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Category: Sporting

The Menopause and how is can affect your tendons

A patient well-known to me, came in a few weeks ago complaining of ongoing Achilles pain. She couldn’t remember any single trauma or injury, but rather a slowly increasing level of pain and dysfunction. I’ve treated her for various sporting injuries over the years. I knew her exercise and training routine well and previously helped shape her training plan. This injury was puzzling though, given there was no clear mechanism injury, the only thing that had changed was the fact that she had started to experience hot flushes. She recently saw her GP to discuss the menopause. At no point did she ever think that her Achilles tendon pain may have also been linked to the menopause.

What is Menopause?

The menopause is a normal and natural part of a woman’s life when she stops having periods. It normally occurs between the ages of 45-55 but can happen either naturally or for medical reasons following the removal of ovaries or with certain types of treatment. The ovaries no longer release an egg every month and oestrogen levels start to decline,

The word ‘menopause’ literally means the ‘end of monthly cycles’ (the end of monthly periods or menstruation), from the Greek word “pausis” (‘pause’) and “mēn” (‘month’).

In most cases, the menopause transition begins in a woman’s mid-to-late 40s (perimenopause) but it’s important to know that some women begin the transition earlier and others later. The average age for a woman to reach the menopause in the UK is 51. Around 5% of women will go through early menopause, between the age of 40-45, and 1% under the age of 40. An ovarian insufficiency known as POI is the result of premature ovulation.

It is possible for women to experience some symptoms, all the symptoms, or a combination of them. In 2019 Currie & Moger conducted a survey amongst 1000 women experiencing menopause symptoms. They were aged between 45 and 65 years and said that they experienced: Night sweats, problems sleeping/insomnia, change to flow/frequency of periods, mood changes, weight gain, low energy levels, problems with memory/concentration, loss of sex drive, vaginal dryness, increased urinary frequency/urgency, headaches palpitations, pain during sex.
Interestingly 38% of women had joint and tendon issues and pain associated with these.

How does declining oestrogen affect tendons?

Tendons connect muscle to bone. During a muscle contraction, tendons withstand tension, transmit forces and store energy. Tendons are comprised mostly of a protein called collagen. Collagen is both flexible and strong and resistant to damage. The fibres arrange themselves in bundles which helps make them even stronger as a unit. Oestrogen is an important controller of collagen metabolism. Mechanically, it acts to decrease tendon stiffness, and as a result, protects the attached muscle from injury. 

When oestrogen levels decline, however, this negatively affects tendon metabolism and healing, reducing the rate of turnover of collagen. Consequently, this reduction in oestrogen causes a decrease in tensile strength (tension under load), a decrease in collagen synthesis, fibre diameter, density, and increased degradation of tendon tissue.

Tendons become increasingly stiff after menopause, and since they are attached to bones, they can be injured. Tendons have less compliance, so they do not respond as quickly to the demands of the muscles that they are attached to. This means that women experiencing menopause are more at risk of injury to tendons.

For more expert advice, book to see Tamara here: https://www.vitality-physio.co.uk/book-an-appointment-online/

SLAP Tears

Did you know that small changes in the position of the clavicle, scapula, and spine all help move the shoulder? The shoulder is able to perform all these brilliant movements mostly because of its shape, but also because it’s supported by those other joints too. The accessory joints (between the clavicle, scapula, and spine ) allow us to create these complex movements. They also make these movements more stable and more powerful too! There are 7 movements that occur in the shoulder: abduction (away from the body), adduction (across the body), internal rotation, external rotation, flexion (upwards), extension (backward), and circumduction (a combination of all the above).

Taxing your shoulder over time with repetitive, overhead movements or participating in contact sports may put your shoulder at risk for injury. Many athletes endure micro-traumatic stresses on the shoulder which can be both unpleasant and painful too! Significant damage happens these injuries are left without being treated.

Is a SLAP tear similar to a rotator cuff tear?

A SLAP tear is not to be confused with a rotator cuff tear. A rotator cuff tear involves a tear to a rotator cuff muscle/tendon. A SLAP tear refers to a tear of the labrum – which is a thick piece of cartilage that lines the shoulder joint. In most cases, there is also damage to the bicep tendon that attaches to the labrum. Sometimes SLAP tears are confused with AC Joint problems. One of the key differences is that in SLAP tears, you’ll have pain when your bicep muscle works eccentrically (like going down on a bench press).

What is a SLAP tear?

