Rotator Cuff Tears


Sydney shoulder Surgeon Professor George Murrell reported some interesting findings at a conference I attended where he had met with all his patients 8 years after  their reconstructive surgery to assess how their shoulders had lasted via ultrasound and MRI. And interestingly enough, 80% of them had in fact re-torn their tendon.

What was interesting about this? Nearly all of these patients were pain free, without any movement problems. 

This research report from Professor Murrell reinforces what I've thought for many years; Radiology can be helpful sometimes, but it's not everything. Although these patients looked injured on ultrasound, their shoulders were doing fine for them. 

Effective Physiotherapy, by increasing range of movement via manual therapy, will almost certainly decrease someone's pain, in this case in the shoulder. Of course, with structural damage, this is not always possible and that's where injections and/or surgery should be considered after consulting your physiotherapist.

So Physiotherapy can be an effective treatment in many cases. I saw an patient last year who hadn't moved his arm for eleven months after a failed reconstruction. In his rotator cuff he had ruptured supraspinatus, ruptured subscapularis and partial tear to infraspinatus. That is, he only had 1 and a 1/2 muscles out of what should have been four. 
His GP referred him in desperation for pain relief but after a few months he had 150 degrees of active flexion and virtually no pain.


The Older Knee & why Exercise is Good

Osteoarthritis (OA) is the most common cause of knee pain in individuals over 50 years of age  and is the major reason for total knee replacement (TKR) surgery. In Australia in 2010, there were more than 25,000 TKR’s done. This represents a 67% increase in TKR’s over the preceding 7 year.  This trend appears to be continuing up to the present time. 

The severity of pain that's OA suffers report ranges from only slight, not affecting the persons ability to perform their activities of daily living (ADL’s) to severe enough that the person in unable to walk. There is still much contention about where the pain of OA is actually generated from. Studies have suggested that it may be from the bony out growths around the rim of the joint which are called osteophytes or from deeper lesions contained in the bone marrow or possibly from the deep infra-patella fat pad.

Recent experimentation in rodents suggests that it is this fat pad complex irritation that is responsible for the pain associated with the early stages of OA. Further to this is the fact that progressive and prolonged asymmetrical walking patterns appear to lead to fibrosis of this fat pad complex, which can lead to chronic knee pain and stiffness. Importantly it has also been found that both poor quadriceps function and an increased body mass index can lead to an increase in  OA knee pain. 

Further to this weak quadriceps muscle function has also been shown to cause an increase in both articular cartilage loss and joint space narrowing. Given these factors, physiotherapists are in a frontline position to aid in addressing the issues caused by OA. Helping to control both the progression and the impact of the OA on your lives. Initially, we need to reduce the pain that you are feeling and in doing so we can eliminate the inhibition of the quadriceps muscles that occurs when pain is present. The pain can be reduced by the use of specific types of taping to unload the fat pad complex. In addition, massage is used to make sure that there is no tightness in the structures around the knee, especially those around the outside of the knee. Once pain is reduced, then strengthening of the quadriceps muscles can occur using exercises that can be performed at home or at a gym.

As the cost of arthritis treatment soars, specific physiotherapy intervention can be the fast option providing minimally invasive and cost-effective patient self-management for OA knee pain. For the clients that do go onto undergo TKR surgery, the above taping and exercise program can help to improve the post-operation recovery.


FAI Syndrome

What is it?

