Shoulder pain

Shouldering the Pain

If you’ve ever had shoulder pain before, you would be well aware of how frustrating and inconvenient it can be. Swimming, lifting and picking up things, bench pressing, playing tennis, throwing a ball, you name it – shoulder pain can make a lot of things difficult.  

 

Why does your shoulder hurt

With certain (acute) shoulder injuries, there is a clear moment where you remember the shoulder being hurt – your arm was jerked one way when lifting something and felt a sudden pain, for example, you fell onto your shoulder, you made a tackle and your shoulder popped out. In many cases, however, whilst we may be able to identify activities that aggravate our shoulder it’s hard for us to pinpoint a reason why these activities are causing our shoulder pain. Often it’s a result of multiple factors coming together and creating the perfect storm. Let’s have a look at a few of these factors:  

 

Poor Rotator Cuff Strength 

The muscles at the back of your shoulder, your rotator cuff muscles, play a major role in keeping your shoulder moving pain-free. Weakness or poor usage of these muscles is a large cause of pain in people who use their arm and shoulder in a repetitive fashion – think swimmers, throwers, weightlifters, painters, people who lift objects a lot for work. 

 

Poor Shoulder-blade Stabilisers 

The muscles around your shoulder-blades (scapula) play an important role in positioning and moving your shoulder-blade optimally against your ribcage. If the scapula sits and moves in a suboptimal fashion, this can put an increased load on other structures in the shoulder and cause pain. In fact, in a high percentage of shoulder injuries, these muscles are not working in an ideal fashion. Again, this can pose an issue particularly in people who perform repetitive motions with their arm and shoulder 

 

Muscle Tightness 

Tight muscles around your shoulder can either pull your scapula into a poor position and/or restrict the motion around your shoulder, thereby pinching or putting an increased load in structures around your shoulder. 

 

Posture 

Believe it or not, your posture can contribute to shoulder pain. Try this – slouch in your seat, lift your arm above your head and make note of how your shoulder feels. Now sit tall, repeat and see how it feels. 

 

Stay tuned for a future blog post with a few simple strategies you can try to help put your shoulder on the road to recovery! 

 

Understanding diastasis recti – part 2

Mind the gap - understanding diastasis recti

In part 1 we looked at what a diastasis recti is and common things to look out for if you suspect you might have a diastasis. Here in part 2, we will discuss how physiotherapy can help, and common dos and don’ts if you do have a diastasis.

 

Physiotherapy

Unfortunately, there is not a one-size-fits-all set of exercises that can be prescribed to “fix” a diastasis. Treatment for this condition needs to be individually tailored depending on the extent of the issue, how many weeks post-partum you are, whether you’re experiencing concurrent lower back and pelvic pain, and what sports or activities you want to return to.

 

Initial physiotherapy treatment focuses on re-connecting to your core muscles, which include your diaphragm, transversus abdominus, and pelvic floor muscles. Once these muscles are working and co-ordinating together more effectively then you can start to progress exercises to integrate more superficial muscles. The eventual aim is to regain proper function and co-ordination so that you have a reflexive core that can cope with all the physical demands of being a mum, and also any higher impact and more strenuous exercise you might wish to do.

 

Women with a diastasis who return to higher-level abdominal exercises after pregnancy without first working to re-connect to their core muscles are potentially at higher risk of making their diastasis worse. We advise women against doing any sit-ups, crunches, planks, Russian twists, burpees, or similar higher level abdominal exercises until they have been checked by a physio or post-natal specialist personal trainer.

 

Dos and Don’ts

In general, any movement or sustained posture that increases the pressure in the abdomen or places unwanted tension through the linea alba (the connective tissue down the front of the abdomen) is best to avoid.

