Can You Have A Rotator Cuff Tear With No Pain? YES!

Over the years, our knowledge and ability to treat rotator cuff tears have really advanced significantly.  This includes advances in surgical technique, rehabilitation processes, and even training modifications.  

Catalyst Physiotherapy sees many clients that report shoulder pain that appears to be coming from rotator cuff pathology.  Notice that I just simple say “rotator cuff pathology.”  To me, it doesn’t really matter if it’s torn, partially torn, impinged, inflamed, or anything else.  The only thing that matters to me is how well you function and how well you move.  Can you lift your arm?  Can you work or play sports without difficulty?  

Still, when people come to see me, all they care about is if their rotator cuff is torn or receiving a specific diagnosis for their symptoms.

Over the years, we have learned that diagnostic tests, like x-rays and MRIs, often don’t correlate with the level of pathology.  This has been shown for injuries such as arthritis and disc pathology which people commonly have but experience no symptoms.  I have seen films of people with really nasty looking backs and knees and minimal complaints.  Conversely, I have seen films of people with minimal findings but debilitating symptoms. So what's worse?

I have been asked on several occasions, “is it possible to have a rotator cuff tear and no symptoms.”  I thought this was a great question, so here it is.

We know in elite level overhead athletes that Conner et al showed that 40% of asymptomatic shoulders had rotator cuff tears.  I always say that throwing a ball isn’t good for your body!  But what about everyone else?

Another article on the subject was published back in 1999 by Tempelhof et al.  They studied 411 asymptomatic shoulders using ultrasound and noted that 23% of subjects had a rotator cuff tear.   That’s 1 in 4!  Pretty significant percentage, but take a look at the breakdown by age:

• 13% of people aged 50 to 59
• 20% of people aged 60 to 69
• 31% of people aged 70-79
• 51% of people aged 80 or above

As you can see, there is a linear increase in the presence of rotator cuff tears as we age.  So the answer to my clients questions are  now pretty clear.

YES!

How Can You Have a Rotator Cuff Tear and No Symptoms?

Catalyst Physiotherapy really put symptoms and function together.  If you have symptoms you probably aren’t functioning well (for example, lifting your arm.), and if you aren’t functioning well, that is essentially a symptom itself.  So the question is, how can you have a rotator cuff tear and no symptoms? 

The answer has to do with a suspension bridge!

Burkhart et al described what is called the suspension bridge concept of rotator cuff anatomy.  If you look at the shoulder from overhead, you can imagine a suspension bridge surrounding the humeral head.  In this model, imagine that there is a tear of the supraspinatus muscle on the top of the bridge.  If the anterior and posterior rotator cuff (the two suspension towers) are intact and functioning well, shoulder function may be maintained.  photo from Burhart et al

This explains the massive irreparable rotator cuff tears that we see and can eventually rehabilitate them back to lifting their shoulder again.  This also explains why so many rotator cuff repairs fail after surgery, but patients are still satisfied with their outcome.  Essentially if we enhance the anterior and posterior cuff’s ability to dynamically stabilize, you can still maintain function with a supraspinatus tear. In layman's terms, Physiotherapy rehab exercise! 

So, you can have a rotator cuff tear and no symptoms, you just need a strong and stable cuff around the tear to help dynamically stabilise.

The 6 Most Common Causes of Knee Pain... FIXES! Part 2

The only way to get permanent relief to knee pain is to fix the movements that caused the problem in the first place...

To reiterate: As with most injuries, once you’re hurt you’ll probably have to take some time off from exercises that bother your knees, not always, but normally.  This is a great time to see a Physiotherapist.   Some soft tissue work and manual therapy is sometimes exactly what is needed to get this area to calm down and stop hurting.  While the area heals up and your knee pain starts to decrease you can get to work on fixing your movement.

Obviously, each person is different. I’m not saying that everyone is going to have the same problems with the same solutions.  However, we here at Catalyst Physiotherapy see a lot of the same things over and over again with knee pain in this athletic and not so athletic population, and applying these principles have been successful.  If you’ve ever been diagnosed with chondromalacia patella, patellofemoral pain syndrome or IT band syndrome then this article is for you.

