Frozen shoulder is a relatively common condition that can have a significant impact on a person’s life. A person with a true frozen shoulder usually experiences a significant loss of motion and experiences a significant amount of pain.

About Frozen Shoulder

Frozen shoulder affects approximately 2-5% of the population. Also called adhesive capsulitis, frozen shoulder can be linked to certain health conditions (such as diabetes or rheumatoid arthritis) but not always. For many patients, frozen shoulder occurs for no apparent reason.

Why is my shoulder stiff?

The precise mechanism of frozen shoulder is still relatively unknown. That being said, it is generally understood that some form of “event” causes the cells in your shoulder to change their activity. Inflammation likely causes the different tissues in the shoulder to contract or “bear down” on the joint. As a result it is very difficult to move since there is a type of “debris” in the way.

Symptoms of Frozen Shoulder

A person with frozen shoulder will likely experience pain when they move their shoulder to the end of available range. Often, the shoulder won’t hurt with movement in a short range and will not really hurt at rest. Contrary to popular belief, the muscles are not damaged or weakened in any significant way. Although it seems like the muscles must be damaged or torn, they usually aren’t. The joint just won’t move!

Tests for Frozen Shoulder

Unlike many conditions, there really aren’t any imaging findings for a practitioner to look for. When a person presents to our clinic with pain, loss of movement and no obvious findings on x-ray, diagnostic ultrasound or MRI, frozen shoulder is a diagnostic possibility.

Phases of Frozen Shoulder

It’s important for people with frozen shoulder to realize the expected healing rate (according to the published literature).  Although some lucky individuals recover from their frozen shoulder relatively quickly, many patients experience symptoms for over a year. According to the literature, the first phase of frozen shoulder lasts approximately 3-9 months. This is the “freezing” period which involves progressive pain and loss of motion.

Second Phase of Frozen Shoulder

The second phase of frozen shoulder occurs between 9-15 months since onset. At this point the shoulder is stiff…frozen shoulder has arrived!

Recovery from Frozen Shoulder

The last phase of frozen shoulder is often referred to the “thawing” phase. It can often occur between 15-24 months and involves a relatively gradual improvement in mobility.

Treatment for Frozen Shoulder

The treatment for frozen shoulder really depends on the phase of development and the amount of pain the patient is experiencing. Conservative treatment (like chiropractic or physiotherapy) is usually recommended and involves such things as stretching, assisted stretching, active release technique and other forms of manual therapy, laser therapy, interferential current, graston and acupuncture. Sometimes a combination of these approaches does the job. For those with very painful frozen shoulder, corticosteroid injections can be helpful. Surgery is also an option for those who fail to respond to conservative treatment (like physiotherapy or chiropractic). Unsure if you even have a true frozen shoulder? Want to know your options for treatment?

Call or email us – info@burlingtonsportstherapy.com. We can help you!

References
Favejee M, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions – systematic review. British Journal of Sports Medicine 2011; 45: 49-56.
Johnson AJ et al. The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. Journal of Orthopaedic & Sports Physical Therapy 2007; 37(3): 88-99.
Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(2): 135-148.

Many patients come to our clinic believing they have shoulder bursitis. Shoulder bursitis is a condition in which the bursa of the shoulder gets inflamed and generates pain. What is a bursa you ask? Let’s start from the beginning…

Bursa and Bursitis

Bursa are anatomical structures that are present throughout our body. A simple way to explain them is that they are “spacers” to separate different tissues in our body to prevent friction…think of a balloon filled with pudding.  Under normal circumstances we don’t even know we have them. They are present in our shoulders, knees, hips (and other major joints) and they usually don’t cause any symptoms or signs of dysfunction. When provoked, these structures can become inflamed. When this happens they swell with fluid and create the painful condition called “bursitis”.

Shoulder Bursitis

Most forms of bursitis are not visible but some can be. In these cases, you might actually see an area of collected fluid which correlates with the painful area. Keep in mind that bursitis doesn’t have to be painful though! In the most common case of shoulder bursitis, the bursa underneath the acromion (the pointy bone on top of your shoulder) gets inflamed. This is called subacromial bursitis. Since there isn’t a lot of extra space in that area to begin with, things get compressed. This is usually painful.

Symptoms of Shoulder Bursitis

A broad area of pain in the shoulder is common for shoulder bursitis. It usually doesn’t involve a specific point area of tenderness, but rather a “spread out” ache. Shoulder bursitis is usually aggravated with overhead activity, compression (like lying on that shoulder) and excessive use. Diagnostic ultrasound and MRI can be helpful in determining whether there is swelling in the bursa.

Treatment of Shoulder Bursitis

There are various treatments for shoulder bursitis. Anti-inflammatory or cortisone injections can be provided by a medical professional. Consistent with the literature, our clinic offers conservative treatment options through our chiropractors and physiotherapists. This avenue of treatment involves various treatment modalities like laser therapy, interferential current, manual treatment (like active release on surrounding tissues), acupuncture and rehabilitative exercise.  The treatment that is right for you can depend on many different factors, such as the duration of symptoms and treatment approaches that have already been tried.  Unsure what to do?  Feel free to give us a call or email us at info@burlingtonsportstherapy.com.  