 

Things to consider:

 

  • Avoid slouching when sitting, standing or nursing your baby – try to use appropriate pillows to support your back and the baby

 

  • In standing you want to keep your hips and pelvis backed up over your ankles, and your ribcage stacked over the pelvis (see photos below). This helps to reduce unwanted sustained tension through the linea alba and helps get your core muscles into a position where they can work more efficiently

  • Avoid movements that create bulging or peaking of the linea alba. Common culprits are getting in and out of bed through a sit-up movement (try rolling onto your side and using your arms instead), and getting up from the sofa from a reclined position whilst holding your baby (again try to use your arms to help you)

 

  • Tightness through the chest, shoulder and hip flexors are also factors that can increase unwanted pressure through the linea alba, as well as constantly sucking your belly in, or straining whilst on the toilet

 

With diastasis recti it’s important to recognize that it is unlikely that one factor will cause harm on its own. It is the accumulation of day-to-day, repetitive, non-optimal loading through the abdomen that can contribute to diastasis recti. But similarly the opposite is true and women can see great improvements in their diastasis by being mindful of how they’re holding themselves, how they’re holding their babies and how they’re moving.

 

If you have any concerns that you may have a diastasis recti please make an appointment to see one of our specialist pre/post-natal specialist physios for a comprehensive assessment – we’re here to help.

 

Understanding diastasis recti – part 1

Mind the gap - understanding diastasis recti

There is so much pressure nowadays for mums to “bounce back” after having a baby. We are bombarded with unhelpful celebrity photos showing us A-listers back in their bikinis weeks after giving birth with seemingly no effect on their figures. Those of us living in the real world know that it’s not that simple, and as a physio with a special interest in pre/post natal exercise, I would urge you not to rush back into an exercise that your bodies are simply not yet ready for.

But yes, here at Hong Kong Sports Clinic, we do want to empower you to get back into exercise again, to help you understand your body after pregnancy and childbirth, and what exercises are helpful or unhelpful for you to do at each stage – this holds true whether you’re a few weeks into being a new mum, or whether you’re a few years down the line.

What is it:

Diastasis recti, otherwise known as abdominal separation, is common after pregnancy with 60% of women diagnosed with this condition at 6 weeks post-partum, and 30% still have it at 12 months post-partum. But what exactly is it and how do I know if I have it?
Diastasis recti is a condition where the two sides of the rectus abdominus muscle (the six-pack muscle) are abnormally separated from each other via stretching or thinning of the connective tissue in the midline (the linea alba).

During pregnancy, the body will naturally accommodate the growing baby and 100% of women will have some degree of abdominal separation at 37 weeks gestation. It is when the muscles remain apart after the baby is born, however, that it can become a concern. A 1-1.5 finger width separation between the muscle bellies is considered normal and anything greater than this is considered a diastasis. It is worth mentioning that diastasis recti is not solely a post-partum problem but can affect women who’ve never been pregnant, and also men.

How do I know if I have it:
The most common symptoms are: -  A persistent tummy bulge after giving birth - Doming or coning of the abdomen when trying to sit up - A feeling of weakness in your “core” and abdominal muscles - Pelvic floor dysfunction -Lower back, pelvic and hip pain

If you relate to any of the above and are concerned that you may have a diastasis then we would advise you to book an appointment with a physio as soon as possible. You can book in to see one of our specialist pre/postnatal physios where they will able to confirm whether or not you have a diastasis, give advice on what exercise you can return to, what you should avoid, and how to resolve the issue in the long term.
In part 2 of our diastasis recti series, we will discuss the impact of posture and alignment on this condition, common dos and don’ts, and how we would go about treating it.

Stay tuned!

Acute ankle sprain injury

Ankle sprain, or "twisting" / "rolling" the ankle is a common injury seen in sports requiring jumping and landing on one foot, or sudden cuts and changes of direction.

Despite all the evidence available, 1/5 of sprained ankles become a chronic problem.

What are the main causes of an ankle sprain?

Landing on an uneven surface, or pushing-off laterally from acute cutting maneuvers are the 2 main causes of injury. Sports like trail-running, tennis or basketball are particularly at risk. The most likely anatomical structure to get damaged is the ankle's anterior ligament, but  somemuscles can also sustain a strain altogether. In the most severe cases, the fragment of a bone can be detached.

How do I know if the ankle sprain is severe, or not?

Over the years, international guidelines have been established to help assessing the severity of the sprain. Specific tests including palpation and questions in regards to what happened immediately after the injury will help to decidefor additional tests like an X-ray, or not.

What should I do right after I sprained my ankle?

