Shoulder pain

Shouldering the Pain

If you’ve ever had shoulder pain before, you would be well aware of how frustrating and inconvenient it can be. Swimming, lifting and picking up things, bench pressing, playing tennis, throwing a ball, you name it – shoulder pain can make a lot of things difficult.  

 

Why does your shoulder hurt

With certain (acute) shoulder injuries, there is a clear moment where you remember the shoulder being hurt – your arm was jerked one way when lifting something and felt a sudden pain, for example, you fell onto your shoulder, you made a tackle and your shoulder popped out. In many cases, however, whilst we may be able to identify activities that aggravate our shoulder it’s hard for us to pinpoint a reason why these activities are causing our shoulder pain. Often it’s a result of multiple factors coming together and creating the perfect storm. Let’s have a look at a few of these factors:  

 

Poor Rotator Cuff Strength 

The muscles at the back of your shoulder, your rotator cuff muscles, play a major role in keeping your shoulder moving pain-free. Weakness or poor usage of these muscles is a large cause of pain in people who use their arm and shoulder in a repetitive fashion – think swimmers, throwers, weightlifters, painters, people who lift objects a lot for work. 

 

Poor Shoulder-blade Stabilisers 

The muscles around your shoulder-blades (scapula) play an important role in positioning and moving your shoulder-blade optimally against your ribcage. If the scapula sits and moves in a suboptimal fashion, this can put an increased load on other structures in the shoulder and cause pain. In fact, in a high percentage of shoulder injuries, these muscles are not working in an ideal fashion. Again, this can pose an issue particularly in people who perform repetitive motions with their arm and shoulder 

 

Muscle Tightness 

Tight muscles around your shoulder can either pull your scapula into a poor position and/or restrict the motion around your shoulder, thereby pinching or putting an increased load in structures around your shoulder. 

 

Posture 

Believe it or not, your posture can contribute to shoulder pain. Try this – slouch in your seat, lift your arm above your head and make note of how your shoulder feels. Now sit tall, repeat and see how it feels. 

 

Stay tuned for a future blog post with a few simple strategies you can try to help put your shoulder on the road to recovery! 

 

Acute ankle sprain injury

Ankle sprain, or "twisting" / "rolling" the ankle is a common injury seen in sports requiring jumping and landing on one foot, or sudden cuts and changes of direction.

Despite all the evidence available, 1/5 of sprained ankles become a chronic problem.

What are the main causes of an ankle sprain?

Landing on an uneven surface, or pushing-off laterally from acute cutting maneuvers are the 2 main causes of injury. Sports like trail-running, tennis or basketball are particularly at risk. The most likely anatomical structure to get damaged is the ankle's anterior ligament, but  somemuscles can also sustain a strain altogether. In the most severe cases, the fragment of a bone can be detached.

How do I know if the ankle sprain is severe, or not?

Over the years, international guidelines have been established to help assessing the severity of the sprain. Specific tests including palpation and questions in regards to what happened immediately after the injury will help to decidefor additional tests like an X-ray, or not.

What should I do right after I sprained my ankle?

For the first 2 to 3 days, it is important to protect the ankle. The use of tape can help to prevent any excessive lateral movement from occurring. The RICE protocol, that stands for Rest, Ice, Compression and Elevation s now being questioned. We can see and understand the benefits from icing for excessive swelling control, and pain management. But as inflammation is the first step towards healing, experts are now re-considering the need to delay the start of the actual healing response.

What exercises should I start with, after the initial relative rest?

Swelling, increased muscle tone and joint subluxation make it important to work on the sprained ankle range of motion. In a sitting position, slowly slide your foot on the ground, forward and back, stopping whenever a pain over 3/10 is felt. Do 3 sets of 10 repetitions. Try also to draw letters of the alphabet with your foot, at a slow and controlled pace.

Lying on your side, with the injured leg on the top, alternate pointing your foot down to the floor, then up to the ceiling. Do 5 sets of 10 repetitions.

