Category: Tendon Pain

Rotator Cuff Strain and SHoulder Impingement

22/2/2023

By Duke Autret, Myotherapist

In this article we will discuss Shoulder Impingement and Rotator cuff strains together since although there are distinctions they also have some overlap.

In terms of the anatomy of the shoulder the rotator cuff consists of a group of 4 deep shoulder muscles which run from the shoulder blade, across the ball and socket joint of the shoulder (Glenohumeral Joint) and attach into the ball part of the upper arm bone (Humerus). This group, collectively known as the rotator cuff is indeed a ‘cuff’ that sits around the shoulder joint and which supports the muscle actions of rotating the ball in the socket at this joint, however, in reality the rotator cuff’s function is more involved with the stabilisation of the Glenohumeral joint rather than its rotation.

Another muscle that we will look at here is the Biceps of your upper arm. A well known muscle for sure, its function is to show off how strong you are… and more specifically, to bend your elbow. They are actually two muscles hence ‘bi-ceps’ ('bi' indicating 'two', and 'ceps' indicating 'heads') and it’s generally the inside bicep (biceps long head) muscle which can be implicated when it comes to shoulder impingement syndromes.

Image sourced from https://www.orthobethesda.com/blog/rotator-cuff-disorders-the-facts/

So what are the overlaps and distinctions of these two conditions?
Generally speaking, the rotator cuff strain refers to some tearing (or micro-tearing) of the muscle/s or tendon/s and graded 1-3 depending on the severity, and is mostly the result of an trauma incident (an injury sustained while using the arm or preventing a fall etc).
And since we are discussing the rotator cuff it would want to be further determined which of the 4 muscles or combination thereof is/are involved.

Now ‘Shoulder Impingement’ on the other hand, can also be graded similarly however tends more to be the tendons of either the Biceps long head muscle and/or one of the rotator cuff muscles that are implicated via impingement (being pinched) between the bones of the ball of the upper arm and the shoulder blade when lifting or using the arm above shoulder or head height, and usually is a gradual onset that has to do with a change in the biomechanics (movement patterns) of the affected shoulder.

When dealing with rotator cuff strains in the acute phase we will advise you on the care options and may work on the adjacent regions compensating for the injury as well and light treatment to the area itself to support its healing. Our plan in early stage care is to reduce pain and restore mobility, while also supporting the stability of the joint while the stabilising muscles are recovering. This can mean our treatment at this stage includes things like gentle manual therapy to reduce pain and inflammation, gentle mobilisation and passive movements, and taping for stability and to let those injured muscles have a chance to recover.

In the later stages we apply more direct work on the specific rotator cuff muscles to ensure the minimisation of any scarring in the muscle tissues and promote the fullest possible recovery. This is where we start to see the sensitivity of your shoulder has already dropped, and we can start to provide some strengthening protocols for you to rebuild the conditioning of your shoulder. Of course, this is always going to be dependent on your unique situation, and we'll find appropriate treatment options for each stage of your recovery. Theres no one size fits all with this.

The treatment plan will also vary depending if your injury is within the muscle fibres or if there is more tendon involvement, whether that be Rotator cuff tendons or Biceps. We will provide you with additional support for integrating movements and exercises to rehab them back to their functional strength. Tendons can take some time to completely recover, and need to be gradually loaded and strengthened.

Personally I find working with shoulder injuries satisfying as they are one of the more complex joints in the human body with lots of movement possible but where so many different things can go awry, and I enjoy seeing them regain all that movement potential.

If this has left you wondering about either of these conditions applying to you and you're looking for some help please feel free to come see me at Simple Wellness Myotherapy in Rowville. I'm available on Wednesdays, Fridays and Sundays - you can find a time with me online or just give us a call on 03 8204 0970 and we can find you a time that suits and book you in over the phone.

Do I have Tennis Elbow or Golfers Elbow?

3/11/2022

‘Golfer’s and ‘Tennis Elbow’ are common complaints when it comes to those suffering from elbow pain, and yes it certainly happens even in people who don't play the sports these conditions take their nicknames from.