For the first 2 to 3 days, it is important to protect the ankle. The use of tape can help to prevent any excessive lateral movement from occurring. The RICE protocol, that stands for Rest, Ice, Compression and Elevation s now being questioned. We can see and understand the benefits from icing for excessive swelling control, and pain management. But as inflammation is the first step towards healing, experts are now re-considering the need to delay the start of the actual healing response.

What exercises should I start with, after the initial relative rest?

Swelling, increased muscle tone and joint subluxation make it important to work on the sprained ankle range of motion. In a sitting position, slowly slide your foot on the ground, forward and back, stopping whenever a pain over 3/10 is felt. Do 3 sets of 10 repetitions. Try also to draw letters of the alphabet with your foot, at a slow and controlled pace.

Lying on your side, with the injured leg on the top, alternate pointing your foot down to the floor, then up to the ceiling. Do 5 sets of 10 repetitions.

Try to balance on one leg, for a total of 3 minutes per day. Remember to soften the knee, and do not hesitate to perform this in 20 to 30 seconds chunks at the beginning.

Stationary bike or swimming are both valid options to keep your endurance up. For cycling, push from the knee, not the ankle. In the pool, add a pull boy between the legs if the ankle feels uncomfortable. Start with 15 minutes, and increase the length progressively.

What next?

When pain starts to become under control, acute ankle sprains require more advanced exercises to add power and control. This is needed before returning to sport. We will get this covered in a future blog post.

Achilles tendon pain and running

The Achilles tendon is the part of your calf muscles that attaches to your heel.The main role of this structure is to store elastic energy, then release it during the push-off phase.

 

What causes the pain?

Achilles pain is very common with runners. Increase in intensity, distance, or change in footwear can all cause an increase of the load on the tendon. Poor running technique, often overstriding - long steps forcing you to land on your heel instead of the midfoot - can also impact the tendon negatively. Achilles tendinopathy is often referred to as an overuse injury.

This is why the tendon capacity can also be reduced by running on consecutive days, shortening the periods of needed rest. 

 

What can you do to prevent it?

As the principle osteopath at Hong Kong Sports Clinic, I will assess your running technique, body stability and various kinetic chains to ensure that you are loading the tendon optimally. As a first line of treatment, you should avoid running 2 days in a row in order to give the tendon enough rest between sessions.  Ensure that you wear comfortable shoes, and that you do not increase your running mileage too fast too soon.

 

Can a long-time injury still be treated?

An irritated tendon goes through different phases: reaction, dysrepair and degeneration. The portion of your Achilles tendon that has degenerated cannot really improve. But our team of practitioners can guide you to strengthen its remaining healthy part. We see runners with barely 30% of their tendon intact still perform very well! A tailored exercise program including progressive load of the tendon is required to go back at running, while diminishing the odds of re-injury.

 

Conclusion

If you suffer from Achilles pain, do not hesitate to contact Hong Kong Sports Clinic team. We will help you to manage the load you put on the tendon, assess your running technique and help you building up the required stability.

Prepare your body for ski season

Asia is quickly turning into a world leading ski resort destination. Japan has always been on the radar for powder hounds but with the 2018 Winter Olympics in Korea and 2022 Olympics in China, Asia is building more world class ski resorts than ever before. There are currently 568 ski resorts operating across the mainland and it is estimated this will rise to more than a 1000 by 2022. This opens up further short haul options for ski bunnies in Hong Kong. 

Hamish Dickie, is a physiotherapist at Hong Kong Sports Clinic and arrived to Hong Kong from beautiful resort town of Queenstown, New Zealand. He was a part of the New Zealand medical team at the 2018 Olympics in Korea. In this article Hamish will share his insights to how you can make you and your family’s ski holiday more enjoyable but most importantly injury free! 

How do injuries occur and what are the most common?

A recent study conducted over 5 years discovered the majority of injures happened via falls which accounted for 74% of all injuries, followed by collisions (9%) and jumps (5%). The most common injuries were to the knee (36%), followed by the back (18%), wrist (14%), head (11%), shoulder (11%), ankle (6%) and collar bone (4%). 

How do we prevent injuries?

