Impingement Syndrome, which is sometimes called Swimmer’s shoulder or Thrower’s shoulder, is caused by the tendons of the rotator cuff (supraspinatus, infraspinatus, teres minor and subscapularis muscles) becoming ‘impinged’ as they pass through a narrow bony space called the subacromial space – so called because it is under the arch of the acromium which is a part of the shoulder blade. With repetitive pinching, the tendon(s) become irritated and inflamed. There are other structures that can cause this so come in for a check to see what the problem is.
Symptoms:
Shoulder pain that gradually comes on over time
Pain at the front/side of the shoulder when lifting the arm above head height
Pain at the back and/or front of the shoulder when the arm is held out to the side (abducted) and turned outwards (external rotation)
The radial nerve runs just beneath the outside part of the elbow and can mimic symptoms of tennis elbow. If the muscles and tendons in the elbow become inflamed they can trap the nerve.
Symptoms:
The same as tennis elbow
Can have neurological symptoms such as pins and needles into the hand.
Also known as lateral epicondylitis. Caused often by playing excessive tennis however is caused by the shock absorbed by the elbow and can therefore happen in many other sports. It is caused by inflammation and of one or several of the forearm muscles usually 2cm below the outer edge of the elbow.
Symptoms:
Pain on the outside of the elbow
Pain when the hand is bent back
Weakness in the wrist
Pain when palpating over the lateral epicondyle (outside of the elbow)
This is pain within the arch of the foot. The arch is formed by the plantar fascia and is a thick band of tissue from the heel to the toes. Its job is as a spring in the foot; so absorbs impact and recoils to aid in running. The plantar fascia collagen fibres break down causing the pain. A heel spur is present in approximately 70% of people with plantar fasciitis. This is a bone growth which can press on the plantar fascia.
Symptoms:
Pain under the heel and along the inside arch of the foot
Pain on heel strike whilst running (especially downhill)
Pain worst first thing in morning then loosens up after few steps
Called a tendinopathy rather than tendonitis because research has shown that there isn’t much inflammation but is a breakdown of the normal tissue structure. It can be caused by a rapid increase in training (acute) or prolonged exercise over a period of time (chronic). With either cause, without treatment, recover can take a while due to the tendons poor blood supply. Other causes include; change to footwear, immobility at the ankle joint and overpronation (rolling in at the ankle).
Symptoms:
Pain over the Achilles; either on the heel or up to 4cm above
This is caused by muscle tension pulling at the periostium of the tibia (sheath surrounding the bone) which causes inflammation and tenderness over the front and inside of the tibia (shin bone). This is typically an overuse injury.
This is caused by a band of tissue called the Ilio-tibial band or ITB. This is a thickening on the outside of the leg and is part of the quadriceps muscles. As you run this flicks over the outside of your femur (long bone in upper leg) causing friction and pain. The tension caused by the pull from the ITB also causes maltracking of the knee i.e. takes it out of it normal position causing patella (knee cap) pain.
Symptoms:
Pain around outside of the knee
Tightness and tenderness along the outside of the leg from hip to knee
When playing contact sports it is common for ribs to subluxate which is where they come out slightly and do not return to their normal anatomical position. Local ligament and soft tissue damage can occur.
Symptoms:
Local pain and tenderness at the rib head which is just off to one side of the spine
Pain when taking a deep breathe in
Pain when pressure is placed over that side of the rib cage
Lesions are typically subluxation or an immobilization of a rib
These are a group of muscles that help to stabilise the glenohumeral joint (shoulder joint) whilst also rotating it. The muscles that make up the
rotator cuff are; supraspinatus, infraspinatus, teres minor and subscapularis. Supraspinatus and infraspinatus are most commonly injured due to their action of providing a lot of shoulder rotation. With rotator cuff injuries either the muscle/tendon can be damaged or inflammation around these can cause impingement (pinching) of surrounding structures.
