It is important to include some stretching exercises before your running routine. If done correctly, stretches can help to improve your flexibility and joint range of motion, and can decrease your risk of injury to joints, muscles, and tendons while running. In this article, we will show you top 5 stretches to do before a run.

Disclaimer: Note that stretching is not warming-up. It is a common misconception that warming-up equates to stretching. ‘Warming-up’ literally means raising your core body temperature. It is advised that before you begin on your stretches and run, a general warm-up such as brisk walking between five to ten minutes be performed to prevent injury to your ‘cold’ muscles. (see To stretch or not to stretch before an event?

Top 5 stretches:

Hamstrings Stretch

click for larger view	Start off with your body close to your thigh and your knee about 90 degree
click for larger view	Straighten the knee gently while keeping your body close to your thigh Hold for 15 seconds and repeat 3-5 repetitions

Calf Stretch

click for larger view	Upper Calf stretch Place hands on front thigh, with one leg to rear Keep the rear leg straight and foot flat with toes pointing forwards Bend the front leg and feel the stretch through the rear leg Hold the stretch for 15 seconds and repeat 3-5 repetitions.
click for larger view	Lower Calf Stretch Place hands on front thigh, putting your weight on your rear leg Keep the rear foot flat with toes pointing forwards Bend rear knee forward over rear foot and feel for the stretch over the lower calf Hold the stretch for 15seconds and repeat 3-5 repetitions

Quadriceps Stretch

click for larger view	In standing, bend your knee and take your heel towards your bottom, keeping your back straight until you feel a stretch in the front of your thigh
click for larger view	To further stretch the front of your thigh, extend your thigh and bring your heel closer towards your bottom Feel for the stretch at the front of your thigh Hold the stretch for 15seconds and repeat 3-5 repetitions

Iliotibial Band (ITB) Stretch

click for larger view	To stretch the IT band of your right leg, stand with your right leg crossed behind your left.
click for larger view	Put your weight on the right leg and lean your body towards the left. You should be able to feel the stretch in your hip and down the IT band along the right side of your right thigh Hold for 15 seconds and repeat 3-5 repetitions

Glueteus (Buttock) Stretch

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Sitting on the floor with one leg straight out, bend the other knee and place the foot over the straight leg Using your hands, gently bring the bent knee up towards the opposite shoulder. Feel for the stretch in the buttock Hold the stretch for 15 seconds and repeat 3-5 repetitions.

Stretches For New Runners is a post from: Musculoskeletal Consumer Review by Core Concepts

When long-distance runners complain about knee pains, it is often complaints about pain in the front of their inner knee, below the knee cap. Pain comes about especially when climbing uphill or up stairs. Given the location, this pain is sometimes misdiagnosed as a MCL (medial collateral ligament) strain when it is actually Pes Anserinus Tendinitis.

What is Pes Anserinus Tendinitis?

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Is it often mis-diagnosed as MCL or  medial-menicus strain because of the close location of the pes anserinus tendon to the MCL and medial menicus.

What strains the Pes Anserinus Tendon?

Things that strain the pes anserinus tendon are

1. Severe pronation of the feet – this causes the tibia (one of the lower leg bones) to rotate inwards which strains the tendons
2. Weak hamstring muscles – when combined with an intense running programme, the hamstrings may not be able to cope with the high workload. This is often an overlooked areas in a runner's strength training regime.
3. Tight thigh muscles (quadriceps) – weakens the opposing hamstring muscle. Muscles tightness here is further encouraged if you have a deskbound job that requires you to sit at the your desk all day long.
4. Sudden change on the volume and intensity of training

Diagnosing Pes Anserinus Tendinitis

Patients typically complain about pain climbing stairs, squatting, running and in severe cases, standing from a seated position.The pain would also appear gradually and for runners, following an increase in their training volume and intensity (uphill, or running faster).

However, even if your symptoms match those listed above, it is advisable to ensure that it is not other possible condition such as Patellar-Femoral Pain (PFP), MCL strain and medial-menicus strain

Treating Pes Anserinus

During the initial inflamed painful stage, your doctor may prescribe NSAIDs to help reduce the swelling and inflammation and recommend rest for the first 24-48 hours. Ice or cyrotherapy can help speed up the recovery by reducing the inflammation.

