Saturday Parking

Salamanca Square Car Park

20 Montpelier Retreat, Battery Point TAS 7004

Parking Directions

Salamanca Square Car Park can only be accessed via Sandy Bay Road due to market day road closures.

From Sandy Bay road… 

1. Turn onto Gladstone Street

2. Turn RIGHT onto Kirksway Place

3. Turn LEFT onto Montpelier Retreat

NOTE: Ticketed 3 hour limit

 

National Pain Week

By Cameron Allshorn

6.9 Million Australians are currently living with musculoskeletal pain. That is a big number, and Osteopaths around the country are joining in the battle to fight chronic pain, particularly those linked to musculoskeletal origins.  

This week is National Pain Week that aims to focus a discussion around chronic, silent pain that affects many Australians both physically and mentally. 

Chronic pain can take many forms and is different in each case. A condition is deemed chronic if it has been present for longer than 12 weeks (3 months) however many Australians are currently living with conditions that have been present for many years. Chronic pain is not particularly picky and can be found at just about any part of the body. Chronic pain can range form dull persistent pain to intense severe pain and everything in between. 

Some of the common chronic pain presentations that Osteopaths often see are chronic headache/migraines, lower back pain, rotator cuff/shoulder tendonitis/opathies, osteoarthritis of Knees/hips/hands and many others. 

Chronic pain is often as isolating mentally as it is debilitating physically.The impact of chronic pain is far reaching beyond the pain itself and can relate to the ability to support a family, complete tasks or  enjoy hobbies (sports, hiking, travel). This impact is a factor to why 33% of Australians suffering chronic pain will develop mental health issues including but not limited to depression and anxiety. The mental strain of chronic pain can take many forms such as behavioural changes, loss of motivation, break down of relationships, isolation and withdrawal.

The first step to managing chronic conditions is starting the management process. Developing a team around you that can help and advise you on the recovery process. As an Osteopath we can help via our hands on treatment that aims to decrease pain and improve musculoskeletal function, in addition to this we can provide information and guidance as to what is the best management for you. This may include exercise recommendations, dietary suggestions and other lifestyle factors that can assist you in managing your chronic pain, in some cases we may need to refer on to other professionals to assist in supporting you managing your condition.

If you are or know someone suffering from chronic pain, please get into contact with a health professional and know that the team at Rockhopper are always there to help you manage your way to feeling better. 

Thanks for reading,

Cameron Allshorn

Osteopath

Here are some helpful links regarding Chronic Pain + National Pain Week. 

http://www.nationalpainweek.org.au/ 

https://osteopathy.org.au/files/Documents/Media/Latest%20News/Media%20Release%20-%20National%20Pain%20Week%20-%20Osteopathy%20Australia.pdf

Injury Perception

INJURY PERCEPTION

When is an “injury” an “Injury”?

Or would that be better phrased when is a “niggle” or an “ache” an “injury”?

It is not uncommon for a new appointment to come up, and through the discussion of the case, there usually has been a tipping point as to why this person has sought treatment at this time. It can be the upcoming overseas trip, a pending new arrival to the family or the approaching season on the sporting calendar and many other reasons. In a lot of cases, the symptoms of the injury have not changed all that much over the preceding days/week however the circumstances surrounding the person has and hence the motivation to resolve the issue has changed. The perception of this injury has changed.

Recently I was following a live tweet of the Salzburg Sports Physiotherapy Symposium (SSPS) and the idea of injury perception was discussed. The discussion focused around the idea of time loss and the idea that people (or in the case of the presentation, the athlete) only consider something an injury when it impacts on performance and thus impacts on participation or involvement. Take a look at the following image showing part of the presentation.

In relation to an athlete, injury and performance are clearly defined and obvious with a clear link to ability and participation, however I think the lines get blurred when we discuss injury over a generalised population due to the variety of circumstances that are inherently changeable, to summarise, consideration of an injury is a matter of circumstance and those circumstances are always changing. (That ankle might feel really sore when it comes to taking the bins out however it doesn't feel so bad when kicking the football with the kids in the backyard)

The first aspect of this chart, - Impact on performance - across a generalised population Is variable from person to person depending on circumstances and can mean many things from our ability to work and complete tasks, our involvement with family activities and the ability to look after them to our overall enjoyment in our day to day lives. Performance is very much an athlete driven word there, if we change that to impact on daily living, it becomes a lot more relatable.  

