Frozen shoulder, "painful stiff shoulder" or "adhesive capsulitis" is characterised as an initially painful but progressive joint condition that causes limited range of motion over time. This is an inflammatory condition that causes fibrosis or "scarring" of the glenohumeral joint capsule. This condition is complex, often occurs in females, and is multifactorial involving both environmental and genetic factors. A major risk factor is diabetes type II. It can take 2-3 years to resolve and some patients may not ever fully recover. Treatment involves a combination of physiotherapy treatment (manual therapy and home exercises involving stretching, strengthening and mobilty) and medical management such as cortisone injections and hydrodilatations (distension arthrography).
Subacromial pain syndrome is a non-traumatic one sided condition of the shoulder. This common condition is two thirds of all shoulder complaints at Acland Street Physiotherapy. This condition is more prevalent as you age. It usually causes pain localised around the acromion (bony process of the shoulder) when lifting the arm. Usually one or structures are injured within the subacromial space.
Common conditions that cause subacromial pain syndrome include:
The above conditions often respond very well to physiotherapy treatment which includes manual therapy, dry needling, extracorporeal shockwave therapy, exercise programs involving stretching, strengthening the rotator cuff and stabilising the scapula (shoulder blades).
Supraspinatus tendinopathy or supraspinatus "tendinitis" is a common source of reported shoulder pain in patients that perform repetitive overhead activities, overloading the tendon. Examples of this include painting, hairdressing or sports requiring overhead actions such as tennis and volleyball. This is commonly clinically diagnosed by experienced physiotherapists and formally confirmed on shoulder ultrasound scans. The supraspinatus tendon is part of the rotator cuff muscle group in the shoulder, involved in stabilising, "externally rotating" and "abducting" the shoulder (side raise). The tendon often experiences impingement as it passes in between the humeral head ("ball and socket" joint) and acromion (the bony process on the shoulder blade). Friction between the tendon and acromion is reduced by the subacromial bursa which can also get inflamed causing "subacromial bursitis".
Supraspinatus tendinopathy can cause significant reduced shoulder function, pain, strength and range of motion, particularly with overhead activites. Physiotherapy treatment is often the first line of treatment before a cortisone injection is considered. Manual therapy, extracorporeal shockwave therapy, dry needling and a rotator cuff strengthening and shoulder stabilisation exercise program often can help resolve the problem quickly.
"Uneven shoulders" are often noticed when you look in the mirror as you get dressed after a shower. This can be a cause of various symptoms such as tension headaches, pain, tightness, pins and needles and a lack of general mobility in the neck and shoulders. Most of the time, it is not a major health concern. Common causes include:
If you are worried about having "uneven shoulders", please do not hesitate to get it professionally assessed by an appropriately trained physiotherapist or your GP.
Subacromial pain syndrome is usually non-traumatic, one sided shoulder problems which cause pain, localised around the acromion (bony process of the shoulder blade). This painful condition makes up over two thirds of the shoulder presentations at Acland Street Physiotherapy. Patients often report the pain to be worse with lifting of the arm. From an anatomical point of view, pain associated with this syndrome suggests that there is a lesion or injury associated with one or more structures within the subacromial space.
Common conditions associated with subacromial structures include:
These clinical conditions often respond very well to physiotherapy treatment and modified rest. Physiotherapy treatment may involve manual therapy, extracorporeal shockwave therapy, dry needling and rotator cuff strengthening, shoulder stretching and stabilisation exercises.
70% of patients who present with neck pain at Acland Street Physiotherapy are clinically diagnosed with cervicogenic headaches or "tension headaches". "Cervicogenic" simply means the headaches are originating from the cervical spine or neck region. It is important to note that different medical conditions can trigger this pain. his includes osteoarthritis, disc prolapses, or even a whiplash injury. It can also be caused by lifestyle factors such as occupational or personal stress and poor posture. Falling asleep in an awkward position with an unsupportive pillow can also trigger such symptoms.
