How can physiotherapy help with my shoulder pain?
Shoulder pain is a common symptom of many different injuries in the neck and shoulder region.
It can be difficult to diagnose what causes your shoulder pain. Imaging technology can be helpful, but often shows only part of the problem.
There are 2 main types of shoulder pain:
- Pain caused by damage to either the joint or soft tissue surrounding the joint
- Pain due to increased pressure or load in the shoulder, without clear damage to the shoulder
Damage may involve the rotator cuff, subacromial bursa (bursitis), labrum or biceps tendon. Most of the time we will be able to diagnose these by testing the specific structure. If further information is needed, we can refer you for imaging. Depending on the damage, we will either recommend conservative treatment or refer you to your GP for further investigation. Conservative treatment consists of advice on your abilities and limitations, and exercises. We will monitor your healing process and update the advice and exercises as you get better.
The second part is by far the most common type of shoulder injury, especially if there was no trauma involved. There is pain, but when you look for damage on scans, there is minimal or no damage at all. It may also be the reason that simply resting your shoulder for a while can help, but as soon as you start using it again your symptoms return. I will explain how this is possible.
For your shoulder to work properly a lot of joints, muscles, nerves and soft tissue have to move in a synchronised way. The moving parts include your neck, upper back, ribs, shoulder blade, elbow and all the muscles that attach to them. If any of these parts do not function properly, it results in restricted shoulder movement and pain in the shoulder joint. It does not mean that the shoulder joint is at fault, it can be any of these parts or a combination of them.
This type of shoulder problem often gets diagnosed as impingement, bursitis or tendinopathy. These diagnoses describe the symptoms but fail to give insight in why the problem exists and does not recover. The cause of the problem remains unclear.
What we do as physiotherapists is look at how all the structures in and around your shoulder work together. We check for damage to the joint and/or surrounding muscles. Then we will look for limitations in movement due to stiff joints or tense muscles. Once all potential issues are diagnosed, a complete treatment plan will be made to tackle your specific shoulder issue.
We will discuss our findings with you and what treatment is recommended. This usually involves a combination of relaxing muscles through massage or dry needling. Mobilisations may be used on the neck, back and shoulder and there will be some exercises and stretches to help you recover.
Our goal is to diagnose and help you understand what is wrong with your shoulder and provide you with the care you need to recover as soon as possible.
By Mark Lute – Physiotherapist