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Things You Should Know About Shoulder Pain

Neck and shoulder pain often go together (and not just because they are next to each other). A lot of activities that strain the neck can also strain the shoulder which can cause the nerves and muscles that cross both, the neck and the shoulder, to become painful.

Exercise for shoulder and neck pain can therefore be highly effective to help stretch tight overactive muscles and strengthen weak muscles to improve posture and reduce load on neck and shoulder structures. Treating shoulder and neck pain with a variety of physiotherapy techniques makes these exercises more effective and easier to perform.

The shoulder is the most mobile joint in the body. It is a ball and socket joint meant for movement, not stability. It relies on muscles (the four rotator cuff muscles) to stabilise the shoulder so that it can move in all directions unlike the knee joint that has limited movement direction, like a hinge. Because of the shoulder’s substantial range of motion and lack of stability it is prone to injury and pain.

Shoulder pain can also be referred pain, i.e. it comes from another area, usually from the cervical spine. This must be excluded by the treating therapist. If the pain is sudden and not from injury you should seek medical attention immediately as shoulder pain can also be a sign of referred heart pain.

Shoulder pain can stem from one or more of the following causes:

Strains from overexertion i.e. rotator cuff tears, Tendonitis from overuse, Shoulder joint instability, Dislocation, arthritis, stroke, Collar bone or upper arm bone fractures, “Frozen” shoulder, pinched nerves.

With some elderly or immobile clients, we also see shoulder pain related to muscle wasting and inactivity. As we age, the rotator cuff muscles thin and become easier to tear especially in people over 60. A lot of older clients we see have had rotator cuff tears with minimal trauma and are often unaware they have injured the shoulder.

      • Difficulty and/or pain with daily activities i.e. putting on bra, reaching for wallet, putting on clothes, reaching for objects, overhead movements, sports or lifting objects you normally could carry.
      • Difficulty sleeping/getting comfortable with your shoulder/neck
      • Difficulty working
      • Stiff locking shoulder
      • Feeling of weakness in shoulder compared to previously
      • Clicking/grinding esp. with pain
      • Thickening and/or swelling of tendons compared to other side
      • Pain more than a week or two in particular
      • Poor posture with or without shoulder pain (poor posture eventually causes problems for neck/shoulder and back)
      • Shoulder pain is also common after a stroke as the muscles that support the shoulder are paralysed and this leads to shoulder load and pain.
      • You have fallen on your shoulder/arm even if you did not fracture, but something has not felt “right” since then (especially in older clients).

Everyone is different and different shoulder conditions require specific exercises. Your therapist will assess your shoulder and work in with your doctor/other health professionals to organise scans/tests if needed to help come up with the right treatment.

Shoulder exercises almost always involve posture correction. This is because the shoulder often rounds when its in pain, and the shoulder blade muscles become weak.

Your physiotherapist will show you how to improve your posture and shoulder strength with exercises such as

      • Imagine a piece of string holding you up tall (or the queen pinning a medal on your chest). Poke your chest out and look straight ahead. This should bring your shoulder blades into a “V” shape without arching your back. You can do this standing, sitting with back supported, or laying down on back or side.
      • By squeezing your shoulder blades together repetitively during the day, with your stomach in and head up, and in time improving your posture you can often relieve shoulder pain.
      • Your physio may progress your exercises to involve hydrotherapy, use free weights and resistance cords for internal and external strengthening exercises, including biceps curls and triceps pushes, or gym-based exercise i.e. lateral pulldowns, seated rows etc.

Apart from providing personalised exercises your physiotherapist may

      • Help you stretch out overactive muscles, like the pectorals, biceps and upper trapezius, that become tight and painful
      • Use electrotherapy such as TENS/ultrasound and manual therapy hands on techniques to help your range of motion in your shoulder and neck.
      • Use heat/ice and topical creams such as Fisiocrem to help with swelling and pain
      • Advice on ergonomics such as avoiding overhead movements and how to support your shoulder throughout your day to help it improve.
      • Postural taping
      • Hydrotherapy can be highly effective as it takes strain off the joint and is much easier to move and strengthen without pain.
      • Involve occupational therapist to assist with modifications to reduce strain on your shoulder at work/home i.e. reaching sticks, aids for shower/kitchen/toilet/dressing while you do your shoulder rehabilitation.
      • Work in with your doctor/shoulder specialist for a tailored program pre and post shoulder procedures.

Shoulder and neck pain can be particularly painful and can affect your quality of life, but they do not have to. There almost always is something we can do to assist, so if you are having difficulty with your shoulder pain please contact us and we can help.

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