27 Haven Lane, Ealing, W5 2HZ

Tel: 0208 997 1555

Email: info@w5physio.co.uk

We’re hiring!

July 15, 2019 by  
Filed under W5 Physio News

W5Physio is looking for not one, but two people to join the team at our Ealing-based clinic. Think you’d be a great fit? Here’s a little more about each of the roles:

FULL TIME MSK PHYSIO:

PART TIME RECEPTIONIST:

Please send CVs to recruitment@w5physio.co.uk

Lower back pain treatment & rehab

June 17, 2019 by  
Filed under W5 Physio News

As one of our previous recent articles explained, lower back pain is really common. Most often, this pain is caused by mechanical issues, but problems can also sometimes be non-mechanical, and can need further investigation by a medical professional to help with a diagnosis.  If you didn’t read our previous back pain blog, we suggest giving it a read first, here. 

Lower back pain will usually improve within a few weeks or months with some simple, temporary (or permanent, if necessary) lifestyle changes. Our physios will provide you with advice and a programme of exercises that will help to improve any reduced mobility and/or strength, and will use their knowledge and experience to make sure you have the right exercises and information to help improve your lower back pain and prevent reoccurrence. 

Self-help

In the meantime, here are a few pointers that may help your back pain improve in the very acute stages or if you’re unable to get to a physio right away:  

  1. Don’t stop moving – moving is really important when you have pain because it keeps the muscles working. Try to keep moving as normal but if certain movements are too painful then try avoid them temporarily to allow the body not to get to oversensitive to the movement.
  2. Try some stretches – stretches and flexibility exercises can be very helpful when your movement is restricted or the muscles are very sensitive and tight.  At the end of this blog I’ll detail some stretches and exercises that may be helpful to improve your symptoms.
  3. Hot and cold treatment – this may help to reduce your pain and allow you to move better without pain. Your body may respond to one treatment or both, so give them both a try.
  4. Get professional help – if your symptoms are not improving, always seek a professional opinion. Usually, pain doesn’t mean permanent damage and a large percentage of back pain is in fact protective in nature. X-rays or MRIs are not always necessary – pain can be caused by many different structures that won’t present on a scan. But by getting a professional diagnosis, your physio or doctor will be able to advise on the best course of action to get you on the road to recovery.  
  5. Pain relief – use pain relief in the form of painkillers if prescribed, or as advised by your GP. 
  6. Stress relief – if life is very stressful and if you think it might be contributing to your pain, then it may be good to evaluate where you could make lifestyle changes and reduce stress levels.

Exercises and rehabilitation for Lower back pain:

It’s really useful to know what causes, affects or aggravates your lower back pain because this will guide your treatment. So, if your pain is aggravated by bending or sitting, it means that flexion-type activities should either be temporarily avoided or done differently to help reduce pain. Exercise could involve extension-based movements to help offload the painful structures. 

If leaning backward or rising from sitting type movement is the aggravating activity, then extension-based movements should be temporarily avoided or done differently to help reduce pain. 

Below are some safe exercises you can have a go at. Everyone’s pain is slightly different, so it’s worth trying one set of exercises first to see if they help. If they don’t, simply try a different set.

Lower back pain exercises that may help pain associated with bending/flexion. 

  1. MCKENZIE BACK EXTENSIONS:                                                                                                             
  • Lying on stomach, place hands in the press up position.
  • Slowly perform a press up lifting out the breast bone so as to achieve an even back extension.                                                                                                                                                    
  • Stop when the front of the pelvis starts to leave the floor.                                                                                     
  • Repeat 20-30 times up to 5 times per day if able and if relieving.                                                                                       
  • Progress by bringing the hands closer under the shoulders to start

Alternatively, this can be done in standing by pressing your hands on your lower bottom and supporting your weight as your lean back. Don’t hold the movement into pain.

2. THE SHOULDER BRIDGE:

  • Lying on your back with your knees bent, engage your deep abdominals. 
  • Roll the pelvis back and peel the spine up one segment at a time to rest on your shoulder blades; hold for up to 6-10 seconds using the bottom muscles
  • Gently peel back down, one segment at a time.
  • Repeat 10-15 times.
  • Be sure not to lift too high and arch your back into any pain. 