The importance of an event is going to impact on how we perceive an injury. For an athlete this could be the difference between a regular season match or a finals game. When applied to a general population we can discuss - for instance - taking a day off work due to injury could be deemed suitable when workload is quiet but taking the day off when there is a full schedule of important meetings and so on involved,in this event the injury takes a back seat.

When it comes to self management it is a goal of mine and all the Osteopaths at Rockhopper to help people into the best position to manage their own bodies. The physical component of injury is obviously a focus point for us and our management of your injury will come in various forms from hands on in clinic treatment to out of clinic directives such as stretches, exercise programs, educational content.

However self management doesn't always mean management in isolation or on your own. A key component of self management is being able to discern when the need for follow up treatment or additional help is required. As shown in the image way up the top of this page, a key aspect of perception is understanding and if we can identify and understand an injury that will change how we perceive it and put us in a much better position to manage it now and also in the future.

So, with all the discussion here, I'd make a few changes to this chart and present it as shown below.

Physitrack @ Rockhopper

The days of taking home a scribbled piece of paper with a few (poorly) drawn exercises are over (we’re osteopaths not artists after all, haha). No more searching for it in the car or turning the house over trying to find that damned piece of paper.

A warm welcome to Rockhopper’s new favourite toy. Physitrack!! An app based program that allows us to send a structured tailored program of exercises that can be accessed from your phone easily - How cool is that!

The programs we set at rockhopper usually run from 4-8 weeks depending on the presentation, when we set these programs we like to schedule an extended consult (45 min) as a follow up session towards the end of your program, this allows time for a full treatment and reassessment of your exercise program that can then be edited to match your abilities and progression!

Below are a few tips to accessing your program plus a few things that each of us here at Rockhopper are loving about it.

Each program is accessed via an 8 letter code that is specific to your program. This means your program is only accessed by you and the osteopaths at rockhopper.

Step 2

Download Physiapp or log in online

Within the email is a link to download PhysiApp which is your access point. You can also view your program online at physiapp.com. Once you’re in you can set reminders and also pre download any video content so you can access it offline.  

Each program will come with a short message from your osteopath, if we have any additional information for you, it will show here. Depending on the case, we may include a specific questionnaire for you to complete at the start and end of your program, this is called an outcome measure and it is a way for us to track your progression from start to finish, and importantly can help us pick up areas that may need extra attention.

Step 4

Your program!

Most rockhopper programs will include 3-10 exercises. The order they appear in your program is our recommended way of completing the program. Each exercise will have a schedule of reps and sets. There may be some additional notes that we have included just for you too.

Step 5

The Exercise!

Each exercise has a video and a text description to ensure that you are doing them in an informed and correct manner. Occasionally, we will make small adjustments to how we would prefer the exercise to be done, those notes will be shown here. Once you have completed the designated sets and reps hit the complete button up in the top right.

Once you complete your exercise, fill out the amount of reps and sets you were able to complete and if there was any pain during the exercise. You can also give specific feedback for each exercise. This is a great spot to ask any questions, we’ll do our best to get back to you about it quickly.

Here is what the Rockhopper team has been saying about Physitrack.

What’s Cameron’s favourite part of Physitrack

“It is fantastic not having to write out programs by hand and use terribly drawn stick figures as diagrams. The videos and descriptions allow me to provide a few extra exercises into a program to really get things moving without making the program overwhelming”

What Tegan enjoys about Physitrack

“I really like how it enables us to manage and create tailored home-based exercises to fit the individual needs of our patients. Not only is it simple and easy to use, but it is also beneficial for all age groups and fitness levels. I really love how Physitrack reminds you to do your exercises, so you are less likely to forget to do them.

What Tink loves about Physitrack

“I love that I can still have lots of hands-on treatment time and know that the Physitrack videos are more thorough to help people remember the details of the exercises we give, rather than spending as much time as previously during treatment explaining them.”

If you have been using a physitrack program be sure to let us know what you enjoyed about it!

