You must have often heard about sports person, especially those associated with tennis or baseball (that involves continuous arm movement) suffer from rotator cuff injury. But what exactly is this injury? To understand the condition better, you need to know what is a rotator cuff. A rotator cuff is a group of tendons and muscles that keep the shoulder joints stable enabling a person to rotate or lift their shoulders freely.

With time, certain activities may cause a wear and tear of the rotator cuff injuring them. The injury sustained can result from a partial or a complete tear.
A partial tear of the rotator cuff may damage the tendons, but it will remain attached to the bones. However, in the case of a complete tear, the injury is more severe that penetrates deep within detaching the tendons off the bone (humerus).

Who can suffer from a Rotator Cuff Injury?
While the condition can affect anyone, people under the following situations stand a greater chance of injuring their rotator cuff.

People in their old age may suffer from the Rotator Cuff injury as with age the tendons and muscles may undergo a degeneration.
The injury may also be genetically linked.
The problem is found to be common among tennis and baseball players.
Painters, as well as carpenters who need to move their arms and shoulders continuously in a particular direction, stand at a risk of injuring the rotator cuff.
Symptoms associated with a Rotator Cuff Injury
People with a Rotator Cuff Injury may exhibit the following symptoms and associated discomfort.

The rotator cuff ensures the free and comfortable rotation of the arm and the shoulder. An injury will limit this rotation. As a result, a person may experience great difficulty and pain in lifting and moving the arm.
Lying on the affected shoulder can be a painful experience.
There is instability of the shoulder joints followed by weakness.
A person finds it difficult to carry out the basic activities such as bringing a glass of water close to the mouth or combing the hair.
Treatment

Anti-inflammatory drugs and painkillers (Acetaminophen) may be used to reduce the pain and swelling associated with the injury.
Physiotherapy and various strengthening exercise can go a long way to deal with shoulder weakness, stiffness, and restricted movement. However, one needs to have patience as the treatment may take time to produce the desired results.
In extreme cases, the doctor may opt for a surgery.
Arthroscopic surgery: The procedure is simple and involves a small incision on the affected shoulder to place an arthroscope (that comes fitted with a camera and the surgical instruments) to treat the condition.
The doctor may also carry out an open surgery or a mini-open surgery (an amalgamation of open and arthroscopic surgery) to fix the tear.

Rotator Cuff Injury - Symptoms Associated With It!

From marathon runners to footballers, amongst athletes, 'pulling a hamstring' is the most common type of injury. The hamstring is a group of four muscles at the back of your thigh. When one of these muscles gets overloaded or begins to tear, it is known as a hamstring injury. While a hamstring injury is painful, it does not indicate the end of an athlete's career.

Minor hamstring injuries may heal by themselves. In cases where one of the muscles is torn, surgery is required to repair and reattach the muscles. Recovery time depends on the severity of the injury. Stretching and exercising the muscles of the leg are the most important parts of rehabilitation. The healing of a hamstring injury can be divided into four stages.

1. Acute phase: The first five days after a hamstring injury is known as the acute phase of rehabilitation. The aim of treatment at this phase is to reduce inflammation and keep the other muscles from atrophy. For minor hamstring injuries resting the leg, using ice packs and keeping the leg elevated can accelerate the healing process. Once the pain and swelling has decreased, patients can use a cane or crutch to exercise the leg.

2. Subacute phase: From the fifth day to the 3rd week after the injury, the focus of the treatment shifts from minimizing swelling to strengthening the leg and increasing the range of possible motions. At this time, an athlete can resume cardiovascular training. Swimming and other forms of aquatic training are said to be especially beneficial to the treatment of hamstring injuries.

3. Remodeling phase: The remodeling phase continues upto 6 weeks after the injury. Strengthening the leg is the focus of this stage of treatment. Using ankle weights can be beneficial towards strengthening the leg muscles. It is important to be careful about the weight being used and to gradually increase this weight to avoid an added injury.

4. Functional stage: This stage can last upto 6 months until the athlete can regain full function of his or her leg. As the athlete's gait gets back to normal, they may start jogging and short sprints. Gradually, more sport specific exercises may be added to the workout.