Symptoms:
Acute
Pain and tearing feeling giving severe pain
Painful raising arm out to the side
Very pin point pain
Chronic
Usually found on dominant side
40+ usually with gradual onset of pain and some weakness
The AC joint is where the acromium (part of the shoulder blade) joins the clavicle (collar bone) and is usually the highest part of the shoulder.
Separation of these two bones is due to ligament damage. Most common onset of the pain is falling either onto the shoulder itself or onto an outstretched arm. There are grades from 1-6 for AC separation so you should get it checked out to see how bad the damage is.
Symptoms:
Pain over the tip of the shoulder; at first the pain is diffuse but later becomes very focal.
A ‘step deformity’ may be visible; it is seen as a raised lump on the shoulder
Pain when raising the shoulder above shoulder height
This is a generic term used to describe pain over the front of the knee cap. Muscular imbalances in the thigh cause the patella (knee cap) to move out of its normal position in a groove on the femur (thigh bone) and rub against structures such as cartilage, which can cause damage to them and pain to the patient.
Symptoms:
Aching around the borders of the knee cap
Pain sitting for prolonged periods
Clicking of the knee when it is flexed (bent)
Tight muscles in the legs; quadriceps, hamstrings, calf.
The hamstring muscles (group of 3) run from the back of the knee up to the bottom of your pelvis. The muscles assist in many movements but their main action is to bend the knee, pulling the heel towards the bottom. They are commonly shortened through a lack of stretching both before and/or after exercise. They can be damaged through over-stretching or over use whilst playing sport or in the gym.
Symptoms:
Change to gait
Tenderness and pain – especially whilst stretching
Feeling that ‘it’s going to go’ where the muscle strain has occurred
The medial meniscus is a crescent shaped structure which sits between the tibia (shin bone) and femur (thigh bone). Its role is as a shock absorber and also to make the bones more congruent (fit together). As more weight goes through the inside of the knee, the medial meniscus is more bound down and has attachments to the medial collateral ligament. It is commonly injured through impact to the knee, from a twisting motion or through wear and tear as one ages.
Symptoms:
Instability and reduced weight bearing on that side
Pain and swelling within 48 hours
Locking of the knee
Positive orthopaedic test – McMurrays and Apleys (done by your osteopath)
The anterior cruciate ligament runs from the back of the femur (thigh bone) diagonally down to the front of the tibia (shin bone). Its role is to stop the tibia sliding forward away from the femur when a force is placed from below it. It is commonly caused by a twisting movement being placed through the knee whilst the foot is planted. It can also occur from a tackle.
Symptoms:
Instability and swelling
Restricted range of movement especially in straightening the knee
Pain felt can be very high – especially straight after the injury
Your medial collateral ligament (MCL) runs along the inside of your knee and joins your femur (thigh bone) to your tibia (shin bone). It is usually damaged when a force is placed on the outside of the knee going across the knee. This causes a gapping of the knee and, if the force is great enough, a partial or complete tear of the MCL. The grade of injury (as with all ligament damage) can vary from grade 1 to 3. Grade 1 is classed as 10% of fibres are torn and Grade 3 is a complete tear. Grade 2 falls inbetween meaning the symptoms can sometimes vary.
Symptoms:
Tenderness over inside of the knee
Some swelling around the area
When gapping the knee there is joint laxity – gives the feeling of instability
This is the most common cause for ankle pain and happens when the ankle twists spraining ligaments either on the inside (eversion sprain) or outside (inversion sprain) of the ankle. Rolling over the ankle into an inversion sprain is the most common. There are 3 key ligaments on the outside of the ankle and often the anterior talofibula ligament (which joins the leg to the ankle at the front) will be damaged as your weight rolls over the ankle.
Symptoms:
Pain and tenderness over the outside (inversion) or inside (eversion) of the ankle
Pain whilst weight bearing and walking, often causing a limp
Swelling and characteristic bruises around the malleolus (boney parts of ankle)
