Rotator Cuff Tears

rotator cuff tear anatomy shoulder

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.

Rotator cuff is a group of 4 muscles and their tendons that together form a « cuff » around the head of the humerus (upper end of the arm). The 4 muscle, originate from the scapula (shoulder blade), are upraspinatus, infraspinatus, subscapularis and teres minor. Tendons of each muscle fit on the humerus tuberosity.

Rotator cuff’s functions :

  • Lift the arm

  • Turn the arm

  • Stabilize the humerus in the joint

Causes

rotator cuff tear anatomy

The causes of a rotator cuff tear can be an acute injury such as a fall or because of chronic wear with tendon degeneration. For people over 40 years old, the pinching of the tendon on the underside of the scapula may participate in tearing.

Diagnosis

Diagnosis of rotator cuff tears is based on an examination and/or diagnosis study such as a MRI (magnetic resonance imaging) to confirm the diagnosis. Diagnosis early on in the first symptoms and rotator cuff’s treatment can help to boost the treatment’s results.

Treatment

Goals treatment are to relieve pain and restore strength to the injured shoulder. Several tears in rotator cuff can be treated without surgery. Anti-inflammatory drugs, steroid injections and physical therapy can all be beneficial in treating the symptoms of a tear in the cuff.

Even though a full-thickness tear needs to be cured with surgery, it’s possible to use non-surgical treatments to have a satisfactory function in some cases.

Surgery

rotator cuff tear anatomy surgery

Surgery is recommended if there is persistent pain or shoulder weakness that doesn’t improve with non-surgical treatment. Often patients who have surgery indicate nocturnal pain and difficulty using the arm for lifting and reaching. Many will indicate persistent symptoms despite several months of treatment and limited use of the arm.

Surgery is also recommended for active people who use the arm for overhead work or sports.

Surgical options

The type of repair performed is based on the findings at surgery. A partial tear my necessarily only a trimming or smoothing procedure called a debridment. A full-thickness tear with the tendon torn from its insertion on the humerus is repaired directly on the bone.

3 techniques are used for rotator cuff repair :

  • Open repair (through a traditional incision)

  • Mini-open repair (partially assisted by a camera view, with a smaller incision)

  • Arthroscopic (performed with only a small camera inserted through multiple small puncture wounds)

Recovery and rehabilitation process

Whether for the treatment of non-surgical and surgical rotator cuff tear, rehabilitation has a very important role. Usually recovery is at least 6 months or more depending on the extent of the tear.

When there is a tear, there is frequently a loss of shoulder movement. An exercise or physical therapy program is needed to restore strength and improve shoulder function.

Although surgery repairs the defect of the tendon, the muscles around the arm remain weak and an important effort is necessary in the rehabilitation so that the procedure is a success. After surgery, a complete re-education can last several months.

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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 .

Overuse Injuries

overuse injuries sport injury

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.

There are 2 types of injuries : Acute injuries and overuse injuries. Acute injuries are usually caused by a single traumatic event. Here are some examples :

  • Wrist fractures

  • Ankle sprains

  • Shoulder dislocations

Acute injuries are less common in sport than overuse injuries. Overuse injuries are usually subtle and appear over time, making them difficult to diagnose and treat. Here is some example :

  • Tennis elbows

  • Swimmer’s shoulder

  • Pitcher’s elbow

  • Runner’s knee

  • Achilles tendinitis

  • Shin splints

Why

Human body is extraordinary to adapt to physical stress. We’re used of thinking that « stress » is bad for our emotional well-being, but physical stress is simply doing an exercise or activity. This is beneficial for our muscles, tendons, ligaments and bones. This physical stress causes an internal process called remodeling. Remodeling process involves both the breakdown and the build up of tissue. It’s necessary to have a good balance between 2, if breakdown occurs more rapidly than buildup, an overuse injury occurs.

