Frozen shoulder, correctly known as Adhesive Capsulitis, presents as a combination of shoulder pain and stiffness causing sleep disturbance and marked disability.
In a frozen shoulder the capsule surrounding the shoulder joint is more thickened than normal and it shrinks, adhering to the humerus (arm bone) and itself – hence the name adhesive capsulitis. It is associated with inflammation, causing pain followed by scarring, causing stiffness.
Clinical features of frozen shoulder
Gradual onset of arm pain.
Unable to lie on affected side.
Restriction of movements, usually into elevation and outward rotation.
Diagnosed by a thorough shoulder examination.
X-rays may rule out other causes of shoulder pain but are unable to diagnose a frozen shoulder.
Runs a distinct course which can be broken into 4 phases or simply “pain-predominant” and “stiffness-predominant”. Phases of frozen shoulder
Phase 1: Usually pain.
Phase 2: Increasing pain and increasing stiffness but still predominantly pain.
Phase 3: Pain abates, leaving stiffness.
Phase 4: Resolution, usually by 2 years.
Who gets frozen shoulder?
Mostly occurs between ages 40 and 60 years.
More common in women and diabetics.
Often appears for no apparent reason but can stem from an injury to the shoulder or following shoulder surgery.
20% of patients will develop it in the other shoulder in the future but almost never occurs again in the same shoulder. Common shoulder problems
Unable to: Reach above shoulder height
Throw a ball
Quickly reach for something
Reach behind your back e.g. doing up bra, tucking in shirt
Reach out to the side and behind e.g. reaching for seat belt
Sleep on your side How can physiotherapy help?
Although a frozen shoulder is generally self-limiting, the aim of physiotherapy is to keep the shoulder joint as pain free and mobile as possible. Physiotherapy may also help reduce the time taken to move through each phase.
Phase 1 & 2- pain relieving techniques such as gentle mobilisation, muscle releases, dry needling, taping.
Phase 3- shoulder joint mobilisation and stretches, muscle release techniques, dry needling and exercises to regain range and strength. Treatment should not be too aggressive.
Phase 4- shoulder mobilisation and stretches followed by strength exercises to control and maintain the returning range of movement.
If there is one thing worth mastering to avoid injury it is the art of lifting. Setting yourself up correctly before attempting to lift something will keep you injury free. To achieve this it is best to practice the movements as an exercise to train the body so that correct posture and execution become second nature. The suitability of the pick up options below will depend on your physical condition so it is important to pick the right technique for the right situation.
The Golf pickup for lifting
Suitable for light items that can be picked up with one hand only. Saves on the effort of a squat for picking up something small like a pencil. Be sure to use your leg to counter
balance your weight. This technique is great for those who have some degree of stability and flexibility. Using a prop such as a chair, wall or table to stabilise yourself is also a good idea. The Squat for lifting
A squat is something we often do without paying much notice to how well it is being performed. For those who lift items as part of their job, the squat is an integral part of manual handling duties.
As an exercise it is particularly good for your legs and one of the best to develop leg strength, working the kinetic link from the ankles all the way up to the hip. Stronger legs also offer greater support for the back, as performing better squat technique helps maintain correct spinal control.
So as well as strengthening our legs the squat exercise is also working our spine. As such the back should stay straight whilst the hips do the bending.
To performing a correct squat it is important to have the correct equal bend though our hip and our knees, making sure that the level of our knees is in line with but behind the level of our toes. Lowering yourself enough to create a ninety degree angle through both hip and knee, sticking the bottom down and back, plus maintaining a neutral position through the back is essential.
The Lunge for lifting
Whereas the squat offers a wide base of support and a higher power output for lifting, the lunge in contrast requires greater balance and is better for lifting smaller items.
The lunge is more like a variation of the squat. It works the same muscles but in a different way, challenging balance and control with an uneven load. Rather than both legs taking an equal load the front leg is working a lot harder to keep the body stable. The same posture principles of a squat apply, so ensure that there is an equal ninety degree bend through the hip and the knee whilst keeping your back straight. Remember when lunging it is important for the front knee not to go past the level of the front foot toes. In order to get down far enough the back heel will need to come up. When completing the lunge be sure to go down as far as is comfortable.
