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shoulder pain - physiotherapy torontoShoulder pain is one of the most common reasons people seek treatment from our trusted physiotherapists, chiropractors or massage therapists here at Rebalance Sports Medicine.  In some cases, there is a specific injury that occurs, but more often shoulder pain develops gradually for no apparent reason.  In both cases, it is important that you have your shoulder pain assessed by a physiotherapist and or chiropractor. The earlier you seek treatment, the faster you will have pain relief and it is less likely that stubborn compensation strategies take over making it harder to recover.

Seeking treatment with a trusted Physiotherapist, Chiropractor, Massage therapistSports Medicine Doctor and/or having an Ergonomic assessment is a smart way to treat the pain or prevent it before it happens.

Why is the Shoulder Joint Unique?

The shoulder is very mobile area of the body and it functions as result of many joints working in conjunction.  These joints include:

  1. Glenohumeral- ball and socket
  2. Scapular-thoracic joint- shoulder blade to rib cage
  3. Acromino-clavicular- attaching your collar bone to the ball and socket
  4. Sterno-cavicular- attaching your shoulder, arm and hand to your torso

The joint we think of when it comes to the shoulder is the ball and socket, Gleno-humeral joint.  This joint is inherently unstable by design which allows the shoulder joint to have a large range of motion. When you think of this joint, imagine it like a golf ball sitting on a golf tee. It has a large round bone articulating with a shallow small crest. Due to this, the shoulder relies heavily on the strength and co-ordination of muscles, ligaments, and an intact labrum to move effectively and without pain. A centered shoulder is a happy shoulder, and this ball should remain in the centre of the socket as we move. Problems arise when there is poor centering of this ball through range which wears on the soft tissues that hold it in place.  This occurs especially overtime with poor postures of the spine and shoulder.

What are the Causes of Shoulder Pain?

Rotator Cuff Dysfunction: This can include strains, tendinopathies or even tears in these four important stability muscles of the shoulder.  The rotator cuff muscles include the Supraspinatus, Subscapularis, Infraspinatus and Teres minor. In this injury one or more of these muscles have been overloaded and irritated creating tissue damage.

Bicep Tendinopathy: The bicep muscle links your forearm and upper arm to the front of your shoulder and due to postures or repetitive movement, this tendon can be vulnerable to overload and/or increased friction and irritation.

Shoulder Impingement: As described above, a centered alignment of the shoulder throughout movement is important to prevent injury. If the ball, of the ball and socket joint, is tracking high/forward in the shoulder or if the shoulder blade does not move in a co-ordinated fashion, the muscles and or bursae will be pinched under the bone above. This causes a sharp catching pain as your raise your arm above head. Overtime, if not corrected, it can wear out the tissue and lead to rotator cuff dysfunction or shoulder bursitis.

Shoulder Bursitis: A bursa is a small fluid filled sac found in areas of high friction caused by muscles or tendon movement. Their purpose is to help lubricate the area and provide sensory feedback. If abnormal movement patterns or excessive compression occurs then the bursae can become inflamed. While in an acute inflammatory stage, a shoulder bursitis can cause strong pain, weakness and significant loss in range of motion. In later stages of bursitis, it may appear more like a shoulder impingement or Rotator cuff dysfunction.

Frozen Shoulder or Adhesive Capsulitis: This is one of the most frustrating shoulder injuries because the true cause is unknown and can take six months to two years to resolve and it cannot be clinically diagnosed by imagining. In this injury, the joint capsule of the shoulder is believed to experience an auto-immune reaction that causes it to become inflammed and tighten around the glenohumeral and acromio-clavicular joint. Pain, gradual loss of range of motion and stiffness ensue.

Shoulder Instability and Shoulder Dislocation: The shoulder is inherently more unstable due to its anatomical design. When there is an underlying shoulder dysfunction it can be looser and/or with a significant force applied to the shoulder it can become dislocated. In a dislocation scenario, you will need to head over to the nearest emergency room to have it relocated and the muscles and nerves checked.  To avoid this from happening and also rehabilitate this type of shoulder injury, strengthening and stabilization training will be integral to the successful treatment.

Labral Tears: The Labrum a strong tissue seal that surrounds the outside of the socket deepening it and creates an air tight seal to further stabilize the shoulder joint. The Labrum is typically torn after a shoulder dislocation or trauma and therefore once the seal is broken the shoulder has lost a percentage of stability. This is a common injury for surgeons to operate on but research does show that conservative treatment in the form of physiotherapy can help reduce the need for surgery and can lead to a pain free recovery without having to go under the knife.

