Most clinical words ending in “itis” means inflammation of some sort – for example, peritonitis and laryngitis. A bursa is a fluid-filled sac which prevents muscle insertions rubbing on bones within your body.

Shoulder bursitis occurs when one of the bursa sacs around your shoulder joint becomes inflamed and sore. Often the cause of this is overuse – constant, repetitive movements of the arm rub the tendon permanently on the shoulder bursa, which then causes the inflammation. After that, any lifting of the arm above 90* or overhead causes pain and interferes with mobility. At best, shoulder bursitis is a nuisance, at worst can spell problems for the continuing career of an athlete. If your livelihood depends on you fast-bowling in cricket, then the onset of bursitis can be a disaster.

There are two bursae in the shoulder that are most likely to be affected:-

Subdeltoid Bursa

This little sac lies on the side of your upper arm, where your main shoulder muscle (deltoid) meets your arm bone (humerus). If you have pain when your arm is held out to the side at shoulder height, and you are sure that you have not sustained a rotator cuff injury, then bursitis is likely to be the cause. If the pain seems to be at the top of the shoulder as opposed to partway down the arm, it may be caused by impingement. Shoulder impingement occurs when the soft tissues of the shoulder become trapped under the bony bit on the top of the shoulder girdle (called the acromium process), causing - surprise, surprise – painful inflammation.

Subacromial Bursa

This bursa sits on top of the shoulder; if moving your arm in an arc from 90* to reach your fingers to the ceiling causes the pain, this is possibly the culprit. Bursitis in this area is also known as shoulder impingement.

If you can tick the above boxes regarding pain in the shoulder, and especially if you have been performing lots of repetitive-type movements, then you probably have shoulder bursitis. A visit to a physician for diagnosis is a good idea, although there are some elements of shoulder therapy that you can do yourself:-

1. Rest from the activity you are doing. Bursitis is an overuse injury, and many cases will clear up all by themselves if left in peace and not aggravated.
2. Ice the area. Take the appropriate ice precautions. Cold reduces inflammation and can speed up recovery. In acute stages do not be tempted to hop into a hot bath to ease the pain – it may feel better at the time, but in the long run will make things worse.
3. In severe and chronic cases, an injection of hydrocortisone may be necessary.
4. When inflammation has eased, build up your surrounding shoulder muscles to take some of the strain.

Most cases of bursitis respond well to conservative treatment, and may not recur if the appropriate remedial and rehabilitation exercises are done regularly.

All the best,

Carol J Bartram
(Sports Therapist, Personal Trainer & Pilates Instructor)

Shoulder Bursitis 

A shoulder injury, however caused, can cause months (or even years) of pain and restricted movement. You may not even remember the incident that caused it! Some injuries to the shoulder build up over a long time; repetitive movements can cause overuse injuries, much like those that happen to the wrist muscles (RSI). 

The muscles that sit on the top of the shoulder and extend for a handspan down the arm are called the deltoids. These are powerful muscles and lift your arms out to the sides and up, and assist with forehand and backhand movements. It is quite a feat to “pull” a deltoid (i.e cause a tear in the muscle), and most people who come to me with shoulder problems haven’t actually damaged the deltoid, but one of the smaller muscles near it.

A pulled deltoid would give pain as the arm moved away from the side of the body; most people can complete at least part of an arc with the arm before pain kicks in. If the client winces as the arm passes above shoulder level, I suspect impingement shoulder – there is inflammation around the joint which is squeezing the nerves there.

Rotator cuff injury is a common cause of shoulder pain. The rotator cuff is made up of 4 small muscles called supraspinatus, infraspinatus, teres minor and subscapularis. Their actions are as follows:-

Supraspinatus –  Brings arm out to the side (abduction) for the first 30*, then the deltoid kicks in. If the supraspinatus is torn, the arm will not lift away from the side.

Infraspinatus – Brings the arm down and out in a backhand motion (extension and lateral rotation). Often a muscle injured by tennis players.

Teres Minor – Assists infraspinatus.

Subscapularis – Brings arm in towards the body and into a forehand motion (adduction and medial rotation). Again, a racquet player’s speciality!