Depending on the cause or trigger, this condition generally responds well to physiotherapy advice and treatment. Treatment may involve heat therapy, dry needling, soft tissue massage release of the affected structures including muscles, nerves and ligaments). Stiff joints in the neck (often the cervical facet joints often respond very well joint mobilisation, joint manipulation and therapeutic exercises.
This is an introductory explainer YouTube video (3:54) I often share with my patients at Acland Street Physiotherapy who are clinically diagnosed with cervicogenic headache. Enjoy!
Low back pain (LBP) and associated sciatica (leg symptoms originating from the lower back) is the leading reason why the local residents of St Kilda visit Acland Street Physiotherapy.
Low back pain affects 60-80% of the population (see reference) throughout their lifetime. According to multiple recent studies, about 10% of the population are physically disabled by low back pain.
Low back pain is usually characterised into 3 types:
1. Acute - Symptoms experienced for less than 6 weeks.
2. Sub-acute - Symptoms experienced between 6-12 weeks.
3. Chronic - Symptoms experienced for greater than 6 weeks.
At Acland Street Physiotherapy, we commonly see patients in all 3 categories with both the acute and chronic categories being the most functionally debilitating for our patients.
Non-specific or mechanical lower back pain accounts for approximately 90% of the cases of low back pain presentations in primary care, that is seen by physiotherapists. 10% are generally more serious medical conditions that need urgent medical intervention.
Very occasionally at Acland Street Physiotherapy are we presented with more serious medical conditions associated with low back pain symptoms. In such cases, we generally refer these patients directly for further diagnostic imaging or back to their primary GP for further investigations.
Through taking the patients history and physical testing, physiotherapy assessments aim to rule out the unlikely chances of a more serious medical condition or emergency. In addition, it aims to identify the impairments and likely causes that may have contributed to the pain and the likelihood of the lower back condition becoming persistent.
From our many years of experience, non specific low back pain is commonly caused by disorders of the neural or musculoskeletal structures of the lumbar spine, which often responds well to physiotherapy treatment and advice.
Diagnostic imaging (ie. x-ray, CT scan or MRI of the lumbar spine) are generally not recommended in the first month of lower back pain and only when more serious medical conditions are suspected.
Sciatic or leg pain originating from the lower back condition is a common presentation. Like low back pain, it is often due to disorders of neural or musculoskeletal structures of the lumbar spine assessed by a physiotherapist. In addition, low back pain is generally caused by the result of such structures.
International clinical guidelines recommend non-pharmacological management of non-specific low back pain which is commonly physiotherapy treatment. Physiotherapy treatment often involves manual therapy to alleviate the symptoms and encourage movement, therapeutic exercises, personalised education and supportive taping. Prevention of lower back pain recurrence involves the physiotherapist to devising an individualised exercise program for you to target the specific issues assessed, as well as to improve general health and wellbeing. This could involve a home exercise program, supervised gym program, recommending pilates or yoga classes, or a gym and swimming program.
Learn about some self help exercises for your low back here.
FOR ADVANCED EXERCISE INDIVIDUALS: WHAT ARE THE BEST STRENGTHenING EXERCISES to prevent hamstring injuries?
Hamstring injuries are a popular presentation at the Acland Street Physiotherapy due to gym/HIIT related and sporting injuries. Common clients I see who come in needing physio treatment for their hamstring injuries include those are who involved in HIIT (high intensity interval training) training (such as sprints), track and field athletes, soccer, football and rugby. If you would like to prevent hamstring injuries and are involved in a strength and conditioning exercise program, it is important to appreciate that different hamstring injuries require different exercises to ensure adequate loading during rehabilitation.
