PHYSIOTHERAPY FOR SHOULDER JOINT PAIN

Is your shoulder pain mechanical?

If you use your shoulder, i.e. reach overhead, carry/more weights or sleep on your painful shoulder, it causes more pain. If you find that your shoulder pain gets worse/better independent of your activity you may be dealing with referred pain from your neck, or red flag signs like: infection in your shoulder (coupled with fevers), heart conditions (referred symptoms).

How did you hurt your shoulder? 

Was it an acute injury? 

Acute injuries that result in a loss of function, like not being able to move through range as normal, generally should have a further imagining like: an X-ray (rule out fractures), US (ligaments and rotator cuff injuries) or MRI (gold standard : identifies all issues) based on the suspected damage. 

Acute shoulder injuries can be complex and can involve multiple structures, however for our understanding we can categorize them into 3 different types.

Shoulder pain without an injury

Alternatively if you’ve had an acute injury with no major loss of function, and unsuccessfully waited for your shoulder pain to subside, you’ll fall into our second category of shoulder pain. Shoulder pain can gradually build up/accumulate with small aggravating activities over time, and it does not require significant trauma.

Over the last decade there has been a shift in how we classify shoulder pain. There is a movement away from seeking a pathological diagnosis for shoulder pain in chronic shoulder pain cases, as research has shown that asymptomatic individuals show shoulder damage on imaging at similar rates as those with shoulder pain. This call to question what is meaningful tissue damage and what isn’t, in pain presentations?

Diagnosis

Unless your shoulder pain falls firmly in the aforementioned categories, we will designate it the title of cuff related or sub acromial shoulder pain. You may think that without knowing specifically what’s hurt how would we know what to treat? We aim at restoring your shoulder strength, mobility and stability deficits and gradually expose your shoulder to more load. This is a tried and tested method that has been shown to be effective in treatment of shoulder pain (Pieters et al., 2020).

These exercises are progressively more challenging for shoulder stability and strength. Even more important than the actual exercise is your loading principle: 3/10 pain during and 1 hour after exercise is okay. If you can complete 3 sets of 8-10 reps of a particular exercise well, make it harder by adding more load/weight or move on to the next level. Start at 1 and 2. 

Self treatment and manual therapy. 

This is not the main solution, however it is a great adjunct to your treatment. You can do the following self-manual-therapy techniques.

How do we prevent shoulder pain? 

Make your shoulder stronger and more stable than what it needs to be for everyday demands. In other words, train your shoulders capacity to do work. For a practical example: if you can press 10kg overhead with one arm, lifting a 5kg box from a shelf is less work for your shoulder than if you could only overhead press 5kgs. We use this theory to guide our pre-employment screens for physically demanding work roles, and identify risk of injuries/ fitness for work. 

Although this blog may present your shoulder pain as being simplistic, there are always nuances to shoulder pain that require the input of a physio. If you need any advice, treatment or want to prevent shoulder pain contact us at a PEAK sports and spine center. 

Pranay Singh

PEAK Physiotherapist and Coach

PEAK Sports And Spine Centre

References

Pieters, L., Lewis, J., Kuppens, K., Jochems, J., Bruijstens, T., Joossens, L., & Struyf, F. (2020). An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. Journal of Orthopaedic & Sports Physical Therapy, 50(3), 131–141. https://doi.org/10.2519/jospt.2020.8498