Frozen Shoulder
If you have been diagnosed with ‘Frozen Shoulder’ (or Adhesive Capsulitis), you will be suffering from some pain in or around the shoulder joint. Your movement will be limited but not necessarily ‘Frozen’.
With Frozen Shoulder, the problem develops gradually and over time movement becomes increasingly limited. But don’t get disheartened, Frozen Shoulder is very treatable. It is important to get help sooner rather than later. If left too late, surgery may be the only solution, which is generally very effective but both expensive and invasive.
Treatment
In our clinic, your arm and shoulder joint will be brought through a range of tests which assess the quality of movement, strength and nerve function. With shoulder problems there is usually a muscle imbalance between sets of muscles which should work in harmony together around the ‘rotator cuff’ (all the muscles surrounding the shoulder joint as in the picture here).
Techniques
Associated muscles tighten and may develop ‘trigger points’ (sore painful areas which refer pain elsewhere like down the arm or up into your ear or head) and other muscles become weak. We address the trigger points in order to relieve tension and increase movement and work on strengthening the weak muscles. We use techniques such as ‘skin rolling’ and ‘myofascial release’ which help separate the different layers of muscle to create more movement and release the pressure on the shoulder joint itself.
Time
This process does take time and plenty of home exercises. You will need to set aside a certain amount of time each day in order to rehabilitate your shoulder correctly (this is where a bit of dedication is needed!). I often get asked how long will it take, and really there is no set answer. It depends on how long you have had the problem. It also helps to know (if possible) how the problem developed in the first place. Very often it could be what we call a ‘slow burner’ developing from bad posture habits, or the result of a knock which may have gone unnoticed.
The important thing is to keep your shoulder, arm and neck moving as much as possible, but the movement must be pain free. If you force your shoulder to move, you risk further injury. Please get professional help as injuries like these, if not treated properly can recur, which is a real pain in the…shoulder!
Exercises
Have a go at a couple of these simple exercises, remember to go only as far as comfortable without pain.
Wall Crawl
- Stand about a foot away from a wall (facing the wall).
- Slowly using your fingers, crawl up the wall as far as is comfortable.
- Hold this position for 5 seconds.
- Take a deep breath in and as you breathe out, try and crawl up a small bit further. Hold this position for a further 10 seconds.
- Come back down again slowly.
- Repeat this a couple of times periodically throughout the day. I like to use a post-it to measure the distance (also a great way to see your daily improvement).
- You can then change the angle of your body to activate different arm muscles. So for example turn your feet 20 degrees to the right or to the left and crawl back up the wall as before.
Pendulums
Pendulums are great as they don’t require a huge amount of effort. They encourage the shoulder muscles to relax and release pent-up tension in the joint.
- Lean forward slightly (keeping your back straight and feet hip width apart), putting your good arm against something (like a kitchen table) for support.
- Let your bad arm hang and make small clockwise circles as if your arm was a pendulum.
- Change direction and repeat circles. Try to increase the circle size slowly as you build up momentum, but don’t overdo it!
You can book an appointment with us here if you’d like us to assess your shoulder.
Broken or sprained wrist?
A common question I get in the clinic is “how do I know if my wrist is just sprained or actually broken?” If you have fallen and are unsure about what to do (and think “Ah it’ll be ok after a while”), my advice is put an ice pack on your wrist, go to the A&E and get an X-Ray. Untreated broken or fractured bones can be serious.
Wrist break or fracture
Fracture of the Scaphoid bone
The most common bones broken are the wrist end of the radius, the scaphoid (a small bone in your wrist which can be fractured by falling on an outstretched hand usually causing pain at the base of your thumb), and less commonly the ulna (the smaller bone beside the radius).
Your wrist may be broken if:
- You see deformity
- You have immediate persistent pain without movement
- You cannot move, or it is extremely painful to move your wrist
- You hear grinding or grating if you move your wrist
- You have numbness in your fingers (which is a sign of nerve damage)
- You have difficulty gripping small light objects
If you suspect you’ve been in pain for an unusually long time, yet all the X-rays were clear, you may have a hairline fracture. You should return to your doctor, as a hairline fracture should be immobilised (an MRI may be needed to show up a hairline fracture) until the bone has healed.
Wrist sprain
Ligaments of the wrist
A wrist sprain can also be very painful. If you fall on an outstretched hand, you risk tearing one or more of the many ligaments in your wrist. Sprains are graded from mild (where you have small “micro” tears and swelling) to severe (total tear of wrist ligaments).