If you have suffered an injury in any of these muscles and are recovering, there are several rotator exercises and also general shoulder exercises that you can do to strengthen the muscles and make re-injury less likely. Work carefully and stop at the first sign of pain. Do not be impatient! Trying to do too much too soon is a recipe for disaster and could delay full recovery for much longer.

If you have access to gym machines, rehabilitating the muscles is easier, but most strengthening exercises can be done with bodyweight and an elastic exercise band (called a flexiband in the UK, and available cheaply at most large stores).

Strengthening the Deltoids – Push-ups, Shoulder Press, Lateral Raises, Reverse flyes. Start by using no weights (for push-ups, do shallow, box push-ups to start), then progress to light hand weights.

Strengthening the Rotator Cuff – Mimic tennis fore-and-backhand moves holding a flexiband that has one end tied securely to a wall fitting or door handle (close the door!). The band should be at the level of your elbow when your arm is hanging by your side. Elbow should be bent at 90*, palm facing up. Keep elbow close to your side throughout and do not allow your shoulders to shrug.

If you follow the above instructions, plus all those given by your health professional, a minor injury should be as good as new in 2 – 3 weeks. In fact, the shoulder will probably be stronger than before, and less likely to tear again. These exercises can then be added into your weekly fitness routine to improve your general condition.

To learn more about Rotator Cuff Injuries pleas follow the link.
 

All the best,

Carol J Bartram
(Sports Therapist, Personal Trainer & Pilates Instructor)

Rotator Cuff Exercises To Strengthen The Shoulder  

If you have pain in your shoulder, it is wise not to try and self-diagnose; some shoulder pain can be referred from the neck or back. Make an appointment with a physiotherapist if the pain does not go away within a day or two.

If you are active and play sports regularly, you can sustain a rotator cuff injury. Tennis, golf and basketball players are particularly susceptible to this type of injury as they rely heavily on the shoulder muscles – imagine the muscle power needed to serve a tennis ball at the incredible speeds recorded at top level competition!

The force of such actions can also cause impingement, shoulder muscles swelling and pinching the nerves on top of the shoulder. This causes “electric shock” jolts of pain all the way down the arm to the elbow (sometimes past it). Pins and needles and numbness in the fingers can also happen. Any symptoms such as these should never be ignored as medical treatment may be necessary. Again, a physiotherapist is a good person to go to as he will refer you to a clinician if needs be.

The shoulder is a very mobile joint, but can be unstable. Some people’s shoulders dislocate very easily, as the shoulder socket is quite shallow. A fall onto the arm can also cause the humerus (upper arm bone) to slip out of the socket. If this happens to you, the pain will be considerable, the shoulder will look misshapen and you will not be able to move the arm out to the side. Medical attention is obviously paramount as an xray or MRI scan may be necessary, but a dislocated shoulder is quite easily put back in. The danger then is that it will happen again, as muscles may be damaged and ligaments torn, so shoulder therapy needs to include strengthening exercises and careful rehabilitation before a sporting activity is resumed. So many re-injuries are caused by trying to do too much too soon!

Treatment will involve the shoulder being immobilized for about one month with the arm in a sling. After that, gentle movements with the shoulder girdle kept still until mobility is regained. Exercises with light weights can then be introduced, building up to full functional fitness. The golden rule in this case is that if an exercise hurts – don’t do it!


The danger position for dislocation of the shoulder is when the arm is held out at shoulder level, elbow bent – as if you are about to return a high tennis serve. This is the point at which the joint is most vulnerable.
Athletes who rely on their shoulders in competition for throwing or racquet sports may require surgery to tighten the ligaments and muscles.

The type of therapy will depend on the injury itself, but with care and common sense, most shoulder injuries can be successfully rehabilitated.

To learn more about shoulder and Rotator Cuff Injuries please click the link.

All the best,
 

Carol J Bartram
(Sports Therapist, Personal Trainer & Pilates Instructor)

Shoulder Therapy 

There are several reasons why you may get leg pain - lower leg pain in particular may be caused by shin splints. If you are active and doing high-impact sports involving lots of running and sudden turns, the pain and inconvenience of a shin splint can be a nightmare and can become a chronic injury.

