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Shoulder Dislocations

Posted on 2:36 pm in Uncategorized |

How do they happen?   The shoulder is the most mobile joint in the body. It is a very shallow ball and socket joint supported by the rotator cuff, its capsule, the labrum and the larger overlying muscles. The configuration of the joint allows us to do many things with our hands like fixing the overhead gutter or pitching a baseball at breakneck speeds. We can get a shoulder dislocation due to a sudden trauma or due to an underlying instability. Due to the mobility of the shoulder we can dislocate the shoulder in many different directions and this is one way to classify the dislocation ie superior, posterior, inferior, anterior. The shoulder is the most commonly dislocated joint and it can be quite a painful and arduous experience.   How do I know if I have a dislocation?   When the joint is forcibly separated, many muscles and ligaments tend to be torn resulting in a lot of pain. You will be unable to move your shoulder in any direction. Physically you may be able to see what is called a step deformity where the shoulder appears squared off as the humeral head has moved out of its place from the glenoid fossa.   How do I treat a dislocated shoulder?   Depending on the severity of the dislocation, you may need your shoulder relocated or put back into place, or the dislocation may reduce back into the joint. Your physio can determine how long and how you need to immobolise your arm, and when you can begin to do exercise to strengthen the structures again. As most young people dislocate their arms during sporting activity, its important that you undertake a rehabilitation program to get you back to be able your sport.   If you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at

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Deadlift Technique

Posted on 12:53 pm in Uncategorized |

  The deadlift has various forms, for the sake of this blog we will be focusing on the traditional deadlift. Deadlifts are a movement pattern that are performed every day to perform simple tasks such as picking up objects off the ground.   Whilst it is a very important movement skill it is often looked upon as a “dangerous” exercise, as if it is performed incorrectly there is a high risk of injury to the disks in the lumbar spine/lower back. Lumbar flexion (curving of the lower back) results in an increase in disk pressure, this pressure is increased when we are lifting a load (such as when deadlifting). This pressure can promote movement of the fluid within the articular disk to move more posteriorly and therefore generates a higher risk of disk-related injury. The vertebral bodies and disks are responsible for load transference through the spine and a neutral spine ensures appropriate transfer to the posterior chain, without putting the disks in a vulnerable position. In addition, activation of the deep core musculature can result in improved spinal stability due to the attachment of the core muscles into the fascia surrounding the spine. .   To ensure injury prevention when deadlifting individuals should ensure: Shoulders are above the bar Squeeze shoulder blades back and down/activate Latissimus Dorsi to increase core stability and minimise lumbar flexion Activation of core musculature Keep weight through heels/mid-foot to increase posterior chain activation (gluteals, hamstrings, calves) Attempt to “push floor away from you” Do not increase weight beyond what your abilities allow Take extra caution with technique when performing low repetitions and/or max deadlifts There are multiple forms of deadlifts which can be utilised to provide variations in an individual’s training program, these injury prevention tips to protect the lumbar spine can be used with all different techniques. If you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at References Cross-Fitness Injury Prevention: Protecting the Lumbar Disc in Squatting Motions. (2018). Retrieved 9 March 2018, from How To Deadlift: A Beginner’s Guide. (2018). Retrieved 9 March 2018, from Stokes, I., Gardner-Morse, M., & Henry, S. (2011). Abdominal muscle activation increases lumbar spinal stability: Analysis of contributions of different muscle groups. Clinical Biomechanics, 26(8), 797-803.

