Bursa Thickening: A Normal Adaptive Process

Shoulder joint structureHere is another piece of research to suggest that changes within the body such as bursal thickening are (often) painless adaptive processes. Which is why, seeing these on scans should not assume that they are the cause of someone’s pain.

After all, in the study below, bursal thickening was shown to increase as the amount of swimming increased, with no correlation between bursal thickening and shoulder pain.

And this makes sense. A bursa is a fluid filled sac which is there to help reduce the effects of friction. More training means more friction. More friction means the body will adapt and so increase the thickening of the bursa.

This is normal!

The body is super amazing at adapting to whatever we put it through. But these changes are nothing to be afraid of.

However it is important to note the difference between bursa thickening caused by an acute episode (which usually is painful) and the thickening caused by an adaptive training programme (which is usually painless).

As always, every client is different. Which is why an MRI is only one part of the puzzle.

Source: https://www.ncbi.nlm.nih.gov/pubmed/24907190

Ultrasound Of The Asymptomatic Shoulder


Many of my clients have asked if an MRI or Ultrasound can explain why they have pain in their shoulders (and anywhere else that they are experiencing pain).

And the more I research, the more I believe that the findings from scans such as MRI or Ultrasound are only one part of the jigsaw and should be interpreted closely with clinical findings to determine the cause of symptoms. After all, we now know that pain does not correlate with damage (or abnormalities).

According to the research below, shoulder abnormalities were found in 96% of the subjects. The thing is that all these subjects were those that had NO pain at all. They were what we refer to as asymptomatic.

And in looking further at the findings in more detail:
– 78% of these had thickening of bursa
– 65% had joint osteoarthritis
– 39% had supraspinatus tendinosis

So again, these people had something that many medical professionals believe is an issue (and some believe issues that require surgery), but they are experiencing no pain or dysfunction.

How on earth then can we take a scan of someone who is in pain, who have the findings of those people above, and determine that it is the reason for their pain.

Surely if that was the case then EVERYONE who had those findings should have pain, right? Wrong. Again, see the results above!

Everyone is different. For some, their findings may actually be the cause of their pain. For others, it may not be quite as simple.

Source: https://www.ncbi.nlm.nih.gov/pubmed/21940544

I’m Moving!


It’s 12 months since I moved to Crossfit Wrexham but unfortunately my time there has come to an end. Family commitments have taken priority which has led me to move back to my old office in Llangollen. (Any appointments from July 3rd onwards will be back at The Malthouse).

Originally the decision felt like I was taking a step backwards in my career by moving to Llangollen, however I realise it is anything but.

We don’t make mistakes in life. Instead we create opportunities to learn from our experiences. And these last 12 months have created many lessons for me, both personally and professionally.

I am full of gratitude for what this past year and all the clients I have worked with have taught me. At times it’s been challenging but that’s what makes it so worthwhile. It’s with these challenges that we evolve and become better therapists, better people.

So yes I’m moving back to my old ‘home’ but as a therapist I’m without a doubt, moving forwards.

Sarah X

Simple But Effective


This is an example of how quickly a functional leg length can be improved with just one exercise and less than 3 minutes. (The images show lines placed below the lateral malleolus/ the inner ankle bone on both legs)

In this instance the hip of the shorter leg was contracting and holding tight (hence the shorter leg). When this happens, I’ve found that stretching often makes no difference.

However, using isometrics or muscle energy techniques (where the muscles contract but don’t more) can make a huge difference even if it feels like you’re hardly doing anything.

There is often the belief that you have to do something big to achieve something big but this really is not always the case.

When I see leg length discrepancies I simply take them as a baseline from which to work from. No big fuss. I just use them to help me find out what works and what doesn’t.

I then try a technique and retest. If it changes the LLD then I’m happy that whatever we did is probably going to help in some way. If it doesn’t change then I try a different technique. And so on until I’ve created a change. This doesn’t always happen (sometimes a person has a structural leg length discrepancy). But more often than not, something is simply holding one leg shorter than the other. The key is to test and retest until you work out what!

This particular client had come to see me with plantar fasciitis as well as an old shoulder issue and back pain in sacroiliac joint, all of which can be caused by a leg length discrepancy like this. And again, more often than not, it’s the simple techniques and movements that make the biggest difference.

The exercise that was used to create the changes in the image is the good old leg press

(Hold for 20-30 seconds; Repeat 2-4 times; Repeat 2-4 times a day)

Why People Have To Squat Differently

“There is absolutely no one size fits all squat position. If you don’t believe me, you are in for a treat. This article will help show you why athlete comfort should dictate squat width, why some people’s (not EVERYONE) feet point out (no matter how much “mobility” work they do), why some people have a really hard time squatting deep, and why some people are amazing at pistols while others can’t do them at all.

When someone has difficulty squatting, or their feet turn out, or they like a wide stance, we all want to jump on the bandwagon and say “your hips are tight, you need to mobilize them”. If we say that without considering anatomical variations of the hip joint, we can be misled.”


“Athlete’s won’t squat the same, and they SHOULDN’T!

Athlete comfort will dictate the stance that puts their hip in a better bony position. There are narrow squatters and there are wide squatters. That may have nothing to do with tight muscles or “tight” joint capsules and have more to do with bony hip anatomy.

Very few people are at the end range of their hip motion, so hip mobility drills are definitely a good idea.

People will express their hip mobility in different planes, and that is not a bad thing.”

Read the original article here.