But you don't have to be a regular athlete to suffer. Doing too much exercise too soon if you have been sedentary is also a common cause - joining a running club after being inactive for many years and trying to keep up with the regular runners from day 1 is also a recipe for sore shins!

There are two types of shin splints; Anterior and Posterior. If you feel down the front of your lower leg, you will feel the edges of a bone close to the surface - it's like you have a school ruler in your leg.

This is the edge of your tibia. A shin splint is caused by inflammation of muscles close to the tibia. When they become inflamed, they pull on the connecting tissue that attaches them to the bone, and that's where the nagging ache comes from.

Anterior shin splints can be caused by activities requiring sudden stops, starts and turns at speed - football and basketball are good examples. Given that some of these footballers are big, hefty lads weighing in at around 200 lbs, the strain on those small shin muscles is immense. These guys are quite fit, however - if you are unfit and suddenly take up running 10k races without a gradual build-up, your chances of getting an anterior splint are high.

Posterior shin splints occur on the other side of the shinbone and are more likely to be caused by poor posture when running. Main culprits here are flat feet and tight calf muscles, which cause muscular imbalances. One of the first things I do when someone comes to me with this kind of shin splint is put them on a treadmill and watch their running action. I look for feet rolling out, landing flat, or knees moving in. The latter often happens with ladies, as we have a wider pelvis than men, so the angle of the thigh bone (femur) is more acute. This can also cause knee pain.

For anterior shin splints, I advise a rehabilitation program involving non-impact cardio training such as rowing or cycling to rebuild or maintain fitness, then introducing sport-specific activities gradually.

Posterior shin splints require a strengthening of core and postural muscles - I advise leg strengthening exercises and Pilates, often on a one-to-one basis, so that the imbalances that caused the splint in the first place can be addressed.

Both types of shin splint should in the acute stage be treated with rest and ice, and you should always warm up before exercise and stretch afterwards. As with most injuries, prevention is much easier than cure!

All the best,

Carol J Bartram
(Sports Therapist, Personal Trainer & Pilates Instructor)

Pain Lower Leg

Imagine the scenario. You have embarked on a fitness regime after years of being sedentary. This is something you've been promising yourself for a long time, but have never got round to, due to working, raising kids and being Chief Cook and Bottlewasher, Laundry Maid and General Dogsbody.

Your weight has increased slowly but inexorably, your bust and waistline have simultaneously headed south, and somehow your favorite clothes seem to have shrunk and are too tight. You, who used to run for your school and played hockey at regional level.

You are determined to stop the rot and regain at least some measure of your former fitness (and figure!). So you join a local running club and turn up religiously in kit and new running shoes. After the first run you are exhausted, but really proud of yourself - you have embarked on the New You.

All goes well for a while; you increase to 3 runs a week and your weight starts to go down. But then your shins start to ache during your run. Not too bad at first; it's uncomfortable, but you keep going - can't let those young ones beat you! But then the pain gets worse and comes on earlier in the run. You have to stop and rub your shins to try and alleviate it. It doesn't help, and you end the run at a hobble, close to tears.

So what's gone wrong? You never had pains like this in the old days. Is there something wrong with your leg bone? Shin cancer??

Relax. It's not the end of the world and you're not crippled for life. You've got a shin splint.

Shin splints are just a name for a muscle inflammation over the shin. The muscle involved is called Tibialis Anterior and runs down the front of your lower leg from knee to ankle. If this long, thin muscle is overused, it gets strained and swells up - hence the pain and the impulse to rub your shin. Bad idea, as this will spread the inflammation.

The most important thing is to stop running at once and get some ice on the area as soon as possible. Use a proper icepack, or wrap something frozen in a towel - ice must not come into contact with bare skin. Rest the leg for at least 3 days, put a compression bandage on it for part of the day and sit with your leg up if possible. Let the family run round after you for a change.

After 3 days, try some low-impact exercise such as swimming or cycling, and take it easy on the running - start with a slow jog once a week and see how your leg feels, then build up from there. Shin splints are a sign of too much of the same activity, so vary your workouts. You'll get just as fit, and should make a full recovery.