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Yoga & Physiotherpay

Posted on 2:26 pm in Uncategorized |

  21st century postures have been shown to increase joint and muscular loads on our spines, most predominantly with prolonged sitting. Whilst the actual position of sitting is not as bad as we had originally postulated, it is more the lack of movement and sedentary postures that increases stiffness, deconditioning of our stabilising muscles, dehydration of intervertebral discs, and many other biological occurrences that fall under the general ‘wear and tear’ process. There has not been a huge amount of high quality research performed on yoga and its effect on low back pain, but you can be assured that if you ask someone who regularly practices yoga, they will quickly and confidently expose its benefits on their body and mental state.   Sherman et al. state that, “Yoga is a complex multifactorial intervention with a number of potentially different therapeutic mechanisms, including physical effects of movement, benefits of breathing, and benefits of concentration (Sherman, 2013). Yoga has many therapeutic benefits for a wide range of patients, for example, alleviation of pain in low back pain sufferers (Sherman et al. 2011). This research proposed the mechanisms behind this as a combination of increased physical activity, improved self-awareness, decreased stress, improved sleep, and improved neuroendocrine function, which may occur with regular yoga practice. As many patients seeking physiotherapy are sufferers of low back pain, yoga seems an excellent adjunct to rehabilitation for this patient group.   While the science does not put yoga greatly ahead of other common exercise interventions, there is a huge amount of empirical evidence for the benefits of yoga. Many of us know that stretching is beneficial for our muscles and joints, but it is the issue of compliance of regular stretching that we are unable to adhere to. Regular yoga practice allows us to regularly stretch and strengthen our bodies every week and thus working against the stiffness build-up that occurs with sitting, work postures and the stresses of everyday life. Yoga is a beautiful tri-prong of stretching, strengthening and mediation that I firmly believe is the best non-specific exercise intervention (if done regularly) for reducing lower back pain and other stiffness related injuries.   If you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at   Sherman, Cherkin, Welmann, Cook, Hawkes, Delaney & Deyo (2011). A Randomized Trial Comparing  Yoga, Stretching and a Self- care Book for Chronic Low Back Pain. Arch Intern Med. 2011;171(22):2019-2026. doi:10.1001/archinternmed.2011.524 Sherman, Wellman, Cook, Cherkin & Ceballos (2013). Mediators of Yoga and Stretching for Chronic Low Back Pain. Evidence-Based Complementary and Alternative Medicine Volume 2013 (2013), Article ID 130818. doi;10.1155/2013/130818  ...

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Plantar Fasciitis

Posted on 1:44 pm in Uncategorized |

  Plantar fasciitis is a condition which affects the sole of your foot. The condition has many names in which it may be referred to; these include Plantar fasciosis, plantar heel pain, and plantar fascial fibramatosis.   The plantar fascia is made up of fibrous connective tissue which originates on the medial calcaneal tubercle (heel bone), and splits into five bands as it attaches to all 5 metatarsal heads (toes). Pain can be felt where the fascia joins the heel bone (insertional) or in the central portion (non insertional). The plantar fascia joins the paratenon of the Achilles tendon, foot muscles and the skin and subcutaneous tissue.     The foot absorbs up to 110% of body weight while walking and 250% while running. The plantar fascia deforms most during barefoot walking vs. shoe walking. During walking or running the tibia (shin bone) loads the foot and creates tension through the plantar fascia, this called the windlass mechanism. The tension created in the plantar fascia adds critical stability to the loaded foot and minimises muscle activity.   Prognosis   Evidence states that episodes of plantar heel pain last longer than 6 months and it affects 10-15% of the population. However, approximately 90% of cases are treated successfully with conservative care.   Causative Factors   This condition is most common in the middle aged, women, and the athletic population. However it can occur outside these parameters. It makes up 8-10% of all running related injuries. Other risk factors which contribute to plantar heel pain including but not limited too: Loss of ankle range of motion (dorsi flexion) Flat feet or high arches Excessive foot pronation dynamically Impact/weight bearing activities such as prolonged standing, running, etc Improper shoe fit Elevated BMI > kg/m2 Metabolic conditions such as Diabetes Mellitus   Symptoms   Heel pain with first steps in the morning or after long periods of non-weight bearing Tenderness to the anterior medial (inside) heel Limited dorsi flexion (ankle ROM) and tight Achilles tendon A limp may be present or may have a preference to toe walking Pain is usually worse when barefoot on hard surfaces and with stair climbing Many patients may have had a sudden increase in their activity level prior to the onset of symptoms Diagnosis   The condition can be diagnosed clinically through a comprehensive subjective and objective assessment by your physiotherapist at Get Active Physiotherapy. In rare cases further investigation such as radiographs, diagnostic ultrasound or MRI may be required.   Physiotherapy Management   – Stretching- gastroc/soleus (calf), plantar fascia, – Soft tissue releases/massage and joint mobilisations – Orthotics – Night splints – Specific Strength training   Here at Get Active we can provide you with the best individualised treatment options to optimise a speedy recovery.   If you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at...

