Shoulder Dislocations

The shoulder is an amazing joint with incredible flexibility. It doesn’t attach directly to the spine, like the hip joint; instead, it is held to the body through a complicated system of musculature and
indirectly by the collarbone (clavicle) to the front of the rib cage. Many other joints in the body are extremely stable, thanks to the structure of the bones and ligaments surrounding them. However, the shoulder has so much movement that some stability is sacrificed. It is for this reason that shoulder dislocations are a relatively common occurrence.

What is a dislocation and how does it happen?

As the name suggests, a dislocated shoulder is where the head of the upper arm is moved out of its normal anatomical position to sit outside of the shoulder socket joint. Some people have more flexible Joints than others and will unfortunately have joints that slip out of position easily without much cause. Other people might never have a dislocated shoulder except for a traumatic injury that forces it out of position. The shoulder can dislocate in many different directions, the most common being anterior. This occurs when the arm is raised and forced backwards in a ‘stop sign’ position, which can occur in many situations.

What to do if this happens

The first time a shoulder dislocates is usually the most serious. If the shoulder doesn’t just go back in by itself (spontaneous relocation), then someone will need to help to put it back in. This needs to be done by a professional as they must be able to assess what type of dislocation has occurred, and often an X-ray needs to be taken before the relocation happens. A small fracture can actually occur as the shoulder is being put into place, which is why it is so important to have a professional perform the procedure.

How can physiotherapy help?

Following dislocation, your physiotherapist can advise on how to allow the best healing for the shoulder. It is important to keep the shoulder protected for a period to allow any damaged structures to heal as well as they can. After this, a muscle-strengthening and stabilization program can begin. This is aimed at helping the muscles around the shoulder to provide further stability and prevent future dislocations.

This information is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

Gluteal Tendinopathy

What is Gluteal Tendinopathy?

When tendons are repeatedly placed under more tension than they can deal with, they can have a failed healing response. This can cause changes to the structure of the tendon and is known as a
tendinopathy. When this occurs in the tendons of the gluteal muscles it is referred to as gluteal tendinopathy. The gluteal muscles are three large muscles located at the back of the pelvis that provide most of the muscle bulk of buttock region. These muscles work together to keep your pelvis level when standing and are responsible for many movements of the hip. They play an important role in standing, walking and running. The two deepest gluteal muscles, gluteus medius and gluteus minimus, attach from the center of the pelvis (the sacrum) and insert into the bony
outer region of the upper thigh, called the greater trochanter via the gluteal tendons.

What causes tendons to develop tendinopathy?

Tendons, like muscles, skin and bones are living tissues and their strength and elasticity is influenced by a variety of factors, including hormones, age, how often and how much they are used. Rapid changes in activity levels or simply performing the same tasks too often can place a tendon under more stress than it can tolerate and it begins to break town. Recently it has been shown that
tendon health is also negatively affected by compressive forces, which can occur from blunt trauma or even habits such as crossing you legs, or sleeping on your side on a hard mattress.

What are the symptoms of Gluteal Tendinopathy?

When gluteal tendons are affected by tendinopathy, a typical pattern of sharp pain at the outside of the hip with specific movements is present. The pain is usually worse with walking, going up and down stairs and running. The pain can become quite severe, and eventually can impact day-to-day activities.

How can physiotherapy help?

A thorough assessment is required for an accurate diagnosis and once gluteal tendinopathy is confirmed, your physiotherapist will be able to identify which factors have contributed to your condition and help to address these. It has been shown that specific loading exercises and muscular retraining can stimulate the tendon to heal and remodel the collagen fibres into a more organized pattern again. Your physiotherapist can investigate any postural habits or activities are contributing and address these as required.

This information is not a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

LCL Tears

What is the LCL?

The knee is one of the largest joints in the body and has only one plane of movement. This means it bends and straightens but does not twist (much) or move from side to side. To keep the knee from moving in other directions, the knee is supported by many strong ligaments, with two of these being found on either side of the knee. The inside ligament is the ‘Medial Collateral Ligament’ (MCL) and the outside one is the ‘Lateral Collateral Ligament’ (LCL). The primary role of the LCL is to prevent the lower leg from moving too far towards the midline in relation to the upper leg.  Both the LCL and MCL are extremely strong ligaments and provide lots of support to the knee during movement however, they are still vulnerable to injury.

How do tears happen?

The LCL is injured less often than the MCL, however tears do still occur. The most common way the ligament is damaged is through a force causing the knee to move inwards in relation to the upper leg, or a twisting of the knee. This can be seen in sports that involve changing directions or with a direct force, such as a rugby tackle. This injury can also occur from a simple fall and as with all sporting injuries, it is not only athletes who can be affected, anyone can tear their LCL in the right circumstances.

What are the symptoms?