Stay mobile,

Cameron Allshorn

Osteopath @ Rockhopper

The Health Benefits of Riding a Bike

By Tegan Hailey

Special Event of the Week:

Ride2School Day – 22nd of March 2019 

Ride2School is a nationwide program that enables students to be physically active on their journey to school. Did you know that only 2 out of 10 students are riding or walking to school everyday, in comparison to 8 out of 10 in the 70’s? The latest report states that there are not enough kids partaking in sports and using active transport. Over the last 40 years the number of children who are physically active everyday has dropped significantly! With the number of children living a sedentary lifestyle on the rise at an alarming rate, it is really important that we find ways to keep our kids active. New research has revealed that students who use active travel to get to school arrive awake and alert, improving their ability to concentrate in class and ability to understand what they are being taught. Ride2School is designed to support and encourage schools and their students to feel empowered to get physically active on their journey to and from school. Is your school involved? Ask your school today.

Check out their website for more information; https://www.bicyclenetwork.com.au/rides-and-events/ride2school/

Topic of the Week:

 Riding a bike & the health benefits

Riding a bike has been found be a healthy, low-impact exercise that can be enjoyed by people of all ages. Not only is it fun, but it is also cost-effective and environmentally friendly. Riding a bike is a great way to combine regular exercise with your everyday routine. Whether you ride to work, the shops or just on the weekends with the kids, regular bike riding not only improves your overall fitness but also helps reduce the health risks associated with a sedentary lifestyle (1). 

Why riding a bike is good for everyone?

• Low impact: Less likely to cause an injury compared to most other forms of exercise

• Good muscle workout: Uses all of the major muscle groups as you pedal 

• Easy: It does not require high levels of physical skill (training wheels available for kids)

• Builds strength and stamina: It’s a great cardio workout which increases your body’s efficiency to supply oxygen around the body

• Variable intensities: Depending on what you want, it can range from a very low to a very high demanding physical workout

• Enjoyable: Have fun while you get fit via social rides or by exploring new places

• Time-efficient: As a mode of transport it is faster than walking, and even sometimes driving a car

(1)

 The introduction of electrically assisted bicycles (e-bikes), have allowed many individuals to overcome some of the many reported barriers in bicycle commuting. With riding up steep hills being the most commonly reported barrier. These e-bikes allow for all fitness levels and ages to enjoy what riding a bike has to offer (2).

How does it affect my health?

As riding a bike is an aerobic activity, it means that our heart, blood vessels, lungs as well as our muscles all get a workout. Known health benefits if done regularly can include:

• Increased cardiovascular fitness

• Increased muscle strength and flexibility

• Improved joint mobility

• Improved posture and coordination

• Strengthened bones

• Decreased body fat levels

• Prevention or management of disease

• Decreased stress levels

• Reduced anxiety and depression

(1)

Useful Resources:

Helmet and Bike Check

 Check out the following images for a guide on how to fit a helmet and make sure your bike is ready for use.

Step 1

Bike Check

Step 2

Helmet Check

References:

1. Cycling - health benefits [Internet]. Betterhealth.vic.gov.au. 2019 [cited 26 February 2019]. Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/cycling-health-benefits

2. Bourne J, Sauchelli S, Perry R, Page A, Leary S, England C et al. Health benefits of electrically-assisted cycling: a systematic review. International Journal of Behavioral Nutrition and Physical Activity [Internet]. 2018;15(1). Available from: https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-018-0751-8

 

An ABC Radio Chat about Computer Usage and Neck Pain

This is a short radio piece about computer strain and neck pain, have a listen and see if there is anything here that helps you reconsider the way you are addressing your workplace ergonomics. It has a discussion about neck stretches that have been published on another blogpost www.rockhopperclinic.com.au/blog/2018/10/24/tinks-favourite-neck-stretches-

An ABC Radio Chat About How to Choose your Pillow...

Tink was asked to speak about choosing pillows on the radio and this is a common conversation in the treatment room, given how frequently we see people with neck pain, headaches and arm pain which may all be aggravated by an incorrect pillow or sleeping position. Feel free to have a listen here;

Shoulder Series Part 2 - The Neck, Ribs and Scapula By Osteopath Cameron Allshorn

In my last blog I spoke about the rotator cuff and broke down the individual key components that make up shoulder function (Read part 1 here) . The shoulder is complex and there is more to it than meets the eye. A key component of the shoulder is how it functions around other regions such as the neck, ribs and scapula.  

THE SCAPULA

Physically part of the bony makeup of the shoulder joint however it also forms part of the acromioclavicular (AC) joint, the scapulothoracic articulation (ST) and provides an attachment point for fifteen muscles.

