facet joint syndrome

What is Facet Joint Syndrome?

When we think about our joints, it’s the larger ones that usually come to mind: hips, knees and shoulders, for example. We rely on them to keep us moving, but we generally don’t think about them unless they aren’t working well.

We do have other joints, however, that are equally important to our well-being, although we’re not usually aware that they exist. They are called facet joints and are located on the back of the spinal column.

Facet Joint Anatomy

Each vertebra has two facet joints, one on each side of the spine. They are the joints responsible for spine stability and flexibility and make it possible for you to bend and twist.

The facet joints in each area of the spine are angled and shaped differently in each region of the spine: cervical, lumbar and thoracic. When they are healthy, they are cushioned by cartilage, allowing them to move smoothly against each other and are lubricated by synovial fluid to prevent wear and tear.

Like any joint, your facet joints are subject to injury or pain. When these joints become painful and swell, the result is called facet joint syndrome.

The joints can also be injured; the stiffening of facet joints is called hypomobility; excessive joint motion is called hypermobility. Facet joints can also lock in place, impeding movement in the opposite direction.

Facet joint syndrome can generally be attributed to the combination of injury, excessive pressure and aging. Discs in the spine can degenerate and collapse, affecting the alignment of your facet joints. The misalignment wears on the cartilage, which is eventually destroyed, along with the lubricating synovial fluid, leaving bone rubbing on bone.

Facet joint problems are common causes for neck, back and thoracic spine pain. Generally, 55 per cent of facet joint syndrome sufferers have pain in their cervical (neck) region, while 31 per cent have problems in their lumbar (back) area.

What are Symptoms of Facet Joint Problems?

Unfortunately, facet joint inflammation can be confused with other conditions. In the cervical region, the symptoms may be similar to those of a herniated disc or a torn spine muscle. Abdominal problems and neck issues may also mimic the symptoms of facet joint issues, so a careful diagnosis is imperative.

Symptoms of facet joint problems may include:

  • Acute, intermittent episodes of pain in the lumbar or cervical regions of the spine that occur a few times a month or year;
  • More discomfort when leaning backward than forward;
  • Low back pain that radiates through the buttocks and the back of the upper legs, but not the front of the legs or below the knees;
  • Pain in the shoulders and upper back that doesn’t affect the arms or lower back; and/or
  • Pain points above the facet joints and loss in spinal muscle flexibility.

If you have facet joint syndrome, you may have difficulties in bending or twisting your spine. Issues with the facet joints in your neck may make it challenging to turn your head left or right, while problems with facet joints in your back may make rising from a chair hard to accomplish. Lumbar facet joint syndrome will also make sitting and riding in a car challenging.

Diagnosing Facet Joint Syndrome

Facet joint syndrome will be diagnosed by your physician based on your symptoms, your history, an examination and tests: an X-ray, a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan.

What Helps Facet Joint Pain?

Your physician will probably refer you to a physiotherapist to help you rehabilitate your joints, restore your range of motion and alleviate your pain.

Your physiotherapy treatment will generally include a course of exercises to restore movement, strength and flexibility, along with soft-tissue massage; acupuncture is also an to alleviate localized pain. Potentially, spinal traction and joint manipulation will also be recommended.

Your physician may also suggest non-steroidal anti-inflammatory drugs to alleviate pain quickly and prescribe muscle relaxants. If the pain continues, your physician may give you a steroid injection for temporary relief.


Although facet joint syndrome is partially a consequence of aging, it is possible to make lifestyle choices that reduce your chance of developing it as you age. By exercising regularly, maintaining a healthy weight, eating a nutritious diet, practising good posture, and avoiding tobacco and excessive alcohol consumption, you can slow down the forces that cause it.

Suffering from Facet Joint Syndrome?

post concussion syndrome

What is Post-Concussion Syndrome?

Hard hits to the head in any sport, including ice hockey and football, can cause mild traumatic brain injury, which is essentially how a concussion is defined. Violent shaking or the impact of a car crash can also lead to a concussion.

Post-Concussion Syndrome

As if an injury to the brain isn’t worrisome enough, there is also the possibility of developing post-concussion syndrome. Post-concussion syndrome refers to the persistence of various concussion symptoms long past the time of injury.

Researchers haven’t yet identified the reasons why some concussion victims suffer from post-concussion syndrome and others do not.

Some researchers believe the syndrome is caused by structural damage to the brain or disruption of the messaging system within the nerves, resulting from the impact that first resulted in a concussion. Others contend that the causes are rooted in psychological factors, since a number of the most common symptoms are also seen in people with anxiety, depression or post-traumatic stress disorder (PTSD).

Both the physiological impact of a concussion and the emotional reaction to it can contribute to post-concussion syndrome. You may be more susceptible if you have a history of PTSD, depression or anxiety, or if you have significant life stresses, poor coping skills or poor network of social supports.

How Long Can Post-Concussion Syndrome Last?

Most people who suffer concussions recover within a few months, but, for others, symptoms linger on. These varied symptoms are generally labelled as post-concussion syndrome, a poorly understood and often misdiagnosed condition that can greatly affect quality of life.

Post-Concussion Syndrome Symptoms

Post-concussion syndrome is a difficult condition to diagnose because its symptoms can often be attributed to other causes and may also be vague.

Some of the most common post-concussion syndrome symptoms are

  • Headaches
  • Dizziness
  • Problems with sleep

Other symptoms – physical, emotional and cognitive – include:

  • Irritability or aggression on little or no provocation
  • Apathy or lack of spontaneity
  • Changes in personality
  • Difficulty finding words
  • Trouble in busy environments
  • Light sensitivity
  • Noise sensitivity
  • Nausea/vomiting
  • Difficulty following conversation that includes several people
  • Difficulty initiating tasks
  • Persevering at tasks.

In making a diagnosis, your physician may consider your history of head injury and symptoms, conduct a physical exam and request a magnetic resonance imaging (MRI) or computed tomography (CT) scan to check for any structural abnormalities in the brain. They may also attempt to rule out other causes of the symptoms, such as bleeding in the brain or infection.

Post-Concussion Syndrome Treatment

There is no standard way of treating post-concussion syndrome. Your physician will provide and/or recommend treatment tailored to your individual symptoms. Everyone has a different mix of symptoms that occur with different frequencies. Education is a powerful tool in addressing post-concussion syndrome, because addressing the fears about the condition often help ameliorate symptoms.

If you have headaches, some of the medications used for migraines or tension headaches seem to be effective. Be aware that overuse of over-the-counter and prescription medications may lead to continuing symptoms.

For cognitive symptoms of post-concussion syndrome, time may be the best healer. Cognitive therapy may also be helpful, especially if it focuses on areas that need strengthening. Cognitive symptoms may increase with stress, so learning stress management techniques may lessen them; relaxation therapy is another option.

For cases of post-concussion syndrome that exhibit symptoms of depression or anxiety, the sufferer may opt for psychotherapy or request treatment with anti-depressants.

To improve quality of life, a course of physiotherapy may be suggested. Patients with post-concussion syndrome recover faster with physiotherapy than with rest alone, researchers have found (Schneider KJ et al. 2103). Physiotherapists may use various techniques, depending on symptoms. Manual therapy may calm the nervous system and acupuncture may improve sleep and headaches. Exercise therapy may help with balance and sensory reintegration.

Concussion Prevention

There are no guaranteed ways of preventing post-concussion syndrome, but it is possible to take precautions against suffering a concussion in the first place.

Suggestions include:

  • Avoid motor vehicle collisions: drive defensively and eliminate distractions such as phone calls or eating.
  • Be cautious when playing sports: wear appropriate safety gear and avoid head collisions.
  • Avoid tripping and falling by keeping clear paths indoors: be careful of throw rugs, watch placement of pet dishes and be aware of loose flooring.
  • Educate yourself on concussions: be aware of risk factors, signs and symptoms, and how they can affect your health.

Your brain is precious – take good care of it and don’t return to your routines until you are completely symptom-free.