For pain aggravated by backward bending or leaning, try the following exercises: 

  1. KNEES TO CHEST:    
  • Bring both knees (one at a time) towards the chest and hold for 20 seconds.
  • Repeat 5 times and do 2-3 times a day.
  • You may add a side-to-side roll to release the lower back

2. CAT

  • On all fours check your alignment and engage your deep abdominals
  • Gently curl the tailbone under and allow the rest of the spine to follow into a comfortable cat stretch position
  • Hold for a few seconds then slowly return to neutral, and gently to arch the other way into extension.
  • Repeat 20 times and do 2-3 times a day

Alternatively, these exercises can be helpful for both:

  1. LUMBAR ROTATIONS (KNEE ROLLS):                                                                 
  • Lie on your back with both knees bent up and connected together.  Arms are out to the side and the shoulder blades are anchored on the mat.
  • Engage the deep abdominals. Gently roll the knees to one side, allowing the head to roll in the opposite direction and return to middle.                                                                                       
  • Repeat to the other side.
  • Continue alternating 10-20 times in each direction and do 2-3 times a day.

2.  PRAYER CHILD’S POSE ROCKING

  • On all fours, engage your abdominals. Then slowly sit back onto your heels.
  • Press your hands forwards to feel a stretch along the sides of your body and try get your bottom to touch your heels.  
  • Hold this for 3-5 seconds and then come out of the position and rock forwards a little while arching your back a little as shown in the picture below.
  • Repeat 20-30 times and 2-3 times a day if you can.

Here are some simple strengthening/activation exercises to start getting your back, gluteal and abdominal muscles working better:

  1. PELVIC TILTS
  • Lie on your back with your knees bent up.
  • The spine should be in neutral and the deep abdominals engaged.
  • Gently squeeze the buttock muscles and roll the pelvis to flatten the low back into the mat.
  • Hold the position for 2-3 seconds but don’t hold your breath, then return to neutral.   
  • Repeat 20 times slowly 1-3 times a day.

      2. LEG LIFTS

  • Align the body in neutral and engage your deep abdominals.
  • Without allowing the upper abs to tense or the pelvis to move, float one leg up to 90 degrees.
  • Repeat 8-10 each side.

3.FULL SQUATS OR SIT TO STAND

  • Perform your squat by leaning forwards with your hands and upper body and folding back(sitting back) at the hip joint, not the spine. The spine should stay in its neutral position.
  • Ensure the kneecaps stay in line with the hips and second toe. Return to the start position pressing through the heels to activate the inside quadriceps and buttock muscles.
  • Repeat 10-12 times slowly and up to 3 times a day to start. Then you can slowly increase the repetitions and do more at once to fatigue the muscles more.
  • If this is too hard then first add a chair to sit down on to help with support or if it feels too painful then don’t perform this exercise.

Remember that these exercises are simply guidelines. If you experience more pain while trying them, stop immediately and consult with your GP, or book an appointment at our clinic.  We’ll happily advise on treatment options. 

Causes of shoulder pain

June 3, 2019 by  
Filed under W5 Physio News

Mobility over stability

The upper limbs are crucial. They help us to explore the world, allowing us to reach, pull ourselves up, push open doors and save ourselves if we fall. Without even thinking about it we use our upper limbs to carry out hundreds of different tasks each day. Perhaps it’s no surprise then that a lack of shoulder stability is a common issue.  

To explain the shoulder in a little more depth, it’s a complex system comprising three joints and three bones: the humerus (upper arm bone), the clavicle (collarbone), and the scapular (shoulder blade). The size of the humeral head (the bulbus bit of the bone at the top) is approximately the size of an orange and the surface it articulates on is the size of a 50 pence piece. So how does the large humeral head (the orange bit) refrain from slipping off or falling out from the small 50p-sized joint surface?  

Well, firstly, there’s a really cleverly designed rim known as the labrum. The labrum increases the surface area of 50p and two muscles (and a group of muscles collectively referred to as the rotator cuff) hold it in place. Additionally, a membranous cover (called the joint capsule) which surrounds the 50p also helps to hold everything in place. As well as this there are liquid filled sacks called bursa which aim to reduce friction between the muscle tendons and the bones. A miraculous combination of all of the above working together results in the shoulder being quite an extraordinary apparatus!

Causes of shoulder pain

With so many different components working simultaneously to make our shoulders function, it’s understandable that problems can occur. Linked to the anatomy described above, some of the most common difficulties include:

1. The rotator cuff tendons can be overloaded and become problematic (they can swell, thicken and eventually degenerate). This problem is referred to as “tendinopathy”.

