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Why Do My Shoulders Hurt?

Have you ever felt a pop or pain in your shoulder while stretching to grab an item behind you? Do you feel pain in your shoulders when you lift your arms above your head? These may be symptoms of injury around the tendons of the shoulder known as Rotator Cuff Syndrome.

The shoulder is a very mobile joint and gets its stability from the muscles and tendons arranged in a cup or cuff-like manner, around the joint. These structures may be injured from sudden movement that tears the tendon, as seen when you lift a heavy item or overuse from repetitive, overhead activity as seen in painting, carpentry, playing tennis or volleyball.
Some people get rotator cuff injury even without having an aggravating factor and they are found to have weakness or poor control of the muscles around the shoulder.

What are the symptoms of Rotator Cuff Syndrome?

The pain is felt in front of the shoulder and often radiates down into the mid-arm and worsens whenever the person reaches overhead. If this injury is left untreated, the pain may be felt while at rest. The person may experience decreased range of motion in the shoulder especially when lifting the arm.

How do I treat my shoulder pain?

The treatment of rotator cuff injury is dependent on the severity of the injury and it is aimed at controlling the inflammation in the tendons and restoring the range of motion and strength so that you can improve the function of your shoulder.

An ice pack can be applied as soon as the injury occurs. It can be applied for fifteen minutes. You can make your own ice pack by putting ice cubicles in a plastic bag and then wrap the plastic bag in a towel to prevent skin irritation from the ice directly placed on your skin. Icing can be done 3- 4 times per day.

Over-the-counter, anti-inflammatory medication such as ibuprofen or naproxen can be taken with food for short periods.

Basic Exercise for Shoulder Pain

  • Pendulum Exercise

A basic exercise program may begin with pendulum exercise.

This is done by leaning forward and allowing the affected shoulder and arm to hang down freely. Start by rotating your arm in small circles, in one direction then switch direction.

Count to 10 each time. Start with very small circles and increase the size of the circle every day as the pain improves until you can make a large circle without pain.

  • Wall Crawl

Another exercise that you can try for treating your shoulder pain is to use your fingers to crawl up a wall. Crawl as far up as you can get without pain and as the pain improves, try to crawl higher each day.

  • Glass Wipe

Hold a soft cloth in your hand, stand in front of a large mirror or glass, even a wall with a smooth surface. Bend your elbow and raise your hand to your eye level, start by wiping a small area in one direction and then change direction. As your pain improves over time, increase the size of the circle.

If the pain persists, a doctor will recommend therapy where ultrasound and other treatments are added. In some cases, a steroid injection around the shoulder in the inflamed area may be necessary.

Surgery may be necessary if the pain persists even with treatment or if there is a complete tear of the tendon.

Avoid aggravating activities during shoulder rehabilitation and comply with a home exercise program to improve and resolve your shoulder pain.

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The Launch of the Haemophilia Society of Jamaica

On Sunday, October 22, our Medical Director, Dr. Paula Dawson was a presenter at the launch of the Haemophilia Society of Jamaica at the Courtyard Marriott Hotel in Kingston, Jamaica. She spoke on the role of the physiatrist in the treatment program for Haemophiiacs.

 

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Rehab Caribbean’s Second Public Lecture- Non-Surgical Treatment for Lower Back Pain

On Wednesday, October 25, the Rehabilitation Institute of the Caribbean hosted its second public lecture entitled, “Non-Surgical Treatment for Lower Back Pain”. The presenters – Medical Director and Jamaica’s only US-Board Certified Physiatrist, Dr. Paula Dawson; Doctor of Physical Therapy, Dr. Norell-Lee Morrison Ramsay; and our distinguished guest speaker, Women’s Health Specialist, Dr. Bernadette Frankson delivered exceptional presentations. The event was sponsored by Pfizer.

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A Five-Step Guide for Treating Knee Pain

Knee pain affects persons of all ages; young and old. Incidentally, it is one of the most common musculoskeletal complaints made by patients. The knee joint’s main function is to bend and straighten for moving the leg. In order to perform these actions and support the entire body, the knee relies on a number of structures including bones, ligaments, tendons and cartilage that can easily be damaged.