Once less painful, your therapist may suggest the following treatment depending on your cause of the tendinitis as list above.

1. For severe foot pronation – orthotics can help correct over pronation of your foot
2. To strengthen the weak hamstrings – see Hamstring Exercises for Long Distance Runners
3. Release tight thigh muscles with sports massage and a stretching programme.
4. A training programme that appropriately increases your training volume and intensity.

¹ Ed note. The Sartorius is the longest muscle in the human body

Why is my MCL strain not getting better? Because it is Pes Ancerinus Tendinitis. is a post from: Musculoskeletal Consumer Review by Core Concepts

A slipped disc can be very painful and debilitating. However, in most cases, it should get better on its own, within six-eight weeks and there are certain things that you can do and avoid doing to aid and speed up your recovery.

What happens in a slipped disc?

Although people often mention about having a slipped disc, nothing in your spine has actually slipped out of place. Having a slipped disc means that one of the discs which sit between each of the bones in your spine has been damaged. When the disc is damaged, the soft gel-like inner pad of the disc squeezes out through a weak point in the torn outer layer, causing a bulge that often presses on nearby spinal nerves. This result in severe pain with symptoms that radiates down the leg/arm commonly referred to as sciatica. Slipped disc, also known as disc herniation, can occur in any disc in the spine but the two most common forms are lumbar disc and cervical disc herniation.

What can I do?

During the first 48 hours, a torn outer layer of the disc would result in the release of inflammatory chemical mediators which may directly cause severe pain, even in the absence of spinal nerve compression. This is the basis for the use of anti-inflammatory medication for pain associated with disc herniation. Thus, early treatment may include taking painkillers, anti-inflammatory medication and rest to give time for the body to reabsorb the herniated part of the disc. Before taking any medication, always see your doctor for a prescription.

Cold therapy should be applied immediately and after any activity that aggravates your symptoms as it helps to reduce pain and swelling. Use an ice pack or bag of frozen vegetables wrapped in a towel for no more than 10 minutes, every 2-3hrs. After 72hours or more Heat therapy, such as a wheat bag or warm soak can be used to promote muscle relaxation and pain relieve and may be used before performing stretching and strengthening exercises.

As the pain lessens, you will most likely to return to work and begin exercises to strengthen your back muscles and joints. Exercise is introduced to improve strength, flexibility and proper back mechanics as part of recovery. A physiotherapist will be able to give you an individually tailored exercise plan to help to strengthen any muscles that have become weak and also using techniques such as spinal manipulation to help improve the mobility of the spine. Physiotherapy would also help to correct one’s posture and use body mechanics to minimize stress and strain on any portion of your spine. This includes incorporating these exercises and posture principles into all your daily (e.g. sitting and lifting) and recreational activities.

What shall I avoid doing?

Don’t rest excessively and avoid activities. Studies have shown that it is important for one to remain active and keep up with your normal activities as much as possible.

However, it is paramount to discontinue with any activities that aggravate your symptoms such as bending over, heavy lifting and any quick twisting or jerking motions. Avoid standing or sitting (e.g. driving) for extended period of time as it would increase strain to your spine and aggravate disc pain. At home, keep away from overstuffed and low furniture, because it is difficult to stand back up after sitting in them. Don’t lie on stomach and prolonged bed rest especially during early stage post injury.

In the long run

Back pain from a slipped disc may return, whether or not you have had treatment and it is important to learn how to avoid damaging your back again.

The outcome for most people is that they will feel better within six-eight weeks; although for others it may take a while longer. With proper care through correct posture, core exercises and back ergonomics, it is possible for one to remain pain-free.

Slipped disc – Do’s and don’ts is a post from: Musculoskeletal Consumer Review by Core Concepts

Someone with a lower spine that frequently moves through a larger-than-normal range of movement is more susceptible to low back pain. This tendency of moving beyond its normal range is known as lumbar segmental instability.

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What keeps the spine stable?

