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Suffering with shoulder pain at night and getting very poor sleep sucks right? Are you struggling to lift your arm and have limited movement all of a sudden? Are you between the ages of 35-60? Well, it very well could be a "Frozen Shoulder". In this blog post, we’ll explore what Frozen Shoulder is, who it affects, the risk factors, how physiotherapy plays a crucial role in its treatment & give you 3 early stage exercises for treatment of Frozen Shoulder, to help you manage the shoulder pain at night. What is Frozen Shoulder? The Stages of Frozen Shoulder Risk Factors for Frozen Shoulder Physiotherapy Treatment for Frozen Shoulder Physiotherapy + Injection Therapy for Frozen Shoulder 3 Mobility Exercises to use if you have a painful shoulder with limited movement Conclusion What is Frozen Shoulder? Frozen shoulder, medically known as adhesive capsulitis , is a condition effecting the shoulder joint, characterized by worsening stiffness and pain. The capsule surrounding the joint becomes inflamed which leads to thickening and fibrosis . This leads to a decrease in the space available for the shoulder to move, which results in stiffness and limited mobility. In turn, the condition can cause severe pain, especially at night. Have you recently had surgery or a specific shoulder injury? Well you would be more at risk if you had the above, but a large proportion of frozen shoulders have a random insidious onset! How strange... and annoying. Frozen Shoulder can severely limit range of motion making even simple daily activities like reaching for an item on a shelf or putting on a jacket difficult and painful. Left: Normal shoulder joint capsule, Right: Pathological inflamed shoulder joint capsule   The Stages of Frozen Shoulder The condition typically progresses through three main stages: Freezing (Painful) Stage : This is the initial phase where pain onsets and leads to pain particularly with movement. Frozen Stage : During this phase, the pain may reduce, but stiffness increases significantly. The shoulder becomes very rigid, limiting range of motion and ability to use the shoulder. Thawing Stage : In the final stage, the shoulder gradually regains mobility, and the pain continues to decrease, though recovery can take months or even years. The 3 stages of Frozen Shoulder Risk Factors for Frozen Shoulder While the exact cause of frozen shoulder is not always clear, several risk factors are associated with an increased likelihood of developing this condition: Age : As mentioned, frozen shoulder is most common in people aged 40 to 60. Gender : Women, particularly those who are middle-aged, are more likely to develop frozen shoulder than men. Diabetes : People with diabetes are at a significantly higher risk of developing frozen shoulder, especially those with poorly controlled blood sugar levels. Other Medical Conditions : Thyroid disorders (hypothyroidism or hyperthyroidism), heart disease, and Parkinson’s disease are also linked to a higher incidence of frozen shoulder. Previous Shoulder Injuries or Surgery : Any trauma to the shoulder, including surgery or a fracture, can increase the risk of developing frozen shoulder due to prolonged immobility or altered movement patterns. Physiotherapy Treatment for Frozen Shoulder Physiotherapy is an excellent treatment option for Frozen Shoulder. The goal of physiotherapy is to manage pain, restore shoulder mobility, and improve function, with specific treatment modalities utilised in differing phases of the condition. Treatment typically involves: Pain Management : Initially, managing pain and inflammation is key. Modalities like heat or cold packs, electrical stimulation and prescribed pain medications may help to alleviate discomfort. Stretching and Mobilization : Once pain is controlled, physiotherapists will guide patients through gentle stretching exercises to improve or maintain the range of motion. These exercises target the shoulder joint capsule to reduce tightness and improve flexibility. Strengthening Exercises : As movement improves, strengthening exercises are introduced to help rebuild muscle strength around the shoulder. This is essential for enhancing joint function and functional use of the shoulder. Manual Therapy : Manual techniques, such as joint mobilizations, soft tissue massage, may be used as a package treatment to help improve shoulder movement and reduce stiffness. These hands-on treatments are often combined with exercises to maximize their effectiveness. Education : Physiotherapists also play an important role in educating patients on posture, body mechanics, and activity modifications to prevent exacerbation of symptoms during daily activities.   