While not considered a true joint the ST articulation can been seen as a good indicator of efficient shoulder function. The AC joint is one you are likely familiar with as it a common site of injury particularly in throwing or contact sports. The AC joint is a critical joint for our overhead abilities. Some key muscles that attach to the scapula are Pectoralis Minor, Serratus anterior, Triceps (Long head), Trapezius plus the rotator cuff muscle group (Discussed here in part 1).   

THE NECK

Is the origin of all of the nerve supply to the shoulder and surrounding areas thus any restriction or injury that impacts at a nerve root level can affect the shoulder via pain, weakness, muscle spasm or loss of muscular tone. (more on this in part 3)

Additionally, the neck is closely linked with shoulder function via multiple muscular connections. Often injury to either the neck or the shoulder can impact the other. Muscular links between these areas include the upper portion of the trapezius, levator scapulae and scalenes while the platysma and sternocleidomastoid (SCM) should also be considered through their attachment to the clavicle and thus potential to impact the shoulder via the AC joint.

THE RIBS

Connected to the shoulder via the scapulothoracic articulation (ST) that functions as the relationship between the anterior face of the scapula and the posterior surface of the rib cage.

Injuries to the ribs (fractures, costovertebral joint sprains or intercostal strains) can disrupt the fluidity of the ST and thus impact the function of the shoulder. Muscular attachments to consider here are the pectorals, particular pectoralis minor that originates at the coracoid  process of the scapular and attaches to the anterior 1st-3rd ribs. Additionally the serratus anterior fans between the medial (inside) border of the scapula and the upper 8 ribs with the action of protracting and stabilising the shoulder, particularly in overhead movements. The rhomboid group while not directly linked to the ribs themselves runs between the scapula and the thoracic spine and thus could be impacted via a costovertebral (rib) dysfunction or sprain.

BREATHING

May not be something you closely relate to your shoulder or shoulder pain in general however it is something that can often be overlooked.

A lot of the musculature we have discussed previously here make up what is collectively called the accessory muscles of respiration (trapezius, pec major and levator scap plus many others), generally these muscles contribute to respiration only during periods of high exertion however the presence of injury or dysfunction through the upper body can increase accessory activity.

As Osteopaths

when dealing with a shoulder presentation, we will test and asses various regions of the body in addition to the presenting shoulder. This will include the neck, ribs and thoracic areas to provide us with as much information as possible regarding the presentation of the injury. This allows us to provide an accurate working diagnosis and the ability to give you -the client- the best possible prognosis and overall outcome from your consultation.

Thanks for reading :)

Cameron.

“It’s because I’m getting older” By Tegan Hailey

‘It’s because I’m getting older’ is a little phrase that many of us are guilty of saying, especially after we have hit the mid 30’s. In this post I’m going to discuss a little around coming to terms with getting older.

From as early as the 30’s our bodies have begun to change. We begin to experience some joint stiffness or have begun to notice slight difficulties when carrying out activities that were once easily done. Our muscles, tendons and ligaments have started to become less elastic, and are more prone to injury. The density of our bones has begun to decrease, and our joints have begun to lose their mobility, leaving us prone to developing age-related disorders such as arthritis and osteoporosis. With all these subtle changes over the years, we start to shrink in height, and our posture begins to alter. Aches and pains begin to arise, especially on movement, and we find that it takes a lot longer for us to get from ‘A to B’. But don’t stress, all of these changes are completely normal as we move on in our lives.

However, there are many misconceptions about ageing, and the things that you are no longer able to do due to pain and restriction, and the things you can. So where does osteopathy come into play? Many people think that an osteopath is unable to help with the symptoms of ageing. But, did you know that over half of Australian osteopaths are treating patients age 65 years and older? In which many osteopaths are treating patients with all kinds of age-related disorders, including arthritis and osteoporosis (1). Osteopathy is not purely designed for helping the young, fit and active, but for all walks of life.