Chiropractic Burlington Ontario and Degenerative Disc Disease

Our spine is made up of boney blocks called vertebrae. Separating each vertebrae are cartilage discs. These discs can wear down with time and use, which lead to the diagnosis of degenerative disc disease. Degenerative disc disease can be considered a relatively normal process that occurs in the spine. Unfortunately, it can also be associated with considerable pain and disability for some individuals.

Facts About Degenerative Disc Disease

In a nutshell, degenerative disc disease is a process that occurs over a considerable length of time.  Various factors (age, genetics, occupation, previous trauma) wear the disc down and cracks can form.  The jelly like material on the inside dries up and the overall height of the disc decreases.  The surrounding joint structures (such as ligament, bone and cartilage) can also be involved. Significant reduction in disc height can also affect the nerves that exit at each level of the spine.

Who Gets Degenerative Disc Disease?

For many people, signs of degenerative disc disease begin when they are in their twenties.  Although the prevalence of degenerative disc disease increases with age, genetics seem to be the best predictor of those who will be prone to the condition.  The activities that you do on a regular basis also seem to play a role. I often use the analogy of the tires on your car; you can’t expect to drive your car day after day and not see any wear in the tires. Your spine (and the discs in your spine) is somewhat similar.

Disc Bulge or Disc Herniation?

An easy way to understand the intervertebral disc is to picture a jelly donut. There is an outer crust to the disc and an inner jelly material. Simply stated, a disc herniation is when the crust is torn right through to the jelly in the middle and the jelly pushes out of the crack. A disc bulge is when the jelly in the donut squishes really close to the edge of the donut (because there are tears in the crust) but the jelly doesn’t pierce through the entire dough to be visible from the exterior.

Treatment for Degenerative Disc Disease

Surgical treatment for degenerative disc disease is usually viewed as a last resort if conservative treatment didn’t do the job. Conservative treatment usually consists of treatment like chiropractic, physiotherapy, laser therapy, acupuncture and massage therapy.  At Burlington Sports Therapy we have a variety of treatment techniques and services that can assist patients with degenerative disc disease. What is right for each individual patient depends on a variety of factors, including duration of symptoms, severity of symptoms and previous failed treatments.

For more information about how we can assist you, please email us at info@burlingtonsportstherapy.com

References
Adams MA and Roughley PJ. What is intervertebral disc degeneration and what causes it? Spine 2006; 31(18): 2151-2161.
Beattie P. Current understanding of lumbar intervertebral disc degeneration: a review with emphasis upon etiology, pathophysiology and lumbar magnetic resonance imaging. Journal of Orthopaedic & Sports Physical Therapy 2008; 38(6): 329-340.
De Schepper EIT, Damen J, van Meurs JBJ et al. The association between lumbar disc degeneration and low back pain. Spine 2010; 35(5): 531-536.
Viderman J, Gibbons LE, Kaprio J, Battie MC. Challenging the cumulative injury model: positive effects of greater body mass on disc degeneration. The Spine Journal 2010; 10: 26-31.

So you have a sore, painful shoulder and you’ve been told it’s a rotator cuff tear. But what does that mean? How do you treat a torn rotator cuff muscle? How do you know if your rotator cuff is torn? Let’s start with the basics…

What is a rotator cuff tear?

A rotator cuff tear is a very common injury affecting one (or more) of four different muscles in the shoulder. A tear can be partial or complete and can sometimes involve retraction of the tissue. Rotator cuff tears can be painful but they don’t have to be. They can often be associated with a traumatic event…but they don’t have to be! Rotator cuff tears can occur after years and years of use and are much more common in those people over 60.

Symptoms of Rotator Cuff Tear

Rotator cuff tears typically cause local pain in the shoulder. The pain can also travel down the shoulder toward the elbow. Surprisingly though, you may have one right now and not even know! A 1995 study published in the Journal of Bone & Joint Surgery performed MRI’s on people without shoulder pain. They found that rotator cuff tears in 4% of patients under 40 and in 54% of those greater than 60. A similar study found tears in 40% of those older than 50.

How do you know if you’ve torn your rotator cuff?

A skilled practitioner with the appropriate knowledge to diagnose your condition is obviously essential. One benefit of seeing a chiropractor is that we can order the appropriate x-rays right away. Although a rotator cuff tear is a muscular injury, there are clues that can be found on plain x-rays. Combining this information with certain clinical tests performed during your examination can allow for an early diagnosis so treatment is not delayed.

What is the best imaging for rotator cuff tears?

MRI (magnetic resonance imaging) is known to be one of the most accurate tools for diagnosing rotator cuff injuries. In Ontario, the wait can be long so many patients are referred for a diagnostic ultrasound. Although this modality isn’t as accurate, the wait times are usually shorter and can usually provide an early diagnosis.

