How can I help my shoulder pain?
You’ve probably never knew shoulders could be such a pain. Shoulder pain can have a significant impact on your life and the ability to complete everyday tasks. We will explore the common causes of shoulder pain, management strategies and when seeking professional advice is important for recovery.
What is Shoulder Pain?
Shoulder pain can be any type of pain or discomfort around your shoulder and may refer into your neck or elbow. The shoulder is a ball and socket joint which is the most mobile joint in the human body. But the shoulder joint complex comprises of 3 separate joints: the glenohumeral joint, the acromioclavicular joint and the scapulothoracic joint. That's 3 joints but we also must consider that neck pain and elbow pain present as shoulder pain. All that sounds very complex and in about 50% of cases of shoulder pain people’s pain gets better within 6 months.
Some of the common issues that people come to us with are:
- Rotator cuff tears - this is a group of 4 tendons that surround the shoulder joint and work together to provide stability. Tears are caused through either overuse or injury and are a common culprit for shoulder pain.
- Bursitis - this is often shown on ultrasound scans and is an inflammation of the bursae (which is a fluid filled sac which is there to reduce friction between tendons, skin and bone).
- Tendinopathy - this is a failed healing response of a tendon that is associated with overuse of that tendon. This can cause pain, reduced function and reduced exercise capacity.
- Osteoarthritis - This is when the normal recovery process of the joint is dysfunctional and leads of a wearing of the joint. There can be many reasons to cause this process but generally focusing around healthy habits and strengthening will be beneficial in managing pain.
- Frozen shoulder - This is were the capsule, which surrounds the shoulder joint, becomes increasingly stiff leading to restriction in range which is often pain.
- Impingement - this term is a little outdated now but refers to compression of the tendons and bursae at the top of the shoulder. We do find that this is generally not the cause or driver of someones pain and healthy tendons can tolerate a level of compression.
- Fractures or dislocations - this is the serious stuff and should be treated initially in hospital or through a fracture clinic. But fractures and dislocations often lead to lasting shoulder problems. Therefore, early intervention is important to aid and optimise recovery.
However, we should be aware that imaging is often unhelpful in diagnosis. MRI's are used to diagnose structural abnormalities in the shoulder and there is little difference in structural abnormalities found between painful and non-painful shoulders. Although imaging can be helpful if we are considering surgery to find surgical targets if the imaging finds correlate with clinical assessment or to rule out serious pathologies such as fracture and cancer.
Myths regarding causes of shoulder pain
It is often suggested that poor posture is the cause of shoulder pain. There is some debate in the literature around this with some studies suggesting scapular position (position of the shoulder blade) affects the subacromial space which is thought to be linked with pain. However, we know that there is weak evidence to correlate size of our subacromial space to pain, pathology or disability caused by our shoulder.
Do you need a surgery to fix a rotator cuff tear? This depends on the tears, for example many rotator cuff tears are chronic without any trauma causing them, in this case you likely will be better suited to physiotherapy as the tear was likely present before your pain started. In the case of traumatic rotator cuff tears, for example falling onto your arm/hand, we know 50% of these injuries generally have good outcomes without surgery therefore trialing physiotherapy prior to surgery may help you prevent surgery.
My shoulder is out of position! This is commonly said and in some cases can be correct (e.g. shoulder dislocations) in which case the best route to treatment in through accident and emergency for relocation of the joint. For shoulder dislocations it is important that you attend physiotherapy to help prevent future dislocations which can occur in up to 50% of patients. However, the feelings of a shoulder being out of position often can be caused from weakness around the shoulder and is best helped through targeted rehab for your shoulder and education around possible causes.
Managing shoulder pain
Recovery from shoulder pain is generally a lengthy process that takes time and a physiotherapist is there to help guide you though this process. Working with a physiotherapist is important but here are some tips to help you make the most of your physiotherapy sessions:
Open communication - We love to hear about your pain or problems so tell us as much detail as you can. We will likely as you some questions at the start of the session to help prompt you. If you have any changes to your symptoms from the treatment or exercises, if they are good or bad, please always let us know.
Completing your exercise program - Physiotherapy is there to help you know how best to manage your condition. But generally this does require some work from you. So being clear around the time and effort that you can put into your exercise routine. A good physiotherapist should work with you to help this exercise fit easily into your daily or weekly routine.
Technique of exercise - this sometimes can be challenging because there is generally a lot covered in the sessions. If you are every unsure on the technique, please contact your physiotherapist for some additional guidance.
Listen to your body - This is important and it does take a couple of sessions to ensure that the exercise routine is right for you. So please don't be disheartened if your pain becomes worse with exercise, it's ok to stop and review the exercises with your physiotherapist, it helps us get a better understanding of what exactly is happening with your specific condition and may contribute towards diagnosis.
We may look at doing some manual therapy or dry needling to help you get the most out of the exercise routine. This can provide some pain relief and additional movement. Although sometimes this can give short term pain relief, with an appropriate exercise routine, these therapies can have long lasting benefits to your shoulder. For this reason, it is important to also complete the exercise routine.
Importance of perseverance
Due to the nature of shoulder pain, which is often lingers around from a while (it is suggested that for 14% of patients have ongoing pain for over 3 years), you should continue with exercises and active management where possible. This further highlights the importance of getting timely and appropriate advice on how to manage your pain and methods of rehabilitating your shoulder as soon as you are able.
Conclusion
Physiotherapy plays an important role in supporting a healthy recovery from shoulder pain. Physiotherapy can offer a range of treatment options involving tailored exercise programs, education around pain and pathology, advice around positive and negative habits around shoulder pain and acute pain relief. We will help you develop solutions and goals to return to a normal life.
For more information regarding physiotherapy or to book, click here: Sycamore Health