Firstly, yes there is a difference between Tennis Elbow and Golfers Elbow, which is that one occurs at the outside of the elbow (Tennis Elbow) whereas the other occurs at the inside (Golfers Elbow).
The other difference is of course implied in the names in that they are often brought on by different repetitive activities that involve movements of the elbow - but its not limited to just tennis or golf.
Beyond these distinctions however, is what they have in common, which is that they are both tendon overuse injuries, and that they are either going to be from the over-gripping activities which will require the muscles at the palm-side of the forearm, or else from the overextending activities of the wrist which will require the muscles at the backhand side of the forearm. And in case you haven't already guessed it, yes either of these muscle groups is connected to either side of the elbow!

The best approach in terms of hands-on treatments with these types of injuries is to focus less work on the tendons themselves and rather more on all the muscles and muscle groups that join up with the tendons involved. This is because if the muscle tension at those specific muscles can be reduced it will relieve some of the tension at the tendons as well and essentially ‘de-load’ them, which can subsequently give them the time off they need to heal while not being constantly re-aggravated by the forces pulling on them. While most people often think of massaging sore areas, tendons that are already acutely inflamed actually don't love being directly worked on.

Being tendon injuries, or what we call Tendinopathies (formerly Tendinitis/Tendinosis), they are usually an overuse type injury rather than acute (although an initial acute or sudden trauma/injury to a tendon can also lead to more chronic tendinopathies too), meaning that they usually come about as the result of repetitive use. For example, in this case, a builder having to use power tools for long periods and needing to grip tightly with their hand/s to maintain a stable hold while it moves and vibrates. All of this can stress and strain the tendons, and so it's important to remember that, due to the nature of the injury mechanism, we want to try and limit the forces on tendons as much as possible so as not to exacerbate them.
So although we can work on muscles to reduce their potential strain on the tendons, it’s also necessary to reduce the loads on them in general, which could look like taking more regular but shorter work breaks, switching between different tasks and/or tools, using lower settings on machines and tools where possible, and being conscious of how hard you might be gripping / how much tension you really need to use vs how much you can relax as you maintain the task at hand.

Anti inflammatories can be really helpful for this type of pain. We know a lot of patients who see us don't like to use medications, but tendon injuries are one type of condition that really responds well to that extra anti inflammatory support. By taking an anti inflammatory medication (as directed by your GP or pharmacist!) you can reduce the pain of your tendon and give yourself a chance to complete some of the pain relieving exercises we suggest.
If you don't want to take anti inflammatory tablets, you can use a topical cream rubbed straight into the elbow.
Also using ice on the tendons after a hard day to bring the inflammation back down and give them more time to recover during the night can be valuable.

Another brilliant strategy with these elbow tendon issues is to use an elbow brace. Its an easy to use, affordable option that provides your angry tendon with a chance to take a break. The brace wraps around your forearm, and has a pressure point imbedded into it that you position over the area where the muscle and tendon connect, and this brace allows us to take load off the tendon by forming a new mechanical tension point. When you're wearing the brace, the muscle now moves from the brace to its other insertion point at the wrist, and gives the elbow attachments a recovery window. Our practitioners can help you fit the brace in the correct position for your pain.

Lastly, once the initial symptoms are under control it’s a good idea to start rehabbing and building up strength and endurance of the muscles and tendons so as to ensure they have the capacity to do the work required of them.
Using graded exercise is typically an important part in the actually healing process of the tendon repair too, as it helps to ensure that not only they build their capacity, but that they remodel and realign the tissues fibres and heal properly with less likelihood of reinjury by regaining some of there elastic and tensile properties.
Tendons go really well with loaded exercises, but of course we need to get the weight level right for you. If you're already someone who has a lot of strength, you may start at a higher resistance level, but if you try to go too heavy too quick, that tendon can get very upset again. Our practitioners can help you with a quick daily exercise program that gets your tendon healthy again.

Tendons can take time and persistence. You'll see us frequently at first while we get the pain levels under control, but our ultimate aim is to get you to the rehab stage where you follow the exercise program to rebuild strength. You may also experience a "stepping forward, stepping back" type of recovery with a tendon issue, because that area can get sensitised easily. We are here to help and support you through the process.

If elbow and forearm pain has been getting in the way, please come and see us, we are here to help. Just call or leave a message with us at the Simple Wellness Myotherapy clinic here in Rowville on 03 8204 0970, or alternatively you can visit our website to see our booking schedule and make an appointment yourself for a time that best suits.

Rotator Cuff Strain and SHoulder Impingement

Do I have Tennis Elbow or Golfers Elbow?

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