There is no fixed time when an athlete can return to active sports after a hamstring injury. While players with minor injuries may return to the field after 3 weeks, athletes with muscles tears may take upto 6 months to recover completely. Hamstring injuries tend to reoccur and hence before they can get back to active sports, an athlete must pass an isometric strength test and flexibility test. This ensures that there are no subtle after effects of the injury that can increase the risk of a repeat injury.

Hamstring Injury Recovery and Return to Sports

Spinal fractures are extremely painful and usually happen when an external force applied to the spine exceeds the vertebral column s ability to bear the load. Many times, the bone fragments pinch and damage the spinal cord, which leads to an injury or dislocation of the bony vertebra. Although spinal fractures can develop anywhere along the spine, the most common site is the lower back.

What causes spinal fractures?

Spinal fractures can occur due to both minor trauma/falls and major accidents. The following are the probable causes of such fractures-

  Injuries sustained while playing a sport
  A traumatic injury
  Spinal instability
  Injuries sustained after falling from a height
  A whiplash
  Injuries sustained in an accident
  An underlying condition such as Osteoporosis, which causes the spinal bones to weaken

Symptoms observed:

Spinal fractures are characterized by the following symptoms-

  Muscle spasm and swelling
  Numbness
  Acute pain that worsens when you walk or stand for a long time
  A tingling sensation
  Restricted mobility of the spinal column
  Spinal deformity/disability
  Sudden onset of pain in the lower back region

What are the various types of spinal fractures?

Spinal fractures primarily fall into four categories, namely the following-

  Compression - Compression fractures are quite common in people with osteoporosis or bone cancer. The bones become fragile and brittle. If sudden force is applied with extreme pressure, the vertebra may not be able to support the load and that may result in a fracture.

  Burst - Severe trauma, such as a car accident can cause burst fractures. The external pressure is so much that the vertebra gets crushed. As a result, the bony fragments spread out and cause spinal cord injury. Unlike a compression fracture, where only a part of the vertebra is damaged, a burst fracture leads to multiple fractures in the vertebra.

  Flexion-distraction - This type of fracture is likely to happen if you are involved in a car accident. Normally, the spine is made to flex forward. However, a sudden jerk that pushes your body forward can put a lot of pressure on the spine and cause the vertebrae to break.

  Fracture-dislocation - This debilitating condition results from a torn ligament and broken bone.

What is the treatment for spinal fractures?

Treatment options for spinal fractures include both non-surgical and surgical methods.

  Non-surgical treatment - Most cases of spinal fractures can be treated with immobilization in a corset or brace for up to 10-12 weeks. Bracing will help prevent deformity and reduce pain.

  Surgical treatment - The doctor may recommend surgery in severe cases. The two standard surgical procedures are-

Vertebroplasty - The surgeon will insert a tube, known as a catheter, into the compressed vertebra. Through the catheter, he/she will inject bone cement into the fracture site. This will harden and stabilize the vertebral column. Vertebroplasty has proved to be an effective procedure to reduce pain. The surgery restores mobility and prevents loss of bone due to bed rest.

Kyphoplasty - During this procedure, the surgeon inserts a catheter into the spinal column under the guidance of an X-ray. Next, he/she makes small incisions along the back and inserts an inflatable bone stamp. The tamp, once inflated, bring back the vertebral body to its original height. It also creates a cavity to be filled with bone cement, which seals the cracks. The bone cement stops the vertebra from collapsing again. After the whole procedure, the surgeon will remove the catheter and stitch the incisions.

Following surgery, you will need to wear a brace for about 6-12 weeks. Physical therapy is strongly recommended initially to help you get back to your daily activities in a week or two.

Spinal Fractures - All You Should Know!

If you have a desk job that involves sitting right in front of your computer throughout the day or for a major part of the day, you could be unknowingly putting yourself at augmented risk of reduced hip mobility. The hips are one of the major muscles in your body that are used in a number of activities you do everyday.