2. The rotator cuff can tear, often due to acute overload. This doesn’t always mean lifting a heavy weight but can happen with things like gardening or putting flat-pack furniture up with the wrong tools. 

3. The bursa (those fluid filled sacks that reduce friction between the tendons and the bone) can become inflamed due to an occurrence such as a fall. 

4. The joint capsule (the cover round it) can become inflamed and contract causing what is known as a “frozen shoulder”. A frozen shoulder goes through a number of stages of pain and stiffness before eventually resolving and the condition is much more prevalent in women than in men. It’s seen most frequently in females above the age of 40 and although there are a few theories for this, the medical world is yet to agree on exactly why this is the case. 

5. A break, fracture or dislocation to the bones/joints. Skiing season means we see a lot of impact fractures (referred to as Hillsachs lesions) to the humeral head due to patients falling onto the shoulder, elbow or an outstretched arm. If you’ve taken a fall onto hard ground whilst skiing or playing another sport and your shoulder pain continues, get it checked by your GP or physiotherapist. An X-ray may be necessary to rule out a Hillsachs lesion.

Less frequent problems include:

6. Arthritis in the joints. Arthritis can occur in the main joint between the humerus and acromion, the acromioclavicular joint or the sternocalvicular joint. What a mouthful! Best to get checked out for an accurate diagnosis on this one! 

7. Referred pain from the neck. This is most commonly seen in patients who have problems with organs, such as liver disease or duodenal (small intestine) which can cause right shoulder pain. Slightly less commonly experienced is referred pain under the right shoulder blade which is the result of gallbladder or gallstone issues.

8. The big C. Cancerous tumours can cause shoulder pain, but again, thankfully, these are extremely rare.  

As you can see there are a number of structural and functional problems than can cause shoulder pain. Shoulders are complex, so don’t be tempted to self-diagnose. It’s important that to arrange a thorough examination with a GP or physiotherapist. At W5Physio, we will ask you lots of the right questions, plan a physical examination and recommend any further investigation such as ultrasound imaging, X-rays, MRI or CT scans. If in doubt, come and get checked out! 

Why hydration is so important to our health

June 1, 2019 by  
Filed under W5 Physio News

We all know that water is essential for any living thing. Humans, animals, plants and trees all need to stay hydrated in order to survive.

The NHS recommends that adults drink between six and eight glasses of water daily. Two-thirds of the human body Is made up of water, so it’s important we’re keeping topped up, and especially so if we’re active.

Athletes can lose between six and ten per cent of their body weight when taking part in professional sports, and that’s just from perspiring. But even if we’re not all the next Usain Bolt, if you’re carrying out any form of exercise, it’s best practice to replace any fluid lost – and that’s in addition to the NHS’s recommended daily intake.

A survey carried out by the RNLI (Royal National Lifeboat Institution) showed that out of the 2000 British adults who took part, 17% didn’t drink any water at all during the average day. Only 8% consumed 1.5 litres (approx. 7.5 glasses), whilst just 6% drank two litres.

Men, it seems, are less hydrated than women, with 20% of men who were surveyed claiming they drink no water at all in comparison to 13% of females.

Yet the health benefits of good hydration are widely publicised. Water doesn’t damage teeth like hot or sugary drinks can, it’s calorie-free and is cheap! When it comes to taking care of our joints, water ensures that they are lubricated and cushioned and drinking a good amount of water also provides protection for tissues and the spinal cord. Good hydration has been proven to regulate body temperature and maximise physical performance whilst improving strength, power and endurance.

Research has further shown that it boosts energy and activates metabolism, and taking on water after a massage can reduce soreness as well. Some studies even claim that drinking water can help you to lose weight.

So, what are you waiting for? Water has many more benefits than simply quenching your thirst. And with a number of fitness and wellbeing apps now available that will remind you to drink, it’s easier than ever to reach your hydration goals. Keep a jug on your desk, or a water bottle in your bag. And see what a difference H20 will make to your health and performance.

 

For more advice on reaching your health and fitness goals why not make an appointment with one of our experienced physios? Or read another of our blogs. 

