Step Up                                 Front Plank with Hip Extension
  • Superman                                           Superman
  • Side lying Hip Abduction

Of the studies the 3 best all round exercises for the Glute Maximus & Medius are:

Front Plank with Hip Extension: try to build up the time you can hold this position, maybe start with 10 sec in front plank, extend left hip for 5 secs and repeat with the right.

Front Plank with Hip Ext

Side Plank with Hip Abduction: try to build up the time you can hold this position, maybe start with 10 sec in side plank, as you get better abduct left hip for 5 secs and repeat with the right side.

Side Plank with Hip Abduction

And finally a single leg squat, there are a number of ways to do this exercise depending on your ability and injury. While performing this exercise it is important to ensure you are activating (turning on) your glute muscles.

glute exercise

I instruct clients to do this exercise on the last step of the stairs and once they have mastered activating their glute muscles and they are squatting correctly they can work their way into a deeper squat.

There are a number of glute strengthening exercises that can be done, those above maybe to difficult for you to start with. I have included some easier glute activation exercises in the video above and progress to the more advanced exercises.

If you are suffering from Knee Pain, Hip Pain or Low back pain, please contact me for a consultation and treatment at Range of Motion Physical Therapy Dublin.