What are the common causes of knee pain?

The common causes of knee pain include strained or torn ligaments or tendons around the knee, meniscal tear (which usually occurs when twisting or turning quickly or with the foot planted while the knee is bent); Patellofemoral Syndrome or maltracking syndrome (a condition characterized by severe to mild pain originating from the kneecap); dislocating knee cap; gout; trauma; bone abnormalities and fracture.

Groups at Risk

People who are most at risk of knee pain include individuals with weak muscles (quadriceps) around the knee, runners and other athletes who do not secure the kneecap properly before bending or extending the knee; the elderly with arthritis and people recovering from a slip and fall, car accident and other trauma to the knee.

Treatment

The recommended treatment for knee pain is dependent on the cause of the pain. The first line of treatment for sudden onset of knee pain due to trauma or other acute causes can be recalled using this acronym: PRICE.

P- Protect the knee using a brace, bandage or crutches to prevent any further injury.

R- Relative rest because prolonged immobility can lead to loss of muscle strength and further weakness in the muscle.

I-Ice which should be done at 15 minutes intervals with 5 minutes rest, and repeated 3-5 times, to control swelling and reduce the pain.

C- Compression with a bandage which can also control swelling. Be sure not to bandage the knee too tight as this may lead to further pain, difficulty bending the knee and slow blood flow.

E- Elevation which will reduce swelling by allowing the excess fluid to flow back into the blood stream.

Mild to moderate cases of arthritis usually respond well to an effective therapy program and a few cases will need injection with medication to control inflammatory or regenerate the injured structures in knee. A lubricating injection is appropriate in other cases.

Surgery is necessary in severe cases.

Knee rehabilitation with a home exercise program may be essential for recovery.

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SCOPE: “My Journey as a…Physiatrist” Presentation

Our Medical Director, Dr. Paula Dawson was the guest presenter at the first staging of SCOPE “My Journey As A…” career in medicine series held at the Faculty of Medical Sciences Teaching & Research Complex on the University of the West Indies Mona Campus.

The session, organised by a professional development committee within the Jamaican Medical Students Association, focused on Dr. Dawson’s journey to becoming Jamaica’s only US Board-certified Physiatrist. Dr. Dawson recalled her academic journey and shared insights into the field of Physiatry, complimented with a few anecdotes from her many years of experience.

According to Local Exchange Officer of SCOPE, Vikram Asnani, “we also asked her to specially highlight the importance of being a professional in her everyday life, and to give guidance on how she has honed her professional skills.”

More information on SCOPE

The Standing Committee on Professional Exchange (SCOPE) has launched a “My Journey As A…” series where professionals from different areas of medicine facilitate an engaging session with the UWI Mona medical student cohort. SCOPE, operated through the International Federation of Medical Students Associations (IFMSA), is a student-run organisation that facilitates the global exchange of medical students, thereby promoting cultural and intellectual understanding of different medical systems. SCOPE’s primary mandate is to offer educational programs including electives/clerkships to medical students worldwide.

 

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How do you know your child has Cerebral Palsy?

Cerebral Palsy is a collection of syndromes characterized by disorders of movement and posture caused by non-progressive injury to the immature brain. This condition occurs when the area of the brain that controls movement has been damaged close to the time of birth or early in the child’s life. Therefore, some children are born with the condition (congenital) or the symptoms may develop after birth (acquired).

Is My Baby At Risk?

The main risk factors for cerebral palsy (CP) that occur before or at the time of birth include; low birth weight especially babies who weigh less than 5 pounds or 2500 grams, decreased oxygen to the baby during the delivery called perinatal hypoxia even in babies delivered at full term; and maternal problems such as certain infections while pregnancy e.g. Rubella, German measles, Chicken Pox and Herpes as well as exposure to toxins, decrease blood flow from mother to baby across the placenta. Risks for CP after delivery include problems that affect the baby’s brain, such as an infection in the brain (encephalitis) or around the brain (meningitis), brain trauma, severe jaundice which is the presence of extremely high levels of bilirubin that causes the yellowing of eyes in new born as well as near drowning which would cause decreased oxygen to the brain.

