Shoulder Instability Or Dislocations

shoulder instability anatomy

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Shoulder is the most mobile joint of the body. This allows you to lift your arm, rotate your arm and lift your arm over your head. It’s possible to have a greater range of motion with less stability.

How

Shoulder instability

This happens when the humerus head (the upper arm bone) is forced out of the shoulder’s cavity. Usually this happens as a result of a sudden traumatic injury.

Once the shoulder is dislocated, the shoulder is vulnerable to repeat. When the shoulder is loose and slips several times, it’s called a chronic shoulder instability.

The shoulder is made of 3 bones : humerus (upper arm bone), scapula (shoulder blade) and clavicle (collarbone).

Dislocation shoulder

shoulder dislocation anatomy

This may be partial, which means that the arm’s ball partially comes out from the cavity. This is called a subluxation. This can be complete which means that the arm’s ball comes out completely from the cavity.

Symptoms

Symptoms of chronic shoulder instability are :

  • Pain caused by the shoulder injury

  • Repeated shoulder’s dislocation

  • Repeated instance of the shoulder giving out

  • A persistent sensation of the shoulder that is loose, slipping out of the joint or hanging.

Diagnosis

Specific tests help assess shoulder instability (including general relaxation of ligaments). A doctor may prescribe imaging tests such as X-rays, CT Scan or MRI to confirm the diagnosis and identify other problems.

Treatment

First, chronic shoulder instability treated with nonsurgical options. If these options don’t relieve pain and instability, surgery may be needed.

Nonsurgical treatment

shoulder dislocation treatment non surgical

Generally, it often takes several months of nonsurgical treatment before success can be assessed. Nonsurgical treatments includes :

  • Activity modification

  • Non-steroidal anti-inflammatory medication

  • Physical therapy

Surgical treatment

shoulder dislocation treatment surgery bankart repair

Often, surgery is often required to repair torn or stretched ligaments so that they can maintain the shoulder joint in place.

Bankart lesions (tearing of the front labrum from the cavity) can be repaired surgically using suture anchors to reattach the ligaments to the bone.

Arthroscopy => Soft tissues of the shoulder can be repaired using tiny instruments and small incisions. It’s a procedure that is done the same day or outpatient. Arthroscopy is a minimally invasive surgery. The surgeon examines the inside of the shoulder with a small camera and performs the operation with special instruments.

Open surgery => These are patients who require open surgical intervention. This involves making a wider incision on the shoulder and performing the repair under direct visualization.

Rehabilitation

After surgery, the shoulder can be temporarily immobilized with a sling. When the sling is removed, it’s essential to do ligament rehabilitation exercises. These exercises improve the range of motion of the shoulder and avoid scarring during ligament healing. Thereafter, exercises for strengthening the shoulder will be added in the rehabilitation program.

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-Steph

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Mature Athlete

mature athlete

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Physical exercises are for everyone, including the mature population. Exercises allow older people to keep a healthy body and maintain their independence. The main health problems of the mature population are arthritis, high blood pressure, heart disease, lung disease, depression and hearing and sight loss. With the exception of hearing and sight loss, all these health problems can be serious decrease with an adequate workout program.

All mature athletes should have a complete medical and musculoskeletal assessment before starting any workout program. Having a complete medical examination, medical advice and a workout program helps to avoid serious injuries and health accidents. These 3 things should meet the needs of a mature athlete to avoid disease, increase endurance, strength, body image and competitiveness.

Exercises are beneficial

It’s important that a qualified personal trainer create a specific workout program to improve strength, endurance, balance and flexibility. If the workout program includes sports such as golf or tennis, the technical knowledge of the golf/tennis instructors is helpful to avoid injury and improve performance. For results, workout programs must be consistent for at least 30-45 minutes, 3-4 days a week.

If physical conditions require correction, a cardiac or pulmonary rehabilitation program or physical therapy may be helpful before starting a workout program. These rehab programs should be taught to mature athletes at a fitness level where they could continue with their own workout program.

