Shoulder Impingement Syndrome
Shoulder impingement syndrome is a common cause of pain and limited mobility in the shoulder. Pain can range from a dull, heavy discomfort deep in the joint, to an acute sharp one that spreads across the top of the shoulder and outside of the upper arm. Because it often produces profound loss of mobility, some doctors and physios often incorrectly diagnose impingement syndrome as a frozen shoulder, which is a very different and much rarer complaint. In this blog, I aim to explain where and how impingement syndrome happens, the tissues involved and how I try to help someone suffering from impingement syndrome
Peer Pressure, Brotherly Competition, and the Dingle Half Marathon
As many of you will know I have recently been training for a half marathon. I’d like to say from the outset that I am not a natural running, feeling much more at home in the swimming pool or sea, nor do I particularly enjoy running. This might lead you to wonder why I would sign up for a half marathon. The answer is simple. My younger brother Mark said he had signed up and slyly dropped a few digs that he would have complete one before me on a Facebook post.
As any older sibling can relate to this sort of call out can not go unanswered. I immediately told him to sign me up, which he did (because I’m still the bossy older brother) before google searching “Best Running Apps”. I wasn’t to be beaten.
Risk- A Risky Business
Last week I did a discussion piece based on a Telegraph article, headlined- RAF contractor sues Physiotherapist he claims left him paralysed. It raises the important subject of risk in manual therapy.
Risk is defined as a situation involving exposure to danger. Risk involved in pretty much anything including all elements of medicine. To me, if a treatment modality has the potential to do good, you have to accept it has the potential to do harm as well. Of course, some techniques, surgeries or medications will carry more risk than others, or pose more risk to one individual and their circumstances than they will to another. Managing this risk is part of what makes one healthcare provider more professional than another.
Patients have been advised to demand proof of their physiotherapist’s experience and qualifications after an RAF contractor alleges he was paralysed following massage therapy on his neck.
Jason Davidson, formerly a fit and active 39-year-old, will spend the rest of his life in a wheelchair after physiotherapy treatment at a high street practitioner appeared to go disastrously wrong.
Mr Davidson had suffered neck pain after lifting a heavy power strip at work. His GP diagnosed muscular strain and after administering an anti-inflammatory injection and pain medication Mr Davidson was advised that physiotherapy might help relieve the pain.
Donal discusses whether osteopaths, physiotherapists and chiropractors are becoming middle men between databases of pre-prepared exercise plans and their patients.
Nowadays manual therapists are being constantly bombarded by new guidelines from National Institute of Cinical Excellence (NICE), governing bodies and new research that always seems to be telling us exactly how to treat and manage our patients.
The product of their research seems to restrict or dictate to therapists, telling them what their patients need. On the face of it you might assume that this is a good thing however I think the pendulum has swung too far in the direction of evidence based practise and that it is damaging to the reputation of therapists and the health of the patient they treat. The result of new guidelines and protocols is that the 3 or 4 years of training that a physiotherapist or an osteopath go through to develop diagnostic skills, learn how to deliver hands on treatment and devise patient tailored management plans are, in my opinion, being undermined.
Osteopathy within the Workplace, caring for YOUR Workforce.
This has a knock on effect on staff morale, productivity and absenteeism. The main cause for working days lost in 2013 was musculoskeletal conditions (such as back and neck pain), leading to 31 million days lost.
In business your workforce is your biggest asset. Making sure they are comfortable and pain free is vital to productivity and profits. Whilst absenteeism is lower within the private sector compared to the public sector (1.8% and 2.9% respectively) it is still costing businesses. London had the lowest rate of absenteeism and this is potentially due to the progressive attitude taken by employers here. Many employees have a company health insurance policy that means the cost of treatment can be recouped by the individual. Cost of treatment is always a barrier to someone seeking treatment for aches and pains. Unfortunately this can mean that sufferers wait longer, until the symptoms become intolerable, before seeking treatment. Typically the longer a person suffers for, the longer it takes to recover.
Sports injuries from an osteopathic perspective
As many of you might know I am a big Ulster rugby supporter and one thing that I have noticed across a lot of the forums is a lot of misinformation regarding injuries. I think most people (interested in rugby) are interested in the injuries when they happen. There are also a few crossovers with other sports where injuries occur and I am happy to open this up to suggestions, so if you have any, please do let me know.
To kick off my first sports injury blog I thought that we would focus on one of our own, Paddy Jackson. He suffered a dislocated elbow playing against Toulon, little over a week ago. So what does a dislocated elbow look like, how do they happen and how long does it take to get better?
Let’s start at the beginning- the STRUCTURE of the elbow. The elbow is a complicated hinge joint made up of three bones, the humerus in the upper arm and the ulna and radius making up the forearm. The joint is supported by ligaments, the joint capsule and the surrounding muscles. The role of any ligament anywhere in the body is to prevent the joint moving too far into a range of movement.
The primary FUNCTION of the elbow is to allow bending of the upper extremity meaning the hand can be moved towards the face (flexion) and secondarily allow the forearm and hand to rotate (pronation/ supination – think using a screwdriver or door knob). The elbow is designed to allow these functions to happen but within tolerable limits only. These limits are set by the shape of the bones and the tension in supporting ligaments. DYSFUNCTION, in this case dislocation occurs when these limits are breeched and that inevitably means damage will occur either to the bones themselves or the ligaments that provide support .
There are several types of elbow dislocation however by far the most common one is posterior dislocation. This is where the bones of the forearm get shunted backwards behind the humerus. It commonly occurs when someone falls onto an outstretched hand (sometimes shortened to FOOSH) or in a car crash when someone braces themselves against the steering wheel. In the unfortunate case of Paddy Jackson he was attempting to fend off or hand off a Toulon player. The picture below shows how the bones move in all of the different types of dislocations, however posterior locations account for 90% of all elbow dislocations.