abdominals, Gymn Dangers, Physiotherapy, Pilates, Shoulder, Stability

Strong is the new SEXY

Strong is the new sexy but you have to be stable to be strong

Fit Woman

The media image of gorgeous and sexy has changed in recent years. It seems the willowy overly thin or the voluptuous curvy image of attractive woman has been surpassed with healthy strong and muscular women like Michelle Bridges or Anglina Jolie as Lara Croft. Men with muscles and great posture have always been the most admired and now the girls are aiming for the same.

In endeavouring to achieve this end it is essential to increase core strength and stability as we build power. A failure to address the “stability” part of “strong” will leave the body at risk of injury. Building muscle bulk is quite possible without core strength but pain might build to and there is nothing sexy about being injured or in pain!

We see increasing episodes at the clinic of back pain, tendon injuries and knee injuries in the strong but unstable individual who has been focusing purely on developing power and a good looking pysique.

Cross TrainerSome gym machines provide so much control of movement there is no challenge to stability, resulting in increasing strength but without the protection offered by the co-activation of stabilising muscle systems throughout the body.

Holding onto the handles of the cross trainer has the machine providing control of movement direction, minimising how much stability you have to provide from within.   Using the cross trainer not holding the handles ensures YOU have to provide the stability and control to maintain smooth movement.

Try it and feel the difference…. carefully at first!!  It is a much harder workout – and thats the acid test.  If its easy its not doing you as much good.

BOSU

Incorporating free weights and weight bearing exercise on unstable platforms like a BOSU will have you protecting the joints while building strength.

We know that good control and correct activation of the deeper abdominals flatten the tummy. Without this the rectus abdominus  (the six pack muscle) can strengthen but the abdomen can remain distended.  We often see very strong men with big bellys… a result of poor training technique.

Strengthening the deeper muscles around the shoulder girdle gives improved contours through the back and will stop the winging of scapular (Chicken wings). Strong shoulders look great!!

So ..if you are aiming for Strong and Sexy remember to train for stability too. Power in useless without control!!

Post by Catherine Stephens B. App Sc (Physio) MAPA.

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Physiotherapy, Shoulder

Frozen Shoulder – a predictable mystery

Although the reasons for onset of Frozen Shoulder remain unclear to the medical profession, the physiological process and symptoms experienced are quite predictable.

Most patients present with a general stiffness, restricted movement and some associated pain in the shoulder that radiates down the upper arm.  In some cases the pain is slight and in others extreme.

Ultrasounds and MRIs can detect many subtle abnormalities of joints and surrounding muscle and tissue but Frozen Shoulder is largely diagnosed by the physician based on movement dysfunction and associated pain, especially when elongated timeframes are involved e.g. 6 months plus.

Frozen shoulder age chart

It might sound a bit hit and miss but Frozen Shoulder is quite common – in fact 2% of the population suffer it with the vast majority of patients in their 50s.  If you have diabetic issues then the chances of it developing are even greater.

And ‘Developing’ is the only way to describe it.  Frozen Shoulder mainly occurs from no obvious associated injury to the shoulder.  In fact it can just develop for no apparent reason, though it will often accompany a recent traumatic incident – though again not necessarily to the shoulder.  A patient presented recently who had had a car accident, suffering whiplash and three weeks later developed a frozen shoulder.

The Process:

What happens is that the body ‘believes’ the main shoulder joint is damaged and therefore triggers an inflammatory response in order to heal it.  This involves streams of white blood cells, platelets and fibroplasts being sent to the joint lining and surrounding joint capsule and ligaments which causes inflammation and subsequent shrinkage which in turn restricts movement.

Frozen Shoulder Capsule

Left: Normal capsule allows generous movement Right: Frozen capsule shrinkage restricts movement

This process is like a ‘domino effect’, once started it naturally continues with no known way of stopping it – even though there is no original injury that triggered it.

Domino effect

It is as if the immune system makes an error of judgement.  In fact it is a natural hormonal change that instigates this ‘Inflammatory Cascade’ in the first place, which is why it affects women in their early 50s and men in their late 50s who are experiencing natural hormonal life changes at this time.

