SHOULDER IMPINGEMENT

Shoulder impingement can be divided into functional and structural.
The usual presentation of functional impingement is someone under 40 years of age. They will commonly be involved in overhead sports such as tennis, swimming, gymnastics of football.
They may have a history of instability of the shoulder or have generalised ligamentous laxity.
Essentially, impingement occurs when the humeral head translates too far anteriorly in overhead positions, placing strain on the upper rotator cuff and compressing the subacromial space. Sometimes, when the instability is more pronounces, biceps and subscapularis can be involved.
Treatment is conservative first. NSAIDs for pain relief and cuff and scapular stabiliser retraining.
Injections are rarely required and discouraged.
Structural impingement occurs on an older population and results from a narrowed subacromial space. This can be from swollen tendons, bursitis, AC joint osteophytes, glenohumeral arthritis or full thickness rotator cuff tear. In this group, it important to asses the integrity of the cuff with XRAY and ultrasound.
Anyone under 60 with a full thickness tear should be considered for surgery to avoid shoulder joint arthritis. Anyone with >50% thickness cuff tear can be monitored, but may need surgery. < 50% tears are usually monitored with 6-12 monthly ultrasound and rehabilitated.
Injections are often helpful to relieve pain, but muscle retraining remains important.
Decompression surgery my be required if all else fails.

 

Sports Medicine by Sport and Exercise Medicine Physicians

Mornington, Frankston, Narre Warren/Berwick

MY STRESS FRACTURE PAIN HAS GONE – CAN I RUN AGAIN?

Unfortunately, just because the pain has gone, it doesn’t mean that the bone is strong enough to run or resume sport.
Bone strengthens through load. After a stress fracture, it needs to be gradually reloaded to allow the force lines to strengthen and prevent further damage.
You can start some strengthening quite early and then progress to more dynamic loading, but just because the pain has gone at 2 weeks, it doesn’t mean you are fixed. You still have 4- 8 weeks to go!

Sports Medicine by Sport and Exercise Medicine Physicians

Mornington, Frankston, Narre Warren/Berwick

Does exercise weaken or boost your immune system?

Written by Dr DR MONA SHABGHAREH

Every day our immune system protect us from a lot of pathogenic microbes and viruses that we are constantly exposed to.
Immune function can be influenced by many factors such as genetics, stress, aging, nutrition, sleep and physical activity level.
Recent researches have revealed that a person’s level of physical activity influences the risk of some infections, specially upper respiratory tract infections (URTIs).
URTI is an illness caused usually by a virus or bacteria which involves transmission through the upper respiratory tract, including the nose, sinuses, pharynx, or larynx. Common cold, sinusitis and tonsillitis are examples of URTIs.
In fact, when you do moderate intensity exercise, regularly, your susceptibility to illness reduces because this type of exercise boosts your immune system.
Regular exercise increases white blood cell (body’s immune system cells that fight pathogens) function and also both directly and indirectly decreases stress hormones.
On the other hand, strenuous exercise causes increased levels of stress hormones (adrenaline and cortisone) which suppress white blood cell function and have negative effect on the function of immune system.
That is why vulnerability to infections increases for a period following prolonged moderate to high intensity exercise or an unaccustomed high intensity exercise session.
Another possible reason for higher risk of getting URTIs after high intensity exercise is higher rate and depth of breathing during exercise and subsequently, higher exposure to pathogenic microbes and viruses.
So if you want to boost your immune system and be safe, do exercise regularly, avoid overtraining, eat healthy, sleep enough, practice relaxation techniques and of course do not forget to be wash your hands and maintain social distance!
If you’d like to know more about the content discussed in this article, please call (03) 9770 2398 to book an appointment with Mona.
Sports Medicine by Sport and Exercise Medicine Physicians
Mornington, Frankston, Narre Warren

Exercise and diabetes type 1, what you should know!

By Dr Mona Shabghareh
In patients with diabetes type one, the Pancreas’ ability to produce insulin is impaired. Therefore, this type of diabetic patients needs insulin replacement therapy to maintain their blood glucose level in the normal range.
It is critical to take a proper dose of insulin to prevent hypo-glycemia or low blood glucose level.
Many researches have shown that moderate levels of exercise can reduce blood glucose levels by multiple mechanisms and this effect is more significant if you exercise for a longer duration. The effect of exercise on blood sugar is additive to the effect of insulin and it can last up to 24 hours.
On the other hand, high intensity exercise may lead to an increase in blood sugar level by increasing stress related hormones such as adrenaline and cortisone. In addition, injuries that may happen during exercise and sport participation can also increase blood glucose levels.
So despite the fact that regular exercise have a lot of health benefits such as reducing the risk of heart and vascular disease, improving your mood, making your bones and muscles stronger and helping you to control your body weight, it can lead to hypo or hyper-glycemia or even be detrimental to your health if you do not know how much and what type of exercise suits you.
The best way to ensure you are doing the correct thing is by consulting with an expert physician.
However, some other helpful tips include;
1. Checking your blood glucose levels before and after an exercise session. It is safe to do exercise only if your blood glucose level is between 6.6-10 mmol/L.
2. Always have some quickly digested carbohydrate (such as fruit juice or barely sugar) available when you are exercising.
3. Eat something 1-2 hours prior to exercise.
4. Avoid dehydration.
5. If you want to inject insulin prior to your exercise session, use a site away from the exercising muscles to inject.
6. Do not drink alcohol after exercise as it dehydrates and lowers blood glucose level.
7. You should adjust your pre-exercise insulin if you are doing strenuous activity for longer than 1 hour.
8. Be aware of the signs of hypo-glycemia and stop if they appear.
9. Avoid exercising in extreme temperatures.
Based on the guidelines from the American College of Sport Medicine (ACSM), you should visit and be evaluated by a Sports Physician or Cardiologist if you are over 35 years old or have had diabetes for a couple of years or want to do any exercise that exceeds the demands of brisk walking.
If you’d like to book an appointment with Dr Mona Shabghareh, please call (03) 9770 2398