The shoulder is a big area if you consider all of the places we refer to as the shoulder. Some people have shoulder pain around the ball and socket or the rotator cuff. Others have shoulder pain over the top of the shoulder where the trapezius muscle is. A very significant number of people get pain around the shoulder blade or inside the shoulder blade. What all this means is that there are a lot of different complaints that come under the heading of shoulder pain.

HOW PHYSIOTHERAPISTS DIAGNOSE SHOULDER PAIN

From a physiotherapy  perspective, the first thing we like to do with shoulder pain cases is find out how they started, what caused them and how long they have been there. This gives us significant clues as to the real cause of the shoulder pain.

Once a physiotherapist has taken a good case history, All That Remains is to examine  the area. For us, this examination includes the Glen humeral joint, all the ball and socket, the rotator cuff, the biceps tendon insertion at the front of the shoulder, the shoulder blade, the scapula, and the ribs.

Once we have taken the history and examined the patient, we will have a relatively clear idea of what is causing  the pain and which of the many tissues in the shoulder are generating the pain. In rarer instances, we order x-rays  or scans. That is reserved for occasions when we are concerned that there is some more profound damage or possibly some disease process affecting the shoulder, although most shoulders are simply mechanical pain  and Don’t require scans and x-rays.

By far, the most common type of shoulder pain we see in the clinic is behind the shoulder blade. The patient often feels this as a deep upper back or shoulder blade knot. This tends to be caused by a combination of the upper rib cartilage getting stuck(usually due to poor posture) and the trapezius and rhomboid muscles developing deep knots. Stress plays a big part in the generation of this type of shoulder pain: stress and too much sitting.

Slightly less common than the shoulder blade type of shoulder pain is the kind of shoulder pain that stops you from lifting your arm over your head. This PAIN tends to sit around the tip of the shoulder where the ball and socket joint is. Pain in this region that stops you from lifting your arm tends to be caused by impingement of the rotator cuff muscle tendons. Modern humans are highly prone to this problem due to the amount of sitting we do. Even though the situation tends to come along when we’re active, the Real causes all the sitting we do while we’re inactive.

A third kind of shoulder pain we see slightly less often but still every week is the type of shoulder pain that sits right at the front of the shoulder. This type of shoulder pain is caused by the bicep muscle tendon  or the subscapularis  muscle tendon  which attaches to the front of the shoulder. We tend to associate the bicep with the arm, so it can be a surprise to learn that it can cause shoulder pain  but it does this type of shoulder. Pain will often come along during activity, but like the other forms of shoulder pain, it is primarily related to sitting too much.

Thankfully, rare kinds of shoulder pain are the more serious  ones. A frozen shoulder causes severe joint restriction, fractures , and dislocations, which can cause a complete loss of joint use. These more serious issues are usually very apparent and lead to X-rays and scans. Physiotherapists  can sometimes help with these types of problems, yet naturally, the more serious the issue, the more likely you are to need a surgeon .

Choosing the best treatment  for shoulder pain is mainly dependent on where the PAIN is within the shoulder complex and how it has manifested. If you have muscle knots, the ideal treatment will differ from the best treatment for a rotator cuff tear.

An excellent rule of thumb that physiotherapists apply to shoulder pain is the principle of rolling out the least invasive and safest treatments first. Only then should more invasive treatments like surgery be considered if the conservative methods have not worked. Happily, the vast majority of shoulder pains respond well to conservative treatments  and do not require invasive measures  to resolve. Increasingly, patients are even managing to resolve the likes of rotator cuff tears using physiotherapy  instead of surgery. 

In New Zealand, exercise prescription  is the classical way of approaching physiotherapy. For good reason, the body of evidence that supports the use of exercise exercises to manage pain in the long term is very significant. There is almost no chronic pain  in the human body that does not require the support of movement and strength exercises in the long term. Yet naturally, some of the more serious pains and injuries require more than exercises. If your shoulder is sufficiently inflamed. There’s no way you’re going to be able to do strength exercise  exercises on it at the gym. These cases need pain relief. This is where physiotherapists lean into a deep well of PAIN management  tools. Some of these physiotherapy tools are classical methods, and others that are far more high-tech and modern.

The modern physiotherapy tool kit includes gentle sound waves like ultrasound , powerful sound waves, extracorporeal Shockwave , deep tissue Laser , dry needling, deep tissue release and joint manipulation , among many others. These naturally pose the question, ‘Which physiotherapy treatment is best for me?’ 

And that’s where all this good news can turn a little frustrating. 

The truth is that even from a physio and experience to a physiotherapist’s perspective , it can be shockingly brutal to know which treatments  will work for which patients. There’s no question that you can make educated guesses, but ultimately, there is nearly always a bit of trial and error with each patient to determine which treatments work for them.

Imagine the best chef in the world who can make the most delicious food at high speed to order. No matter how good that chef becomes, she will not likely be able to look at a new customer and predict what food they would like because their personal and physical preferences for different foods are such a complex issue. Pain treatments  are a bit like that. Even after you’ve examined patients, it remains a guess as to which treatments the Body will respond best. It’s all part of the great mystery that human biology still is in so many ways. 

But the good news is if you have a physiotherapist  with enough tricks up their sleeve and have a little bit of patience and trust, you can work through this with them and figure out which treatments  will work for you.

PHYSIOTHERAPY PREVENTION FOR SHOULDER PAIN

When it comes to healthcare of any kind, prevention is the holy Grail. An ounce of prevention is often worth a metric tonne of cures. 

When it comes to shoulder pain , three main principles most commonly arise with effective prevention. The first of these is the principle of strengthening .

Most modern humans must sit for long hours to sustain themselves and survive, whereas our immediate ancestors hunted, gathered, or farmed and have done so for eternity. All the sitting means that we tend to have muscle wasting around our shoulder , and all that muscle wasting around our shoulders is a major cause of shoulder pain. So strengthening  is the king of the Castle.

Lifestyle intervention is a second and almost equally important variable in preventing many shoulder pain cases. If you are seeing a physiotherapist for shoulder pain  and you want them to fix you, yet you spend all day Saturday desk at Work, then when you go home, you sit in front of another computer to play video games for five hours. If you haven’t been to the gym for five years, it may be difficult for the Physio to help you as much as they would like to. For some shoulder pain cases, working with your physiotherapist  to figure out how to make life better for your shoulders in terms of the day-to-day is a vital part of the prevention pie.

The third major shoulder pain prevention  principle in our trifecta is stress management. We are a profoundly overstimulated bunch of human beings at the moment. When we aren’t working or dealing with heavy traffic, there is a constant digital information onslaught. Our nervous systems are very overstimulated. And that’s before any actual life stresses kick in. When we are overstimulated and or stressed, we tend to clench  around our shoulders and neck. This is reflected by the truly massive number of people who turn up with bad shoulder pain during periods of high stress  in their lives. So, inconveniently, stress management can be a very significant prevention principle for many shoulder pain cases.

CONCLUSION

You may have noticed what emerges if you have successfully read between the lines in this physiotherapist’s perspective on shoulder pain . Is that what shows? The pain is, to a considerable degree, a lifestyle-related issue. The combined variables involved in modern life cause imbalances and weaknesses to develop on our shoulders. So naturally, the best way to approach physiotherapy for a shoulder is with tools, tricks, and tips designed to offset, heal and strengthen the effects of the modern world on our poor shoulders.