A rotator cuff injury can be a major set back for athletes who encounter it.
Whatever sport you may play or activity you participate in, we demand a lot from our shoulder. However, unlike the joints lower down in the body, soft tissue is the main form of support.

There are four muscles that make up the rotator cuff - supraspinatus, infraspinatus, teres minor & subscapularis. Given the size of these 4 muscle the work load which is demanded of them is high. They can be torn due to direct trauma or overuse.

To maintain optimal rotator cuff health there are 2 things which can be done. Range of motion exercises & strengthening.

1) Maintain full Shoulder Range of Motion

Reaching your hand behind your back & slide your hand up your spine & touching the bottom of your shoulder blade
Reaching behind your head and move your hand down your spine between your shoulder blades
Note differences between the 2 shoulders

If there is a difference, stretching can help increase flexibility. A towel stretch can help with this
Place a towel behind your back, one hand holding from the top & the other holding the bottom. Try and walk your fingers together up & down the towel.
Hold for 15 secs then repeat 3 times

2) Strengthening the Rotator Cuff Muscles

Exercises such as internal rotation on a cable machine. Your working hand should be closest to the machine. Rotating your hand from the outside of your body to the inside, bringing your hand towards your stomach.

External rotation on a cable machine.
Move so the arm working in further away from the machine. Keep your arm at 90deg and rotate your hand outwards from your stomach

With carrying out range of motion exercises & also strengthening to the Rotator Cuff muscles the likelihood of a Rotator Cuff injury will decrease.


 
In the average human body there are 360 joints, 206 bones and about 640 muscles. 
No part of your body moves independently, even a small movement requires the help of various muscles and joints. Your muscles are consistently working to keep your body stable and upright. This is generally known as  your posture.

A individual will suffer from postural problems usually due to the result of incorrect alignment or prolonged positions, which can then lead to muscle imbalances. An example of this could be being seated for a large percentage of the day, such as office workers. With time certain muscles will become shortened in length. When a muscle is shorter than the length intended, it not only affects the opposing muscle, which becomes loose and weak, but can have a knock on effect to the entire musculoskeletal system.

Most postural muscle imbalances are due to a sedentary lifestyle. 

The typical office worker will sit for long hours working in front of a computer. Such postural problems could potentially lead to neck pain, headaches, upper back pain, lower back pain &  sciatica. Below are examples of how these occur.

HUNCHED, ROUNDED SHOULDERS & FORWARD HEAD POSTURE:

Due to a lot of us relying on computers, workers are drawn in towards their computer screens, keyboards and mouse’s. As a result the shoulders become more rounded, the back becomes hunched and the head and neck are protruded forward.

When the shoulders are rounded this tends to cause tightness through the chest muscles and the muscles in your upper/ mid back and around your shoulder blades become lengthened and weak. 

Over time these muscle imbalances can cause your spine to become curved with a hunch back posture. This can lead to pain in the back, neck, and in some cases down the arms.

Forward head posture also becomes more pronounced from hunching due to the spinal curve having to compensate. Forward head posture develops from computer use due to the strain to read and see what is on the computer screen. As a result the muscles through the front of the neck and at the base of the skull become tight which can further lead to next pain and an increase in headaches.



SWAY BACK AND PROTRUDING ABDOMEN.

Another common problem from sitting for too long is tight hip flexors due to you having the hips in a flexed position for a prolonged period of time. 

The results of this are: the pelvis rotating forward, the lumbar spine then becomes excessively arched which tightens the lower back and furthermore the abdominal muscles become loose and weak. The primary hip extensors or glut muscles (bum muscles) also become lengthened and weak as a result. 
To compensate for the increase in the lumbar spine spinal curve the thoracic spine becomes more rounded or hunched and forward head posture can develop further.

Sitting for extended periods can also cause chronic hamstring tightness due to the knees being bent for a prolonged periods. There are a few posture problems associated with tight hamstrings. If the hip flexors are tight and the glut muscles are weakened then the hamstrings will become your main hip extensor, which is not its normal role and can therefore not stabilise the pelvis as well during day to day movement. Injuries such as sciatica, disc injuries and lower back pain can occur from this.

EFFECTS OF POOR POSTURE AND BACK PAIN

Poor posture places additional strain and stress on the muscles, ligaments, joints and discs of the back. 

These changes or imbalances are what usually causes back pain. Poor posture is also sometimes due to inherent factors or biomechanical factors (ie. leg length discrepancy).


Hannah Schofield
HS Injury Rehab
 
The achilles tendon is located at the back of the heel. It attaches the muscles located at the back of the lower leg to the heel bone.
An individual who has suffered with achilles tendinopathies (problems to the tendon) is more susceptible to an achilles rupture. An achilles tendon rupture can either be complete or partial.

