Our Physio

Our Physio

Tuesday, 26 March 2013

Always believe in continuous professional development, because it is essential to keep the profession to improve and move forward, in order to provide better service to the public.

Time passed by so fast, and we closed the calendar of 2012, yet I managed to attend 2 interesting workshop which were so interesting and will like to summarised what I had learn in these 2 workshop.

Shoulder instability and impingement

Presented by : Mr Wayne Rodger

Date: 30-31 May 2012

Venue: Singapore

Shoulder pain syndrome are very common in racket games such as badminton, squash, and overhead throwing movement e.g, baseball, basketball, handball etc. I always think that shoulder joint is the most complicated joint, and treatment take very long time. That why I intended to attend the shoulder joint cause, to sharpen my knowledge on this condition.

Mr Rodger presented a very detail and clear explanation on shoulder problem especially shoulder impingement syndrome.


First of all, to understand in detail what is the structure that provide stability to a shoulder joint, he divided it into 4 types
Global muscles – the muscle surrounding the shoulder joint, which provide the shoulder’s contour ( humeral torque) and it is for power production.

Dynamic stabilisers – this is another group of muscle which is to provide the shoulder’s dynamic stability and the major group of the muscles are the shoulder’s rotator cuff. Also must not forget the scapular ( shoulder blade) stability muscle which is equally important as a ‘foundation’ of the shoulder joint.

Passive controls – these are a group of soft tissue which attach the glenoid and humeral head ( the socket and the ball of the shoulder), which are the capsule and ligament surrounding the shoulder joint.

Osteological features or bony structure of the shoulder joint. – the shoulder joint is consist of a ball (humeral head) and a socket (glenoid fossa). The concave surface of the glenoid fossa provided a vacuum kind of suction, to suck the humeral head in position, and subsequently, the passive support from the shoulder ligament, capsule, labrum further increase the attachment and the stability of the shoulder joint.
Shoulder impingement syndrome, simple to say is the condition whereby there are some soft tissue ( commonly rotator cuff tendon or subacromial bursa) being pinched by the bony structure of the glenoid fossa and humeral head, and when there is up to certain extent that there will be a rotator cuff tear after prolong pinching of the tendon.

Most of the time, we are too concentrate on the injury part, and as usual as a physiotherapist, we will try to speed up the healing of the torn tendon by providing the patient some electro therapy e.g ultrasound, TENS, but forget to look for the reason behind the injury, and resulting in ineffective treatment.

Mr Wayne Rodger emphasis a lot on the stability on the shoulder joint, as well as the scapular (shoulder blade) stability.
We cannot change the passive support or the bony structure of the shoulder joint, but we can do something over the dynamic support of the shoulder joint and scapular.
Picture above showing the relationship of the scapular towards the head of shoulder joint. At the end of one of the scapular angle ( the triangle bone ) which will become the concave surface of the shoulder joint or glenoid fossa that will later attach with the head of the humeral bone ( upper arm bone) and formed shoulder joint.
The arrow above showing the muscles surrounding the scapular and imagine that, if one of the muscle either tight, or weak, it will amend the position of the scapular bone, as well as the position of the glenoid fossa on the humeral head position, and the dynamic function of the shoulder joint will change, causing some shoulder structure under stress, and resulting in " overuse" injury.

The above 2 pictures indicate the normal shoulder level with good alignment of both side of scapular, and the picture on the R showing the different height of shoulder level, with higher possibility of the muscle imbalance among scapular stability muscle( of course there will be some other reason that causing the indifference of shoulder level such as scoliosis of the thorax spine, which is beyond our discussion.)

So, to improve the muscle imbalance, we need to strengthen the weak or lengthen muscle, stretch or relax the tight muscle. When the dynamic support are improved, so will be the quality of the shoulder joint movement.

During the workshop, we were taught on the specific exercises on strengthening the weak muscle and the way to relax the tight muscle, even with self massage with massage ball.

I did learn a lot from the 2 days workshop, and now, I improved my skill in analysing of the shoulder joint assessment, which helps in my clinical decision on the treatment for patients who suffer from shoulder problem.

I will praise the workshop as five stars, cause I found that my knowledge and my management on shoulder pain is improved after since the meet up with Mr Roger.

Did you see any difference in between the 2 shoulder blade when this young man performed the activity by pulling apart the elastic band?

R shoulder level higher than L side, with the shoulder blade shift more laterally( away from midline, body twisted to Right side more than L side, what is the muscles that is not working well to maintain the shoulder blade(scapular) in centre?

Dry Needling

Presented by  : Mr Lau


Venue : Island Hospital, Penang

Dry needling using IMS (intramuscular stimulation) concept. IMS is a type of "dry needling" method using western medicine's understanding of neurophysiology of pain and it is founded by Dr Chan Gunn. He introduced an assessment techniques of identifying underlying muscles which have nerve irritation to treat chronic pain issues.

It is different from the Traditional Chinese acupuncture which focuses on the pre-mapped out points on the body (or so call acupuncture points) and meridians of energy running through the body.

IMS is widely used in western world and most of the person who practice these technique will professional such as physiotherapists and doctors, who have proper training in the human anatomy, recognise the muscles of the human body. Most of the time, the practitioner will look for abnormal ‘feeling’ over the body muscle, e.g a taut band over the muscle. When the needle is applied or insert into a taut band of the muscle ( a trigger point which having hyperactivity of the muscle fiber), sometimes, patient will feel a twitch over the muscle, and the needling point can be very sore.

Commonly patient complained of tired or sleepy, and the muscle will be sore as those as they just finished doing a session of vigorous exercise.

During the course, we were introduced on variable muscles which can be effective in applying needles. The workshop was a practical workshop, and of course, during the workshop, you will not miss the voice of 'ouch' 'ah'.... but, majority of the apprentice, enjoyed being needle.
Some muscle which I’ve never learn to needle were introduced by Mr Lau and will be much helpful in improving by dry needling skill.




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  6. Is dry needling a part of basic physiotherapy? Because I am starting physiotherapy in Mississauga next week but I feel a little weary of the needles. Is that something I should bring up with my doctor before I start?

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