Suffering From Post-Concussion Syndrome?

spinal stenosis definition

What Is Spinal Stenosis?

Referring in frustration, to a “pain in the neck” is a figurative way of calling someone annoying. However, it’s also an apt descriptor for cervical spinal stenosis, an ailment that literally can cause a pain in your neck – and other places, as well.


Spinal stenosis refers to the narrowing of the spinal canal, which houses the spinal cord, and the openings in it that provide passage for peripheral nerves that thread their way to other parts of the body. This narrowing can choke the spinal cord and/or the roots of your nerves.

There are two types: cervical spinal stenosis, which affects the spinal column in the neck region, and lumbar spinal stenosis, which narrows the spinal column in the lower back.

What Causes Spinal Stenosis?

Aging is the most prevalent cause of spinal stenosis. As you age, your spine gradually degenerates. The discs between your vertebrae lose height through dehydration; your bones and joints may enlarge due to increased stress on them and destruction of cartilage, potentially leading to bone spurs that occupy space in the spinal canal; and your ligaments may thicken and calcify, encroaching on the space in the nearby canal.

Middle-aged and elderly people are also subject to osteoarthritis of the spine, or spondylosis, which is chronic and the result of wear and tear on the spine. It can also lead to the formation of bone spurs that constrict the spinal canal and cause spinal stenosis.

Although people over the age of 50 are the most likely to suffer from it, younger people who suffer a spinal injury or are born with a narrow spinal canal are also subject to spinal stenosis.

spinal stenosis

What Are the Symptoms of Spinal Stenosis?

Spinal stenosis may be present without your being aware of it. The spinal canals of many people over 50 narrow, but it only becomes apparent when the nerves are squeezed and they feel the resulting symptoms. It may take time for the symptoms to develop.

Your family physician will generally be able to diagnose spinal stenosis based on your symptoms and your medical history, using appropriate tests to confirm the diagnosis. The doctor may order a magnetic resonance imaging test (MRI), X-rays or computed tomography (CT) scans to rule out other possible causes of the pain.

What Is Cervical Spinal Stenosis?

With cervical spinal stenosis, you may feel some stiffness, pain, numbness or weakening in your hands, shoulders, neck or legs. You may find that you have problems with co-ordination and balance, causing you to stumble when moving or shuffle as you walk. There may be problems with fine-motor skills, such as typing or buttoning a shirt. You may also experience some incontinence.

What Is Lumbar Spinal Stenosis?

If you have lumbar spinal stenosis, leg pain when you’re in motion will usually be your primary symptom, since the nerves in the lower spine extend into the legs. It is often more severe when your spine is extended: for instance, when you are standing straight or leaning backward. The pain generally eases when your spine is flexed: whenever you are sitting, riding a bicycle or bending over your shopping cart.

Lumbar stenosis also manifests itself through additional symptoms, including low back pain; cramping, weakness or numbness in the legs, feet or buttocks; thigh and leg stiffness; and possible loss of bowel or bladder control.

What Is the Best Treatment for Spinal Stenosis?

Once a diagnosis is made, your physician will probably suggest physiotherapy as a treatment option that will ease the symptoms. In extreme cases, surgery is warranted to relieve pressure on the spinal cord and nerves, but, usually, you can address the symptoms through other means.

At home, you can use non-steroidal anti-inflammatory drugs to ease the pain and reduce the inflammation. Your physiotherapist will do the same for you, using methods that may include ice, unloading taping techniques, electrotherapy, soft tissue massage and acupuncture.

Spinal Stenosis Exercises

Once the inflammation settles, your physiotherapist will help you focus on range-of-motion and alignment exercises, as well as muscle strengthening.

Exercises will usually take the form of lower abdominal and core stability exercises, since you want to strengthen the muscles that control and stabilize the movement of your spine.

Cervical spinal stenosis exercises will aim to maintain flexibility and strength and improve posture.


There are some basic things you can do in order to prevent symptoms to manifest themselves or recur:

  • Maintain a healthy body weight.
  • Develop or maintain good posture.
  • Exercise regularly, including stretching exercises, such as yoga.
  • Don’t smoke, since smoking decreases bone density and increases risks of fracture and bone deterioration. It has also been linked to disc problems.

Spinal stenosis should be taken seriously; if you follow the guidance and treatment plan you receive, you usually should be able to make your pain disappear within a reasonable timeframe.

Let’s Get You Some Relief!

stiff neck causes

Stiff Neck Remedies

Anyone who has ever had a stiff neck knows that they’re painful and awkward. The inability to turn your head sideways without pain makes everyday tasks challenging and driving a car impossible. It’s an inconvenience that no one wants, but trying to find a stiff neck remedy is a step in the right direction.

How to Get Rid of a Stiff Neck

A stiff neck usually refers to soreness and difficulty in moving the neck side to side. In fact, it may require that you turn your entire body to look over your shoulder. The pain may be accompanied by a headache, shoulder pain or arm pain.

If a stiff neck is bothering you, try simple remedies to start your stiff neck treatment:

  • Ice is nice. Apply ice to the affected area for the first 48 to 72 hours; afterward, substitute heat in the form of hot showers, compresses or a heating pad. Don’t place ice packs or heating pads next to bare skin.
  • The bottle. Of over-the-counter pain relievers, that is. Acetaminophen or ibuprofen should banish the pain.
  • Move it. Motion will help keep inflammation at bay, but no jerky movements allowed.
  • Rub-a-dub-dub. Ask a partner or a friend to gently massage the area.
  • Stiff neck exercises. Range of motion exercises gently stretch neck muscles. You may wish to consult a physiotherapist for additional suggestions.
  • Chuck the cushion. Try sleeping pillowless or with a special neck pillow.
    Depending on the cause of your stiff neck, some lifestyle adjustments may be in order:
  • Redecorate. Be sure that your work station is set up ergonomically to keep your head, neck and back in a natural position. You may need a different chair or an adjustment to the height of your computer monitor.
  • Stare at the ceiling. If your sleep position is causing a stiff neck, you’ll need to modify it. Sleeping on your back or your side are best for the neck. If you sleep on your stomach, your head generally twists in one direction for hours at a time.
  • Pillow talk. Buy a pillow that isn’t too high for you or too firm.
  • S-t-r-e-t-c-h. You may need to stretch regularly to prevent your neck muscles from injury. A physiotherapist can design a targeted exercise program for you.

stiff neck remedy

Stiff Neck Causes

To figure out how to get rid of your stiff neck, you need to look into what causes a stiff neck. The most common cause is a muscle or soft tissue sprain. The cervical spine housed in the neck comprises seven vertebrae that protect the spinal cord while connecting the skull to the upper back and its thoracic vertebrae.

To the back and side of the neck is the levator scapulae muscle that connects the neck to the shoulder, and it is this muscle that is most susceptible to sprains.

A levator scapulae strain has a variety of potential causes:

  • A fall or sudden impact that moves the head side to side.
  • Sleeping with the neck in an unusual position.
  • Holding the head at an unnatural angle for long periods of time – for example, by cradling a phone between ear and shoulder or by looking down at a computer monitor.
  • Poor posture.
  • Stress or anxiety.
  • An activity that requires you to repeatedly move your head from side to side, such as swimming the crawl stroke.

If the pain appears shortly after a fall, the cause will be obvious. Otherwise, you may not be able to pinpoint the exact cause; misusing your muscles over time can have a cumulative effect.

In addition, there are spine disorders that can result in a stiff neck, including:

  • Cervical osteoarthritis. The breakdown of joints between the bones of the vertebrae.
  • Cervical herniated disc. Breakdown of a disc’s outer layer causes fluid to leak out and cause inflammation and compression in surrounding tissues.
  • Cervical degenerative disc disease. Discs lose height and hydration over time, potentially exerting pressure on nearby soft tissues, joints and nerves.