 

https://www.everydayhealth.com/water-health/water-body-health.aspx

https://www.naturalhydrationcouncil.org.uk/press/how-hydrated-is-britain/

https://www.nhs.uk/news/food-and-diet/six-to-eight-glasses-of-water-still-best/

https://www.nhsinform.scot/campaigns/hydration

https://www.healthline.com/health/food-nutrition/why-is-water-important#immunity

 

 

 

 

 

 

The truth about back pain

May 2, 2019 by  
Filed under W5 Physio News

What a pain!

Back pain is without doubt one of the most common problems we see in our physiotherapy clinic. Statistics claim that up to 80% of us will experience back pain at some time in our lives. For some of us, back pain is sporadic, whilst for others, it’s more persistent. But whatever the frequency and cause of your back pain there are lots of things that can be done to treat it.

 

Why does my back hurt?

Mechanical issues

Let’s start with the good news – back problems are only occasionally serious business and for most of us back discomfort stems from spinal soft tissues, or sometimes the bones or joints.

Nowadays, it’s common for people to hunch over desks, constantly scroll through phones and tablets, or sit in cars for long periods of time, and many cases of back pain are purely the result of poor posture. Let’s face it, we live in a fast-paced world where remembering to sit and hold ourselves correctly is often the last thing on our minds.

Stress is another modern-day yet common cause of back pain. Did you know that simply feeling tense or run down can play havoc with your back?

For others, back problems occur because of moving or lifting awkwardly, or can be the result of a sprain or strain.

All of the above examples are of what we call ‘mechanical’ back pain and cover the majority of back problems that we’ll see at W5Physio. It’s important to remember that mechanical difficulties will normally start to get better within a few weeks. And physiotherapy can definitely help in your recovery.

Other conditions

Of course, non-mechanical causes of back pain sometimes occur too. Non-mechanical problems often present with other symptoms such as stiffness, numbness, tingling or weakness.

They include sciatica – nerve irritation that causes pain to radiate in the lower back, buttocks and down the leg into the feet; spondylolisthesis (easy for you to say!) which is the result of a bone in the spine slipping out of position; a prolapsed (slipped) disc, where spinal cartilage presses on a nerve; or ankylosing spondylitis which is basically the swelling of joints in the spine.

Again, all of these conditions will benefit from physio and visiting your doctor or one of our physiotherapy professionals (who are used to seeing these kinds of problems daily) can diagnose you properly and advise of the best course of action.

Infrequently, back pain is the result of something more serious. An infection, cancer, broken bone or cauda equina syndrome (severe compression of nerves in the lower back) are all examples, but they’re extremely rare. Again, visit us for an accurate diagnosis if you’re concerned.

Tips for treating your back pain

As we’ve identified above, there are many reasons why you could be experiencing soreness in your back. And that’s why it’s important to have a professional identify the exact underlying cause.

Generally, though, there is some ‘rule of thumb’ when it comes to alleviating your back pain. Here are our top tips:

  • Don’t stop moving

Even if pain seems to be worse on moving, aim to continue with your normal activities, where possible. Steadily and gradually increase your activity and try not to fear twisting or bending. Studies have shown that people who remain active are likely to recover more quickly.

  • Try some stretches

Trying some gentle stretches can take the edge off your pain and loosen tight muscles. Our physios can provide you with a programme of stretches to do in the comfort of your own home. Stretching even when you don’t have pain is a great way to prevent future back problems occurring.

  • Hot and cold treatment

Some people find that heat, such as a warm bath or hot water bottle helps their back pain. Others find that putting something cold on it (like an ice pack), is better – never put ice directly onto the skin though! Our physios can advise on whether hot or cold treatment, or a combination of both, is best for your specific condition, so give us a call.

  • Get professional help

Backs can be tricky things! And with so many diagnoses, it’s safest to get a professional opinion to ensure you’re taking the right steps to aid your recovery. Seek advice from a physiotherapist or your GP.

 

If you’re experiencing acute or chronic back pain, make an appointment with us today. Our physiotherapists have a wealth of experience in physiotherapy, acupuncture and pilates.

Our tailored treatment plans have great success rates and we’ll not only help to get you back on the road to recovery but prevent future back problems too.

 

 

 

Strength training for running

May 2, 2019 by  
Filed under W5 Physio News

Running appears to be more popular than ever. With an influx in local running clubs opening and park runs being organised, it’s attracting individuals of all ages and fitness levels. People are starting to push themselves more and more, setting goals from just the occasional 5km to training for half marathons, full marathons and obstacle courses.

