The phrase “shoulder impingement” is often used as an umbrella term for many different types of shoulder pain. It refers to the irritation or trapping of varying structures - musculotendonous or bursal in between the top of the humerus (arm bone) and beneath the tip of the acromion (edge of the shoulder blade. ) Its quite difficult to determine this type of pain from early frozen shoulder or even pain referred from the neck.
While you can consider visiting a physiotherapy clinic for proper diagnosis, there’s no harm asking yourself some questions to see wether you really have shoulder impingement. Here are the three simple questions you can ask yourself to clarify the matter
Any numbness/pins and needles or shooting pain to the hand?
Weird symptoms like tingling (pins and needles), shooting electrical pains to the hand and numbness rarely come from shoulder impingement. These symptoms could come from the neck or an area such as the thoracic outlet and need further investigation.
Does the pain wake me up at around 2am?
Bizarrely whilst many shoulder issues are painful to sleep on, rotator cuff tendonitis seems to consistently wake patients up at around 2am. If you’re not waking up it doesn’t meant that you don’t have impingement, but if you are it may indicate that you do!
The Arc Test
This is a simple test where the arm needs to first be in a relaxed position. Now start moving it outwards toward your head in an arc. You will need to check the angle at which you experience the pain. For instance, if you feel the pain in the mid-range which is from 60degrees to 135degrees but not before and not after, you may well have shoulder impingement.
One of the best ways to deal with shoulder impingement is by utilising a through physiotherapy assessment and treatment. Medications to reduce inflammation (NSAID’s) or injection therapy to reduced inflammation (steroids) or provoke healing (PRP) can be of use. However, correcting your mechanics and dealing with restrictions within the soft tissues and joints whilst increasing strength and stability have been found to be just as good as surgery and with a fraction of the risk and pain. Furthermore repeated use of corticoseteroids into the shoulder have been shown to reduce the strength of the tendon and increase risk of further tears.
Whilst there are occasions for surgery, a recent study actually showed that surgical decompression for shoulder impingement was no better than a sham/placebo surgery. Think carefully before going under the knife and remember….you are not your MRI!
via Integrative Physio Pte Ltd
In the first part of this article series, we looked at some off-beat remedies for treating back pain. Although visits to your physiotherapy clinic may still be required for diagnosing and managing acute injuries or chronic pain conditions, you can use some alternative treatments methods simultaneously. Here are some more unusual yet effective ways to deal with neck pain.
1. Eat Well
There is growing opinion and research to suggest that a number of nutrients are involved in pain relating to neuromusculoskeletal system. Vitamin D for joints and pain in general, magnesium for muscle, nerve and bone health and B vitamins for energy production in general and neurological health are key in the full functioning of the systems that support you on a day to day basis.
2. Perform aqua exercises
Getting into the pool is possibly one of the most fun ways of managing your back pain. Consider a mild swim session once a week. Perform a few squats and free hand exercises as you stand bust-deep in water. Water provides a controlled resistance to your movements, reduces joint compression through buoyancy thus safely working wonders for aches and pains.
3. Apply ice and heat
Both warm compress and ice packs can work wonders for your neck pain. If it is a muscle sprain or spasm, consider using a heat pad. Ice pack is best suited for acute injuries (the first 12 hours). They can be applied for 20mins every two hours. You can seek further advice on this from a specialist in your nearby physiotherapy clinic.
4. Don’t sit straight - move
A large and growing body of evidence is attempting to fight popular opinion (since Victorian times) that sitting straight is best. The evidence suggests that no posture is better than any other when it comes to static/repetitive low loads. More likely, the suggestion is that movement is best. After all we were made to move, not to sit, nor stand still, no matter the position, for any length of time. The key to life and pain free living, perhaps, is variation.
via Integrative Physio Pte Ltd
Neck pain is both very common and fairly scary. Patients often rush to their doctor for scans to get to try and seek the answer to their pain but this often proves disturbing and unhelpful in equal measure. Often, neck pain is caused by poor posture, lack of movement or poor movement patterns that are occurring both in the neck and the rest of the body. Other common causes include sudden injury from an accident, degenerative disorders, spinal infection, and even stress or emotional tension. Most cases of neck pain do not require a surgical treatment. Self-help measures or home treatments help deal with most cases of neck pain. For more serious neck problems, you can visit a physiotherapy clinic or try other non-surgical treatment options.
If you have acute, short-term neck pain, you can use over-the-counter pain relievers or seek medical attention. Some common types of drugs that work well for neck pain include anti-inflammatory drugs, muscle relaxants and even opioids.
You may also be advised to use cervical collars to help support the neck and restrict extreme neck movements for a short period. Make sure you do not use it for more than one or two days. Long-term use of soft collars has not shown to be of benefit and may even worsen a neck condition by causing weakening of the surrounding muscles that support the neck.
Physical Therapy (Physiotherapy)
Combining manual therapy with exercise is one of the most effective treatments of neck pain. Manual therapy includes targeted soft tissue release (various types of specific massage), mobilisation of the joints and manipulation. If done correctly, this type of treatment helps release tension and muscle stiffness naturally. However, it is very important to undergo any kind of manual therapy under the guidance of an expert such as a Physiotherapist or Osteopath. chiropractor or osteopathic doctor. Physical therapy (physiotherapy) can resolve most cases of neck pain within three to six weeks. You practitioner will also ask you to continue doing some stretching and strengthening exercises at home to help prevent any possible relapse.