 What are the signs of Cerebral Palsy?

The degree of the brain injury will determine the range of severity of the impairments. The main symptoms and signs in Cerebral Palsy are muscular and movement problems. These may be associated with:

  • variation in muscle tones – either too stiff or too floppy
  • poor coordination and balance,
  • overdeveloped or underdeveloped muscles
  • delays in the development of gross and fine motor functions
  • involuntary movement
  • limited range of movement
  • difficulty producing speech

Other impairments that may accompany a diagnosis of CP include seizure disorder, intellectual development disorder, learning disabilities, eye movement dysfunction, mouth movement dysfunction and gastrointestinal impairment.

How can parents get help?

It is recommended that parents consult with a medical doctor, preferably a paediatrician who will assess the child for one or more of the signs mentioned above. The paediatrician’s assessment will include a discussion about the child’s development as well as the mother’s medical history during the pregnancy. He/she will examine the child’s posture, movement, muscle tone, motor skills and reflexes. A diagnosis of Cerebral Palsy will require several assessments to determine the child’s developmental needs. Additionally, a comprehensive diagnosis is not usually completed until the child turns 2 years old as some symptoms may not be apparent before that age.

Following the diagnosis, the paediatrician will recommend a team of medical professionals that includes:

A Physiatrist/Rehabilitation Doctor– who will treat the child’s physical problems by using oral antispasticity agents such as muscle injection to decrease the stiffness such as botulinum toxin injections and phenol injections; and intrathecal baclofen pump management to improve function and decrease pain.

An orthopaedic doctor will treat problems with muscle, tendon, or bone development.

A neurosurgeon will treat problems relating to the brain, spinal cord or the spinal nerves to decrease stiffness.

Based on the severity of the child’s medical diagnosis, continued care by a team of therapists with specialized training may be recommended. The team of therapists may include:

Physical Therapist/Physiotherapist

Occupational therapist

Speech, language and swallow therapist

Nutritionist

Otolaryngologist (Hearing doctor)

Ophalmologist (Eye Doctor)

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Pathways to Healing with Physiotherapy

Physiotherapists (also known as physical therapists) are movement specialists who aim to improve and restore function in persons from pre-injury or disease to their safe return to everyday, physical activities. This simply means that you do not have to be injured to seek physical therapy.

Before you are injured, the therapist will do an assessment to determine your predisposition to injury as well as strengthen and condition muscles to guarantee maximum function, prevent injury and some disease processes.

When someone happens to meet with an accident or injury, a physiotherapist helps the individual to recover, improve and maintain his/her physical abilities by introducing an individualized rehabilitation program based on the physical assessment.

Physiotherapists work in various medical settings to include a multi-disciplinary rehabilitation facilities, hospitals, medical centers and sports medicine clinics.

Specialist Treatments Offered by Physiotherapists

Physiotherapists are commonly known to offer generalized treatment in Orthopaedics, and sports clinics. However with the constant discovery of new evidence influencing the development of unconventional treatment modalities, the field of physical therapy has become diverse. Let’s explore some unconventional services now offered by physiotherapists at the Rehabilitation Institute of the Caribbean.

Aquatic Therapy

Aquatic Therapy offers treatment for patients whose muscles have been weakened due to a disability or injury. Generally, therapy sessions are held in a pool where the natural buoyancy of water reduces the pain that can be associated with physical exercise. This also assists patients with movement so that they are more productive in therapy sessions.

Dry Needling

Dry Needling is a technique used by physiotherapists to treat myofascial pain. This treatment method involves inserting a “dry” needle, meaning one that has not been saturated with medication, into areas in the muscle. The goal of dry needling is to relieve pain and improve range of motion by releasing trigger points or making them inactive. It is important to note that dry needling is a single technique incorporated in a larger treatment program. It is not a stand-alone, treatment option.

