It’s not very humerus!

Causes

Most people are going to have shoulder pain at some point in life. Whether you’ve lifted a bit too much weight at the gym, tweaked them playing sport or the weight of the world is weighing on them, shoulder pain can be a pretty nasty time. In this instance, I’m going to explain a common cause of shoulder pain; rotator cuff-related pain.

Shoulder Anatomy

To dig into the shoulder I first want to discuss the anatomy of the shoulder a little bit. The shoulder is a Ball and Socket Joint, which means that it consists of a bone end with a ball and a bone end with a socket. However, unlike the other major ball and socket joint (The Hip), the shoulder joint has a very shallow socket. This is because the shoulder needs to have increased mobility so that we can use our arms for a variety of tasks, unlike the Hip joint with its primary role of facilitating gait.

When you lift up your arm, only about 90 degrees of motion is due to your humerus moving in your shoulder socket. The rest of the motion occurs in tandem with movement of the shoulder blade (or scapula) over the ribcage. The muscles that control this movement of the scapula are grouped together and named “The Rotator Cuff”.

The tendons of the Rotator cuff muscles run underneath the acromion bone of the shoulder and above the head of the humerus in an area called the ‘Sub acromial space’. In general, most of the tissues in this area are implicated in shoulder pain, whether it be a bursa (fluid filled sac), bone, or the tendons themselves. However, even with imaging such as x-rays or MRI, it is difficult to ascertain which structures are causing the pain. Because of this, any shoulder pain without any traumatic mechanism or non-musculoskeletal cause is described as sub-acromial pain or rotator cuff pain syndrome.

Treatment

The treatment for this type of pain is relatively simple; reduce irritating activities and increase strength of the surrounding musculature.

When I talk about reducing irritating activities some patients take this to mean I want them to stop using the shoulder entirely to let it heal, but this isn’t the case at all! It’s important to continue your daily activities as best you can, as long as it only causes mild pain that settles quickly. This helps keep the shoulder moving so that it doesn’t lose any strength or movement, but also stops you provoking your shoulder.

Strengthening will often consist of exercises involving both the major muscles surrounding the shoulder (Trapezius, Deltoid), the rotator cuff muscles, and the muscles that provide stability of the scapula. A good strengthening programme will generally progress in difficulty as your pain reduces, so that the healing tissues are constantly challenged as your pain and function improve.

If you’re experiencing shoulder pain, contact one of our physios for more information and assistance in removing your pain.

Is Pilates just the latest fitness craze? Or is it here for the long term? What are its benefits and can it be the right fit for me? Time to answer your questions!  Pilates is now a well-established fitness and rehabilitation option that many people enjoy and benefit from.

As physiotherapists we have long used Pilates principles as a base for exercise therapy when treating our patients, especially in regards to injury prevention. The style of Pilates we offer at Ponsonby Physio is referred to as Clinical Pilates. It is a key component of our wellness pathway in helping patients get back to performing at their best, then maintaining strength and mobility ongoing.

When you join a Pilates session with us we start out one-on-one; it’s you and your physiotherapist. Individualised exercises are prescribed and these focus on correct alignment, muscle activation, balance, strength and stability particularly around the pelvis and spine; and overall movement. So no matter what your starting point, you’re in the ideal environment to gain the best results for you.

Tell me more about Pilates!

Back in the early 1900s, Joseph Pilates developed 34 traditional Pilates exercises designed for fit and healthy athletes, originally ballerinas. They required good baseline strength, flexibility and balance. However, Joseph’s passion for movement, strength and stability started well before this, with himself. As a child he suffered from rickets, asthma and rheumatic fever. He used yoga, meditation and exercise regimes based on the Greeks to become physically stronger to help heal himself.

Later in life, working as an orderly in an English hospital through WW1, he was appalled to see patients wasting away in bed. He created a gentle exercise programme for them to counter this. When it became apparent that Joseph’s patients were healing faster than others, doctors gave him permission to incorporate the use of resistance using springs from old hospital beds to further these exercise regimes.

Fast forward to the 21^st century, there have been many changes and modifications to Pilates over the years but the core principles remain the same. Clinical Pilates works by retraining local muscle groups, strengthening global muscles throughout the body, and then incorporating synergy between both these muscle systems.