Despite this increase in popularity in the sport, many runners are surprised to hear that running alone is not enough to improve performance and to push their bodies to the next level. People can be put off by the mention of strength training as it can be associated with bulking up – something that runners generally want to avoid, along with the aching or stiff muscles that can follow.

However, for runners, strength training doesn’t have to mean bulking up. Training should be centred on strength as opposed to muscle gain, and because of the miles put into running, any increases in muscle mass are relatively low.

Benefits of strength training for runners

In reality, there are many benefits of strength training for runners. The main three accomplishments are:

  1. Preventing injuries by strengthening muscles and connective tissue
  2. Increasing running speed by improving neuromuscular coordination and power
  3. Improving running economy by encouraging coordination and stride efficiency

In an interview with The Guardian, Mo Farah explained that squatting 200lb and doing core work had made a significant difference to his running. A study in 2008, carried out by Storen et al, looked at runners that performed heavy squats three times a week, alongside runners who performed only their normal distance training. The findings showed that runners doing the squats improved their running economy and time-to-exhaustion at maximum aerobic speed without any change in their body weight.

Strength training further makes your body more efficient at converting metabolic waste into energy, decreasing  recovery time following long runs. Regular strength training can also help to correct muscle imbalances and weaknesses that are common in modern life, especially for runners who take up the sport as adults and spend their non-running hours at a desk.

How and when to strength train

Ideally, you should strength train three times a week, but even just once per week is better than nothing. Strength training is meant to help your running, not detract from it, so incorporate it into your regular run training routine. You can do strength and submaximal run sessions on the same day providing you leave a six hour window between sessions.

And importantly, always ensure you have rest days. It’s essential to give your body time to recover and to ensure you’re stretching effectively.

Below, we’ve included some strength training exercises for runners. They target upper body, lower body and core. If you have specific imbalances or recurrent injuries it’s best to arrange a full assessment with a professional. We can help with this kind of assessment at W5Physio and will design a tailored programme for you – get in touch with us here.

Exercises

1. Single leg squat

 

2. Romanian single dead lift

3. Single leg bridge

 

4. Squats with weight

 

5. Lateral band walk

6. Side plank

 

7. Plank

 

8. Bird dogs with tucks

 

9. Burpees

 

10. Push ups

 

11. Bent over rows

 

12. Rotational shoulder press

These exercises target upper body, core and lower body. Choose a few in each area to create a full body workout or simply concentrate on one area at a time. For best results add them to your easy or cross training days. And remember if you’d like further advice, contact us – we’re here to help!

 

 

How to prevent the most common running injuries

March 13, 2019 by  
Filed under W5 Physio News

There’s no denying that running is a great way to keep fit. It can help you to lose weight, lower cholesterol, increase lung function, boost immunity and relieve stress. Running has become an increasingly popular sport with many people now challenging themselves to organised 5k and 10k events, and half and full marathons.

However, running does come with risks, and if not done correctly can cause a whole host of injuries to knees, ankles and hips, muscles, tendons and ligaments. Even regular runners with great technique and habits can find themselves faced with occasional aches and pains related to their exercise or training routine.

At W5Physio, we see a whole host of running-related problems in our clinic, so here, we’re going to share with you our top tips for preventing some of the  most commonly seen injuries.

The golden rules

There are some golden rules of injury prevention that seem to work for most people, most of the time. There’s no guarantee they’ll  prevent you from ever getting hurt, but if you incorporate these principles into your running, you will be more likely to enjoy a long and healthy running life.

