The shoulder is vulnerable to a many differing problems due to its complex nature - combining several joints, tendons and muscles which allow for a broad range of movement. The shoulder is inherently unstable and its function can be likened to a seal trying to balance a ball on it's nose! It is very reliant of good muscle strength and function for support and stability and when this is not present, one of the common painful conditions which may develop is shoulder impingement also referred to as rotator cuff tendinopathy or impingement syndrome.

Treatments include Physiotherapy (usually the first approach) which may involve exercise, manual therapy and medical acupuncture/dry needling, as well as other procedures such as local injections and surgery in certain cases.

What body part is affected by an ACL injury?

The anterior cruciate ligament (ACL) is one of the two major ligaments in the knee, the other being the posterior cruciate ligament (PCL).These ligaments perform the vital function of connecting the large femur bone of the thigh to the lower leg bone called the tibia.

The ACL’s main purpose is to maintain the overall stability and support of the knee, the largest joint in the body. The ligament is positioned just behind the kneecap and holds the leg and thigh bones in place preventing the leg bone from slipping forward and rotating during pivoting movements. The ACL is supported by the thigh, buttock and very importantly the hamstring muscle groups.

Ligaments are tough bands of tissue that connect various bones together within your bodies. Although they are very strong too much stress on them due to intensive sports or overloading during a sudden twisting movement can cause them to stretch too far, possibly even to snap. If the ligament snaps, that is a complete rupture, we use the technical term ‘’he did his ACL”.

Adequate preparation as well as appropriate rest and recovery from sport and activity can help prevent overuse injuries from occurring. However with every good intention an overuse injury is easily sustain and is a common type of injury we see here in our Physiotherapy practice.

To fully understand the nature of the overuse injury, how to treat it and prevent it from happening again we must take a look at some background information about this common condition.

What is an overuse injury?

As a result of our sport or activity we can sustain one of two types of injuries - acute or overuse types.

Acute injury

This type of injury can be characterised by the sudden onset of a ‘sharp’ pain with the potential for the sudden loss of function, usually as a result of a traumatic event. Some examples of acute injuries would be sprains of the ankle, dislocation of the shoulder, bone fractures, etc.

Overuse injury

This type of injury is quite different from the acute injury in that the presence of pain and in some cases inflammation too can be totally absent. Instead of the sudden onset of pain and dysfunction there are numerous and repetitive micro traumas that occur to the muscles, tendons, joints and bones. These micro traumas are subtle and if frequent enough they will eventually lead to pain and dysfunction due to the eventual breakdown of the affected body part.

Lorraine and I are enjoying a busy 2014 with our young family, the busy clinic and Pilates studio as well as our University tutoring and lecturing roles. We are proud to be involved in higher education supporting upcoming students as well as fellow medical professionals and we’d like to share some of the details of what we have been up to.

Lorraine has been regularly lecturing as well as examining on the undergraduate physiotherapy programme as well as the prestigious Masters in Neuromusculoskeletal Physiotherapy at UCD over the last number of months. Given such positive student feedback she has once again been asked to be a clinical tutor for Masters degree students on placement at the Mater hospital over the coming weeks. Lorraine will again this month present a lecture in lower limb biomechanics and injury management to the Irish College of General Practitioners.

Know your risk level and how best to self-manage pain in pregnancy

Pelvic girdle pain (PGP) is common in pregnancy with some studies[1] indicating as much as 33-50% of pregnant women will experience PGP before 20 weeks of gestation, possibly increasing to 60-70% prevalence in the late pregnancy stages.

Pelvic pain as well as associated low back pain can vary in severity and its degree of debilitation which does not necessarily subside postpartum.

Not all pregnant women develop PGP and some women are more susceptible than others. Women at higher risk may include those with a past history of PGP, lower back pain or any past pelvic trauma. Other contributing factors considered in some studies include high stress levels and psychological variables such as catastrophising and fear-avoidance beliefs[2].

The idea that the common back pain, specifically lower back pain, can be a result of our modern lifestyles does make some sense. In general people are sitting more for extended periods of time which contributes to lower activity levels. These factors alone can negatively affect posture which often lead to problems in the synovial joints of the spine, nerves and surrounding muscles which all play their role in causing back pain.