In order to understand what causes lumbar segmental instability, we first need to understand what keeps it stable in the first place. The human body holds the spine stable or steady through the help of three basic structures – the passive, active and neural structures.

1. Passive structures in the lumbar spine are the vertebrae, the discs, then joints and ligaments. These are structures that do not move.
2. Active structures are the global and local muscles. These contract or relax depending on the direction of the force required.
3. And finally the neural structures; nerves that control and direct the muscles. This control is also known as motor control.

A stable lumbar spine segment coordinates global and local muscles using the motor control system to supply compressive forces along the spinal passive structures for stability. This coordination helps maintain the spine's normal curvature at a segmental level as we move about.

Active Structures

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• Rectus abdominis,
• External oblique
• The thoracic part of lumbar illiocostalis (an erectae spinae muscle). ·

These three muscle groups are large torque producing muscles that provide general trunk stability and allow movement to occur.

The local muscles attach directly to the lumbar vertebrae. They are:

• Lumbar multifidus,
• Psoas major,
• Quadratus lumborum,
• Lumbar parts of lumbar illiocostalis and longissimus (more erectae spinae muscles),
• Transverse abdominus,
• The diaphragm and
• Posterior fibres of internal oblique.
• Interspinalis/ Intertransversii

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The two lowest spinal segments, L4 and L5 vertebrae, are the most susceptible to segmental instability. This could be due to pathological/ degenerative changes to the passive structures that sometimes show up on x-rays. Instability can also occur if there is a loss of motor control and muscle strength/stamina within the neutral zone.

What does it feel like?

A person with lumbar segmental instability typically has a patient-history something along these lines.

1. Back pain may have started after a direct injury to the area, or it may have just developed gradually.
2. The pain tends to be recurrent and has more debilitating effects as time goes on.
3. That person will try to do as little as possible in an episode of pain. According to a survey (O’Sullivan 1997), people most commonly describe the pain sensation as · catching, · locking, · giving way or · feeling of instability.

Classically, the most painful postures are sitting or standing for long periods of time, or being in bent over postures.

The most painful movements are

• bending forwards,
• moving unexpectedly quickly,
• standing up straight after being bent over, lifting or sneezing.

So basically….

The lumbar spine moves in an uncontrolled manner, causing pain. Because the big muscles and little muscles don’t work together properly and the body is unable to control each segment as the body moves.

How do I get rid of it!?

A physiotherapist will need to perform an assessment to find out what type of segmental instability is present (and the type of control that is lacking due to which structure – passive, active or neural). Based on the findings, an intervention will be planned.

In cases where the passive structures have degenerated, it is often possible to train the active and neural structures to compensate for the lower level of stability provided by the passive structures.

With this sort of condition, the exercises that are required are more ‘brain’ exercises than ‘muscle’ exercises. A new way of moving has to be re-learnt, and it requires a lot of concentration.

Lower Back Lumbar Segmental Instability is a post from: Musculoskeletal Consumer Review by Core Concepts

If you are a regular reader of MCR, you know that the number of people suffering from low back pain is quite staggering. The national statistics is that one out of every 5 persons suffers from low back pain at any one time and that there is an 80% chance of a person having low back pain sometime in their lives. One of the key things in treating low back pain is the correct classification of it and understanding the contribution factors. Of these factors less often addressed by physiotherapists is the psychological factor.

With chronic low back pain (classified as those persisting 3 or more months from the onset of pain), the treatment approach needs to be multi-dimensional as there are many factors that perpetuate the pain. Some of these factors include

1. Pathological changes in the structure of the spine -  e.g. joint degeneration, disc herniation (slipped disc), fractures
2. Mechanical loading of the spine- possibly due to the type of work that the back pain sufferer has to perform
3. Poor control of the muscles around the spine
4. Sensitivity of the nervous system- the brain and the nerves are over sensitised to pain, projecting pain greater than it really is
5. Psychological factors- clients’ emotions e.g. fear, anxiety depression, their beliefs that if they do a certain activity that their backs will go, being wheelchair bound or something catastrophic, and often wrongly reinforced by a healthcare professional.

