What is the labrum of the shoulder?
 
The shoulder is a remarkably mobile joint, however this flexibility comes with the cost of less stability. The glenohumeral joint, where the upper arm meets with the shoulder blade is a ball and socket type joint. The surface area of the ‘socket’ part of the joint (the glenoid fossa) is much smaller than the ball part of the joint (the head of the humerus). A fibro-cartilaginous ring called a labrum surrounds the edge of the glenoid fossa which acts to increase both the depth and width of the fossa. 
 
This labrum provides increased stability and is also the attachment for a part of the biceps muscle via a long tendon. The labrum can provide flexibility and stability that a larger glenoid fossa might not be able to, however being a soft structure it is prone to tearing which can be problematic. 

​What causes the labrum to tear?
 
The most common way the labrum is torn is through a fall onto an outstretched arm or through repetitive overhead activities such as throwing or painting, as the repeated stress on the labrum can cause it to weaken and tear. 
 
Suspected labral tears can be diagnosed in a clinic by your physiotherapist through a series of tests, however, an MRI is usually required to fully confirm the presence of a labral tear. Labral tears are classified into different grades, which are determined by their location and severity. This grading is used as a guide to help determine the correct treatment. 
 
What are the symptoms of a labral tear?
 
A labral tear is often associated with other injuries, such as a rotator cuff tear, which can make the clinical picture a little confusing. Commonly there will be pain in the shoulder that is difficult to pinpoint and the pain will be aggravated by overhead and behind the back activities.
 
 Severe labral tears can lead to instability and can also be related to dislocations of the shoulder. 
 
How Can Physiotherapy Help?
 
The severity and grade of the labral tear will guide treatment. Smaller tears can be treated with physiotherapy that is aimed at increasing strength and control of the shoulder. Other tears may require surgical repair after which physiotherapy is an important part of treatment to rehabilitate the shoulder.  

A serious injury of the knee is a tearing of the ACL (Anterior Cruciate Ligament). This ligament is  important for stability of the knee and may need to be repaired surgically. The primary function of the ACL is to keep the bottom surface of the knee joint from sliding forwards during movement. An unrepaired knee may feel unstable or give way suddenly.
 
Not all ACL injuries require surgery and some may heal well with proper rehabilitation, however for those who do need surgery, there is a significant rehabilitation period afterwards.

What does the surgery consist of?
 
Each surgeon will have a slightly different technique for surgery. The most common approach is the arthroscopic approach, which uses a small camera and allows the surgeon to make only small incisions into the knee. They will then replace the torn ligament with either a graft from a tendon or ligament at another part of the body or using a synthetic graft.
 
How long does rehabilitation take?
 
Full rehabilitation following surgery can take 9 to 12 months and is divided into different stages. As surgeons can have different protocols for their approaches to surgery, time frames will vary for everyone. 
 
Initially after surgery, the graft will be quite weak while a new blood supply is being established. It can take up to 12 weeks before the graft is at its strongest point and evidence suggests that it may never have the strength of the original ligament.
 
In the early stages, rehabilitation will be focused on restoring movement to the joint and strengthening the muscles around the knee without putting any undue stress on the graft.
 
As the graft begins to heal and strengthen, rehabilitation can progress to include stability and control exercises and gradually build up to a complex program that prepares the knee for a full return to sport.
 
The path to full rehabilitation from a knee reconstruction can be a long and bumpy one, however, there are high success rates with this surgery, particularly when followed up with full physiotherapy rehabilitation.

Your physiotherapist has a wide variety of skills and can help you with so much more than just pain and injury. Here are a few reasons to visit your physiotherapist that can keep you healthy and pain-free, before injury strikes...

Stiffness and Inflexibility
 
Almost all of us have experienced pain and stiffness after a day of increased or unaccustomed exercise. This kind of stiffness usually wears off quickly and is referred to as DOMS (delayed onset muscles soreness). However, if you find yourself feeling stiff for more extended periods, or even most of the time – it might be time to see a physio. There are many different causes of stiffness and inflexibility. By far the most common is lack of movement. Our joints and muscles both lose flexibility if not moved through their range regularly. Muscle stiffness can feel like a tightness with a bouncy feeling of restriction, and joint stiffness can create a harder ‘blocked’ feeling when you try to move. 
 
When it comes to stiffness that evolves from lack of movement, you may not even notice that you have lost range, as it can be easy to adapt your movements to compensate. Your physiotherapist can help you to identify where you have areas of inflexibility and help you to exercise, stretch and mobilise your joints to get them back to a healthy range. Disease processes such as osteoarthritis and rheumatoid arthritis can also cause prolonged stiffness, and your physiotherapist is well equipped to help you deal with these conditions. 
 