Eventually, after many months (usually around 5-7 months) the ‘dominoes’ run out and the inflammatory cascade stops, at which point Myofibroplasts are then sent in to smooth out the scar tissue.  This is exactly what happens with external injuries where the initial ugly scar tissue will soften and decrease until it eventually all but disappears.

Frozen shoulder timeframe

Pain starts to decrease and mobility return, but this is often a very slow process taking up to two years (and sometimes more) to complete and cannot be hurried along.

Treatment:

The most common treatment that can be effective during this ‘post freeze’ time is a cortisone injection into the glenohumeral (shoulder) joint which reduces the inflammation making it less painful and debilitating to everyday activities for around 3-4 weeks.  The injection can be repeated if needed.

Cortisone effect chart

It is a popular treatment that has much success but doesn’t always have optimum effect and in some cases can be relatively ineffective.

There are other methods for severe cases including arthroscopic capsular release, which is a key-hole, day-surgery procedure.

Physiotherapy:

Shoulder treatmentPhysiotherapy may exacerbate the pain in the first few months following the onset of symptoms in the ‘freezing’ phase or the inflammatory phase. But in the ‘thawing’ phase when the inflammation has settled, then physiotherapy and stretch exercises will help accelerate recovery in range of motion.

Due to the restrictions on movement inflicted by the Frozen Shoulder, all the other muscles surrounding the shoulder area will weaken and ligaments shrink, so a gradual stretching and re-building of muscle tone will be required over at least 6 months, sometimes longer.

Your physiotherapist is best to advise on exercise and stretching regimes, while taking care not to impinge the recovering joint.

Arms Spread

Author: This is a shortened version of an in-depth article by Mark Haber, specialist orthopaedic surgeon, M.B. B.S.  F.R.A.C.S. (Ortho). All illustrations copyright Mark Haber.   See full length article here.

Mark Haber conducts consultations at Warringah Medical Centre, Dale Street, Brookvale on referral from your GP.

Improving Movement, Physiotherapy, Stability

5 exercises to keep your shoulder stable and healthy

The key to a healthy, pain free and strong shoulder is a stable scapula (or shoulder blade) which is the base from which all shoulder movement occurs. It is the bone where the “socket” of your shoulder is found and to which the “ball” of your upper arm (humerus) connects.

Losing scapula stability is often the first step toward developing painful injuries such as rotator cuff tears, subacromial bursitis and arthritis.

The following exercises are very effective for improving scapula stability and therefore improving shoulder function. Please keep in mind that you should never have pain during or after doing these exercises. If you do, please consult a physiotherapist before continuing.

scapulaScapula Clock#1.Scapula clock: Stand close to a wall with your elbow bent. Place your hand on a small ball on the wall just below shoulder height. Roll your shoulder blade back and down and hold it set in this position.

Make circles alternating from clockwise to counterclockwise with your hand on the ball while maintaining your shoulder set. Repeat 10 times each way.

Pull Downs#2. Pull downs: Using a cable or theratube secured above you.

Pull down with straight arms to the side of body and simultaneously draw your shoulder blades back and down to feel muscular squeeze in the middle part of your back just below the shoulder blades.

Repeat 10-20 times.

Wall Push Ups#3. Wall push ups: Place hands on wall below shoulder height and slightly wider than shoulder width.

Stand with feet together and away from wall so you are weight bearing through your arms and hands.

Do slow push ups on the wall being mindful to keep the shoulders back and down as you press toward wall.

As you press away from the wall roll the shoulder blades around the ribcage to arch the upper spine.  Repeat 10 times.

4 Point Kneeling#4. Four point kneeling: Assume four point kneeling position.

Take weight forward so your nose is in front of your fingertips. Bend elbows and take shoulders down away from your ears.

Keep shoulders back and down and maintain stability on one arm as you lift the other out in front.  Repeat on the other side and do 5-10 repetitions.

Ball Roll#5. Roll out on ball: Assume start position as pictured.

Ensure shoulders, hips and knees are aligned and support weight on hands.

Slowly roll the ball out in front of you, keeping your body aligned and extend the arms away from the body to allow the elbows and forearms to rest on the ball.

Maintain shoulder blades down and back. Repeat 10 times.

Post by Angus Tadman