Generally, a stiff neck resulting from muscle strain should clear up on its own within a week. If the pain and stiffness remain, however, it’s time to consult a physician to determine if a spinal disorder is the underlying cause.

If your neck pain persists longer than a week, it’s possible that you have an underlying condition that is causing the stiff neck, such as those mentioned above. You should check with your physician to be sure that any serious problem is identified quickly so you can seek additional treatment. Meanwhile, heads up!

Wondering How to Fix a Stiff Neck?

high ankle sprain recovery time

What Is a High Ankle Sprain?

If you’re a professional basketball fan you’ve undoubtedly seen one of the players on your favourite team hobbling off the court in pain, often supported by teammates or the trainer. If the player is suffering from a high ankle sprain, he could be off the court for as little as a week for a mild sprain, but the more serious version could keep him out for months. When a star player gets injured in this fashion, he may not break the ankle, but he breaks many fans’ hearts.

How Does a High Ankle Sprain Occur?

A high ankle sprain differs from the mild sprain that occurs when you roll your ankle. The ankle joint is a complex one, because it is the location where the two lower leg bones, the tibia (shin bone) and the fibula (outer leg bone), come together and join to the foot.

A high ankle sprain is an injury

  • to the ligaments (connective tissue that joins two bones),
  • of your sydesmosis (a fibrous joint at the juncture of the two leg bones just above the ankle bone that includes Interosseous Membrane between the two bones), and
  • the anterior (front) and posterior (back) Tibio-Fibular ligaments.

It generally results from force reverberating through the ankle (e.g., when you slam it into the ground) combined with the rotational stress of turning the foot outward in relation to the leg.

Imagine two basketball players leaping for a rebound and colliding as they hit the ground, with one player’s knee knocking into the other’s. The two lower leg bones may be forced apart, the force causing the ligaments to stretch too far or tear.

It can also happen during side-to-side running, turning while in motion or stopping and starting your feet repetitively.

bones of the foot

How Do You Know if You Have High Ankle Sprain?

Symptoms of a high ankle sprain may include:

  • Minor swelling.
  • Significant bruising to the inside, outside and higher portion of the ankle.
  • Inability to walk.
  • Severe pain.
  • Pain when you try to rotate the ankle outward.
  • Pain when the ankle is touched.

How Long Does It Take to Recover From a High Ankle Sprain?

When a high ankle sprain occurs, it is with one of three degrees of severity. The recommended treatment for a high ankle sprain depends on the degree of severity involved. They are slower to heal than the more common low ankle sprains. While they heal, your physician may suggest a brace, splint or cast to immobilize the ankle as it heals.

  • Grade 1 sprain: This is the mildest variety of sprain with minimal damage to the ligaments, usually accompanied by pain and swelling. These milder sprains are generally treated with rest, ice, elevation and compression. Healing usually takes about six weeks, although you may not be ready to return to action immediately. You may experience joint stiffness and muscle weakness or tightness.
  • Grade 2 sprain: These sprains involve extreme stretching of the ligament and may include a partial tear. There is usually significant bruising and swelling under the skin and the ankle is unstable. It generally takes 6 to 12 weeks for recovery.
  • Grade 3 sprain: The most severe sprain involves a complete rupture of the ligament and walking is usually difficult. It may require surgery, especially if there is a lot of instability: your surgeon can insert a “syndesmotic screw” between the tibia and fibula to hold the bones in place while the ligament heals and is able to hold the bones in their proper positions. High ankle sprain rehab following surgery generally takes 3 to 6 months.

high ankle sprain treatment

High Ankle Sprain Rehab

Proper recovery from a high ankle sprain includes three phases, no matter how severe the injury:

  • Rest, swelling reduction and protecting the ankle.
  • Restoring range of motion, flexibility and strength.
  • Returning to normal activities.

Your physiotherapist will be instrumental in the recovery process, providing you with exercises and treatment that will assist you in returning to regular activities. Your physician may also suggest that you wear an ankle brace when you participate in sports.


Unfortunately, once you experience a Grade 3 sprain, you are more prone to high ankle sprains. You can attempt to prevent further sprains by:

  • Stretching properly before you exercise.
  • Warming up beforehand and cooling down afterward.
  • Discussing any planned new physical activities with your physiotherapist.
  • When participating in high-impact sports, be conscious of your footwork.
  • Stay hydrated, especially during the activity.

A high ankle sprain may put you out of action for a while, but with patience and effort, you’ll soon be back in the game.

Suffering From a High Ankle Sprain?

rotator cuff injury symptoms

What is a Rotator Cuff Injury?

As the Major League Baseball season heads toward the World Series, its dramatic conclusion, commentators can be heard chattering about the pitchers whose arms are giving them trouble after a long campaign. Often, the words rotator cuff injury are bandied about, drawing moans and groans from the fans. To them, it raises the fear of potential surgery and the possibility that their favourite player won’t be healthy for the following season.

Should you be concerned when you hear those three words, rotator cuff injury? Let’s define the rotator cuff, discuss exactly what a rotator cuff injury is and consider how it can be treated.

The Rotator Cuff Explained

The rotator cuff comprises a group of four small muscles that stabilize and control your shoulder movement. The shoulder is a ball and socket joint, and the muscles come together to form a covering for the ball at the top of the arm bone (humerus) where it fits into your shoulder blade, or scapula.

The rotator cuff is connected to the bone with tendons. To allow the arm bone to glide easily, a lubricating sac called a bursa, separates the rotator cuff from your acromion, the bone at the top of your shoulder.

rotator cuff muscles

What Is the Best Treatment for Rotator Cuff Injury?

Impingement injuries resulting from overuse respond well to rest and anti-inflammatory medications. Your physiotherapist may also prescribe exercises to help you heal, restore range of motion and strengthen the muscles. Basic exercises for rotator cuff injury that are often used include:

  • doorway stretch;
  • side-lying external rotation;
  • high-to-low rows;
  • reverse fly; and
  • lawn mower pull.

Rotator cuff tears can be either partial or full. Partial tears result when a part of the rotator cuff pulls away from its attachment to the bone. They rarely require surgery and respond well to rest, ice, physiotherapy, medication and, perhaps, an occasional cortisone injection.

If the tear isn’t healing despite these treatments, there is now the option of having a bioinductive patch applied to the area using minimally invasive arthroscopic surgery. The patch induces the rotator cuff to regenerate and heal itself.

A full tear means the rotator cuff and its tendon are pulled completely away from the bone. If non-surgical means don’t work in treating your injury, or if your job depends on using your rotator cuff, your physician may suggest surgery to repair it. Generally, a surgeon will reattach the tendon to the humerus bone.

The most common surgical options are open repair, which requires a surgical incision; arthroscopy, which requires a tiny incision and uses a microscopic camera to guide the surgeon; and mini-open repair, which combines the two techniques.

Common Rotator Cuff Injuries

Your rotator cuff is protected from minor bumps and knocks by the bones and the ligaments that create an arch over your shoulder. However, injuries can happen, both acute and degenerative.

rotator cuff injury

Acute rotator cuff injuries result from a single incident, such as falling down onto an outstretched arm or using a jerking motion to lift something too heavy.

Degenerative rotator cuff injuries result from wear over time; they can occur naturally as we age. The blood supply to our rotator cuff muscles and tendons lessens, impairing the body’s ability to repair itself.

Rotator cuff injuries can result from the strain of repetitive motion, making tennis players and baseball pitchers susceptible, as well as painters, carpenters and anyone else who does work overhead.

Common rotator cuff injuries include impingements and tears:

  • Impingements result when rotator cuff muscles become irritated, swell and obstruct the space between the arm and shoulder bones, causing pinching and irritation to the tendons and bursa.
  • Tears and rips – either partial or full – in the rotator cuff muscles or tendons that attach the muscles to the bones.

What Are the Symptoms of Rotator Cuff Tear?

