Shoulder pain is one of the most common injuries we see in the clinic, with up to 67% of people experiencing shoulder pain or injury in their lifetime; making it the third most common musculoskeletal issue in the world. Unfortunately, many people report that they never get a full resolution of their shoulder pain symptoms; this is one of the reasons we are so passionate about helping people to get their shoulders strong and back to 100%.
What causes shoulder pain?
Shoulder pain can be caused by a number of factors – with the initial distinction being pain that is caused by a traumatic or forceful injury and pain that is caused by overuse or degeneration over time. There are also indirect causes of shoulder pain, such as referred pain, chronic pain and nerve related pain.
Traumatic shoulder injury is normally caused by falling on your arm or shoulder, which can tear the rotator cuff, ligaments/capsule and fracture a bone or by explosive movements – such as throwing (baseball) or serving (tennis/volleyball) in an overhead motion. In the latter example, the injury to the rotator cuff happens as the rotator cuff muscles act to decelerate the arm from the incredible speeds that athletes achieve – this can be in part prevented through correct technique. This type of motion will typically cause a tear of the rotator cuff muscle named the Supraspinatus.
Non-traumatic shoulder injury can be caused by wear and tear/overuse over time without adequate rest and recovery. This is important to note, because many people believe that the shoulder will wear out over time through use, however you can absolutely use your shoulder at a high level without issue if you listen to your body, strengthen the supporting muscles and allow it time to recover when needed. It is also important to point out that degenerative changes in your shoulder are a normal part of ageing and there is high level research to support that there is little correlation between this degeneration and pain.
Physiotherapy treatment for shoulder pain
Before we get started with our Physio treatment for shoulder pain, we need to address the number 1 myth about musculoskeletal injuries – degeneration does not equal pain and that structural damage does not equal pain or dysfunction.
This may seem counterintuitive, however we now have incredible research that shows that damage to a structure is just one part of your pain experience. It may make sense simply to think that the amount of pain that you feel is directly related to the degeneration or damage, however especially in degenerative or overuse injuries, it only plays a very small part. This is a really good thing, because it means that you can be completely pain free with a functioning shoulder without having to worry about or fix every degenerative change in your shoulder and rotator cuff.
Degeneration should be thought of in the same way as a grey hair or a wrinkle on your skin, all are degeneration but none actually mean that it should be painful.
Research has shown that in middle aged people without any shoulder pain, if you were to take a scan of their shoulders you would find that 78% have bursal thickening, 65% have AC joint degeneration, 39% have Supraspinatus tendinopathy and 22% have Subscapularis tendinopathy; all without pain at all!
Hopefully that gives you great hope for your shoulders!
The first part of our physiotherapy treatment for your shoulder will be to begin to ease your pain. It’s important that we get you out of pain as fast as possible because shoulder pain can be so debilitating and affect so many other areas of your life, including your ability to get a good night sleep – which is one of the most common associated complaints. It’s also necessary to reduce your pain before we diagnose exactly what’s wrong with your shoulder, because whilst in pain, every test we do on your shoulder will cause you pain & it will be improbable to give you an accurate diagnosis
Once we’ve begun easing your pain, the next step is to begin to increase the mobility of your shoulder through gentle exercises as stretches. You will also find that by adding in more movement, although it can be tender at first, it will accelerate the pain relief as we progress.
As part of your shoulder Physio treatment we will also work on the mobility in your thoracic spine as we now understand that this can play a large role in shoulder dysfunction. By making small improvements in your thoracic spine mobility, we are able to see large reductions in symptoms and an increase in function. This is in part due to the shoulder joint no longer having to compensate for a lack of mobility in the surrounding areas.
Just think if one person on a team isn’t pulling their weight, then everyone else has to work harder & will likely become overworked easier. The same applies in your body, if one area isn’t working efficiently the
Rotator Cuff Strength
You may have heard of the rotator cuff before, these are the muscles that support the shoulder girdle – compromising of the shoulder blade and humerus (upper arm bone). As the shoulder is such a mobile joint, the socket (which is in the shoulder blade) is very shallow and therefore the shoulder relies heavily on the rotator cuff to stabilise the joint through all planes of motion – this is why it is much more common to hear about shoulder joint dislocations compared to hip joint dislocations.