Reduced Strength or Weakness
 
There are many possible reasons for weakness in the body, from generalised disuse, weakness in one muscle group following an injury, neurological weakness or structural weakness of joint following a ligament tear. Musculoskeletal deficiency of any kind can predispose you to future injuries and are difficult to resolve without targeted exercises. Your physio can determine the cause of your weakness and prescibe the best treatment to restore your strength. 
 
Reduced Balance
 
Keeping your balance is a complicated process and your body works hard to make sure you stay on your feet. Humans have a small base of support for our height and we use all our senses together to determine which movements we should make to stay upright, including our visual, vestibular, muscular and sensory systems. As balance is essential for walking, if one system that supports our balance begins to weaken, the others will quickly compensate, so you may not notice that your balance has worsened until you fall or trip over unexpectedly. 
 
As a general rule balance deteriorates as we get older, but this doesn't mean that falling should be an inevitable part of aging. Actively working to maintain or improve your balance can have a significant effect on your quality of life and confidence in getting around. Your physiotherapist is able to test all aspects of your balance and provide effective rehabilitation to help keep you on your feet.

Chronic ankle instability, as the name implies, is a chronic condition of instability affecting the ankle and it’s surrounding structures. It usually develops after a severe ankle sprain. However, some people are born with less stable ankles and these individuals are generally extra flexible throughout their bodies. Approximately 20% of ankle sprains lead to chronic ankle instability due to the resulting changes in ligament support, strength, postural control, muscle reaction time and sensation. 

What are the symptoms?

As well as being more susceptible to ankle sprains, people with chronic ankle instability may notice they feel cautious during high-intensity activities, running on uneven surfaces or when changing directions quickly. They may experience a sense of weakness or frequent ‘giving way’ around their ankle.

What are the causes?

The primary causes of this condition are ligament laxity, decreased muscle strength of the muscles surrounding the ankle and reduced proprioception. 

Following an ankle sprain, ligaments can be stretched and slightly looser than they were. In severe cases, they may have torn altogether, leaving the ankle less structurally sound. Without full rehabilitation, the surrounding muscles also become weaker and studies have shown that balance and sensation of the ankle can also be reduced. This means that the ankle is more likely to be injured again, creating a cycle of recurrent injuries, leading to further instability.

How can physiotherapy help?

Physiotherapy treatment for chronic ankle instability focuses on improving strength, control and balance with a variety of techniques and exercises. This approach can significantly improve ankle stability and reduce the risk of future sprains. Physiotherapists can help patients to regain confidence and get back to their best performance. 

In some cases, braces for support can be used. However, this can lead to dependence and further loss of strength and control if used unnecessarily. In cases of extreme ligament laxity or if physiotherapy fails, surgery to repair the damaged ligaments is considered. This is usually combined with a full physiotherapy rehabilitation program for greatest success.

If you don’t feel 100% confident with your ankle, come and have a chat with one of our physiotherapists to see if we can help improve your ankle stability.

Why are ankles particularly vulnerable to injuries related to poor balance?
 
Our ankles have to support our entire body weight when standing on one foot. To provide us with agility as well as stability, our ankles have the ability to move from side to side as well as backwards and forwards. There is a complicated process constantly operating to keep your foot in the correct position while supporting all this weight, particularly with quick changes of direction, activities done on tiptoes, jumping and landing.
 
If the ankle rolls excessively inwards, the ligaments on the outside of the ankle can be damaged and torn. Balance is an important part of keeping the ankle in the correct alignment and not twisting too far to either side during challenging activities.
 
A study of high school basketball players  by Timothy McGuine et al. in 2010 showed that students with poor balance were up to seven times more likely to sprain their ankle than students with good balance. Other studies have shown that balance training is an effective way of preventing falls in elderly populations.
 
Balance can vary from one leg to the other.
 
Most of us tend to favour one side of our body for all activities. This is more obvious in the upper body, with most of us identifying as either left or right handed. The same is also true for our lower body, with each of us favouring one leg over the other for balance activities. This can mean that one leg has better balance and strength than the other, leaving one leg more vulnerable to injury.
 
Reduced balance can mean your body has to work harder to perform activities, with muscles activating in a less coordinated way. Improving your balance can also improve your body’s efficiency of movement, which can, in turn, improve your overall performance without actually improving your muscle strength.
  
Balance can be trained rapidly.
 
Balance is one of the most overlooked dimensions of physical health however, the good news is that it can be improved relatively quickly. Do a quick check to see if you can stand on each leg for two minutes with your eyes closed. If this is difficult you might find that improving your balance is a great next step in your training program.
 
Your physiotherapist is able to identify any deficits in your balance is and is able to develop a training program for you to improve it. Come and see us for an appointment to see how we can help.​