Jacky Chiang, Author at Anytime Physio

How to Fix Shoulder Pain During Bench Press

Jacky Chiang — Tue, 27 Aug 2019 02:04:32 +0000

If you have been lifting weights at the gym for any length of time, no doubt you or someone you’ve met at the gym has experienced shoulder pain. Unless there has been a serious injury, the cause of shoulder pain is from an overload of one of the structures of the shoulder. This could be due to poor form, muscle imbalances such as muscle weakness, poor muscle activation patterns or muscle tightness. Overzealous progression of the training program can also be a factor. In this post, we go over 3 exercises that our Brisbane-based physiotherapists use to help our clients get on top of sore shoulders.

Bench press shoulder pain

You may experience shoulder pain due to your posture with bench press. If your shoulders are rounded forward during bench press they will be more internally rotated. This will cause impingement or excessive stress on the rotator cuff muscles. To prevent this, ensure that you pull the shoulders back by squeezing the shoulder blades together and push up at mid chest level. Also, check your range of extension by pulling your elbows backwards in standing. Be careful with the depth of bench press as it should not pass the end-range of your shoulder. This puts excessive stress on the joint. Likewise, do not flare out the elbows too much as it can decrease the space in the shoulder joint as you bench up.

Is the bench press bad for shoulders?

Bench press is not harmful to the shoulders with the correct technique. However, without the correct technique the following conditions may arise. These include shoulder impingement, instability or rotator cuff injuries. Bench pressing with dumbbells may be a safer option compared to barbell bench press.

Avoiding a bench press blowout: Rotator cuff exercises!

The rotator cuff is an important group of four muscles that attach to the shoulder to stabilise the head of your arm bone within the socket. Strengthening of the rotator cuff muscles may assist with bench press or prevent future injuries. You can do rotator cuff exercises can with a resistance band and a pair of dumbbells.

1. Rotator cuff exercises with resistance band
Stand in an upright position. Hold a tensioned exercise band in both hands and bend your elbows to a right angle. Keep your shoulder blades back and down and rotate your symptomatic arm outwards, keeping your elbow loosely by your side and your shoulder blades in a good position. Control the movement then return back to the start position. Relax and repeat.

2. Rotator cuff exercises with dumbbells
Lie on your good side with a weight in your affected hand. Keep your upper arm against your body and bend your elbow to 90 degrees Keeping your elbow at your side rotate your forearm upwards to lift the weight. Ensure you do not roll backwards during the movement.

Ensure that you start with the lowest weight and progressively increase the weight once you are comfortable with three sets of 10 repetitions. You may warm up with light weights or do the exercises after bench press – do no exhaust the rotator cuffs before heavy bench press.

How do I know if I have damaged my rotator cuff?

The cause of rotator cuff injuries may involve overloading from sudden increase in exercise intensity. Contributing factors may involve poor lifting technique, muscle tightness or weakness. Initial presentation may be pain in the shoulder. Pain whilst lifting the arm, or pain and weakness with outward rotation of the upper arm. Muscle tears may be partial or full-thickness. Our physiotherapist will determine if your shoulder pain originates from rotator cuff injuries.

Why do my front deltoids hurt when I bench?

You may be experiencing pain in anterior deltoid area due to referred pain from rotator cuff. If you are bench pressing with the shoulder rolled forward, it places excessive force on the muscle tendons in a compromised position. Ensure that you squeeze your shoulder blades together so that the head of the upper arm is in an optimal position in the socket. Weakness of rotator cuff muscles may also contribute. This is because of the positioning of the head of arm bone inside the shoulder joint. Another common condition involving pain with lifting arm is bursitis. This is an inflammation of the fluid-filled sac as the space in the joint decreases, secondary to shoulder impingement.

What helps shoulder pain from lifting?

Depending on the contributing factors, management can vary. If rotator cuff tear is the underlying cause, 6 weeks of physiotherapy treatment is recommended as high-level evidence has suggested non-conservative management for rotator cuff tears. Treatments may involve soft tissue release, manual therapy, postural education, exercises or taping.

If bursitis secondary to impingement is suspected. The initial management involves exercises and ice. 15-20min every 2-3h with towel for first 48h. Avoiding aggravating postures such as reaching arm across or overhead activities. It is recommended to see a physiotherapist for a thorough examination of your shoulder pain for a specific exercise program. Please consult with one of our physiotherapists to check the safest form and exercises for your shoulder.

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Muscle Strain, Tear or Contusion?

Jacky Chiang — Thu, 15 Aug 2019 01:55:36 +0000

Strain or tear?

