The most common cause of shoulder joint problems is shoulder impingement syndrome, also

know as subacromial impingement. If you feel growing pain and limitations of the shoulder

joint mobility during exercising or everyday activities, you may be suffering from this

condition.

ANATOMY:

The subacromial space is the shoulder joint area defined by such anatomical structures as:

Superiorly: acromion, coraco-acromial ligament, coracoid process, acromioclavicular joint

Inferiorly: humeral head, greater tubercle of the humerus

Chronic and repetitive compression of the elements within this area may cause lasting pain.

Elements such as: subacromial bursa, supraspinatus tendon, biceps tendon, articular capsule

of the humerus

The elevation of upper extremity, often above the head level, causes significant narrowing of

the subacromial space leading to mechanical compression of the above-mentioned structures.

This motion, if repetitive, can create inflammation and degeneration of the supraspinatus

tendon as well as the other rotator cuff muscles.

ETIOLOGY:

- rotator cuff weakness (supraspinatus, infraspinatus, teres minor and subscapularis muscle).

Properly functioning rotator cuff muscles prevent the humerus head from migrating

upwards, which limits the subacromial space compression

- decreased muscle performance caused by chronic, repetitive process in which upper

extremity is elevated above the head level

- overload training, especially in disciplines like: TENNIS, VOLLEYBALL, SWIMMING

- overload and incorrect exercising technique- especially when it comes to free weights

- acromion morphology (there are three types: flat, curved, and hooked which is associated

with cuff tear)

SYMPTOMS:

- shoulder joint pain during the upper extremity elevation (in sever cases, even the slightest

movement or muscle flex can cause pain)

- limited shoulder joint mobility (shoulder occurs to be stiffer)

- night pain

- rest pain (without doing any activities)

TREATMENT:

There are a lot of treatment methods for the above-mentioned condition. Measures taken early

on to improve health status give the best chance of speedy recovery. Inhibiting inflammatory

process in the early stages helps to prevent degenerative changes in tendons or muscle venters

counted among rotator cuff.

In the severe stage of this condition, it is elementary to concentrate on hindering the ongoing

joint inflammation. It can be achieved with physiotherapy procedures such as:

- Cryotherapy

- Iontophoresis

- Shock wave therapy

- Interferential therapy

- Laser therapy

- Ultrasound therapy

Manual therapy is proven to be vitally important in treating subacromial impingement. By

using manual therapy we can increase the mobility in the constricted joint and loosen soft

tissue, which due to the occurring symptoms, might be overly tensed. Thanks to this

procedure the stiffness in the shoulder joint decreases noticeably.

In our practice, we also use KINESIOTAPING, which is a taping technique that helps to

relieve the strain on muscles and reduce the pain.

The last, and often the most important part of physical therapy are properly selected exercises

that help to strengthen the rotator cuff and the shoulder girdle. Their main goal is to lower the

humeral head and to reduce the compression in the subacromial space. Furthermore, proper

and systematic execution of personalized exercises is the best preventive measure against a

recurrence.

In CORE and MORE we provide complex rehabilitation for patients suffering from „Shoulder Impingement Syndrome” using all methods mentioned above.

If You have some symptoms described in this article or have some problems with daily activities or during sport – we invite You to contact us!

Sport is healthy! Ubiquitous fashion for exercising is a very positive social phenomenon.
Everybody knows someone who runs, swims, cycles, with higher or lower intensity. More and more people teams up those three disciplines into one - triathlon. More and more amateur sport teams is being created. You can train alone, work with a trainer or take part in the group trainings. Every person has an individual approach when it comes to triathlon.  The number of hours you have to spend for training - doesn't matter if it is an individual training or under the supervision of a trainer is large - from a few to a dozen or so a week - when it comes to the amateur sport of course.
With some many training hours contusions aren't rare. Runner's knee, jumper's knee, shin splits, pain in plantar fascia, tearing and overloading of the muscles, contortions of the joints, pain in the toes - those are recurring problems among people training triathlon.
There is many factors causing those medical conditions   - increasing the load too quickly, inappropriate training equipment, lack of the proper warm up, no stretching, and no time for regeneration of the body .
One of the main causes is the preparation of a competitor for the intensive , specialized sports training. 
Not everyone of us has been interested in sports since childhood. Not everyone has been participating in regular physical activity since young age. It is known,  that to know how to run you first have to learn how to walk.  To learn how to walk - you have to learn how to stand. We can assume that everyone can run, but the problem isn't the activity itself but its quality.
Quality is the key to success!
It is easier to understand while studying the Pyramid of the Optimal movement preparation.(G.Cook 2012)

As the pyramid says, as it is with sport - before you may lay your body on a lemond ( technical and tactical skill) while riding, you must prepare your body so it will be able to survive long hours in the position requiring the specific ranges in the joints (basic mobility).
Before we run 42 kilometers during covering the ironman distance (directed mobility) we must strengthen the gluteal muscles (basic mobility) so you don't overload your knee or spinal joints halfway to the finish.
A conclusion is simple - you have to return to the basics. Without a good foundation,  problems will appear sooner or later in the form of  pain or contusion.

