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Shoulder Injuries and Tennis Elbow - How an Exercise Physiologist can help

Shoulder injuries are said to be the 3rd most common musculo-skeletal complaint and are often presented in clinic by workers involved in repetitive manual labour. Another commonly presented and equally frustrating upper limb injury is tennis elbow or lateral epicondylitis.


The shoulder is a complex, yet incredible structure and it is important firstly to understand exactly what is occurring and not just at the sight of the pain. Upon presentation your therapist will work to assess and understand what is occurring with the injury, as well as with the surrounding structures and movement patterning of the affected joint or area.


Pain may be present at the front point of the shoulder, into the armpit, around the shoulder blade or perhaps radiating down the arm to the fingers and it is important that we work to understand when and how the pain is occuring, what eases or aggravates the condition, how long it has been present and also other factors such as what is involved with work, what hobbies the patient is engaging in and even their preferred sleep position. With this information we become empowered to understand the mechanics of the injury and how we can work to strengthen and mobilise the injury site. An important fact to note is that no two upper-limb presentations will be the same and therefore rehabilitation must be adjusted accordingly.


Issues regularly seen in the clinic are rotator cuff injuries, frozen shoulder, bicep tendinitis as well as tennis and golfer's elbow. All can cause debilitating pain responses and affect quality of life, but with a structured and graduated rehabilitation program, a collaborative team approach between treating practitioners and diligence with both clinic and home exercise programming there is a strong prospect of achieving pre-injury mobility and strength, if not better than before.


Seeing every patient as the individual they are is something we pride ourselves on and we love finding the right type of treatment, movement and exercises that benefit the patient we are working with. Research is continually emerging on best practice treatment methods and our practitioners are passionate about staying well informed. Our long term aim with all patients is to have them graduate to be self-managed and informed so they are able to complete their personalised program at home using simple and effective movements that require minimal equipment. Our focus is on the long term and to living the best life possible.


So to finish, let's explain some of the common ailments we see.


Frozen Shoulder or Adhesive Capsulitis is the significant decrease in both passive and active range of motion (ROM) of the shoulder. There is often a ‘hitch’ of the shoulder and the shoulder capsule has become contracted. Frozen shoulder affects around 2-5% of the population and is more common in women of 40-60 years of age. Interestingly it is an injury that can present in persons suffering with other medical conditions such as Diabetes, Parkinson's disease, Breast Cancer, Myocardial Infarction, Stroke and Auto-immune conditions. Treatment of Frozen shoulder will typically involve treatment with a Physiotherapist and Exercise Physiologist with focus being on working through passive then active ROM, mobilization and progressing to active strength principles.


Rotator cuff injury or tendonopathy can be due to degeneration, partial or full thickness tears, irritation or strain of one or more of the four rotator cuff muscles. Overuse and poor mechanics can cause irritation as well as imbalance between the muscles making up the cuff. When treating rotator cuff injuries or supraspinatus syndrome, as an example, we want to address the mobility of the shoulder blade (scapular) and upper back (thoracic spine) in the first instance. Ultimately we want these muscles to do their job and not leave everything to the smaller shoulder muscles. From here we then work on more specific isolation and strength exercises.


Bicep Tendonopathy or inflammation to the longest part of the bicep which connects to the shoulder is another shoulder condition commonly associated with overuse and repetitive type movement. It tends to present in conjunction with rotator cuff conditions or with impingement of the subacromial space as noted in supraspinatus syndrome. Again ROM exercises, stabilbilising of the shoulder and shoulder blade and changing the loading through movement have all been found to be of benefit.


Tennis elbow, or lateral epicondylitis is a debilitating and frustrating injury that causes the majority of sufferers a great deal of frustration. Another overuse type injury it presents as pain over the muscles of the forearm and swelling or tearing of the tendons that assist in flexing the elbow. Again a focus on shoulder and upper back muscles is important as well as considering grip positioning and strength progression. Treatments can involve hands on treatment of surrounding structures, dry needling, mobility, active release treatment, splinting, and movement load through eccentric training. Epicondylitis is a condition that is very much affected by a patient's work, hobbies, and ability to modify activities and each component will affect the rate and ability of recovery.


If you have any questions regarding any of the conditions above or would like to book in please contact us and find out how we can help.