Causes of Hip Immobility-

1. Sitting for long hours at the same place and working. This is common to people who work in front of the computer screens for extended hours continuously.

2. Toxic Synovitis, which is an inflammation of the hip joint. It causes pain and stiffness.

3. Juvenile Arthritis

4. Rheumatoid arthritis

5. Tendinitis or inflammation of the tendons that causes severe discomfort in movement

6. Ankylosing spondylitis that mainly affects the spine. It can cause extreme pain and discomfort in the movement of the hips. This makes it difficult to sit, stand or lie down.

7. Injuries

8. Fractures and breakage

9. Muscle and tissue ruptures near the hip region

10. Sprains and strains

11. Lack of proper blood circulation

12. Pain and injuries in the lower back region which can spread to the hip, causing stiffness and swelling

Physiotherapy for Hip Mobility-

Physiotherapy alias physical therapy is considered as one of the fastest growing allied areas of present generation medicine. Being an important rehabilitative service needed in a community and a vital therapeutic supplement of the medical profession, it's the treatment of diseases and disabilities using physical exercises, heat radiations, cold therapy, hydrotherapy, acupuncture and therapeutic massage. 

As doctors, physiotherapists or physical therapists are essential in helping the patient to recover and rehabilitate from a state of incapacity, due to genetic defect or the result of an accident or an illness. Physiotherapy for Hip Mobility involves certain exercises. Below give are some of the most common exercises for hip mobility-.

Lying Hip Rotations. One has to lie on the back on a padded mat, then put one leg over the other, exactly over the knee on one s lower thigh. Now, use either a towel or the hands to get to the leg that is placed below and without hyperextending, slowly pull this leg s knee closer to the chest.

Butterfly Movements and The Frog Posture.

The Kneeling Lunge. Here, one has to lunge forward with one knee on a padded mat. Then position the foot carefully beyond the knee that is put forward. Place your hands over the knees; straighten hip of the rear leg while leaning with the hips forward. Hold this particular stretch and repeat with the opposite side.

The Squatting Position.

The Pigeon Posture. In this, your knees need to be right below the hip on the padded mat. Then lower the outer side of the right buttock to the mat. You have to position your right heel in such a manner that it is exactly in front of the left hip. Hold this stretch for about 5-6 breaths and exhale deeply through the nose.

Bending forwards or backwards, guided and assisted by a physiotherapist.

Stretching Exercises.

Hot compresses on the area of inflammation.

Ice packs can also be applied alternately on the spot of injury.

Massage helps to regulate blood circulation and is an important part of physiotherapy.

Physiotherapy for Hip Mobility

Hip arthroscopy is a minimally invasive surgical procedure in which doctors view the joint problem without making any cuts through the skin and other soft tissues. Hip Arthroscopy is performed to treat several hip problems.

In Hip Arthroscopy, the doctors insert an arthroscope (a small camera) into the hip joint. The pictures are displayed on a video monitor with the help of an arthroscope. The surgeons will use these images to guide the surgical instrument.

As the surgical instrument and arthroscope are very thin, the surgeons make a very small incision compared to the one that is done in open surgery. As a result, patients feel less pain and stiffness in joints. This type of surgery also takes less time to recover and one can return to their normal life within a short period of time.

Hip Anatomy:

The hip is a socket and ball joint. The socket is formed by a part of a large pelvis bone called acetabulum. The ball joint is on the upper end of the femur (thighbone). Articular cartilage is a slippery tissue that covers the surface of the socket and ball. It creates a frictionless and smooth surface that helps the bones to glide across each other easily. Strong fibrocartilage is ringed on the acetabulum called labrum. It creates a gasket around the socket.

The joint is surrounded by a ligament, which creates a capsule to hold the joint together. The inner surface of the capsule is lined by a membrane called synovium. It produces a synovial fluid that helps in lubricating the joints.

When to Recommend Hip Arthroscopy?

If a person is suffering from chronic pain and does not respond to any other nonsurgical treatment, including physical therapy and medication, doctors may recommend a person opt for hip arthroscopy.

