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Rotator Cuff Related Shoulder Pain

What is Rotator Cuff Related Shoulder Pain?

“Rotator Cuff Related Shoulder Pain”

The rotator cuff is made up of a group of muscles that help keep the head of the humerus bone (‘the ball’) in the shoulder socket.  The rotator cuff muscles are also involved in moving your arm up and out to the side and rotating the shoulder.

“Rotator cuff related shoulder pain” is commonly seen with people who perform repetitive overhead activities such as painters, swimmers, tennis players etc. “Rotator cuff related shoulder pain” can also develop after a one-off event such as a fall or a quick jolt.

People who have “rotator cuff related shoulder” pain may have pain on the outside of the upper arm that is usually made worse when lifting the arm overhead.  It can also be painful to lie on the affected side.  In more severe cases, the pain may be constant, rather than only on specific movements. 

Types of Rotator Cuff injuries

Injuries to the rotator cuff muscles and/or tendons are quite common.  Anytime we use our hands and arms for any day to day task or sport, we are simultaneously using our shoulder muscles.  Injuries to the rotator cuff can occur at any age.  As well as the rotator cuff muscle and tendon complex, there are other structures in the shoulder that can cause pain.  Here are three of the more common causes of “rotator cuff related shoulder pain”.

1: Rotator Cuff tendinopathy

Tendinopathy can be acute (recent occurance) or chronic (lasting for weeks or months).  It is where there is degeneration or inflammation of the tendons, which causes pain.  This may be caused in some cases by repetitive overhead activities, a recent increase in shoulder exercise, or even a return to previous levels of activity, after a long period of inactivity.

2: Rotator Cuff tear, partial or full-thickness

This is where one of the rotator cuff muscles or tendons tear partially or fully.  This can happen due to a trauma, degeneration, or indeed from repeated microtraumas.  

3: Bursitis / sub acromial pain / impingement

You may hear the above terms in relation to shoulder pain.  Sometimes in reports such as an MRI report, bursitis may be reported, or sub-acromial impingement.  A recently published International Consensus Paper (Requejo-Salinas, Lewis et al, 2022) recommended that the above three terms were not clinically useful and that the term “Rotator Cuff Related Shoulder Pain” be an overarching term to include ‘bursitis’ and ‘impingement’.

Can Physio help?

Yes! We will start with a comprehensive assessment.  This is important so that we determine the reason for your shoulder pain, and start you on the right path to recovery.

Rehabilitation for “rotator cuff related shoulder pain” often involves a combination of manual therapy, and a graduated programme of strengthening exercises.  The exercises will be sepecific to you, depending on your contributing factors.  The exercise programme is not a ‘one-size fits all’ approach.

We will also investigate lifestyle factors specific to you (ergonomics, sports technique, posture, sleep etc.), so that your rehabilitation programme is tailor made, giving you the best possible results.

Start your recovery today, book online at: www.ionaphysio.com 

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Blog

What is a ‘Sports Physio?’

Do I need a 'Sports Physio?'

 

DO I NEED TO SEE A ‘SPORTS PHYSIO’?

The term ‘sports physio’ is used a lot, and you if you are involved in sport and get injured, you may be advised to seek out a ‘sports physio’. 

So, what is a ‘Sports Physio’?

Sports Physiotherapy’ (or sports physio) is a specialist area of physiotherapy that involves assessment, treatment and rehabilitation of sporting related injuries.

Chartered physiotherapists that specialise in musculoskeletal injuries are experts in treatment of all sporting injuries and for all age groups.

At IONA Physiotherapy clinic in Drumcondra, our team is made up of clinical specialists and senior musculoskeletal Physiotherapists.  Our physiotherapists have previously worked in professional sport and performance with Leinster Rugby and Riverdance among others.

If you are looking for a ‘sports physio’, then please contact our experienced team for a thorough assessment and rehabilitation program.