Muscles are strained or torn when some or all the fibres are unable to cope with the force. These injuries commonly occur in sports. This can affect muscles such as the quadriceps, hamstrings, calves (gastrocnemius or soleus) or the rotator cuffs. Muscles are more prone to tears from training error, sudden acceleration or deceleration. Risk factors involve insufficient warm-up, inadequate rest periods, muscle or joint tightness, muscle weakness or previous injury. The treatment depends on the severity of the injury.

Grades of muscle strain or tear

Grade I – The strain of a small number of muscle fibres, causing pain and minimal decrease in range of motion but usually no loss of strength. Recovery usually take 2-3 weeks.

Grade II – a large number of muscle fibres are torn but not completely ruptured. This causes pain and swelling and a loss of range of motion and strength. Partial tears may require 2-3 months before returning to sports.

Grade III – complete tear of muscle fibres or tendon causing severe pain, swelling, loss of strength and range of motion. Full rupture may require surgery to reattach the fibres. These injuries can take more than 3 months to heal.

Treatment of muscle strain/tear

Acute management of muscle strains or tears is similar to ligament strains treatment. This involves RICE

Rest – Taking care not to make the injury worse avoiding activities that put stress on the muscle. This may include standing for long periods or running.

Ice – Apply an ice or cold pack straight after the injury occurs to prevent and minimize swelling. Apply the ice for 10 to 20 minutes, 3 times a day for up to 48 – 72 hours. Avoid apply ice directly onto the skin.

Compression – Apply a compression bandage to the injury. This will help to reduce swelling.

Elevation – Elevate the injury above the level of the heart, whilst applying ice and when you are sitting or lying down.

Nonsteroidal anti-inflammatory drugs such as ibuprofen will also help to relieve pain and swelling. We may recommend a short period of immobilisation, depending on the severity of the injury. An ultrasound or MRI can be helpful in differentiating the grade of the injury

What is muscle contusion?

The cause of muscle contusion is commonly a direct blow or collision in sports, resulting in localised muscle injury and bleeding. Symptoms can involve pain, swelling, bruising or a lump over the skin called haematoma. In severe cases, this may be related with bone fractures and dislocations. Acute management also involves the RICE protocol for 48-72 hours followed by heat. See your doctor or physiotherapist to determine the severity of the injury. You may need an X-ray, ultrasound or an MRI. Contusions usually heal fast. Rehabilitation will be required to to restore pain-free range of motion, strength and flexibility. This will allow a return to sport.

Relevant Links

Ankle Sprains and Strain Treatment

The link between stress and muscle strain

Knee Injuries Explained

Strains-and-sprains-self-care

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Knee Pain – Patellofemoral Pain Syndrome

Jacky Chiang — Thu, 15 Aug 2019 00:58:27 +0000

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome (PFPS), is one of the most common causes of knee pain. It is commonly presented as a diffuse ache around the knee cap that is worse with knee movements. The can occur particularly with loaded activities such as climbing stairs or running. Sometimes, prolonged sitting can also cause pain, known as the “theatre sign”. Crackling or popping sounds may also suggest PFPS due to malalignment or instability of the kneecap. Typical onset of PSPS is usually gradual with recent change in training frequency or load. The cause of the pain is an imbalance of forces on the kneecap which causes malalignment

Risk factors of patellofemoral pain

Many other risk factors can also contribute to PFPS, including:

Altered biomechanics (e.g. foot rolling inward)
Previous injury or surgery
Quadriceps weakness
Reduced kneecap mobility
Poor lower limb flexibility
Change in footwear

Therefore, a thorough examination by a physiotherapist is recommended to explore the underlying cause of your knee pain and to also rule out other conditions such as patellar tendinopathy or fat pat syndrome.

How can physiotherapy help?

Studies have shown that physiotherapy can help with PFPS and that good outcomes are maintained after long-term follow-up. Effective treatment of PFPS involves a thorough physical assessment to target the underlying cause. Initial treatments may involve resting from aggravating activities, soft tissue massage, manual therapy to improve joint mobility, taping or strength and flexibility exercises. Orthotic devices may also be beneficial for some people to address biomechanics of the lower limb. However, there is no one-size-fits-all treatment as an individually tailored program is essential to address the underlying cause of your knee pain. See one of our physiotherapists for a thorough assessment and specific exercises to help you get back to previous level of function as quickly as possible.

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Shoulder Pain – Impingement and Bursitis

Jacky Chiang — Thu, 15 Aug 2019 00:30:00 +0000

What is shoulder impingement?

Shoulder impingement is a condition where the bursa or rotator cuff tendons are compressed in the subacromial space. This is the area between the head of the arm bone (humerus) and the acromion, a bony prominence at the top of the shoulder joint. The cause of shoulder impingement can be a bony spur on the acromion, poor posture, weakness of the rotator cuff muscles or muscle tightness. This can also relate to a rotator cuff tear or tendinopathy, this is an overuse injury.