Causes

overuse injuries sport injury gym fail

Usually, it’s training errors that cause overuse injuries. These errors are too fast acceleration of intensity or duration or activity frequency. These injuries can also happen to people who return to the sport/activity after an injury. They try to make up for lost time as quickly as possible to reach the level they had before the injury. Doing an exercise with a good technique is important to avoid overuse injuries. When the exercise’s technique is bad, it creates overuse injuries. It’s for this reason that coaches, athletic trainers and teachers can play a preventive role so that athletes avoid overuse injures.

There are people who more easily have overuse injuries. An unbalance between strength and flexibility around certain joints predisposes some people to have this type of injury. Body alignment, such as knock-knees, bowlegs, unequal leg lengths and flat or high arched feet, also impact overuse injuries. There are also people who have weak links because of old wounds, incomplete rehabilitation of wounds or others anatomy factors.

Other factors must also be taken into account as equipment such as the type of running shoe or ballet shoe and terrain (hard versus soft surface in aerobic dance or running).

Diagnosis

Generally the diagnosis is based on the athlete’s history and physical examination. It’s recommended to make a diagnosis with a sports medicine specialist with a specific interest and knowledge of your sport. In some situations X-rays, bone scan and MRI may be necessary.

Treatment

overuse injuries sport injury ice

Here are some recommendations for treating an overuse injuries :

  • Cutting back the intensity, duration and frequency of an activity

  • Adopting a hard/easy workout schedule and crosstraining with other activities to maintain fitness levels

  • Learning about proper training and technique from a coach or athletic trainer

  • Performing proper warm-up activities before and cool down after

  • Using ice after an activity for minor aches and pain

  • Using anti-inflammatory medications as necessary

If symptoms persist, a sport medicine specialist may create a more detailed treatment plan for your specific condition. This may involve an exam of your training program and an evaluation of predisposing factors.

Prevention

Majority of overuse injuries can be avoided with a proper training program, common sense and learning to listen your own body. The quote : « No pain, no gain » doesn’t apply here. The 10% rule helps a lot to get things to the next level.

In general, you should increase the training’s intensity to a maximum of 10% per week. This allows your body to have enough time for recovery and response. This rule should be used to increase pace or milestone for walkers or runners. Or for the weights amount to increase for strength training programs. In strength training, add flexibility exercises and core stability exercises help tremendously to minimize overuse injuries.

It’s recommended to seek advice from sports medicine specialist or athletic trainer to prevent chronic or recurring problems. Your training program can also be modified to maintain fitness levels safety while you recover from your injuries. You must return to the sport only if an authorization is granted by a health professional.

Remember, it’s very important to warm-up before training and cool down after training.

Stats

3.5 millions of children are treated for overuse injures every year.

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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 .

MRSA Infections

mrsa infection 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.

Methicillin-Resistant Staphylococcus aureus (S. Aureaus), or MRSA, is a bacterium that creates skin infections and other types of infections. The first time that MRSA was seen in US hospitals during the 1970s. Recently, there is a new strain of MRSA know as Community Acquired Methicillin-Resistant Staphylococcus aureus, or CA-MRSA, has left hospitals and began to spread in the community.

This is the strain that is prevalent among athletes. The difference between CA-MRSA and Healthcare-Associated MRSA (HA-MRSA) is in their effects. CA-MRSA usually creates skin infections while HA-MRSA causes bloodstream, urinary tract and surgical site infections. This make CA-MRSA less dangerous than HA-MRSA. Another difference is that CA-MRSA is more vulnerable to antimicrobial.

Symptoms

Signs of infections are :

  • Redness

  • Warmth, Swelling

  • Pus

  • Pain at sites where there are skin wounds

  • Abrasions or cuts

MRSA has the ability to spread to other organs in the body and when that happens, symptoms are more severe.

At this stage, symptoms are :

  • Fever

  • Chills

  • Low blood pressure

  • Joint pain

  • Severe headaches

  • Shortness of breath

  • An extensive rash over the body

These more advanced systemic symptoms require immediate medical attention.