Therefore, in this and future posts, we will try to explain to you the exercises which will help you to enforce the foundation to succeed in sport.

Let's begin with central stabilization:

Training of a triathlonist is full of sacrifices.  What you are supposed to do when you don't have time for the supplement training ? Just find some time 🙂
It may be just 30 minutes a week - start and you will see a difference in quality of your triathlon training. You will avoid the situation when you work to participate in a competition whole year and just before the season a contusion occurs.

If you have second thoughts about choosing the strengthening exercises or you want  to find out how to do this properly and effectively - we want to invite you for a consultation at CORE and MORE.

Photography is very popular hobby. Each of us had an opportunity to take pictures at work, on the trip or under different circumstances. However, we very rarely look into this picture in the contests of the risk it can carry for the human's body.

Every professional photographer has experienced the consequences of this long difficult job. During the Warsaw photography fair PRESS PHOTO EXPO 2017, as a part of the project "Healthy Photographer", our physiotherapist Aleksander Wieteska had an honor to show an influence of the photographers' job on their health and the methods of treating and preventing the injuries that result from the character of this job.

The most common medical conditions are:

- Spine diseases - e.g. the pain caused by the excessive muscular tension, sciatic neuritis, brachial neuritis, degenerative changes in the spinal joints, discopathy

- Diseases of the upper limb - e.g. rotator cuff syndrome, carpal tunnel, inflammation of subacromial bursa, subacromial impingement syndrome, degenerative changes in glenohumeral joint, "tennis elbow", "golfer elbow"

- Others - e.g. inflammation of infrapatellar bursa, overextension of the sciatic ishiotibial, and gluteal muscles

Very important element is choosing the appropriate equipment for our job. If we use a satchel, we will have to remember that its weight shouldn't exceed 10% of our body mass. We should always try to divide the weight of the equipment equally between both sides our body. However, if we prefer a backpack, it should adhere tightly to our body and not hang below our lower ribs.

What are the most common mistakes made by photographers at work?:

- Working too long
- Excessive weight of the equipment
- Position taken while taking pictures tiring for the body
- Lack of physical preparation for work
- Lack of relaxation and stretching exercises after work
-"I am moving all the time, so I am in a good shape" (photographer's profession is a heavy manual labour and it shouldn't be considered as a training or strengthening our body )

If you want to prevent the eventual unpleasant results of the distress related to not ergonomic position while working you should try a few things that will help your body:

-  Put the equipment aside every 20 minutes
- Often change the techniques of taking pictures
- Take a break from work every 30 minutes
- Drink water - dehydration of the body increases the risk of soft tissue injury
- Warm up before you get down to work!
- Perform some stretching exercises after work

According to the rule "it is better to prevent then to treat" in CORE and MORE clinic we developed a specific training program which will help you to work more hours without pain and afflictions. Here is a few examples of our training programs:

Injury prevention - warm up

Injury prevention - strenghtening excercises

Injury prevention - stretching excercises

If you feel pain and excessive fatigue after work and you are able to work less and less  without feeling pain - we encourage you to contact CORE and MORE clinic. We will help you to get rid of unpleasant consequences of hard work and we will prepare your body for new professional challenges. 

On Saturday the 28th of January CORE and MORE clinic had a pleasure of hosting patients for free of charge physiotherapeutic consultations. Among our guests were very young people as well as adults - because you must take care of your health in every age!

During the appointments we were performing examinations and diagnosing different health problems of our patients. The next step was deciding on the actions that will improve the condition of their health and help  to return to the full efficiency. Thank you for your trust and cooperation.

Remember about our recommended exercises and the affects will surely come!

It is nothing new that the spine is a pillar of our body that amortizes disruptions and protects the functional center of our body - spinal cord and nerves. Spine possess its specific curves that serve for the amortizing purposes: cervical and lumbar lordosis  and thoracic kyphosis. Amortization of the forces that influence our body is possible thanks to the intervertebral discs.

