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Online Hallamshire Physio Clinic (Read 10266 times)

HPclinic

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#75 Re: Online Hallamshire Physio Clinic
March 15, 2017, 09:11:17 am
Hey Guys -

Another shoulder question.  My left shoulder/upper arm has been having recurring discomfort.  I wouldn't call it pain, and I can't think of anything acute.  It's been something off and on for the last 6-8 months, progressing from irritating to concerning, then to nothing, and back again.  I have no pain from raising my arms overhead, no pain or discomfort while doing any rotator cuff or I, Y, T's.  If I raise my arm fully, I feel a "stretching" sensation in my lat? near the tricep.  If I hang from a bar, I feel discomfort in my upper bicep/deltoid area while warming up. Once warmed up fully, I don't notice anything really until the end of a very long session.  My gut says I may have some tendonopathy in the long head biceps tendon, but I'm not sure.  Any other thoughts? 

If it is a biceps tendonitis/osis issues, any ideas on therapy?
Cheers,
Squatch
Hi apologies about the delay in response, have been away.
You could be right regarding the long head of biceps. The other area I would be interested in looking at is your neck and upper back/ ribs. The best advice is to go and get a physio assessment and they can determine the prime cause of the pain and symptoms. The problem with it now being chronic ( more than 6 weeks) is that you may be compensating.
Often these problems slowly occur over time and can be related to work and life postures and not always directly related to climbing.
Regards matt

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#76 Re: Online Hallamshire Physio Clinic
March 15, 2017, 11:21:07 am
Hi - I'm not sure if you guys are still offering advice, but thought I'd give you a try.

About 3 weeks ago I banged my hand badly while dynoing, smacking the tip of my unbent pinkie causing immediate pain and swelling around my PIP joint. Being smarter than I look, I stopped climbing straight away and iced my hand.

3 weeks on, the swelling has substantially gone. I now have full mobility back for 'daily life' tasks - however the joint doesn't like being involved in climbing; giving me pain both underneath the PIP joint and ontop of the knuckle when I engage the pinkie in any way.

I've asked Doctor Google and am fairly sure I have acquired a Volar Plate injury from hyperextending the finger. I have a hard mass on the underside of my finger, between PIP joint and palm, which I assume is scar tissue. This is tender when pressed.

Assuming my diagnosis is right, I have two questions:
i) Should I be massaging the 'hard mass' to break down scar tissue, or am I likely to be aggravating my injury?
ii) Can you advise any exercises / stretches that will aid recovery? Google doesn't turn much up on this front. So far I've been using rubber bands / squishy balls to provide as much resistance as possible until I feel pain.

Your advice would be much appreciated!
Hi, my apologies about the delay in responding I have been on hols.
Massaging the mass might help and you may find through everyday movements it slowly disappears. Ultimately you want a joint moving freely without any restrictions. You can stretch it both into flexion and extension but sometimes there will be a restriction to what we call accessory movements. These are movements that you cannot actively do but they are essential for normal movement e.g. Slight traction or gapping of the joint as well as forward/ backward and sideway glide. It may be worth a once of physio assessment if there is still a restriction or pain.
You may have started back climbing but if not then try some lower grades and bigger hols and start increasing the load over a 4-6 week period bringing in crimping after 4 weeks. Expect some discomfort but this shouldn't get worse.
Let me know how you are going.
Regards Matt

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#77 Re: Online Hallamshire Physio Clinic
March 15, 2017, 11:30:05 am
Hello, any help would be appreciated...

I have seen doctors/physios about this but nothing is helping so far so thought I'd see what other advice I could get!

I've been having pain in my wrists (yes, both) for about a year now - I had about 5 weeks off over summer but this didn't seem to help much, I've also restricted my climbing to one or two sessions a week for most of this time. The pain is mainly concentrated on the outside (pinky side) but it also comes over the top and on the other side fairly often. I can't do push ups due to the pain or any other motion where I am pushing with the palm of my hand with much force. Also any climbing moves that involve twisting the wrist at all tend to hurt (and I avoid) as does pulling on slopers. Advice so far has been a variety of stretches, icing, rest, taping all whilst avoiding particular climbing moves/styles that worsen the pain. I also spent a while doing lots of antagonist training on the forearm but this didn't really help and if anything made it worst. I've also had two separate weeks where I took ibuprofen which seemed to help and now use ibuprofen gel on a daily basis - this helps, but doesn't take away all the pain. Probably worth mentioning I spend most of my working day at a desk using a laptop (with a mouse though) which unsurprisingly doesn't help the issue.

One of the physios I saw referred me to someone to get steroid injections, but that person decided they weren't right for me. I'm currently trying to get referred to a orthopedic hand specialist - but unsurprisingly the NHS aren't making this easy...

Not really sure what I'm asking here, but any tips/suggestions different to what I've tried before would be great  :)
Hi Will,
Are your wrists very mobile? If so I am wondering whether you may be going onto excessive extension when you are loading them and possibly disrupting the triangular fibrocartilage disc and complex. It is difficult without looking at your wrists. Have you tried putting a wide piece of tape around your wrist at the joint to block excessive extension. Have a look at TFCC injuries and see if this sounds like your wrists. The fact it is both wrists might more towards just excessive movement and joint impingement. Let me know your thoughts.
Regards
Matt

Thanks for getting back to me. I wouldn't say they're that mobile. I have tried taping them and do now tape them most of the time when climbing. I had come across TFCC injuries before and thought they fitted my symptoms, but the physios I've seen have suggested they don't think that's the problem. I'm trying to push to get a scan of some kind so that I'm not just getting differing opinions but some kind of objective test, would you advise this?

Thanks.
Hi Will, my apologies about the delayed response. I am not sure you will necessarily find anything on a scan but sometimes it is a process of elimination.
Another thought would be that if you are sitting at a desk then try regular movements above your head i.e. Alternate arm reaches every hour. Combine this with neck rotations to the right and left as well as trunk rotations. The fact you have bilateral symptoms could be coming from a cervical and upper back origin so move it more in the day and avoid poor sustain postures. Might be worth suggesting this to a local physio and get some treatment.
Regards Matt

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#78 Re: Online Hallamshire Physio Clinic
March 15, 2017, 11:36:27 am
Jumping on the band-wagon too:

I've recurring problems with my elbows, but the pain is not isolated to the classic medial/lateral epicondylitis (golfers/tennis elbow) trigger points.

The pain I experience can be quite crippling at times (nauseating at worst) and radiates down the outside of the humerus, but when palpated is not specific to the brachialis origin.

Could the source of pain be nervous in origin? The symptoms are generally short lived (<2hrs) if i stop climbing when they start, and hence very difficult to present to a physio - what would your suggested course of action be?
Hi apologies about the delayed response, I have been away.
The fact you are getting bilateral symptoms down your arms could indicate a central problem, i.e. Neck or upper back with possible nerve involvement. A physio will get a detailed history and should get a good idea where it is coming from. Where you are getting your pain may not be where the origin is, hence symptoms may be reproduced when palpating the neck. Work and lifestyle postures and positions may also be relevant. Book yourself in to see a physio.
Regards Matt