Physioworx

31/01/2021

Have you ever noticed the countless number of feet jogging on concrete roads for some unknown health benefit? I wonder how this bizarre practice came in to existence.
Any physical exercise should be goal specific. If you want to loose weight then brisk walking should be a better option (Diet modifications should come first for obvious reasons).
Whereas running improves your muscle strength and power.
Jogging is not efficient in achieving either of two health goals, but it does come with some cost. Consult your physical therapist to know more. Be specific in your goal and clear about what you want to achieve.

08/08/2020

One of the risk factors in development of Posterior internal impingement is scapular malposition. let's see what the evidence says.

15/07/2020

15/07/2020

Dear friends, let us discuss about a relatively less explored shoulder pathology and treatment.
Posterior Internal Impingement
You must have experienced shoulder pain once in your life time if you are involved in any throwing, bowling or pitching sports. Posterior internal impingement is one of the many shoulder problems faced by recreational and professional athletes. It’s relatively less common shoulder condition in general population. It presents with posterior shoulder pain in its isolated presentation. It’s often combined with other shoulder pathologies. PII is more common in throwing athletes who perform repetitive extreme external rotation with shoulder abduction (impingement happens during late cocking and early acceleration phases of pitching).
The sports generally related to this are:
• Baseball pitching
• Tennis
• Volley ball
• Swimming
Non-Athletes can also present with PII. Older adults and patients with other shoulder pathologies might also show the signs of internal impingement. Its difficult to diagnose PII in this population because of co-existence of other shoulder impairments.
Why is it called INTERNAL impingement?
The term shoulder impingement is generally used to denote external impingement which occurs at subacromial space. Structures which get impinged in this space are rotator cuff tendons and subacromial bursa and it’s the external surface of these structures which get impinged and injured over a period of time.
In internal impingement, the inner surface of rotator cuff tendons gets impinged between greater tuberosity of humerus and posterior labrum of glenoid fossa, hence called internal impingement.
Etiology:
• Acquired instability (excessive humeral translation)
• Decreased scapular stability/ scapular dyskinesis
• Tight and hypertrophied posterior inferior GH joint capsule
• Tight posterior rotator cuff muscles
• GIRD > 25 degrees compared with contralateral side
Clinical presentation:
• Symptoms are variable and non-specific
• Posterior shoulder pain (diffuse or localized to GH joint line)
• Can also present with acute pain after an injury
• Decrease in performance
• Subjective weakness of shoulder and arm after throwing (dead arm)
• Abnormal decrease in neuromuscular control of scapula
• Increased anterior shoulder laxity
• Rotator cuff weakness
Diagnosis:
• Physical examination
• MRI
Medical management:
• Conservative treatment:
- Rest
- Ice
- NSAIDS
- Corticosteroid injection
• Surgical management:
- Arthroscopic Debridement
- Decompression
- Repair
Physiotherapy management:
• Avoid participating in aggravating activities (sports involving throwing or any activity which includes repetitive abduction and extreme external rotation)
• Strengthening of scapular stabilizers and rotator cuff muscles
• Posterior capsule stretch
• Follow sports specific/activity specific rehabilitation phases, leading to full participation in sports or returning to pre injury status
• Rule out other shoulder pathologies