Fix #1 – Promote Ankle Mobility

If you lack flexibility in the ankle (Dorsiflexion) then whenever you challenge the end range of your joint, you’ll end up compensating to complete the motions.  Think about performing a deep squat or stepping down a step.  If you lack ankle mobility it could be the cause of a compensation at the knee which is commonly called dynamic genu valgus.  In lamen’s terms that means your knees travel inwards. 

Unfortunately this applies to every exercise that challenges the flexibility of your ankle (end range dorsiflexion in physiotherapy terms).  That means the same thing goes for running, lunges, pistols, jumping and landing!  So let’s sort this.

Fix your Ankle Mobility:

and stretch the soleus:

Fix #2 – Promote Foot Stability

What’s important to keep in mind is that our knees movement are dictated by our hips and feet.  If you’ve got poor movement (poor stability in this case) at the foot, you’ve got poor movement at the knee.  When I refer to stability it means being able to support your foot in the 'proper position'. 

The research supports this too, those with a flatter foot (more pronation) are more at risk for knee pain.  We’ve been wearing shoes to help support our feet our entire lives, is it any surprise that our feet are weak and lack stability?

Understanding the short foot position (creating foot stability)

Fix #3 – Promote Hip External Rotation and Abduction Strength

Since our knees are a have a vital relationship with our hips it makes sense to attack the hips in order to promote efficient movement at the knee.  I like to approach the hip with exercises specific to what we’d encounter in the gym.

Squatting Patterns

Lunging

Sinle leg patterms

Fix #4 – Promote Hip Mobility

If we are tight in our adductor (groin) musculature and limited in hip external rotation and flexion then we’re going to have a few issues.  Limitations here will bring us right back into genu valgum (knee moving inwards) at the bottom of a squat.  If we’ve got issues here we’re also opening ourselves up to hip pain and problems like femoral acetabular impingment (FAI) and subsequent hip labral tears.  So what’s the fix?

Mobilize your hip flexors and adductors

Workingon hip external rotation and stretching the capsule 

Fix #5 – Promote Core Stability

This picture sums up the problem at the pelvis, hip and foot that leads to a poor knee position.  Take note of what’s going on at the pelvis.  It’s tilting to the person’s left.  If we want to fix everything that’s wrong with this picture, we need to address the core and we’re going to do this by promoting stability.

Fix: Strengthen the Glutes, Hamstrings and Trunk musculature to reset the pelvis in a neutral position and keep it there while we move or exercise.

We have to select exercises that challenge our core to combat rotation and lateral flexion, the specific forces that will lead to knee pain.

From the image below, you can see that strengthening and therefore shortening) the rectus abdominis (6-pack muscles), glutes and hamstrings will help us stay in a better pelvic position.  A neutral position of the pelvis will help keep the lower limb aligned better.

Fortunately for us the exercises described to strengthen the hips have already started the process of strengthening the core.

In addition to strengthening the glutes and hamstrings, you’ll need to hit a work on a few additional exercisesto challenge core stability.  I’m a big fan of certain plank exercises and dead bug variations because they challenge our core to resist rotation and that’s key for keeping our knees in proper alignment during exercise.

Dead Bug:  Make sure to keep your lower back flat against the floor, or atleast in a neutral position.

Around the world plank variation

Fix #6 – Fix your technique

So when we’re looking to correct knee pain we’ve got to take a total body approach.  I say it again and again.  I love foam rolling and other forms of soft tissue work, manual physical therapy and taping techniques as much as the next guy but…

The only real solution to the problem is going to be fixing the movement that caused the problem in the first place.

Treat each exercise you do in the gym as a skill.  Keep the weights heavy enough to get a training effect (build some strength and muscle) but light enough to ensure perfect technique.   Be honest with yourself.

Part 3, prinicples of the above

The 6 Most Common Causes of Knee Pain... Part 1

Knee pain sucks, especially if you’re an athlete.  Unfortunately, The clinic sees a lot of runners and athletes with knee pain.  Running and deep squatting already place a bunch of stress on the knee and if you aren’t moving properly (ie: good technique) the situation gets worse.  Individuals with knee pain usually present with some 'interesting' ways of moving that lead to knee pain. 

The only way to get permanent relief is to fix the movements that caused the problem in the first place.

Fortunately for us, in most people with knee pain the poor movement is predictable and fixable, providing the client is willing to work!

As with most injuries, once you’re hurt you’ll probably have to take some time off from exercises that bother your knees.  This is a great time to see a Physiotherapist. Some soft tissue work and manual therapy is sometimes exactly what the doctor ordered to get this area to calm down and stop hurting.  While the area heals up and your knee pain starts to decrease you can get to work on fixing these common problems.

Obviously, each persons mechanics and anatomy is slightly different.  This is an online article and I’m not saying that everyone is going to have the same problems with the same solutions.  However, we see a lot of the same things over and over again with knee pain in this athletic and less athletic population, and applying these principles have been successful.  If you’ve ever been diagnosed with chondromalacia patella, patellofemoral pain syndrome or IT band syndrome then this article is for you.

Cause #1 – Poor Ankle Mobility

This one is absolutely huge, especially if you’ve got a history of ankle sprains or instability.  I’d say that most people could benefit from some extra ankle dorsiflexion and those with knee pain usually have significant limitations here.  If you lack Dorsiflexion in the ankle then whenever you squat your knees will end up shifting inward into a rubish position (Genu Valgus). This puts you on the fast track to knee pain city.

The same thing can happen with running.  Basically any exercise that requires a significant amount of ankle mobility into dorsiflexion can cause this problem.  This means lunges, pistols, squatting, running, jumping and landing!

Cause #2 – Poor Foot Stability

I get people ask me about their knee pain frequently and they’ve usually got a history of plantar fasciitis, heel pain or Achilles tendon pain on the same leg. People who complain to me about foot pain often have knee problems too.  The two are linked.

What I’m getting at here is that if you have a lot of pronation (flat feet) while standing at rest and especially with single legged exercises like running, we’re going to have our knee move into the same poor genu valgus position that causes knee pain (notice the runner’s knee coming in and their foot flattening out on their right leg).  

This phenomenon will happen during running, jumping, landing and all types of lifting (especially single leg exercises).

What’s important to keep in mind is that our knees are slaves to the foot and hip.  If you’ve got poor movement (poor stability in this case) at the foot, you’ve got poor movement at the knee.  The research supports this too, those with a flatter foot (more pronation) are more at risk for knee pain.  We’ve been wearing shoes to help support our feet our entire lives, is it any surprise that our feet are weak and lack stability?

Cause #3 – Poor Hip External Rotation and Abduction Strength

Your jumping movements should never look like this...

What this means is that if we are lacking strength in our hips to help keep our knee in a safe position, we’ll find ourself in genu-valgus again.  

Keep in mind that the muscles in your feet are way weaker then the muscles in our hips.  Of course if we want a shot at fixing the knee we need to attack the issue from both sides (feet and hips).  However, the hips muscles are large and powerful and will most likely have more influence on our knee position then the feet.

Cause #4 – Poor Hip Mobility

The hips are strong and stable joints with many large muscles and ligaments contributing to it’s inherent stability and strength.  Because of this and our tendency to do a ton of sitting throughout the day, they can get extremely tight.

This principle is going to apply mainly to deep squat variations.  If we are tight in our adductor (groin) musculature and limited in hip external rotation and flexion then problems may lie ahead.  Limitations here will bring us right back into genu valgum at the bottom of a squat and that’s not desirable.

Cause #5 – Poor Core Stability

This picture beautifully sums up what’s going on in your legs that lead to knee pain.  Take note of what’s going on with that big bowl shaped bone in the person’s hips called the pelvis.  It’s tilting to the person’s left.

As you can see, this seems to set up a chain reaction for all of the joints below.  Just like we need to address stability at the foot and hip we need to address stability at the core.  When I say core I’m addressing all of the musculature that attaches to the before mentioned bone called the pelvis.  These muscles have a direct effect on the position of our hips and subsequently our knee as well.