Following an injury to the LCL, common signs and symptoms are a ‘popping’ sound at the time of injury, immediate pain with weight bearing and swelling and a feeling instability. The severity of the injury will impact how much each of these symptoms are felt and LCL tears are classified as either Grade I, II or III, which helps to direct treatment. A grade I tear is where a few fibers of the ligament are stretched and damaged, a grade II is where this a partial rupture of the ligament with some instability of the knee and Grade III is a complete tear.

How are LCL tears diagnosed?

Your physiotherapist is able to perform clinical tests to evaluate if there is any instability of the knee from an LCL tear. An MRI can confirm this diagnosis and an Xray may be required to rule out any associated fracture. It is possible for nerve damage to occur at the same time as an LCL Tear, which will result in weakness and loss of sensation in the lower leg. Severe injuries are more likely to involve injury to other parts of the knee and your physiotherapist will make a full evaluation of all your injuries on assessment. Most LCL tears are managed well with just physiotherapy and support of the joint, however severe tears and associated nerve damage may require surgery. Your physiotherapist and medical team will work together to help determine the best course of action for each individual injury

How can physiotherapy help?

For tears that don’t require surgery, your therapist will advise you on how to best support and protect the injured joint. In the first 48 hours, RICE protocol (Rest, ice, compression, and elevation) is applied to reduce any pain, swelling, and inflammation. Following this period, you will be advised on how best to mobilise the joint whilst preventing any further damage. Return to sport will be dictated by healing times with a full recovery expected by 6-12 weeks. Following ligament damage, balance, strength, and proprioception are often impacted and your physiotherapist will develop a program to address this, which is an important part of preventing further injury. Tears that are repaired surgically will require a longer program of rehabilitation and close liaison with the medical team.

This information is not a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Snow Sport Injuries

Snow sports are exhilarating and fun, but as we know only too well, they come with a safety warning: injuries can happen. A recent study titled New Zealand Snow Sports Injury Trends Over Five Winter Seasons 2010–2014 found that over a five-year period, more than 18,000 skiers and snowboarders suffered injuries on the slopes. Falls accounted for 74.3% of all injuries, followed by collisions (9.6%), jumps (7.3%), man-made terrain features (5.3%) and lifts (2%). The most common injuries were to the knee (36%), followed by the back (18%), wrist (14%), head (11.2%), shoulder (11%), lower leg (6.4%), and collar bone (3.4%).

At Queenstown Physio we see hundreds of knee injuries every season, mostly from skiing.  They are typically ligament injuries, most commonly MCLs. They tend to be twisting-type injuries where the knee becomes the pivot point. Skiers can also have more serious knee injuries such as ACLs, and again, that’s when a person’s ski doesn’t release from their boot. Another injury specific to skiers is “skier’s thumb” – when skiers fall and the pole forces their thumb backwards injuring the ligament.

Snowboarders, on the other hand, come to our clinic with mostly upper limb injuries because both their feet are attached to the board, so they don’t have the same twisting force to the lower limbs. Snowboarding injuries are commonly fractured wrists or collarbones, or shoulder and elbow dislocations. However, snowboarders can also rupture their ACL following a “big air, flat landing”, where they overshoot a jump and miss the angled slope, and land on the flat with their quad muscles absorbing the full force of the landing. Then there is “snowboarder’s ankle” or a talus fracture, also from landing hard after a jump. This injury has become more common since snowboarding increased in popularity.

Injuries are usually the result of the force of a fall, but sometimes it is purely bad luck and the way the person happens to fall. However, clients often blame fatigue. Our physio Deborah’s advice?
“We always say, don’t call last run.” As the name implies, “last run” is the last run before heading to lunch or home for the day, and this can often be when an injury occurs. She says that “weekend
warriors” like herself are most at risk from fatigue-related injuries. These are people who work Monday to Friday and go to the mountain only on weekends. “We’re likely to think we’ve only got the weekend, and then we go too hard and too fast.” Another common cause of injury is people exceeding their technical ability. People go too fast for their skill level, use the chairlift before
they can get off safely, or progress to the more challenging slopes or the terrain park – where the jumps and other man-made obstacles are – before they are ready. There are other factors that can play a part, such as poor gear setup, particularly if the boot binding is too tight and doesn’t release; and icy conditions, which make falling injuries more severe. That’s when we see whiplash and concussion, which we see in both skiers and snowboarders. Or it can be breaks and fractures.

There are ways to mitigate the risk of injury, and Deborah’s advice to clients is simple and easy to follow: “Obviously the stronger and fitter you are, the less likely fatigue will play a part in any injury. But I always tell my clients to walk from the car park and not to take the shuttle, because the walk is a nice, gentle warmup, especially for lower limbs. And then to ease into it on the
slopes, start gently.” Deborah recommends protective gear, including helmets for everyone and wrist guards for snowboarders, particularly for beginners and those progressing to the terrain park where there’s further to fall and, therefore, more force in the landing. After a day on the slopes, Deborah would encourage stretching, particularly the lower limbs – quads, hamstring, glutes and hips. For pre-season preparation, Deborah prescribes squats, particularly done on an uneven surface to challenge balance as well as build strength.

