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?

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

1 comment:

HansMassage said...

You did not mention how the tendonitus originated. Often if a vigorus athlete gets a small strain in mid or low back causing an antalgic lean to one side. The posture reponce is to hold the arm away from the body oposit to the lean thus putting a reppettitive use stress on the superspinatus. This sets up the muscle for sprain strain in athletic activity. Be shure to look for and correct any antalgic lean to reduce reppettitive use to the strained muscle.
Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist