Ice or Heat

Heat v Ice to Treat a Sports Injury

Most patients ask ‘do I use heat or ice?’ Now the answer to this question generally is if it’s acute or chronic.

An acute injury, being one that happened suddenly, will show signs and symptoms of pain (usually intense), local tenderness, redness, warm to touch and swelling. These signs and symptoms are mostly the result of internal bleeding and inflammation, which is the body’s response to an injury occurring suddenly and usually the inflammatory process should last 48 hours. The best therapy for an acute injury in these initial stages is rest and iceIce is a vasoconstrictor (it causes the blood vessels to narrow) and limits internal bleeding at the injury site and would therefore reduce the swelling and pain. Apply ice (wrapped in a thin towel) to the affected area for 10-15 minutes at a time and generally repeat every hour (if needed). The main goal during these initial stages is that you want to isolate, decrease and prevent the inflammation from spreading further.

Chronic injuries, on the other hand, can be subtle and slow to develop. They sometimes come and go, and may cause dull pain or soreness. They are often the result of overuse, but sometimes develop when an acute injury is not properly treated and doesn’t heal. Chronic injuries generally do not have inflammation or swelling and that is when heat a good form of therapy. Heat is best to stimulate blood flow, increase the elasticity of joint connective tissues and help relax tight muscles or muscle spasms. Safely apply heat (i.e. wheat pack) to an injury 15-20 minutes at a time and use enough layers between your skin and the heating source to prevent burns. Because heat increases circulation and raises the skin temperature, you should not apply heat to acute injuries or injuries that show signs of inflammation, as this will generally make them worse. This is a common mistake made by a lot of people with acute injuries, so please use cold in the initial stages of injury.

Some exemptions to the rule are:

Heat is recommended in an acute injury once the inflammation has settled down (usually after 48 hours). This will encourage the blood flow to the injury site and promote the healing process.

If you have a chronic injury, but suddenly aggravate the injury and the pain greatly increases in severity, ice would be recommended for the next 2 days. This type of injury is also known as acute on chronic.

If you are unsure or the injury does not show signs of improvement within 48 hours please consult with your local doctor or osteopath.


Written by: Daniel Stasiuk

Ankle Sprains

The ankle is made up of 3 bones: The Tibia (the shin bone), Fibula (runs on the outside of the shin bone) and Talus (connects our foot to the shin bone). The bony bumps found on the inside and outside of the foot are called the medial and lateral malleolus.

The way the ankle is designed, its primary movement is dorsi and plantar flexion (up and down), while it is subtalar joint which produces eversion and inversion movements (turning foot in and out).


The ankle has a number of ligaments which holds the bones together and allow the ankle and foot to move. The two main sets of ligaments which originate from the malleolus are the Medial and Lateral Ligaments.

The Medial Ligament, or the Deltoid ligament is a strong, flat and triangular band which consist of four ligaments and fans out from the medial malleolus to the talus, calcaneus and navicular bones. The primary action of this ligament is to resist over-eversion of the foot or rolling the foot inwards. This particular type of rolling motion which may cause an ankle sprain is rare and is normally associated with a fibula fracture known as a Pott’s fracture.

The lateral Ligament has 3 parts to it, which we separate into 3 different names. The Anterior talofibular, Posterior talofibular and Calcaneofibular ligaments. They all originate from the lateral malleolus and attach onto other bones of the foot. These ligaments all resist over-inversion of the foot. This type of ankle sprain is the most common.

So how do we treat a sprained ankle?

As osteopaths, we have a number of special test that we can do to make sure that we are able to identify the exact ligament that is involved and rule out a fracture. If we are unable to rule out a fracture we may advise an x-ray to identify a break and possibly a cast if needed.

If no break is suspected, the first goal of treatment is to assist in getting the swelling down while keeping as much range of motion throughout the foot and ankle bones. Rehabilitation is extremely important with a ankle sprain and vital for getting the person back to their sport or daily task. We would start off with some advice which would include rest, ice, compression and elevation (RICE). Then followed by basic ankle and foot range of motion exercises such as the ABC’s (which is just moving the foot to the letters of the alphabet).

Once the person’s pain and swelling has decreased and their range of motion is better, we can start to add in some harder exercises like balance exercises, theraband ankle work and increasing their range of motion exercises. The very last step is to make the persons rehab a little more sport specific to them, such as hopping, jumping and changing directions. Whether it is basketball, running or just getting back to playing with the kids.


Written By: Brendan Ashman

Concussions and Our Kids In Sports

After a conversation with one of the Beach Integrated Health Clinics patients, the topic of concussions with kids in sports came up. It prompted me to write a little bit about concussions, what to look out for and how as Osteopaths we can help.

So what is a concussion? A concussion is an injury to the brain that results in temporary loss of normal brain function. It is usually caused by a bump, blow or jolt to the head or body. This force to the body or head may or may not involve a loss of consciousness. Often there are no specific signs of head trauma like bleeding or even a bump.
A person who has suffered a concussion often cannot remember what happened immediately before or after the injury and may act confused. Which is why it is important to know the type of questions to ask someone if you suspect a concussion has occurred. A concussion can manifest in different ways such as altered memory, judgment, reflexes, speech, balance and muscle coordination.

Who can suffer from a concussion?
Everyone has the potential to get a concussion at some point in their life. Studies have shown that concussions seem to effect women more than men. Which could be for a number of reasons, though researchers seem to think the main reason for that is because women are more likely to report it or at least mention it to their healthcare professionals. A person who has had a previous history of concussions, especially a history of 2 or more concussions, are more at risk for increase in symptoms.

Symptoms of a concussion may include:
• Prolonged headache
• Vision disturbances
• Dizziness
• Nausea or vomiting
• Impaired balance
• Confusion
• Memory loss
• Ringing ears
• Difficulty concentrating
• Sensitivity to light
• Loss of smell or taste
There are also some post Concussions symptoms to be aware of, as some symptoms may not show immediately.
• Mental fog
• Mental slowness
• Memory loss
• Confusion
• Irritability (especially in children)
• More emotional
• Nervous
• Sad
• Difficulty falling asleep
• Sleep changes
There are ways to decrease the risk of a player getting a concussion in many sports like encouraging kids to wear a helmet in sports such as hockey and rugby if it isn’t already compulsory, however, this will not 100% stop a concussion from occurring.
The treatment for a concussion is rest. However, we must take into consideration the severity of the concussion and other factors that might be inhibiting the individual to heal. For example: after a tackle in football a player may hit their head and get a concussion. After 72 hours they may still have some neck pain and a dull headache. Although the concussion may have settled down, the player may have some neck stiffness or pain, which is causing the headache to be persistent. This is where our Osteopaths can help. Having spent time as an Australian Football league Trainer 1 have seen my fair share of concussions and it is important to treat all concussions as a serious injury. While taking a medical history and we decide on techniques that are a little gentler, so we don’t expose the individual to a jolting sensation through the body, neck or head to our treatment.
If you come across a person who you suspect does have a concussion the rule that I like to follow is if in doubt sit them out. While they may be unhappy that they cannot return to the sport, it is always better to be cautious. If they subject their body or head to another heavy blow, it may increase the persons symptoms exponentially.

By Brendan Ashman
Manual Osteopathic Practitioner

Getting your bike setup correctly

Over the last three weeks, the Tour De France has been running. The Tour consists of 21-day stages over a 23-day period, and the riders will cover around 3,500 kilometres (2,200 mi). While not all of us are elite athletes, there has certainly been an increase in cyclist on the road with the nice weather.

Cycling can be a great form of exercise. We get a great cardiovascular workout and it helps improve the strength of the leg muscles. There are, however, many common injuries that can occur when we start to ride or with high volume riding without the correct recovery methods.

Some of the most common sites of pain in cyclists are the neck, shoulder, knee, lower back and sacroiliac joints (SIJs). There are many reasons in which a person might be experiencing pain. It could be related to a new hobby, a predisposing injury, muscle tightness, or it could even be the set-up of your bike. Just like a work desk, our bike set up can be incredibly important to ergonomics, decrease injury, aid in decreasing pain and keep you riding for a longer period of time.

Getting the correct set up on your bike will depend on what kind of bike you have, how tall you are, shoulder reach, as well as what feels comfortable.

Here are a couple of quick tests you can do:

To check your seat height get onto your bike with one leg straight and place the heel of your foot on the pedal at the lowest point, which should make your leg straight. If this does occur then your saddle should be at the correct height for you.

To find the best saddle position, you should sit on the bike with the pedal at 3 o’clock. Place your foot with the joint of the toes on the pedal spindle. In the perfect scenario an imagery perpendicular line should run from your knee-cap through the spindle of the pedal. If the line runs behind the spindle, then the saddle needs to be pushed forward. If the line runs in front of the spindle then the saddle needs to be pushed backwards.

There are a lot of measurements and angles to take into consideration when setting up your bike with an ergonomics assessment. My best advice is that if you are experiencing any pain before, during or after riding your bike, it might be worth a visit to your local bike shop or your local specialized practitioner and ask for an ergonomic bike set up. This will allow to can for longer with the correct posture and decrease your chances of dealing with some of the getting some of the common cyclist pain.

If you would like more information on ergonomic set ups on bikes. Please ask us for a bike set up hand out.


Written by Brendan Ashman


Did you know that Brendan recently did a certification course for bike fitting and setup. For more information please ask Brendan at [email protected] or call (416) 546 4887












Most Common Basketball Injuries

The Toronto Raptors are in the NBA playoff finals for the first time in History and what an exciting time it is to be in the city of Toronto. With a current 2-1 lead, a championship certainly favours the Raptors. With certain key players like Thompson and Durant out with Injury, it has certainly made the Raptors job easier. Pivotal moments like this, where injury is a huge factor, it brings on a great topic of discussion – INJURY.


What makes basketball players susceptible to injury?

In basketball, there are a lot of quick pivoting moments such as jumping, running, cutting. You have people going in different directions at all speeds, playing offense and defense. Athletes today are stronger and more powerful with more explosive force than ever before, thanks to sports nutrition, sports performance and conditioning.

What can players do to prevent injury?

Maintain a good balanced workout, stretch daily and strengthen your core muscles. Flexibility is extremely important, but it’s not as much of a focus for young athletes. As you get older, flexibility becomes important to help limit injuries on the basketball court.

What are the most common injuries in Basketball?

  1. Foot and ankle injuries

Lateral ankle sprains are the most common injury in Basketball. With the quick movements, lots of jumping and especially big feet in some players, some injuries are bound to happen. You may see a player jump and land on another players foot, causing their foot and ankle land awkwardly, resulting in a sprain.

High ankle sprains, an injury to the ligaments between the two lower leg bones (tibia and fibula), can be more of a serious injury and sometimes require surgery to reestablish the relationships between the bones.

With a sprain, follow RICE: Rest – Ice – Compression – Elevation. A lot of these injuries don’t need surgery, but if you can’t put weight on it, get an X-ray to rule out a fracture.

  1. Hip and thigh injuries

An injury to the hips, such as a strained hip flexor, can result from quick pivoting movements. Getting a knee from another playing into the thigh can cause bruising and possible contusions. This may seem like no big deal, but it can be painful and keep you out of the game. For this, ice it for the first 24-48 hours, then switch to heat and stretching so the thigh doesn’t get too tight.

  1. Knee injuries

Basketball requires extensive stop and go and cutting maneuvers which can put the ligaments and menisci of the knee at risk. Injury to the medial collateral ligament is most common following a blow to the outside of the knee and can be often be treated with ice, bracing and a gradual return to activity.

An injury to the anterior cruciate ligament is a more serious injury and can occur with an abrupt change in direction and landing for the jump. Although this ligament tear is most commonly a season ending injury that requires corrective surgery, current techniques used to repair the ACL ligament generally allow the player to return to play the following season.

  1. Wrist and hand injuries

From jammed fingers to sprained, dislocated or fractured fingers, these injuries are very common among basketball players. The ball can hit it your hand or fingers at a fast speed and can cause a significant sprain or break. Sprained wrists can occur if a player falls and puts his hand down to protect himself.

  1. Head and face injuries

Concussions, bloody lips, and other head injuries are usually the result of getting elbowed accidentally or coming down from a layup and getting hit in the head. It’s common when a player is rebounding or fighting for position.

For concussion, players should always get out of the game and have an evaluation by a medical health professional that regularly manages concussions.


For an assessment, treatment and management of your Basketball Injuries our osteopaths, massage therapist and chiropodist at Beach Integrated Health Clinic can help you get back on the court. Feel free to contact us directly with any further questions on (416) 546 4887 or  book an online appointment.

Tennis Elbow

The most common elbow condition is tennis elbow,  also known as lateral epicondylitis,  is caused by overuse and excessive strain on the extensor muscles of the forearm resulting from wrist extension, such as in back hand tennis players, or occupations that involve repetitive wrist movement, such as carpenters or bricklayers. It may be provoked by any exercise that involves repeated and forcible extension movements of the wrist, like using a screwdriver or hammer.

Symptoms of Tennis Elbow

Tennis elbow usually has a gradual onset but it can also be sudden. There may be a constant muscular ache in the forearm and/or near the outer elbow. It is aggravated by movements that involve extension of the wrist, such as picking up bags or turning on taps and sometimes it may feel like there is less strength when grasping objects. The outer elbow can be tender to touch, is painful with resisted extension of the wrist and is painful when stretching the wrist.

Tennis Elbow Treatment

In the acute phase of the tennis elbow rest is vital. Apply ice 2-3 times daily to reduce inflammation and pain. Anti-inflammatory medication or gels can also work very well. Osteopathic treatment can help loosen and stretch the muscles involved and also reduce the amount of inflammation in the elbow. Your Osteopath will also check any other areas that may be affected, such as the shoulder or upper back and neck, and show you stretches you can do to reduce tension in the forearm muscles and also show you exercises you can do to strengthen these muscles.

Achilles Tendinitis

Achilles tendinopathy or generally known as achilles tendinitis is a common condition characterised by localised pain and swelling at the achilles tendon. The achilles is a large tendon connecting the major calf muscles, the gastrocnemius and the soleus, to the heel bone. During a calf contraction tension is put through the achilles tendon and if this tension is excessive due to too much repetition or high force, damage to the tendon occurs, leading to subsequent degeneration and inflammation.

Signs & Symptoms of Achilles Tendinitis

Pain at the achilles tendon is most commonly felt either at the mid-point of the tendon or at the portion where it joins with the heel bone. The pain can either be sharp or a dull ache. There may also be limited ankle flexibility, redness or heat over the painful area, a nodule (a lumpy buildup of scar tissue) that can be felt on the tendon, or a cracking sound (scar tissue rubbing against the tendon) when the ankle moves.

Causes of Achilles Tendinitis

Achilles tendinitis commonly occurs in both recreational and professional sports athletes, usually involving running and jumping type activities. Occasionally, it may occur suddenly due to a high force going through the Achilles tendon beyond what it can withstand. This may be due to a sudden acceleration or forceful jump. It can also be caused by adverse lower limb biomechanics, tight or fatigued calf muscles, previous calf strain/ tear and ankle sprain, weak muscles, overtraining, increasing training load too quickly, excessive hill running or speed work, overpronation and inappropriate footwear.

Treatment, Management & Prevention of Achilles Tendinitis

If you start experiencing achilles pain, then stop doing the activity that started the pain and rest. Ice the area for 10-15 minutes multiple times a day, until the swelling subsides. Take some anti-inflammatory medication is the pain persists for more than 2 days.

Manual therapy such as osteopathy can help with the pain, muscle tightness, joint mobility, body alignment, inflammation and swelling. This may include techniques and modalities such as  soft tissue massage, manipulation, dry needling, electrotherapy and taping.

Shock wave therapy has also shown to be effective, especially more for insertional achilles tendinopathies.

A strengthening program should be implemented once the swelling has gone down. This exercise program should consist of eccentric exercises, but also exercises such as concentric strengthening and other exercise to address possible functional deficits (ie. weak gluteals). One of the most useful strengthening technique for the achilles is the heel drop. This is where you lower yourself from being up on your toes and allow your heel to slowly drop down and off the level of a step. This exercise should be done slowly and it can be normal it feel some pain, but as long as it doesn’t stick around longer than the exercise (irritable). From this exercise once it becomes easier and less painful, load can be added (ie. a backpack), increased repetitions, increase in range, and increase in speed (much later). Although this is one exercise it is best if you consult your osteopath or physiotherapist to rehab your achilles tendon correctly.

If you are a runner, you can start running once there is no pain on calf raises, heel drops or hopping. Make sure that there is no speed or hill work in these run sessions and there is at least one rest day between each run. Once there is no pain during or between runs you can gradually increase your volume.

Plantar Fasciitis

Plantar Fasciitis and Running:

The Plantar Fascia is a broad, dense fibrous connective tissue that runs across the bottom of your foot and connects your heel bone to your toes. The plantar fascia is designed to support the foot and form the arch. Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.

Plantar fasciitis is one of the most common causes of heel pain and it commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Plantar fasciitis is particularly common in runners. In addition, people who are overweight, women who are pregnant and those who wear shoes with inadequate support are at risk of plantar fasciitis. It is also common in occupations that require you to be on your feet and especially if the surface you are standing on is hard, such as factory workers. Other factors that can have an influence are improper shoes and faulty foot mechanics.

Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. You may also develop foot, knee, hip or back problems because of the way plantar fasciitis changes your walking. Common problems including shin splints, patella tendonitis and ITB syndrome. Continuous pulling of the fascia at the heel bone eventually may also lead to the development of bony growth on the heel. This is called a heel spur.

Running Injury Management Tips:

  • Put your feet up. Stay off your feet for several days when the pain is severe.
  • Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper or foam cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.
  • Decrease your distances. You probably won’t have to permanently retire your running or walking shoes, but it’s a good idea to cover shorter distances until pain subsides.
  • Take up a no- or low-impact exercise. Swap swimming or bicycling in for walking or jogging. You’ll likely be able to return to your regular activities as heel pain gradually improves. However, some people find that the only way to avoid a recurring problem is to give up high-impact activities, such as running and some forms of dance.
  • Add arch supports to your shoes. Inexpensive over-the-counter arch supports take the tension off the plantar fascia and help absorb shock, or if you want to invest more in a good pair of custom orthotics go see your local podiatrist. Also make sure that your runners are not too worn out as they will generally cause you more problems; general rule of thumb is 600km until a new pair is required.
  • Stretch.Simple exercises using household objects can stretch your plantar fascia. Also try using a rubber bouncy ball or a golf ball to help release certain tension points in the muscle. Simply do this by having the ball on the ground and apply pressure directly onto it where it is sore. Also stretch your calfs and hamstrings as these muscles will have an impact on the plantar fascia.
  • Treatment. Go see your local osteopath for pain relief and for a speedy recovery.

Prevention of Plantar Fasciitis:

You can take some simple steps now to prevent painful steps later:

  • Maintain a healthy weight. This minimises the stress on your plantar fascia.
  • Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don’t go barefoot, especially on hard surfaces.
  • Don’t wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you’re a runner, buy new shoes after about 600 kilometres of use, as uneven wear can develop.

Foam Rolling For Runners


The foam roller can be a great tool, especially for runners who cover a lot of kilometres per week. This simple tool acts as a deep-tissue massage, working out kinks in over used muscles. It is especially effective to release myofascia, such as the iliotibial band or ITB. If all runners would spend just 10 minutes with a foam roller a few times a week, they would restore the structural integrity necessary for optimal performance.

There are many causes that can lead to a problem in the body’s kinetic chain,  such as work, stress, gravity and pattern overload. The more you run, the more you’ll experience pattern overload. It can place a lot of stress on the body’s systems. Any dysfunction in movement as a result of myofascial tightness, can ultimately lead to an altered gait, tissue trauma, loss of range and eventually injury.

ITB exercise

To massage the ITB, lie on the foam roller on the side. Start at the hip and work your way down to the knee and then back up to the hip. Repeat the process and stop at tender points to allow a release. You can use your arms to control how much body weight you put down on the foam roller.


Balancing on a foam roller requires your body to recruit more muscles, especially in your core, to perform the move. Here are some simple exercises that you can do at home. Try doing these exercises two to three times a week to build total body strength that will help improve performance and guard against injury.



Works abdominals, glutes, back & shoulders

To do:  Place your palms shoulder width apart on the foam roller. Keep your elbows slightly flexed, your back straight, and your neck neutral. Stabilise the foam roller in this position, and hold for 30 seconds. Repeat three times.

Push-up With Leg Lift

Works chest, triceps, abdominals, glutes

To do: Start in foam-roller plank. Lower your chest toward the roller, keeping your elbows in. Lift your right leg up, then lower it. Repeat the push-up, then lift the left leg. Alternate for three sets of eight to 12 reps.


Wall Squat

Works quadriceps, glutes, abdominals

To do: Stand with a foam roller between your midback and a wall and your feet shoulder width apart. Slowly squat down toward the floor until the foam roller reaches your shoulder blades. Stand and repeat eight to 12 times for three sets.


Bridge With Leg Lift

Works glutes, hamstrings, quads, abdominals

To do: Lie on your back, heels on a foam roller. Raise your hips up toward the ceiling, then extend your right leg. Bring your right leg down and hips back to ground. Do three sets of eight to 12 on each leg.


Rotator Cuff Injury

Many common shoulder ailments can be caused by underlying shoulder impingement syndrome.  In fact, it is the most common problem in the shoulder and it is thought that up to 20% of people will suffer symptoms at some time!Shoulder impingement, or better described as subacromial impingement syndrome (SAIS), can contribute to a spectrum of shoulder pathologies, such as:

  • Partial thickness rotator cuff tears
  • Tendinopathies – Irritation to the tendons of the rotator cuff and/or biceps leading to inflammation (tendonitis) and/or degeneration (tendinosis)
  • Calcific tendinitis
  • Subacromial bursitis


Signs and symptoms of impingement

Shoulder pain, weakness and loss of shoulder range of motion are of the most commonly reported signs and symptoms.  Pain is often exacerbated by over head activities.  Many patients report pain in the upper arm, which occasionally can radiate into the forearm and hand.  Shoulder pain at night is common, particularly when a patient lies on their affected shoulder.

The onset of symptoms may be acute, following an injury, or gradually worsening over time, particularly in older patients with no specific history of injury.


Who is at risk?

SAIS most commonly occurs in people who engage in repeated overhead movements.  Sports that require repetitive overhead motions include tennis, swimming, baseball and volleyball and are thus common culprits for impingement syndromes if shoulder biomechanics is suboptimal.  In the workplace, painting, carpentry and construction work may contribute.  But even after years of seemingly normal use, older individuals may gradually develop impingement syndromes too.

How does it occur?

The ball and socket style shoulder joint (glenohumeral joint) requires a great deal of dynamic stabilisation from the muscles of the rotator cuff.  The rotator cuff consists of four short muscles originating on the shoulder blade, with the tendons of each attaching to the head of the humerus (upper arm bone) close to the glenohumeral joint.  When the shoulder is in motion, it is primarily this muscular cuff that stabilises the ball of the humerus within the socket of the shoulder blade.


As you raise your arm the space between the humeral head and the acromion (outer most tip of the shoulder blade) naturally reduces.  If this space reduces beyond its normal range it can eventually cause pain and pathology by compressing the structures that pass through the subacromial space.


Possible causes of SAIS

The possible causes of SAIS may be many and varied, ranging from boney spurs which reduce the subacromial space, poor dynamic stabilisation of the shoulder joint by the rotator cuff muscles, or an unstable shoulder joint with ligamentous laxity.  It is very important to determine the cause of the impingement in order to effectively reduce it!


Although the rotator cuff muscles are capable of generating torque (creating shoulder joint rotations), they also depress the humeral head.  Without an intact or effectively working rotator cuff, particularly during the first 60 degrees of arm elevation, the upward directed muscular pull of large shoulder muscles may cause the humeral head to jam upwards underneath the bony acromion. An effective rotator cuff will act to depress the humeral head to limit its superior migration as the arm is elevated above the head.


The diagnosis of SAIS is usually made from a detailed history and a physical examination.  During the physical examination, an Osteopath will use a variety of orthopaedic tests in which your shoulder is manoeuvred into a range of motion whereby the subacromial space is reduced to assess for replication of your signs and symptoms.  Furthermore, neck, upper back, and rib mobility, as well as stability and muscular control of the shoulder blade and shoulder joint are often assessed to ensure optimal stability during movement.

Diagnostic imaging such as x-ray and ultrasound may be utilised to assess the integrity of the subacromial space and its contents if deemed necessary.



Conservative treatment with manual therapy is often sufficient to treat SAIS.  Importantly, this involves resting from aggravating activities!  To help restore your shoulder’s natural mechanics, an osteopath will use a variety of manual techniques, including a specifically tailored exercise rehabilitation program to improve muscular control and stability of both the shoulder blade and the shoulder joint.

Medications such as anti inflammatories may be used for a short period of time to reduce inflammation of impinged structures.  In more severe cases, or if conservative management fails, cortisone injections may be considered.


In Summary

Shoulder pain can be caused by a number of different pathologies, and an osteopath can help determine the precise reason for your shoulder pain! Subacromial impingement syndrome is one very common reason for shoulder pain in many populations and whilst it can be debilitating for some, it is also very effectively treated using osteopathy.