RHP Physiotherapy Blog
The latest from RHP Physiotherapy
RHP Physiotherapy is one of Brisbane’s premier physiotherapy practices. We’ve started this blog in order to provide an informed and authoritative discourse on a range of health related topics.
Our hope is that we can provide you with up to date information and events associated with a range of health topics not limited to sports injuries and musculoskeletal problems as may be associated with traditional ‘physio’ or physiotherapy.
Our sports physiotherapists are amongst the country’s elite but we have worked hard to establish a culture of excellence across a range of health related issues. Many of these topics we hope to discuss in coming blogs.
In our lower back we have a very important thick band of connective tissue called the thoracolumbar fascia (TLF).
Fascia is like a strong spider web-like material that surrounds and connects most of our body parts including muscles and organs.
The TLF is very strong and multi-layered. Its function is to provide stability to our lower spine, and help control bending forces.
Many muscles attach into the TLF, and when these muscles contract, they help to stiffen the TLF, which enhances its function. Three of the most important of these muscles are the transverse abdominis (TA), the gluteus maximus (GM), and the multifidis.
The TA is the deepest abdominal muscle that activates to stabilise and protect the pelvis and lower spine. Via its attachment to the sides of the TLF, it acts to tension the fascia, and also controls movement of each lumbar vertebrae.
The GM is the big buttock muscle, and its muscle fibres interact with the outer layer of the TLF. As it contracts and tensions the TLF, it helps to stabilise across the sacro-iliac joints.
The multifidus is a deep muscle in the back just adjacent to the spine and deep to the fascia. A strong and active multifidus and other back muscles help to tension and stiffen the TLF from within, as well as directly attaching and controlling each spinal segment.
The TLF is also possibly a source of low back pain. There have been pain receptors found within the fascia, though at this stage the research teams are still determining the significance of this.
When RHP physiotherapists are assessing and managing your spinal pains, we are very conscious of the interplay between fascia, muscles and joints. Our exercise programs are designed in part to enhance the function of the thoracolumbar fascia, to help with the integrity and support of your spine.
If you are experiencing back pain, please feel free to contact us for your initial assessment. RHP Physiotherapists have many years of experience treating various kinds of back pain and we look forward to assisting to get back to full health.
The pectoral muscles (or pecs) are familiar to most of us as chest muscles. They work very hard in exercises like push-ups, bench press in the gym and gradually get tighter with everyday activities like lifting, carrying and working on computer screens.
Tight pecs can be a major contributing factor to many different aches and pains. If you have neck pain, upper back/ thoracic pain, shoulder pain or chest pain (always check with your doctor with chest pain first!!), chances are very high that your tight pec muscles may be involved – especially if they are recurrent or long-standing issues.
If you are troubled by any of these aches, try this simple stretch to change your life!
Pec major stretch
Remember – you want a mild comfortable stretch – NO pain!
If you have any questions or need help with troublesome aches and pains call us on at RHP Physiotherapy on 3856 5566 today!
– Knees bent a little as per the drawing.
– Lower back and head back onto the wall.
– Arms against the wall as per the picture.
– If you cannot get your forearms onto the wall, your chest is too tight or your upper spine too rounded. Seek advice from your physio.
– If your shoulder joints hurt then cease the exercise and seek advice from your physio.
– Repeat small arm movements up and down 15 repetitions. 3 sets.
This is one of my favourite exercises for improving upper body posture, and shoulder blade stability on the rib cage.
Most of the tasks we perform during the day involve our arms being in front of our body e.g computer work, cooking, and mechanical work. These postures use our flexor muscles of the chest (pectorals), which over time can become dominant and tight, contributing to a “protracted” shoulder girdle. (see below image)
A “protracted” shoulder girdle involves
- Tight pectoral muscles
- Weakened upper back muscles
- Weakened muscles that hold shoulder girdle position
- Rounded upper back and forward position of the head on the shoulders. This in turn loads the neck joints, and upper trapezius muscles and can promote headaches and neck pain.
The Lower Trap Wall Slide exercise will
- Relax and stretch the pectorals, opening up the chest and straightening the upper back.
- Strengthen the upper back muscles
- Strengthen the shoulder blade stabilising muscles
- Improve position of the head on top of the shoulders, improving posture and decreasing headaches and neck pain.
Shoulder dislocations can be scary and occasionally debilitating for a short period of time. The aim of this blog post is to shed some light on what happens in a shoulder dislocation. A future post will explore what to expect when recovering after this relatively common injury. Behind bone fractures and soft tissue injuries (e.g. ‘a corky’), joint dislocation was the third most common reason for presentation to a hospital emergency department in Australia during 2011-12. The most common dislocations occur at the fingers, with the shoulder joint being a close second.