Shoulder and Neck Pain caused by a Cervical Radiculopathy: The pain that is felt in the shoulder is actually coming from compression or irritation of a nerve from your neck. This also can refer pain down into the arm and hand. If you have this condition, you may also experience pain and/or stiffness at the neck. It is important that you have a thorough assessment performed by your trusted Physiotherapist or Chiropractor to ensure that that you have been diagnosed properly.

How can Physiotherapy, Chiropractic, Massage Therapy and a Sports Medicine Doctor Help Your Shoulder Pain?

A team of healthcare professionals can personalize your treatments to address your specific injury and help you return to your personal lifestyle goals. Each member of the team has its role. Treatments with a Physiotherapist can include controlling pain with therapeutic modalities, acupuncture or Gunn IMS. Physiotherapy and chiropractic can help improve range of motion of the joint with hands on manual therapy or manipulation as well as increase or maintain range of motion, strength and motor control with exercises. Soft tissue release is also important and may require adjunct massage therapy treatment. Education in regards to lifestyle modifications, posture re-education and ergonomic set up are also important.  If your shoulder pain has not resolved in 1-2 weeks or is worsening, it is best to be assessed by a trusted health care professional.

How Long Does it Take to Recover from Shoulder pain?

Depending on the cause, severity, duration of the pain and your ability to get the proper treatment, recovery can take a few weeks up to months. It is important to understand what is happening and to seek guidance and treatment from a qualified health practitioner as soon as possible. Remember to be patient and consistent with your exercise program. Keep in mind that your trusted physiotherapist and/or chiropractor sees these types of conditions regularly and will be the best person to advise you on the best route of management. They will inform you if your symptoms are not progressing as expected and if you should book a consultation with a Sports Medicine doctor for further investigations or treatment options.

What are the Best Exercises to Help with Your Shoulder Pain?

A well-rounded program should address neck, upper back and shoulder range of motion in addition to a graduated shoulder strengthening program. It should also include a daily mobilization and stretching regime. These exercises should be individualized to your particular needs and goals.

Some of the most common exercises are listed below, to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after their performance. For motor coordination please preform them paying close attention to good form, in a slow and controlled fashion and about 3 sets of 10-15 reps.

  • Range of motion (ROM) exercises of the shoulder joint
  • Mobilizations of the thoracic spine and scapula
  • Internal rotation (IR) and External rotation (ER) of the shoulder
  • Abduction in the scapular plane (Scaption) with resistance and control
  • Serratus Anterior activation
  • Middle Fibres of Trapezius (MFT) and Lower Fiber of Trapezius (LFT) activation and strengthening
  • Pectoralis stretches

How to Treat Shoulder Pain at Home?

  1. If you have acute pain in your shoulder, you may first want to try ice especially immediately after an injury or specific event. If the pain has developed more gradually or has been lingering for some time then heat to the neck and shoulder might be the better choice.  You may also choose to apply both intermittently depending on how they make your symptoms feel.
  2. You should also try to figure out the positions and postures that aggravate your symptoms. Pay close attention to the positions that make you feel worse such as working at your computer, sleeping on your sore shoulder, lifting or carrying. Try to modify these positions or avoid them temporarily until you can gradually reintroduce them back into your routine.
  3. During early and more painful stages of the injury, try gentle ROM exercises.Start with a shoulder pendulum; hang your arm forward while folding at your hips and let the arm sway side to side, forward and back and in small circles. You can do this several times a day for about 1 minute. It should be pain free and provide you with some relief.

    To progress, try some active or active assisted range of motion. To perform these, have your thumb pointing towards the ceiling and raise your arm forward and out to the side. If this is painful, try to use your other arm, a wall or a stick (such as a broomstick or cane) to help raise your arm up. Keep these movements within your pain free limits. A qualified physiotherapist or chiropractor will be able to guide you on more individualized and specific exercises that will benefit you.

  4. If the pain continues and does not respond to the aforementioned strategies, then over the counter pain or anti-inflammatory medication might be indicated, talk to your pharmacist to help direct you.

If your shoulder continues to have pain and/or feel stiff, an assessment and treatment with a qualified Physiotherapist, Chiropractor and/or Massage Therapist is highly encouraged.

Heather Imrie, FCAMPT Physiotherapist

Heather Imrie is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.

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YONGE & ADELAIDE
UNIVERSITY & KING
Yonge & AdelaideRebalance Clinic Yonge Adelaide
110 Yonge Street Suite 905
Toronto, ON M5C 1T4
T: (416) 777-9999
E: [email protected]
University & KingRebalance Clinic University King
155 University Avenue Suite 303
Toronto, ON M5H 3B7
T: (416) 306-1111
E: [email protected]

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