Exercise type for the workout program

physical exercise type

An athlete should use types of exercises based on his/her desire, pre-existing conditions and his/her ability to exercise without pain. For an athlete with lower extremity joint problems such as arthritis or instability, it’s recommended to avoid exercises with repetitive impacts like running. For athletes with an unstable shoulder, it’s recommended to avoid overhead exercises such as military press and pull-ups.

Using several types of exercise to improve strength, can allow better recovery of muscle and tendon tissue. If a mature athlete wants to make a sport that can aggravate a pre-existing problem on a muscle, tendon or bone, that athlete should be in a good condition before doing this sport. It’s recommended to decrease this sport’s frequency to reduce the painful symptoms.

What equipment to use

Having shoes that fit with the exercise and/or the sport is beneficial. If the person has a foot with significant deformity such as flat feet (fallen arches), using orthopedic shoes helps to reduce stress on the entire lower extremity. The symptoms of arthritis in the knee may be decrease by the use of specialized braces.

Prevent injury or discomfort during exercise

If there is discomfort during or after physical exercise, this should be analyzed to prevent it from starting again or getting worse. Over-the-counter painkillers and anti-inflammatory can be used in the short term if there is no interference with other medical conditions. It’s important to know that the use of ice, heat, massage and flexibility programs can decrease several symptoms caused by exercise.

There is more aggressive treatment with narcotic analgesic and/or cortisone injections but this should only be used to treat a specific lesion. This shouldn’t be used to allow an athlete to complete in the short term.

Summary

Creating a customized workout program with a medical professional and/or a qualified personal trainer helps a mature athlete to :

  • Keep independence

  • Increase physical abilities

  • Prevent injuries

  • Improve the quality of life

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-Steph

P.S. If you’re in Miami and you like Caribbean food, go to my cousin’s bistro to eat Haitian food. Click here.

Articular Cartilage Injuries

articular cartilage injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interessted in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Definition

Articular cartilage is difficult to understand because there are 3 types of cartilages in the body : articular of hyaline cartilage (covers joint surfaces), fibrocartilage (knee meniscus, vertebral disk) and elastic cartilage (outer ear). These cartilage’s types differ in their structure, elasticity and strength.

Articular cartilage is a complex element, it’s a living tissue that is on the joint’s surface. The function is to provide a low friction surface to allow the joint to withstand weight loads through the range of motion needed to perform activity of daily living. To put it simply, articular cartilage is a very thin shock absorber. It’s built in 5 distinct layers and each layer has a structural and biochemical difference.

Injury

articular cartilage injury

Articular cartilage injury may be due to trauma or progressive degeneration (wear and tear). This can be mechanical destruction, a direct blow or other trauma. The healing of articular cartilage cells depends on the severity of the damage and the location of the lesion. Articular cartilage has no direct blood supply so it has very little ability to repair itself. It the lesion penetrates the bone under the cartilage, the bone provides blood in the area which improves the chances of healing.

Mechanical degeneration (wear and tear) of articular cartilage occurs with progressive loss of normal cartilage structure and function. This loss begins with the softening of the cartilage, then progresses to fragmentation. As the loss of articular cartilage lining continue, the underlying bone no longer has any protections against normal wear and tear of daily life and begins to get damaged leading to osteoarthritis.

In many cases, a patient experiences knee swelling and vague pain. At this stage, continuous physical activity isn’t possible. If a loose body is present, words such as « locking » or « catching » might be used to explain the problem. With wear and tear , the patient often experiences stiffness, decreased range of motion, joint pain and/or swelling.

Diagnostic

The physician examines the knee to look for a decrease in range of motion, pain along the joint line, swelling, fluid on the knee, abnormal alignment of the joint’s bones, and ligament or meniscal injury.

Cartilage lesions are difficult to diagnose and it’s possible that the use of magnetic resonance imaging (MRI) or arthroscopy may be necessary. Plain X- rays don’t usually diagnose articular cartilage problems but they used to rule out other abnormalities.

Treatment

articular cartilage injury treatment

 

Articular cartilage injury that doesn’t penetrate the bone doesn’t repair itself. A lesion that penetrates the bone can heal but the type of cartilage created is structurally unorganized and doesn’t work as well as the original cartilage.