Some of the key benefits and aims of osteopathic treatment regardless of age can include…

§  Reducing pain and stiffness in your muscles and joints

§  Increasing and improving the mobility of your joints

§  Reducing the effects from poor posture and other biomechanical strains  

§  Promoting blood circulation throughout the body

There is no age limit where osteopathic care becomes no longer useful. The only things that may change with your consult with your osteopath, as you get older is…

1)    How they assess you

2)    What they are treating, and

3)    How they will treat you

There is no denying that as we increase in age, so too does our risk of falls. It has been found that by maintaining and improving muscle strength, and the ability to balance in the elderly, we have been able to reduce the occurrence of falls. Balance and other strengthening exercises, which an osteopath can prescribe, are vital in helping individuals to not only live more independently as they get older, but to also make them feel more confident whilst doing so (2).

It seems many people would like a ‘cure-all’ or ‘magic pill’ to avoid the aches and pains associated with getting old. Osteopaths believe that our manual therapy techniques, rehab exercises and ergonomic advice may help support people in continuing as many things they love, for as long as they can. With the modification of how you perform your activities, or even a slight change in reduction of pain, or increase in mobility in your joints, it may enable you to still continue to do the things you love, regardless of your age.

1)    King Channell, M., Wang, Y., McLaughlin, M., Ciesielski, J., & Pomerantz, S. (2016). Osteopathic Manipulative Treatment for Older Patients: A National Survey of Osteopathic Physicians. The Journal Of The American Osteopathic Association, 116(3), 136. doi: 10.7556/jaoa.2016.030

2)    Hafström, A., Malmström, E., Terdèn, J., Fransson, P., & Magnusson, M. (2016). Improved Balance Confidence and Stability for Elderly After 6 Weeks of a Multimodal Self-Administered Balance-Enhancing Exercise Program. Gerontology And Geriatric Medicine, 2, 233372141664414. doi: 10.1177/2333721416644149

What is Dry Needling? By Osteopath Cameron Allshorn

Here is a quick explainer post all about Dry Needling and why I find it useful as a complementary part of my osteopathic treatment.

Dry needling is a method of treatment I here at Rockhopper, it is a common technique that is used by many osteopaths and other allied health modalities. It is a safe and minimally invasive technique that has seen great results for many musculoskeletal injuries and ailments (1)

Most people find Dry Needling to be a relatively pain free technique, with only a small instance of pain as the needle is inserted or removed, feeling like a pinch. While the needles are in place you may feel a twitching sensation within the muscle fibres.

Here are a few points of information that may answer some of those questions you had.

Dry Needling is performed using a sterile single use fine acupuncture needle inserted into a muscle to decrease pain and increase mobility. The needles have a range of sizes and gauges (width), predominantly I use a 30-45mm length 0.22-0.30mm gauge needles to provide this treatment, though some larger muscle areas may require a larger needle.

Dry needling was developed on the principles of muscle bound myofascial trigger points that can cause pain and restrict movement. Myofascial trigger points or knots as they are known colloquially form after a muscle fibres are shortened during a contraction and are unable to relax. Overtime this trigger point can become sensitive causing increased pain and discomfort.  

The presence of the needle draws blood supply which carries oxygen and other nutrients to the area involved and allows for the muscle to relax over a short period of time allowing for increased mobility and reduced sensitivity once the needles have been removed.

Needles are located within the muscle tissue for a short period of time usually around 5 minutes and 10 minutes. The size of the treatment area will dictate how many needles are used with larger muscles requiring more needles.

Despite sharing equipment dry needling differs from acupuncture via the treatment approach. Dry needling is very specific to a particular muscle or muscle group as opposed to the approach of Acupuncture that uses the meridian points to guide the technique with the aim to treat various regions of the body.  

Dry needling is a great way to manage acute muscular symptoms and can be a great management option for many other ongoing conditions such as plantar fasciitis, lateral epicondylitis (tennis elbow) and patellofemoral pain plus many more.

Shoulder Series Part 1 Rotator Cuff - The High 5 by Osteopath Cameron Allshorn

The High 5, Something we all enjoy at any age, that crisp sound and the awe of those around you when that epic sound reverberates off the walls. How often have you considered what is going in in your shoulder during a High 5?

Before we can get to that end goal, we should take a look at the muscular components that make up the rotator cuff (RC), Supraspinatus, Infraspinatus, Teres Minor and Subscapularis, as implied by the name these muscles work together to rotate and move our shoulder. 