  1. Avoid doing too much, too soon and too fast. This is the number one cause of running injuries. The body needs time to adapt to increases in mileage or speed. Muscles and joints need recovery time so that they can handle greater demands. If you rush that process, you could break down rather than build up.
  2. Build your weekly mileage by no more than ten per cent per week. So, if you run 5km the first week, run 5.5km the second, about 6km the third week, and so on. Use the ten per cent rule as a guideline, but even that might still be too aggressive an increase, so be sure to work at your own pace.
  3. Listen to your body. Most running injuries don’t come out of nowhere. Usually there will have been warning signs – soreness, aches and persistent pain.
  4. Buy good trainers. There’s no single best shoe for every runner – your goal is to find the one that offers the best support and fit for your anatomy and biomechanics. Try visiting a specialist running store – the staff there will watch you walk or run, and help you find the best shoe for you.
  5. Take some time after each workout to write down notes about what you did and how you felt. For instance, you may notice that your knees ache when you run on consecutive days but you feel great when you rest in between running days. Look for patterns. This will help you identify any weaknesses and the best routine for you.
  6. Experts agree that most runners can draw benefit from cross-training activities (swimming, cycling, rowing) and core strengthening to help improve muscle balance and stay injury free.
  7. Respect your limits. They’re determined by genetics, anatomy, biomechanics, age, level of fitness, history of injury, gender, lifestyle and many other factors that are out of your control.
  8. Increasing your stride rate has been linked to a lower rate of injuries. Ideally, aim to take 170 to 180 steps per minute.

Warming up is key

Hitting the road after you’ve just spent eight hours sitting at a desk can be a shock to the system, so it’s smart to do a dynamic warm-up before you launch into a workout. A dynamic warm-up prepares your body for the demands of running by increasing body temperature, improving range of motion and increasing blood flow to the big muscles you’ll rely on most while running – your glutes, quads and hamstrings. Exercises we’d recommend in your warm-up are the following:

  1. Warrior lunge

This warms up the core muscles and promotes hip mobility and achilles tendon flexibility.

Lift your arms above your head. Step your left foot forward into a lunge, making sure your knee doesn’t extend forward past your foot/toes. Step back to start, bringing arms down. Switch legs. Do eight to ten reps on each leg.

  1. Lateral squat

Lateral squats will activate the glutes and adductor muscles. Stand with your feet wide apart and shift to the left as you lower down into a squat, bending your left knee. Touch your right hand to your left foot. Return to standing, then switch sides. Do ten reps in each direction.

  1. Toy soldier

This exercise warms up the glutes, hamstrings, and quads.

Without bending your knee, step forward and kick your right leg out and up to waist level while extending your left arm, as if to touch your toes. Release and swap legs. Do ten reps each side.

  1. Star touch

This Improves hamstrings and glute flexibility. Stand with feet wide apart, toes pointing forward. Keeping the legs straight, reach your left hand across the body and try to touch your right toe. Return to the centre. Repeat on the other side. Do eight to ten reps on each side.

Our physios have a wealth of experience in running-related injuries, and many of them are keen runners themselves. Get in touch for advice on developing a safe running routine, or if you’re experiencing any pain or injury that you think may be related to running, be sure to contact us to make an appointment. We look forward to helping you back to fitness as quickly as possible.

What is atraumatic shoulder instability?

February 25, 2019 by  
Filed under W5 Physio News

Whilst most shoulder dislocations are a result of trauma (an injury), some people also experience episodes of instability without having injured themselves. As physios, its important for us to work out why such instability has occurred. Here we explain a bit more about Atraumatic shoulder instability.

Basically atraumatic instability is instability of the shoulder i.e. dislocation, without a trauma. Done.

Well, not quite…

The majority of people who suffer from this will have a combination of underlying laxity in the ligaments and the joint capsule, and reduced muscle strength and control. Causes can vary from repetitive movements that create some micro trauma to the joint capsule, for example, in sports where there is a lot of throwing or overhead activity or where the joint is forced into extreme rotation, like gymnastics. This kind of activity loosens the capsular restraints.

Other causes can be our genetics, our development or some studies have even shown some psychological causes are possible.

Who is affected?

This condition is primarily seen in the younger person – those under the age of 25. As mentioned, there will be no clear history of injury but there may have been something slight that started it all off. A person may be higher on the hypermobility scale, there may be a history of subluxations or dislocations.  In someone suffering with atraumatic instability, we’d expect to see evidence of pain, particularly at the front of the shoulder and there may be fear around moving or performing tasks with the shoulder.

What can we do about it?

There are some cases that will need to be referred into a specialist shoulder unit, and some that will need surgery. However, once abnormal muscle patterning has developed, amongst other life stresses, surgery can sometimes result in a poorer outcome. But should that be the case, your physio and shoulder doctor will discuss the options with you.

The good news is, a large number of people will be able to recover and manage with physiotherapy and rehabilitation and this should be the first port of call. Having a good, structured rehabilitation programme, which factors in all muscle function, pain and any psychological factors such as fear and anxiety about moving the shoulder (1) is key. Then being consistent with your rehab is vital as some studies suggest that it takes a high level of compliance and commitment to achieve results…and most of these studies took place over 12-24 weeks, so it takes a long time and is not easy (2, 3, 4).

