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Shoulder SOS

Alistair and Johnny Brownlee will propel their body’s 1.5km through Round Hay Park Lake in the World Cup Triathlon event by performing over one thousand swimming strokes. Each stroke involves a full shoulder range of movement, strength and technique. There is no margin for error.

For most other people, we often take our shoulders for granted, that is until they initiate pain and/or restrict our ability to perform normal every day activities.

The shoulder joint is a very mobile structure and when functioning well it allows us to position our hands so that we can perform a variety of tasks. From common daily activities such as washing and dressing to the physical demands of work, through to the extreme requirements of high level sport. If however our shoulders fail to function correctly then our quality of life is affected.

The shoulder is a ball and socket joint, the ball is about the size of a golf ball and the socket is swallow and not much bigger than a two pence piece. Consequently, this design, whilst permitting a vast range of movement is very unstable. To keep the joint together we have a range of tendons called the rotor cuff and a complex arrangement of muscles to provide stability and power.

Just as with any joint, if these structures are damaged, worn or irritated then a mechanical and inflammatory pain response can be initiated.

Clinic 360 has mentioned before the importance of a tissue based diagnosis as opposed to a diagnosis based on a description of pain. With ultrasound scans it is possible to see beneath the skin and look directly at muscles, tendons, bursa and bony contours; and see these tissues actually moving.

Common problems include the enlargement of the bursa, tears within the rotor cuff and degenerative changes to the acromioclavicular joint.

Frozen shoulder is another pathology which results in gross stiffness and extreme pain.

Once an accurate diagnosis is made a variety of evidence based treatments can be provided. Excessive inflammation can be supressed with guided injection therapy, Frozen shoulders can be stretched via Hydro-dilation, which involves high volume fluid injections into the joint. Degenerative changes can be eased with steroid or Hyaluronic acid injections. And muscle problems can be addressed with specific rehabilitation.

Clinic 360 has worked with and helped many swimmers, plasterers, care workers, mechanics and racket sports players. Irrespective of age or sport or job the anatomy of the shoulder remains the same and the pathway to recovery starts with a real diagnosis, not guess work.

To find out what your tissue based problem is please book an appointment with Clinic 360. Initial consultation including ultrasound scan is £65. Injections, if required cost £75.

Knee problems are common and affect the quality of life for many people. Whether the pain limits a person’s ability to run or enjoy a social walk, or the knee hurts at work or even disturbs sleep, it is important to get a professional diagnosis.

For some individuals, their condition may have been linked to pathology because of the way it feels or how they describe their pain experience. The pain felt from a knee joint however, is not a reliable indicator of what the real tissue problem is. A much better way is to clinically assess and scan the joint to look for tissue damage and inflammation.

At Clinic 360 we use high-specification Ultrasound scanners which have the ability to provide a detailed picture of joint swelling, tendon and ligament damage. Linked with expert clinical examination this assessment process can quickly highlight most tissue based problems.

For some individuals, their knee pain experience will be linked to effusion and inflammation. With an accurate diagnosis, excessive joint fluid can be aspirated via guided injections. In a joint with osteoarthritis and degenerative changes it is not uncommon for Clinic 360 to aspirate up to 40ml of fluid. The immediate relief a client gets is significant.

The use of corticosteroids can further supress excessive inflammation, whilst medication such as Hyaluronic acid can aid joint lubrication. Clinic 360 is realistic about treatment outcomes, if a joint is severely degenerated or has significant damage then surgery will be flagged up as a valid consideration. However, most joint problems don’t need surgery and with accurate diagnosis an appropriate treatment can be administered.

For some people part of their problem relates to mechanical irritation because of how they are moving. Do you have good alignment in your legs when climbing stairs or going to sit down? Most people don’t! For many individuals, the alignment of their legs is not even a consideration.

Research has shown that if you want a healthy strong knee then you need to optimise your alignment, strength and pattern of movement. We also know that the strain through the knee joint is increased with dynamic activities such as running or walking downhill and this can produce an impact force of 1.5 to 8 times your body weight. With these faster or more complex movements, Clinic 360 performs a slow-motion bio-mechanical analysis to help reveal where your movement problem is and help shape appropriate rehabilitation.

With a reduction in joint inflammation and improvements in alignment an individual can then start to rebuild the strength of their knee and help regain a quality of life.

At Clinic 360 we can make an appropriate diagnosis and then apply evidence based best practice to get you back on your feet. We specialise in all joints, muscle and bone related problems.