The relative contribution and dominance of the above factors to a client’s chronic pain will differ for each patient. It is important to understand which factors are dominant and whether the client has adapted to the disorder positively or negatively so we can address the disorder more specifically.

Flickr: mag3737

Muscles are not meant to constantly contract, it should contract when it needs to and relax when it doesn’t need to. These clients often never ever relaxes their muscles in fear that by doing so, their backs will give. Because of the constant contraction of the back muscles, the back muscle becomes overly strong and tight and can no longer switch off, leading to an excessive compression of the spine (the back muscles will approximate the vertebrae closer together, resulting in increase loading and compression). At this stage bending activities will hurt, not because of the original problem, but because the muscle now cannot relax to allow the vertebrae to move freely. These types of back pain sufferer will often be spotted NOT lounging into the chair, they will instead sit up tall without support and will have very defined back muscles. These clients have adapted negatively to their disorder, prolonging the pain.

The solution to these types of chronic pain is to change their belief, to assure the client that bending is fine, especially now that the pain is not caused by the original cause. To show them that in a relaxed stretched position that the pain actually reduces, rather than increase. This is usually done by releasing the offending muscles and testing the aggravating posture- bending or squatting. Specific exercises will be taught to facilitate the stretching and relaxation of the overactive tight muscles.

There are many other types of presentation of chronic pain, the above is only one. The concept of the treatment of chronic pain is simple- understand the underlying pain mechanism i.e. what is driving the pain and solve it as best as we possibly can. Those with a dominant psychological driver, often, a psychologist is needed to help change their beliefs.

Chronic Low Back Pain – The Psychological Factors is a post from: Musculoskeletal Consumer Review by Core Concepts

By Dr Fong Shee Yan

Surgery on the spine that once required large incisions, hours in the operating room and extensive blood loss, can, in some cases, be done through an incision less than an inch long.

After the common cold, back and neck pain are the second most frequent reason that Americans visit the doctor, according to the North American Spine Society. Treatment of low-back pain alone costs Americans at least $50 billion each year and is the most common cause of job-related disability and a leading contributor to missed work.

Minimally invasive spine surgery, for the right patient, can make the sometimes difficult decision of whether to undergo surgery a little easier. In traditional spine surgery, a surgeon has to make a large incision and dissect several layers of muscle to access the area of the spinal column he or she is trying to correct. The injury caused by cutting through this muscle and tissue significantly adds to a patient’s recovery time after surgery. In some cases, it can leave long-lasting weakness in the back muscles. Minimally invasive techniques limit injury to surrounding muscle and tissue without compromising results.

A vivid example is a procedure called endoscopic lumbar microdiscectomy, which is used to treat a ruptured or herniated disc in the lower back. The bulging disc compresses nerves in the spine, causing disabling leg pain. Traditional discectomy requires lengthy incisions and the stripping of several levels of muscle to give the surgeon a good view of the area where the disc material compressing the nerve needs to be removed. Now, microdiscectomy can be done through a two-cm incision. A tube is inserted through the incision, creating a tunnel for the surgeon to reach the affected disc with a microscope and surgical instruments with minimal blood loss (Huang 2004, J Orthop Res 23: 406-11). Patients typically can go home the same day or next. This is achieved as post-operative pain is significantly reduced and these often young working adult patients can return to work early. In fact, the average number of disability days was reduced from 49 to 27 days (Hermantin 1999, JBJS 81: 958-65).

Dr. Fong Shee Yan

Qualifications M.B.B.S, Masters of Medicine (Orthopaedic) Fellow of the Academy of Medicine, Singapore Fellow of the Royal College of Surgeons Professional Highlights Dr. Fong is a practicing Consultant Orthopaedic Surgeon with Island Orthopaedic Consultants. Set up Singapore’s first day surgery spine service in Tan Tock Seng Hospital Winner of the Prestigious N Balachandran Award for Outstanding Orthopaedic Trainee (Singapore Orthopaedic Association)