There are many different routes for rehabilitation to follow and many different exercises that can be done. It will depend on individual assessment as to where the focus may be. This will usually involve working on the muscles that control the scapula (shoulder blade), the muscles that act on the humerus (upper arm) and the muscles that control the shoulder joint itself.

The below are just a few examples of the sort of thing you might be doing at each stage.

Stage 1:

In this stage we are trying to reduce pain, fear and avoidance of movement and any associated anxieties which are common place and natural emotional reactions to shoulder instability. It is important in this stage to find a ‘safe zone’ which is a range where you feel comfortable to move the arm, so that we can begin to get some activation of the muscles.

To encourage this, a good place to start is with what we call ‘closed chain exercises’ where we can get some load through the arm but on a stable surface. This allows us to work on joint stability, proprioception and some co-contraction of the muscles. In this stage I would also start to introduce some isometric (static) contractions of the rotator cuff.

Here, we are not as worried about hitting specific sets and reps but working from 30-60 secs for 3-4 times is a good place to start with the focus on building confidence.

Here are some examples of the kinds of exercises we would generally recommend during Stage 1 of recovery:

1. 4 point kneeling weight shift – watch the video here.

2. 4 point Progression – watch the video here.

3.  Isometric External Rotation – watch the video here. 

Stage 2:

In Stage 2, we are aiming to introduce some weighted movement to start to build some strength and endurance. It’s best to work with pain, effort and fatigue when defining sets and reps which means work to fatigue with what you can manage. This will normally equate 3-4 sets of 12-20 repetitions as we look to build control and stability.

Here are some examples of Stage 2 exercises:

1. Side lying external rotation – watch the video here.

2. Prone external rotation – watch the video here.

3. Prone Horizontal abduction – watch the video here.

Stage 3:

During Stage 3, we’re looking to put different movements together and tap into the rest of the body’s kinetic chain.

Examples may include the following:

1. Flexion with external rotation – watch the video here.

2. Lunge with resistance – watch the video here.

3. Ball rotations – watch the video here.

Stage 4:

In Stage 4, we want to add some dynamic movement, working some of what we call our ‘stretch shortening cycles’ as you start to progress back to your normal activities and/or sport.

1. Throwing and catching – watch the video here.

2. Drop and catch – watch the video here.

 

The general rule should be that if there is positive progress at 12 weeks, a patient should persist with the rehab programme for another 3-6 months. If at 12 weeks no progress has been made then it is probably time to explore other options.

Here’s our summary:

  1. Physio is first line of management for atraumatic instability. It’s a long process and it’s hard work. Be consistent and stick with it. You will get there.
  2. The entire process needs to be a joint decision-making process with you, your shoulder consultant and your physio.
  3. If you’re not improving, then referral on to a shoulder consultant will be necessary. Some people will need a direct referral depending on certain criteria (as discussed above).
  4. Build confidence, stability, control and then add the fun stuff.

If you’re struggling with shoulder pain, get in touch for an appointment with one of our skilled and experienced physiotherapists. We look forward to seeing you soon!

 

6 Top tips for healthy Valentine’s Day

February 13, 2019 by  
Filed under W5 Physio News

It’s Valentine’s Day…cue the chocolates, wine and meals out. Although the occasional indulgence won’t hurt, if you’re keen to stick to a more healthy routine this February, there are plenty of ways to show your partner your appreciation for them, without completely neglecting your well-being in the process.

Here are our suggestions for some alternative Valentine’s activities

1. Get moving

Valentine’s Day doesn’t have to mean sitting indoors, eating or watching a rom-com. Why not try getting sweaty with your partner by heading out for a run, cycle or walk? There’s nothing more rewarding (or romantic) than feeling like you’ve both achieved a shared goal. You could even pack a picnic. After all, you’ll need to keep your strength up after burning all those calories.

2. Cook a meal together

We all know that cooking at home is the healthiest option when it comes to avoiding hidden calories, fats and sugars. This Valentine’s Day, why not plan a tasty but healthy meal in the comfort of your own kitchen? Enjoy time with your loved one as you share the food prep, before sitting down at your very own candlelit table for two. It’s the perfect way to enjoy a special evening without piling on the pounds.