Lesion less than 2 cm have the best prognosis and the best treatment options. These options are arthroscopic surgery using techniques to remove damaged cartilage and increase blood flow from the underlying bone (drilling, pick procedure or microfracture ).

For smaller lesion of articular cartilage surgery is not required.

For larger lesion, it’s necessary to transplant the articular cartilage from another area of the body. Talk to your doctor or specialist to have more information about the decision to have a surgical operation.

For patients with osteoarthritis, non-surgical treatment consists of physical therapy, lifestyle modification (for example reducing activity), bracing, supportive devices, oral and injection drugs (like non-steroidal inflammatory drugs, cartilage protective drugs) and medical management.

Surgical options depend on the severity of osteoarthritis and may provide a reduction in symptoms that are usually short-lived. Total osteoarthritis may relieve the symptom of advanced osteoarthritis but this usually requires a change in the lifestyle and/or level of activity of the patient.

Statistics

Based on published studies, the overall prevalence of articular cartilage injury in the knee is 36% among all athlete and 59% among asymptomatic basketball players and runners.

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-Steph

Knee Instability

knee anatomy

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

When the knee extended, external and internal lateral ligaments stretched and prevent rotation of the joint. Standing on one foot, knee wedged in extension, which means that there is no need for muscle action to stabilize the joint.

knee anatomy extension flexion

When the knee flexed, external and internal lateral ligaments relaxed. In this position, the joint only stabilized by the action of the muscles.

knee anatomy meniscus

In flexion-rotation of knee, meniscus moves forward on the side of rotation If the extension of the articulation which follow is poorly controlled, it may happen that meniscus doesn’t back in its place quickly enough. In this case, meniscus pinched between condyles and there may be a meniscal lesion. If during pinching, a small piece of meniscus has been cut, a surgical operation may be necessary to remove it.

knee anatomy meniscus ligament

During asymmetical exercise such as lunges (lunges and dumbbell lunges), it’s important to preserve the knee joint to control movement in speed and straightness to avoid any injuries.

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-Steph

Tear Of Hamstring Muscle

hamstring muscle anatomy tear

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

In bodybuilding, tears of hamstring muscles are common. This often happens during squat when the torso is too much inclined. All hamstrings muscles (except biceps femoris short head) are extremely stretched and squeeze strongly to straighten the pelvis. Precisely at this point, there may be a muscle tear in the upper or middle part of this muscle group.

It’s possible that the tear of hamstring muscle occur with machine (leg curl). There may be a muscle tear with a heavy weight at the beggining of the movement when legs stretched and muscles stretched.

Usually, tears of the muscular fibers of hamstrings are small and not serious (it’s rare to see a major muscle tear or tendon disinsertion) but these tears are always painful and causes complications.

Indeed, often after a tear on this muscle group, there is a fibrous scar that causes a painful and disabling rubbing for sport practices. And it’s important to note that this scar isn’t elastic and can tear again during an intense effort.

Tip to avoid hamstring tears

To avoid theses muscle tears during squat or deadlift, it’s important to make specific stretching movements for hamstrings, before or between sets.

There are also other exercise like « Good-morning », stiff-legged deadlift or Romanian deadlift which helps because of their combined actions of muscle building and stretching.

After a tear of hamstrings

To avoid having a fibrous scar, it’s necessary to do a re-education a week after the tear. It’s important to do stretching exercises for the back of the thigh slowly. This allows you to stretch the injured muscles and to soften the scar so that it doesn’t tear when you start again the training.

feedback of hamstrings muscles

hamstring muscle anatomy tear pelvis

In modern societies, we sit for several hours. This can create in some people a feedback of hamstrings muscles. This muscles retraction of the back of the thigh puts the pelvis in retroversion and this creates a bad position of the spine.

This poor position of the spine causes the natural curvature of the spine to be lost over time. This results in poor posture, flat buttocks and round back that can trigger spinal pathologies.

To limit this feedback of hamstrings muscles, it’s recommended to do exercises that have a combined action of muscle strengthening and stretching at the back of the thigh as the « Good-morning », stiff-legged deadllift and Romanian deadlift. Then after this exercise session, it’s advisable to do some sets of stretching for hamstrings.