Cause #6 – Too Much Weight, Too Many Reps

Your brain is very obedient.  If you tell it to squat 200kg for 10 repetitions it’s going to try its damnedest.   The only problem is that with fatigue or too much weight we have a natural tendency to break our form.  In the case of the squat our feet flatten and our knees move inward.  This is because your body is looking for extra stability to help lift the weight.

Think about it.  The weight is too heavy to keep a nice arch in your foot so your foot flattens and rests on a bunch of bones all compounded together.  Our knees cave in and we get extra stability from the ligaments in our knee.  Problem solved right?  We get the weight up.  Good job brain, teamwork for the win.

The only problem is that these structures were not meant to bear weight.  Over time we develop pain because we’re stressing structures that aren’t meant to be stressed.  Unfortunately if we do this too often over time we can create permanent damage and some good old knee surgery.  (Meniscus tears anyone?)  Unfortunately our total knee replacements don’t provide us with super human strength yet.

So when we’re looking to correct knee pain we’ve got to take a total body approach.  I love foam rolling and other forms of soft tissue work, manual physiotherapy and taping techniques as much as the next guy but…

The only real solution to the problem is going to be fixing the movement that caused the problem in the first place.

In part 2, we will show you specific exercises to address these common causes of knee pain.

References

Powers C M. The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. Journal of Orthopaedic and Sports Physical Therapy February 2010 vol 40:N 2:42-51

Behnke R. Kinetic Anatomy 2nd Edition Human Kinetics 2006

Macrum, E., Bell, D., Boling, M., Lewek, M., & Padua, D. (2012). Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of Sports Rehabilitation, 21(2), 144-150. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22622377

Barton, C., Bonnano, D., Levinger, P., & Menz, H. (2010). Foot and ankle characteristics in patellofemoral pain syndrome: A case control and reliability study.Journal of Orthopaedic and Sports Physical Therapy, 40(5), 286-296.

Pain when lifting your hands above your head? We have the answer!

Pain in the shoulder joint when lifting the arm above shoulder height is commonly known as subacromial impingement syndrome. Subacromrial impingment syndrome can then lead to many issues such as bursitis, tendinopathy or tendinitis, calcific changes and much more! This makes it vital that we correct the factors that predispose people to this issue.

FREE VIDEO:Do you have shoulder pain during pull-ups or during other exercises where hands are above the...

Posted by Muscle and Motion on Sunday, October 18, 2015

The video above depicts one of the most common reasons behind people experiencing subacromial impingement syndrome, and that is what we call in the business, excessive medial rotation of the humerous bone due to poor rotator cuff control (the muscles keeping your shoulder aligned). 

Why the shoulder? Well unfortunately the shoulder isn't your normal ball and socket joint. As opposed to the hip, which has a deep socket (acetabulum) making it extremely congruent but not overly mobile, the shoulder is more like a seal balance a ball on its nose. It has a very small shallow socket (glenoid) and a very large ball (humeral head), this giving it vast mobility but this increases the demand to have muscles (rotator cuff) to keep the ball in the centre of the socket.

The pictures show how just a small change in humeral rotation can completely remove the presence of the supraspinatus tendon (green) rubbing between the two bones. 

So, how do we correct this?

Because of the nature of the beast, massage, acupuncture and other techniques will only offer short term relief. The best way to target and eradicate these issues is to complete a detailed exercise programme as prescribed by your Physiotherapist in conjunction with massage, acupuncture and other treatments. These exercises will be solely focused on improving not only the strength of your rotator cuff muscles, but improving the control of the shoulder joint. This all equates to improved shoulder function upon overhead activity. 

Does any of this sound familiar? 

Visit one of the team today!

Can Your Posture Become A Problem?

Yes.

Especially if it is the only one you have. But that is a movement problem not a postural problem.

Even what we might consider a really good posture could be a problem if it does not have any movement!

We often swap something (bad) for something else (good – maybe) but we should be swapping it for 'something’s' (plural) in the form of movement and the ability to move into many different postural positions.

The postures you adopt for too long may cause problems as well. Take your amazing posture and sit in front of the computer for 8 hours and it may start to let you know about it. The key again maybe the lack of moving not the posture you had to start with.