In theory, spine is a very resilient structure. It shouldn't be easy to injure such a "block" of bones.

But it seems that more and more people is suffering from the pain in the back - the young, the older, the middle-aged. What do they have in common? Usually, working in the sitting position.

Slouching while sitting - we very often spend even 8 hours working  in this position  in front of the computer that increases the spinal discs' overload by 85%.

Sitting isn't good for us!!!

What are we supposed to do if we can't move to a tropical island and we will probably spend our future working 40h a week in the sitting position.

Here is a few simple tricks that you can use in your daily life:

- set the alarm to go off every hour and walk at least few steps (it is easy to forget without the alarm)

- do 10 backward circles with your shoulders (to move the shoulder girdle and  to take a different position for a moment)

- move your head 10 times towards the left and to the right shoulder (from the center to the side and back to the center)

- stretch your chest by stretching your hands to the sides as far as you can (very slowly) and keep this position for 30 seconds

- at the end stretch your trapezoid muscles

Try to introduce small changes to your work schedule and you will feel better in no time

And of course spend one hour a week taking care of your body: training at home, yoga, pilates, swimming, going to the gym
If the pain is severe, chronic, often recurring and causing the feeling of "stiffness" in the cervical area you should visit a physiotherapist.

There is many therapeutic methods which decrease muscular tension caused by long hours of working in the sitting position. Some of them are:

- Physical therapy (ionophoresis, laser therapy, TENS currents, interferrating currents)
- Kinesio Taping (proper application of the tapes helps to lower the muscular tension)
- Relaxing and therapeutic massage
- Manual therapy
- Functional training ( the last stage of rehabilitation  which will protect our body from other afflictions )

In CoreandMore clinic we use all of the above methods so you can quickly get rid of the pain and  return to work. With the help of our special therapeutic plan we have helped many patients with such health problems.

If you have a problem with choosing the exercises appropriate for you and you suffer from pain in the spine due to the sitting job - we want to invite you for a consultation to CoreandMore!

Kinesio Taping is relatively new therapeutic method. I is supposed that this method was created - according to different sources- in the 70s XX century. This method has quickly become popular among rehabilitants and sportsman. It has spread from Japan to other Asian countries and the USA, and then it has finally reached Europe. Kinesio Taping was becoming more and more popular among people interested in professional sport since it was introduced at XXIV Olympics in Seoul (1988). It was most often used to speed up sportsmen recovery and their return to trainings and competitions after different  injuries or to prevent eventual injuries .

Tapes used for Kinesio Taping have particular parameters that make them similar to skin.  One of the specific features of this tape is that its longitudinal stretchability  is between 130% and 140% of its original length and lack of transverse stretchability.  Thickness and weight of the tape improvise features of the human skin. Tape is made from cotton and elastic fibers without latex that minimizes a chance of allergic reaction . Acrylic glue that is activated by heat is spread on the plaster in undulatory manner.   It is imitating papillary lines and allows the tape to shed the humidity. Thanks to those features tapes hold on to the skin 3 to 5 days what helps in continuation of the therapy. An improvement is visible immediately after applying Kinesio Tape and sustains the whole time when the tape is on the skin. It allows the therapists to act quickly even in acute states when the therapeutic procedures are very limited. Other methods can be used along with Kinesio Tape what fosters holistic approach to the therapy. 

While watching media coverage from the biggest sporting events, we can see how common Kinesio Tape is, and that it is often applied to all the body parts of the sportsmen. Up to 2009 the tape was also used in swimming competitions. When FINA - Worlds Federal Swimming Organisation (FédérationInternationale de Natation) introduced new regulations regarding the specifications of the swimming attire, the approach towards using tapes including Kinesio Tape changed. Using the tapes during swimming competitions was strictly prohibited despite lack of any scientific evidence that Kinesio Tape stimulates the performance.

Kinesio Taping is a therapeutic method which - as it was said before - is present in many activities related to sport. It is sometimes used in the therapy of  balance disturbances of the muscles , injuries of the locomotor system, fascial disturbances or the disturbances of blood and lymph flow. 

One of the basic qualities of Kinesio Taping is the ability to influence muscular tonus , which is highly regarded by sports therapists. When we deal with increased or decreased muscular tonus, we can - by proper application of Kinesio tape - reach the optimal muscular tonus in particular set of muscles. Thanks to that we can help the muscles that have been weakened by some kind of contusion. It fosters recovery in adverse situations during the training cycle. It allows the competitor faster return to the full training capacity.