Femoroacetabular impingement or FAI is a condition to too much friction in the hip joint. Basically, the ball (femoral head) and the socket(acetabular) rub abnormally creating damage to the hip joint. The damage can occur to the articulate cartilage (smooth white surface of the ball or socket) or the labral cartilage(soft tissue bumper that encircles the socket).
FAI generally occurs as two forms, either Cam or Pincer types. Cam form describes the femoral head and neck relationship as aspherical or not perfectly round. This loss of roundness contributes to abnormal contact between the head and the socket. The Pincer form describes the situation where the socket or acetabulum has too much coverage of the ball or femoral head. This over-coverage typically exists along the front-top rim of the socket (acetabulum) and results in the labral cartilage being "pinched" between the rim of the socket and the anterior femoral head-neck junction. The pincer form of the impingement is typically secondary to either"retroversion", a turning back of the socket, "profunda", a socket that is too deep, or "protrusio", a situation where the femoral head extends into the pelvis. Most of the time the Cam and Pincer forms exist together and is called "Mixed impingement.
FAI is associated with cartilage damage, labral tears, early hip arthritis, hyperlaxity, and low back pain. FAI is common in high level athletes but it can also occur in active individuals. It is not definitively known why or what causes FAI however it may possibly be congenital with a genetic association, or it may be due to significant athletic activity before the individual's skeleton has reached maturity. Most likely it is caused by a combination of genetics and environmental factors.
How is it diagnosed?
The diagnosis can be straightforward or a diagnosis of exclusion. Most patients can be diagnosed with a good history, physician examination and plain X-Ray films. The patient's history will generally include complaints of hip pain either in the front ,back or side, and a loss of hip range of motion. Low back pain can also often be a symptom however the reasons behind this are not well understood. The physical examination will generally confirm the patient's history and helps to eliminate other possible cause of hip pain. Other possible causes of hip pain include -hip dysphasia, -groin strains, -hamstring tendinitis, -trochanteric bursitis, -pisiformis syndrome,- Lumbar spine problems, and lumbar spine radiculopathy.
Possible imaging for FAI
The usual imaging that is ordered include plain X-rays,- supine AP Pelvis view, -Hip cross table lateral view. Other possible imaging that are ordered are an MRI+/- with a injection of contrast dye into the joint, or a 3D CT scan. The images obtained help to determine the "Alpha angle". This angle refers to the measurement taken of the hip ball( femoral head and neck junction ) to help determine how much Cam impingement exists. By convention an Alpha angle greater than 50-55 degrees may be considered indicative of Cam morphology. Therefore the larger the Alpha angle the larger the Cam impingement lesion.
Common activities associated with FAI
These include Horseback riding, Yoga, Soccer, Ballet/Dance/Acrobatics, Golf, Tennis, Lacrosse, Field hockey, Rugby, Cycling, Martial arts, Surfing, Rowing sports, and deep squatting activities such as power lifting.
This is an example of a Cam Form Lesion.
Treatment Options
Non operative management of FAI is possible, however it involves a change in lifestyle form active to less active and a commitment to maintaining hip strength. Non operative management will not change the underlying abnormal hip biomechanics of FAI. Operative management of FAI can be addressed via hip arthroscopy in most situations. The hip is distracted and often all the components of FAI such as labral tears, damaged cartilage, and friction between the ball and socket can be treated in the one operation. Depending upon the amount of work that needs to be done the operation can last anywhere from 1-3 hours.
Recovery time from most arthroscopic FAI operations is approximately 3-4 months to full unrestricted activities. Physiotherapy post operatively is required to reduce post op pain and swelling around the hip joint as well as helping to regain full hip muscle strength and range of motion. The progression of exercises and activities during the rehabilitation phase is subject to the surgeons requirements and the general irritability of the hip joint. For more information please contact the clinic or your local doctor.


Cycling Pain & Injuries

While cycling can be filled with loads of fun and enjoyment, cycling pain is a potential problem. Though common cycling injuries are considered to be fractures stemming from nasty high speed falls, it is repetitive cycling injuries that cause most cyclists unnecessary pain. As a cyclist myself, I am personally aware of knee pain, back pain and neck pain from too many kilometers in the wrong position. However, many of these pains have reduced significantly after attending to my seating position on my bike.


Whether you are interested in triathlons, mountain biking, road cycling, veledrome cycling or just the odd commute to work, the cycling injury prevention principles are quite simple but vary across the various types of cycling.

A comfortable and efficient riding position is vital when setting up your riding position. It’s important that your bike is properly set up and adjusted to match your body shape and riding style. If your bike is adjusted to fit your particular body shape and size, you’ll feel more relaxed and have the ability to ride longer distances with less effort. So if you’re having difficulties with your riding position and simply want to see if anything can be improved to maximize your power output, come and see us today to get that perfect set up!


Call us today on 9455 1177