Appropriate screening

Hamish works with 15 athletes who are in the Park and Pipe high performance program and regularly tours with the group to North America, Europe and parts of Asia. The high risk, high demand sports meant the group of athletes lost 840 days of training and competition to injury last year. Every athlete undertakes regular risk analysis where athletes are scored on a number of categories including neuromuscular control, strength and landing patterns just to name a few. Hamish can personally take you through these screening profiles so an appropriate individualized program can be developed specifically for your needs. 

Strength and Conditioning

Obviously the stronger and fitter you are the less likely fatigue will play a part in your injury. Skiing and snowboarding have specific physical demands and movements and the team at Hong Kong Sports Clinic can help you with a strength and conditioning program to meet these demands. 

Previous injury

The biggest predictor of injury is previous injury. Therefore if have an old niggling injury come in and get it sorted out by the staff at Hong Kong Sports Clinic before you head away on holiday. Comprehensive rehabilitation of injuries is the cornerstone of staying injury free while away. 

Finally – have fun! As the options for us in Hong Kong continue to grow for short haul ski options, enjoy the wonderful new terrain and environments on offer.

ACL Reconstruction – They aren’t all the same!

Each orthopedic surgeon has their specific way of doing an Anterior Cruciate Ligament Reconstruction (ACLR). I think it is important to ask your doctors (It is important to get more than one opinion when considering this surgery) the following questions:

How many ACLR’s do you perform annually? 

I think this is an important question because if you are a semi/professional sports person or if you are doing sports that involve pivoting, changing of direction or jumping (soccer, basketball, field hockey, martial arts) you need to give your knee the best chance going forward if you would like to continue with the sport you love and avoid re-injury or chronic pain.

Since I tore my ACL in November 2018, I have consulted with 4 different orthopedic surgeons. The first two doctors I saw told me they only did 20-40 ACLR annually, the third and fourth doctors were doing 100-140 annually. The varying number of surgeries has nothing to do with their expertise but more to do with sporting population size etc. For example, Australia has the highest numbers of ACL reconstructions annually. But Australia is also one of the most active countries in the world, so that makes sense.

Which graft type do you use? 

When this injury does occur, the athlete has some serious decisions to make including which graft to choose for the reconstruction. Often, people leave that decision up to the orthopedic surgeon without really analyzing if it is best for their lifestyle, age and goals.

Next, I would like to explain the difference between an autograft and an allograft. An autograft is your own tissue. An allograft is the tissue of a cadaver.

The most common choices are a hamstring tendon, patella tendon, quadriceps tendon autograft and a patella tendon allograft. It is important to discuss these options in detail with your surgeon. The research and debate between the hamstring and patella autograft will continue, as there is a lot of research going into the re-injury rates as well as post-surgery pain. I decided to go with the hamstring autograph. Its known to be very painful and it has lived up to that reputation. But with correct management, 8 days post-op I am already off the analgesics.

END.

– Cardeux Nel, Physiotherapist

Joseph March
Founder and Physiotherapist

After graduating from university in Australia, Joseph had solid exposure in a wide range of areas including professional sports, neurological, pediatrics, gerontology, and rehabilitation.

Joseph has over a decade of experience in Hong Kong, specializing in rehabilitation of musculoskeletal and sports injuries. He has treated issues related to pregnancy, desk jobs, as well as the unique injuries that come with a variety of athletic pursuits.

He has partnered with the Hong Kong Football Club as the performance squad physiotherapist, as well as the Hong Kong Ballet as the consulting physiotherapist.

Joseph’s hobby outside of work is the pursuit of a better functioning body. This has led him to delve deeply into many types of exercise and performance training. He has years of experience in Olympic weight lifting, movement training, powerlifting, yoga, pilates and strength, and conditioning. Through his own journey, Joseph has positioned himself well to understand other bodies and across a wide range of exercise and sport.

In the past Joseph competed at a high level in football and long distance running.

Cardeux Nel
Senior Physiotherapist

Cardeux represented South Africa and attained her first karate world championship medals at the age of 11. Cardeux’s other sport of interest is field hockey, which she has also played at a national level. From a young age, she attended physiotherapy to enhance performance and recovery. Understanding the importance of this stimulated her to pursue a career in helping others.

After graduating from The University of The Free State in South Africa, Cardeux spent a few years working in private practice as well as gaining experience in sports physiotherapy. She assisted with the Springboks in the lead up to the 2015 Rugby World Cup and worked at the Comrades Marathon for 4 consecutive years.