We have some cool sensors called Acid Sensing Ion Channels or ASICS within our tissues that sense changes in the ph value. If we don’t move around, or put strain on our muscles and nerves that may reduce blood flow, then these little bad boys can sense the tissue becoming more acidic and transduce this into a sensation of discomfort or even pain.

Ever sat for to long in a lecture or seminar and felt the need to get up and stretch as you are feeling a bit sore? You probably just went through this process. ASICs may get even better at sensing changes if the cell body decides to pop some more ion channels down to the terminal ending so that sodium can get into the cell more easily and make you more sensitive to acidosis of the tissue.

What causes 'poor' posture?

Well it could be pain.

In fact you may have looked at the problem the wrong way round. Pain may have been a driver to adopt an adaptive or potentially maladaptive position to reduce pain.

People with "poor posture" suffer from bouts of pain like us all, but if posture were the only driver for their pain they would probably be in permanent pain as, lets be honest people rarely seem to change their posture.

The habits people have will also probably outweigh the occasional stretch and strengthening that they do.This paper *here* discusses exactly that!

Their conclusion being:

"objective data to indicate that exercise will lead to postural deviations are lacking. It is likely that exercise programs are of insufficient duration and frequency to induce adaptive changes in muscle tendon length"

In some cases, other factors such as our visual and vestibular systems may affect our postures too so it is not simply "short and tight" and "long and weak" muscles and if it does not seem to cause pain, then who cares anyway?!

So, is changing your posture justified?

We may have to realize that success in trying to change posture maybe due to the process (through exercise or movement) of trying to change posture. This maybe the most important element in helping painful body parts become less painful, and not the outcome such as an actual significant change in the posture. So you would be totally justified giving a body part that has a lack of options (stuck) some more options (varied movement).

In fact rehab programs designed to change posture can help people out of pain without changing their posture.

As discussed before, if it is the only posture someone has - such as we may see at the lumbar spine with being hyper extended - focusing on this can often help. Whether success is contingent on getting a change in the posture is quite another matter entirely.

If your goal is to change the aesthetics of your or somebody else’s body by trying to alter your posture then its up to you….. but good luck with that!

Are Deep Squats Bad For The Knees?

Another hot topic with the squat is knee health.  I’m sure we’ve all thought it, come on now.  Are all of those really deep and heavy squats good for the knee?  I’ve been coaching others to squat for almost 5 years and I’ve luckily yet to have anyone’s kneecaps explode off of their bodies while squatting.

After what was far, far too much online researching with a drug like dependence on coffee, I’ve decided to put together my thoughts on the deep loaded squat and it’s effect on the knees.

So… Is deep squatting safe for the knee?

This is a very difficult question to answer and the best response is probably, it depends.  Different parts of the squat stress the knee in different ways, everyone is an individual.  Some forces increase over the course of the squat and some maximize at certain points.  There’s also conflicting evidence in the medical literature (Why is it always so complicated???).

For example:  Several authors state that compressive forces within the knee joint increase the deeper into a squat you descend and maximize at the very bottom of a squat(3).  Other authors state that this research does not take into account several other factors and deeper squats actually decrease compressive forces on the knee(1).  

In order to determine how dangerous squats are, we’ll have to first define the stresses on the knee joint during a squat.   Understanding the stress on the knee will help shed some light on whether or not squats are actually dangerous.  The 2 types of forces we’ll be talking about today are compressive and shear forces.

1. Compressive forces – The quadriceps muscle attaches to your knee cap (patella) via the quad tendon and the patella attaches to your tibia via the patellar tendon.  As your knee bends the quadriceps and patella form a strap which will create compressive forces behind the patella during squatting.
2. Shear forces – Joints in our body have two major movements, a roll and a glide.  As you bend the knee the joint spins in place (roll) but it also has some translatory motion (glide).   These translatory forces (shear forces) are created during the squat, vary with the depth of the squat and stress different structures of the knee at different depths in the squat.  These shear forces are in part, controlled by the musculature around the knee.

Both types of stress are important to the overall health of the knee and need to be taken into consideration when determining how safe deep squats are.