Other spine procedures that now may benefit from minimally invasive approaches include: lumbar fusion to correct back and radiating leg pain caused by spondylolysis, a defect or fracture of the wing-shaped parts of a vertebrae in the lumbar region or lower back. The fusion procedure, which traditionally required an incision that exposed the vertebrae, can now be done through incision an inch long. Similarly, the rods and screws that hold the spine in place while the fusion heals can be inserted via multiple small incisions even less than an inch. Thoracoscopic instruments — tools that aid in visualization and operation through portal holes in the chest — allow a surgeon to address part and, in some cases, the whole correction of a patient with scoliosis. During kyphoplasty to treat painful vertebrae fractures caused by osteoporosis, the surgeon makes two small incisions and inserts a tube in the centre of the vertebrae. Cement is injected into the weakened vertebrae, creating almost immediate pain relief.

Minimally Invasive Spine Surgery is a post from: Musculoskeletal Consumer Review by Core Concepts

Jessica Ellison

Education

• Bachelor of Physiotherapy, Curtin University of Technology, Australia

Career Highlights

• Physiotherapist at Core Concepts Group

Quick Facts

Jessica is a Physiotherapist with Core Concepts. Her area of interest is the spine.

 

Jessica Ellison is a post from: Musculoskeletal Consumer Review by Core Concepts

When should you use heat or ice therapy? The answer is – it depends. In general, heat therapy is for chronic conditions and ice is useful in acute situations.

If you recently sustained an injury or aggravated an old injury, ice should be applied for a period of 15mins each time for the first 3 days. If you feel your muscles are feeling tight and stiff, a hot pack on the muscles will help to relieve the tightness.

This spectrum of acute to chronic looks at the duration since injury. If the injury is sustained within 36 hours, it is considered to be in the acute stage. At this stage the inflammation process is ongoing. Ice will help to bring down the inflammation and swelling so that the injury can heal better. Note that applying heat to this stage will increase the blood circulation, inflammation and hence swelling.

There are 2 common scenarios that cause pain, making you reach for that heat/ice pack.  One of them is the acute injury (for example a fall, twisting movement or direct blow that is immediately painful) and the other is the chronic injury (happened over a period of time or from an acute injury that failed to heal).  Each scenario requires a different approach to reducing your pain and speeding up your recovery.

Acute Injuries

It might be that you have just sprained your ankle playing soccer, shut your fingers in the car door or fractured your hand.  All these are examples of acute injuries and will show the following signs:

• Sharp, severe pain
• Swelling
• Redness
• Increased warmth
• Restricted joint movement
• Unable to put weight through the structure (e.g. leg, ankle, wrist etc).

Flickr: Kyle May

There are many ways of applying ice like using an ice pack; wrapping ice cubes in a wet towel or using a bag of frozen peas (sometimes that is the only thing on hand!).  The cold agent should be in contact with the area for up to 20 minutes at a time and re-applied every 2-3 hours for around 3-5 days or until the swelling settles.

How does ice work?

1.    Decreasing the pain

There are a few proposed theories regarding how ice decreases pain and it is possible that a combination of some of them can cause pain relief.

• Decreased nerve transmission in pain fibres
• Cold reduces the activity of free nerve endings
• Cold raises the pain threshold
• Cold causes a release in endorphins
• Cold sensations over-ride the pain sensations

2.    Reducing swelling

Ice cools the surface of the skin and its underlying tissues, causing narrowing of the blood vessels.  This narrowing leads to a decrease in the amount of blood delivered to the area and subsequently reduces the amount of swelling.  After a few minutes, the blood vessels re-open allowing blood to return to the area.  The narrowing and opening repeat in cycles.

The decrease in swelling also allows more movement in the area and lessens the loss of function associated with the injury.  Pain is also reduced as pressure from the swelling lessens.  Chemicals that intensify the pain are released into the bloodstream when tissues are injured, thus the narrowing of the vessels help to minimize this release and pain.

3.    Decreasing metabolic rate

Ice reduces the metabolic rate and oxygen requirements of the cells.  Thus, even with the decreased blood flow and oxygen delivery that comes with narrowing of the vessels, the risk of cell death will be lessened.  This prevents further injury.

