Shouldering a problem

Shoulder problems are very common and certain occupations and sports have a higher predisposition to injury and overuse. Tradies, Nurses, Computing, Musicians, Hairdressers to name a few, are over represented in the shoulders we see.

Mobility is very important for the shoulder but the joint is relatively unstable due to its anatomy and relies on the muscles to provide the necessary stability. Muscle imbalances and posture can thus contribute to the development of shoulder pain and our physiotherapists can address these in conjunction with pain relieving treatment.

Shoulder pain can also be referred from you neck- This Neck Guide can help differentiate where your pain may be coming from.

There are three broad categories of shoulder pain and injury:

1.Injury – such as shoulder dislocation and rotator cuff tears

2.Muscle imbalances leading to impingements, bursitis and rotator cuff tendinopathies and degeneration.

3.Stiff and painful shoulders such as frozen shoulder or arthritis

Many problems present similarly, so a detailed examination and assessment is important to understand the contributing factors. We need to assess the role of the scapular and the muscles around. Studies have shown that the identification and rehabilitation of the underlying mechanisms are instrumental in the recovery of shoulder problems. Although some people can identify a particular incidence eg nurses, the majority develop insidiously over weeks or months. ( computer use). Overuse or unaccustomed loading are frequent precursors of the older shoulder pain, with underlying poor muscle control of the scapular and glenohumeral joint. Steriod injections do not address these underlying mechanisms.

Shoulder problems are generally acute or chronic and treatment will be directed to the stage of the problem. The shoulder can also have pain referred from the neck and mid back so these will need assessing too. Poor upper spinal movement can contribute to the development of shoulder symptoms.

What you can do

• Find a comfortable position for the shoulder. Often a rolled towel, cushion or pillow wedged between your body and your elbow can give some relief – but if it hurts, take it out!.
• Do not sleep on it and try to keep good posture.
• Modify your aggravating activities and check your work station set up. Long hours on computers and mouse use are often part of the degenerative and reactive tendinopathy picture.
• Place your computer mouse as close to you as possible and support your forearm.
• Carry items close to your body and use a backpack.
• Take regular breaks from activity and stretch.

Generally speaking the shoulder responds very well to ice for pain relief, however, particularly in chronic shoulders, heat may work better – this is up to you and how ice or heat makes it feel.

Our free pdf : 5_dangerous_shoulder_exercises is available here for information about the 5 most commonly dangerous shoulder exercises

Next get a thorough assessment. Management depends on the type of injury or problem you have. Unloading with taping techniques, mobilization of stiff joints, postural correction and activity/ technique modification, soft tissue massage and stretches and graduated reloading and addressing of muscular imbalances are all components of our shoulder rehabilitation programmes.

The sooner you get an understanding of the pain and the options available for management, the sooner you can get your pain under control. Your Physio can discuss with you your treatment options, possible imaging techniques or even specialist referral if needed. Research shows the majority of shoulders will settle with correct exercise, modified rest and re-education. Call us on 83462000 or email us at info@hindmarshphysio.com.au for an appointment at either of our locations.

Neck and shoulder pain are often connected- you're welcome to download our Patient Resource on Managing Neck Pain here: Neck_pain_guide