Why Does My Shoulder Hurt When I Don’t Remember Injuring It?
The shoulder is a complex joint and has many different anatomical components that could be the source of pain. At a recent shoulder course, the lecturer listed off at least 48 different diagnoses for shoulder pain. One of the most common diagnoses that can cause ongoing shoulder pain with no apparent mechanism of injury is tendinopathy.
What is the difference between Tendinopathy and Tendinitis?
Most of us have heard the word tendinitis but not tendinopathy. Any type of pain around a tendon used to be called a tendinitis. The issue with this terminology is that it implies that all tendon injuries have an inflammatory component. Research does not support this. Studies show that overuse tendons tend to degenerate or have changes and degradation of the collagen fibers, but have minimal inflammation. These changes can cause pain, weakness and sometimes tearing. Why does the terminology matter? Treatment for an actual tendinitis where the tendon is hot, swollen and is due to a recent injury most likely would be rest and anti-inflammatories. Treatment for a tendinopathy is very different as there is no need to target inflammation. Research recommends functional rehabilitation that includes specific eccentric strengthening exercises as well as targeting the causes or aggravating load to the tendon.
How does a Tendon injury occur?
A tendon is the part of the muscle that attaches to the bone. It is designed to withstand high repetitive loading. When too heavy or constant, repetitive loading is placed on a tendon, it can cause too much strain or stress on the tendon and create microtears. If the rate of healing is less than the injury rate, as is the case with constant or repetitive overloading, the tendon will go into disrepair and collagen degeneration will occur. This is called a tendinopathy. The most common areas in the shoulder this occurs in are the supraspinatus, infraspinatus, long head of biceps or subscapularis tendons. This overloading can be caused by multiple reasons, including overtraining in a sport or exercise, or repeating the same movement repetitively at a job or household chore.
Symptoms of a Tendon injury in your shoulder
-Pain can come on suddenly, appearing seemingly like there was no cause for the injury
-Pain is usually worse with the use of your arm but may be better at rest
-Pain may be worse as the day goes on and you may be more stiff and sore in the morning when you wake up
-Crunching or noises with shoulder movements may also be present
Early intervention and correct diagnosis is the key to recovery. A qualified Physiotherapist can do specific testing to sort out if your shoulder pain is a tendinopathy or one of the other 47 diagnoses. If it is a tendinopathy, they can assess what stage of repair that tendon is in and make appropriate treatment recommendations.
Tendon injuries can be very frustrating as they can appear to come on suddenly even though the tendon has most likely been overloaded over a period of time. They can take weeks to months to recover depending on how much collagen degeneration has occurred. If the tendon persists to be overloaded or used in the wrong way too early in its process of recovery, further damage can be done to the tendon, lengthening the recovery time.
To keep from injuring the tendon further you may need to learn how to change how you are performing your work or aggravating activities. You may need to learn how to correct muscle imbalances around your shoulder blade, neck and shoulder. If it is a specific sport that is causing the damage, getting help improving your technique may be beneficial. Closely monitoring your exercise or work loads can also help. Doing a proper warm up, not starting with too heavy of a load or doing something for a long period without proper breaks can go a long way in preventing these types of injury.
Getting your shoulder pain assessed early on, being patient with your tendon injuries and receiving proper physiotherapy treatments can lead to a quicker recovery!
Submitted by: Renee Poloprutsky
BScpt, FCAMPT, IMS Certified
Brett M. Andres, MD and George A. C. Murrell, MD, Dphil Clin Orthop Relat Res. 2008 Jul; 466(7): 1539–1554. Published online 2008 Apr 30. doi: 10.1007/s11999-008-0260-1
Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon
Dry Needling is becoming a commonplace modality used by many healthcare practitioners such as Physiotherapists, but what exactly is it and how does it work? Fifth Ave has you covered – listed below are the answers to some frequently asked questions about Dry Needling: Q: What’s The Difference Between Dry Needling and Acupuncture? A: This is the most frequently asked question that we get at Fifth Ave Physio. They both use needles, right…? Right, but then that’s where the similarity ends. Acupuncture is a traditional Chinese medicinal practice that uses fine filament needles inserted along meridians (thought to be pathways of energy flow throughout the body) to establish an equilibrium within the system. With Acupuncture, the needles are often left in place for a longer duration of time (about 15-30 minutes), and there’s often very little sensation felt with these needles. Dry Needling on the other hand, uses a slightly thicker gauge needle inserted directly into palpable focal regions of tension within the muscle tissue – motor points (which are often referred to as “knots” or “trigger points”) with the intent of relaxing or resetting the muscle to its normal resting condition. This resetting of the muscle provides relief of both the local pain and/or tension as well as the referral pain that may be created by some trigger points. In most cases, the needle is not left in; however, if the muscle is particularly tight or resistant to releasing, the needle may be left for a few minutes and may be combined with electrical stimulation. Unlike Acupuncture, there is often a strong sensation of an involuntary muscle twitch which is often described as “odd” and occasionally “achy” or “uncomfortable”. In summary, the main differences between Acupuncture and Dry Needling include the foundational theory, the goal of the technique and the application of the needle – the location, duration, sensation and effect.
