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Common shoulder injuries amongst athletes and how we treat them

Common shoulder injuries amongst athletes and how we treat them

Mar 12, 2024

Photo by Quino Al on Unsplash

Acromioclavicular joint injury

The acromioclavicular (AC) joint is the point at which two bones, the collarbone (clavicle) and part of the shoulder blade (scapula), meet. An injury to this joint is characterised by shoulder separation and can be defined as one of six types. The severity of the injury also impacts the treatment approach.
1. Type I. The AC ligament is slightly torn; however, there is no significant damage to the coracoclavicular ligaments. Treatment often centres around rest and recovery, with the joint being iced and protected, often with an arm swing. Following this, range-of-motion exercises are recommended as soon as they can be tolerated. 2. Type II. The AC ligament is completely torn; however, there is little to no tear to the coracoclavicular ligaments. Initial treatment involves rest, ice, pain medication, and up to a week of shoulder immobilisation in a sling. Range-of-motion exercises are recommended alongside strengthening exercises.
3. Type III. The AC and coracoclavicular ligaments are completely torn, resulting in the collarbone separating from the scapula. Although treatment for this injury can be conducted non-surgically, as with type I and II injuries, the duration of recovery is significantly longer, with a sling being required for up to a month. 4. Type IV, V, VI. Treatment of these injuries almost exclusively involves surgical interventions, with specialists required to reduce the risk of long-term complications. In these cases, regenerative medicine may also be considered.

Rotator cuff tendonitis

Rotator cuff tendonitis is characterised by pain and swelling of the cuff tendons and the surrounding bursa (a soft fluid filled sack that cushions the joint). This injury, unlike an injury to the AC joint, does not occur all at once. Usually, rotator cuff tendonitis transpires over a substantial period of time following repeated irritation to the area. Although it can affect anyone, this injury most commonly presents in people with loose joints, abnormal bone anatomy in the shoulder, and those who do repetitive heavy lifting, such as weightlifters and powerlifters.
Treatment of rotator cuff tendonitis is predominantly non-surgical and involves plenty of ice, NSAIDS for pain management, including ibuprofen, and steroids. In the instance that surgery is required, the most common procedure is an acromioplasty. However, recent advances in regenerative medicine have permitted the accelerated and enhanced recovery of these injuries using mesenchymal stem cell therapy.

Beyond these individual conditions described, there are also activity-specific injuries, including thrower’s shoulder, swimmer’s shoulder, and rugby shoulder. At Opus, we ensure that your injury is fully assessed so that you receive the best possible treatment that is tailored to your needs. Get in touch to discuss your recovery with one of our world renowned specialists.

Can regenerative medicine help with back pain?

Can regenerative medicine help with back pain?

Mar 4, 2024

Photo by Gordon Cowie on Unsplash

Back pain is a silent problem amongst the general population, with figures suggesting that approximately 1 in 6 people are experiencing back pain at any given time in England. What’s more, back pain is deemed the largest single cause of disability across the UK. But why is this? And why are the numerous treatments available not bringing these numbers down?

Most cases of back pain are caused by muscle and ligament strains and, in the vast majority of cases, cannot be avoided. However, there are several other causes of back pain, including sciatica, a slipped disc, and ankylosing spondylitis, that can often occur spontaneously and without trauma. Then, we move to treatments. For the most part, treatments of back pain focus on rehabilitation and pain management, which, although great in getting you back on your feet, does not always treat the underlying cause and prevent further injury. Sports medicine is a great option to educate you on preventative measures; however, regenerative medicine offers more long-term symptom relief.

The role of regenerative medicine

Let’s first consider platelet rich plasma (PRP) injections. For those experiencing repetitive and debilitating back pain, surgery is usually the last option you want to take; however, PRP offers an effective alternative that could treat the pain of your injury as well as prevent further strains. Depending on the root of your back pain, PRP can be injected into the discs, facet joints, and paraspinal muscle, with previous patients seeing an improvement in their symptoms within six weeks of their first treatment. In clinical studies, PRP injections have been used to treat patients with degenerative disc disease, join-related pain, and pain or functional decline caused by facet joint arthropathy.

Mesenchymal stem cell therapy, on the other hand, has shown great success in patients with chronic discogenic low back pain. This type of pain is caused by chemically or mechanically damaged discs in the back and is often caused by trauma. However, this pain also arises due to deterioration as a result of ageing. Stem cell therapy is deemed a valid alternative treatment for back pain caused by disc disease, with one study demonstrating treatment success in over 90% of patients. This success is down to the regenerative impact of stem cells and their ability to differentiate into cartilage at the site of injury.