So if you want help with the recurring misery of shin splints - if you want to get on with your workouts and training without the constant interruptions caused by leg pain - click on this link and start your Shin Splint Treatment today!

All The Best,

Carol J Bartram
(Sports Therapist, Personal Trainer & Pilates Instructor)

Bone Shin Splints

My name is Carol Bartram and with my husband Bob we make up the Tubby2toned Exercise team. We both love Pilates and the benefits it can bring and we hope to persuade you that Pilates is worth the time and effort required to master it.

What Is Pilates?

Pilates is a relativity new exercise system developed by Joseph Pilates in the 1920's.

Many people start Pilates because they gave been referred to it by their health professional to help correct some postural imbalance which may be causing them some pain. That's why we both started Pilates; to get rid of pain we had!

I, after a lifetime of falling off horses, have amongst other injuries a twisted pelvis. Bob has nearly constant back and neck pain due to appalling posture. Once we started to feel the benefits (less pain, better posture) we decided to invest in teacher training so that we could teach it to other people.

Did I say I loved Pilates? I love the fact that we receive people into our classes in such a state that it is a miracle they got into the studio! No, they haven’t been in multiple car crashes, they just have half a lifetime of bad posture and feel the pain. They have such poor core stability that they struggle with the simplest of exercises – even standing on one leg is nearly impossible at first. But if they stick to attending regularly for 6 months – well, all I can say is – the difference in them is amazing! They are much stronger, walk taller and look the world right in the eye. Their pain is much improved, if not gone altogether, and their stress levels are way down, too.
Lets be honest here. Pilates is good, but it can't work miracles. Half a lifetime of postural incorrectness can't be fixed in 6 sessions. You have to stick to it, probably for the rest of your life. Although that’s not as terrible as it sounds; once you get the hang of the basic principles, you start putting them into your everyday life almost automatically. I have many clients who tell me they hear me nag “Shoulders back and down!” when they’re walking sloppily round the mall and I am miles away!
Sadly, we do sometimes get clients who are looking for a quick fix and get frustrated when results are not instant. They tend to drop out quite quickly, convinced that Pilates “doesn’t work”. Hey, you can lead a horse to water…

Although you can teach yourself Pilates from our Free Exercises, books or DVD's, taking a class is much more effective. A qualified instructor knows how to get you into the right position and give you correct teaching points. It is impossible to check your own form whilst doing the exercises so you'll never be 100% sure you’re doing the exercises correctly.

Free Pilates Exercises are helpful to see if it's the sort of exercise you'd enjoy doing and after you've been to a class you will have the material to remind you of what your supposed to be doing and where you are supposed to be feeling it!

Remember practice doesn’t make perfect it makes PERMANENT! If you learn an exercise incorrectly and practice a lot, you will permanently do it wrong. Then you will have to unlearn the exercise (which takes a long time) before you can re-learn the correct movement pattern.

So if you think Pilates may be for you – and I’ve never met anyone it wouldn’t benefit - then find a qualified instructor and join their classes. You won’t regret it, I promise you.

Carol J Bartram
(Pilates Instructor, Personal Trainer & Massage Therapist)

What Is Pilates

I don’t always feel like exercising. There are days when I hide under the duvet when I hear the word. Gone are the days when I could eat anything I liked, and as much of it as I liked, and stay under 115 pounds. In fact, in those days – not so long ago, I didn’t think about eating healthily and exercising at all.

Sure, I was active and always on the go, but my body was a lot more forgiving than it is now! I may be a Personal trainer, but I’m not a skinny one. and boy, do I love my food.

Even eating half of what I used to eat, I still put on weight if I do no exercise. And with a house to run, husband, dogs and child to look after, AND a business to run, if I don’t watch it then it’s my exercise time that suffers. I’m sure you know where I’m coming from here.

So how to fit enough exercise into a busy day? Here are some ideas:

Be selfish. Even if you only take 20 minutes to exercise it’s a hell of a lot better than nothing. The ironing isn’t going anywhere, and if he wants that shirt so badly, he can iron it himself.