Q: What’s The Difference Between Dry Needling and IMS (Intra-Muscular Stimulation)?
A: There are several models for the application of Dry Needling which differ slightly in the theory and methodology of using the needling technique; however, they are largely the same. Dry Needling is a generic term for the use of a needle to release a motor point in the muscle, while IMS (Intramuscular Stimulation) and FDN (Functional Dry Needling) are essentially brand names that depict the Practitioner’s specific training background.
Q: Why Is It Called ‘Dry’ Needling?
A: Dry Needling implies that there are no injections involved in the technique. The needle is blunt without a lumen (no hole to inject fluid), so it is simply the stimulus of the metal needle within the muscle tissue that is sufficient to create the desired result.
Q: How Does Dry Needling Work?
A: The introduction of the metal needle into the motor point of the muscle causes an involuntary twitch response. This muscle contraction has been shown to quickly remove the pain producing chemicals such as hydrogen ions from the muscle. This allows the muscle to reset and normalize its contract-relax cycle, whereas it had previously been stuck in the contract phase. The sudden contraction of the muscle has also been theorized to restore normal blood flow to the region, which provides nutrients and substrates required for normal muscle function. A muscle that is deprived of these nutrients is unable to relax properly, thereby limiting its functional use and resulting in the accumulation of chemicals that cause muscle soreness and fatigue.
Q: Who Can Do Dry Needling?
A: Due to the high level of knowledge and skill involved, Dry Needling is considered a restricted activity by the College of Physical Therapists of Alberta (CPTA). Only a Health Care Practitioner who has been trained and examined in the use of Dry Needling is permitted to use this technique. The CPTA website provides information regarding whether your Therapist is permitted to perform this restricted activity.
Q: What Conditions Can Be Treated With Dry Needling? How Do I Know If It Is Right For Me?
A: Dry Needling is used to treat a wide variety of musculoskeletal conditions, including ankle sprains, whiplash, TMJ dysfunction, lower back pain, and carpal tunnel. Just about every injury or pain state creates dysfunction within the surrounding muscle tissue, which can be effectively treated with this technique. For example, an ankle sprain may result in tight muscles along the shin or in the calf, which can lead to excessive pain and discomfort in the ankle. In this situation, dry needling can be used to relax and off-load these muscles in order to provide optimal conditions for the healing ligaments and tendons.
Q: Why Am I Sore After The Dry Needling Treatment?
A: The process of resetting the muscle causes a cascade of events to occur in the muscle cell. The soreness following Dry Needling is attributed to the release of hydrogen ions, a component of lactic acid. These ions are trapped within the tight/contracted bands of muscle. When the muscle is released by the needle, these ions are released into the bloodstream as they get flushed out of the muscle. This creates a sensation quite similar to post-exercise muscle soreness (fatigue, achiness, heaviness), which can last 24 – 48 hours following treatment. The muscle is not injured or damaged with the insertion of the needle. The tip of the needle is actually blunt, intended to separate the cells as it enters the muscle rather than cut through the cells the way traditional needles do. On occasion, bruising may occur, but this is due to the needle coming in contact with a blood vessel and does not indicate injury to the muscle.
All Fifth Ave, Physiotherapists are fully trained and highly skilled in the application of Dry Needling. If you think you’re a candidate for this type of treatment, come see us today for an assessment, or contact us at [email protected] for more information!