SUBSCAPULARIS

To set up for that high 5 you first need to stabilise the shoulder readying for what is to come. This is done in part by the Subscapularis, Sitting on the inner surface of the shoulder blade the muscle works to:

A.             stabilise the scapula in relation to the ribcage and humerus.

B.             Assist with internally rotating the shoulder when our arm is by our side.

C.             Assist with adduction of the upper arm

When tight, sore or overloaded, the subscapularis can limit shoulder abduction and external rotation and thus limit actions such as reaching, throwing and of course the ability to high 5.

SUPRASPINATUS

Next up is lifting and rotating the arm to get in position to generate the power for that high 5. This involves the Supraspinatus, a muscle that sits atop the scapula and weaves under the clavicle and acromioclavicular joint and works to:

A.             Aid in abduction of the upper arm

B.             Stabilse humeral head into shoulder joint

The supraspinatus is often at risk of impingement between the bony surfaces above and below. Impingement can be painful itself and also be precursor to further shoulder ailments if left unmanaged.  

Tears within the supraspinatus worth discussing here as they occur here in 80% of RC cases (1), often occurring as a result of a direct movement or action such as a fall on outstretched hand (FOOSH). Males (3:1 M/F ratio) aged 35-60 are considered most at risk of a supraspinatus tear (1). Injury to the supraspinatus is common, particularly within the sporting industry and can be avoided by early intervention and management.

INFRASPINATUS & TERES MINOR

Infraspinatus and Teres Minor form the final two components of the RC that we will discuss here. These sit closely together along the back of the scapula as shown in the images above and work to:

A.             Externally rotate the shoulder

B.             Assist in adduction

C.             Stabilise shoulder joint

These two muscles work are key components of overhead actions such as marking in AFL, spiking in volleyball or celebrating a wicket on the cricket pitch with a high 5 of course. A tight or restrictive infraspinatus or teres minor can limit function but can also reduced the ability of the shoulder to cope with activity increasing load on other structures around the shoulder.

A balanced shoulder is often a good and functional one however keep in mind there are many of other components beyond the rotator cuff that are important when considering the shoulder and isolating what is potentially causing pain or restriction. Lats, pectorals and deltoid are of key importance in terms of muscular control while the mobility of the cervical and thoracic spine is important when considering consistent nerve innervation and vascular supply to the aforementioned musculature.

So if you are finding that your high 5’s aren’t quite up to standard, perhaps taking some time to consider the biomechanics involved could give things a boost.

Stay mobile.

Cameron Allshorn

Osteopath.

Works Cited

Jancuska J, Matthews J, Miller T, Kluczynski M, Bisson L. A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff. Orthopaedic Journal of Sports Medicine. 2018 September; 6(9).

Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 3rd ed.: McGraw Hill Companies; 2012.

10 Tips w 10 Days to Go - Point 2 Pinnacle by Cameron Allshorn

Only a week to go before the run to the pinnacle begins. Here are 10 quick tips to help you to the top injury free.

1. Warm Up - Stretching cold can be counterintuitive so it is best to do your stretches after a  short warm up jog.

2. Dynamic V Static stretching - Dynamic stretching is great for pre event/exercise stretching as it helps with joint mobility and muscle flexibility while static stretching is a great addition to post run cool down.  

3. Don’t bounce - When stretching it is important not to force or bounce past the barrier of the muscle. This can cause the muscle to spasm and tighten up once the stretch is over.

4. Timing is everything - holding a stretch for the incorrect amount of time can be wasteful it is important to hold for 15-20 seconds each side.

   Hamstrings

5. Single Leg Arabesque (Dynamic): Standing, lift right leg to a 90/90 position. Reach both arms out in front and begin to bend forward, as lumbar flexion begins, extend the right leg to a straight extended position. Should feel stretch in left hamstring. (this is also a great exercise for glutes and abdominal function as well as overall balance.

6. Hamstring Stretch (Static): Standing perpendicular to something of knee to mid thigh height, with one leg further forward. Place elbows on surface and flex through lumbars. Gradually move knee of forward leg forward until stretch is felt. Alternatively this can be modified to using a wall if no applicable surface can be found.

Thoracic Rotation + Psoas Stretch

7. Thoracic Rotation + Hip Mobility (Dynamic): Start in a push up position, step forward with one leg, Lower arm of the same side until elbow is touching ground. Reach with same arm reach towards the ceiling (rotating through the thoracic region). Kneel back onto the back leg allowing the forward leg to come into a straight position.