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Patella Tendinopathy

Posted on 3:03 pm in Uncategorized |

Do you have pain with running, jumping, lunges that you feel at the bottom of your kneecap? Patella tendinopathy, commonly referred to as ‘jumper’s knee’ due to the increased incidence in jumping sports i.e. basketball, netball, athletics, is a condition of deterioration and subsequent weakness and pain of your patella tendon. Tendons are thick elastic tissues that connect muscle to bone. Unlike muscles, tendons have very little blood supply, meaning that the nutrients and ‘healing’ mediators that are in our blood are not very evident in our tendons. Due to this property of tendons, they are not very good at healing. In this way, continuing to exercise through pain in the hope that it will sort itself out in time is often an unlikely occurrence. The body is an incredible system that is very good at self-healing and regeneration, but tendon tissue react and heal differently, thus needing a different approach.     Clinical Symptoms   localised pain at the base of the knee-cap (patella) pain initially with exercise (such as running, lunges), which then warms up and is less painful, only to become painful when exercise is finished, or notably the next morning after exercising that previous day Can appear puffy and swollen at the base of knee cap tender to touch, or to kneel on ground pain walking downhill, or down stairs more than uphill or up stairs   Causes   The biggest pre-disposing factor to developing tendon injuries is a relatively sudden increase in load, i.e. increased volume or frequency or exercise from a previously less intense regime/nil exercise. The other causes are often strength and flexibility imbalances in the rest of the leg or the non-symptomatic leg. The longer you have had your symptoms for generally means the longer it will take to completely heal. A person who has had persistent pain for the first time can take between 3-6 months to reach a full recovery. If you have had the pain intermittently for over 6 months, then it can take up to 12 months. This is probably the most frustrating element of patella tendinopathy, but the sooner you start, the sooner you will be on the road to recovery.   How Do We Fix It?   There is a considerable amount of quality evidence suggesting that a loaded and customised strength program, which we can take you through here at Get Active Physiotherapy, is an effective intervention to a full pain-free return to activity or sport. It is important to note the slower healing time for tendon injuries. Volume modification of exercise/sport is a huge component of management with this injury, and thus a thorough understanding of how much is too much will be explained to you by your physiotherapist. Leveling out any biomechanical abnormalities or asymmetries will be a key focus within your recovery plan, and this will reduce likelihood of developing other injuries in different areas in the future. Remember, the longer you have had this pain for, the longer it may take to heal, so book your initial appointment today and feel the difference tomorrow.   If you have any questions or would like to address any running issues or injuries you may have, book in to see one of our physiotherapists. Please do not hesitate to contact Get Active Physiotherapy on 1300...

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Running and Physiotherapy 

Posted on 1:09 pm in Uncategorized |

Running is one of the most common forms of recreational exercise currently performed by Australians. It is cheap, time-efficient with no specialist equipment required. You may run home from work, go to the local oval and do laps, or running could even be your way of “switching off” and relaxing. Whatever your reason for running and wherever you do it, it is important to understand some basic principles which could significantly reduce your risk of injury.     Capacity & Load Management   Everyone has a capacity that their body can deal with when it comes to any task. You wouldn’t try and lift a 100kg bench press if your previous best was 60kg. Similarly, it is not appropriate to attempt to run 20 km’s when last week you struggled with a slow 5 km run. If our bodies/body parts can’t deal with the load that we put on them, we are more likely to get injured and be in pain as we exceed the capacity we can deal with. A gradual increase in load is important to minimise the risk of injury.   Dispelling a Myth   Around 80% of runners land with a heel-strike pattern. You may have heard this is wrong and a forefoot strike is better for you and less likely to result in injury. Both forms of strike can be acceptable, depending on your running style and injury history. For some current or previous injuries forefoot strike can actually aggravate your symptoms. Either way, it’s really important to get assessed to find out which style is the most appropriate for you.   Reasons For Injury Due To Running   There are many factors that influence a running style. There are, therefore, many reasons why we might get injured with running. Common reasons include overstriding with each step, being too stiff during the strike phase, too much ankle dorsiflexion in a number of positions during the running cycle and poor proximal control and stability. These are but a few of the reasons we may get injured with running.   Physiotherapy & Running Retraining   Physiotherapists can be excellent clinicians at identifying the reasons you are getting injured with running. At Get Active Physiotherapy we perform a thorough assessment that will get to the bottom of your running injury. The assessment is split in to two parts. Firstly, a detailed assessment of the function of multiple body parts in isolation, combined with functional movements, identifies any weakness or restriction you may have. Secondly, a treadmill running assessment focusing on your running style, this is to identify any potential harmful mechanics. Cues are then given to retrain the body and running style. Specific exercises are also given to overcome any issues identified in the assessment and get you back on track (pun intended!).   If you have any questions or would like to address any running issues or injuries you may have, book in to see one of our physiotherapists. Please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at