Action of hamstrings at squat

hamstring muscle anatomy tear squat

During squat, hamstring muscles squeeze to straighten the pelvis. This prevents the torso (in this phase the torso is bound to the pelvis by the contraction of the abs and lumbar) from bending too much forward.

hamstring muscle anatomy tear

Note

Fibrous scars can also be treated in parallel by a physiotherapist with manual or mechanical massages to soften the lesion.

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-Steph

Spinal Disc Herniation

disc herniation

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

First we can say : « disc herniation » or « herniated disc » but I prefer use « disc herniation » in my article.

Disc herniation is a common pathology in bodybuilding. This often occurs because of poor back placement during exercises such as squat, deadlift and rows (barbell bent row, seated row, etc).

During the execution of theses exercises, the main defect observed is the rounding of the back or a flexion of the spine. Because of that discs are pinched forward and loosened backward.

disc herniation

If an intervertebral disc cracked or aged, the gelatinous fluid of the nucleus pulposus moves backwards and can compress the spinal cord or roots of the spinal nerves. The symptoms of a disc herniation depends on the nature of the lesion, the amount of nucleus displaced and the surface that nucleus compresses.

The disc may have a bump or even worse, the nucleus may explode through the surrounding annulus fibrosus. It’s also possible that the posterior ligament that joins the vertebrae to each other is broken. The compressions caused by the rupture of the annulus fibrosus are always painful and incapacitating.

In bodybuilding, disc herniation are mainly at the lumbar level. Often between the 3rd and 4th lumbar vertebrae or between the 4th and 5th lumbar vertebrae. The pain is dull and deep and sometimes with numbness and tingling. Often the pain is in the middle of the back or on one side. The pain extends onto the glutes, pelvis and pubis. Sometimes pain can be felt throughout the leg following the path of the sciatic nerve because the sciatic nerve is compressed at the root (hence the name of sciatic to define this type of pain).

disc herniation sciatic nerve

Usually disc herniation resolve spontaneously and the pain gradually disappears. But in some cases the bump on a vertebral disc doesn’t disappear and can continue to painfully pres on the nerves or it’s a loose piece of intervertebral cartilage that compresses the nervous elements.

In these 2 cases, the doctor will think of doing a surgical operation to remove the part that compresses the nerves.

To avoid having a disc herniation, it’s essential to do squat, deadlift, « good morning » and rows (rows, barbell bent row, seated row) with excellent positioning technique.

Attention

For all exercises done with very heavy weight, it’s necessary to perform a « blocking » :

  1. Take a deep breath and block the breathing to fill the lungs like a balloon. This stiffens the ribcage and prevents the top of the torso form tilting forward.

  2. Squeeze abs stiffens the belly, This increases the intra-abdominal pressure and prevents the torso from sagging forward.

  3. By slightly arching the lower back with lumbar squeeze, this allows to have the spine’s bottom in extension.

These 3 simultaneous actions is what we call « blocking ». This « blocking » has the function of avoiding the rounding or bending of the spine because with very heavy weights, it can create disc herniations .

Note

After a training session with very heavy weights, it’s advisable to do stretching for the spine. There is an excellent exercise to relax the back muscles and rebalance the pressure inside the intervertebral discs. Click here .

Bad position

disc herniation bad positon squat deadlift

For exercises such as deadlift or squat, it’s important not to round your back to avoid lower back injuries.

Disc herniation

disc herniation

Flexion of the spine with heavy weights can create disc herniations at the level of the lumbar vertebrae.

These disc herniations are common at squat and deadlift. This is caused by a bad back position during exercise. That’s why it’s important to work the technique for these exercises.

Disc herniation according to the age

disc herniation intervertebral

From the age of 30 years old, intervertebral discs degenerate and don’t worry, it’s normal, The annulus can crack and the nucleus pulposus dries progressively.

Vertebral discs of people over 30 years old are more rigid, less elastic and the mobility of the spine is more limited. But as the viscous gel of the nucleus pulposus deacreases due to drying, the risk of the vertebral discs moving and compressing the nerves diminished.