Try to balance on one leg, for a total of 3 minutes per day. Remember to soften the knee, and do not hesitate to perform this in 20 to 30 seconds chunks at the beginning.

Stationary bike or swimming are both valid options to keep your endurance up. For cycling, push from the knee, not the ankle. In the pool, add a pull boy between the legs if the ankle feels uncomfortable. Start with 15 minutes, and increase the length progressively.

What next?

When pain starts to become under control, acute ankle sprains require more advanced exercises to add power and control. This is needed before returning to sport. We will get this covered in a future blog post.

Achilles tendon pain and running

The Achilles tendon is the part of your calf muscles that attaches to your heel.The main role of this structure is to store elastic energy, then release it during the push-off phase.

 

What causes the pain?

Achilles pain is very common with runners. Increase in intensity, distance, or change in footwear can all cause an increase of the load on the tendon. Poor running technique, often overstriding - long steps forcing you to land on your heel instead of the midfoot - can also impact the tendon negatively. Achilles tendinopathy is often referred to as an overuse injury.

This is why the tendon capacity can also be reduced by running on consecutive days, shortening the periods of needed rest. 

 

What can you do to prevent it?

As the principle osteopath at Hong Kong Sports Clinic, I will assess your running technique, body stability and various kinetic chains to ensure that you are loading the tendon optimally. As a first line of treatment, you should avoid running 2 days in a row in order to give the tendon enough rest between sessions.  Ensure that you wear comfortable shoes, and that you do not increase your running mileage too fast too soon.

 

Can a long-time injury still be treated?

An irritated tendon goes through different phases: reaction, dysrepair and degeneration. The portion of your Achilles tendon that has degenerated cannot really improve. But our team of practitioners can guide you to strengthen its remaining healthy part. We see runners with barely 30% of their tendon intact still perform very well! A tailored exercise program including progressive load of the tendon is required to go back at running, while diminishing the odds of re-injury.

 

Conclusion

If you suffer from Achilles pain, do not hesitate to contact Hong Kong Sports Clinic team. We will help you to manage the load you put on the tendon, assess your running technique and help you building up the required stability.

Dereck Fu

Physiotherapist

 

Dereck completed his physiotherapy training at the Hong Kong Polytechnic University. After graduation, he started practicing in a public hospital where he had extensive experience in treating different musculoskeletal, orthopedics, and sports conditions. He recognizes the complex contribution to pain and musculoskeletal injuries and is keen on using a wide range of skill sets such as exercise therapy, manual therapy, and acupuncture tailored to individual conditions.

Before joining HKSC, Dereck completed his Master of Clinical Physiotherapy (Musculoskeletal Physiotherapy) and accreditation in Level 1 strength and conditioning coach under the Australian Strength and Conditioning Association (ASCA). These exposures enriched his practice, considering the psychosocial, biomechanical, and training load aspect of the clients’ story.

He has a particular interest in treating sports-related injuries and desk job conditions, assisting clients on their way back to function, and prevent recurring injuries.

Dereck has been a sports enthusiast since his teenage years. He is a keen football (soccer) and badminton player who treasures the enjoyment and satisfaction brought by both team and individual sports.

Icy Bo Lin

Head of Mobility

Icy has spent thousands of hours studying yoga, stretching and mobility through a broad range of in-depth courses. She has more than 7 years of experience teaching group and 1-on-1 classes to people ranging from athletes, pregnant ladies and new mums, children and especially the average Joe’s.

Icy is passionate about helping people move better, recover well and get pain free.

She believes it takes a combination of tools to help build a healthy body and has therefore spent substantial time practising strengthening and conditioning as well

Her passion for her craft is demonstrated through a focus and attention to detail with her clients.

Icy is a mother, experienced former banker and we are proud to have such an accomplished person on our team.

Below is a list of her completed training:

Leslie T. Evangelista

Head of Strength and Conditioning

Leslie’s athletic achievements speak for themselves. She is a true world class power lifter and continues to compete at the highest level. She has reached the pinnacle of her sport, medalling in a number of international powerlifting federation events. She has been Asia’s best lifter and holds a number of national records.