What is bursitis?

Bursitis is an inflammation of a fluid filled sac in the joint called bursa. The bursa reduces friction between muscles, ligaments and bones. The shoulder is a ball-and-socket joint and the bursa is often inflamed in the subacromial space. Another term for shoulder bursitis is subacromial bursitis

What causes shoulder bursitis?

The cause of shoulder bursitis is usually due to overuse of the shoulder. This can be from activities such as throwing, swimming, cleaning or gardening. Subacromial bursitis is commonly related to shoulder impingement. The onset of pain is usually gradual, but sudden onset of pain can happen from direct trauma to the shoulder, such as a fall.

Symptoms

Shoulder bursitis results in pain with reduced range of motion (painful arc). Activities that may aggravate this injury include lifting and overhead movements, or lying on the affected side. For example, reaching across, hands behind back or rotating arm inward.

How is shoulder bursitis diagnosed?

Your physiotherapist will assess the shoulder with a series of tests to assist in the diagnosis of shoulder bursitis. Shoulder bursitis may be concurrent with other conditions. Sometimes X-ray, ultrasound or MRI scans can be helpful to differentiate between other pathologies.

Treatment of shoulder bursitis

The first step to treat shoulder bursitis. Avoid aggravating positions and activities that cause the microtraumas. This will reduce exacerbation of symptoms. Icing for 15min every 2-3 hours may be beneficial to reduce the inflammation for the first 48-72 hours. Nonsteroidal anti-inflammatory drugs such as ibuprofen can useful to reduce pain. Rehabilitation involves postural correction, manual therapy, and taping. There will also be exercises that strengthen and stretches weak or tight muscles. In severe shoulder bursitis, your physiotherapist may refer to your medical practitioner. This will be for an ultrasound-guided corticosteroid injection. This will help to reduce the inflammation. Evidence suggests that the effects of corticosteroid injections are only short-term. You should avoid favoring the injection over physiotherapy. It is crucial to continue with the exercises prescribed by your physiotherapist. This will ensure positive long-term outcomes.

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Common Cause of Heel Pain – Plantar Fasciitis

Jacky Chiang — Thu, 15 Aug 2019 00:07:59 +0000

What is plantar fasciosis?

Plantar fasciosis, or commonly known as plantar fasciitis, is pain at the attachment site of plantar fascia. The plantar fascia is a thick connective tissue stretching from the bottom of the heel along the sole of the foot to the toes. It is important for shock absorption and arch support of the foot. Plantar fasciitis is more correctly termed as “plantar fasciosis” as the underlying cause is more related to overuse and degeneration rather than inflammatory changes.

What causes plantar fasciosis?

Activities that involve repetitive movements of the ankle can cause microtears in the fascia leading to cellular changes. Sudden increase in load such as running or unsupportive footwear can contribute to development of plantar fasciitis. Obesity, low or high arch of the foot, decreased ankle range-of-motion or muscle tightness are other risk factors that can cause plantar fasciosis.

What are the symptoms?

Typically, someone with plantar fasciitis usually presents with gradual onset of sharp or throbbing pain over the inside of the heel. The heel pain is usually aggravated by weight-bearing activities such as running, prolonged walking or climbing stairs. Symptoms usually worsen during the push-off part of walking. The pain may also be worse after a period of inactivity such as prolonged sitting, standing or first thing in the morning.

How can physiotherapy help?

An experienced physiotherapist will conduct a series of examinations to correctly diagnose your heel pain. An initial 6-week conservative treatment is recommended to treat plantar fasciosis. Treatments can involve ice, rest, activity modifications, massage, taping, stretching and specific exercises to gradually reduce the symptoms. An ultrasound scan is usually not required but may be useful to investigate the degree of swelling and thickness of the fascia. Nonsteroidal anti-inflammatory drugs may also assist in reducing pain. Speak to one of our experienced physiotherapists today for pain relief and gradual return to previous level of exercise.

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Ankle Sprain Treatments

Jacky Chiang — Wed, 10 Apr 2019 01:22:52 +0000

Treatment for Acute Ankle Sprains

Acute ankle sprains are one of the most common sporting injuries treated by physiotherapists. Fortunately, most are simple to treat and can be managed a series of exercises and stretches taught by your physiotherapist.

What is an ankle sprain?

Ankle sprains cause stretching of ligaments around the ankle which can result in minor to complete tears. The most common sprain occurs when the ankle rolls outward with the foot turned inward. Causes for ankle sprains may be from twisting of the foot on uneven surfaces, falls or trauma from sports activities.

What are the symptoms?

