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I am suffering from frozen shoulder. How is it treated?
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Question :

Hey Physio, a month ago I was on the escalator when another passenger’s luggage cart fell down and the luggage managed to clip me on my left shoulder. At the time I only felt a little pain and weakness and assumed it was just a small accident. It’s been almost two weeks I’m still feeling the pain and shoulder weakness! Is this a frozen shoulder that I have? How is it treated? I would be very grateful of your reply!

Answer :

From your description of symptoms, you may not necessarily be suffering from frozen shoulder (also known as Adhesive Capsulitis). Frozen shoulder generally begins with a gradual increase of pain and with this, a loss of range of motion in the joint. As the condition worsens, generally pain will subside and mainly the stiffness remains – hence the name “Frozen shoulder”. There are a variety of other syndromes and disorders that may produce similar signs and symptoms. Therefore, the shoulder must be tested through a range of activities to find out pain location and movement restriction for an accurate diagnosis.
From the mechanism of injury, a structure(s) within the shoulder may have been sprained – this may have been muscle, ligament, tendon, or even the joint capsule. Initially an inflammatory response would have been induced for the first day/couple days. After the inflammatory process, soft tissue injuries continue their healing process however without the proper treatment and management, there is often a lack of flexibility, causing pain and fatigue during activity, as well as an increased chance of re-injury.
In physical therapy perspective, the general anti-inflammatory and analgesic treatment guidelines based mainly physical therapist will then be extended, for the relevant activities of organizations such as tendons, joint capsule, and finally to the movement to strengthen the muscle strength and consolidation therapy effect. Only soft tissue injuries such as shoulder inflammation, will feature therapy, exercise and home care, usually 6-8 times to treat the condition can be greatly improved. If the condition is too long, the treatment time will be longer.
In a physiotherapy treatment perspective, the initial treatment would include anti-inflammatory and analgesic treatment. This would be followed by a gradual prescription of exercises focusing on improving flexibility and enhancing healing of the tissues, as well as strengthening relevant muscles to prevent re-injury. A course of physiotherapy treatment generally lasts between six to eight sessions. Unfortunately, holding off from treatment often results in either or both of two things – 1. Secondary issues arise from mismanagement, 2. Re-injury to the currently damaged and weakened structures; both of which result in a longer and more difficult prognosis.

I am suffering from back pain. Should I take an X-ray to see why there’s pain?
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Question :

I am suffering from back pain. Should I take an X-ray to see why there’s pain?

Answer :

Most mechanical low back pain (pain caused by a specific posture or movement) is generated by a structure that doesn’t show up on an X-ray. The possible scenarios of requiring an X-ray may be: after a heavy trauma, if there is no change in the condition after a course of treatment, or if there are any suspicious circumstances requiring further investigation. It is therefore always recommended that a health care professional should examine the situation before any radiographic reports are taken.

Is sciatica caused by a shift in my intervertebral disc? How long does this normally take to heal up?
Question :

Just the day before yesterday, I suddenly felt this left foot numbness – I wasn’t able to feel any heat or cold and there was this feeling of pressure throughout the whole leg. From what my friends have told me, it sounds like it’d be a nerve compression by the intervertebral disc. How long does this take to get better?

Answer :

There are many causes of leg paralysis, and waist intervertebral disc (ie cartilage shift) is one of the common causes leading to sciatica, but in conjunction with other clinical examination in order to make the correct diagnosis. You have both hot and cold did not feel the pain, the situation of non-light, please consult a doctor promptly. I suggest look at the orthopedic surgeon, and then sub-mediated doing physical cure. If your diagnosis is the disc, most patients can recover.


There are many causes of leg parenthesis, one of the most popular being what you’ve just mentioned, the intervertebral disc compressing onto one of the nerve roots, leading to sciatica. However, this requires a proper clinical examination to make a correct diagnosis. You have numbness of the leg and you can’t feel heat or cold, quite a severe case of parenthesis. Do not treat this lightly. I would suggest a review from your local family doctor, or if you can, an orthopedic specialist doctor. If your diagnosis is stemming from the intervertebral disc, physiotherapy is beneficial and most patients can recover.