Treatment

The 1st choice for treating MRSA skin infection is to use an antibiotic that has been created to kill bacteria with mild side effects. Most early infections with no widespread symptoms can be treated with oral antibiotics. Because of the nature of this decease and antibiotic options, many patients think they’re « cured » after only a few doses and decide by themselves to stop taking the prescribed drugs. However, MRSA is able to re-infect the patient and become resistant to antibiotics used previously.

For moderate to severe infections, treatment may be with intravenous antibiotics.

These infections associated with deep abscesses or boils require open surgical drainage in addition to antibiotic therapy. Most infections resolve in 7-10 days with an adequate treatment despite the fact that a deep abscess can take up to 4 weeks to eradicate the infection by resolving the abscess cavity.

Early identification and treatment of MRSA infections decrease the amount of playing time lost and decrease the chance that the infection will become severe. Skin may be protected by protective clothing or gear designed to prevent skin abrasions or cuts.

Prevention

mrsa infection anatomy

It’s necessary that athletes have good personal hygiene but it must be added that athletes and visitors to athletes facilities must also keep their hands clean by washing them often with soap and water or using an alcohol-based hand rub. The minimum is to have clean hands before and after sports and activities. For example when we use weight training equipment that is shared by all gym members, it’s important to have clean hands after using toilette or when someone is injured taking care the wounds (including changing bandage).

Ordinary and antimicrobial soaps are effective for washing hands. It’s noted that liquid soap is a better option because it’s not possible to share this type of soap compared to bar soap. Alcohol-based hand sanitizer that contain at least 60% alcohol are the perfect choice.

Athletes should shower immediately after exercise and shouldn’t share soap and towels. Washing all uniforms and clothes after each use is important. Athlete should avoid sharing items that are in contact with the skin and avoid sharing personal items as they contact the skin. Fortunately, most surfaces don’t provoke a risk of spreading staph and MRSA.

Athletes who have had MRSA

Several high school, college and professional athletes have contracted MRSA infections. There have already been epidemics among athletes on the same team. A study published in « The New England Journal of Medicine » shows an infection MRSA among St. Louis Rams professional football franchise (USA) athletes. During a single season, MRSA infections were found among 5 of 58 Rams athletes (9 percents) that was tested. All infections developed on areas of the body that are common places for turf injury.

Stats

  • Today, MRSA accounts for about 50-70% of the S. Aureus infections that are present in healthcare facilities across the world.

  • Statistics fro the Kaiser foundation in 2007 indicated that approximately 1.2 million hospitalized patients contract MRSA infections.

  • Serious MRSA infection is still predominantly related to exposure in the healthcare setting, where approximately 85 percent of all serious MRSA infections occur.

  • Fortunately, in children under 18 years old, mortality rates are much lower (1%), even though the number of hospitalized children with MRSA has almost tripled since 2002.

Subscribe to my newsletter and share this article if you think it can help someone you know. Thank you.

-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 .

Biceps Tendon Rupture

biceps brachiitTendon rupture

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

Rupture or tear of the biceps long head is the serious injury the most frequent in sport

This injury usually appears on a muscle weakened by tendinitis caused by a sudden movement of the arm. Sudden arm movements are usually thrown like baseball, tennis, throwing sports and also Olympic weightlifting during the snatch. At this point, all tension transferred to the biceps long head which breaks most often where the tendon passes into the intertubercular sulcus of the humerus.

In bodybuilding, this injury is a little different, especially with the deadlift.

There is a technique in deadlift which consists of having a hand with a pronated grip and the other with a supinated grip to lift heavier weights and to avoid that the barbell rolls in the hands.

This simple technique is at the origin of the rupture or the disinsertion of the lower of the biceps (where the muscle is inserted on the humerus). Fortunately, this injury rarely happens.

During the positive phase of the deadlift, the muscles that work are legs, glutes, back and abs. Arms relaxed but they stretched as cranes cables.