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Should You Go Under the Knife?

Posted on 12:45 pm in Uncategorized |

  So you’ve been dealing with extreme pain for quite a while now, maybe in your knees or in your lower back and medication is not providing the same sort of pain relief that they once did. You go to your doctor, desperate for a solution. “Let’s investigate further, get some scans” they may  suggest. You go for said scans and the results are not good, the outlook is terrible. The report reads something like a doomsday letter – “massive eruption of tendon”, or “extreme protrusion of sac on nerves” or “end stage degenerative joint disease”. Your doctor reads the report as your palms begin to sweat. “Ah this is why you are in so much pain” they exclaim. Straight to the orthopaedic surgeon! A few days later you walk through the doors of the lush clinical orthopaedic surgery ready for going under the knife.     Is It Necessary?   It has been long known that scans show a lot of things which may not be the cause of your pain, especially when your pain is chronic. Evidence shows that MRI results are a poor way to find the cause of chronic pain, furthermore they can actually lead to worse outcomes than if they had not been done at all. Why is this so? Studies show that almost no matter which area of the body goes under, there is a high percentage that you will find something wrong even in parts that don’t give you pain.   Recent evidence is now showing that many of the surgeries that have been used for a long time to correct the anatomical deficits found in scans to be useless. Take for example knee osteoarthritis. Knee osteoarthritis is very common and in even the worst cases does not always result in pain. One study was conducted where real knee surgery was performed versus sham surgery where the surgeons would just create an incision in the skin. The study was conducted over a few years where subjects would report their function and to no surprise, both groups reported equally better knee pain and function at all points in time. This strongly suggests that surgery may not be effective due to the structural changes made but by the change in psychology of the person who had the surgery. Subsequent research has also proved that surgeries for the knee for osteoarthritis are no more effective than interventions such as physiotherapy, exercise, weight loss and over the counter medicine.   Not all surgeries are useless but some are. Sometimes a well designed rehab solution is what is needed to keep you from being on that surgeons table.   If you have any questions or would like to book in to see one of our physiotherapists, please do not hesitate to contact Get Active Physiotherapy on 1300 8 9 10 11 or email us at...

