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Do you have a painful shoulder?
Shoulder pain is very common. It can be disabling and has the capacity to impact on quality of life. Often people with shoulder pain do not experience any major episode that leads directly to their pain. An experienced physiotherapist could be your best option in getting to the bottom of your pain, and getting you back to those activities you value as soon as possible.
What causes shoulder pain?
When no trauma is involved, it can be difficult to make sense of where the pain comes from. The current understanding is that non-traumatic pain is multi-factorial. Anatomical, activity (or non-activity), behavioural and emotional factors may be involved. Your physiotherapist will thoroughly assess your shoulder, collect an in-depth history and assist you by developing a management plan to return you to the things that you enjoy. Simple tasks like cleaning or getting dressed, gardening, doing yoga, or lifting weights can be difficult to complete when you have a painful shoulder.
How are shoulder problems diagnosed?
One of the most common diagnoses for shoulder pain is sub–acromial pain syndrome, which may be responsible for over half of shoulder pain presentations. (*1) This condition describes pain arising from several possible anatomical sources, with potential contributing factors such as poor shoulder control, or muscle weakness, not just tissue injury. Imaging such as XRAYS, ultrasounds or MRI’s are not always required. A large percentage of the population who are not experiencing shoulder pain have findings on imaging including bursal thickening, and other abnormalities including rotator cuff pathology. These findings are not always the source of pain!
Are XRAYS or other imaging required?
The best advice is that imaging is most valuable when a person fails the initial course of conservative management. (*2)
Physiotherapists can order imaging and are well placed to make recommendations for further review if needed. Sometimes, patients will have imaging completed which shows changes in the shoulder resulting in invasive treatment prior to physiotherapy. This path may not be best practice. Cortisone injections for shoulder pain may be beneficial in some cases, though generally following a course of physiotherapy management. Furthermore, there is not consistent evidence that surgery provides a superior outcome in general for non-traumatic shoulder pain, and is generally the last management option. (*3)
How can Physiotherapy help shoulder pain?
Physiotherapist treatment of shoulder pain may consist of various interventions including reducing aggravating activities, shoulder and postural control exercises, manual therapy, strengthening and conditioning of the shoulder.
Exercise and strengthening forms a vital part of effective shoulder rehabilitation.(*4) You need to have a strong and functional upper body to complete normal tasks. Your Physiotherapist can guide you on ways to do this safely, and give you advice for your individual situation. Having a strengthening and conditioning program designed for your individual needs, whether sitting at a computer, playing tennis or rock climbing, can help build up your resilience to future episodes of pain.
How long does it take to fix shoulder pain?
As the factors leading to shoulder pain are not always sudden, improving the function and strengthening of the shoulder can take time too. It is reasonable to expect improvement of the shoulder over 6-12 weeks, though it can take less time or more.
It is important to have an assessment and start rehabilitation as soon as possible. Often when people experience shoulder pain they stop all activity involving the shoulder. This can regularly result in persisting dysfunction. It may be necessary to rest the shoulder for a brief period after onset of pain, however, if you have shoulder pain, see your physiotherapist first. Remember though, not all approaches to the management of shoulder pain are the same. Your physiotherapist should help you address the causes of your pain not just the symptoms. They should give you a thorough understanding of your situation and the plan to get you back to your best.
Who can help?
At Sydney Physiotherapy Solutions our physiotherapists are experienced in treating shoulders in a holistic way, by understanding our patient’s goals and needs, with a focus on the most up to date and evidence based approach.
Does posture cause shoulder pain?
Lets face it – shoulder pain and desk jobs go hand in hand! If you spend several hours a day working on a computer, you may unconsciously find yourself adopting poor postural habits such as hunching over your keyboard. This position is usually a sign that you have a tight chest and a weak upper back.
Over time, this type of bad body posture can contribute to you developing a rounded upper back, a condition called kyphosis, which can cause shoulder pain and upper back stiffness and pain.
Do some shoulder exercise to correct it! Stretches for the chest and upper trapezius in the upper back & neck will allow your shoulders to come back and be better centred in the joint.
Add some strengthening work for the deep neck flexors and back muscles and…. voila!!!! Better posture and less shoulder pain.
If you do continue to suffer from shoulder pain contact one of our shoulder specialists who are part of the team at Sydney Physio Solutions.
Exercises for shoulder pain
This is tricky as there are so many potential problems which can occur with this complex joint; but here are some to get you started
Can Pilates help shoulder pain?
Pilates can be a fun way to rehabilitate shoulder injuries. Read more here.
References:
*1: Bhattacharyya R, Edwards K, Wallace AW. Does arthroscopic sub-acromial decompression really work for sub-acromial impingement syndrome: a cohort study. BMC Musculoskelet Disord. 2014;15:1.
*2: Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, et al. Guideline for Diagnosis and Treatment of Subacromial Pain Syndrome. Acta Orthopaedica. 2014 May 21;85(3):314–22.
*3 Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, et al. Guideline for Diagnosis and Treatment of Subacromial Pain Syndrome. Acta Orthopaedica. 2014 May 21;85(3):314–22.
4* Kuhn JE. Exercise in the treatment of rotator cuff impingement: A systematic review and synthesized evidence-based rehabilitation protocol. Journal fo Shoulder and Elbow Surgery. 2009;18:138-160
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