The medical history of any back pain sufferer is an important consideration for the Physiotherapist when understanding how best to help relieve the symptoms. There is not a single most effective approach for all conditions of back pain and in fact sometimes the seemingly sensible treatment only makes the symptoms worse. We wrote about such back pain confusion in a previous article.

Over-reacting to back pain can cause both patient and Physiotherapist to take unnecessary measures and potentially over-treat the condition. The most important factor is intervening early before the pain progresses to a more chronic state. An experienced musculoskeletal Chartered Physiotherapist will be able to suitably educate you on your type of pain, potential causes and other important considerations such as the risks of fear-avoidance behaviour.

Do you suffer from frequent episodes of Low Back Pain?

We offer a 1-hour physiotherapy 'Low Back Pain Maintenance' treatment session specifically designed to help reduce the frequency and severity of your painful episodes.

Who may benefit?

Frequent episodes of low back pain has many causes. These may include generally poor conditioning of the spine, muscle stiffness with ‘trigger points’, low levels of activity, stress and other lifestyle factors. Your low back pain may also be due to a degree of 'wear and tear' of the spine, what is medically referred to as spondylosis or osteoarthrosis of the spine.

Recurrent episodic mechanical low back pain can be well managed with intermittent 'maintenance' physiotherapy sessions.

Our team of Chartered Physiotherapists have designed this 1-hour treatment session to assist you in the management of this type of low back pain with the intention of reducing how often and how severely the episodes occur.

Calf pain is more often a muscular complaint and we regularly treat such conditions here in our Physiotherapy clinic. However, calf pain can indicate a far more serious and dangerous health concern as I have been cautiously reminded of by a recent experience.

As Chartered Physiotherapists we are first-contact practitioners where patients can schedule consultations directly with us without having to go through their GP first. We therefore see many patients presenting with what they believe is muscular pain and dysfunction. In a recent case where calf pain was the complaint the more serious symptoms of Deep Venous Thrombosis (DVT) were presenting.

The medical training of Chartered Physiotherapists equips us with the knowledge and ability to identify these "red flag" symptoms and immediately refer for further medical review and investigation. As medical practitioners it is important we keep the differential diagnosis in mind and refer on if necessary.

Its that time of year again when I am fortunate and privileged to offer my experience and clinical expertise at the UCD School of Physiotherapy. I am currently teaching as an external lecturer on the Musculoskeletal module with my main role to cover the more practical ‘hands on’ aspects of managing patients with spinal conditions.

There is a bridge to gap between the world of academia and course work as offered in the University setting, and the application of this knowledge in a real world clinical setting. This is where I come in as I try to help students learn the manual therapy, exercise and patient management skills to be able to help the patients they encounter as students and upon graduation.

This brings me to some criticism of the University system, which is that of attendance. Given that these skills are only taught once in this setting, I am concerned when the lecture and practical classes don't have a 100% attendance by the physiotherapy students. These are the basic skills anyone wanting to work in musculoskeletal physiotherapy requires to be effective, they are the bread and butter of our practice. The time to gain the knowledge is now, so why not make attendance a priority? The University are trying to address the issue by making practical attendance contribute to the final module grade, however as yet this has not quite made the full impact. I feel that students have to want to learn and that if the passion and enthusiasm is there, attendance would never be an issue.

Having gone through two pregnancies myself in the past three years I've had first hand and recent experience in dealing with the physical demands of pregnancy. Combining my own experience of back and pelvic pain with my knowledge and insights from my Physiotherapy practise I am able to offer you these ten top tips to help you cope.

1. POSTURE:

Your posture will change during pregnancy especially as your pregnancy progresses and as your baby grows. Your centre of gravity changes and moves more forwards, as such you tend to lean backwards to compensate for this and to avoid falling over. This can pinch the lower back region and make your back muscles work very hard which can lead to back pain during pregnancy.

When standing remember these tips:

• Head up straight & tuck your chin in slightly
• Shoulders back & your chest forward
• Knees straight but not locked
• Weight balanced evenly on both feet
• Lower tummy gently tightened which helps support your bump and flattens the lower back slightly
• Avoid standing in the same position for too long
• Alternate resting one foot at a time on an small elevated surface for short periods
• Take regular breaks from prolonged standing

Related article - Pregnancy Posture