     

     

 

 

 

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Blog

Physio for Headache

Physiotherapy and headaches

Did you know that many headaches originate from the neck?  These headaches are known as Cervicogenic Headaches (CGH), and they occur due to some dysfunction in the upper 3 segments of the spine.  Thankfully, physiotherapy can help with the treatment and management of a CGH.

What causes Cervicogenic Headaches?

A mechanism known as “Convergence” means that pain coming from your neck can be perceived by your brain as a pain in your head.

This occurs because the nerves from the upper part of the neck converge (meet at the same point) with a sensory nerve in the head called the Trigeminal nerve.  If there is dysfunction in the neck, when these two signals converge, the brain mistakes the dysfunctional message as coming from the head and causes the headache.  It is simply referred pain from the neck.

“Convergence” also explains why sometimes people with gallbladder problems can feel the pain into the tip of their right shoulder. The body is pretty amazing!

 

How can a physiotherapist help?

As physiotherapists, we can help alleviate your symptoms through guided exercise prescription, advice, and manual therapy.

If you think you may be suffering from cervicogenic headaches, please book an appointment with us for an assessment.

*Please note that there are numerous causes for a headache, and numerous different types of headaches.  This article is only related to cervicogenic headaches.  If you have a headache with any of the following symptoms, please seek urgent medical care: Sudden onset, worsening in nature, blurred vision, dizziness, loss of balance, slurred speech, blind spots, fever, nausea or vomiting, shortness of breath, confusion, a headache after a fall or a concussion, stiff neck with a rash.

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Blog

Back pain and working from home

For many of our patients at IONA Physiotherapy in Drumcondra,  ever-increasing computer usage can be associated with neck, shoulder and even arm pain.  Often, if the computer workstation is not set up well, this neck and shoulder pain gets worse, the longer you spend at your computer.   Sound familiar?   The good news is, is that there is lots you can do to optimize your workstation and minimize discomfort!  Neck and shoulder pain is one of the most common complaints that we see at IONA Physiotherapy in Drumcondra, and an analysis of the workstation is an important part of the assessment.  Based on the most common mistakes that we see, here are our top tips!

Top tips for Improving your computer Workstation

  • If you use a laptop, make sure that you can separate the keyboard from the screen. An old keyboard that you can plug into your laptop will do the trick, allowing you to move the screen away from you to the correct position.
  • The top of your screen should be level with your eyes, and should be placed directly in front of you.
  • If you need glasses for the computer, wear them!  Otherwise, you are likely to lean your head excessively forward to read the text, causing strain which can lead to neck and shoulder pain.
  • Ensure that there is enough cord attached to your keyboard to allow you to place your keyboard close to you. Your arms should not need to reach forward to use the keyboard.
  • Similarly, you should be able to easily reach the mouse with your arm comfortably by your side. Consider a shorter keyboard if you don’t frequently use the number’s keys on you keyboard.
  • Your feet should be flat on the floor, if your feet don’t reach the floor while sitting back into your seat, use a foot rest.
  • The chair should be firm but covered with soft padding.  Ideally it should have a lumbar support to support the natural hollow in your lower back.  The backrest should recline roughly 15 degrees, and lock into position, allowing you to rest back into your seat.
  • If the chair has arm rests, they should slide under the desk, allowing you to get close enough to your keyboard.
  • Use a document holder between your keyboard and screen if your work combines computer and paper work.

 

 

What next?

The above are some examples of the most common mistakes that we see at IONA Physiotherapy in Drumcondra.  This does not take the place of a thorough assessment by a physiotherapist, but it’s a good start!  For further information regarding the set up of your work station, click on the following link:

https://www.osha.gov/SLTC/etools/computerworkstations/checklist_purchasing_guide.html

 

We hope that the above helps, however if you continue to have ongoing pain or discomfort, then we recommend that you make an appointment at the clinic for an assessment.  Please phone 01 7979545 for appointments.

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Blog Injuries

Ankle pain and how to treat it

What causes ankle pain?