Sub-acute phase

A few days following an acute injury, the pain and swelling may have decreased so much that there may be no sign of the original injury.  However, the tissues are still in the process of recovery and will still benefit from modifying your activities (less vigorous) as well as using both ice and heat alternatively.  This means to apply ice for 10 minutes, followed immediately by 10 minutes of heat.

How does this work?

Doing this will cause massive increases in blood flow to the area as the narrowing caused by cooling is reversed when heat is applied, resulting in an influx of blood to the damaged tissues.  The increased blood flow to the area provides proteins, nutrients and oxygen for better healing.  It also helps remove the products of inflammation and reduce residual swelling.
An important point to note is to ensure that inflammation has stopped before applying this technique.  That means that the area should not be red, and should not be warm to touch.

Chronic Injuries

Flickr: Capture Queen

In order to treat these, heat should be used to help relax tight, aching muscles and joints, increase the extensibility of ligaments and tendons and promote blood flow to the area.  Heat can also be used before exercise in chronic injuries to warm the muscles and increase flexibility.

Heat can be applied to the area in the form of heat packs, a warm damp towel, hot water bottles or heat rubs.  If using a heat pack or hot water bottle, ensure a suitable layer of protection is placed over the skin to prevent burns.  The heat should be applied for 15-20 minutes.

How does heat work?

Heat applied on the skin increases the temperature of the skin and the underlying tissues.  This in turn opens up the blood vessels like your ateries, allowing more blood to flow into the area. This increase flow helps  to remove waste products from cells and deliver more nutrients, relaxing tissues. The increased temperature of the blood also warms up surrounding tissues. Heat also has an effect of increasing flexibility of the soft tissues.

Both heat and ice are cheap, easy to use and effective ways of speeding up recovery when used correctly.  Besides managing your injuries with these modalities, it may be a good idea to consult a physiotherapist in helping you rehabilitate and/or prevent the same injuries from occurring.

Heat or Ice? When to use which? is a post from: Musculoskeletal Consumer Review by Core Concepts

Do you experience pain at the back of your heel? Is the back of your heel red and swollen? And you were told that it might Achilles Tendonitis? But so far treatment for Achilles Tendonitis does not seem to be working? You might be suffering instead from Retrocalcaneal Bursitis.

Background

www.merck.com

This condition is often mistaken for Achilles tendinitis but it can also occur in conjunction with Achilles tendinitis.

Signs and Symptoms

In retrocalcaneal bursitis, pain at the back of the heel is the main complaint from patients. Pain may worsen when tip-toeing, running uphill, jumping or hopping. Often, those who are accustomed to wearing high-heeled shoes on a long-term basis may also complain of pain at the back of the heel when switching to flat shoes. This is because when in high-heeled shoes, the calf muscle and the Achilles tendon are in a shortened position. Switching to flat shoes would cause an increased stretch to the calf muscle and Achilles tendon, irritating the Achilles tendon and the retrocalcaneal bursa. Other symptoms may include redness and swelling at the back of the heel.

What leads to Retrocalcaneal bursitis?

There are several factors which can lead to a person developing retrocalcaneal bursitis. In athletes, especially runners, overtraining, sudden excessive increase in running mileage may lead to retrocalcaneal bursitis. Tight or ill-fitting shoes can be another causative factor as they can produce excessive pressure at the back of the heel due to restrictive heel counter. A person with an excessively prominent posterosuperior aspect of the heel bone (Haglund deformity) may also have a higher predisposition to retrocalcaneal bursitis. In such individuals, pain would be reproduced when the ankle goes into dorsiflexion.

How do we tell that it is not Achilles Tendonitis?

Careful examination by your physician or physiotherapist can determine if the inflammation is from the Achilles tendon or from the retrocalcaneal bursa. Tenderness due to insertional Achilles tendinitis is normally located slightly more distal where the tendon inserts into the back of the heel, whereas tenderness caused by the retrocalcaneal bursa is normally palpable at the sides of the distal Achilles tendon.

Diagnosis can be confirmed with an ultrasound investigation, MRI or CT scan.