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Achilles Tendinopathy

Posted on 2:06 pm in Uncategorized |

  Achilles tendinopathy is a common, yet potentially debilitating injury in which load can be both anabolic and catabolic (Cook and Purdam., 2008). There are multiple contributing factors to Achilles tendinopathy and rehabilitation can often be difficult and prolonged (Kountouris and Cook., 2007).       Diagnostic criteria for Achilles tendinopathy   When diagnosing Achilles tendinopathy, the main diagnostic criteria is patient history and pain on palpation over the tendon (Maffulli, Kenward, Testa, Capasso, Regine and King, 2003). Cook, Khan and Purdam (2002) suggest that Achilles tendinopathy results in local pain over the Achilles tendon and does not refer elsewhere. The other diagnostic criteria are direct relationship between worsening of symptoms and increase in training load and load related pain (Cook, Khan and Purdam., 2002). Gymnastics is an example of a sport which puts individuals in a high-risk category for Achilles tendinopathy with incidence as high at 17.5% due to the excessive plantarflexion and high recoil aspects of this sport (Emerson, Morrisey, Perry and Jalan., 2010). If a patient has an isolated location of pain over the mid-portion of the tendon, this decreases the likelihood of differential diagnoses such as sever’s disease, avulsion fracture of the calcaneus or insertional tendinopathy (Adirim & Cheng., 2003). Gradual onset of symptoms that warm up 5-10 minutes into training, stiffness during exercises and decreased function/muscular endurance of the calf are also characteristic of a tendinopathy (Joyce and Lewindon., 2016).   Causative factors of Achilles Tendinopathy   It is now widely documented that the causes of Achilles tendinopathy are not well-known and diagnosis may be complicated due to close proximity of numerous other soft tissue structures (Hutchison et al., 2012; Kader, Saxena, Movin & Maffulli, 2002). Causative factors include both extrinsic factors such as training load and potentially poor technique and intrinsic factors such as family history, collagen make-up, muscle/tendon strength, biomechanics and previous injury history (Abate et al., 2009).   Training load/repetitive stretch-shortening cycles   Increased training volume that coincides with onset of symptoms is one of the biggest predictive factors for developing a tendinopathy (Cook, Khan and Purdam., 2002; Clement, Taunton and Smart., 1984; Abate, Gravare-Silbernagel, Siljeholm, Di Iorio, De Amicis, Salini, Werner and Paganelli 2009; Joyce and Lewindon., 2016). For example, Gymnastics and trampoline require high levels of repetitive, explosive/plyometric loads with up to 6-8x body weight being absorbed in running, hopping and jumping (Malliaris and O’Neill., 2017). When the tendon is overloaded there is a breakdown of the quality of tissues within the tendon which causes inflammation and degeneration (Notarnicola, Maccagnano, Di Leo, Tafuri and Moretti., 2014). Repeated loading through an injured tendon results in micro-ruptures occurring due to the breakdown of cross-links by collagen fibres sliding past one another (Abate et al., 2009). This cumulative micro-trauma leads to a change in ground substance, collagen disarray and increased vascularity which therefore decreases tensile strength (Abate et al., 2009; Brukner and Kahn., 2007). Type 1 collagen fibres, which make up normal tendons, are often replaced with Type 3 collagen in injured tendons which makes the tendon weaker due to a decreased volume of cross-links between and within the tropo-collagen units (Kader, Saxena, Movin and Maffuli., 2002).   Biomechanics/Strength & Stability   Sports such as gymnastics require a large amount of controlled jumping and landing and therefore a high level of functional motor control for these...

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Common Causes & Treatments For Hand Injuries

Posted on 1:26 pm in Uncategorized |

The hand is one of many complex structures in our body. Given the importance of our hands and their role in facilitating our everyday tasks and activities, it is essential to have your injury or symptoms addressed at the onset of your symptoms.   This article will briefly outline some of the common presentations and give a brief description of how to manage them. It is important to seek the advice and assessment of a Hand Physiotherapist to ensure you are receiving the highest level of care. Firstly, if we take a look at the wrist, it contains many small bones neatly joined together by ligaments. This area is commonly referred to as the Carpus. The other end of the carpus is where our finger and thumb bones join, our metacarpals and the ends of our fingers called phalanges. Our thumb contains a proximal and distal phalanx, and the 2nd to 5th digits contain a proximal, middle and distal phalanx. Each joint of the hand shares ligaments that help maintain the stability of the joint by connecting two bones together. The joints between our metacarpals and phalanges are call metacarpal-phalangeal joints (MCPJs) and the joints between our phalanges are called proximal interphalangeal joints (PIPs) and distal inter-phalangeal joints (DIPs). We have a number of tendons and muscles that either traverse the top or bottom of the wrist and or digits and accompanying these are nerves and blood vessels. When we look at types of injury, we can very loosely divide them into two categories; a traumatic presentation and an overuse condition. Typically with traumatic injury, we generally feel symptoms immediately and generally, these symptoms immediately follow a particular movement or mechanism of injury. An overuse injury, refers to symptoms that have developed over a period of time, whether the symptoms stay the same or gradually change. One common mechanism of injury for the wrist is falling on an outstretched hand. This is a common occurrence out on the football field, tripping over when walking or coming off a bike. Structures that are commonly injured around the wrist include: a fracture of the distal radius / ulna scaphoid fracture scapho-lunate ligament tear / / scapho-lunate dissociation (separation) Triangulo-fibrocartilaginous complex tear (TFCC) Each of these structures will require a period of immobilisation in a particular position prior to commencing rehabilitation to restore movement and strength to the hand and wrist. Wrist pain can also occur after repeating a movement for a prolonged period of time, or vigorous repetitions with force. Some of the conditions that can occur include: Carpal Tunnel Syndrome De Quervain’s Tenosynovitis Intersection Syndrome Tenosynovitis or synovitis of the extensor or flexor tendons at the level of the wrist and forearm Management of these conditions would typically involve splinting into a specific position for a period of time with regular tendon gliding exercises, icing of the affected area. Once the symptoms have begun to subside, weaning from the splint is introduced and gradual strengthening and movement exercises are prescribed. When we look at common traumatic injuries to the thumb and digits, the following presentations come to mind: fractures of the metacarpals and phalanges dislocations of the PIP and DIP joints (most commonly) collateral ligament tears to the base of the thumb (MCP joint), PIP joints of the thumb and...