There are many reasons someone may suffer from ankle pain. For the purpose of this article, we will
focus on one of the most common ankle injuries, namely a lateral ankle sprain.
Injury to one or more of the lateral ankle ligaments typically happen when you ‘roll your ankle’. This is
when the foot rolls inwards suddenly, maybe over a curb or from an uneven surface. This can sprain or
tear the supportive ligaments on the outer ankle and cause pain, swelling and difficulty walking.

Ankle Pain

How to treat ankle pain?

If your ankle is swollen then it is recommended to adopt the PRICE protocol for the first 48 hours.
PRICE stands for: Protect, Rest, Ice, Compression, and Elevation. This can be done by wearing a
bandage or an ankle sleeve, applying ice to the region for 10 minutes 3-5 times a day, resting, and
elevating your foot while resting. This should help speed up healing and reduce your ankle pain over the
first few days. In fact if you do this, you are likely to not only get better faster but also need less
physiotherapy sessions!

What can my physio do?
The good news is that most ankle sprains are not serious, however, they do require rehabilitation. Your
physiotherapist will guide your ankle rehab. Exercises and therapy will focus on restoring full normal
range of motion to your ankle, ankle strengthening and balance training.
A guided rehabilitation program, prescribed to you by your chartered physiotherapist, will enable you to
return to your chosen activities and greatly reduce your risk of recurrence.

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Blog Uncategorised

What’s Behind Our Name?

Physio-in-Glasnevin

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So many people have asked us down through the years how we came up with the name ‘IONA Physiotherapy’. 

Firstly, it’s not a misspelled version of “I own a physiotherapy practice”. Secondly, we do not have any links to the Iona Institute! 

Historical Roots

Many of the streets in the surrounding area of Glasnevin are called after Iona, an island off the coast of Scotland. And so, the name actually stretches way back to monastic Ireland as Iona had links to Saint Mobhí, an abbot of Glasnevin monastery in the 6th Century.

As we are deeply rooted in the community, we thought it appropriate to use the local placename in Glasnevin for our physiotherapy practice. IONA Physiotherapy has been providing private physiotherapy to the surrounding areas of Glasnevin and Drumcondra since 2001. 

All of our physiotherapists have a Masters Qualification meaning that we can provide an expert level of service, so that you get the best possible care. If you’re looking for a physio in Glasnevin, Drumcondra or the surrounding areas of Dublin 9, we would be delighted to help.  Bookings can be made online here, or by phoning the clinic here.

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Blog

COVID-19: Level 3, 4, and 5 restrictions and access to Physiotherapy.

Here are some frequently asked questions and answers.

Q: Can I still attend a physio appointment under level 3, level 4, and even level 5 restrictions or lockdown?

A: Yes, IONA Physiotherapy clinic is open and will remain open under all levels of Covid restrictions, as an essential health service provider.

Q: What precautions are in place for my visit to the clinic?

A: At IONA Physiotherapy, we have put rigorous infection control measures in place to keep you and our staff safe.  The consultation begins with a video call prior to entering, outside the clinic, where you will be asked some screening questions. 

The physiotherapist will be wearing PPE and adhering to strict infection control guidelines.  All staff temperatures are checked every day.  Your temperature will be taken on entry.  You will be given a brand-new medical grade mask for your visit.  The level of protection from a mask is really important, so we use a specific grade that is used in hospital settings (EN 14683:2019.) 

We will open the doors for you, and take payment through your phone to minimise touch points.

Touch-free hand sanitizers are in every room and hallway of the clinic.  Both you and the physiotherapist will use the sanitiser before your appointment begins and again as you exit the building.

We have a one-way system in place, to ensure you do not physically meet any other patients on entry or exit.

We have put enormous effort and planning into our health and safety response to Covid-19.  Our motto is to give each patient the same level of care as we would our own nearest and dearest.  Our in-house Covid safety plan is 80 pages long!  We won’t bore you with the details, but you can get a sense of our level of attention to detail by watching our health and safety video here. 

Q: What if I need physiotherapy but am cocooning, or prefer not to visit the clinic?