Cardeux’s treatment is focused on exercise, education, and a holistic therapy approach. As a keen trail runner, she specializes in performing full running assessments, both clinical and video. She has also completed her post-graduate course in Dry Needling which she provides as part of her treatments.

Cardeux spends her time off continuing to pursue sports-related endeavors. She is captain of the Valley Premier women’s field hockey team, coaches running, and manages the Hong Kong Sports Clinic running team. She also extends her passion for the sport by giving back, as a member of WISE HK – Helping empower, educate, and connect women and girls through sport in Hong Kong.

 

Pronouns: she/her

Elaine Leung
Principle Chiropractor

Elaine completed her chiropractic training at Macquarie University in Sydney, Australia with a Bachelor’s degree in Chiropractic Science and Master’s degree in Chiropractic. She then moved to Hong Kong to pursue her career and to promote the importance of health and the work-life balance.

Coming from a family of martial artist and traditional Chinese lion dancers, Elaine also developed an interest in Muay Thai, BJJ and weight training. This of course also comes with some injuries which have always been managed with chiropractic.

Her long interest and love for animals have then lead her to complete a Certificate in Animal Chiropractic in the USA to enable her to provide care for animals as she does for people. She is passionate about getting people (and animals) out of pain and living their lives to the fullest.

Emma Piachaud
Senior Physiotherapist

Emma returned ‘home’ to Hong Kong in 2011 after having spent her childhood here. She completed her Bachelor’s Degree (Hons) in Physiotherapy in the UK and has subsequently worked in the UK, France, and Hong Kong in a variety of settings, including the National Health Service, private hospitals and clinics, and a ski resort.

Emma is a keen sportswoman, which has led to a natural interest in sports injury rehabilitation and exercise-based therapy where she has completed many postgraduate courses specialising in manual therapy and core stability retraining. These have been in areas such as the lumbopelvic complex and thoracic rib cage and their combined effects on the musculoskeletal system. She has used this knowledge when treating clients, from elite athletes with chronic overuse injuries to postnatal women returning to sport.

Emma is available to assess and manage all musculoskeletal conditions including neck and back pain, sports injuries, thoracic and ribcage issues, and post-surgical rehabilitation. In addition, Emma has a specialist interest in treating specific problems related to ante and post-natal women, including pelvic girdle pain, rectus diastasis, mastitis, and assisting in return to sport and fitness.

Katia Kucher
Principle Nutritionist

Katia is a nutritionist with a Precision Nutrition certification and NASM Sports nutrition certification. Katia has also been a fitness, road, and trail running coach for many years. Her focus is on finding the ideal personalized diet plan to maintain a healthy lifestyle. Her other certifications include NASM Personal Trainer, PTA Global Personal Trainer. She also does corporate talks and presentations about nutrition and fitness.

As a nutritionist, her goal is to create a personalized nutrition plan and diet to help clients reach their health and fitness goals, or resolve any health issues. The key is to find a healthy, balanced, life sustainable diet that is adaptable to the client’s body type, metabolism, and lifestyle. For athletes, she creates nutrition programs to improve their performance, strength and endurance levels, and promote faster recovery.

Her background also includes helping clients dealing with injuries, by recommending a diet and specific foods that follow the healing phases to help with the healing quality and speed.

If you find it challenging to find a proper diet that will help you reach any of your goals, Katia can help you achieve your goals or help with any health issues, by recommending a diet you will enjoy and be able to maintain.

Taras Makarenko
Principle Osteopath

Taras is the Principal Osteopath with the Hong Kong Sports Clinic, where he specialises in mechanical pain associated with sports injuries, “desk-bound” related back pain, and nerve entrapment syndromes, like sciatica pain.

He has post-graduate training in both pre and postnatal as well as infant and newborn treatments. His experience includes over 6 years as an independent osteopath, working with multi-disciplinary fields alongside general practitioners, sports doctors, and physiotherapists to provide a higher level of effective recovery for his patients. He has engaged with high-level athletes in the field of tennis, soccer, rugby, field hockey, basketball, dance, ballet, trail-running, and triathletes.