Take the dog for a 30 minute brisk walk every day. He’ll love it and the fresh air will do you the world of good. if you don’t have a dog, borrow one. You’re welcome to one of mine!

When you go shopping, park as far from the store as you can and walk. Pushing a full trolley will really trim the backs of those arms.

Join a gym or enrol for a series of exercise classes. You don’t need your best friend to go with you, honest. And once you’ve booked to go to a class, you’re more likely to actually go. Any instructor worth their salt will make you welcome – just hop around at the back of the room, and you’ll burn more calories than the girls that know all the moves by heart.

Run up and down stairs ten times a day. At work or in shops, always use the stairs instead of the elevator.

Walk to the local store, walk in your lunch hour for 10 minutes and remember that every little counts. Exercise not only burns calories at the time, it also revs up your metabolism – which is your body’s “furnace” and that means you keep on burning calories for hours afterwards.

But remember; strolling along won’t do! You need to stride out so that your heart rate rises, your breathing gets faster and you start sweating a bit. If you finish your walk as cool as a cucumber, you haven’t done enough.

It’s not actually all that difficult to fit in 30 minutes of exercise – the Government’s recommended amount – into a day. Even a frantic, hectic day offers possibilities. Don’t forget; your exercise is just as effective done in 3 x 10 minute sessions.

So get out there, get moving and start feeling better!

Carol J Bartram

Article

The Best Way To Lose Weight

 According to the World Health Organisation, health is defined as; “A complete state of physical, mental and social well-being; not merely the absence of disease.”

Fitness, on the other hand, is defined differently, as we are all individual and different. Being fit enough to enjoy daily life and activities and keep excess weight at bay is the way the average person sees it, whereas a world class athlete views it as being physically faster,superior and stronger than everyone else.

You may be healthy but unfit, although it has been proved that some measure of physical exertion on a daily basis will not only make you healthier, but will keep you that way for longer.

Here are some of the benefits of  fitness:

Aerobic fitness

The word “aerobic” means “in the presence of oxygen”. The heart and lungs pump blood filled with oxygen to the working muscles. The fitter an individual, the more efficient the heart and lungs are in doing their job and the longer the muscles can keep going without fatigue or breathlessness. Activities such as walking, swimming and rowing are classed as aerobic.

Muscular strength

The ability of a muscle to exert as much force as possible in a single contraction – say in lifting a heavy box into the trunk of your car without dropping it on your foot. Doing exercises with weights is the best way to build strong muscles – and that applies to women as well as men.

Muscular Endurance

The ability of a muscle to exert less than maximum force, for a longer period of time – lifting several not-quite-as-heavy boxes without becoming exhausted and dropping the last one on your foot. Exercises holding light weights will increase muscular endurance.

Flexibility

The more flexibility an individual has, the better the range of motion in their joints and muscles. Some people are far more flexible than others naturally, but if you do not move and stretch your muscles and joints regularly, they soon get stiff, range of motion becomes less and your movements become limited. Age doesn’t help, as flexibility decreases, but there’s still a lot you can do to maintain it. Use it or lose it. That being said, it’s NEVER too late to start flexibility exercises; in my Pilates classes there are many older folk whose muscular strength and range of movement are improving with every month that passes.

Motor Skills

Nothing to do with driving! Gross motor skills are those such as catching or hitting a baseball. Fine motor skills are precise movements like threading a needle. Both types are “learned” by practising activities that involve such movements. Mastering such skills is beneficial for both body and mind as they increase spatial awareness and proprioception (the brain’s ability to know exactly where the limbs are during any movement. Reaching for a cup and your fingers closing on empty air is due to lack of proprioception. Unless you haven’t got your glasses on!).

The above components are the main physical benefits of starting to exercise regularly, and any exercise program should involve all of the above on a regular basis. This is not as complicated as it sounds; if you go for a brisk walk, move all the furniture to vacuum, play tennis and go to a Yoga or Pilates class each week, you’ll have covered most of them!

Carol J Bartram

Article -

Exercising is Good for Your Health