Cardiopulmonary Rehabilitation

Cardiopulmonary rehabilitation is designed to help persons with heart dysfunction, lung and heart diseases such as Asthma, Pneumonia, heart attack and post cardiac surgery. Cardiopulmonary rehabilitation requires a team approach which should include a medical doctor, rehabilitation nurses, physical and occupational therapists.

Vestibular Rehabilitation

A less known branch of neurological rehabilitation, coordinated by a Neurophysiotherapist, is a super-specialty called Vestibular Rehabilitation which includes rehabilitation of dizziness and balance disorders. This includes persons suffering from a spinning sensation called vertigo; or dizziness from either a brain or inner ear problem – e.g. after a head injury, after inner ear infections (eg labyrithitis), dizziness following viral illnesses such as ‘Chick V’; other ear conditions such as Menier’s disease (fluid imbalance in the ear) and a common condition called BPPV (Benign Positional Paroxysmal Vertigo) where dizziness is brought on by positional changes. Generally, the aim of Vestibular Rehabilitation is either to restore function or recommend strategies that teach persons how to adapt to their symptoms.

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Hand Therapy for Carpal Tunnel Syndrome

The Carpal Tunnel is a narrow passage in the wrist that is made of small bones and tissues which houses the flexor tendons of the hand and the median nerve responsible for some movement of the fingers. Carpal Tunnel Syndrome (CTS) may cause numbness, pain and tingling in the forearm, hand, wrist and fingers. These symptoms arise when the carpal tunnel becomes restricted causing a compression of the median nerve.

Risk Factors

There are some lifestyle practices and medical conditions which may predispose persons to this condition. These include:

  • Repetitive hand and wrist movements, or poor positioning of hands and wrist while working; known as incorrect ergonomics.
  • Health conditions that cause swelling in the soft tissue in the forearm/hands or reduce the blood flow to the hands such as: Rheumatoid Arthritis, Obesity, Diabetes, Multiple Sclerosis. This can also occur during pregnancy.
  • Smoking may restrict blood flow to the median nerve.
  • Broken wrist bones, dislocated bones, and new bone growth might add pressure on the median nerve

Difficulties Associated with Carpal Tunnel Syndrome

In addition to pain and numbness in the hand and forearm, persons with Carpal Tunnel Syndrome may experience reduced grip strength in the hand which may cause cramping and pain whenever they engage in activities such as writing, driving, typing on a keyboard, preparing meals especially using knives, opening bottles or doors; washing and dressing.

Treatment – Hand Therapy

Fortunately hand therapy, which is a specialty practice area done by an occupational therapist or a trained physiotherapist, can help patients with Carpal Tunnel Syndrome to recover successfully. A hand therapist can teach you how to avoid provoking and worsening the symptoms by introducing you to these treatment options:

  • Relative resting– through discussion, the hand therapist will advise you on how best to incorporate rest in your daily routine to relieve some of the symptoms.
  • Splinting provides support for the affected hand by positioning the median nerve in its most open position, relieving the pressure of the nerve and allowing for a restoration of blood circulation which reduces pain and discomfort.
  • Hand Therapy Exercise will increase the strength of the muscles in your hand, wrist and shoulder.

On average, most patients with CTS see improvement in their condition within the first 6 weeks of hand therapy, however this is dependent on several factors which include: the severity of the compression in the carpal tunnel, the patient’s compliance with the treatment program and treatment of the existing medical conditions or lifestyle practices which caused the carpal tunnel syndrome in the first place as mentioned earlier.

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One of the Secret Weapons for Neck Pain

Neck pain affects just about anyone, even healthy people in the prime of their lives. This should not be surprising since the neck works in balancing the head, which on average weighs 10 pounds. Neck pain can be triggered by improper sleeping positions, poor posture or injury to the spine. Now one of the secret weapons for common neck pain is isometric neck exercise.

What is an isometric neck exercise?