The symptoms for different types of rotator cuff injuries are varied, but common indicators include:

  • an arc of shoulder pain or clicking when you lift your arm to shoulder height or overhead;
  • shoulder pain that can extend from the top of your shoulder to your elbow;
  • shoulder pain when your arm is at rest (usually seen in more severe rotator cuff injuries);
  • shoulder pain when you are lying on your sore shoulder;
  • shoulder muscle weakness when attempting to reach or lift something;
  • shoulder pain when reaching for a seatbelt; or
  • shoulder pain when putting your hand behind your back or head.

A rotator cuff injury is best diagnosed using a diagnostic ultrasound scan. Although MRIs are often used to assess the injury, they have been known to miss rotator cuff problems.

If you are experiencing shoulder pain, don’t hesitate to talk to your physician or your physiotherapist. The sooner a rotator cuff injury is diagnosed and treated, the more likely that you’ll have a complete recovery.

Get Relief for Your Rotator Cuff Pain

shoulder bursitis

What is Shoulder Bursitis?

You’ve caught that high fly ball winging its way toward left field with a leap and a grab. As you throw it to third base for the out, you feel pain in your shoulder. Oh, no! Is this the beginning of the end of your career as an amateur outfielder? Will you have to give up a game you so enjoy?

Let’s hope not. What you may be experiencing is bursitis of the shoulder, also known as subacromial bursitis, because it occurs in the bursa beneath your acromion, the bone that forms the roof of your shoulder joint. Very well, you say, but whatever is a bursa?

What Causes Bursitis of the Shoulder?

A bursa (plural, bursae) is a fluid-filled sac that helps to reduce the friction between the bones in a joint and the soft tissues, such as tendons. The bursae lubricate and cushion the areas where these structures rub against each other. Inflammation to these sacs is called bursitis and it may occur in the shoulder, knees, elbows or wrists. Bursitis, while painful, isn’t life-threatening and usually responds well to treatment.

Common causes for shoulder bursitis are:

  • Overuse and repetitive movement.
  • Sudden injury, such as a blow to the area.
  • Aging; formation of calcium deposits on collarbone that interfere with bursa.
  • Sudden trauma, e.g., falling so that the shoulder absorbs the blow.
  • Lifting items overhead.
  • Underlying weakness of the rotator cuff or shoulder blade stabilizers that impinges upon the bursa.

Athletes who use an overhand throwing motion are susceptible to shoulder bursitis, such as swimmers, tennis players and volleyball players. Non-athletes who may experience shoulder bursitis include people involved in chores such as hanging the laundry or painting the house. Shoulder bursitis often occurs as the result of another injury, such as a torn rotator cuff, that begins to impact the bursa.

What Does Bursitis in the Shoulder Feel Like?


The main indicators of the onset of shoulder bursitis are pain and restricted movement:

  • Tenderness or stiffness in the affected area.
  • Gradual onset of pain that progressively worsens in intensity following or during repetitive activity.
  • Rapid onset of pain if caused by trauma.
  • Skin may swell and be warm to the touch.
  • Pain located at the outside of the shoulder and it may radiate to the mid-arm; it can spread as far as the wrist.
  • At rest, shoulder feels more comfortable when held across the body, as if in a sling.
  • Pain increases when you lie on the injured side, but it can also hurt when lying on your unaffected side with your arm slung across the body.
  • A tightening sensation in the upper arm.
  • Pain intensifies when you use your arm for actions that require you to lift it above shoulder height, such as reaching for an object on a high shelf.
  • Inability to lift arm away from body, because pain causes a feeling of weakness.

What Is the Best Treatment for Bursitis in the Shoulder?

If you are experiencing shoulder pain that you think might be bursitis, a visit to your physician is indicated. Once he or she diagnoses it, a course of rest and home treatment will generally be successful, but physiotherapy may also help you by strengthening the muscles around your joints; it will certainly be useful in preventing a recurrence.
To heal properly:

  • Rest is best. Avoid engaging in any activity that puts pressure on the shoulder or may cause pain.
  • Freeze it. As soon as you feel muscle pain or pain near a joint, apply ice for 10 or 15 minutes, as often as twice an hour, if needed. Continue for 72 hours (three days).
  • Dull the pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen help reduce inflammation and cut the pain.
  • Move it. Gently move the affected joint through its full range of motion daily to avoid stiffness. Work with your physiotherapist to add exercises that strengthen the surrounding muscles.

If the swelling is severe, your physician may decide to remove some of the fluid using a needle. He or she might also suggest a pressure bandage for the affected area.

Can Shoulder Bursitis Be Prevented?

Keep your shoulder healthy by:

  • Staying the course. Continue with your treatment and exercise regimen.
  • Slow but steady. Slowly re-start the activity that aggravated your shoulder, warming up beforehand and stretching afterward. Do the activity for short periods of time to give your body a chance to adjust.
  • Improve technique. If a certain activity has caused bursitis, make sure you are doing it with proper technique to avoid further injury. If equipment is necessary, check it to make sure it is doing its job in protecting you.
  • Look for alternatives. If the activity that led to injury is a sport you play for fun, consider looking for an alternative that doesn’t require overhead motion.

Remember: shoulder bursitis may be painful, but it can be healed. Be patient and follow the advice of your healthcare professionals and you should soon be feeling fine.

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pinched nerve

How to Treat a Pinched Nerve

As a child growing up, you, like most of us, were probably victimized on occasion by a sibling who pinched you for effect: the resulting screeches tend to be dramatic. A pinched nerve may not cause you to howl with the same pain and indignation, but it is unpleasant and requires tending. Unfortunately, calling for your mother to punish the offender isn’t an acceptable solution in this case!

What Is a Pinched Nerve?

Nerves are the highways and roads extending throughout our body to carry signals to and from the brain. When the surrounding tissues – cartilage, bones, muscles or tendons – place too much pressure on a nerve and pain and/or other symptoms result, it is called a pinched nerve.

You can experience pinched nerves at a variety of places throughout the body. For example, you may have a pinched nerve in your wrist, causing carpal tunnel syndrome, or a herniated disc that results in a pinched nerve somewhere in your spine. Many people experience a pinched nerve in their neck, shoulder, lower back, arm and feet.

What Causes a Pinched Nerve?

Some of us are more prone to pinched nerves than others. Your susceptibility is increased if you exhibit any of the following characteristics:

  • Female sex. Women are more likely to develop carpal tunnel syndrome.
  • Bone spurs. If trauma or injury causes a bone spur, it can narrow the passage for nerves to travel, leading to a pinched nerve.
  • Thyroid disease. If you have thyroid problems, you are more prone to carpal tunnel syndrome.
  • Rheumatoid arthritis. Arthritis often causes inflammation, which puts pressure on your joints.
  • Diabetes. People with diabetes have a higher risk of pinched nerves.
  • Overuse. If you participate in sports or hobbies that require repetitive motion, you stand at risk of a pinched nerve.
  • Prolonged bed rest. Lying down for long periods can lead to compression of your nerves.
  • Pregnancy. Pregnant women are susceptible to pinched nerves due to the pressure put on nerves by weight gain and water retention.
  • Obesity. Carrying excess weight can place pressure on your nerves.

Pinched Nerve Symptoms

If you have a pinched nerve somewhere in your body, you may experience one or more of these sensations:

  • Numbness or decreased sensation in the area supplied by the nerve.
  • Frequent feeling that a foot or hand has “fallen asleep”.
  • Muscle weakness in the affected area.
  • Sharp, aching or burning pain, which may radiate outward.
  • Tingling, pins and needles sensations (paresthesia).
  • Burning or hot and cold sensations.

pinched nerve symptoms

How Is a Pinched Nerve Diagnosed?

The connection between a pinched nerve and its symptoms may not be obvious, because the pain may not appear at the source; it may be felt further down the path from the affected nerve. Your spine, however, is a very intricate structure, so any changes to the surrounding muscles or tendons may have an impact.