The key distinction between Opus and other private clinics in the UK is that we are the only institution that offers a regulated and licenced mesenchymal stem cell treatment. Get in touch with our team to discuss how we can support you in your treatment journey using either our world renowned sports medicine specialists or regenerative medicine.

The Different Approaches to Treating Scoliosis through Physiotherapy

The Different Approaches to Treating Scoliosis through Physiotherapy

Feb 22, 2024

Physiotherapy Scoliosis Specific Exercise (PSSE) is the umbrella term and model that encompasses specific education, physiotherapy exercises, psychological support and bracing for scoliosis (Berdishevsky et. al, 2016). PSSE approach has become a more accepted form of conservative treatment due research showing an improvement in cobb angle, posture and breathing function (Seleviciene et. al, 2022). The PSSE model incorporates a multidisciplinary approach and can be used as an adjunct to medical treatment (Berdishevsky et. al, 2016). There are currently 8 scoliosis schools which use PSSE, however the Schroth method, Scientific Exercise Approach to Scoliosis (SEAS) and Barcelona Scoliosis Physical Therapy School approach (BSPTS) are the most researched and shown to be the most effective in reducing Cobb angle and quality of life (Seleviciene et. al, 2022)

Schorth method

The Schorth method is the most studied approach with research demonstrating reduced prevalence of surgery, improved self-image and quality of life. This method uses ‘body blocks’ to help explain the scoliosis and therefore determine the most appropriate treatment. For example, the spine is split into hips, lumbar, thoracic and shoulder blocks to help assess the curvature and rotation of the spine. This provides a clear exercise programme and prioritises the manual therapy techniques. Education is used throughout the various exercises to help teach the patient to elongate the concave areas in order to improve posture. The four most common exercises include:

  • 50 X pezziball – The ’50 X pezziball’ involves the patient sitting on a swiss ball in front of a mirror and using a wall bar to self-correct the spine alignment. The patient uses the mind body connection and cues to aid spine elongation and core engagement.

  • Prone exercise- This exercise uses shoulder traction and counter traction to aid the thoracic curve while activating the iliopsoas for the lumbar curve.

  • Sail exercise- Sail involves stretching and elongating the thoracic cavity.

  • Muscle cylinder- This involves side lying on the convex side to engage QL and correct the lumbar curve against gravity. (Berdishevsky et. al, 2016)

SEAS

The SEAS approach focuses on increasing spine stability and is often used alongside wearing corrective braces to maintain range of motion and muscle tone. This approach is more functional by encouraging postural correction in different activities of daily living. Equipment such as balance boards are regularly used to aid muscle endurance and neuromotor function. (Berdishevsky et. al, 2016)

BSPTS

The BSPTS approach is based on the Schroth method and focuses on challenging the trunk with or against gravity. This includes supine exercises which remove gravity and allows the patient to focus more easily on posture corrections, as well as side lying exercises which concentrate on lumbar concavity by working against gravity. The various exercises use corrective pads and cueing to promote elongation, traction/counter traction and muscle activation to improve posture. (Berdishevsky et. al, 2016)

Despite the various research conducted on these approaches, there is still a lack of research (Seleviciene et. al, 2022); therefore, it is important to incorporate each method into clinical practice to aid posture and quality of life (Berdishevsky et. al, 2016).

Reference List

Berdishevsky, H., Lebel, V.A., Bettany-Saltikov, J., Rigo, M., Lebel, A., Hennes, A., Romano, M., Białek, M., M’hango, A., Betts, T., de Mauroy, J.C. and Durmala, J. (2016). Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools. Scoliosis and Spinal Disorders, 11(1). doi:https://doi.org/10.1186/s13013-016-0076-9.

Seleviciene, V., Cesnaviciute, A., Strukcinskiene, B., Marcinowicz, L., Strazdiene, N. and Genowska, A. (2022). Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice. International Journal of Environmental Research and Public Health, 19(15), p.9240. doi:https://doi.org/10.3390/ijerph19159240.

Platelet rich plasma: The scientific evidence

Platelet rich plasma: The scientific evidence

Feb 17, 2024

We have already had a look at how platelet rich plasma (PRP) works (if you haven’t had a chance to read this yet, you can find it here), but now we are going to dive more deeply into the scientific evidence behind this treatment.
Randomised controlled trials (RCTs) are the gold standard study for determining if one treatment offers superior benefits over another. In these trials, patients are randomly assigned to either receive the treatment of interest or an alternative treatment, usually the standard of care or a placebo. Moreover, the patients are ‘blind’ to what treatment they are receiving. Here, we are going to look at two RCTs that investigated the use of PRP to treat knee osteoarthritis and chronic tennis elbow.