This is a type of neck strengthening exercise performed with the neck held in a non-moving position in the midline and the hands are used to apply force to the head at the front, back and sides, so the neck muscles contract without changing its length and position. The neck is held in this non-moving position to isolate and build the resistance of the neck muscle; repeating this activity will strengthen the neck muscles and help with neck stability.

Once there are no contraindications, the goal of isometric neck exercise is to reduce muscle stiffness and ease the pain for persons experiencing neck discomfort from most conditions. They are quick, neck strengthening exercise that can be performed at your convenience, at any time. However, it is best to speak with your medical doctor, physical therapist or occupational therapist before performing these exercise.

4 Isometric Neck Exercise in 60 seconds done without changing the position of the head.

  • Strengthening Muscles on the Right Side of the Neck

Place your right hand on the right side of your head, above your ear. Tilt your head to the right against your hand while pressing your hand against your head, without moving the neck and hand. Hold for 5- 8 seconds and then repeat twice.

  • Strengthening Muscles on the Left Side of the Neck

This is same as above however you are using your left hand on the left side of the neck.

  • Strengthening Muscles at the back of the neck

Place the fingers on one hand between the fingers of the other hand (interlocking them) then place both hands on the back of your head, just above your neck. Press your head backwards without moving position against your hands while pressing your hands against your head. Do not lean the head backward. Hold for 5-8 seconds and repeat this exercise twice.

  • Strengthening Muscles at the front of the neck

Place the palms of both hands on your forehead above your eyebrows. Press your hands against your forehead while pressing the forehead against your hands, without leaning the forehead forward. Hold for 5-8 seconds and repeat this exercise twice. Remember to consult with a medical doctor and then a physical or occupational therapist before performing basic, isometric neck exercise. If done incorrectly, this will lead to injury or permanent damage to your neck.

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Non-Surgical Treatment for Lower Back Pain

According to the American Academy of Physical Medicine and Rehabilitation (AAPMR), lower back pain is a commonly diagnosed physical ailment, identified in up to 84 percent of adults at some time in their lives. Lower back pain may be acute, i.e. comes on suddenly and lasts no longer than about 4-6 weeks; or chronic, lasting greater than 3-6 months.

What are some effective, non-surgical treatment options for lower back pain?

Physical Therapy

The goal of physical therapy is to decrease back pain while increasing function. Physical therapy exercise for lower back pain includes specific back stretching and strengthening exercise to increase the patient’s rate of recovery. Additionally, the physical therapist will prescribe a specific maintenance program for the patient to prevent future back problems.

Pain Medication

Pain medication is prescribed after an assessment by the medical doctor and may include, an anti-inflammatory such as ibuprofen or diclofenac; or analgesic such as acetaminophen or codeine; a neuropathic or nerve pain medication; or a muscle relaxant; or vitamins such as Vitamin B complex.

Heat or Ice Application

Applying a heat or cold pack may relieve pain and/or inflammation.

Therapeutic Massage

Therapeutic massages decrease muscle tension. When the muscle relaxes, it becomes more flexible thereby reducing pain intensity and allowing more mobility.

Fluoroscopic-guided (x-ray) intervention spine injection

A medical doctor who specializes in spine treatment such as a Physiatrist (rehabilitation medical doctor) may use x-ray or fluoroscopic-guided tools to identify where the pain originates, isolate that area and then inject therapeutic medications into the specific area. This procedure offers optimal care for patients with acute or chronic back pain because the rehabilitation doctor targets the source of the pain.

Spine Manipulation

Spine manipulation is sometimes used to relieve pain and improve physical function by using the hands or a device to apply controlled force to the spine. The amount of force applied depends on the form of manipulation used.

Cognitive Behavioural Therapy

For patients with chronic pain, the goals of cognitive behavioural therapy are to modify the patient’s view of their pain, and change the physical and/or psychological response that may contribute to how they perceive the pain. Cognitive behavioural therapy is usually combined with other methods of pain management.

If the pain intensity increases after multidisciplinary medical intervention, surgery may be required.

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