This is a tear to the ring of cartilage (labrum) that surrounds your shoulder’s socket. A SLAP tear tends to develop over time from repetitive, overhead motions, such as throwing a baseball, playing tennis or volleyball, or swimming. Usually, you’ll have pain at the top of the shoulder, clicking, and pain with those overhead activities.  If you’ve had a SLAP tear your:

Athletic performance decreases. You have less power in your shoulder, and your shoulder feels like it could “pop out.

Range of motion decreases. You may not feel able to throw or lift an object overhead like you used to, as your range of motion decreases.

Shoulder hurts and you can’t pinpoint the pain. You have a deep, achy pain in your shoulder, but you can’t pinpoint the exact location.

There are 4 types of SLAP tears:

Type I SLAP lesions have been described as isolated fraying of the superior labrum with a firm attachment of the labrum to the glenoid. These types of SLAP tears are typically due to degenerative changes. It has been suggested that the majority of the population has some variation of a Type 1 SLAP lesion. These often present with no symptoms and are no cause for concern.

 

Type II SLAP lesions are defined by a detachment of the superior labrum and the origin of the tendon of the long head of the biceps brachii from the glenoid cavity. This can often cause instability in the shoulder. This is the most common type of SLAP tear and often needs surgery for repair.

 

Type III SLAP lesions are tears in the shape of a bucket-handle. The labrum peels back, with no damage to the long head of bicep tendon.

 

Type IV SLAP lesions are a combination of Type II and Type III tears. This involves a bucket handle tear to the labrum, which extends into the bicep tendon. This type of tear often causes instability in the shoulder and the long head of the bicep.

 

Do all SLAP tears heal on their own?

Unfortunately, SLAP tears do not heal on their own.  Sometimes surgery is the best option, depending largely on the type of SLAP tear. If a SLAP tear is left untreated, the shoulder can become unstable, leading to dislocation. Reduced range of motion, chronic pain, and adhesive capsulitis (frozen shoulder) are also common. Discuss this with your trusted healthcare provider after a thorough assessment of the injury, and what the best option is for you. A good clinician will always be able to advise about the advantages and disadvantages of the treatment options.

What does conservative management look like?

Exercises that develop strong control of the rotation in the shoulder are very important. They help ultimately to manage the load placed on the upper labrum (superior labrum), relieve pain, and help overhead athletes move their arms more efficiently.  Watch me show you my favourite SLAP tear exercises!

Rotator cuff tears

How do you tear your rotator cuff?

Rotator cuff tears are common. They tend to occur more often amongst people over the age of 50 than younger people in their 30s and 40s. Older people tend to get tears due to age-related changes. In fact, it’s so common almost 50% of people over 60 get them. One study showed that asymptomatic tears were twice as common as symptomatic ones! Younger and middle-aged people tend to get them due to trauma, trying to lift a very heavy object or catch something heavy. Tears can also happen from a fall onto the shoulder or arm. It can also occur from a boom-bust cycle too much too soon type of exercise such as trying a new sport and overtraining without sufficient strength and conditioning to support the shoulder. In older people, it tends to happen because of age-related changes from decreased blood supply to the tendons connecting muscles to bones.

Do I have a rotator cuff tear or a sore shoulder?

There are many conditions that can give you pain in the shoulder. Pain can be referred from the neck as well as other organs like the gall bladder, lungs, and even your heart. It’s important to know that your shoulder pain is not a symptom of any other condition. A good Physio (like all of us at Vitality Physio) will ask all the relevant questions to keep you safe.

Some of the most noteworthy features of rotator cuff tears are:

  • The affected shoulder hurts when lying on it while resting.
  • Pain when lifting or lowering the arm during simple activities such as reaching for a shelf.
  • A feeling that the shoulder is weak. It’s particularly noticeable when lifting your arm to shoulder level or when rotating your shoulder.

Does the rotator cuff always need surgery if it is torn?

Let’s take a closer look at the anatomy:

The rotator cuff tendons are special. They are all connected via the rotator cable. Therefore, they all work together to make the rotator cuff a continuous structure, working harmoniously together. The cable functions as a stress shield. It acts in the same way that a suspension bridge transmits loads across to its supporting towers.

 

Here’s the good news- this means that even when you have a large tear of a  rotator cuff tendon, you can sometimes neither have pain nor a loss of function!

However, tears that affect the function of the rotator cable are likely to need surgery. Therefore, the location, more than the size of the tear is more relevant in deciding whether surgery is needed.

How can Physiotherapy help?

It is important to address all factors that may have contributed to tendon injury or tear when treating rotator cuff injuries when surgery is not needed.