Unfortunately, when a hand is with a supinated grip this shortens the biceps (the biceps is extremely powerful with a supinated grip). The result is that there is tremendous tension due to the heavy weights which cause the tearing or total rupture of the tendon of the radius. The biceps with a supinated grip works more than the biceps with a pronated grip.

In the deadlift, the injury is exclusively on the distal tendon of the muscle. The arms hang along the body, which causes the tension to be distributed at the top of the muscle between the tendons of the short head and the long head. For other exercises when the tension is at the bottom of the muscle, the tension is supported on a single tendon insertion.

biceps brachiitTendon rupture

The rupture of the biceps tendon causes a pain relatively moderate compared to the severity of the injury. If we compare the rupture of the biceps tendon with the major pectoralis or the adductors of the thighs, the pain is different. With a rupture of the major pectoralis tendon or adductors of the thighs, the suffering is so strong that the athlete must stop the effort.

It often happens that during a powerlifting competition, athletes who have a rupture of the biceps tendon during the deadlift, continue until the end of the movement.

When this injury occurs, there is swelling in the forearm because of hemorrhaging. But the most surprising thing is the retraction of the biceps which forms a ball at the top of the arm near to the pectoralis major and deltoid. This biceps retraction causes the brachial muscle in the lower arm to be more exposed.

biceps brachiitTendon rupture

It’s always possible to make a flexion of the arm with the rupture of the muscle, which less powerful than before, thanks to the brachial muscle, brachioradialis, long and short radial extensor of the carpus and the pronator teres muscle. On the other hand to make a movement with a supinated grip is a problem because the end of the movement is only carried out by a single muscle, the supinator muscle.

You have to be careful because this injury should be treated quickly by surgery to restore the brachial biceps tendon to the radius. If this surgical operation is not performed in time, the ball will have a fibrous transformation and retraction will be final. The arm’s mobility will always be possible but the loss of strength in flexion and supination is inevitable.

There is a solution to avoid this type of injury with deadlift with a bicep work to have a tendinous reinforcement. This exercise is to do a flexion only with forearms with a straight barbell. This exercise reinforces the biceps distal tendon but be careful by controlling the movement.

Share this article if you think it can help someone you know. Thank you.

-Steph

Rupture Of The Pectoralis Major

rupture, tear, pectoralis, major, tendon

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

Pectoralis major begins on the anterior surface of the thoracic cage and its insertion is to the anterior surface of the upper end of the humerus.

Pectoralis major is a muscle which has the function of bringing the arm forward in front of the rib cage which make it possible to make hugs.

Bench press can create small tears at the pectoralis major which can sometimes cause a partial rupturing of its tendon (around upper chest).

This partial rupture of the tendon occurs in powerful athletes who have gained an abnormally rapid strength, which didn’t allow time for tendons to strengthen. This injury can also happen to athletes who make a « dry » diet, so a low-calories diet to better make muscles more visible. These low-calories diets weaken joints, tendons and muscles.

The wound always arrives during a bench press and affects only the clavicular head of pectoralis major.

The rupture of the tendon can be so painful that the athlete may lose consciousness. Often a tumefaction with eccymosis apprears on the anterior surface of the arm and the retraction of the clavicular head create a hollow around the upper chest.

Diagnostic error

how much

A problem that very often happens with this wound is that doctors, after diagnostic, considers it to be gravity-free. This is an understandable mistake because during the diagnostic, the injured person can make all movements related to the pectoralis major’s motor function. It’s for this reason that doctors consider this wound as a simple muscle tear rather than a ruptured tendon or a severe muscle tear.

Indeed, many muscles compensate the functional loss of clavicular head of pectoralis major to continue to move the arm. I spit of the rupture of the clavicular head of pectoralis major, it’s possible to raise the arm forward by the sternal portion (middle chest) and abdominal portion (lower chest) of the pectoralis major which also compensates.

When there is rupture of the pectoralis major, it’s necessary to have it reinserted as quickly as possible on the humerus with a surgery operation.

If not done as quickly as possible, there is retraction and fibrous transformation of the muscle. In this case, surgery is no longer feasible.

It’s true that the injured person can still move his/her arm without the upper portion of the pectoralis major but the injured person can never regain its initial strength and will be seriously handicapped to continue to do heavy bench press.

Share this article if you think it can help someone you know. Thank you.

-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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Teenager’s training (Part 2)

teenager training

Part 2 of JamCore DZ’s videos  about teenagers training. This is what I share with you today.

After talking about nutrition, let’s talk about training. This is a bodyweight training, no need weights. Do this training 2-4 times per week. Your aim is to focus on the good quality of exercises execution to develop yourself physically. That’s workout can be done from 11 years old.

Each session have 6 exercises that target every muscle of your body (full body). Learn the good position and execute the movement really well avoids injuries during all the years of training and implement nutrition tips from Part 1 will really help you evolve well.

The problem of people who learn bad an exercice is that they will have all time injuries and that is why people fail to make progress.

Session 1

Exercise 1 : Pull-up

Train back

pull-up chair

To do this exercise you need a bar. In stores you can buy bars that you can fix on your bedroom door. When you begin this exercise, you’re a little weak and that’s normal. Now that you have the goal of having a better body, you will do everything to have it. If there are students who mock you, ignore them, soon you’ll show them that you can have a better physique. It’s sad to experience situations like that but shows them that you can do it.

Once you have installed the bar using a bench or chair to put the tip of your feet on it. Hold on to the bar, bend your legs and put the tips of your feet on the chair and doing the movement so that your chin above the bar. Chair or bench allows you to control the movement.

Do 2-3 sets of 4-10 repetitions.

Over time when you have mastered the movement, you will do pull-up without a chair or s bench. Warning ! The quality of movement’s execution is more important than the repetitions number .

Exercise 2 : Push-up

Train chest, triceps, shoulders and back

push-up

push-up with knees

Most people don’t do pumps properly because they always want to do more reps, « How many push-up do you do ? ». True push-up is with stretched legs, back straight, you pull your stomachy and your face is almost touching the ground with each repetition.

If you have a weight problem, you do them with your knees on the floor until you’ve lost weight to do them with stretched legs. Anyone can do push-ups, there’s no excuses.

Do 2-3 sets of 8-12 repetitions.

Exercise 3 : Squat

Train legs

bodyweight squat

bodyweight squat

You going to do bodyweight squat to properly learn the movement because you’re going to evolve in your training and later you gonna do squat with weights. And as you will know well how to do the move, you will not wound by the squat with weight.

Be standing with your feet to your shoulder’s width. There are 2 methods to help you to keep your back straight when you go down :

  • Hands behind head

  • Arms outstretched in front of you

When you go down, you do like you’re going to sit down on a chair until your thighs are parallel to the ground and you go up. Did the exercise slowly. When you go down down put all the weight on your heels and your knees are in the same direction as the tip of your feet.

Do 2-3 sets of 10-12 repetitions.

Exercise 4 : abs

crunch

Everyone loves abs but beware, abs don’t come in 24 hours, it takes time. You’ll do the classic crunch. No need to lift your whole back of the ground to touch your knees. Exhale during the muscle’s contractions, look at the ceiling and doesn’t pull on your head because it’s bad for your neck.

Do 2-3 sets of 15-30 repetitions.

Exercise 5: Mountain Climber

mountain climber

It’s a biometric exercise with a little cardio. The starting position is the push-up position. Hands at the shoulder’s width and you pull your stomach. Now, you run in this position without knees touch the ground.

Do 2-3 sets of 20-40 repetitions.

Exercise 6 : Dips

Train triceps

dips with chair

Use a bench or chair.

Do 2-3 sets of 10-15 repetitions.

This Session 1 is to do 2 times per week. If you want to do more, 4 times per week is the maximum.

When you find that Session 1 is too easy, which means you’re doing the Session 1 and at the end you’re not really tired, you can do the Session 2.

-Steph