An example of shoulder physiotherapy Physiotherapy + Injection Therapy for Frozen Shoulder Corticosteroid injections may be considered for very stiff and painful shoulders, on a case-by-case basis. Essentially, Corticosteroid injections aim to have a short-term analgesic effect, reducing pain and allowing a more intensive period of rehabilitation where the shoulder isn’t limited by severe levels of pain. Corticosteroid Injections alone are likely to have little to no long-term effect on the shoulder. Additionally, if injection therapy is successful, evidence suggests the analgesic effect lasts no long than 8-12 weeks. Therefore, a holistic decision should be made by Physios & wider health professionals to ensure this is the right decision for someone with frozen shoulder. Steroid Injections used to manage Frozen Shoulder in some cases 3 Mobility Exercises to use if you have a painful shoulder with limited movement Now we've spoken about Frozen Shoulder, Here are some easy and gentle exercises to help you manage the shoulder pain and have a better nights sleep: 1. Pendulum Exercises In standing over sitting, lean your upper body forward so the affected arm is hanging. In this position, you can make pendulum motions but gently swinging the arm is different directions like forward and backward, side to side and in circular motions. 2. Finger Wall Walks Standing next to a wall, start the hand low and use your fingers to gently walk your hand up the wall, this will help to raise the arm higher up. Do this while facing the wall directly to work on shoulder flexion and while facing perpendicular to the wall as shown below and work on shoulder abduction. 3. Assisted External Rotation In sitting or standing, grab a straight object like a walking stick, umbrella, golf club. With your elbows tucked into your side hold the object tightly in the unaffected hand, with the end of the object pushed into the palm of the affected side. Now, push the object with the unaffected side, aiming to guide the affected sides hand out and away from the body, as shown in the picture below. Conclusion Frozen shoulder is a painful and debilitating condition that can significantly impact a person’s quality of life . While it is more common in middle-aged adults , particularly those with underlying health conditions, it is treatable with proper intervention. Physiotherapy is a vital part of the recovery process, focusing on pain relief, restoring mobility, and strengthening the shoulder to ensure long-term function. If you experience symptoms of frozen shoulder, seeking early physiotherapy intervention can greatly improve your chances of a full recovery. Find some extra links below to more information from the NHS & Journal Articles: NHS Information: https://www.nhs.uk/conditions/frozen-shoulder/ Frozen Shoulder Research Article: https://pubmed.ncbi.nlm.nih.gov/36075904/ Corticosteroid Injection + Physiotherapy in Frozen Shoulder: https://pmc.ncbi.nlm.nih.gov/articles/PMC6153137/ Jake Solomons (HCPC, mCSP) ElevatePhysiotherapy

Shin splints, also known as medial tibial stress syndrome (MTSS), is a common injury affecting runners, athletes, and people who engage in high-impact activities. In this blog post, we will look at lower limb anatomy, risk factors for Shin Splints and What the goal of Physiotherapy is in this condition. Anatomy Risk Factors for Shin Splints Physiotherapy Treatment for Shin Splints 3 Shin Splint Rehab Exercises to try Conclusion Anatomy The Tibia (Shin Bone) and its surrounding soft tissue structures including muscles and tendons aim to ensure appropriate force absorption during impact activities such as running. Shin Splints typically develops from overuse and repetitive stress, where the medial (inside border) of the Tibia becomes inflamed and painful. Inflammation occurs as a result of bony microtrauma and consequential stress response of the outer lining of the bone (Periosteum) as a result of overloading. Though not as serious as fractures, shin splints can still cause significant discomfort and disrupt physical activity. If not treated properly, they may lead to chronic pain and more severe injuries, such as stress fractures.   