Passionate about results

Our team of physio’s are certified with the Australian Physiotherapy & Pilates Institute (APPI). Exercises are based on a combination of traditional Pilates and the latest research findings for training lumbopelvic stability specific to the rehabilitation population. The APPI method has been designed by physiotherapists, breaking down the traditional exercises into levels and modifying them to be suitable for our clinical population.

We are passionate about using Pilates as one of our main exercise therapy rehab tools. We believe it’s effective and appropriate as the exercises can be easily modified to tailor and suit almost every person in the rehabilitation of all injuries. And ongoing benefits in maintaining your fitness and muscle strength are clear. That gets us pretty excited and we’d love to share this with you!

We have Pilates sessions, led by our physiotherapists, offered in Mat and Reformer as one-on-one sessions, or in a small group class.

If you are interested in preventing injury and staying strong. If you’re struggling with ongoing neck & back pain. Or you simply want to stay on top of your game supporting your mobility and flexibility. Then we recommend giving our Clinical Pilates programme a try. Contact us at the clinic to start.

Knee and hip arthritis are common conditions we see at the clinic, occurring as a result of thinning or loss of cartilage in the joint over a period of time.

Even though an x-ray is the most reliable way to get a diagnosis, osteoarthritis diagnosis is primarily determined by the symptoms you feel, such as:

• • Pain
  • Swelling
  • Stiffness – especially in the morning or after periods of inactivity
  • Feeling unstable
  • Clicking / grinding

Why am I getting pain?

As we age, our joints change. This, along with our hair going grey and skin getting wrinkles, is a normal and natural part of aging that we cannot reverse. Osteoarthritis has been previously referred to as a “degeneration condition”, however today as new research and evidence emerges, this terminology is changing to “normal age-related changes”.

If we take x-rays of 100 knees in people over 40, we will find arthritic changes in a majority of the population, however, many of these people will not experience any sort of pain. Conversely where some people experience a lot of pain and stiffness, their x-ray results may show only minor arthritic changes. What causes pain in some people and not others is when the joint itself gets sensitised or irritated.

This is why a diagnosis of arthritis is typically not made from the x-ray alone, but in combination with the symptoms that present.

There are many reasons why a joint gets irritated and causes pain. Most commonly either doing too much activity too soon, or not doing enough at all. Other factors that can have an influence include stress and worry about our injuries and conditions, having a poor night’s sleep, or even it just being in our genetics and chemical make-up to experience pain more or less intensely than someone else.

X-ray results and structural changes at the joint are just one piece in the puzzle of what creates pain in arthritis. And while we are unable to reverse the x-ray imaging, what we can do is focus on the pieces of arthritis and the presenting pain, which we can impact positively.

The benefits of exercise with osteoarthritis

Physical activity is so important in not only the prevention of osteoarthritis but as a way to manage symptoms. Gone are the days where we use the term ‘wear and tear,’ which creates the idea that if you use your body by exercising and being physically active, that eventually it will be overused and breakdown.

Just like muscles, bones, and ligaments, which adapt and get stronger when we use and load them, it is becoming clearer that joints work in the same way, by responding well and getting stronger when we exercise over time.

There has been a huge amount of research into looking at the safety and effectiveness of exercising, particularly with knee and hip arthritis. They show that not only is it safe and doesn’t cause damage, but also that pain can be reduced massively as joints and muscles adapt and get stronger, creating a desensitising effect!  Exercise is essential if your goal is to avoid surgery for as long as possible. While it may cause some discomfort, especially at the beginning, it’s really important to understand that you are not causing damage to your knee.

The first-line treatment for symptomatic knee osteoarthritis includes education around the condition and physical activity. To continue to be active is not only good for the general benefits of exercise and positive impacts on joint health and pain, but to be able to continue living and doing what makes you happy.

What kind of exercise is best?

The best kind of activity that you can do to help your arthritis, is the activity that you enjoy the most! It’s also really important to gradually increase exercise over time, rather than overdoing it straight away. This reduces the chance of a big flare-up.

There are plenty of different types of exercise, so here are some ideas that can be put together into a programme:

Aerobic Activity:  Getting your heart rate up! A few examples include walking, cycling, or rowing. At a minimum, a simple walking programme alone can have a positive effect on arthritic knees, as it stimulates the production of our natural anti-inflammatories, which as a result reduces pain.

Resistance Activity:  Building strength through resistance exercise improves function and reduces pain. The resistance used could be weights, resistance bands, or even your own body weight. Floor and reformer Pilates is an amazing way to build strength and improve the function of grumpy knees and hips (here’s a link to great our Pilates programme at the clinic!)