Remember that the co-ordination involved in performing these techniques for lifting and the use of momentum will lessen the need for isolated muscular strength and aid injury prevention. Also by switching on your core stabilising muscles on before doing any of these movements you will have greater control over the movement.
By doing a mixture of squats, lunges and golf lifts you will benefit from working a variety of muscles in different ways. Also if you happen to acquire an injury then having options as to how you pick something up will better enable you to rely on other muscles whilst the injured area recovers.
Incorporating these exercises into a routine and performing them correctly, will ensure that when you do need to use them in a practical manner throughout the day, that you are moving correctly.
The Instituto de Biomecánica (Biomechanics Institute-IBV) has developed SUNfeet, insoles which are customized to the anatomy of the user’s foot, which increase the comfort of footwear and reduce pain and fatigue in the feet. This product is now available in Europe.
These insoles display an innovative technology used in their development: a combination of a system for capturing and digitizing the shape of the foot which is easy and intuitive for the user via smartphone and a 3-D printing system which allows insoles to be manufactured in a totally personalized manner.
SUNfeet arose from the idea of combining the latest trends in health, technology and fashion to develop exclusive insoles which make footwear more comfortable and care for the feet, thus promoting an active lifestyle.
The SUNfeet smartphone app was designed for the 3Dcapture system, making it possible to obtain the shape of the foot extremely accurately and conveniently from any location.
The process is very simple: while seated, the user places the bare foot on one side of a sheet of paper. The app itself will guide him/her until three images of each foot are obtained. The files are then sent to a server which reconstructs the foot in 3-D, using pattern recognition and shape analysis algorithms. The 3-D image of the foot can be displayed on screen in less than one minute. Finally, the system assigns a unique identification code to each image, which will subsequently be used to design the customized insole.
At the same time, this technology is also present in the manufacturing process through 3-D printing, opening the way for more creative designs and the customization of the functional properties of resistance and flexibility, adapting them to the specific needs of each user and activity.
The power and precision of SUNfeet technology allow for optimal customization: not only are the insoles adapted to the anatomy of the foot, but also to the characteristics and lifestyle of each user. With this in mind, three different models of insole have been created (Sports, Casual and Elegant), taking into account the type of activity and the characteristics of the footwear in order to select the most suitable materials and thicknesses. Thus, the impact cushioning, energy return and pressure distribution requirements are adapted to each use and to the characteristics of each individual.
The Instituto de Biomecánica (Biomechanics Institute — IBV) has introduced, as part of the Science Museum “Príncipe Felipe” of Valencia, this SUNfeet technology, incorporated as a new module of the exhibition “We Take Care About Your Quality of Life.”
IBV director, Javier Sánchez Lacuesta, reminded those present that “this exhibition -promoted by CVIDA association- was developed by IBV in collaboration with the Science Museum and opened in October 2007 in order to make available to the citizen technologies, products and services that take care of their health and wellbeing. This is an interactive show in which the visitor can check their skills in different environments and attractions.”
The foot care is essential to reduce hassles that come to limit the way of life. Using comfort insoles helps keep feet healthy during daily activity. SUNfeet combines a precise system of capturing and digitizing the foot and a 3D printing system that allows develop fully customized insoles.
The user can select the insole that best suits his lifestyle: Casual insoles for continued use shoes that achieve comfort and reduce foot fatigue; Elegant insoles that fit with most elegant and formal shoes; and Sports insoles that improve performance and help to prevent injuries.
Juan Carlos Gonzalez, IBV Clothing Director, showed attendees the performance of this system, highlighting the ease of use, accuracy when carrying out the capture of the foot and versatility of the system that allows getting perfectly tailored insoles to the needs and characteristics of the user and the function to which they are intended.
Asociación RUVID. “SUNfeet technology for the customization of comfort insoles using a smartphone.” ScienceDaily. ScienceDaily, 19 October 2015. <www.sciencedaily.com/releases/2015/10/151019072208.htm>.