Surgery for Rotator Cuff Tears

Surgery is appropriate for some individuals, but there are many different factors to consider. Many rotator cuff tears “re-tear” after surgery. Despite this, surgery can still improve function and decrease pain. Delaying surgery can be a bad idea though; your tear can get larger (especially if you’re over 60 years old), it can retract, can become infused with fat tissue and it can also atrophy (shrink). Each of these events will make recovery more difficult. Surgery is usually a more obvious decision for younger patients with a new, severe tear. Older patients have to carefully discuss with their surgeon and weigh out the benefits and risks.

Should I try more conservative treatment first?

According to the evidence, it is usually a good idea to try conservative treatment (like chiropractic or physiotherapy) for approximately six to twelve weeks prior to choosing surgery. This approach is most suitable for those people who still have some strength in their shoulder. Thinking of waiting to see if it improves? It is generally understood that larger tears will not heal with time. In fact, it would be more likely to get worse and retract. Significant retraction can make surgery more difficult.

Physiotherapy for Shoulder Pain

Our Burlington Chiropractic and Physiotherapy clinic offers many different ways to treat rotator cuff tears. Exercise, interferential current, laser therapy, acupuncture, graston or hands on treatment (like Active Release) are some of our “tools”. The best treatment for rotator cuff tears depends on many factors. Age, the duration of your symptoms, your x-ray findings and clinical findings (like strength) all play a role in the decision making process. Give our clinic a call and start with a diagnosis…we’ll help you figure it out!
Email – info@burlingtonsportstherapy.com

References
Hansen M, Otis J, Johnson J et al. Biomechanics of massive rotator cuff tears: implications for treatment. The Journal of Bone and Joint Surgery 2008; 90(2): 316-325.
Keener JD, Wei AS, Kim HM et al. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. The Journal of Bone and Joint Surgery 2009; 91: 1405-1413.
Maman E, Harris C, White et al. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. The Journal of Bone and Joint Surgery 2009; 91: 1898-1906.
Sher JS, Uribe JW, Posada A et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. Journal of Bone & Joint Surgery 1995; 77:10-15.
Wolf B, Dunn W, Wright R. Indications for repair of full-thickness rotator cuff tears. Americal Journal of Sports Medicine 2007; 35: 1007-1016.
Zingg PO, Jost B, Sukthankar A et al. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. The Journal of Bone and Joint Surgery 2007; 89: 1928-1934.

Piriformis syndrome occurs when the sciatic nerve is compressed by the piriformis muscle. As discussed in a previous blog, “sciatica” is pain in the distribution of the sciatic nerve. This can cause symptoms in the buttock, posterior thigh and or lower leg and foot.

Piriformis Muscle

The pirifomis muscle is a small muscle located in the area of your buttock. It lies beneath the larger, more powerful gluteal muscles. Specifically, it runs from the edge of the sacrum to the top of the femur and functions to externally rotate the hip (the motion of turning your foot outward). The location of this muscle with relation to the sciatic nerve makes it the topic of discussion for many practitioners and researchers alike.

The Sciatic Nerve and Piriformis Syndrome

The sciatic nerve is located underneath the piriformis muscle. For some however, the nerve passes right through the muscle. There is much debate in the literature as to the actual incidence of piriformis syndrome and whether or not it is over diagnosed by manual practitioners. This continues as an ongoing debate.

Symptoms of Piriformis Syndrome

Research has indicated that true piriformis syndrome typically has 4 defining characteristics:

- Pain in the region of the buttock.
- Sciatic pain that is often aggravated by prolonged sitting.
- Tenderness to touch in the buttock area (sciatic notch tenderness).
- Reproduction of pain with active or resisted external rotation of hip.

What causes piriformis syndrome?

Piriformis syndrome can occur for various reasons. Some of these reasons include overuse or thickening of the piriformis muscle, spasm or tightening of the piriformis, continued external pressure to the area, and congenital variations in the piriformis or the course of the sciatic nerve. There are many activities and various sports that place large demands on this relatively small muscle. These demands can cause injury to the muscle or surrounding fascia, leading to adhesions or scar tissue, possibly interfering with the path of the sciatic nerve.

Diagnosing Piriformis Syndrome

It is important to note that although one may have all of the symptoms listed above, there are several other conditions that mimic piriformis syndrome. Lumbar intervertebral disc herniations, stenosis within the lumbar spine or space occupying lesions are just a few of the more common conditions that share similar symptoms. As always, the most important step you can take if you have any of these symptoms is to see a qualified health practitioner who has the education and training to properly diagnose your condition.

Treatment of Piriformis Syndrome

Piriformis syndrome can be treated in a variety of ways. Our clinic has found success using different approaches like active release technique, laser therapy, graston and acupuncture. The approach that is right for you depends on a number of factors…too many to list here. If you think you may have piriformis syndrome and are looking for help, please contact us.

info@burlingtonsportstherapy.com

References
Hopayian K, Song F, Riera R, Sambandan S. The clinical features of piriformis syndrome: a systematic review. European Spine Journal 2010; 19: 2095-2109.