Pregnancy is one of the biggest changes a woman’s body will every go through. It is remarkable that a woman’s body is able to grow and accommodate a human being; muscles expand, organs shift, and blood volume doubles to create space for the tiny human. This change happens over 40 weeks, but, unfortunately, many women end up living with the after-effects for years!
Once you have had a baby, you are considered postpartum: even if you are a grandmother, you are still considered postpartum. This is not a negative label, but a record of what your body has done; however, this becomes a problem if you are not able to get your body back to its original capabilities. We often see women who have not been able to reach their goals or exercise at the same level of intensity as they were before their children – even 10 years later!
Shockwave Therapy has been used in Canada for more than 2 decades. It is a common treatment offered to patients who have a tendinopathy. You may know of the condition as a tendinitis. But this term is not scientifically correct because research shows that there is actually little or no inflammation present in these conditions.
What you need to know about tendinopathies:
- A tendinopathy is a broad term that includes a painful tendon and the surrounding area in response to overuse.
- Tendons are tough fibres that connect muscle to bone. Tendon injuries usually occur in three areas:
- musculotendinous junction (where the tendon joins the muscle)
- mid-tendon (non-insertional tendinopathy)
- tendon insertion (where it attaches into bone)
Most tendon injuries occur near joints like the shoulder ankle, knee, and elbow. A tendon injury may seem to happen for no apparent reason, but usually it is a result of a repetitive overload.
So, what is actually going on in your tendon that has forced you to stop playing your favourite sport?
When you look at your Physiotherapist’s business card, do you ever wonder what do all those initials mean?
May is National Physiotherapy month, and what better time to clarify what all the letters behind our names mean. Seeing the collection of letters may cause you to feel many things: intimidated, that you are good hands or maybe you are just plain confused and have no idea what they mean. Like many professions, we like to speak in our own “special” language that means a lot to us but can be confusing to you.
Let’s decode many of the common acronyms and abbreviations, so you are aware of the designations your Physiotherapist may have and what difference it may make to you.
Establish a baseline so you can play to your strengths and work on your weaknesses. What if I told you that your Physiotherapist or Massage Therapist is actually an excellent resource to do check-ups on your body, even if you’re injury free? That way we can check out even those minor aches and pains to help prevent them from getting worse. We all know that we go to the dentist to prevent cavities and we get our car serviced – why wouldn’t we do the same thing with our body? Here are some excuses I hear all the time:
There are so many benefits to Massage. If we view Massage as a treatment rather than an indulgence, would we value it more and therefore, view it in a different light?
I know… we all have a visual of a Massage room. Some see it as a relaxing place. Others, a table in a closed space with a strong Therapist waiting to treat us. These visuals are somewhat true, but even so, there are tremendous benefits to be achieved through regular Massage Therapy. Whether you need a moment of relaxation, reduced muscle tension or relief from chronic pain, Massage can enhance your overall sense of emotional and physical well-being as well as your quality of life!
Your office chair is fundamental to your workplace. It is a piece of equipment that gets a lot of attention when we talk about ergonomics. So what is ergonomics? The principle of ergonomics has been around for a long time. In the effort to decrease physical and emotional stress humans have done tasks in different ways. To make work easier and more efficient, shovels were made lighter, cockpit controls were made more logical and machines were made to be driven by electricity. When we discuss ergonomics in the workplace we commonly refer to posture and sitting in front of the computer.
Are you a great Patient?
As Physiotherapists, we want to take amazing care of you, have you feel better and have you move without pain. Physiotherapy treatment should be collaborative, educating, motivating and empowering. Sometimes the greatest barrier to treatment is in fact, you, the patient. Yes, at times treatment can be frustrating, as change can be slow and it can be a little painful because you may have neglected moving into certain positions for a while; but we are determined to get you moving and are privileged to get to play an important role in your physical health. So what can you do as the patient to ensure success – to reach your goals, get moving, get stronger and be more resilient?
Pain. We all experience it. Sometimes, it’s an immediate response to an event such as the case with immediate tissue injury, trauma or emotional experience. Other times, it’s a shifting, changing, gradual sensation that changes over time in intensity and area. Sometimes pain goes away after a month or two, never to be heard from again as we return to our previous levels of functioning.