Physiotherapy rehabilitation exercises such as Romanian Deadlifts (RDLs) and hip extensions (which are hip dominant) have a higher recruitment of the long head of biceps (lateral "outer" hamstring) relative to medial "inner" hamstrings (semimembranous and semitendinosus). Exercises such as Nordics & Hamstring Curls (which are knee dominant) have a higher recruitment of medial hamstrings relative to long head of biceps.
So what are the practical implications of these hamstring specific exercise concepts?
ACL reconstruction patients with a hamstring graft (semitendinosus tendon) would benefit greatly from Nordics/Hamstring Curls, and hamstring strains to the long head of biceps which is commonly injuried during sprinting would more likely benefit from RDLs and Hip Extensions.
I would highly recommend that you should incorporate both types of hamstring strengthening (hip dominant and knee dominant exercises) in a general hamstring injury prevention program, However, if you are limited for time, it is it is best to see an experienced physiotherapist to get thoroughly assessed and prescribed a specific exercise program to ensure quality and safety.
1. Well documented holistic health benefits
Running can significantly improve your mental and physical health. Benefits include:
It takes less than 2 months to prepare yourself to run for 5km. The Mayo Clinic provides a 7 week training schedule for beginners which involves a mixture of running, walking and resting.
This strategy proposed helps you reduce your risk of injury, stress and fatigue while keeping the activity enjoyable.
3. Time efficient and versatile
You can run 5km anywhere safely without relatively minimal disruption to your busy life. Allocating 30-45 minutes of your day to go for a 5km run is not too much to ask for even for the busiest individuals in the world. Running is a great way of maintaining fitness levels as it can easily be incorporated into the lifestyles of those who regularly travel to unfamiliar locations perhaps where there are potentially no gym facilities, exercise classes or basic equipment.
It also allows you extra time to do different forms of cross-training and exercise activities without getting bored and maintaining your general health.
On a rainy day, you can also perform your run indoors on a treadmill or at the gym with a 1% incline to simulate the benefits of outdoor running.
4. Cost effective and simple
There is minimal equipment that you will need to invest in. You simply need some comfortable and supportive running shoes such as a pair of ASICs and some loose shirts and shorts.
Overuse injuries are more likely to occur with longer distances such as training for a marathon. Overuse injuries can increase your healthcare costs with your doctors and physiotherapists. Running injuries include:
Meeting national exercise guidelines:
Running 3 times per week for about 30-60 minutes at moderate to high intensity satisfies evidence based national physical activity guidelines. Once you improve and start running faster at high intensities, you can satisfy the guidelines by running 25 minutes 3 times per week, saving you time.
5. Compete instead of painfully finishing
Competing against yourself and others can give very satisfying and a rewarding experience.
The challenging of trying to finish say a marathon can place significant stress on your body and potentially have a negative impact on your health.
Free timed community Parkruns are available all around the world to benchmark against yourself or others.
In addition, you can quite easily compare how fast you run compared to others in your age group and gender using the popular age graded calculator:
In running, age-graded scoring is based on how fast you run (by correcting it to what your speed would have been at your prime age) and a percentage value of the world record for your gender. Performance standards listed on the USATF site give approximate comparative levels: 90 percent = world class; 80 percent = national class; 70 percent = regional class; and 60 percent = local class.
6. 5km runs do not cause nipple bleeding
Nipple bleeding can be extremely painful and unmotivating. It is a result of your skin directly rubbing on your clothes, poor ventilation and sweating.
7. Help yourself and help others
Many charities and non-for-profit organisations hold fundraising events associated with 5km runs as the distance is suitable to get everyone involved. Therefore, 5km runs are a great way to contribute to be social, contribute to those in need and help yourself in the process.
The following are some fun photos of me competing in a half marathon event and local Parkrun in Melbourne:
Many of my patients ask me the following question: What exactly is the exercise dosage I should do (the number of reps and sets) perform to optimise their either physical rehabilitation or fitness program for strength gains?
As a rule of thumb, here is the advice I generally give to someone who is relatively physically normal with no particular past medical history that may make performing the following task unsafely: