Acute rotator cuff injuries are frequently left undiagnosed and mistreated and can sometimes end up causing months of pain and shoulder dysfunction later down the track. It is important to seek medical treatment for shoulder injuries from physiotherapists (initially) and exercise physiologists (afterwards) earlier rather than later to increase successful treatment outcomes and be able to return to pre-injury level as fast as possible.

The rotator cuff is a term used to describe four key muscles and their tendons that work together as a synergy to move and control the ball and socket joint that is your shoulder.

The muscles help to secure the ball (arm bone) into the socket (shoulder) to stabilise the joint and allow for correct movement patterns when moving the arm.

When just one of these four muscles is damaged, it can lead to altered movement patterns, which can cause further issues and pain within the joint.

If you are experiencing pain or difficulty with lifting your arm out to the side, rotating it outwards or lowering it from out in front, a rotator cuff issue could be present.

Treatment of this injury depends on the severity of tear, level of pain and restriction it is causing.

Treatment approaches can be surgical or non-surgical in nature. Interestingly, a recent study has shown that at a five year follow up of patients with full thickness chronic rotator cuff tears, there was no difference seen in the outcomes between the two different approaches. Simply put, this means that no treatment approach was proven to be better than the other.

Allied health interventions such as Physiotherapy and Exercise Physiology can provide you with this successful non-surgical treatment approach.

Physiotherapy involves in depth assessment of your injury, hands on treatment progressing to Exercise Physiology which provides specific exercise therapy to strengthen weakness and return full function to your shoulder.

Stay tuned for a four-part break down of each rotator cuff muscle and it’s important role on our website blog soon. If you have any questions regarding this article or regarding treatment please visit our website at www.dovestonhealth.com.au.

1. Goldstein Y, Dolkart O, Kaufman E, Amar E, Sharfman Z.T, Rath E, Mozes G and Maman E., (2016) Bicycle-related shoulder injuries: etiology and the need for Protective gear. IMAJ, Vol 18.

(2) Sørensen AK, Bak K, Krarup AL, Thune CH, Nygaard M, Jørgensen U, Sloth C, Torp-Pedersen S., (2007). Acute rotator cuff tear: do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma. J Shoulder Elbow Surg; Volume 16(2):174-80

(3) Boorman RS, More KD, Hollinshead RM, Wiley JP, Mohtadi NG, Lo IKY, Brett KR. (2018).

What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following non-operative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg; Volume 27(3): 444–448.

Any movement is better than no movement.

Even if you are unwell it is beneficial to have a walk around your house or yard than to sit and do nothing. If you are so unwell that you are in bed or a recliner move whatever you can while you are in that position.  

Moving your feet backwards and forwards helps to promote blood flow through the legs and prevents blood clots. Lifting your arms up overhead helps to prevent shoulder and upper back stiffness. Squeezing your butt cheeks helps you to remain strong when standing.

Try not to get into the habit of letting your family do everything for you. Do as much as you can yourself. 

Sitting is the new smoking!

Sitting may be required for certain tasks but it is essential that you get up every 30 mins if you need to do a lot of sitting.

2 minutes of walking around after 30 minutes of sitting can negate all of the issues that can arise from sitting too much. Sitting causes us to become weak in our bottom or gluteal muscles which are essential for standing and prevent lower back pain. When you are watching TV don’t skip through the ads if you are watching something recorded. When the ads are on get up and move around a bit, your body will love you for it.

Sitting also puts more pressure on lower back structures. Ever wondered why it is hard to straighten up when you have been sitting? Your muscles and tissues have a memory and if you sit a lot it is more difficult to straighten up your back and hips after sitting. This should be reason in itself to avoid the sitting posture for too long.

It is necessary to load the bones and joints for them to keep strong. Any weight bearing exercise will keep those bones strong and help prevent osteoporosis. It is not always necessary to hold hand weights to do this.

Modified push ups on a bench is great for loading up the upper back, shoulders and arm bones,

Walking is great for loading up the hip joints, lower back and leg bones. Actually walking is one of the best forms of exercise around. It is particularly good for people with lower back pain as long as the pain does not worsen during the walk.

Load bearing exercise also helps to keep the pelvic floor strong as long as there is no straining involved. It is well known in the physiotherapy field that people doing a lot of weights, high impact exercise and dancers can all have poor pelvic floor function.

Balance exercises are essential to prevent falls and keep you mobile. In fact they also help to keep your pelvic floor strong. If your balance is off your pelvic floor is usually weak also.

Good balance requires good activation of your core muscles and the ability to hold a good posture. Good balance also ensures that you look good. You hold your posture upright and tall and keep your tummy in when your balance and posture is good.

This can also help to make you look younger and who wouldn't like this!

Balance exercises are easy to do while you are in the kitchen cooking dinner, making a cup of tea, when you get up out of bed etc.

Exercising with a friend usually means that you become more accountable and are less likely to stop exercising.

We are usually more likely to let ourselves down than let a friend or group of friends down.

Setting aside certain times during the week when you meet up with a friend to go for a walk or having a group class that you attend every week is a great way of ensuring that you keep up the exercise.

It is also very important socially and mentally that you maintain contact with other women.

How else are you going to unload some of the pressures that you might be feeling without being judged?! Everyone needs to complain about their partner or family occasionally and women friends are the best to vent to. They usually have a similar story so we learn that everyone has similar issues. This combined with physical exercise is essential for overall health and well being.

Staying healthy and feeling your best is important at any age. Follow these simple steps to help you stay as healthy and active as possible so you can get the most out of life!

Stay tuned for more articles from Angela and the Graceville Physiotherapy team. 

In the meantime, if you wish to get in touch with Graceville Physiotherapy, visit their website or click the button below. 

Graceville Physiotherapy have developed a dedicated team that specialise in sports injuries, back and neck pain, workplace injuries, ante-natal and post-natal care, respiratory conditions and arthritis. 

They are also proud to offer Telehealth Consultations via their Physitrack App. Call them to find out more

It is easy to see then how a cyclist can develop neck pain leading to an uncomfortable ride.

Ensure that your bike it set up by an expert. Your bike set up expert needs to be aware of any past history you have of neck pain and or injury. Tell them of your concerns and if you experience pain while riding make sure that you go back and report to the bike fitter what you are experiencing. Do not put up with the pain. If re jigging the set up does not work make an appointment to see a physiotherapist who can give you some exercises that will help you while you are on the bike.

Pilates style Dart exercises are great for neck and shoulder blade stability. These are done lying on your tummy. Firstly you activate your core by pulling in your belly button but not activating your lower back muscles. You then pull your shoulder blades back together and reach your fingers down towards your feet. Then you lift your chest and head off the ground just a little keeping your head in line with your body and your chin gently tucked in. Hold for 10 seconds and do 10. To strengthen your eye muscle response you can use a “Neck Tek” to strengthen the Occular motor response or practice moving your eyes to follow a square shape in both directions without moving your head and then try moving your head from side to side without moving your eyes.

Increasing the ability to activate your core can be done in a similar position to riding. If we do this on our hands and knees we can teach the core to activate in this position. While on hands and knees gently pull your belly button in towards your spine so that you feel some tension between your hip bones. Just practicing this activation while keeping the weight spread through your hands can help you to know when your core is activated or not. If you then gently lift up one arm or one leg you will notice that your core needs to activate to maintain a flat back. Getting used to this activation can help the core to activate while on the bike.

Gentle stretches of the neck by taking your ear to the shoulder and then depressing the opposite shoulder can help to stretch some of those tight neck muscles. You can also turn your head to look in the same side armpit and then turn your head to look up to the opposite side to stretch other neck muscles. Rolling your shoulders up around and back can help to loosen up stiff shoulders and some gentle lunges to loosen up the hips may be of benefit.

In summary don’t let neck pain ruin your ride ... Bike riding is a fantastic form of exercise and should be pain free!  With a little care and attention to your set up and your bike riding form you will be able to enjoy riding well into the future.

Stay tuned for more articles from Angela and the Graceville Physiotherapy Team. 

In the meantime, if your wish to book an appointment for your sore neck, or any other issue, please visit the Graceville Physiotherapy website or click the button below. 

Graceville Physiotherapy have developed a dedicated team that specialise in sports injuries, back and neck pain, workplace injuries, ante-natal and post-natal care, respiratory conditions and arthritis. 

They are also proud to offer Telehealth Consultations via their Physitrack App. Call them to find out more.

Inflammation is a normal anatomical and physiological response to injury that helps with tissue repair and wound healing.

The acute inflammatory response is self-limiting and usually takes 8 – 10 days from onset to healing.  This is the most commonly encountered inflammatory response and one that most people would be familiar with.  

The process of inflammation involves different cellular components and biochemical mediators that move to the site of injury and promote the classic symptoms associated with inflammation: redness, swelling, heat and pain.  Inflammatory responses as a result of injury can be rapid, occurring within seconds to minutes – depending on the location of the injury.  The diameter of the blood vessels surrounding the injured area increases, slowing blood flow and increasing the volume of blood flow to the injured site.  This allows an increased number of inflammatory cells and chemicals to reach the injured area.  

During the initial response the blood vessels also become more permeable which means that gaps appear between the cells that make up the blood vessels.  This allows plasma to leak out of the vessels, which in turn causes swelling at the site of injury.  Consequently, the circulating blood becomes thicker and flows more slowly.  The increased blood volume and increasing concentration of red blood cells at the site of inflammation cause the warmth and redness observed in inflamed regions.

Inflammation is important during the first stage of recovery as it initiates healing through the removal of bacterial products and dead cells as well as activating mechanisms of repair.  However, if the acute inflammatory response proves inadequate, chronic inflammation may develop and persist for weeks or months.   When this occurs, it can cause cellular and tissue damage and can then actually delay recovery and impact mobility.

One of the ways to help modulate the inflammatory response is through diet.  Anti-inflammatory wholefoods such as extra virgin olive oil, nuts, seeds, fish or fish oil, avocado, and flaxseeds/flax meal/flax oil are all high in Omega-3 which is an essential fatty acid that helps to fight inflammation and should be consumed daily during the recovery process.  These foods are all sources of unsaturated fat (the healthy fat!) which is necessary for the optimal functioning of our bodies and which many people are severely lacking in their diets.  Other anti-inflammatory foods include turmeric, garlic and fruits and vegetables for their antioxidant properties, particularly berries as well as pineapple for its bromelain content.  

Some of these foods are available in supplement form which can further aid the recovery process as they are formulated so that their healing properties can be consumed at higher dosages than what you can practically eat in a day.  However, nutritional supplements (like medication) should be taken under the direction of a professional in the industry to avoid any potential interactions or side effects.  Foods to be avoided during the inflammation stage of recovery include vegetable oils, processed foods and large amounts of animal meat, alcohol, salt and sugar.  All of these foods contribute to inflammation in the body and can hinder and prolong the injury recovery process.

Stay tuned for Kate's next article in January. 

In the meantime, if you wish to get in touch with Kate phone 0423 493 330 or click the button below. 

For this month's contribution from Maximize Health Group, we decided to get some advice on how to get to sleep with a whiplash injury.

We have again enlisted the help of Physiotherapist, Sean McCoola. Sean brings experience to his clients from 20 years as a physiotherapist and has a particular interest in sporting teams and rehabilitation programmes.

Read on to see his insights.

Whiplash from a motor vehicle accident can result in many and varied symptoms. Losing sleep and a loss in sleep quality, are manifestations of sleep deprivation that is a common affliction from a Whiplash injury. Sleep deprivation can result in irritability, lack of concentration, memory loss, decision making challenges and increase emotional instability. If sleep deprivation continues long enough, physical signs appear including weight gain, frequent illness, visual disturbances, skin changes, poor motor skills and some even feel they fall asleep at the wheel (a sign of the phenomenon called micro-sleep). 

Controlling your breath and focusing on this, switches the “flight or fight” response that is commonly turned on after a whiplash injury to the more appropriate and normal “rest and digest” response required for body repair and rejuvenation while you sleep. A breathing technique will relax you physically and mentally and set you up for a continuous sleep. Try the simple technique-it’s all you need. Don’t be fooled by the simplicity, this method is fast and effective

• Breathe in for 3 seconds
• Breathe out for 3 seconds
• Continue for 5-10 minutes before sleep while you are lying on your back in bed
• Breathe in and out through your nose

Heating your neck and shoulder areas while in bed will send you off to sleep. The heat reduces muscle spasm and pain, calms the nervous system and improves healing by increasing blood flow to the area and stimulating the metabolic rate. You can have a warm bath or shower before bed or use a heat pack (microwaveable wheat bags are very effective) while in bed.

Self -massage or massage from someone else is highly affective before bed and will reduce your sleep deprivation. Massage decreases muscle spasm and pain, returns muscle to normal length, sedates the nerve endings causing pain and other sleep depriving symptoms and improves blood flow to the area for improved natural healing.

Whether you have rolled your ankle, broken a rib or torn a ligament, your body goes through the same painful and uncomfortable process to repair itself. 

We sat down with Nick Marshall from Surf Life Physio in Miami, QLD earlier this month to get a better understanding of the recovery journey. Nick has over 17 years' experience as a physiotherapist, having practised both privately for his own practice Surf Life Physio and as a senior outpatient physio for Tweed Heads Hospital.

This article continues our injury recovery series. If you missed the first article on the inflammation stage, read it here.

Nick gives his insights on the next two weeks of an injury and provides tips on how best to manage this stage.

Keep an eye out for the next article on what happens after the first 2-3 weeks and for Nick's advice on how to speed up the recovery process, next month as well. 

The proliferation phase occurs following the inflammatory phase.

Just to remind you, in our analogy of a house fire, the inflammatory phase is like our emergency services  who, put out the fire, cordon off areas and stop an area being touched or moved.

The proliferation phase commences after about 3-4 days post injury.

This phase is the beginning of the rebuild. In our analogy, it is the phase where you contact the insurance company and builders to start the process of the rebuild.

The proliferation phase commences around 3-4 days post-injury and then lasts until 21 days after the injury or about 2 weeks.

The biggest difference between this phase and the inflammatory phase is that the injury is no longer sore at rest. It will be sore and restricted with movement and activity. But inflammation is characterised by constant pain without movement.

At this stage the pain should be much less, swelling should have reduced and bruises become darker.

This phase is about stimulating the blood flow to the area so the collagen and elastin forms and matures into its normal shape.

The body’s cells arrange themselves in a way so that they are best designed to resist future load and prevent damage. It’s in this phase that those early building blocks of the ligaments, tendons and muscles can be designed to reduce the risk of re-injury.

You should be aiming for controlled movement.

This would be the most important area to see a physio.

As the injury is no longer sore all the time there is a tendency to get moving too soon. If your movement is not guided properly then a large amount of injuries develop scar tissue which leads to inelastic tissue and a very real cause of future re-injury.

It is also this phase where far too many people grit their teeth and get back to do normal activity. But unfortunately doing that in an inappropriate way during this phase can cause the injury to relapse into the inflammatory phase and stall healing.

If you missed Nick's last article on the Stage 1 of injury recovery, click the link below. It's well worth the read.

Stay tuned next month for Nick's interview on the final stage of the recovery process in February. 

In the meantime, if you have any questions regarding these tips, injury recovery or other health issues please do not hesitate to contact Nick and his team at Surf Life Physio on (07) 5527 7830 or click the button below. 

Late last year, work had taken place on the Goodwill Bridge to fix the slippery surface after complaints of accidents.

Despite appearances, the upgraded blue surface is still a hazard causing cyclists to lose traction and sustain significant injury, even at really low speeds.

In response to fresh complaints, this month, the government has installed caution signs on the entrance to bridge instructing cyclists to “dismount when wet”.

Evidence (including likely expert evidence) would ultimately need to be obtained to support a case in negligence against the Sate and/or their contractors, servants or agents.

We would argue that the surface:

We would say that the existence of the surface created a specific hazard which posed a foreseeable risk of injury to cyclists.

The State Government were and still are aware of growing issues with the slipperiness of the bridge.
There have been at least nine report of accidents since its resurfacing and countless more prior to that.  

Ultimately, in our opinion, the State have failed in their duty of care to cyclists by:-

If someone (a cyclist) is owed a duty of care by the State 

• and the State breaches that duty of care to them (bad path surface)
• and these people have suffered loss (damages)
• these angry cyclists may very well form a  long line at the court house seeking hundreds of thousands (if not millions) in compensation.

Surely it is just much easier, and cheaper, to put down a non-slip surface over a 400 m bridge?

In June 1817, Karl Drai’s a prolific German inventor, took his two-wheeled Laufmaschine (“running machine”) for a 13 kilometre ride along the banks of the Rhine. The voyage may have only lasted an hour, but it sparked a craze which has lasted centuries.

The number of people riding today is phenomenal, something Karl Drais surely never could have imagined. And the numbers continue to rise!

A report released recently by the Royal Automobile Association of South Australia found that 195 out of 277 collisions between motorists and bicycles were caused by the motorist (that is over 70% of collisions).

​Unfortunately, the potential for injury to a cyclist in a road accident is ever present.

It is statistics like these that revive the age old debate about shifting the burden of proof in collisions involving cyclists.

Currently, Queensland operates a common law or 'fault' based system.  To recover compensation (whether that is for damaged property, injuries or otherwise) the cyclist is required to overcome what is known as the “burden of proof” and prove that the collision was caused by the negligence of the driver of the vehicle.

What many cyclists are calling for is a rule where a motorist will be liable for a crash with a cyclist unless the motorist can show the cyclist was at fault.  What is being suggested is that there be a presumption of fault. 

A presumption of fault would effectively mean a shift in the burden of proof (from the cyclist to the motorist).  

Proponents for a shift in the burden of proof say the change would encourage safer driving by motorists which would in turn lead to safer cycling for cyclists.

It is also said by some that it would simplify the insurance claims process because of the presumption of fault and ultimately result in a reduction in litigation and insurance costs.

Queensland’s largest cycling advocacy group, Bicycle Queensland, have come out this week supporting presumed liability laws and calling for their introduction in Queensland. Bicycle Queensland expect that with awareness of presumed liability laws, drivers would exercise greater care on our roads, reducing accidents and making our roads safer.

Those who oppose a shift in the burden of proof note that its application in other countries has not entirely avoided the issues about fault because most (including the Netherlands) still afford the insurer (or the motorist) the right to argue the cyclist is at fault.  

The cyclist just enjoys the very slight benefit of initially having a presumption of innocence until fault is established.

The debate is generally more focused on the civil arena rather than criminal offences of motorists.

It would be difficult to see the law being altered to assume a criminal offence was committed if a motorist was involved in an incident with a cyclist (irrespective of whether the driver had done anything wrong or not).

There are some more minor regulatory offences or even statutory workplace offences where such a position is adopted but there is much to be said, most would argue, for one of the cornerstones of our criminal system being maintained: the presumption of innocence until proven guilty.

We often hear reports of accidents involving cyclists and cars.

The physical injuries are often well-known.

Trauma is the elephant in the room.

The anxiety and mental problems riders face after they are involved in repeated ‘near misses' can be life changing.

In January 2018, over 50 percent of the riders CycleLaw spoke to suffered psychological trauma as a result of an incident involving a motorist.

Emily Billiau said, "The cyclists who I spoke to listed the same anxiety triggers when getting back on the bike. These included the:

These anxiety triggers, if left untreated, can sometimes develop in to more serious mental illness.

The downward spiral often has a devastating impact on the cyclists ability to carry out their job.

You don't have to physically touch a rider to be liable for the mental harm you cause them.

In the meantime, initiatives such as Bicycle Queensland’s incident debrief service is a valuable support resource for cyclists.

If you would like more information on this service, please visit the BQ website here.