It will be important to seek a physiotherapist that looks for root cause of your condition, be it postural, your movement patterns or restrictions within your shoulders, mid back or even further afield to help solve the route of your problem. More research is now showing that is almost important to get the root of the problem with an MRI!
This treatment method works by inserting a number of fine needles in different parts of the body. That way, they try to restrict the pain singles from reaching the brain. According to acupuncture experts, neck pain or any kind of pain occurs when the natural energy flow or “Qi” of your body gets obstructed. Acupuncture treatment helps to unblock the Qi flow through needling and thus helps restore natural movements of the neck. Make sure you receive any kind of acupuncture treatment from an expert in the field.
Dry needling is another technique often utilised my physiotherapists, osteopaths and medical doctors to resolve pain and reduce spasm, restoring muscle length. It uses the same type of needles as used in acupuncture but in this case the needles are briefly inserted into areas bands of tension causing a “twitch response”. This response causes a relaxation of the tissue and the brief injury to the tissue via the needle helps accelerate the healing process.
In summary there are a large range of treatments available for neck pain. Most of the time neck and back pain can not be adequately explained with an x-ray or MRI and does NOT require surgical intervention and can be resolved with physiotherapy or “conservative” management. The key is early assessment by a qualified practitioner to rule out any serious conditions and identify the route cause of your problem followed by appropriate manual therapy, exercise prescription and potentially adjuncts such as dry needling or acupuncture.
via Integrative Physio Pte Ltd
It is estimated that by 2030, chronic pain will affect 20% of the population in Singapore. Musculoskeletal pain such as neck, back and shoulder pain are highly prevalent. Chronic pain can give rise to other complications like fatigue, restlessness, and mood swings, decreased productivity at work and low mood. Thankfully, physiotherapy, among other treatment options, can help cure the problem from within. Here’s how you can deal with your chronic pain.
Start tracking the pain
Keep a record of your daytime activity, tracking every detail. Mark pain suffered from certain activities on a scale of 0-10. You will be able to see patterns after a week or so. If it is the sedentary nature of your job that is causing the pain, simply change your chair or adjustingyour desk height may be a good start. Sometimes you may even notice changes in pain with certain foods so a food diary may also benefit. A functional medicine practitioner or nutritionist will help guide you with this.
Engage in physical activity
It might sound counteractive, but staying physically active is necessary to fight chronic pain. The body's natural reaction to pain is to protect the concerned part from further strain. If you experience acute pain, you should rest and consult a healthcare professional. However, if you have chronic pain, you may be advised to engage in light physical activity. Go cycling, swim, walk, or get physiotherapy.
Keep the body hydrated
Dehydration is proved to aggravate conditions like back pain and headache. Drink 2-3 litres of water every day and always carry a water bottle with you. Now days water is potentially contaminated with synthetic hormones, heavy metals amongst other toxins. Get yourself a water trusted filter to help avoid this. A functional medicine practitioner can help guide you in this process.
Whilst self management is the aim. A physiotherapist can help to diagnose in structural pathology and also seek the underlying causes of your pain. Choose a practitioner that provides holistic treatment, seeks imbalances and utilises a wide range of techniques including dry needling, manual therapy. A practitioner that understands nutrition and systemic causes of pain is also of real value.
Don't force yourself
Those with chronic pain often have a tendency to get carried away and push through the pain. It might come off momentarily, but it could get even worse the next morning. The focus, instead, should be on time, and not task. Pacing is a technique where you can accomplish all your tasks by knowing how long you can go without experiencing pain. It is not a case of no pain no gain. Work within pain free limits to help “desensitise your brain to movement”.
Dos and Don'ts of eating
Processed food and refined sugar must be avoided, they trigger inflammation. Diets that are easy to digest can help reduce inflammation. These include leafy greens, low-sugar fruits, soy products, and foods rich in omega-3 fatty acids. Turmeric is an excellent anti-inflammatory ingredient which is also good for ligament flexibility. Foods bad for inflammation include dairy, eggs, chocolate, nightshade vegetables, and red wine. Magnesium in leafy greens is great for muscle relaxation amongst hundreds of other chemical reactions in the body and many of us are deficient without knowing.
Watch your posture
You needn't be an expert at Yoga or a member of the armed forces to have a healthy spine. This can be done by simply maintaining good posture while watching TV or working at the computer. Remember posture is the average orientation of body parts over time. This means you don’t have to sit straight ALL the time but on average you want to be in neutral. Basically “your next posture is your best posture” - in other words, keep moving! Set a challenge, move every 20mins - this is a key physiological time.
Stress does many things. It actually changes our hormone production pushing us more towards cortisol and reduces our sex hormone production. This causes all sorts of effects including increasing inflammation, increasing pain sensitivity but also reducing drive (for sex and for work), increasing weight gain around the middle and even effecting hair loss. There are many ways of managing this as we will go through in subsequent articles, but scheduling time out and even simple breathing exercises can make a real difference.
via Integrative Physio Pte Ltd
Integrative healtcare clinic that combines multiple disciplines to transform patients health. We combine multiple specialties to treat injuries, reduce pain and restore function. We seek the root cause of pain and healthcare conditions in order to promote the bodies own healing responses, restoring balance from the inside out.