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Biceps Tendinopathy: What, How & What To Do Going Forward

Posted on 1:02 pm in Uncategorized |

So you’ve been training at the gym for a while now and the numbers on your lifts have been steadily increasing, however you’ve been noticing for last 4-6 weeks that the slight niggle at the front of your shoulder is starting to bother you more and more. Not just while you are training, but sometimes when you try to put your jacket on or when you roll over your shoulder in bed. Alternatively, you may not go to the gym at all. You did that one thing on the weekend – carrying groceries, lifting a heavy couch up the stairs – and that ache just isn’t going away. So what could it be?     Tendinopathies   Tendon pathologies are very common and are probably one the most frequent things we see in the clinic. Tendons are the fibrous tissues that connect muscle to the bone and function to transmit force that facilitates movement around a joint and also absorbs force to limit muscle damage or produce torque. They are composed primarily of water and collagen and their mechanical properties vary depending on the type of stress which is applied to them. Tendon pathologies are thought to occur on a continuum where tendons undergo three distinct phases: Reactive tendinopathy: an acute reversible process, brought about by an increase in mechanical loading Tendon Disrepair: if loading continues to exceed the tendon’s capacity to regenerate for a prolonged period of time, the tendon matrix begins to breakdown and growth of neural and vascular begin to pervade the tendon space Degenerative tendinopathy: further collagen breakdown, advanced matrix breakdown and increased fibre thickness. Once the tendon has reached this state there is very limited ability for the tendon to repair itself. This process is often brought on by increased volume of work on the tendon, be it one supra maximal load or continuous insults to the tendon which are below its threshold but accumulate over a short period of time leading to the reactive tendinopathy. The biceps tendon, particularly the long head of biceps (LHB) has been shown to function as a humeral head depressor/stabiliser of the shoulder joint and research shows that if the rotator cuff loses its integrity (via a tear or strain) the activity of the LHB increases, and superior migration of the humerus may concomitantly occur. This further stresses the soft tissue and the compressive force on the tendon increases. This can be particularly evident when we put the arm in extension (e.g. hand behind the back) or with the arm in abducted and externally rotated positions (high five position). Furthermore, biceps tendinopathy is rarely seen in isolation but commonly exists with other shoulder pathologies such as rotator cuff tears/strains, SLAP lesions and instability.   Biceps Tendinopathy Treatment   If you think you have a biceps tendinopathy, the most important factor in determining the course of treatment is finding the cause. The cause may be increased load, incorrect loading, faulty mechanics at the shoulder or all of the above Altering external stress to below provocative loads is an important first step. Correcting scapular kinematics which may be contributing to the faulty load is also important for preventing future recurrence of the tendon pathology. For example, if there is increased anterior tilt of the scapula there is a decrease in...

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