Shoulder impingement refers to the pinching of soft tissue structures between the shoulder during movement. Pressure along some structures with shoulder movement is common, however chronic irritation will lead to swelling of poor biomechanics and lead to pain. The bursitis in the shoulder refers to a pathologic inflammation of the sub-acromial bursa which has been inflamed due to an injury or due to chronic compression. A chronic shoulder impingement may lead to bursitis which is an extremely painful pathology. Pain will be present with movements as well as lying on the side. If a shoulder impingement has only affected the tendons, painful positions while playing basketball or in daily life will be present.
Examination will reveal pain and may have difficulty elevating the arm due to pain. There may be any underlying shoulder weakness due to irritation of the tendons. Functional daily tasks may become difficult because of the inability to use the shoulder as previously. Specific assessment manoeuvres will help guide the clinical towards its diagnosis, however specific radiology with ultrasound may be used further investigate and exclude other tissue damage. Contributing factors to a shoulder impingement are the spine and shoulder blade mobility as well as muscle balance. Poor mechanics in the latter may lead to impingement.
The management of the shoulder impingement is commonly conservative with great outcomes. This is achieved with ice, anti-inflammatory medication, and activity modification, followed by correction of structural abnormalities and strength imbalances. However, in cases of severe bursitis a corticosteroid injection may be used directly into the bursa. This has great outcomes and will be used in a shoulder that has failed conservative management.
Surgical management may be used to create more space between the impingement sites. Rehabilitation following surgery includes ice and mobility exercises, followed by strengthening and return to sport training.
Scapular/ Thoracic Dyskinesia
Scapular and thoracic dyskinesia are common findings in the athletic and non-athletic individuals. Scapula dyskinesia, which means that the mobility of shoulder blade is not ideal is a very common observed phenomenon which does not correlate with pain. In addition, Thoracic dyskinesia refers to the phenomenon where the upper back is not mobility enough or has areas that are stiff. Both of the latter phenomena can be present without affecting individuals’ function nor pain levels. However, in basketball, restriction will lead to overload of other areas due to the training frequency and volume. The common problem will arise from scapular or thoracic dyskinesia will be shoulder impingement which will then restrict athletes ability to compete.
Examination will reveal weakness or stiffness in the muscles surrounding the shoulder blade leading to a non-symmetric shoulder blade movement. The upper back will not be mobile and this can be visible through some additional testing. Shoulder function will also be assessed, as shoulder pain can lead to scapular dyskinesia.
The management of the latter will include hands-on and a progressive exercise routine that will allow for optimal length and strength relationship between the muscles.
An ankle sprain is very common in a sporting environment but it can happen in the general population. The twisting of the ankle will injure a complex of ligaments on the inside or outside sides and may range from a mild sprain to a tear. The most commonly affected ligaments are on the outside which are a result of an inward twisting of the ankle. Following an ankle sprain there will be immediate swelling with pain. The inability to walk on the foot is a strong indicator that an X-Ray will be required to rule out any fractures.
During examination there will be commonly swelling around the joint with marked instability during functional tasks. The strength will be affected as a result of pain but is not always present. The range of movement will be decreased due to swelling. Specific clinical tests will reveal laxity or pain of the ligaments depending on the grade of severity. On a severe ankle sprain with suspected tears of multiple ligaments it has to be confirmed with radiological investigation. An MRI will show the damage in the ligaments and will guide the management in the severe cases.
The management of ankle sprain in mild to moderate grades is conservative with relative rest, ice, pain and swelling management. Full range of movement and strength will be regained before commencing to balance exercises. Once all the previous steps are completed, functional training and sport-specific exercises will be initiated to prepare you for returning to sport.
Operation will be the management for a full tear of multiple ligaments which will aim to regain normal stability and prevent chronic instability and osteoarthritis. The steps of rehabilitation after the operation are the same as with the conservative management, however with a longer duration.
Mechanical Lower back pain
Lower back pain in basketball is common in the adult athlete. This can be a result of repeated extension of the spine accompanied with rotation following repeated throwing the ball. This can lead to prolonged compression of facet joints which will lead to irritation. Muscle imbalances or extended/increased training schedules may be the result to this mechanical irritation. The symptoms include pain with specific movements of the spine, aggravation with extension and with training.
Examination will commonly reveal pain in the lower back with specific manoeuvres, however in high irritable presentations most movements will elicit some discomfort. Testing the functionality will allow the physiotherapist to guide on specific management. Testing of the lower limb and core function are critical components as any injury or dysfunction may lead to secondary overload of the lumbar spine.
The management of lower back pain varies greatly on the individual. The management is conservative treatment and aims to restore normal pain-free movements of the spine in the initial stages with manual techniques, medication and advice. Following this and when symptoms have settled, a more exercise-dominant rehabilitation will follow, aiming at correcting muscle weaknesses and joint stiffness that can predispose to further injury. Re-introduction to sport will be done with sport-specific rehabilitation and gradually returning to full execution of sporting movements without symptoms.