Aaron Swanson posted a great visual representation of what stresses are on the knee at different portions of the squat.  As you can see, anterior shear forces are high at 0-60 degrees (stressing the ACL ligament) and posterior shear forces start around 50 degrees of knee bend  and maximize at 90 degrees (Maximal stress to PCL ligament).

Compressive forces appear to peak much deeper in the squat, maximizing around the 90-130 degree mark based on this chart.  This is in part due to surface area contact between the femur and patella (discussed below) and also due to the angle of pull changing from the quad as we descend further into the squat (as well as how hard the quad is contracting).  Many studies that implicate deep squatting as maximizing compressive forces on the knee don’t take into account the “wrapping effect” of deep squats and soft tissue approximation of the hamstrings against the calves during the squat (1).

As we go through a squat, different surfaces of the femur and patella are stressed throughout the movement.  Initially during a squat (0-10 degrees of knee flexion), there is no contact of the patella against the femur.  As you get into 10-20 degrees of knee flexion you start to get some contact of the femur against patella.  Initially the surface area of contact between the femur and patella is small.  The boney surface area contact increases as we descend into the squat and maximizes at 90 degrees.  After 90 degrees flexion the boney surface area decreases(3).

Now, if we have more force pressing into a smaller surface area, the stress on that one area increases.  Imagine someone punching you lightly in the arm with their fist vs. punching you lightly in the arm with a knife.  The knife obviously will cause more damage because it hits with a much smaller surface area while the fist has a larger surface area thus dissipating force.  This is the theory behind increased patellar compressive forces as we descend into the squat.

More surface area = more force dissipation and less stress

Less surface area = less force dissipation and more stress

However, once we begin descending beyond 70 degrees of knee flexion in the squat, the quad tendon begins to contact the femur (Thus increasing surface area contact).  This is known as the wrapping effect.  Due to this effect some research (1) shows that compressive forces on the knee actually decrease after 90 degrees of knee flexion.  (The same research implicates 90 degrees of knee flexion being the point of maximal compressive forces into the knee).  Add into account the calf bumping into the hamstring at the bottom of the squat and this changes the compressive and shear forces again.

Keep in mind that not only are compressive and shear forces changing over the course of the squat, so is the stress on varying tissues in the knee.  As alluded to earlier, different portions of the squat have different stresses on each ligament.   Stress changes on different parts of the cartilage and meniscus of the knee as well during different parts of the squat.    This will have major implications for individuals who are currently rehabbing from an injury and have pain.

Does deep squatting stress the knee more then a partial squat?

Theoretically, most individuals can handle more weight during partial squats (to say 90 degrees of knee flexion) compared to a maximally deep squat.  Now, if compression and shear forces on the knee are greatest at 90 degrees of knee flexion then both squat variations are going to (or through) the most stressful portion of the lift.  If the partial squatting athlete is utilizing more weight then the deep squat athlete, then the athlete using more weight will theoretically have more stress on the knee.  In this case you could actually make the argument that partial squats are more stressful on the knee then deep squats (If weights used in the partial squat are higher then a deep squat)

Another major thing to keep in mind is that our bodies adapt to the stimulus that we place on it.  What this means is that exposing your body to loaded deep squatting will promote change in your body.  We’re all familiar with muscular growth and improvements in strength that occur with training the squat, but there are also changes within the joint itself, both with improvements in cartilage thickness and strength of tendons and ligaments (1)

So what does the research show about people who have a history of deep loaded squats and knee health.  Most of the research in this realm is focused on olympic lifters, especially highly competitive and successful lifters.  Olympic lifting athletes perform a great deal of deep squatting in their training.  The research is not taking into account average Joe’s and Jane’s.  Also keep in mind that successful athletes generally gravitate towards what they’re good at (olympic lifting) and wouldn’t be successful if they get chronic knee pain.  Competitive olympic weightlifters also tend to be fairly young as well.  Therefore you get a pretty large selection bias in this research.  Anyway, the research in these lifters does look promising (1):

