Helpful Tips in Avoiding Shoulder Impingement Injuries with Weight Training:

As a physical therapist and active recreational weight lifter, I feel that understanding the shoulder is vital to a healthy workout. Weight training is an exceptional form of exercise when practiced sensibly. In following certain stretches and strengthening exercises, shoulder injuries such as rotator cuff tears, impingement syndromes and bursitis could be avoided.

Below is an example of an external impingement syndrome. Over time, this injury can lead to rotator cuff tears, tendonitis and bursitis.

Shoulder Impingement (External):              

 

Serratus Anterior:

Rotator Cuff Anatomy – The Shoulder Stabilizers:

These are examples of special tests that would indicate an impingement syndrome. These positions would cause pain.

Positive Shoulder Tests: 

1. Hawkin’s Sign     

2. Neer’s Test

Many times, someone with an impingement syndrome will have a tight inferior capsule (arm pit area) or posterior shoulder capsule (back of shoulder) which drives the humerus upward, causing the rotator cuff tendon to be pinched between the humerus and acromion (as shown in the picture above). These are good stretches to restore flexibility and to avoid this problem. Remember, stretches should not be performed to the point of pain.

Shoulder Stretches:

1. Inferior Capsule Stretch

2. Posterior Capsule Stretch

3. Sleeper Stretch

Common Reasons For Injuries:

1. Overtraining: Many injuries occur from repeatedly training to failure or from too much resistance. Not enough recovery time is also a factor. Muscles need about 24 hrs of recovery time. Do not train the same muscle group daily.

2. Not warming up sufficiently. By increasing your body temperature through the use of an Upper Body Ergometer or other cardio equipment, you are increasing the circulation into the muscles and increasing their elasticity.

3. Not stretching sufficiently. It is safest to stretch before and after a workout. Make sure to stretch the areas mentioned above, not just the chest muscles. Hold your stretch for 20-30 seconds minimum.

4. Hyperextension of the shoulder when weight training. For example, allowing your elbow to drop too far below the chest with a bench press or too far back when doing an upright row. This motion may be overstretching the anterior shoulder and encouraging a shoulder impingement over time.

5. Performing shoulder press or lat pull downs behind the head.

6. Poor rotator cuff strength. Poor serratus anterior strength. The serratus anterior is a muscle that moves the shoulder blade upward and outward on your rib cage and is very commonly left out when weight training. Do not forget these small but very important muscles. They will allow your larger muscles to work more effectively and you will be less likely to have an injury.

7. Winging of Scapula. This means, the inside border of your shoulder blade wings outward. This is an indication that your lower trapezius and mid trapezius muscles are weak. Your shoulder blade must be stable on your rib cage in order to lift heavy weights.

See below for examples of shoulder exercises:

Written By:
Gabriel Manzon, MPT

Paspa Physical Therapy

Plantar Fasciitis: Do you feel pain or stiffness on the bottom of your foot when you step out of bed in the morning? While running? After sitting for long periods of time?

Do you feel pain or stiffness on the bottom of your foot when you step out of bed in the morning?  While running?  After sitting for long periods of time?

If yes, chances are that you may have plantar fasciitis.

Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot.  It connects the heel bone to the toes and creates the arch of the foot.

CAUSES

• Arch problems (both flat feet or high arches)
• Obesity or sudden weight gain
• Long-distance running (especially downhill or uneven surfaces)
• Tight Achilles Tendon
• Shoes with poor arch support

SYMPTOMS

• Dull or sharp pain, stiffness, ache or burn in the bottom of heel
• Usually worse when you take your first steps in the morning
• After standing or sitting for a while
• After intense activity
• May develop slowly over time or sudden onset after intense activity

TREATMENT

• Physical therapy to help stretch, strengthen and eliminate pain.
• Anti-inflammatory medications (NSAIDs) to reduce pain and inflammation
• Heel stretching
• Rest from exercise/activity
• Wearing shoes with good support
• Night splints to slowly stretch plantar fascia and allow tissue to heal

** If above treatments do not work your doctor may recommend:

• Wearing a boot cast 3-6 weeks
• Custom made orthotics
• Steroid shots into the heel

PROGNOSIS

Non surgical treatments usually work, however plantar fascia may last for many months to years.

Learn More About Paspa Physical Therapy’s Aftercare Program!

Upon successful completion of your physical therapy treatment, Paspa Physical Therapy provides you with the option to continue with an independent exercise program.  You may choose to maintain your fitness in the comfortable surroundings of our gym.  Feel safe utilizing familiar equipment and know that we are available for questions.