To achieve long-lasting results, Taras strongly believes that structure and function have to be considered equally. His methodology includes an emphasis on educating patients about their pain, and to consider that effective recovery and treatment extends beyond the therapy room. Education is a key component to treatments when walking with patients for their road to recovery, with a mixture of in-clinic and home exercises (stretches and strength focused) as keys factors to improve symptoms.

A French national, he enjoys the fast-paced environment of Hong Kong, with his two kids and wife his loves alongside a keen interest in tennis and running.

Hamish Dickie
Senior Physiotherapist

Hamish originally undertook a Sports Science degree at Otago University and followed this up completing a physiotherapy degree at the Auckland University of Technology. A proud Kiwi, Hamish has worked with a number of high-performance teams and individuals and was part of the New Zealand Olympic team in 2018 where the team won 2 medals.

The first NZ Winter Olympics medals in 26 years. Hamish is still involved with the New Zealand Olympic program and physiotherapist for the Hong Kong Rugby men’s team. In 2018, Hamish’s wife Alex gave birth to the couple’s first child Charlie who has quickly become the apple of his father’s eye.

Prior to Hong Kong, Hamish and Alex spent a number of years in beautiful Queenstown, New Zealand where he developed the regions first high-performance youth sports academy to progress talented athletes. Hamish has worked in other high-performance programs including the New Zealand Baseball team and has worked at major tournaments such as the New Zealand Golf Open.

He has also worked in house at CrossFit boxes and is enjoying working with the CrossFit and weightlifting community in Hong Kong. Hamish was the physiotherapist for the Hong Kong Cricket Club rugby section in 2016/17 and is an active member of the cricket section where he captains the Optimists Sunday premier league team. An avid fitness enthusiast, Hamish loves all the running options that Hong Kong offers and is an avid runner on the wonderful trails.

Needless to say, Hamish understands sports and has a special interest in biomechanics and strength and conditioning components of rehabilitation. Hamish is also a qualified dry needling technician and uses a number of mobilizations, soft tissue and active release techniques to enhance the recovery process. Whether you’re a weekend warrior, youth athlete trying to reach the pinnacle of your sport or an international athlete Hamish is the right physio for you.

Charles Wang
Senior Physiotherapist

Charles completed his Physiotherapy degree at the University of Sydney, Australia. Charles has a particular interest in the link between biomechanics and injury, especially in the lumbopelvic area and lower limb. As such his treatment approach incorporates manual therapies and exercises prescription to optimise movement patterns and to recover from and prevent recurring injuries.

Joe Zhang
Physiotherapist

Joe graduated from the University of Sydney and has worked with a variety of athletes and programs, particularly at the Olympic and Professional level. He was a physiotherapist at the NSW Institute of Sport, working across all the programs in particular the Cycling, Hockey and Wheelchair Basketball programs.

Joe was also a team physiotherapist at the NSW Waratahs Super Rugby team and Sydney FC’s W-League team. He worked also as a state program physiotherapist in gymnastics and netball.

Joe’s treatment approach incorporates soft tissue release, dry needling, mobilisations and exercise prescription to speed up recovery, optimise movement patterns, and prevent injuries from recurring.

Joe has played representative basketball, and was also involved in weightlifting.

Dereck Fu

Physiotherapist

 

Dereck completed his physiotherapy training at the Hong Kong Polytechnic University. After graduation, he started practicing in a public hospital where he had extensive experience in treating different musculoskeletal, orthopedics, and sports conditions. He recognizes the complex contribution to pain and musculoskeletal injuries and is keen on using a wide range of skill sets such as exercise therapy, manual therapy, and acupuncture tailored to individual conditions.

Before joining HKSC, Dereck completed his Master of Clinical Physiotherapy (Musculoskeletal Physiotherapy) and accreditation in Level 1 strength and conditioning coach under the Australian Strength and Conditioning Association (ASCA). These exposures enriched his practice, considering the psychosocial, biomechanical, and training load aspect of the clients’ story.

He has a particular interest in treating sports-related injuries and desk job conditions, assisting clients on their way back to function, and prevent recurring injuries.

Dereck has been a sports enthusiast since his teenage years. He is a keen football (soccer) and badminton player who treasures the enjoyment and satisfaction brought by both team and individual sports.

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