Management

• During the initial acute phase of the condition, patients should apply ice to the back of the heel for 15 to 20 minutes and follow the R.I.C.E.R regime. Avoid activities that cause pain.
• Gradual progressive stretching of the calf muscle and Achilles tendon is also advocated.
• Changing the footwear. Wearing an open-backed shoe may help relieve pressure on the affected region. For those whose symptoms were caused by a sudden change from wearing high-heeled shoes to flat shoes, the temporary use of footwear with a heel height in between may be helpful.
• Inserting a heel cup in the shoe may help to raise the inflamed region slightly above the shoe’s restricting heel counter and relieve the pain. It is advisable to also insert the heel cup into the other shoe to avoid any leg-leg discrepancies that can lead to other problems.
• Training frequency and intensity should be gradually progressed with adequate rest between trainings.

When is Achilles Tendonitis not Achilles Tendonitis? When it is Retrocalcaneal Bursitis is a post from: Musculoskeletal Consumer Review by Core Concepts

In an earlier article, we look at what frozen shoulder was all about. In this article, we will look at some treatment options for frozen shoulders

What is the treatment for a frozen shoulder?

Flickr: nataliej

You can try taking over-the-counter painkillers such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDS) to help reduce pain and inflammation. If these do not provide sufficient relief, see your GP for a stronger prescription.

Applying heat the shoulder can also offer pain relief. This warms up the shoulder to make it easier to move, and easier to sleep at night.

Performing stretching exercises for the shoulder can also benefit in reducing stiffness in the shoulder. Diligent exercise can reduce the chance of severe restriction in the shoulder, which can aid in faster recovery from a frozen shoulder. These exercises will be taught by the physiotherapists.

Physiotherapy can help you in the recovery from a frozen shoulder. A physiotherapist can perform treatment techniques to increase movement in the shoulder joint, as well as reducing pain. They can also show you exercises that are specific to your condition and ensure you are performing them correctly.

Severe and unrelenting pain may require a cortisone injection. This is a steroid injection which may be effective in the reducing pain in the short term. Your GP or specialist will help you decide whether this treatment option is appropriate for your condition.

When conservative treatment fails, more invasive options can be considered. Shoulder distension is a technique where saline water is injected into the joint to stretch the shoulder joint to help allow it move more easily. Another option is manipulation, which can be performed to stretch out tightened tissues. This process is conducted under anaesthesia by an orthopaedic specialist to restore mobility in severely frozen shoulders. Surgery is the last resort for a frozen shoulder. During this procedure, scar tissue and adhesions are removed through arthroscopic surgery to allow the shoulder to move more freely.

What can I do to get better?

It is advised that you see your doctor or a physiotherapist to diagnose your shoulder pain if you are unsure of the cause. If you suspect it is a frozen shoulder, some simple exercises can be performed to help prevent your frozen shoulder from worsening. These should be performed 3 to 4 times a day and should be relatively pain-free, especially if your shoulder is quite painful. See your doctor if your condition does not improve within 3-4 weeks.

Flexion

• In standing, hold a stick horizontally in front of you with hands shoulder-width apart
• With the arms straight, bring the stick from hip level towards the ceiling until you feel your pain come on
• Hold for 5 seconds and return to starting position
• Repeat 10 times

Extension

• In standing, hold a stick horizontally behind you with hands shoulder-width apart
• With the arms straight, bring the stick from hip level towards the ceiling until you feel your pain come on
• Hold for 5 seconds and return to starting position
• Repeat 10 times

External rotation

• Lie on your back and hold a stick horizontal in-front of you with your hands shoulder-width apart
• Bend the elbows to 90 degrees and keep them next to your body
• Using the hand on the pain-free shoulder, push the stick towards the affected side whilst still keeping your hands on the stick
• Hold the end position for 5 seconds and return to starting position
• Repeat 10 times

Internal rotation

• Stand holding a stick with the pain-free arm behind your head, and the affected hand behind your back holding the other end
• Using the pain-free arm, pull the stick up towards the ceiling until you feel the onset of pain in your affected shoulder
• Hold the position for 10 seconds and return to starting position • Repeat 10 times

Thawing Frozen Shoulders is a post from: Musculoskeletal Consumer Review by Core Concepts