Ask one of our staff members for more information including our current fee schedule.

Curbing Holiday Weight Gain With Exercise

Here is another article from The New York Times written by Gretchen Reynolds. Follow the link to learn more about using exercise to avoid any unwanted weight gain this holiday season!

http://well.blogs.nytimes.com/2011/11/02/curbing-holiday-weight-gain-with-exercise/

The Once and Future Way to Run

Here is another article from The New York Times written by Christopher McDougall! Read this for an informative take on the barefoot running trend!

http://www.nytimes.com/2011/11/06/magazine/running-christopher-mcdougall.html?_r=3&scp=3&sq=running&st=cse

Deaths in triathlons may not be so mysterious; panic attacks may be to blame

Check out this great article By David Brown of The Washington Post!

http://www.washingtonpost.com/national/health-science/deaths-in-triathlons-may-not-be-so-mysterious-panic-attacks-may-be-to-blame/2011/10/24/gIQA70NrKN_story.html

Get ready for the upcoming ski season!!!

The winter season is just around the corner.  For most people this means dealing with below freezing temps and having to bundle up with coats and sweaters.  For me and many other winter sport enthusiasts it means getting the skis and boots out of storage, checking to see if you still fit into your ski’ pants, and booking your trip up North. 

I go skiing with my family every season and I try to get in as many ski days as possible.  I love to get out early and catch the first untracked runs and get the last ride up the lift at 4pm. But like so many, I often do not prepare my legs and core in terms of strength and endurance for the sport. Skiing is a sport that you absolutely must do pre-season conditioning. We do not ski throughout the year; we ski a few times/days per year.  Skiing and snowboarding are not part of your regular exercise routine. Also the cold temps, altitude, and ski run challenge that you like to tackle all need to be taken into account. Your fitness level must be there!

You use a combination of pure physical strength and endurance for this sport.  If you are a skier who likes to do moguls, this comes into play that much more.  The quadriceps, hamstrings, calf’s, adductors, gluteals and core muscles are key muscles used in the sport. 

I like to start getting ready at least 8 weeks before the ski season.  I work out all year but I start to increase my cardio, core and leg strengthening before the ski season is upon us.

• Adductors or inner thigh muscle strengthening help to keep skis together in parallel skiing.
• Calf’s and core help maintain balance and upright posture of your trunk when your knees are flexed
• Quads, gluteals and hamstrings are constantly working as you go downhill in a bent knee position, making turns with legs pistoning to absorb the shock of uneven terrain or a mogul run.

For more information on a specific strengthening program contact Paspa Physical Therapy.

Stay healthy and safe this ski season by making sure you are physically prepared for the sport. 

Understand the Doctor’s diagnosis of Lateral Epicondylitis

My Doctor says I have lateral epicondylitis…. What is it?

            Lateral epicondylitis (LE, aka “tennis elbow”) is a condition in which the outer part of the elbow is painful, sore or irritable.  (The condition is named for one of the structures that are being irritated- the lateral epicondyle, which is the bony prominence that is felt along the outer part of your elbow).  While this condition can occur in people who participate in physical activities (such as tennis), it can also happen to those who do not participate in any sports.  Along with tenderness to the lateral epicondyle, the muscles in the forearm are also sensitive to touch and painful.

Aside from primary symptoms of pain and irritability, the muscles of the elbow and/or wrist may feel weak and it can become increasingly difficult to perform routine daily activities (work, self-care or recreational).

Why does it happen?

            One proposed cause of lateral epicondylitis is thought to be repetitive use/excessive exertion of the muscles.  Overuse can occur because of work demands (excessive writing, typing) or physical activity.  Coupled with that is the idea that there is decreased vascularization (blood flow) to certain areas of the body as we age.  So, repeated strain to the elbow will cause minor tears to occur and it takes these tears a longer time to heal.  And if one is performing the same motions multiple times within the day, it becomes easy to see how the trauma becomes cumulative and results in an irritable condition.  In some cases, it may be difficult to pinpoint the exact cause of one’s painful symptoms.  Whatever the aggravating incidents, it can be treated.

Signs and symptoms

The following is a list of signs and symptoms that may be experienced (this is not an all-inclusive list and some people may experience all or some of these symptoms):

• Lateral elbow pain (at rest or with activity)
• Point tenderness along lateral epicondyle or wrist extensor muscle mass
• Difficulty with writing, typing, gripping, lifting activities
• Repeated, exertional activities
• Radiating pain from elbow into forearm
• Forearm muscle soreness or muscle strain/tightness
• Swelling around elbow joint

What can be done to help?