Initial assessment including ultrasound scan is £65.

Book online now or telephone 0113 2860316.

Would spinal injections benefit you?

Back pain is a common problem for much of the population. From the odd niggle to extended time off work to permanent disability, spinal problems affect 80% of the population.

Common causes for back pain include muscle strain, nerve irritation, joint degeneration and inflammation. The bulging or herniated disc is often quoted as a cause of pain and at times can be the culprit.

With regards to management and treatment most people are offered pain medication to supress their nasty experience. This approach alone does not however help to restore the best function of the irritated tissues. It does not fix the underlying problem.

Clinic 360 have previously discussed how most muscle, joint and bone pain typically arises from mechanical irritation and subsequent inflammation. For best management, it is therefore essential that the source of irritation is addressed and the inflammation supressed.

A common area of mechanical irritation includes the spinal facet joints. These are thumb sized joints that help support the spine and consequently degenerate with age. At age 60, over fifty percent of the population will have identifiable facet joint degeneration ( Arthropathy) on radiological images.

Once irritated these structures will initiate a pain response, one that often travels down the individuals leg and it can be mistaken for nerve pain or the much-used term ‘sciatica’.

Whilst mobilisation of these joints can help generate movement, for many people it is the movement and mechanical compression through the joint that is actually causative of irritation and pain.

At Clinic 360, when indicated, we use ultrasound guided injections to administer potent anti-inflammatory medication to minimise inflammation and then deliver rehabilitation focused on movement and core stability. By decreasing inflammation and correcting the spinal mechanics we can help many individuals successfully manage their back pain.

In the past and with fragmented services the success of this approach has not been fully realised. Access to NHS spinal injections is limited and private healthcare costs are prohibitive; often in excess of a thousand pounds.

However, with recent advances in ultrasound technology, ultrasound guided facet joint injections can now be administered safely and effectively within a healthcare setting. This means the costs can be dramatically reduced. Typical facet joint injections including assessment and diagnosis start from £215 at Clinic 360.

With an integrated, professional and timely process, Clinic 360 has the skills, facilities and time to help you realise your best health.

If your fed up with your back problem, lengthy waiting times or high costs for medical care then please contact Clinic 360 and book your appointment.

Conversations about pain and health are frequent. We can often discuss how pain affects us and what it feels like. For most people, there are commonly used descriptive terms, nagging, burning, pulsing, aching, throbbing, pins and needles etc. There are approximately 27 words used in the English language to help us detail our own painful experience.

More descriptions can be made when we use the phrase ‘it feels like’. It feels like something is trapped or my bones are rubbing together. Despite our best efforts there are no descriptions that reliably inform us of the true nature of the problem.

Many of the body’s tissues can become affected by trauma, aging, disease and repetitive irritation. Back pain, knee and shoulder pain are all common experiences, but the causative factors that generate this painful experience vary and there are thousands of pathologies, but still only a handful of descriptive words.

The advancement in health care has however allowed us to see beneath the surface of the skin and now we have the ability to peer deep into tissues and help determine the most likely cause of a person’s pain.

One recent area of development is the use of ultrasound scans. Previously ultrasound was only associated with monitoring pregnancy as there are no harmful side effects to the examination. Now, ultrasound is used to accurately assess and diagnose tissue problems within muscles, tendons, ligaments and joints.

At Clinic 360 we have found many people gain relief from simply being able to see the inflamed tissues or damaged tendons that lurk beneath their skin. Whilst the pain may persist, when the individual gains a clear understanding as to the true nature of their problem, some of the worry associated with pain is eased.

The other key factor to having a tissue based diagnosis as opposed to a diagnosis based on the person’s description of pain is that research can then help determine the most beneficial treatment.

Ultrasound guided injections can help to administer medication in exactly the right place and when linked with specific exercise they can reactivate muscles, improve joint alignment, strength and enhance your physical performance. From the enjoyment of a spring time stroll to the physical demands of cycling uphill; if pain is affecting your quality of life, may be Clinic 360 can shed some light on what the problem is and how it can be effectively managed.

Clinic 360 is a new bespoke musculoskeletal centre based in Garforth, Leeds. Our aim is to treat pain the scientific way and help people enjoy a better quality of life. Over the next few months Clinic 360 will be writing articles on common muscle and bone problems. In the meantime, if you’re in pain please give us a call.

Initial assessment including ultrasound scan is £65.

Book online now or telephone 0113 286 0316