3. Take a dance class

Is there a more perfect excuse to get close to your companion than in a dance class? Dance is one of the best ways to get into shape as it helps with posture and provides a workout for both body and mind. Take your Valentine in your arms and take to the dance floor – it’s one of the most popular hobbies in the UK right now.

4. Book a massage

Low lights, indulgent smells and chilled-out background music. There’s nothing more romantic than a couple’s massage as a Valentine’s treat. Even better is that a massage is a great way to take care of yourself: promoting relaxation, reducing stress and anxiety, easing aches, pains and inflammation, as well as improving sleep.

Don’t fancy leaving the house? Why not pamper your partner with a massage at home? Best of all, they’ll probably agree to repay the favour too.

5. Take a bath

Warm baths are another great way to reduce stress, ease aches and pains and create a little romance. Bring out the bubble bath, light some candles and scatter some petals for the perfect atmosphere. Your loved one will appreciate the effort and your muscles and mind will appreciate it too.

6. Climb a mountain

There are few things more rewarding than testing your body with a hike up a mountain. Better still, there are few things more romantic than the stunning view when you reach the summit. Get adventurous with your sweetheart this Valentine’s Day and create an unforgettable experience. And don’t forget the champagne and strawberries for when you arrive at the top!

 

For more tips on improving your health and well-being, get in touch with W5Physio. We’re experts in rehab and are here to help you reach your fitness goals.

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What to expect from your first appointment at W5Physio

January 29, 2019 by  
Filed under W5 Physio News

At W5, we understand that any form of medical treatment can be daunting. And especially so if you’ve never had physio before. It’s normal to have a whole host of questions such as, will it hurt? Will I see immediate results? And, is physio the right treatment for me? Well, we’re here to help…

Your initial assessment will comprise of three parts: the subjective and objective examinations, followed by a diagnosis.

This short article has been written to put you at ease and provides an insight into exactly what you can expect from your first physiotherapy appointment with us.

The subjective examination

As physiotherapists, we work within a biopsychosocial model…wow! Are you blinded by technobabble yet? Whatwe basically mean is “listening to you about your complaint” – something we call the “subjective examination.”

The first part of your initial appointment will involve us collecting a lot of information from you about what’s wrong and, more importantly, how it’s affecting you so that we can work out how to help.

During this subjective examination, we’ll ask questions that aim to rule out things like chronic pain (pain that’s been present for a long time, comes from the central nervous system and may be better treated by a specialists such as a psychologist); or, things like tumours, that unfortunately won’t benefit from physiotherapy either.

It’s really important we ask you lots of questions to gather as much information as possible. We’ll likely ask you what you think is going on and whether you have any thoughts on how we can help you to get yourself better.

It’s all part of us building a partnership where you’re in the driving seat and we’re simply helping you to your destination of feeling better. And we appreciate that the journey to recovery will look different for every individual.

The objective examination

The next stage is the objective examination. Based upon the information you provided us in the subjective, we probably have an idea of what the complaint could be.

This part of your appointment helps us to test some of our thoughts around what we think the problem is.

This is the “hands on” part of your session where your physiotherapist will use gentle movements and/or manual therapy techniques to confirm your complaint, and to help the pain and restore some movement, should you be having mobility issues.

We’ll ask you to show us where it hurts and when it feels better through guiding you through a series of movements such as bending, stretching and twisting. We’ll carry out a full assessment, palpitating muscles and checking joints for stiffness or laxity.

The objective is also the part of the examination where we use our neurological testing skills. This means testing your reflexes, muscle strength and sensation. A thorough neurological exam helps to “rule in” problems of the nervous system and can help your physiotherapist decide whether you need an x-ray or scan.

The diagnosis

Once we’ve carried out both the subjective and objective examinations we can reach a diagnosis and discuss what we can do to help. We’ll estimate how much treatment is required and how long it will take to reach the goals agreed with you.

By the end of your first session, you’ll understand:

  • What’s wrong
  • What to do about it
  • An approximate recovery time
  • And, how to prevent problems coming back.

Do you think you or someone you know could benefit from physiotherapy? Why not get in touch to arrange an initial appointment. Our team of professional and friendly staff will use their experience and knowledge to put you at ease and ensure you’re feeling better as soon as possible.

 

 

 

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