Balance Activity:  Balance is often a forgotten component of an exercise programme for arthritis. Just like a muscle, we can train our balance skills to adapt and improve them. Our balance abilities reduce as we get older, increasing our risk of falling and getting hurt. Training balance also improves our sense of joint stability, which has a positive impact on joint health.

Your physiotherapist is ideally placed to work with you and create the right programme for your specific requirements.

I love running.

It’s my favourite activity, my favourite sport to watch and way to relax, all rolled into one. It’s also one of the largest sports in the world. Around 1.1 million people participated in a marathon in 2018, and even a small kiwi event like Auckland’s ‘Round the Bays’ attracts over 30,000 people. Unfortunately, when I talk to friends or colleagues, generally they’ll fall into one of two camps…

They either love running, or they despise it.

And that’s a shame because I think running is something anyone can do. You don’t need to be especially coordinated, you can do it anywhere and there’s no membership fees!

So whether you’re thinking about smashing out your first marathon, or just want to lose a bit of weight before summer hits, here are a few tips to help prepare you to hit the pavement.

Be patient

My first piece of advice sounds simple but is often ignored.

Build your mileage SLOWLY.

The general rule of thumb when increasing the distance you run each week is to increase by about 10% per week. Initially this means that each week you are only increasing the total distance run by a very small margin, which sometimes will equate to only increasing by 1-2km per week. This can of course be very frustrating for people that want to quickly increase the amount that they are running.

The reason for this rule however, is that when you run, the amount of force going through your legs is roughly 2-3 times your own body weight. So, if you are only just getting into running or if you’re used to running much smaller distances, and you then suddenly increase the amount you run each week, there is a high risk of becoming injured as your body likely won’t be well adapted to absorbing this level of force for longer periods.

Slow and steady wins the race

Arthur Lydiard was an Auckland born running coach who coached both Peter Snell and Murray Halberg to Olympic gold in the 1960’s. His style of running training is very highly regarded. Arthur was adamant that during the base phase of a runner’s training (where you’re slowly increasing the length of your runs) you should be doing lots of long slow runs, and then gradually increase the amount of short intense running sessions as you get closer to your event.

The thing I want to emphasise here is the word SLOW. If you do every single one of your runs at a fast pace, including your long ones, you aren’t going to have a lot of time to recover between workouts. This can lead to reduced performance as well as sickness and injuries.

Basically, a few times a week you should be running slow and relaxed, and a few times a week you should be running faster and harder.

Get some jazzy sneakers

You probably need some new shoes. Every single time I chat to a patient or a buddy about their running shoes, I generally hear that they’ve had the same pair for about 5 or 6 years and the soles of the shoes are so worn down that they can feel the tarmac under their toes.

Whenever you land onto one leg during a run (what we call ‘stance phase’ in the physiology world) you are applying a force to the ground. This force is then reabsorbed back up your leg into your tendons, muscles, bones, and YOUR SHOES. If your body isn’t used to absorbing this impact (which it won’t be if you’ve just started running), it can predispose you to an injury such as a stress fracture. So having a good pair of shoes can help reduce the amount of force that your body endures.

Pick an event

Goals are important. Even if you’ve started running with your main goal to lose weight and improve your health, picking an event with a set distance to train for can help motivate you. It also forces you to constantly build your training load to complete your event, and this gradual increase in intensity and mileage will lead to better health benefits than just doing the same route at the same pace repeatedly.

Get a buddy

Let’s face it, it’s way easier to commit to an event or activity when a friend is involved. Having a pal to keep you honest can help keep you on track with your training and fitness goals. This might mean grabbing a few workmates to run an event for charity or just jogging each morning with your partner.

Another good option is joining a running club. Older clubs like the Auckland Joggers Club and YMCA Marathon Club have large numbers of experienced members and regular training sessions to get amongst. I’d be remiss if I didn’t mention the Whippets, a quickly growing club with a welcoming culture, that organises RACE09; a metropolitan, orienteering style road race.

Overall, if you’re going to take one thing from this article, it should be to exercise patience. Start running slowly at small distances and build from there, making sure you have more than enough time before your chosen goal. There’s obviously a lot more to running than I’ve outlined here, so if you have any questions about which shoes to pick, which events are beginner friendly, or even if you just wanna get excited about running with me, come on down to the clinic and we can chat.