While discussing an example above there comes the question, does KT method have a stimulating effect on the muscles of the healthy sportsmen.

There is no scientific research regarding the influence of KT method on the muscular power of the swimmers. One trial on using KT in swimming was examining the changes taking place during particular parts of training, which can allow us to relate to the influence of this method

on the improvement of the results. This research is definitely not enough to come to any reliable conclusions regarding using KT in swimming trainings.

Kinesio Taping doesn't unequivocally influence the timings attained by swimmers. Swimmers also don't agree with each other in their subjective opinions regarding the improvement of the particular elements of swimming after applying the tape.

The conclusion is clear - even though the application of Kinesio Type is forbidden during swimming competitions - the tapes are very potent element of the therapy during training cycle in swimmers suffering from overextensions and contusions

Paralympics 2016 in Rio de Janeiro are over. Participating with Polish medical mission during those games was another wonderful experience which gave me new tools and opportunities that will be useful for my future career. Physiotherapeutic care during such prestigious games mainly relies on quick reaction in case of pain or eventual injury prevention. Each physiotherapist has his or her own reliable methods based on long term experience. Thanks to that the procedures elicit expected therapeutic effects. The most popular therapeutic procedures are:

• massage: sport, relaxing, crosswise
• manual therapy
• soft tissues techniques
• physical therapy
• stretching
• dry needling
• and many more

A few pictures from Rio:

Pain located in the lateral area of cubital joint most often suggests the existence of medical condition commonly called "tennis elbow". It is very complicated concept that has wide range of causes and foundations. Pain in the lateral area of cubital joint is the major symptom , and its location is as follows: on the plane of humero- radial joint , in the area of lateral epicondyle of humeral bone, where radialisposteriornerve goes under supinator muscle, on the plane of the head of radius. Patient sometimes can't locate the pain and describes it as "diffuse", however the situation like this is rare.

Performing manual labor or the training requiring pronation and supination movements of the forearm and straitening movements of the wrist joint clearly intensify the pain. We can observe, among other clinical symptoms: weakening of the grip, pain due to transferring during straightening of the fingers and wrist, and fatigability of the hand muscles.

The most common causes of the pain in the lateral area of cubital joint are: enthesopathy of the aponeurosis of extensors carpi, inflamation of the bursa in the area of humero-radial joint, ligamenta glenohumeralia pain syndrome, postraumatic inflammation of the synovial membrane of cubital joint, outgrowth of the synovial recess between the head of radius and the head of cubital bone and calcium accommodation in aponeurosis of fingers and wrist extensors.

In case of enthesopathy of the aponeurosis of extensors carpi, a patient reports pain and  tenderness of the periostium of lateral epicondylum of cubital bone on the front and in the lateral area of aponeurosis of extensors of the wrist and fingers, a little on the front side. During dorsal flexing of the wrist and fingers a patient experiences the intensification of the symptoms.

A bursa in the area of humero-radial joint is located between aponeurosis of extensordigitorum muscle and humero-radial joint. Its inflammation causes the symptoms similar to enthesopathy of the aponeurosis of extensors carpi.

The aponeurosis of extensordigitorum muscle that constantly flexes because of regular contractions may causes pressure on the ligamentum anulare and elicids pain. The disease is characterized by pain in the head of the radial bone area which intensifies during pronation and supination of forearm and flexing of dorsal wrist and fingers. 

Posttraumatic inflammation of the synovial membrane of cubital joint that is often accompanied by hemorrhage into articular cavity is characterized by large swelling and pain in the lateral area of cubital joint. A common symptom is also increased temperature of the skin and in some cases redness.  

A structure that sometimes is overgrown and swelled is lunular fold of the synovial membrane  located between the head of radius and the head of humerus. In this case a patient reports

tenderness in the lateral area of humero-radial joint accompanied by flexing contracture of cubital joint.

Very popular method of treating pain in the lataral area of cubital joint are the steroidal  injections in the area of the lateral epicondylus of humerus. This therapeutic method may lead to precipitation of calcium around aponeurosis of the wrist and fingers extensors.  In addition a local pain may be accompanied by soreness while straightening a wrist.  

There is a lot of various treatments and therapies of pain in the lateral area of cubital joint. Among others:

- correction of the ergonomics of work ( e.g. different hands' alignment on the keyboard)

- rehabilitation (physiotherapy ,  shock wave, needle therapy, loosening soft tissues, crosswide massage)

- Kinesio Taping

- using tourniquet

Our job in CoreandMore clinic is treating various medical conditions and protecting from pain recurrence in the affected area.