• Weightlifters with an average of 17 years training experience (at a national and international level) show the same level of knee cartilage degeneration of an age matched general population
• Weightlifters have been shown to have higher cartilage thickness then non-weightlifters.  The thought here is that with squatting there are anabolic, biochemical and structural adaptations of the cartilage tissue, causing increased mechanical stress tolerance and hence protective effects against degenerative changes in both cartilage and meniscus.  In rat models unloading cartilage causes atrophy and degeneration of the knee.  Squats below 90 degrees stress cartilage of the odd facet preventing cartilage degeneration and atrophy of the odd facet (Which would otherwise not be stressed if deep squats were never performed)
• Olympic lifters in general have a very low risk of injury compared to other sports (basketball, track and field, football and gymnastic) but the most commonly reported injuries occur to the knees and shoulders. (2)
• In international level lifters 95% of knee injuries lasted less then 1 day
• Deep squats loaded or not do not reach stress levels (shear force to ACL or PCL) to cause damage and do not cause knee ligament stability issues (Weightlifters generally have enhanced knee stability).  The stress of deep squatting potentially causes adaptive positive changes in thickness and strength of ligaments and tensile strength of patellar and quad tendons.

Again, keep in mind that this research is in mostly elite lifters, but you can potentially infer that a long career of deep squatting with good technique at a competitive level may help protect the knees and potentially improve knee joint health.  Of course there are several additional things to keep in mind before you go out there and start slamming deep loaded squats right away.

Bibliography:

1. Hartmann, H., Wirth, K., & Klusemann, M. (2013). Analysis of the Load on the Knee Joint and Vertebral Column with Changes in Squatting Depth and Weight Load. Sports Med.
2. Keogh, J. (2005, May 1). The Powerlifter’s Injuries. Pure Power Mag, 4-12.
3. Reinold, M. (2009, May 11). Solving the Patellofemoral Mystery. Retrieved January 10, 2016, from http://www.mikereinold.com/2009/05/solving-patellofemoral-mystery.html

If at First You Don't Suceed...

I found this wonderful image today, perfectly depicting the amount of hard work that goes in to making anything a success. This can apply to anything, but relating this image to Physiotherapy, many exercises or movements may be painful at first, but by building the foundations with smaller movements and Physiotherapy treatments, the end result is success and pain free activity

Sometimes it just takes time and persistence with a helping hand from your Physiotherapist.

Moral of the story..?

Never give up and success will follow

What a pain in the... Back!

So back pain, something statistics show that most people from a western culture will experience at some point in their lifetime. 

So what causes back pain? Unfortunately, that is a question that cannot be answered simply. There are a variety of causes which may provoke back pain, some of these are listed below: 

• bending awkwardly or for long periods
• lifting, carrying, pushing or pulling heavy objects
• slouching in chairs
• twisting awkwardly
• overstretching
• driving or sitting in a hunched position or for long periods without taking a break
• overusing the muscles – for example, during sport or repetitive movements (repetitive strain injury). 

How do we treat it? Well, by analysing the mechanics of the injury and isolating the factors which may predispose someone to lower back pain. We can treat these problems with a variety of hands on treatments and exercise. Treatments may include massage, joint mobilisations, joint manipulations, Pilates based exercise, gym based rehabilitation, taping and acupuncture

How can you manage it at home? We have provided the image above which shows a few things you can do to keep you back pain at a minimum! 

Any issues? Come find us for an initial assessment and one of our highly experienced Physiotherapists can recommend the best way to move forwards! 

The Sexy Scalpel, does exercise need to be more sexy?

Do we need to make exercise more sexy?

Recent studies from highly recognised authors have shown that pain following surgery is no better than a course of Physiotherapy, providing an exercise based programme to increase control and strength.

So the big question is, WHY take the risks of surgery, when you can have a similar, if not better outcome with regular exercise as prescribed by a Physiotherapist. 

Please read the link to the BMJ blog by clicking here

Injury Holding You Back?

Ever feel like aches, pains and injuries are holding you back? This image depicts what injury and pain can feel like, and how if the injury isn't managed correctly, it may feel like someone is holding you back. 

Don't allow your injuries to hold you back from unleashing your maximal potential. 

Any issues, see one of our highly experienced team today!