            Initially after being diagnosed, it is recommended to take some non-steroidal anti-inflammatory (NSAID’s) medications, which may help reduce pain and inflammation around the elbow.  After being diagnosed with LE, it is important to assess daily activities and try to rest the elbow as much as possible.  Another important initial step will be ice.  Ice the elbow with an ice pack (or frozen peas) for 10 minutes or perform an ice up massage directly for 3 minutes.  Most doctors may also recommend physical therapy to assist in regaining strength, increasing flexibility, reducing pain and restoring function with normal activities.

Why Physical therapy?

            Physical therapy can be very important for a person diagnosed with LE.  Below is a list of some of the things that are performed for patients with LE:

• Heat, ice
• Modalities (electrical stimulation, ultrasound, low level laser therapy) to help with pain reduction, swelling and inflammation
• Therapeutic exercises- may include strengthening exercises for elbow, wrist, and shoulder joints.
• Stretching- to help increase muscle flexibility
• Soft tissue massage to reduce any muscle tightness or muscle spasms
• Manual therapy treatment- which is important to assess elbow and wrist joint mechanics.  Manual therapy will also provide resistance to muscles to help improve strength and mobilization techniques to improve joint mobility and flexibility.
• Home exercise program- so that people are able to perform these activities comfortably throughout the day

Part of the initial physical therapy evaluation will include questions regarding a client’s work, daily and recreational activities, so that we may assess performance of those activities and ways to correct them or make them more efficient.

*While there is no “cure” for lateral epicondylitis, physical therapy can provide symptom relief so that one will be able to return to their normal daily activities with less pain, improved strength and better function. 

What’s Going On This Weekend at Paspa PT

Paspa Physical Therapy is hosting and attending a course presented by Wayne Rath called Assess Treat Prevent Neck Pain Disorders and Disability

(Click on the title of the course to view the course information)

A Guide to Understanding Low Back Pain

Low back pain is one of the most common ailments affecting Americans today.  90% of Americans will experience low back pain at one point or another in their lives.  Most symptoms resolve within a few days. But for those individuals who end up in the physician’s office they are usually seeking a quick fix, usually in the form of pain or anti-inflammatory medication.  Well the quick fix can be just that – quick but possibly not lasting.  What can you do to make it stick?  One simple method is to sit up straight.  Sounds simple enough but for most people, it is quite difficult to sit in proper posture for 8 hours per day or longer.

Most pain at the lumbar spine is driven from postural mal-alignments.  What I mean by this is that oftentimes we sit, stand and move in poor posture.

We basically slouch in front of the computer all day.  Then we go home and talk to our friends, not face to face, but in front of the computer using social networking sites. Americans need to move and be more active.

One way to fight back pain is to simply sit up straight.  And by sitting up straight, you will activate the spinal muscles and core muscles to fire and hence strengthen them. Eventually as those muscles get used to working it becomes easier to sit correctly without feeling fatigued and needing to slouch.

Also, we need to start exercising by doing strengthening, cardio and stretching exercises.  Core, gluteal and spinal exercises are key muscle groups to strengthen. Strengthening the lower abdominals and gluteals is a priority here at Paspa. We start simply by having our pts perform abdominal bracing/pelvic tilt exercises and we build from there. The clamshell ex for the gluteals is also given frequently here at Paspa.  These muscles are just two of the many that will help support the lumbar spine and make it easier to sit up straight.

 

Stretching, especially the hamstrings and hip flexors, are also important.  These two muscle groups get really tight from sitting all day..

 

 

 

 

I can’t tell you how many of my patients tell me that they do not have the time to exercise.  The long working hours, commuting time and childcare all make it difficult to find time for YOU. Well, as a full time working mother with two children, I can sympathize but I do not give anyone a pass.  I personally find the time to exercise because it is important to me.  The first step is to make it a priority in our life.  I wake up early (trust me I hate getting up early) and go for a run 4x per week.  Most nights, just before bed, I take 5-10 minutes to do a few stretches and strengthening exercises.

If you really cannot do anything M-F, how about starting on the weekends.  Exercise on Saturday and Sunday or use your lunch hour to go for a walk.  If you start to move your body it will thank you.  You will feel better, have more energy and most importantly, have less back pain.

For more information on back pain and the appropriate exercises to perform contact us and we will be glad to answer your questions.

Pam Paspa and the Staff at Paspa Physical Therapy