Nerang Physiotherapy

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Shoulder pain

As with most other areas of the body, there are 2 different types of shoulder pain, that caused by trauma (e.g. injury, surgery) and that without a known cause (termed insidious). Either way, the approach to the treatment of these types of shoulder pain will vary according to the signs and symptoms. The trick to ensuring a full recovery is to be able to assess which other areas of the body may be involved in the problem.

For example, are you aware that a lot of shoulder pain is caused by hip muscle imbalance?  Yes, the hips are connected to the shoulders via soft tissue and a muscle called the Latissimus Dorsi (or 'lats' in the gym circles). Therefore any fault with the hip can affect shoulder function, and vice versa. The neck, however, is a more common component of shoulder pain and dysfunction. As the neck is directly linked to the shoulder via many muscles and soft tissues, the two areas are inseparable when it comes to treating shoulder pain. Tight neck soft tissues can result in the shoulder being dragged up to the neck, thus causing immediate muscle imbalance/weakness in the shoulder.

With a pattern of weakness developed, the body is now forced to compensate, and when this happens, pain will eventually occur, somewhere. Often the compensation for weak  shoulder muscles occurs in the neck muscles, thus putting the problem right back on the neck, so neck and shoulder pain often run in parallel. So it is evident that treating the shoulder only will not lead to a successful recovery.

Popular approaches to treating shoulder pain is via exercise, but as I have mentioned in other articles, exercises can be detrimental to recovery, especially given in the early stages of treatment. Stiffness is the most common problem with any form of pain, and it is imperative that flexibility be the main focus of the treatment, as with a return of flexibility will come a return in strength. So it is possible to treat the majority of shoulder injuries without exercise, thus preventing and possible unnecessary compensatory actions and dysfunction developing.

It is not uncommon to see someone who has suffered shoulder pain, but only after they have lost 50% of their range of motion in the joint. This is due to the ability of the surrounding muscles to compensate for lost motion in the shoulder. For instance, lifting the arm to the side does not involve the shoulder blade muscles until the arm is approximately 90 degrees up, parallel to the ground. However, if there is shoulder stiffness, this might happen before the 90 degrees, thus causing a pattern of movement which is incorrect and the possibility of pain developing somewhere else in the shoulder/neck/shoulder blade area.

So what causes shoulder pain not a result of trauma? Well, commonly it is some form of overuse. This could come from sports such as tennis or cricket, where the arms are used repetitively in a particular pattern, but it could just as easily come from fixed positions such as being in front of a computer (excuse me while I stretch...). I have found a strong link between the ability of the Autonomic nervous system to control circulation, and the ability of the muscles and soft tissues to operate normally. So, as with other insidious pain, the starting point might be in the nervous system, resulting in poor blood flow rate, thus stiffness and weakness developing. This then results in compensation and eventually pain. 

Shoulder pain is, of course, a natural part of trauma to the shoulder, be it from surgery or direct injury, such as a fall on the shoulder or on an outstretched hand, or from contact in sport. The goal in these cases is the same. Restore good blood flow rate, restore soft tissue flexibility and the strength and function will take care of itself. Once the body feels more stable and comfortable in the function, the pain will ease. Please note, pain is not always the first symptom to disappear, as it is a part of the body's warning system and is there for a reason. If pain is treated rather than the dysfunction causing pain, then you will possibly cause further damage as you are unable to ascertain whether what you are doing is harmful or not. The pain signals are there to say stop, they are not there to be switched off if the body requires them.

This does not mean living with the pain from trauma, this can be eased with pain killers, but as long as you realise it is treating the symptom, NOT the cause, and you still have to take care. There is no way to speed up the healing process, but removing the obstacles getting in the way of the repair is the way to go, enabling the body to repair itself at its own rate.

Shoulder pain can be very debilitating, but be aware of stiffness, as this is often the key precursor to pain. If you feel you are unable to move your shoulder as you did before, even though you do not have pain, get it seen to, you could prevent a lot of pain in the future. The golden rule with pain of any type is: if you suffer pain for more than 24 hours, get it seen to, as the body has not been able to fix the problem, but it will attempt to compensate, and it is this that results in problems.