As impressive as it is, Leslie’s athletic resume pales in comparison to her passion, knowledge and dedication to the science of physical human performance. She is a student and expert of strength and conditioning, working in the industry as a coach and consultant for 10 years. We are very glad to have her on our team as her technical knowledge of compound movements and training methodology helps us bridge the gap between injury and a better you.

Leslie takes most pleasure in teaching the average person. Leslie’s deep knowledge and experience means she can build you from the bottom up or take you to a level beyond your expectations. Whether you are a mother or a mother to be, an office worker wanting to learn how to keep strong, or a youth wanting to learn the essentials of training, she is the expert for you.

Leslie is available as a consultant for long or short-term basis if you are serious about improving your health. She is an invaluable asset to have on anyone’s team.

Hideo “Harry” Loasby

Head Running Coach, Founder of BuffCo

Harry discovered running at 16, and quickly rose through the ranks in Hong Kong and became a national champion over 1500m when he was 17. He represented Hong Kong at the Asian Schools Championships and won several gold medals in cross country and track. Harry’s performances earned him a place on the Loyola Marymount University cross country and track team.

Towards the end of his university career, Harry became increasingly interested in studying various training methods and running philosophies. After moving back home, and knowing first hand the gap in grass roots development in Hong Kong, he set up Buffalo Running Company (BuffCo) in the hopes of changing that for the better. While coaching full time, Harry has remained competitive in the local scene, winning the 2020 China Coast Marathon by over 8 minutes. During the absence of races, he coached himself to personal bests in solo road time trials in the 10k and half marathon, running 31:38 and 70:30 respectively.

After running and now coaching in Hong Kong for the majority of his running career, Harry builds his coaching and training philosophy around the context of the city and what it means to be a runner here. He enjoys hunting for excellence in every level of runner, because he knows what Hong Kong’s running scene has to offer despite the tough conditions. From complete beginner to aspiring college athlete, on any surface over any distance, Harry is keen to help you with your running journey.

Harry is available as a consultant for any race you have on the calendar, but he is particularly passionate in developing runners over several years and building a sustainable relationship with all aspects of the sport, so that you can enjoy a lifetime of healthy, happy running.

May Lee
Sports Massage Therapist and Sports Scientist

May is an Internationally experienced Sports Massage Therapist, she focuses on deep tissue massaging to aid recovery, optimise performance but also general health and well-being. Throughout her years of training and watching others train, May has found that many people neglect the recovery process. The recovery process is fundamental for muscles to grow and develop and more importantly to reduce injury in the long term. Deep tissue massage helps to smooth out those little aches and pains you experience in normal day to day activities.

May has studied Sports Science at degree level and has completed her Level 4 Diploma in Sports Massage Therapy in the UK as well as being qualified in Dry Needling, Myofascial Release, Trigger point therapy and Pre-Hospital immediate care in sport.

She has previously worked a ski season in Niseko followed by working in clinical practice in Tokyo before deciding to move to Hong Kong to pursue her career further.

May has always had a keen interest in sports, training and exercise which has allowed her to pursue a successful career within sports and exercise rehabilitation.

Lizemari Marais
Physiotherapist and Pilates Instructor

Liz is a Physiotherapist and Pilates Instructor from South Africa. Her greatest passion is health education and empowerment, which is why she flourishes in the corporate wellness setting. She’s good at analysing corporate settings to determine risk factors to individual health as well as employee productivity. She will not just remind your employees to sit up straight – she will walk a path with your company to encourage healthy lifestyles and happy employees.

Liz’s approach to rehabilitation is grounded in the balance between mobility and foundation strength. She explores this in her calisthenics, yoga and pilates. She believes that with the right foundation and training, the human body can do anything.

Liz values independence and wishes to equip her patients with everything they would need to maximise their body’s potential, allowing them to pursue independent lives.

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