Bony Anatomy of the Lower Limb Risk Factors for Shin Splints Several factors can increase the likelihood of developing shin splints. These include: Overuse or Sudden Increase in Activity:  A rapid increase in exercise intensity, duration, or frequency, especially in high-impact activities, may exceed the capacity of the bony and soft tissues structures of the lower limb, leading to an inflammatory response. Improper Footwear: Wearing shoes that don’t provide adequate support or cushioning can lead to changes in proper alignment and excess strain on the shin area. Increased BMI:  Having a higher BMI leads to increased lower limb forces during activities, increasing the risk of developing injury, Weak or Imbalanced Muscles: Muscular imbalances or weakness in the lower leg, increases the chance of getting shin splints Previous Injury: Having a history of lower limb injuries increases the likelihood of developing shin splints due to the biomechanical changes that come about as a result of previous injury. Physiotherapy Treatment for Shin Splints Physiotherapy plays a crucial role in managing and treating shin splints. The treatment process follows a systematic approach to relieving symptoms and gradually increasing loading through specific exercises. Here is an example of what a treatment pathway for Shin Splints might look like: 1.     Offloading Period & Pain Management For those with very irritable and painful Shin Splints a specific offloading period is utilised to reduce inflammation and allows the area to “Settle”. At this time, pain management strategies such as Ice/Heat, Analgesia and Taping are prioritised.   2.     Physical Assessment An individualised Physical Assessment is completed to highlight any key areas of muscular weakness and functional imbalance to work on through the Rehabilitation process. This helps us to target important areas of the musculoskeletal anatomy to reduce future likelihood of injury   3.     Re-loading period As the area settles and pain reduces, a graded loading protocol is utilised to regain the functional capacity of the lower limb to be able to manage higher load activities like running. Building through this graded exposure protocol ensures minimal injury flare-up and optimises outcomes of rehabilitation. Exercises may flow from initial Isometric loading > Functional Plyometrics to restore full capacity and tolerance to higher load activities.   4.     Package Treatment A variety of treatment modalities may be utilised on the rehabilitation pathway and may include: Massage, Manual Therapy, Taping, Orthotics, Dry Needling and Electrotherapy. However, these extra modalities are only utilised in addition to our earlier discussed loading protocol and on an individual case-by-case basis.   3 Shin Splint Rehab Exercises to try Depending on the irritability of your condition, you may be able to utilise these exercises in the initial stage of the condition before seeking a Physiotherapist for guided rehabilitation. However, these exercises should evoke a pain response >2/10: 1.     Tibial Raises Strengthening the tibialis anterior (Muscle on the front of the shin) is an important aspect of rehabilitation. Start in sitting or standing, the aim is to bring your toes up towards your shin, then slowly lower. Keep this exercise done slow and controlled throughout the movement for the most benefit early on.   2.     Foot Intrinsics The intrinsic muscles of the foot are important for stability. In the initial stage, simple foot strengthening exercises can be very useful. During running based activities, the foot is the first part of the body to make contact with the floor. Therefore, building a solid base for repeated ground contact is essential. Start in sitting with your foot up and your toes extended, then while keeping your toes extended, point the foot. When you get to the bottom, curl toes your toes, while keeping the toes curled, bring the foot back up, then repeat. 3.     Isometric Heel Raise Just like building strength in the Tibialis Anterior is important, the muscles of the calf complex (Gastrocnemius/Soleus) need some love to. In the initial stage while the area is still irritable an Isometric heel raise is a great way to get some calf loading introduced into your rehabilitation. Its just like completing a normal calf raise, but hold towards the top of the raise and hold for a period of 10-45s, depending on what is tolerated.   Conclusion The Answer to the question above was: Up to 20%!! Shin splints are a painful and often frustrating condition caused by repetitive stress on the lower leg, but with proper care, they can be managed effectively. A comprehensive treatment plan that includes rest, physiotherapeutic intervention, and modifications to exercise habits can help alleviate pain, promote healing, and reduce the risk of future injuries. If you're experiencing shin splints, seeking advice from a physiotherapist can provide personalized strategies to get you back to your routine safely and efficiently. Find some extra links below to more information from the NHS & Journal Articles: NHS Website: https://www.nhs.uk/conditions/shin-splints/ Journal Article - ShinSplints: https://www.ncbi.nlm.nih.gov/books/NBK538479/ If you are interested in more Physiotherapy Blog content check out our other posts! Jake Solomons (HCPC, mCSP) Elevate Physiotherapy