The most common question Deborah gets asked is: “When can I get back on the snow?” For clients on holiday from Australia, the question becomes more loaded. “In the more serious injuries,
that’s really easy to answer: they won’t be back. But in a grade one sprain in any ligament – and the majority is knees – it can be a bit more challenging because they’ve got a limited time and a small injury, and they don’t want it to affect their whole holiday.” Deborah stresses the need to respect healing timeframes, but knows that this can fall on deaf ears. “Often, I recommend that they don’t ski, but I know that a lot of them will. I explain to my patients that they won’t ski to their full ability if they’ve got a little niggle, and that puts them at risk of
other injuries.” When assessing whether a client is fit for return to the ski field, Deborah uses a checklist to assess strength, ability and balance. For an injured knee, she will get clients to hop, jump and lunge. “With a hop, I’m looking more at their power up. When they’re jumping, I’d look at how they land comparing left and right. And with skiers, you need that sideways agility so that’s the lunging or jumping out on one leg to the side.”

In Deborah’s opinion, the risk of injury is small and shouldn’t stop people enjoying the snow. She has worked in a first aid clinic on Coronet Peak and says the statistics tell the story: “On a busy day, we might see 30 patients, but there would be 3,000 or 4,000 people up the mountain. Obviously, some come straight down the mountain, but overall injuries are a very small proportion of the number of people up there having a great time.”

Optimising Injury Healing – Effects of Alcohol

Immediately after an injury there is bleeding from damaged tissue, which forms a bruise. There is also an influx of fluid from the blood stream (swelling), which brings nutrients and cells into the area to begin clearing away the damaged tissues and to fight any infection which may have entered through a break in the skin. Although this swelling is a necessary and important part of the healing process, the formation of new tissue to repair the damage cannot begin until the swelling has subsided and the bleeding has stopped. This process takes from three days to a week. Alcohol is known to increase the diameter of blood vessels, thus increasing blood flow, in a process called vasodilation. Increased blood flow can increase the amount of swelling and bleeding into the injured area, ultimately prolonging the duration of the healing process and recovery time.

 

Alcohol is an analgesic and can mask the pain and injury. Pain is an important indicator of injury severity – after an injury, pain serves the frustrating but useful purpose of stopping you from moving or putting weight on an area that can’t cope with the increased load. Drinking after an injury allows you to do things which would otherwise be limited by pain, and subsequently increases the amount of damage by overloading the injured area too soon.

 

Tissue healing requires vitamins, minerals, fluids and rest. Alcohol decreases the efficiency of nutrient absorption for the gut and is a diuretic, which means that it increases the amount of urine you pass. Consumption of alcohol after injury therefore depletes the body of essential vitamins and minerals and causes dehydration at a time when the body is most in need of good nutrition.

 

Unfortunately, the effects of alcohol consumption do not subside when you sober up. The repercussions of alcohol consumption on the body can last up to five days after two consecutive nights of drinking.

 

http://www.massey.ac.nz/massey/about-massey/news/article.cfm?mnarticle_uuid=752BCC77-BDD9-826F-CB3F-4E7B4699B08E

Bike Injuries – Sports & Exercise Physiotherapy Bulletin

Some very interesting reading in the Sports & Exercise Physiotherapy bulletin on mountain biking injuries. Below is a summary of points:

  • Although the number of mountain bikers is increasing each year and the total number of biking injuries are rising, the actual frequency of injuries per hour riding is decreasing.
  • But, the number of injuries are still high – 50% of recreational and 80% of competitive bikers report at least one severe/major injury related to the sport.
  • Bike park injuries have been reported to be as high as 15 in 1000 exposures with 87% of riders being male and 86% of injuries requiring local emergency attention.
  • Fractures made up a large portion of presentations to medical centres with a 2:1 ratio of upper limb to lower limb fractures seen.
  • As we move from XC –> Trail –> DH disciplines, relative injuries change from more overuse injuries towards an increased risk of trauma from falling.
  • The most common and often preventable overuse injuries are knee pain (patellofemoral pain or tendonopathies), arm/wrist nerve issues (cyclist’s palsy) and neck and lower back pain.
  • Improper bike fit is one of the top causes of overuse injuries in mountain biking.

It is a very interesting read with the full article being found here.

Let’s hope everyone has one of those injury free days like 985 per 1000 rides should be, but if you have one of the unlucky 15, make sure you get that injury dealt with promptly so you can get back on the bike and have fun again. Our team members are all highly experienced with optimising your recovery and getting you back on your bike quickly.

Plus, don’t let that niggle turn into an injury. If you want to get the most out of you bike, book in with Paul for a 2 hour Bike Fit session to prevent injury and maximise pedalling efficiency.