If your physician suspects a pinched nerve, you may be asked to undergo one or more tests to determine whether your nerve is pinched and/or damaged:

  • Magnetic resonance imaging (MRI). A magnetic field and radio waves produce images of your body on multiple planes.
  • Electromyography (EMG). EMG evaluates the electrical activity of your muscles when they’re active and when they are at rest.
  • High-resolution ultrasound. Sound waves produce images of your body’s structures, allowing assessment of damage.
  • Nerve conduction study. Electrodes measure electrical nerve impulses and muscle function.

How Do You Relieve a Pinched Nerve?

No matter whether the pain you are experiencing is minor or strong, it’s important to address it quickly so that you don’t sustain permanent nerve damage. Your physician will discuss options of how to treat a pinched nerve with you based on your condition.

In most cases your physician will turn first to non-invasive treatment options:

  • Rest. The first remedy your physician may suggest is rest of the affected area to allow healing. This may include wearing a splint to keep it immobile, depending on the location of the nerve.
  • Hot and Cold Therapy. Treating the affected area with heating pads and ice packs, used alternately according to instructions, may relieve mild pain.
  • Posture. Aligning the spine properly to distribute your body weight across it evenly can relieve pressure.
  • Physiotherapy. Physiotherapists can perform spinal traction (decompression), and teach you proper stretching and strengthening exercises to support the spine. They can help you increase the endurance and flexibility of the surrounding muscles, especially in the target area, to relieve pressure on the nerve and ease pain. They can also suggest ways to modify movements that aggravate the affected nerve.
  • Massage. A registered massage therapist can use deep therapeutic massage to increase blood flow and promote healing, while relieving pain.

After a few weeks or months, if these non-invasive treatments aren’t bearing fruit, your physician may suggest surgery to relieve the pressure on the nerve. The good news is that, in most cases, you can treat the injury yourself with help from the aforementioned professionals.

Get Relief for Your Pinched Nerve!

herniated disc

Herniated Disc vs. Bulging Disc

We don’t usually give our spines much thought – they are simply part of our anatomy. We know they help keep us upright, but that’s about all the attention they get – unless we have back pain. All of a sudden, there’s a spotlight on the spine, and its component parts – vertebrae and discs – are examined. The older we get, the more likely we are to suffer from common spinal issues: bulging or herniated discs.

The Spinal Column: Vertebrae and Discs

In addition to being part of the foundation that supports our bodies’ soft tissues, the spine plays a critical role: it protects the spinal cord, that rope of nervous tissue connecting the brain to other parts of the body, allowing messages to travel throughout our physical structures.

The spinal column has two component parts: vertebrae, the individual, articulated rings of bone that encase the spinal cord; and discs, the cushions that separate the vertebrae and protect them from grinding against each other.

Discs are made up of a fibrous outer layer of tough cartilage surrounding a gel-like centre of soft cartilage. Over time, these discs show evidence of wear and tear. They dehydrate and the cartilage becomes stiff, which can lead to both bulging discs and herniated discs – and potential pain.

Herniated Disc vs. Bulging Disc: Differentiating Disc Difficulties

Often, people assume a disc is a disc is a disc, but there is a difference between a bulging disc and a herniated disc.

A bulging disc results when stiffening causes the outer layer of cartilage to bulge out around its circumference, looking, as the Mayo Clinic describes like “like a hamburger that’s too big for its bun.” The bulge generally affects a quarter or more of the outer layer of tough cartilage.

A herniated disc occurs when a crack in the outer layer of tough cartilage allows some of the softer, gel-like layer to protrude out of the disc. It is also known as a slipped disc or a ruptured disc. The problem is confined to the area around the crack.

bulging disk

Causes of Disc Problems

As noted, discs lose water as we age, becoming less flexible and more prone to dislocating or tearing from bending or twisting. Bad posture can lead to disc issues, as can work that requires repetitive lifting, bending, driving or standing. If you habitually use your back and arms to pick up heavy objects, rather than relying on the power of your lower body, you are at risk.

Risk factors for disc problems include:

  • Genetics. Some people are pre-disposed to disc weakness.
  • Weight. Additional body weight puts pressure on the discs in your lower back.
  • Occupation. People who have physically demanding jobs are at greater risk of disc injury than others.

Symptoms of Disc Issues: Herniated Disc Symptoms

A bulging or herniated disc may produce no symptoms at all – you may never know that you have one. Symptoms generally arise when the problem disc places pressure on nearby nerves or inflames the nerves, causing pain. Common herniated disc symptoms include:

  • Pain at the site of the nerve compression.
  • Arm or leg pain; when you sneeze or cough, pain may also shoot through these appendages.
  • Tingling or numbness in related parts of the body.
  • Muscle weakness in the arms or legs, causing stumbling or an inability to hold objects; or
  • Muscle spasms.

Treating Disc Problems: Bulging and Herniated Disc Treatment

By avoiding painful positions, following a prescribed exercise regimen and taking pain medication, you should feel better within a few days. When it comes to bulging or herniated disc treatment, your doctor may prescribe physiotherapy as a way of relieving pain and strengthening your body to prevent further injury.

Physiotherapy treatment for bulging or herniated disc may include:

  • Active treatment. Active treatment addresses flexibility, posture, strength, core stability, and joint movement and often includes
    • Spinal traction. Spinal traction gently separates the spinal bones or vertebrae of the neck and back.
    • Flexibility exercises. Ward off stiffness and prepare you for more vigorous movement.
    • Hydrotherapy. Water aerobics are preferable to passive treatment, conditioning your body without undue stress.
    • Core strengthening. Core muscles assist your back muscles in supporting your spine; if they are weak, there is extra pressure on your back.
    • Muscle strengthening. Strong muscles help support your spine and allow you to cope with pain more easily.
  • Deep tissue massage. Relieves deep muscle tension and spasms that prevent movement of the muscles in the affected area.
  • Hot and cold therapies. Your physiotherapist may alternate these complementary treatments. Heat increases blood flow to the area to help healing and to remove waste by-products. Cold slows circulation to reduce muscle inflammation and pain.

If rest, medication and physical therapy aren’t relieving your herniated disc symptoms, your physician may prescribe surgery to remove the herniated portion of the disc, but this is only necessary in a small minority of cases. He or she may also suggest alternative treatments such as acupuncture, yoga or chiropractic spinal manipulation to relieve ongoing pain.

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tennis elbow

Tennis Elbow and Golfer’s Elbow

“Summertime, and the livin’ is easy,” says the old song. School is out, vacations are on the calendar and the weather is conducive to all sorts of outdoor activities. For summer sports enthusiasts, it’s a treat to be able to leave the gym behind and head out to the tennis court or the golf course – unless, of course, injury makes that impossible. For avid tennis players and dedicated golfers, there’s always the danger of an overuse injury such as tennis elbow or golfer’s elbow.

What is Tennis Elbow?

With tennis elbow pain results from repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. How do you get tennis elbow? When playing tennis, you may grip the racquet too tightly or use poor technique, putting stress on the tendons connecting your muscles to your elbow bone. Other activities can also lead to overuse and injury, including:

  • Cutting up ingredients for cooking, particularly meat
  • Repetitive computer mouse use
  • Using plumbing tools
  • Painting
  • Driving screws

What are some of the tennis elbow symptoms? With tennis elbow, pain generally radiates from the outside of your elbow to your forearm and wrist. It may make it challenging for you to hold a coffee cup, shake hands or turn a doorknob.

What is Golfer’s Elbow?

Golfer’s elbow generally results from overusing the muscles in the forearm that allow you to grip, rotate your arm and flex your wrist. The repetition required by gripping and swinging can injure the tendons in your forearm that attach to your elbow. Other athletes, such as pitchers and bowlers are also prone to golfer’s elbow, and it can result from regular hammering, raking and painting, too.

Golfer’s elbow results in tenderness and pain on the inside of your forearm. You may also feel stiffness in your elbow, making it difficult to curl your fingers into a fist. Your hands and fingers may feel weak and there may be a tingling sensation that radiates into your fingers. You may find it challenging to pick up something with your palm facing down or to flex your wrist.

golfers elbow

How do you treat Elbow Pain?