Knee osteoarthritis

A study by Bansal et al. (2021) investigated the optimal dose and concentration of therapeutic PRP required to achieve the desired physiologic efficacy. One hundred and fifty patients were enrolled in this trial, with then being randomised to either receive PRP or hyaluronic acid for their knee osteoarthritis.
The results revealed a significant improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), International Knee Documentation Committee (IKDC) score*, and six-minute pain free walking distance. Besides external improvements, this trial also noted a significant decline in IL-6 and TNF-a levels in the PRP group when compared to the hyaluronic acid group at six months, both of which assist in mediating an inflammatory state (Bansal et al., 2021). If you would like to read more about the role of these cytokines in osteoarthritis, we have an additional blog post discussing just that.
Collectively, this trial, along with several others, demonstrate the efficacy of PRP, specifically with an absolute count of ten billion platelets, in achieving a long sustained chondroprotective effective in arthritis.
*The WOMAC represents an osteoarthritis index and measures a patients’ physical function, pain, and stiffness over a 48 hour period. The IKDC, on the other hand, gives an indication of a patients’ condition, containing questions on knee symptoms, overall function, and sports activities. The scoring system ranges from zero to one hundred, with zero representing the lowest level of function and the highest level of symptoms.

Chronic tennis elbow

A study by Mishra et al. (2014) evaluated the clinical value of tendon needling with PRP in 230 patients with chronic tennis elbow compared with an active control group. Patient outcomes were followed for up to 24 weeks, with the findings revealing several beneficial results at this mark. In those treated with PRP, a significant improvement of 71.5% was observed in their pain scores. Moreover, the percentage of patients reporting significant elbow tenderness notably decreased over this time. This demonstrates the clinical efficacy of PRP in the treatment of chronic tennis elbow on a larger scale (Mishra et al., 2014).

References

Bansal, H., Leon, J., Pont, J. L., Wilson, D. A., Bansal, A., Agarwal, D. & Preoteasa, I. 2021. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Scientific Reports, 11, 3971. Mishra, A. K., Skrepnik, N. V., Edwards, S. G., Jones, G. L., Sampson, S., Vermillion, D. A., Ramsey, M. L., Karli, D. C. & Rettig, A. C. 2014. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med, 42, 463-71.
Platelet rich plasma injections for tendonitis

Platelet rich plasma injections for tendonitis

Feb 17, 2024

Platelet rich plasma treatment(PRP)
represents a promising approach to therapy for a range of conditions, including torn tendons, arthritis, muscle injuries, and tendonitis. We have already looked at the process of PRP and the underlying scientific evidence in our previous posts. Now, we are going to look specifically at the use of PRP in the treatment of tendonitis. But first, what is tendonitis, and how does it affect a person?

Tendonitis is a term used to define inflammation and pain following a tendon injury. This usually causes significant pain, stiffness and alters how the tendon can move. The most common areas that are affected by tendonitis are the rotator cuff, the elbow, and the Achilles tendon, with an overall prevalence of an estimated 11.6% in the general population. Although most cases of tendonitis resolve themselves within two to three weeks with relative rest of the area, icing, and strengthening exercises, a number of cases require medical intervention if they persist.

PRP therapy for tendonitis generally involves three injections, given at two to three week intervals; however, in certain cases, further injections may be needed to complete your journey. But do not worry; our doctors at Opus will discuss this and the treatment protocol with you throughout the process. The procedure itself follows three stages:

    1. The plasma, the liquid where the platelets reside, is drawn from your body through the blood.
    2. This is then placed in a machine to separate the PRP from the rest of your blood.
    3. The PRP is then injected into the area where you are experiencing tendonitis.

    Once the platelets are in the target area, they will break down, releasing growth factors. These growth factors are the pivotal component of PRP and are the reason that this treatment has shown great promise in conditions such as tendonitis. Growth factors are important proteins that stimulate cell growth, differentiation, survival, inflammation, and tissue repair; collectively, triggering your body’s healing process. Specifically, in the treatment of tendonitis, growth factors play an important role in the tendon healing process. Not only are they directly involved in tendon tissue engineering, but they have also been shown to stimulate the action of mesenchymal stem cells. To understand the role of these stem cells in regenerative medicine, we discuss them in more detail here.

    If you or someone you know are suffering from tendonitis, book an appointment today to speak to one of our team at Opus on the next steps to reduce your pain and improve your everyday function.