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Do you have shoulder pain when reaching out to your side, overhead to grab something, behind your back when showering or when sleeping on your side?
Shoulder pain is a common condition that can be chronic and disabling if not addressed. The pain and limitations that often come with shoulder injuries can have a large impact on the person's quality of life, their families, and their ability to work.
Shoulder pain is in the top 3 most common injuries seen by a physical therapist and in my experience top 2 alongside low back pain. The prevalence of rotator cuff injuries and its symptoms affects millions of people worldwide. In the United States alone, shoulder pain results in approximately 4.5 million office visits and incurs about $3 billion dollars in healthcare costs annually.
In this blog we will go over how to manage shoulder pain and find the right specialist in the greater Orlando area who can help with this problem.
The shoulder is made up of many joints and moving parts. Which is why treating the shoulder can be a complex process. The main shoulder joint is where the arm bone (humerus) connects with the shoulder blade (creating the glenohumeral joint). The shoulder blade also connects with the collar bone (creating the acromioclavicular joint).
The rotator cuff muscles you hear about so often when people talk about shoulder pain connect the arm bone (humerus) to the shoulder blade (scapula) and is made up of four muscle tendons, the supraspinatus, infraspinatus, teres minor and the subscapularis.
To make it easier to follow along, remember that tendons attach muscle to bone. Muscles in turn move bones by pulling on the tendons. The muscles of the rotator cuff keep the shoulder joint tightly in the socket (think of a ball and socket joint or a golf ball on a tee). The only issue here is the socket (the glenoid), is shallow and almost flat like a golf tee.
Using the analogy above, when thinking of a golf ball on a tee you know it isn't very hard for the golf ball to fall off the tee, a slight nudge or even a strong gust of wind can cause the ball to fall off the tee. Similarly, just like the golf ball and the tee, the shoulder is very mobile. It has a lot of motion. But because it has so much motion it lacks stability to hold that golf ball on the tee (hold the shoulder joint together).
That's where the rotator cuff muscles come into play. They help move the shoulder and arm without letting the shoulder joint move excessively (let the golf ball fall off the tee). Because the shoulder anatomy is so complex, there are many acute and chronic tendon injuries that stem from overuse and repetitive forces from our environment. Things like lifting or reaching overhead frequently, pushing or pulling to maneuver the task in front of you and even reaching behind us.
If I went through all the different shoulder injuries or diagnosis, we would be here all day. So let's keep things simple and divide shoulder injuries into 3 categories.
*Most of these injuries noted above are frequently used to describe patients who experience non specific pain or symptoms during overhead activities of the shoulder.
Here the Shoulder literally freezes and it's painful to move. Typically characterized by the first stages of freezing to be very painful and with time the shoulder progressively gets more restricted in its ability to move.
Shoulder pain can be caused by direct injuries to the shoulder joint, or it may originate from the neck, chest or other organs. Pain and injury of the shoulder are commonly related to how active someone is, their age and posture when completing activities throughout their day.
The shoulder is challenging to assess and treat because of the many other body parts that work with the shoulder to move the arm, in a small area, with many movements (compare your shoulder movement to your elbow movement).
When dealing with younger patients, you often see instability which can cause subluxation (too much movement) or dislocation when the shoulder joint “moves out of place.” Some injuries can be attributed to the new postural relationship we have developed associated with increased periods of sitting, and increased technology use.
Shoulder injuries do increase with age, most common in ages 45-65 years. This is typically due to the normal aging process as age brings about many changes in the body, including decreased muscle mass, decreased joint flexibility, and changes in cartilage composition.
Work-related risk factors associated with shoulder pain may include repetitive work task such as overhead activities or working above shoulder height, high force demands and vibration (such as a truck driver), work-related posture, prolonged computer work and psychosocial factors including stress, job pressure, social support/job satisfaction.
When someone injures their shoulder, it's often believed that imaging (X-ray, MRI’), injections (cortisone) and surgery are required to treat these conditions. The truth is exercise therapy should be first in line when it comes to treatment as pain related to any of the shoulder injuries mentioned above likely have more to do with your shoulders ability to handle its current load (work, recreational sport, household chores) from sudden or gradual changes in activity and your overall health (nutrition, sleep, exercise) than due to tears, compression, inflammation or pinching of the rotator cuff muscles.
Teunis et al. states “the prevalence of rotator cuff abnormalities in non painful people is high enough that degeneration of the rotator cuff should be considered a common aspect of human aging and makes it difficult to determine when the pain is new or is the cause of the long standing wear and tear your shoulder normally goes through as we age.
Hinsley et al. reported that 48.4% of full thickness tears were asymptomatic
Regardless of which physical therapist you chose, a thorough initial evaluation is crucial in identifying the root cause of your shoulder pain. If you see a physical therapist and their evaluation lasts 10 minutes with some brief questions, a strength test and range of motion measurements, this is not enough! A proper physical therapy evaluation should be thorough as shoulder pain is complex and typically caused by many different factors.
Typically a physical therapy evaluation will include a combination of test and measures mentioned below:
If you have loss of muscle strength and loss of sensation or very severe pain, special diagnostic tests, such as magnetic resonance imaging (MRI), electromyography, or nerve conduction studies may be needed. Physical therapists work closely with doctors and other health care providers to make sure that you receive an accurate diagnosis and appropriate treatment.
Is there one best exercise for shoulder pain and weakness? NO!!! There isn't one exercise or one routine that works for all people or all shoulder injuries. You'll find resources on the internet that will promise a "quick fix" and many times they may provide a temporary or even permanent fix, which is great.
However, it is important to set realistic expectations. Even though shoulder pain has a preferable recovery for most, symptoms don't always get better quickly and can be persistent in people's day to day lives or become episodic where the pain will come and go.
There are many types of exercises that can help alleviate shoulder pain. A lot of times exercises targeting the upper back and neck may indirectly help improve shoulder pain as our body is like a bunch of standing dominoes. If one area of the body is affected the rest of the body will also be affected.
Below I am going to demonstrate 3 categories of exercises that are usually completed for shoulder pain. These 3 categories of exercises are usually done in some combination with other exercises or modalities that may directly or indirectly help with your shoulder pain/limitations.
These Categories are:
Although some acute episodes of shoulder pain resolve spontaneously, as many as 50% of all new episodes of shoulder pain still continue to show symptoms or recurrences at 6 months, with as many as 40% still with symptoms at 1 year. When managing shoulder pain, the strongest evidence currently is for exercise. Physical therapists have a deep understanding of the shoulder complex, related pain mechanisms and exercise prescription which makes them well placed to be the experts to help individuals with shoulder pain, and returning to normal function.
At RehabSpot, your well-being is our priority. If you have any questions, concerns, or would like to schedule an appointment, our friendly team is here to help you. Get in touch with us using the following contact information