Symptoms include:
- Pain with movement
- Tender to touch
- Bruising
- Burning or tingling around the wrist
- Dull deep ache
- Decreased range of motion and stiffness
- Joint instability (increased range of motion which indicates a bad sprain and total tear of wrist ligaments)
Following a wrist break, fracture or sprain it is important to get appropriate treatment. You should be encouraged to do specific mobility exercises to reduce stiffness in the joint and help regain good range of motion. Strength exercises should then follow to bring your wrist back to normal and help reduce risk of re-injury.
Walking on ice?
I see we’re due a very cold spell this coming week. Icy frosty mornings and perhaps even some snow. This is a difficult time for many, especially the elderly. Here are a few tips for coping with the ice.
Getting out and about
Needless to say wrap up warm.
Ice grips - available in Great Outdoors
Correct footwear is most important. Wear shoes with plenty of grip on the soles. They may not help in really compacted smooth ice, but are good elsewhere. For the smooth ice, you might consider getting a pair of ice grips which you attach to your shoes (see end of article for details). A cheaper alternative is putting a pair of socks on over your shoes. The socks will offer some traction.
Look out for black ice – usually early morning in areas shaded from the sun.
Walking technique
- Put your feet straight down on the ice and lift them straight up, in other words walk flat-footed, but with your knees slightly bent.
- You increase traction with your feet ever so slightly turned out.
- Don’t kick or spring off your toes as in normal walking, you risk slipping.
- Take small steps, shuffle along and lean slightly forward. It may look silly but you’ll get a lot further.
- Keep both hands free, they will help balance you.
- Don’t carry heavy loads as they will upset your balance. If you have a small load, distribute the weight evenly.
- If you’re about to fall, try to ‘tuck and roll’; tuck your chin towards your chest, try to relax your body (hard I know!) and roll into the fall. Avoid breaking the fall with your arms as you risk sprain/fracture. If your body is relaxed enough and your head protected, you should be fine and escape with just a few bruises.
- If you do manage to fall and feel you’ve broken or sprained something, get to the A+E for help. For mild pain and bruises…yes apply ice! or better still R.I.C.E. (Rest, Ice, Compression and Elevation to the injured area). This will help keep the swelling down. Arnica (available in pharmacies) is great for bruises.
And if you could…
Take a look out for your elderly neighbours. They might appreciate a look-in and an offer of help to get shopping or clearing paths around their house.
You can buy a pair of ice-grips online at:
Great Outdoors, (from €24.99 + €7 extra for delivery)
Yaktrax in UK (from £15.99 + about £8-10 shipping)
Amazon.co.uk (read the reviews as some types are better than others).
Are you sitting right?
There is quite a bit of debate on how to sit right at your computer or work station. You’ll see many a diagram with 90 degree angles, foot and wrist rests and beautifully straight necks. I know…I have one such diagram on our website! (here on the right)
In reality, despite all good intentions we sit nothing like this. We end up slumping in the chair and poking the chin forward and all this is natural and easy on the body. Over time however it becomes too much and we start to ache. It’s just not natural to sit in the one position for a long time.
I alternate every few days between three ‘chairs’; a regular office chair, a ‘kneeler’ and a fit ball. I don’t imagine anyone reading this has all these items, so apart from getting all the ergonomics right with your own work station (as per diagram or see link below), there are a few extra things we can do to help eliminate pain;
- Alter your sitting position regularly (no matter what your chair is like) and keep moving
- Bring half a cup of coffee back to your work station, it will make you get up and go for the other half soon after!
- If you can’t tilt your seat forward, get one of those cheap wedges in Lidl for about €8 (Murray’s in Talbot St have plush ones for €50 or go to Physio Needs for plush but cheaper!). The wedges are great as they distribute the weight off your ‘sit’ bones and help keep that curve in your lower back.
- If your chair lacks lumbar support just roll up a jumper and put it behind your back. If you find this helps, only then go out an buy a nice one.
- Try a few simple stretches periodically such as sitting in your chair, feet firmly on the ground, look over your shoulder as far as you can. Grab on to the back of the chair with your arms and you’ll go further. Clasp your hands behind your chair and squeeze. This is great for stretching out your chest muscles.
- Cold fingers = bad blood circulation (or the heating’s off!). Your fingers and most likely your forearms are reaching ‘up’ to type. Position your keyboard slightly below elbow level so the blood flows downwards. It will be a lot more comfortable also.
If you’d like further information on ergonomics I’ve a list of guidelines here.
Welcome!
Finally…I’m blogging! Having set up a Twitter account last month and realised I wanted to say more than the 140 characters Twitter will allow me, especially in relation to offering any kind of advice on pain and pain management. I’ll put the first real post up soon…meanwhile if anyone has any topics they’d like discussed just let me know!