Let’s discuss how to treat tennis elbow and golfers elbow. Both usually respond to self care. Most commonly the treatment for tennis elbow and golfer’s elbow is as follows:

  • Take a break. Give your golf or tennis game a rest until the pain disappears. It may be frustrating, but returning to action too soon may cause the injury to recur.
  • Cold comfort. Ice the injured area for a few days to provide relief and reduce any inflammation. Try icing the elbow a few times a day for 15 to 20 minutes, using a pack wrapped in a dishtowel so the ice doesn’t injure your skin. The injured tendons lie close to the skin, so they don’t need long icing sessions.
  • Brace yourself. Wearing a specialized elbow brace can provide support that reduces the strain on the tendon, allowing it to heal.
  • Rub a dub dub. You may want to massage the affected area for five minutes at a time once the inflammation has disappeared.
  • Mouth to hand relief. You may want to use an over-the-counter pain reliever to alleviate some of the pain.

If the injury doesn’t seem to be healing, you may want to consult further with your physician. He or she will probably suggest:

  • Physiotherapy. Stretching and strengthening the affected area will promote healing while preventing further injury. Eccentric exercises, which lengthen the tendons, have proved to be effective. Your physiotherapist may also use ultrasound or electrotherapy to reduce pain and assist with healing.
  • Injections. A new therapy involves injecting platelet-rich plasma into the affected area to hasten healing.
  • Surgery. If there is no improvement within six months to a year, it is possible to have the damaged tissue surgically removed.

What is the main cause of Tennis Elbow and Golfer’s Elbow?

Both tennis elbow and golfer’s elbow are repetitive stress injuries caused by overuse that result in inflammation and small tears to tendons in the arm. Tendons connect muscle to bone. Tennis elbow – lateral epicondylitis – refers to injury to tendons on the front of the arm, while golfer’s elbow – medial epicondylitis – is the name given to injury to a forearm tendons.

How log does it take to recover from Tennis Elbow or Golfer’s Elbow?

You shouldn’t return to tennis or golf – or the other activities that led to the injury – until you can perform the challenging motions without pain. Don’t rush yourself, or you will simply re-injure the tendons.

Return to activity gradually. You may want to wear an elbow brace to start, and it is wise to consult with a professional to ensure that you are using the proper motion. If you feel pain during or after exercise, back off for a while. The goal is to stay healthy.

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achilles tendinitis

Achilles Tendon Problems

In Greek mythology, Achilles was the son of King Peleus, a mortal, and a sea nymph, Thetis, and the greatest warrior of the Trojan War. His mother attempted to render him invulnerable by dipping him in the River Styx, protecting his body except for the heel by which she held him for the dipping: his Achilles heel.

Our own Achilles tendons are the strong bands of fibres that connect our calf muscles to the heel. As legend implies, they are, indeed, vulnerable to injury. These injuries generally happen when you begin moving suddenly, pushing off with your foot. Achilles tendinitis (or tendonitis) and a ruptured Achilles tendon are the most common injuries to this tendon.

What is Achilles Tendinitis?

Achilles Tendinitis is an overuse injury due to repetitive motion that can cause pain, inflammation or degeneration of the tendon. It is common among runners and jumpers.

Achilles tendinitis can result from:

  • Increasing the duration or intensity of your runs.
  • Playing sports only on the weekends in middle age.
  • Sudden change in your training surface (e.g., asphalt to grass).
  • Flat feet that over-pronate.
  • Feet with high arches and tight Achilles tendons.
  • Tight hamstrings and calf muscles.
  • Shoes without enough support.

Signs and symptoms

  • Achilles tendinitis usually starts with mild pain after exercise that requires repetitive motion. You’ll generally feel a mild ache in the back of the leg or heel afterward.
  • During the night or when you awaken in the morning, you may feel more pain and stiffness.
  • If inflammation is involved, the area may be red, swollen, tender or warm.
  • Use of the tendon may result in a crunchy feeling.

Diagnosis: Your physician will examine your ankle and your foot and assess the range of motion and the condition of the tendon. X-rays or other types of imaging may be used.

Achilles Tendinitis Treatment

Once your achilles tendinitis is diagnosed by a doctor, a visit to the physiotherapist is generally in order. Here’s what to expect for your Achilles tendinitis treatment:

  • Your pain threshold will be assessed and any movements that cause increase pain identified.
  • If there is inflammation involved, your physiotherapist may use ultrasound to reduce it and stimulate blood flow, which promotes healing.
  • Deep massage to improve flexibility and further increase blood flow.
  • Stretching and flexibility exercises that can assist in healing without shortening the tendon.
  • Strengthening exercises to protect against further injury while helping your regain any strength that has been lost.
  • Additional support: Your physician may suggest orthotics to elevate your heel, relieve strain on the tendon and lessen the amount of force it absorbs during exercise.

achilles tendon

Recognizing an Achilles Tendon Rupture

What is an Achilles tendon rupture? A rupture is a tear in the Achilles tendon when an abrupt movement is too much for the tendon to handle. It can occur spontaneously, without warning, or you may have experienced tendinitis previously.

Achilles Tendon Rupture Symptoms

  • You may feel a sudden, sharp pain above your heel as the tendon releases the calf muscle.
  • There may be a popping or snapping sensation.
  • The back of the leg between heel and calf may swell.
  • You’ll have difficulty walking, especially up stairs or uphill.

Diagnosis: A physician or surgeon will ask about your history and the circumstances surrounding the injury. A physical exam will include an evaluation of range of motion and muscle strength, comparing it to the uninjured foot. The diagnosis is usually straightforward, but imaging tests may be required.


Immediately after the injury, use the RICE method of treating your achilles: rest, ice, compression and elevation.

Non-surgical option for a ruptured achilles tendon:

  • Minor or partial ruptures.
  • Less active patients.
  • Patients with medical conditions that prevent surgery.
  • Employs a cast, walking boot or brace with a heal lift to support the tendon and allow it to heal.

Archilles rupture surgery:

  • Decreases likelihood of another rupture.
  • May improve push-off strength.
  • Generally improves muscle function and ankle movement.
  • Requires an incision and stitching the tendon back together.

Achilles Rupture Recovery

Healing from surgery usually takes four to six months. Effort is required to restore your heel to health. Your physician will generally recommend physiotherapy to:

  • Strengthen the tendon.
  • Regain flexibility.
  • Improve agility.


Take things slowly. Don’t return to your previous level of physical activity until:

  • Your healed leg feels as strong as your other leg.
  • You can move your healed leg as freely and easily as your other leg.
  • You feel no leg pain when you walk, run and sprint.

An Achilles tendon injury is treatable, so don’t despair.

Are you experiencing problems with your Achilles?

restless leg syndrome

Restless Legs Syndrome

restless leg syndrome
People who work at desk jobs try to remind themselves to get up regularly and stretch, since research has shown it is better for their general health. Those suffering from Restless Legs Syndrome, however, wish they had the choice of sitting still for as long as they wished, rather than being compelled to move.

What is Restless Leg Syndrome?

Restless Leg Syndrome (RLS) is a disorder that causes an uncontrollable urge to move your legs, generally because of discomfort. Between five and 15 per cent of Canadians suffer from RLS and describe the discomfort as a pins and needles sensation under the skin, tingling, crawling or prickling.

It is also called Willis-Ekbom Disease after two physicians, centuries apart, who described the disorder: Sir Thomas Willis, a 17th-century British physician, and Karl-Axel Ekbom, a Swedish physician writing in the 1940s.

Restless Legs Syndrome can begin at any time of life and usually worsens with age. It generally makes itself felt in the evenings and can interfere with sleep. About 80 per cent of people who suffer from RLS experience a related condition, periodic limb movements, twitches and kicks that happen at while you sleep.

what causes rls
Movement provides temporary relief to RLS sufferers, so travel can be difficult, because sitting in a confined space for long periods of time is uncomfortable.