With physiotherapy, you will improve neck, scapular, and thoracic spine function. All of the body parts are integral to good shoulder function. If your neck is stiff or weak, your shoulder joint can often have to work harder. By targeting these supporting areas, you will improve the way your body is set up before you move your shoulder. This means that you give your shoulder the best chance to move both easily and powerfully.

As movement experts, Physios are great at distinguishing whether your joints have the stability to move efficiently too. So, we can help you get your shoulder working to its best potential.

We can help you find interim solutions to find more comfortable positions to sleep, and ways to modify your technique for activities, while you are recovering or getting stronger.

Now, generic exercises – off the internet will help to a certain extent; however, they cannot be replaced by robust, goal-orientated, and bespoke training plans. They are often not targetted to your individual needs, and it’s difficult to guess without an expert to guide you how often, how many repetitions, and how heavy to load your muscles.

To make improvements rehab should always be:

  1. Specific- meaning is it for endurance, strength, balance, flexibility, or a combination of these?
  2. Measurable- it needs to be scored.
  3. Prescribed- so that you know the:
  • Intensity: How many repetitions?
  • Sets: How many times should you repeat a particular number of repetitions of a given exercise?
  • Dose: How many sessions per week?

By working with a well-planned specific rehab program- you’ll make the best gains and use your time efficiently too!

Top 5 Summer injuries and how to prevent them

1. Gardening injuries

We kicked off June with a very balmy Jubilee weekend and it’s been a brilliant summer so far! If you enjoy a chilled glass of rosé, weekend BBQs, and a spot of gardening too, you’ve found good company!

Gardening injuries, however, are quite common, so here are some handy hints to help you get the most of your long summer days. Extended pruning time, using inappropriate tools, and heavy lifting with poor technique are often the biggest culprits!

Try the following to keep your love for gardening alive:

  • Warm up before you weed-up! Try taking a brisk walk to get your heart rate up, prior to starting your gardening session.
  • Sit on a stool or kneel on foam pads to help prevent knee and back pain when planting or weeding.
  • Long handle tools will reduce the work and prevent you from overstretching.
  • Impose a 20-minute limit (to make a cuppa of course) to take a short break especially if you’re a gardening novice!

Don’t spoil a perfect day in the garden with a pesky injury! If you have any questions about an injury or wondered whether we can help, book a free 15min call to chat about how we could help you.

2. Neck strains

If catching some rays on your back is a priority this summer, be sure to set a timer or get someone to wake you. Apart from the obvious perils of turning into a lobster and the pain associated with it, getting a stiff neck from lying prone (on your tummy) on the beach will certainly put a damper on your holiday. Reading for long periods on a sun lounger can also cause a crick in the neck, so be sure to do a few neck stretches every so often to keep your neck mobile. Here are some useful neck stretches to try. 

  • Tilt your head to one side and hold for 15-20 sec and then to the other side. 
  • Roll your shoulders forwards 5 times and then backward. 

 

3. Running shin splits 

Trying to get beach-fit quickly? Trying to run away those extra pounds? A sudden increase in running thresholds (especially if you’ve never run) is one of the biggest single causes of shin splints. This, together with wearing inappropriate footwear, a higher BMI and flat feet are among the top factors that can result in shin splints. Try switching to swimming or cycling instead and seek physiotherapy advice before hitting the pavement again to avoid this common summer injury.  

 

4. Plantar fasciitis

In warmer weather, we tend you to swap our more supportive shoes for flip-flops, pumps, and sandals. Whilst increasing the airflow helps us feel cooler, our feet have to work a lot harder to help us move. This can cause aching burning feet at the end of the day. The intrinsic foot muscles may have deconditioned over the long winter and therefore be subject to strain and fatigue. If you suffer from burning feet, try doing the following: 

Place a bottle of water in the freezer for an hour or so. Place it under your foot to act as an ice roller- trust me, it will absolutely hit the spot to relieve your burning feet! 

 

5. Cycling injuries 

Fair weather cyclists the world over can all relate to a “dead pinky” or lower back pain after getting into the saddle. Bike setup is crucial to your cycling comfort and can also contribute to the work of cycling. Your pre-bike fitness however will set you up to ensure you’re recruiting the correct muscles for your pedal power and avoid injury. Weak glutes are sometimes responsible for overworking the lumbar spine or hamstrings. A simple bridge exercise is useful for hip mobility and strength, particularly for cyclists as it replicates the action of the downward force of pedaling and isolates glut muscles.  

 

We hope that these few simple golden nuggets will help keep those summer injuries at bay and that you have a wonderful and long summer!