Friday, 13 July 2007

Supraspinatus Tendinitis Follow-up

I recently had the second session with my client suffering from a classic supraspinatus tendinitis to see how he has fared since my first treatment. To my amazement he has seen an almost 100% improvement, with almost no discomfort on abduction, when sleeping or at the insertion point on the humerus. The only residual problem appears to be a couple of knots in the mid fibres of the trapezius on the same side. An important factor in the recovery appears to be heeding my advice to rest the shoulder as much as possible and also increase daily water intake which was previously rather low.

This improvement is really encouraging as I felt that my first treatment was perhaps a little conservative and was expecting to do more deep tissue work this time with only modest initial improvement. So, I repeated the inital work (stretching, mobilisation, soft tissue work) and performed a little deep work to the body of supraspinatus, focussing on stretching it into the supraspinous fossa. Then of course deeper topical work into the knots themselves.

Next session will be in 2 to 3 weeks depending on how it holds up but hopefully the injury will continue it's successful progress so far. All-in-all a very encouraging.

Tuesday, 10 July 2007

Ice Baths provide no benefit after exercise?

No pain, no gain, no point?

This is VERY interesting, a recent study at the University of Melbourne has produced findings which contradict the theory that an ice bath directly after exercise eases muscle pain and aids muscle recovery:

... there was no difference in physical pain measurements such as swelling or tenderness, and in fact those who had been in the ice reported more pain when going from a sitting to a standing position after 24 hours than those who had the tepid treatment."

Hmm, interesting. I've never tried a full ice-water submersion bath after exercise but advocate a cold shower after particularly tough exercise. Maybe a tepid shower or bath is a better option?

Here's the full article:

Monday, 2 July 2007

Supraspinatus Tendinitis

I've been getting a few shoulder injuries recently in my clinic, the latest of which being a classic case a supraspinatus tendenitis. Luckily I'd recently studied Upper Limb Injuries as part of my CPD at the Midlands School of Massage (Thanks Claire!) so feel fairly confident that I know what I can do to help.

This particular patient displayed classic signs of this condition:
- pain on resisted abduction (first 15 degrees)
- painful arc between approx 60 - 120 degrees
- nagging, toothache pain which is disrupting sleep
- tenderness over attachement of tendon to humeral head

In terms of treating this condition, I have a deadline to work to as this gentleman is a Thai Boxing coach who needs to be fit in around 8 weeks as he has to prepare a fighter for an important upcoming contest.

So, how am I tackling this? Initially, I have worked on relieving the muscle tension around the upper & mid back, neck and shoulders as my client exhibited tension in these areas although the actual pain was very localised to the tendon insertion point. I'll continue to work these areas but will also begin working deeper into the tissues as time progresses. I've purposely avoided direct frictions to the insertion point so far so as not to cause inflammation.

Of course, I've been using stretches and MET as well to try to reduce the spasm in this muscle which I will also continue. I've also suggested the use of ice particularly post-training with the affected arm behind the back. Along with this, I've mentioned the use of NSAIDs such as Nurofen, taken with food to help reduce any swelling. I'm also supplying Cryogel in this case as I feel it would really help to ease the pain both pre- and post-exercise.

Longer term I intend to move more into exercising and stretching to help to rehab this injury. I'm currently drawing up a list of exercises for my client to carry out between sessions, which I will post up here as soon as they are written. I will propose a selection of both isometric and isotonic exercises to build flexibility, stretch but also strength.

Tomorrow is session #2 so I'll begin the deep tissue work depending on the results from last week. I'm hoping to see a good improvement from last week but with the toothache pain still present. Hopefully his sleep will be a little improved and the general muscle tension slightly lighter.

Has anyone had any experience of this particular condition and any advice?

"Sports Injuries: Their Prevention & Treatment" Peterson & Renstrom
"Upper Limb Injuries" Claire Batty c/o MSM&MT