Vertebral discs of people under 30 years old are more flexible, more elastic and there is more mobility with the spine. There is a greater amount of viscous gel in the nucleus pulposus which increases the risk that vertebral discs will move and compress the nerves. Disc herniation is very common among young athletes.

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-Steph

Shoulder Injury (Part 1)

shoulder

I read a Frederic Delavier’s book « Strength Training Anatomy » and there is good stuff.

Shoulders injuries are frequent in bodybuilding because we want develop all deltoid muscles. To do this, we must perform a signigicant number of repetition and movements thus multiplying the risk of injury.

It’s worth remembering that, in comparison with the solid hip’s articulation where the femur head is deeply embedded in the pelvic cavity of the pelvis, shoulder’s articulation, which must be very mobile to allow arms to move in all direction, is very little embedded.

Shoulders can thus be defined as a joint to muscular fixation, the maintenance of the humerus head on the scapula’s glenoid cavity is mainly ensured by a complex musculo-tendinous ensemble.

Although in bodybuilding most injuries occur during shoulders training, it’s rare to see this muscle directly injured. The wound are generally much deeper and appear most often during a false movement or after a long wear by friction of tendon structure reinforcing the articular capsule.

While in other sports of violent contact (such American football) or rapid arms movements (such as throwers) can result in serious injuries with dislocations and enven tendon pull. The main lesion observed is what we call subacromial bursitis.

Some people when performing elevated arm movements, such as back press or lateral raise, the supra-spinous tendon is rubbed and compressed between humerus head and osteoligamentous vault formed by the underside of the aromion and the coracoacromial ligament.

Consequence

shoulder anatomy

The result is an inflammation which generally begins with the synovial bursa, which normally protects the supra-spinous tendon from excessive friction. And it continue by the supra-spinous tendon itself and ends, if this inflammation isn’t treaed, by touching the adjacent tendons of the infraspinatus at the back and the long portion of the biceps at the front.

Arms elevation becomes extremely painful and there may be an irreversible deterioration of the supraspinatus tendon with calcification and sometimes even rutpure. The latter being observed in general only with people over 40 year old.

The space between the humerus and osteoligamentous vault can vary from one individual to another. Some athletes will not be able to lifte their arms laterally without generating excessive friction. These individuals must therefore avoid all back press, lateral raise to high and also when they train back, pulldown behind the neck.

All exercices with barbell for shoulders should be done in front of, with elbows slightly forward. With dumbbells lateral raise, the correct working angle should be sought, the right movement being the one that is realized painless.

It’s interesting to note that for the same shoulder injury all individuals don’t respond in the same way. Some people can perform all sort of arms raise, compressing and sometimes even deteriorating their tendons without ever triggering a painful inflammatory process. Thus, in the course of an examination, some people have discovered a rupture of the supra-spinous muscle’s tendon without ever having complained of any pain.

Another cause of shoulder pain may be due to an imbalance in the distribution of muscle tension around the joint capsule. Recall that the humerus head is firmly held against the scapula’s glenoid cavity by a muscular system with tendons adhering or passing through the articular capsule. This set is composed at the front by the subscapular, a little more on the outside by the long portion of the biceps, above by the supra-spinous and finally at the back by the infraspinatus and the teres major muscle. Spasm, hypertonicity or, on the contrary, a lack of tonicity of one or more of these muscles, can lead to a bad position of the shoulder joint. This bad position will be the cause, during the movements of the arm, of friction likely to generate inflammatory pathologies.

Exemple : A contracture or a spasm of the teres major muscle and infraspinatus will cause an external rotation of the humerus head which will generate during the movements of the arm, friction in the front of the shoulder joint. And with the time can injure the tendon of the long portion of the brachial biceps.

It will therefore be necessary to ensure to train in a balanced way all the muscles of the shoulder avoiding all the exercices where one will feel a discomfort, a pain or a friction.

Note : Hand massage or better with a vibrator, as well as electostimulation, give very good results to diminish and eliminate spasms and contractures of teres major muscle and infraspinatus.

-Steph

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