The achilles can rupture if an individual:
  • Makes a forceful push off with the foot whilst the knee is straightened. For example jumping, landing then pushing off to run
  • A sudden trip or fall and the foot is put in front to break the fall, stretching the tendon
  • Falling from a significant height or suddenly falling into a hole or off a curb 


Signs & Symptoms
An individual may notice the symptoms come on suddenly during a sporting activity. A snap may be heard or the sensation of being kicked in the back of the leg when the tendon is torn. The sharp pain usually settles quickly, although there may be aching at the back of the lower leg. After the injury, the usual symptoms are:
  • A flat footed type of walk. The individual can walk and bear weight, but cannot push of the ground properly on the side where the tendon is ruptured.
  • If the tendon is completely torn, you may feel a gap just above the back of the heel. However, if there is bruising then the swelling may disguise the gap.

Treatment
An achilles rupture should be diagnosed and treated as soon as possible. The individual may need to be referred on to see a doctor. If a ruptured Achilles tendon is suspected, you should not put any weight on that foot, so DO NOT walk on it at all.
There are 2 options for treatment. One being an operation to surgically repair the tendon. The two torn ends of the Achilles tendon are sewn back together, and perhaps may also use another tendon or a tendon graft to help with the repair. A plaster cast or brace is needed after the operation.

The second option is to allow time for the tendon to heal naturally, resting it in a brace or plaster cast. This is called conservative treatment. However, If the tendon does not heal on its own, a surgical repair can then be done later.

Both options will involve having a plaster cast or brace for about eight weeks, to protect the tendon while it heals. The plaster or brace is positioned so that the foot is pointing slightly downwards, this is done to take the strain off the tendon.
There is a trend towards early mobilisation rather than using crutches was traditionally done. This involves fitting a plaster or brace which you can walk on.

The tendon does take time to heal, usually about six to eight weeks. More time will be needed after this to allow the muscles to regain their strength from before the injury and from being in a brace/cast. The time taken to return to sport is between 4 and 12 months.


Hannah Schofield
HS Injury Rehab 
 
Hockey is sport which requires skill, fitness and the ability to make changes in direction quickly.
As a result of this hockey has a high percentage of injuries. 

Some common hockey injuries include:

ACL (anterior cruciate ligament) rupture
The ACL is an important ligament as its funtion is to help stabilise the knee. ACL ruptures are a common hockey injuries, especially in women. The injury occurs when the knee is twisted during a change in direction. The signs of this injury include knee pain, swelling, instability and difficulty walking. A loud pop may also be heard at the time of the injury. Play should be stopped immediately, and apply the RICE principle (Rest, Ice, Compression and Elevation) and seek medical attention as soon as possible.
Rehabilitation with Sports Therapy or Physiotherapy is needed to help return to the hockey field.

Meniscus tears
The menisci are made up of two rings of cartilage located in the knee - the medial meniscus and the lateral meniscus. Their function is to absorb shock. However with constant twisting of the knee pain, swelling, difficulty bearing weight and inability to bend the knee can begin. 
When this happens play should stop the RICE principle should be again be applied and medical help seeked. Again Sports Therapy or Physiotherapy will be needed to help return back to play, but in severe cases surgery may be necessary to correct the issue then continuing onto rehabilitation.

Ankle sprain
This is a very common hockey injury which occurs when the ankle turns over causing the sole of the foot to turn inward. Damage is usually to the ligaments located on the outside of the ankle. Symptoms of an ankle sprain include ankle pain, swelling, stiffness, bruising and an inability to bear weight. Using the RICE principle followed by rehabilitation with a Sports Therapist or Physiotherapist is the best form of treatment.

Hamstring strain
A sudden, sharp pain at the back of the leg while sprinting or quickly changing direction can signal a hamstring strain. Other symptoms include pain while stretching the muscle, swelling and bruising to the area. There are different grades of hamstring strains, the symptoms ranging from mild to severe. In more severe cases, walking is greatly limited and crutches may be used.
The RICE primciple followed by rehabilitation is the best course of treatment.

Groin strain
A tear or rupture to any of the muscles lacated on the inside of the thigh constitutes a groin strain. This type of hockey injury results in groin pain ranging from mild to severe, grade 1 being mild, 2 moderate and 3 severe. Tightness may be felt in the groin area as well as pain when squeezing the legs together. 
In a grade 3 strain, a lump or a gap in the muscle may be felt. Rest and ice along with rehabilitation are whats needed to help return to the sport.


These are just a number of the ways that players can be injured while playing hockey. In many cases, injury can be prevented by warming up properly for the sport. 
Wearing the correct protective equipment help avoiding some of the contusions and fractures that occur in hockey.

Hannah Schofield 
HS Injury Rehab