Is the bone spurs causing my back pain and will it ever heal up?
Question :

An X-ray of my lumbar spine shows a couple segments with bone spurs. Are the bone spurs causing my pain? Is physiotherapy useful in this case? Will these bone spurs disappear?

Answer :

Bone spurs show up in areas of overuse and degeneration. All the bones of the body are simultaneously being constructed and deconstructed at the same rate. A bone spur in the lumbar spine is essentially when the rate of bone formation overtakes the rate of bone deconstruction as the body’s reaction to prolonged pressure in the lumbar region. This may be due to incorrect posture, incorrect walking technique or other movement patterns, constant bending, and constant lifting heavy objects.


The existence of the spur in itself is not painful; in fact it’s a common phenomenon found in the aging process. There are many cases where bone spurs have shown up in the human body unaccompanied by pain. What may cause pain is the spur oppressing the space around it, compressing other soft tissues – such as tendons, muscles, nerves, joints. This can cause inflammation producing pain or impede on joint activity causing stiffness and possible pain as well. The spur itself can not disappear with conservative treatment or medication – the only option is surgical removal, however there are very few cases in which this is required. What a bone spur does prompt is a release in the pressure of the region. This is done by a combination of different physiotherapy treatment tools including reducing inflammation, releasing the tightened soft tissue structures, and very importantly correcting postural factors and other causing factors to prevent irritation and further formation of the spur.

Can bone spurs put pressure on nerves, leading to paralysis?
Question :

It’s been about two weeks that my sister’s felt half her body lose sensation – hands, feet, the face, the tongue. She saw a doctor who referred her to do a neck X-ray, MRI of the head, however they didn’t find anything abnormal.
 

I heard a friend who said it could be because of a bone spur pressing onto the nerves, giving her all those symptoms.  Is this possibly the case?

Answer :

Thank you for your inquiry. To find out whether your sister has bone spurs, we have to look at the X-rays in order to determine this. X-rays show the bony outline, so any degeneration, osteoarthritis or other bone abnormalities would generally be picked up in the X-ray. If any of these irregularities are found then yes, they have the opportunity to press onto the cervical spinal cord or spinal nerves, causing the current symptoms she is feeling.


At this stage, it is most important to rule out whether there is a cerebrovascular disease and pin point the cause. You may consider looking for an orthopedic specialist to make a detailed examination of the cervical spine. If the cause is definitely due to an issue in the cervical spine, you may be referred to do physiotherapy.

My back pain has recently come back. Is this because I haven’t rested it enough? Does it need more time to heal up?
Question :

I am twenty years old this year. At the end of July I accidentally slipped whilst going up the stairs and fell, hurting my back on the way down. I went to the hospital emergency department and had an X-ray which showed no fracture.

 

The doctors diagnosed it as soft tissue damage and sent me off with painkillers, cream and advised some rest. They said it should all get better by itself within a month.

 

It’s been a month now and the pain has definitely improved, however it’s gone from the sharp, intense pain to a tight and aching pain. It’s been like this for the past week and seems like it’s not improving any more. What may be the possible reason for this?

Answer :

Thank you for your inquiry. From what it sounds, the inflammation from the initial damage has subsided, however complete healing hasn’t occurred. With complete healing comes restoration to the flexibility of the soft tissue, and strength of the soft tissue – especially muscular structures. Currently it’s still at the stage where it’s susceptible to pain when the flexibility or the strength is challenged – such as being placed in a poor posture where it stretches the involved structures, or constant bending where the structure has been weakened.


We recommend that patients recovering from back injury should pay close attention to posture, lifting methods (especially with jobs that require labor), take proper rest and management strategies, and also begin a back rehabilitation program to enhance strength and stretch out the tight areas. These are all done for a full recovery and to reduce the chance of recurrence. Physiotherapy will be key to providing you the details for postural correction and performing tasks in a safe manner, as well as forming a tailor made rehabilitation program to target exactly what it is that you need to get back to your healthy self.