Shoulder Pain Treatment
The shoulder joint is very special because it is the most mobile and versatile joint in the body giving us great reaching and lifting ability; and is therefore very reliant on strong, efficient and coordinated muscles controlling it. Some of these muscles attach to the arm, the shoulder blade the rib cage and the neck … and as a result shoulder pain can affect the arm, trunk and neck.
What is shoulder pain?
Shoulder pain is a term that relates to pain around the front, sides and back of the shoulder. It can also extend into the arm and neck. Shoulder pain is very common and it can affect up to 70% of people at some time in their lives. It can be very limiting and distressing affecting many aspects of daily living such as sleeping, self-care, house hold activities, work and recreation.
Common diagnostic labels for shoulder pain are rotator cuff tear or rupture, rotator cuff tendinopathy, labral tear, subacromial bursitis, subacromial impingement, shoulder arthritis, frozen shoulder and acromio-clavicular joint pain.
Risk factors for shoulder pain:
Shoulder pain can occur from an injury such as a heavy fall on the arm. In these situations, if the pain is severe and there is a loss of power in the arm, it is important to seek medical attention to rule out a fracture or tendon rupture.
Shoulder pain can also occur from repeated or sustained use – especially when the shoulder isn’t conditioned to the task – such as cutting the hedge over-head, sporting activities such as tennis, swimming, cricket and throwing sports. The resulting pain can be severe due to inflammation and sensitivity of the shoulder structures, however there is usually no need to scan the shoulder if there is no history of trauma.
Shoulder pain can also occur when a person is deconditioned, carrying extra weight (especially around the belly) and their general health is poor and these factors can make a person more vulnerable to pain.
Myths about shoulder pain:
✖ Shoulder pain usually means the shoulder is damaged
✖ Shoulder pain usually means a scan is needed
✖ If moving the shoulder hurts it means that the movement should be avoided
✖ Shoulder clicks means there is something wrong
✖ A rotator cuff tear means surgery is needed
✖ Shoulder impingement means that using the arm is dangerous and surgery is needed
✖ A Cortisone injection will fix my shoulder
✖ Frozen shoulder takes 18 months to 2 years to recover
Facts about shoulder pain:
✔ Shoulder pain is common without any damage to the joint
✔ Many people without shoulder pain have rotator cuff tears
✔ Rotator cuff tears do not predict shoulder pain
✔ Clicky shoulders are common and not usually a sign of damage
✔ Scans are usually only needed if you have had a traumatic injury
✔ Using your arm and getting it stronger reduces your shoulder pain in the long run
✔ Lifestyle factors such as healthy diet, sleep and physical and psychological health are all important targets for the treatment of shoulder pain
✔ Shoulder pain is more severe and disabling when a person is fearful, emotionally distressed, avoids movement and lacks confidence to use the shoulder
✔ Cortisone injections may offer very short term relief but a long term rehabilitation program to shoulders back on track
✔ Frozen shoulder responds well to graduated exercise rehabilitation programs
✔ Physiotherapy exercise rehabilitation program is as effective as shoulder surgery for people with rotator cuff tears, shoulder impingement and bursitis
✔ After surgery shoulder rehabilitation programs are needed for full functional recovery
Assessment of shoulder pain:
There is strong evidence that physiotherapy is effective as first line treatment of shoulder pain once serious injury such as a fracture or traumatic tendon rupture has been ruled out. If you have developed shoulder pain over time we can help identify the key factors related to it and build a plan to get you back to full capacity.
- We first undertake a comprehensive history in order to hear your story, how the shoulder pain began and how it impacts on all aspects of your life.
- We will also screen for serious causes of shoulder pain.
- We can diagnose the cause of your shoulder pain and determine whether you need a scan or not
- We will then perform a comprehensive examination of the shoulder and surrounding regions. We are most interested in the postures and activities that you find restricting.
This includes an assessment of:
- the sensitivity of the structures to touch, move and load;
- the mobility of the shoulder, neck and thorax, and the ability to relax the muscles in the region;
- the strength and endurance of the shoulder muscles.
Treatment of shoulder pain:
Based on all this information we will then explain to you in simple language, where the pain is coming from, the factors that are contributing to your pain, and discuss the best treatments options available to you.
Physiotherapists at Body Logic Physiotherapy can first help identify the main contributing factors associated with your shoulder pain. Based on this they will develop a plan that may involve a range of strategies to assist with things such as getting your shoulder moving, reducing pain and getting it stronger.
This may involve hands-on therapies for a short period and will always involve exercise.
Sometimes is scary to get a painful shoulder moving and we can provide you strategies to move which minimise discomfort.
It is also important to know that it is safe to get active physiotherapy even in the presence of the following diagnoses: rotator cuff tear, rotator cuff tendinopathy, labral tear, subacromial bursitis, subacromial impingement, shoulder arthritis, frozen shoulder and acromio-clavicular joint pain.
Shoulders need movement and strength to stay healthy, so setting up a graduated plan to get active is very important.
Other strategies known to be effective in treating shoulder pain include: improving sleep, stress management and engaging in regular physical activity.
In some cases where shoulder pain is very distressing and disabling, working with other health care practitioner may be important.