What Causes Restless Leg Syndrome?

Although researchers are still exploring the cause for RLS, it may result from an imbalance of the chemical, dopamine, in the brain, because its messages help control muscle movement.

Often, Restless Leg Syndrome is hereditary, especially cases that begin before age 50. It may appear during pregnancy, especially in the last trimester, but RLS usually disappears after delivery.

Low levels of iron may bring on RLS, but it usually disappears with treatment. It is also often associated with diabetes and Parkinson’s disease.

Diagnosing the Disease

There is no test to diagnose RLS. The Mayo Clinic notes that a diagnosis is based on the following criteria, established by the International Restless Legs Syndrome Study Group:

  • You have an often irresistible urge to move your legs, usually accompanied by uncomfortable sensations typically described as crawling, creeping, cramping, tingling or pulling.
  • Your symptoms worsen during periods of inactivity, such as sitting or lying down.
  • Your symptoms are partially or temporarily relieved by activity, such as walking or stretching.
  • Your symptoms are worse at night.
  • Your symptoms can't be explained solely by another medical or behavioral condition.

Your physician may order other tests, such as a blood test to check iron levels or a test for nerve damage, in order to rule out other potential causes for your discomfort. You may also undergo a sleep study to determine whether you are afflicted by periodic limb movements.

Restless Leg Syndrome Treatment

restless leg syndrome treatment
You may be able to control Restless Leg Syndrome with lifestyle changes. Try the following suggestions for relief of symptoms:

  • Get regular exercise. Your physiotherapist can devise an exercise therapy that will help alleviate symptoms. Avoid working out too late in the day, however, or the symptoms may intensify.
  • Warm and cozy. Soak in a warm bath and massage your legs to relax the muscles. A physiotherapist can offer a massage that provides relief.
  • Cut the coffee. Sometimes, avoiding caffeine alleviates symptoms, so try staying away from chocolate, coffee, tea and soft drinks for a few weeks and see if there is any improvement.
  • Say om. Try relaxation techniques such as yoga or meditation. Stress aggravates RLS, so the more relaxed you are, the better.
  • Sleep smartly. Fatigue worsens RLS. Develop good sleep habits. Make sure your bedroom is cool, quiet and dark. Go to bed and arise at the same time daily, whether or not it is a workday. These routines should allow for good sleep.

If non-medical remedies don’t make a difference in your discomfort, your physician may recommend medication. However, there is no perfect solution, since each of the available medications comes with its own caveats and/or side effects, including increased drowsiness and susceptibility to falling down.

RLS treatment is highly individual – there is no “one size fits all.” With the help of medical professionals, including physicians and physiotherapists, you should be able to create a relief program that works best for you.
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Shoulder Impingement Syndrome

What is Shoulder Impingement Syndrome?

How can you shoulder your burdens properly if you are suffering from shoulder impingement syndrome?!

All kidding aside, if your shoulder hurts when you try to reach behind your back or retrieve an object from a high shelf, you should see your physician. Since the shoulder comprises a number of bones, muscles and tendons that allow for a range of motion in your arm, it is vulnerable to a variety of complaints.

Shoulder impingement syndrome, also known colloquially as swimmer’s syndrome or thrower’s syndrome, is the irritation of the tendons in your shoulder caused by rubbing against bone. To understand how it happens, let’s first discuss how the shoulder operates.

Impingement Syndrome Shoulder

A Bit of Anatomy and Physiology

Three major bones comprise your shoulder: your upper arm bone (the humerus), the collarbone (the clavicle) and the shoulder blade, or scapula. The latter two bones create a socket for the humerus, which is protected at the top by muscles and tendons that hold your arm in place. These are called your rotator cuff.

A lubricating sac, or bursa, forms a protective covering between the rotator cuff and the upper bones of the shoulder. The lubrication allows the rotator cuff tendons to glide freely through the bridge created by these upper bones.

Shoulder impingement syndrome results when bone rubs on the bursa and tendons and irritates them. Eventually, it can lead to inflammation of the rotator cuff tendons (tendinitis) and bursa (bursitis).

Treatment for shoulder impingement syndrome is important; otherwise, the tendons may start to thin out and tear. We’ve all heard stories about professional baseball players needing to rehabilitate a torn rotator cuff.

Impingement Syndrome Shoulder – Who Is Susceptible?

Rotator cuff pain, including impingement syndrome shoulder, is common among both young athletes and middle-aged adults. Athletes who repetitively raise their arms overhead, such as swimmers, tennis players and baseball players are particularly susceptible. Among adults, those who repeatedly lift things overhead, such as construction workers or painters, are also at risk.

Impingement Shoulder Syndrome

Types of Shoulder Impingement

Shoulder impingement is classified as either internal or external.

External impingement refers to a structural abnormality or interference with the proper operation of the rotator cuff. Primary impingement is generally due to the abnormally shaped arch in the shoulder bones or to bone spurs that come with degeneration of the bone. Secondary impingement usually results from poor shoulder blade stabilization that changes the position of the arch and causes rubbing; it can also be a consequence of tendons weakened from overuse.

Internal impingement generally occurs in athletes whose sports focus on throwing, such as javelin or baseball. The underside of the rotator cuff tendons rubs against a different bone (glenoid labrum) to cause pain at both the back and front of the shoulder.

Ouch, It Hurts!

Initially, symptoms from shoulder impingement syndrome can be mild and sufferers may not immediately seek treatment. Athletes may have pain when throwing or serving a tennis ball, while others may experience sudden pain when they reach or lift. Pain may radiate from the front of the shoulder to the side of the arm. There may be minor pain both during activity and while at rest.

As the impingement becomes more severe, there will be pain at night and loss of strength and motion. Activities, such as zipping a zipper, that require an arm to reach behind the back will become difficult. When this happens, it’s definitely time to seek medical attention.

Shoulder Impingement Syndrome

Diagnosis of Shoulder Impingement Syndrome

When your doctor examines you, he or she will test your shoulder for range of motion. You may also be required to undergo an MRI test, since they are useful for soft tissue injuries and may show the inflammation. An X-ray may be taken if bone spurs are the suspected cause of the impingement.

Shoulder Impingement Syndrome Treatment

Shoulder impingement syndrome treatment will generally begin with non-surgical options, including rest from activities that are suspected causes; non-steroidal anti-inflammatory medicine to reduce swelling and pain; and physiotherapy.

Your physiotherapist will work with you towards restoring the normal range of motion. Shoulder impingement syndrome exercises may include stretching exercises to relieve pain and improve motion. Once the pain in your shoulder begins to subside, your physiotherapist can work with you on strengthening your rotator cuff muscles so the shoulder impingement syndrome doesn’t recur.

If this course of shoulder impingement syndrome treatment doesn’t alleviate your pain, you make receive a shot of the steroid cortisone, since it is a powerful anti-inflammatory.

When all else fails, surgery may be necessary to create more space in your body for the rotator cuff. Generally, the surgeon will remove the inflamed portion of your bursa and may also remove a piece of the arch bone that rubs against the rotator cuff.

If surgery is required, you will probably need to wear a sling for a period of time to support the shoulder as it heals. Physiotherapy will then assist you in regaining motion and strength.

Remember, don’t ignore pain in your shoulder, because your body is signalling that something is wrong.

Suffering from SHOULDER PAIN?

Soft tissue injuries

What is a Soft Tissue Injury?

Coping with a soft tissue injury can be hard, depending on its severity. For active people, it can mean being out of commission for six weeks or more. Without giving rest and recovery their proper due, however, soft tissue injuries can easily recur.

Soft Tissues and Soft Tissue Injury Explained

The term soft tissues refers to muscles, ligaments, tendons and fascia, the connective tissues that bind the body together. Injuries to these tissues are generally tears, pulls or contusions and may occur as the result of a one-time incident, such as a misstep; though repeated use over time, such a work-related injury; or through overuse of fatigued muscles, such as running too soon after a marathon.