Ankle sprains and ligament tears may cause:

Pain
Swelling
Bruising
Tenderness to touch
Ankle instability

What are the grades for ankle sprains?

Grade I: Minor tear or stretching of the ligament(s) with mild pain and swelling around the ankle. There should be minimal or no pain with weight-bearing activities (e.g. walking).

Grade 2: Partial tear of the ligament(s) with moderate pain, bruising and swelling. Walking is painful and ankle may feel unstable.

Grade 3: Complete tear of the ligament(s) with severe swelling, bruising and tenderness around the ankle. It is usually too painful to walk and the ankle feels unstable. Severe tears may be associated with fractures or high ankle sprains.

What is the treatment for ankle sprains?

Ankle sprains usually heal without surgical intervention. For severe tears, immobilisation with moonboot and crutches is recommended for initial management. Further investigations such as X-ray, ultrasound or MRI may be required for moderate to severe tears.

General initial treatment for ankle sprains in the first 48-72 hours is the RICE protocol (rest, ice, compression and elevation).

R – Rest from any activity that aggravates the pain to promote tissue healing.

I – Wrap a towel around ice pack, a bag of crushed ice cubes or frozen peas. Ice the affected area for 15-20 minutes every two hours. There should be no extreme pain.

C – Apply firm pressure with bandage or brace. Ensure that there is no discolouration or increase in swelling which indicates restricted blood flow.

E – Elevate the affected foot above the level of your heart.

Initial goal is to reduce pain, swelling and restore full range-of-motion. Your physiotherapist may tape your ankle to protect it from twisting or rolling. Next phase of rehabilitation will focus on improving strength, flexibility, balance and then gradual return to activities.

How long does it take to heal?

Grade I	Approx. 2-3 weeks
Grade II	Approx. 6 weeks
Grade III	Approx. 6-12 weeks.

According to a systematic review, ligament healing and mechanical stability of ankle occurs from 6 weeks to 3 months after injury, particularly Grade III ankle sprains. However, you may still experience mechanical laxity or subjective ankle instability up to one year depending on the severity of injury.

Need Help With An Ankle Sprain?

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More information

Foot and Ankle Injuries

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The Best Treatment For Low Back Pain

Jacky Chiang — Fri, 29 Mar 2019 06:42:42 +0000

What is the best treatment for lower back pain?

There is no one-size-fits-all treatment of low back pain. There is strong evidence that physiotherapy is recommended as the first line of defense against lower back pain, resulting in reduced use of pain medications and less overall health-care expenses. Generally, the first step to relieving back pain is to understand pain. Studies have shown that pain is poorly related to tissue damage and sometimes, the pain that persists is more about sensitivity rather than the damage. Our nervous system is like an alarm system which warns us of danger. However, in approximately one in four people, the alarm does not calm down after ramping up and stays extra sensitive, decreasing the tolerance to normal, safe movements. The spine is resilient and the tissues around it are adaptable.

It is recommended to avoid prolonged sitting, standing or repetitive twisting and stay active within pain-free range for initial management. Exercises, spinal mobilisations, acupuncture or heat pack are some effective non-pharmacologic management of lower back pain. Compelling evidence has shown combined manual therapy, exercise and education are efficacious for low back pain. For further information, please see your physiotherapist for an individually tailored program.

How do you strengthen your lower back and core?

Depending on individual presentations, strengthening of the lower back may involve functional exercises such as deadlift and squats. However, lower back pain conditions usually require retraining normal movements with manual therapy, exercises or stretches first. Exercises favouring a particular direction of movement can decrease pain, disability and medication use. Depending on the patient preferences or presenting symptoms, some people may also benefit from motor control exercises as it has similar effects in treating chronic lower back pain compared to graded activities. For further guidance, consult with one of our physiotherapists.

I think that I have a slipped disk, do I need a scan?

High level evidence suggests that the prevalence of disk bulge in a healthy, pain-free population ranges from 30% in 20-year-olds to 84% at 80 years old. Similarly, disk degeneration in asymptomatic individuals increases from 37% to 96% between the age of 20 to 80. Therefore, imaging results don’t always correlate to back pain, highlighting the significance of understanding pain. For a thorough examination, please see a physiotherapist.

Is walking good for lower back pain?

Generally, if walking does not aggravate your symptoms, it is a viable exercise. Walking can improve pain, disability and induce positive psychological changes for chronic lower back pain. Australia’s Physical Activity and Sedentary Behaviour Guidelines for Adults recommends a minimum of 150 min (30min daily) of moderate intensity physical activity each week. Therefore, brisk walking can be beneficial to chronic lower back pain. However, walking is not more beneficial than other exercises and a thorough examination is required to prescribe the most appropriate exercises.

Need Help With Your Low Back Pain?

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Back Pain Treatment

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