Hip arthroscopy helps a person to get relief from many problems that cause painful symptoms including damaged articular cartilage, labrum, or other soft tissues. The damage can be the result of any form of injury. However, there are other orthopedic conditions that can also lead to damage. The orthopedic conditions include:

Femoroacetabular Impingement (FAI):

In this type of disorder, an extra bone is developed on the femoral head (cam impingement) or along the acetabulum (pincer impingement). The overgrowth of the bone is known as spurs that damage the soft tissues surrounding the hip joint. In most cases, the bone spurs develop in either part. However, there are cases in which the bone spurs develop in both femoral head and acetabulum.

Dysplasia:

In this condition, the hip socket is abnormally shallow. Due to this problem, more stress is put on the labrum in order to keep the femoral head within the socket. This may raise the condition of the labral tear.

Snapping Hip Syndrome:

In this condition, the tendon rubs across the hip joint repeatedly. This type of popping or snapping is generally harmless and can be repaired without any treatment. However, the tendon may be fully damaged due to continuous rubbing in some cases.

Other conditions where hip arthroscopy is recommended include synovitis, hip joint infection, and labral tear.

Arthroscopic Femoroacetabular Surgery:

If the diagnosis results show that damage is caused by femoroacetabular impingement and a patient is not getting relieved from pain by any nonsurgical method, doctors recommend going for Arthroscopic Femoroacetabular Surgery.

In this type of surgery, the doctor repair and clear out the damage of the articular cartilage and labrum. He may also trim the rim of the acetabulum bone and shave the bump of the femoral head.

Arthroscopic Labral Repair:

If patients are not getting relief from conservative treatment, doctors recommend Arthroscopic Labral Repair. In this type of surgery, surgeons cut out and remove the damaged or torn part of the labrum. He further repairs the torn part by sewing it.

Take Away:

Both treatment methods are minimal incision processes and require fewer hospital stays. However, it is always advisable to consult a doctor before opting for any treatment.

Know More About Hip Arthroscopic Surgery!

Acupuncture is a kind of therapy that combines needles with pressure and pain points in order to delicately apply pressure for pain relief. This form of physical therapy is being increasingly recognised as an efficient method of treating pain in joints, muscles, bones and even for migraine pain. So let us find out more about Acupuncture and pain management.

    Chronic or Long Term Pain: There are many ailments that cause chronic or long term pain. These include back pain, neck pain, stiffness in the joints, osteoarthritis, headache and migraine, and pain in the shoulders. All this can be treated over a long period of time with the help of simulated acupuncture which uses pointed apparatus for activating better blood circulation for overall improvement in the pain that is being experienced in the area. The use of this apparatus helps in avoiding the harmful medication that can have adverse side effects.
    Menstrual Cramps: A fine needle method at the right points can help in bringing down the symptoms of the painful condition called dysmenorrhoea during menstrual cycles. With acupuncture, the acupuncturist can administer acupoint therapy to relieve menstrual cramps. This will help in moving the qi, or life force, in a better way so that the pain will stop. 
    Acute Pain: Over use of muscles, joints and repetitive, work related movements and strain can lead to acute pain. This includes wrist pain, shoulder pain, elbow pain, back pain, lower back pain, neck pain and even leg pain. With acupuncture, the patient gets rid of the pain in close to twelve sittings.
    Pain due to Cancer Treatment: Cancer and its treatment can take a heavy toll on the body and lead to a series of complications which also includes pain. A clean needle procedure can be followed along with the chemotherapy and radiation or after it, so as to relieve the patient of the pain experienced. Also, it can be used to replace traditional chemotherapy and radiation. 
    Better Rest: When the needles or apparatus touch the pressure points and circulate the blood and life force, it actually creates a soothing effect and helps the patient sleep and get better rest. This is also a requirement for pain relief. It can bring better blood flow to the area and help in removing anxiety and stress related to pain so that there is better chance of getting rest. 

With the use of acupuncture, pain can be taken care of with the needles and various tools that come in various shapes. These tools and equipment can also use laser treatment along with the point focused treatment.

Acupuncture and Pain Management

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