Acute shoulder dislocations usually occur as a result of impact; whether falling on an outstretched arm or direct impact to the shoulder such as what might happen during an unsafe ‘spear’ tackle and landing on the front or back of the shoulder.
A quick spot of Anatomy
The shoulder is generally thought of as the functional unit made up of the Clavicle attached to the Scapula, which is predominantly controlled by a group of muscles around the upper back/ chest, as well as the joint between upper arm and scapula; the Glenohumeral joint. It is the Glenohumeral (Glenoid of scapula to Head of Humerus) joint that is the focus here.
This joint, simply, is a ball in a socket joint, allowing a large amount of movement in many directions. It is made stable by a rubbery fibrocartilage labrum, that blends into the joint capsule and Glenohumeral ligaments. Our rotator cuff muscles are the primary contractile units that aid in stabilising the joint. Other larger muscles such as your Latissimus Dorsi and Pectorals, and to a lesser extent your Biceps and Triceps all move the Glenohumeral joint and can play a lesser stabilising role, although their primary role is large movement.
|Pic 1: Front to back view of Glenohumeral joint:bones and ligaments (courtesy Wikipedia online)||Pic 2: Back to front view of rotator cuff (courtesy Wikipedia online)|
Dislocation of the Glenohumeral joint is an injury whereby the Head of Humerus, typically sitting comfortably within the joint capsule afforded by the Glenoid rim, becomes effectively detached from this position. This creates a strain on the supporting structures and results in significant pain and often long term instability.
Anterior vs. Posterior Dislocation
The most common shoulder dislocation is the anterior shoulder dislocation, 90-95% of shoulder dislocations. Posterior dislocations make up 5-9% with Inferior dislocation being the least common form. The anterior form of dislocation most often occurs as a result of a fall, particularly with the arm being pushed up and backwards in the ‘stop-sign’ position, forcing the Humerus forwards within the joint. This strains the capsule and ligaments that otherwise provide stability at the front and lower portions of the Glenohumeral joint. There is often a popping sound and immediate pain. In severe cases, tingling or numbness in the arm and altered blood flow may occur, although this is less common.
Posterior dislocation often involves impact to the front of the upper arm, close to the shoulder, or a fall onto the outstretched arm in front and across the body, which forces the Humerus backwards within the joint.
Inferior dislocation is rare and occurs when the arm is abducted and abuts up into the acromion, thereby straining the capsule and inferior ligaments and slipping the head of the Humerus inferiorly in the joint.
Pic 3: Left anterior shoulder dislocation (free usage rights via google images)
Complications from dislocation and relocation
Clearly there is a risk of significant damage to the primary static and active stabilisers of the joint (capsule, ligaments and muscle). There is also a risk of damage to the labrum (labral tear), fracture of the scapula aspect of the joint; the Glenoid rim (Bankart Lesion), or fracture to the Humeral head (Hill-Sach’s Lesion). As mentioned earlier, there is also a risk of damage to the axillary nerve or blood vessels. Finally, it is very common for a dislocation to recur, usually being reported in approximately 2/3rds of patients who have suffered a Anterior Dislocation.
It is encouraged that when a person presents with an acute shoulder dislocation, a pre-relocation x-ray be performed, but this is often not possible. In some instances, the shoulder may relocate spontaneously, often if the person is leant forward and relaxing the arm. More commonly, a skilled professional may assist with relocation. Following the relocation, an X-ray is encouraged to rule out bony fractures and to ensure the head of the Humerus is again sitting in its appropriate place.
I would like to stress at this point that it is important that should a dislocation occur, a trip to the hospital is advised. Relocation by a skilled professional is paramount, as a simple and thought-less tug or push can compromise blood vessels and nerves, leading to long term damage.
What to do next?
If the dislocation has been relocated safely and ensured that no nerve or other major damage has occurred, the next step is to rest. These checks will have been performed in hospital. Occasionally a shoulder sling will be provided and is often recommended. There might be differences in sling and arm position depending on the injury sustained and whether a bone or labral lesion have occurred.
It will be important to check-in with your physiotherapist to start your rehabilitation within the first weeks. Engaging the damaged stabilising muscles and ensuring appropriate relative rest, as well as reducing any swelling and excess muscle tone.
1. AIHW: Kreisfeld R, Harrison JE, & Pointer S 2014. Australian sports injury hospitalisations 2011–12.Injury research and statistics series no. 92. Cat. no. INJCAT 168. Canberra: AIHW.
2. Jamali, S. (2011). Anterior shoulder dislocation: Seated versus traditional reduction technique. Australian family physician, 40(3), 133.
3. Brukner, P. (2012). Brukner & Khan’s clinical sports medicine. North Ryde: McGraw-Hill.
4. Vermeiren, J., Handelberg, F., Casteleyn, P. P., & Opdecam, P. (1993). The rate of recurrence of traumatic anterior dislocation of the shoulder. International orthopaedics, 17(6), 337-341.