A: No problem, we have a video-link appointment option that can ensure you get access to physiotherapy without needing to attend in-clinic.  This is through doxy.me which is really easy to use.  You don’t need to download any software, we just send you an email or text with a link, which you then click on.  Remember to allow your microphone and camera.

Note: Do not attend if you are experiencing symptoms, have been a close contact with a confirmed case, you or anyone of your household are waiting to be tested/ waiting on a test result, or you have been abroad in the last 14 days.  Please phone first.

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Blog

Hamstring Muscle Injuries

Hamstring Muscle Injuries

If you are involved in sport, at any level, you will know someone who has had a hamstring injury, or you may have even had a hamstring injury in the past yourself.

 

What are the hamstrings?

They are a group of muscles located at the back of your thigh. Their primary function is to flex (bend) the knee and extend (straighten) the hip. They also have other functions, such as stabilising the knee joint and the pelvis.

They are named Bicep Femoris, Semitendinosus, and Semimembranosus.

There is also a 4th muscle that blends with the hamstrings called Adductor Magnus

How do they get injured?

There are a few ways in which a hamstring can get injured, but typically the mechanism of injury may be:

  • Running / sprinting

  • Kicking

  • Bending over from the hip

 

 

Rehabilitation

Adequate rehabilitation is essential, and your chartered physiotherapist will guide you through this process. The length of time from injury to a safe return to your chosen activity will largely depend on the severity of the muscle injury.

Muscle injuries are graded either: Grade I, Grade II, or Grade III.

Grade I muscle injury: A mild muscle strain

Grade II muscle injury: A partial muscle strain

Grade III muscle injury: A complete muscle tear or rupture

Thankfully the most common injuries are the Grade I and Grade II strains.

 

Rehabilitation Process

The overall aim of the rehabilitation period will be to strengthen your hamstring back to its pre-injury level and stronger.

Your physiotherapist will structure your rehabilitation into phases. Initially the goal will be to eliminate pain from walking and day to day activities. Once that landmark is achieved you can start loading (strengthening) your hamstring.

As the primary functions of the hamstring muscle group include flexing the knee and extending the hip, the strengthening exercises prescribed will reflect this.

Your program may include the following exercises:

  • Bridge

  • Squat

  • Split Squat

  • Deadlift

As well as strengthening exercises your physiotherapist will aim to include running as early as possible into your program. As you progress and get closer to full fitness some plyometric exercises will be added as well as some running drills.

 

Return to sport

You will set specific goals around return to sport with your physiotherapist. Your physiotherapist will explain and set out the specific criteria that you must meet in order to achieve these goals. This will help you understand your progress and achieve a successful outcome.

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Blog

Tips for dealing with Tennis Elbow

Tennis Elbow
Tennis Elbow

 

If you’ve ever had pain on the outside of your elbow with gripping objects or lifting, you’ll understand just how annoying it can be not to be able to use your arm properly. 

 

Tennis elbow, known as “lateral epicondylalgia” in medical circles, is very common, affecting roughly 3% of the population.   It is more common in manual workers and tennis players, but lots of people who do neither of these activities also develop this condition.   The pain is typically felt on the outside of the elbow, with activities such as gripping and lifting, particularly with the elbow straight and the palm of the hand facing down.  When severe, people may also complain of pain at rest, without moving the arm, or pain with just bending and straightening the elbow.

 

MRI or ultrasound of the tendons on the outside of the elbow may show some degenerative changes (wear and tear.)  However, radiological imaging is not particularly helpful in most cases, as research has shown that these kinds of changes are seen just as frequently in those without symptoms. 

Tennis elbow diagram showing a detail of the damaged tendon tissue.


The research in this area has been really fascinating over the last few years.  Research has shown that there are widespread changes in the sensory system, in those with tennis elbow.  Simply put, if you press on the shins of someone with tennis elbow, they will register pain quicker than those without!  They are more sensitive to pain all over.  The muscles of the whole upper limb also change, showing a reduction in grip strength and a failure of the muscles around the wrist to be able to hold the wrist in a good position during functional activities.  So, it seems that with tennis elbow, it is not as simple as the problem being confined to the tendons on the outside of the elbow.  Often the trigger is excess load or more load than the person is used to, causing pain in these tendons on the outside of the elbow.  This then is associated with widespread changes to the sensory and muscle system at and beyond the elbow.