Soft tissue injuries are categorized into three grades:

Grade 1: Mild. Usually involves no more than 10 per cent of the muscle or ligament and will heal in a week or two.

Grade 2: Moderate. Involves 10 to 90 per cent of the tissue structure. Healing takes several weeks.

Grade 3: Severe. Severe tears; complete rupture of muscle or ligament. Will require physiotherapy over time to rehabilitate.

Common Soft Tissue Injuries

Some common soft tissue injuries include:

  • Back strains and sprains
  • Ankle strains and sprains
  • Torn ligaments in the knees, shoulders and ankles
  • Plantar fasciitis
  • Carpal tunnel syndrome
  • Tennis elbow
  • Bursitis
  • Tendinitis

Soft tissue injury back

How Bad Is It?

If any of these conditions apply to your injury, you should have it assessed by a physician:

  • You are unable to put any weight on the injured area
  • The injured area now has an unusual shape or looks deformed
  • You heard a pop or crack when the injury occurred
  • Any of the surrounding bones feel painful
  • You feel numbness or pins and needles around the injury or anywhere else

Soft Tissue Injury Treatment: First Steps to Recovery

If you injure yourself, you want to contain the damage and start the healing process as soon as possible. During this acute phase of the soft tissue injury, while the swelling, bleeding and pain are at their height, you want to protect yourself from further injury.

Soft tissue injury treatment

The first step of your soft tissue injury treatment is to stop the activity you were doing when the soft tissue injury occurred and following the RICE method: rest, ice, compression, and elevation.

Rest: Take any load off the injured body structure. Avoid all activities that cause pain and allow yourself time to recover.

Ice: Reduce the pain and swelling by applying ice to the injured area in the form of cubes or crushed ice wrapped in a towel; frozen peas – they mould nicely to the injured body part; or a sports ice pack. Ice for 20 minutes every two to three hours while you’re awake.

Compression: Wrap with a bandage that doesn’t obstruct blood flow or cause additional pain. This helps keep the area stable.

Elevation: To reduce pain and swelling, raise the injured area above the level of your heart, supporting it with pillows or a sling, as needed.

During the acute phase of injury, it’s also important to avoid HARM: heat, alcohol, running and massage. You don’t want to increase the blood flow too soon – it will only increase damage. This phase, during which the soft tissue injury settles, generally lasts a day or two.

Moving Toward Full Recovery

Once your soft tissue injury has stabilized, your body will enter the sub-acute phase, repairing itself by laying down new tissue that strengthens over time, reducing the need to protect the injury. During this phase, a physiotherapist will usually assess your soft tissue injury and oversee your soft tissue injury treatment.

Soft tissue injury

You will likely be given a mix of passive treatments, hands-on mobilization, rehabilitative exercises and support. Rehabilitation time depends on the severity of the injury, your own physical health and your age.

Passive treatments stimulate the injured area to promote the healing response by increasing energy to the site using electrical stimulation, ultrasound, magnetic field therapy or laser stimulation. Your physiotherapist may also manipulate your joints and will assign you exercises designed to help return your body to normal functioning. You may need to wear a brace or strap your injury to provide it with additional support as it heals.

Remodelling Yourself – Soft Tissue Injury Healing Time

Six weeks after injury, your body enters what is often termed the remodeling phase. Your new tissue is fairly strong, but it hasn’t stop regenerating. If the tissue isn’t strong enough to handle the level of activity you require, it will continue to stimulate the growth of more tissue so that your body can support you properly.

Remember: your treatment and soft tissue injury healing time depends on your injury, your age and your body. Don’t measure your progress against anyone else’s because everyone’s body is unique. Follow the advice of your physician and your physiotherapist and your body should return to its recognizable self.

Think you have a SOFT TISSUE INJURY?

frozen shoulder

What is a Frozen Shoulder?

It’s understandable if the thought of a frozen shoulder sends a chill down your spine, because it is a condition that equates to loss of mobility, something no one wants to experience. Frozen shoulder, also known as adhesive capsulitis, is a condition resulting when there is injury and inflammation in the soft tissues surrounding the shoulder.

The shoulder is a ball and socket joint, and the head of the upper arm bone, the humerus, fits into a cavity created by the shoulder bone, the scapula. The inflammation in this capsule makes movement more difficult and painful. The joint may also lose some of the synovial fluid that lubricates it.

However, reduced movement causes capsule to thicken and contract, leaving less room for the shoulder joint to move around, so it is actually a vicious cycle: the shoulder is painful, so you move it less often, but the less you move it, the more likely the capsule is to contract. In advanced cases, scar tissue can form between the upper arm bone and the capsule.

What is the main cause of Frozen Shoulder?

Frozen shoulder often occurs when a person doesn’t undergo therapy after an injury or a bout of tendinitis. It can also happen following a period of enforced immobility, such as being bedridden after a stroke or heart attack, or occur following a fall or an automobile accident.

Adults over 40 are most susceptible to frozen shoulder, and more women experience it than men. Diabetics are also susceptible. The condition may appear without any obvious injury or inflammation.

Frozen Shoulder Stages: A Three-Stage Concern

The development and healing of frozen shoulder is generally divided into three stages: the freezing stage, the frozen stage and the thawing/healing stage.

During the freezing stage, the inflammation has occurred. The shoulder stiffens and hurts and movement becomes challenging. The pain is generally worse at night. There are five symptoms generally associated with inflammation: pain, swelling, heat, redness and loss of function.

Once the shoulder is frozen, the inflammation begins to subside, because the shoulder capsule has thickened and reduced range of motion.

“Thawing” a frozen shoulder refers to eradicating the conditions that caused it, allowing for movement and disappearance of pain. Once inflammation has subsided, it is possible to move the shoulder more; this action allows for the lubricating synovial fluid to being flowing again and work its way into the shoulder capsule. As the shoulder moves more, scar tissue begins to break up and becomes reabsorbed by the body.

Frozen Shoulder Diagnosis

After discussing the symptoms with you, your physician will test your range of motion to see where the limitations in movement occur and assess the pain you are feeling. Frozen shoulder doesn’t allow for a great range of motion, either passively – when someone else moves your shoulder – or actively – when you move your own shoulder.

frozen shoulder exercises

X-rays or magnetic resonance images (MRIs) may be used to rule out other potential causes of your pain and restricted movement, such as arthritis or a torn rotator cuff.

What is the best treatment for a Frozen Shoulder?

Frozen shoulder doesn’t heal overnight, so patience is required; full recovery can take up to three years. Many patients respond to simple treatments to control pain and restore motion. The goal of treatment is to alleviate pain and restore motion with the help of physical therapy.

Initially, assistance comes in the form of pain management. Your physician will probably suggest a non-steroidal anti-inflammatory pill that is available over the counter: Aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn). Gentle massage may also be useful.

If you don’t respond to the non-prescription painkillers, your doctor may inject a corticosteroid into the shoulder joint or the surrounding tissue.

Concurrently, you should be working with a physical therapist to stretch the joint capsule and, later, to strengthen the surrounding muscles. Physiotherapy is a major key to recovery; your physiotherapist will determine how far you can push yourself and teach you frozen shoulder exercises that you can ultimately practise at home, including both stretches and range of motion exercises for frozen shoulder. Sometimes, heat is applied to loosen the shoulder prior to exercise.

Surgery for Frozen Shoulder

In extreme cases, surgery may be required to loosen the shoulder capsule. This most commonly means either manipulation under anesthesia or arthroscopic surgery or a combination. During manipulation, the doctor forces shoulder movement, tearing scar tissue and allowing healing to begin. Arthroscopy requires small incisions to cut through the joint capsule to loosen it. Post-op rehab physical therapy is necessary after frozen shoulder surgery to maintain the gains that it achieved.

If you suspect that you are suffering from frozen shoulder, consult with your physician so that the proper course of treatment can be followed. After all, it’s no fun to ask for help in reaching objects on a high shelf or putting on your coat.