As part of your shoulder pain treatment, one of our main aims will be to strengthen your rotator cuff in a functional way. We have good evidence to support that if we strengthen your rotator cuff, we will be able to reduce your pain and drastically improve your function, whilst simultaneously decreasing the probability of this happening in future.
Functional Return to Activity
The next step in your shoulder physiotherapy treatment journey is to gradually load you back into the activities that are important to you. This will happen progressively over a period of weeks and is one of the most important aspects of your treatment, this is also where there is the largest chance of re-injury.
The reason for this is that in this stage pain has usually ceased, however there has been deconditioning of the injured area and surrounding supporting structures and, as people do, when things feel good we like to push it a bit and don’t always follow the gradual loading protocol. This is why it is incredibly important to follow the graded loading program closely, even if it feels a little slow at times!
An injury prevention programme should be included in all shoulder physiotherapy management, especially due to the evidence suggesting that injury in your shoulder will put you at a higher risk for future injury in not just the same shoulder, but your other shoulder too!
Your injury prevention programme will likely consist of some mobility exercises, a bit of rotator cuff strengthening and some soft tissue release work around your shoulder blade. It typically will only take 5-10 minutes to complete and in our opinion is well worth the time in the long run!
Shoulder Pain Physiotherapy Treatments at Home
If you are looking for what you can do at home to begin to get your shoulder out of pain so you can return to doing what you love, then a good place to start is with some self release of the muscles around your shoulder blades.
In order to do this you will need either a massage spiky ball or a self release rubber ball:
- Place the ball on the ground and lay on top of the ball facing the ceiling
- Place the ball under your shoulder blade and find a place that is a bit tender
- Let your body weight sink into that tender area on the ball for about 10 seconds (this shouldn’t be excruciatingly painful however!)
- Move around slowly to find another tender spot and repeat 3-4 times over the muscles of both shoulder blades.
A great strengthening exercise that many people can do at home for their rotator cuff (which has been incorrectly demonised over the past decade) is the lateral raise. This exercise has been shown to activate and strengthen all the muscles of your rotator cuff simultaneously. Previous incorrect assumptions had been made that this exercise would cause issues in the shoulder joint by narrowing the space between the bone and the tendons, however this has been shown to be incorrect by the evidence. It is important to note that this exercise is often performed with too much weight and the weights are ‘thrown’ to get them moving, which could cause discomfort over time.
To perform the lateral raise you will need a couple of small dumbbells of equal size:
- Lift the dumbbells to your side until you reach shoulder height
- Hold at this point briefly
- Lower the weights, taking 2-3 seconds on the lowering portion of the movement
- Repeat for 8-15 repetitions and up to 3 sets – important to note that you should begin with lower reps and only 1 set, working your way up gradually
**Avoid training any muscle group to failure, this could be an entire post on it’s own – it does not give you any benefit so always leave 1-2 repetitions in the tank
How Many Physio Sessions Do I Need For Shoulder Pain?
This is a common question that we get and the answer is that it depends on a number of factors including:
- The severity of your shoulder pain and injury
- The length of time that you’ve had your shoulder injury
- The type of shoulder injury that you have
- Any contributing factors you may have
- Your age and health status
- Your commitment to the treatment plan
Most shoulder injuries will take on average between 8-12 sessions in order to:
- Decrease your pain
- Improve your shoulder thoracic mobility
- Strengthen your rotator cuff
- Gradually load you back into functional shoulder movements
- Create an injury prevention programme
Can Physiotherapy Make Shoulder Pain Worse?
Physiotherapy can certainly be uncomfortable at times when treating your shoulder pain, however this is usually because we are working with you to improve your mobility and strength in the early phases of treatment, which is necessary to speed up your recovery so that you can return to doing what you love.
This doesn’t mean that you should be experiencing large amounts of pain unnecessarily; the most important thing is communication between you and your Physio. If you feel that your shoulder is more painful during treatment than you expected it would be, simply let them know and they will be able to modify it to accommodate how you are feeling. Never suffer in silence!
Physiotherapy for shoulder pain and injury has great evidence to support that it can help you to become pain free and return to the functional activities that are important to you and if you are in pain, we can help you today.