 

This research may sound complex, but it has given us as physiotherapists a much better understanding of what is happening at the elbow, meaning that physiotherapy is now a very effective treatment for tennis elbow.  In fact, physiotherapy is now considered the gold standard of treatment, and any possible new treatments need to be benchmarked against that.  Injection and shock wave therapy have been shown in research to be ineffective treatments, with worse outcomes medium to long term (than controls) for those who receive an injection for tennis elbow, which cannot be reversed by physiotherapy.   Your physiotherapist will also assess your neck, as this can be an underlying factor causing some elbow pain, and needs to be addressed in order to achieve a good outcome.

 

Some tips

  • Don’t rub, or let anyone else rub/massage/friction the tendons on the outside of your elbow.  Remember there are changes in the sensory system with tennis elbow and “pushing on the sore bit”, because of increased sensitivity, just tends to make the pain worse.
  • Don’t have any injection for tennis elbow, without trying a good rehabilitation programme first.
  • If there are any factors which could be causing strain on your neck, address those e.g poor ergonomics, sleeping on your tummy at night etc.  Ongoing neck pain/stiffness is a risk factor for developing tennis elbow and other types of referred elbow pain. 

IONA Physiotherapy is a Clinical Specialist Practice.  All of our physiotherapists are chartered and have a Masters Qualification.  For appointments or further information, phone: 01 7979545

 

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What to Expect When You Attend Your Chartered Physiotherapist

physio-first-time

 

 

Your first Physiotherapy Session 
Your first visit with a Physiotherapist will involve us asking you some questions and listening to your story regarding the history of your injury or condition.  We will also take a detailed medical history. This allows your Physiotherapist to gain a better understanding of you and your problem and helps direct the physio assessment.  This is the cornerstone of being able to make an accurate diagnosis, which will direct your physiotherapy treatment plan and optimise your recovery.  So, forgive all the questions, but it is so important that we get to the bottom of what is wrong!


Do I need a GP referral for Physiotherapy?

It’s not necessary to have a GP referral to attend IONA Physiotherapy but if you already have a letter from your GP, consultant or other health professional as well as any written reports from any scans and investigations related to your problem, do take them with you so  that your Physiotherapist can understand the background of your issue better. 

 
What should I wear to Physiotherapy?

Wear loose, comfortable clothes that you can move well in and that you feel comfortable in. This also allows your Physiotherapist to assess your injured area or condition better, e.g. shorts for a knee, ankle or foot problem; a vest/loose top for back, shoulder or arm problem. 

 

If you have an injury or pain in your feet, please bring a selection of the shoes that you wear most often.  We may need to look at your footwear to see if it is contributing to the problem.  Also, if you need orthotics, it is helpful if you have the shoes that you wear most often with you on the day of your appointment.

 
Do I need to bring anything?


If you are attending as a result of a sporting injury, it can be useful to bring in your usual sporting equipment, e.g. for runners, bringing in your usual pair of runner shoes; for a tennis player, your tennis shoes and racket, etc. It can also be of benefit to take a video of yourself in action, playing your sport, so that we can have a look at your usual technique and biomechanics.  Remember, when taking the video, do what you usually do for the camera and not what you think you should do! Seeing you in action gives us a wealth of information about your biomechanics, movement patterns and technique which may be contributing to your injury.

 
Arrive early!


If this is your first visit, it is helpful if you can arrive 5-10 minutes before your appointment time, so that you can fill in any necessary paper work before you are called in for your appointment. 








IONA Physiotherapy is a Clinical Specialist Practice.  All of our physiotherapists are chartered and have a Masters Qualification.  For appointments or further information, phone: 01 7979545.  www.ionaphysio.com – Online booking coming very soon