8. Thoracic/Lumbar Rotation + Psoas Stretch (Dynamic): Start in a lunge position, upon reaching the end of the lunge rotate through the body towards the side of the forward leg. Return to the middle and step forward with the back leg maintaining the lunge position and repeat.

Gastrocnemius/Soleus Stretch (Calf)

9. Calf Warm up/stretch (Dynamic): Create an angle by leaning towards a fence or wall. Replicate normal gait motion. This is best done in four parts. Toes forward, Toes pointing out, toes pointing in and toes forward with knee bent (to engage the soleus muscle)

10. Figure 4 Stretch (Static): Seated with one leg straight and the other bent to replicate a 4, reach forward with both arms to touch toes of straight leg.

The Shoulder & What It Is All About - Intro to 5 part series by Cameron Allshorn

To round out 2018 I will be uploading a 5 part series based around the common shoulder presentation we see as Osteopaths.

Speaking broadly, pain in the shoulder is a common presentation within clinical life; this can range from intermittent and diffuse nagging pain to outright debilitating pain and varying degrees of functional restriction. It is a complex and often multifaceted presentation. 

The complexity of the shoulder comes from the anatomical structure it forms. It is - in my opinion - the most fascinating structures of the human body. At its heart is the ball-in-socket glenohumeral joint (GH), the formation of a ball-in-socket joint between the humeral head and the glenoid fossa of the scapular. Beyond this we must also consider the Acromioclavicular joint (AC) as well as the distal extensions of these joints - The sternoclavicular (SC) and the elbow.

Due to the level of mobility required through the shoulder the GH requires a level of flexibility not seen in other ball-in-socket joints of the human body. This mobility requirement means that a lot of the structural support falls on the ligaments of the region (fig1.2). Injury to these ligaments can lead to a loss of function and mobility but also cause hypermobility of the GH leading to persistent reoccurrence of shoulder pain and an increased risk of dislocation.

An important point to remember is not every dysfunctional shoulder will cause pain. A 2011 study into shoulder pain noted that prevalence of asymptomatic full thickness rotator cuff tears was doubled after age 50 (1) while asymptomatic (meaning non pain producing) AC joint arthritis was apparent in 93% of x-ray images for people over 30 (1). That is to say that shoulder dysfunction and pain are not synonymous nor is it a lifelong sentence.

There is much to consider in relation to the shoulder that gives us the mobility we require, this also incorporates the lower back and elbow. At a muscular level the rotator cuff is a critical driver of shoulder function. More detail on this in part 1 when we take a look at how a rotator cuff injury can impact your ability to have an awesome high five.   

Function of the shoulder muscles is controlled via nerve structures exiting from the spinal cord at the neck (cervical region). This forms a complex web that is known as the brachial plexus, which we will touch on in more detail in parts 2 & 3. Injury or restriction to the neck or shoulder can impact the brachial plexus and present as shoulder pain but also contribute to neck, elbow, wrist and hand pain.

As Osteopaths, we tend to see shoulder presentations two to six months into their presenting history. This can align with the nature of a shoulder complaint in that they are often developed over a period of time through a repetitive action (throwing, writing or lifting for example) or from a habitual postural consideration (sleeping position, poor desk/workplace set up etc).

Shoulder pain is not picky and anyone has the potential to unknowingly fall into its path. However we do know that certain conditions have distinct precursors the increase your risks of developing shoulder pain. These include poor posture, previous history of injury (dislocation, tears or fractures), overuse or repetitive use. Early treatment and management of a shoulder presentation can quickly stop the progression and get you feeling great again. 

Osteopathic treatment may vary between patients and between presentations however following thorough assessment of the shoulder and the surrounding region osteopathic treatment will aim to restore any lost mobility and function with the shoulder using mobilisation, articulation and muscle energy techniques. Treatment may also include joint manipulation of the shoulder, cervical and or the thoracic region should your osteopathic assessment deem that it is necessary. To compliment treatment your osteopath may provide you with some exercises to complete between consultations to assist with recovery.

Keep an eye out for Part 1 of our shoulder series next week!

Works Cited

Cadogan A, Coates M, Hing W, Laslett M, McNair P. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskeletal Disorders. 2011 May; 12(119).

Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. 6th ed.: Lippincott Williams & Wilkins; 2010.

Why Tink Became an Osteopath