Post-script: Interestingly, on the day of writing this, I was conveniently present as an opposing player at an indoor sports court happened to dislocate his shoulder by getting his hand caught on some netting surrounding the field while running… Fate? Coincidence? Never-the-less, it made for a very personally relevant first blog post!
Prophylactic Ankle Taping
Definition of Prophylactic: Preventative or Protective
This year RHP Physiotherapy is proud to be working with Netball QLD and are providing physiotherapy services for U17, U19, U21 State teams; as well as the Firebirds and Fusion teams. As always, we are committed to seeing our athletes and teams achieve the best result that they can, and that means keeping our players’ bodies moving as well and as pain-free as possible so individually and as a team they can achieve the results they train hard for.
Ankle injuries account for a large proportion of injuries sustained in any sport, but particularly court sports such as Netball and Basketball. Spraining the ligaments on the outside of your ankle is more common (will occur 80% of the time), and can be graded in terms of severity from a grade 1 to a grade 3. Even a simple sprain of the lateral ligaments of your ankle can see you out of competition and training for a minimum of 7-10days, and a severe ankle sprain could potentially result in 6-8 weeks or longer depending on the damage.
In order to protect against this, the recommendation is to apply either preventative ankle taping or wear an ankle brace (or both!) in order to minimise the risk of injury occurring. Studies have reported conflicting evidence about taping and bracing, however they have been shown to reduce the rate of ankle sprains in sports. This may be because it increases your brains’ awareness of what your ankle is doing and the positions it’s in and can therefore turn on the right muscles to protect you, as well as the structural support it provides to the ankle ligaments themselves. There is no evidence that taping or bracing will weaken your ankle over time.
Typically, the way we sprain the ligaments of the ankle is in a turning or landing position when the toes are pointed, and the ankle is rolling inwards. Tape and bracing aims to prevent this motion, thereby giving the ankle protection from a possible sprain. We will go through how to tape to treat, and to protect against a lateral ankle ligament sprain.
What do I need?
There are many different types of tape available to us, however to restrict the movement that may cause a sprain we need a rigid, adhesive tape as pictured – and generally for ankle strapping 38mm is the most appropriate size. For those with tape allergies you can use it in combination with hypoallergenic tape applied underneath the rigid tape, such as Fixomull. You may want to use a spray or adhesive to help the tape to stick.
Ankle Taping Techniques
The skin should be cleaned, with grease and sweat removed, and should be dry prior to taping. Having your leg shaved prior to taping can help avoid irritation and pain with removal. Apply Fixomull or another hypoallergenic tape to the area to be taped prior to applying rigid tape if you have sensitive skin or are allergic to strapping tape.
Step One: Anchors and Stirrups
Start with the anchors which go around your leg approximately 1/3 of the way up your shin. You may want to apply one or two, this is used as the point where you attach the rest of the tape to. This can be applied gently.
Stirrups run from the inside of your ankle from the anchor, underneath your foot, and you apply tension as you bring it up to the anchor on the outside of your ankle. Follow the contours of your ankle, you may need 2-3 strips of tape crossing over ½ the width of the tape with each application. Keep the foot up so that the toes are coming up towards your shin for the duration of the taping.
Step Two: 6’s
If you are prone to getting tape cuts, you may want to put down a small strip of tape across the front of your ankle joint to protect it. To apply the 6’s, start on the inside of the leg on the anchor and bring the tape underneath your foot to the outside of your ankle, then pull it across the front of your shin bone with tension to meet close to where you started from.
Repeat x 2
You can do a reverse 6 in the opposite direction for some added support, starting with the straight tape down the outside portion of your ankle and crossing the ankle joint from the inside heading to the outside of your ankle.
Step Three: Heel Lock/Sling
As shown in the pictures, with this tape you start at the centre or on the shin bone and angle the tape underneath the foot (you will do this in both directions), for the first one go to the outside of your ankle and underneath your heel. Then bring the tape around the heel on the inside of your foot and then cross the Achilles tendon (do not put any pressure on the tape over the Achilles!). Bring the tape to meet the anchor. Repeat to the other side.
Step Four: Lock off
As per the first instuction, put the tape with no pressure circumferntially around the shin to lock off the rest of the tape
You shouldn’t be getting any pins and needles, numbness from the tape – if your toes are turning blue you have it on too tight! If you have any questions or want to learn how to tape your ankles, come and see your Physiotherapist.
Cordova, M. L., Ingersoll, C. D., & Palmieri, R. M. (2002). Efficacy of Prophylactic Ankle Support: An Experimental Perspective. Journal of Athletic Training, 37(4), 446–457.
Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014 Jan;44(1):123-40. doi: 10.1007/s40279-013-0102-5. Review. PubMed PMID: 24105612