Shoulder Pain 101:

If you’re experiencing shoulder pain, you could be suffering from one of many different ailments. Some common conditions include:

Rotator cuff tear: This is what happens when the tendons that constitute the rotator cuff muscles around the shoulder detach from the bone, causing a severe decrease in the range of motion that a healthy rotator cuff allows us to have. These injuries are very painful and have two general causes:
Repetitive use: As the name implies, repetitive use injuries are caused by repeated activities that wear the rotator cuff thin over time. This is typically seen in older patients or people who put an unusually demanding strain on their rotator cuffs, such as professional athletes.
Trauma: Traumatic injuries, such as breaking a fall with an outstretched hand, can lead to rotator cuff tears as well. This cause is much less common than repetitive use and is most often the culprit of rotator cuff tears in patients under 60 years of age.
Frozen shoulder: Also known as adhesive capsulitis, frozen shoulder is a medical condition that includes a decrease of motion in the shoulder and pain that progressively increases. There are three stages of frozen shoulder:

  • Stage 1: The freezing stage, or the beginning of pain and loss of motion, both of which begin to steadily increase.
  • Stage 2: The frozen stage. By now, the shoulder’s range of motion is severely restricted, but the pain is likely starting to decrease.
  • Stage 3: The thawing stage, where pain is minimal and shoulder motion slowly returns to normal.


These are only a few of the possible conditions that can cause shoulder pain. Some are more serious than others. Call your doctor, and consult us for your physical therapy needs, if you’re experiencing any of the following symptoms:

  • Inability to carry objects or have full use of your arm
  • Joint deformity
  • Shoulder pain that doesn’t ease at night or while resting
  • Lack of motion, including an inability to raise your arm
  • Swelling or bruising around the shoulder joint or upper arm
  • Signs of an infection, which could include fever, redness, and warmth

A few common treatments that may bring relief include:

A little rest & relaxation.

This can help soothe many aches and pains in the shoulder region, but medical experts advise you to use caution with this approach as too much rest can lead to the discomforts associated with a frozen shoulder.

Ice and heat.

Ice packs should be used on recent injuries that were sustained in the last 48 hours. Ice packs are especially helpful where swelling is involved, as they can help decrease the swelling in the injured area, thus helping to reduce the pain. Heat treatments, such as hot pads, should be used only to relax and loosen tissues in cases of chronic conditions. Heat treatments should not be used after periods of significant activity (if you’re concerned about muscle soreness, use the heat treatment before participating in the activity) or after an acute injury.

Stretching.

The shoulder is a very mobile joint. The less the shoulder is stretched, the tighter the joint becomes, causing more muscle and joint stiffness and leading to more pain. Stretching the muscles and tendons surrounding an aching joint can spell relief in many cases.

Physical therapy.

It has been shown that physical therapy is “an important aspect of treatment of almost all orthopedic conditions,” and shoulder pain is no exception. The treatments utilized by physical therapists can ease pain, increase strength and mobility, and help patients resume the level of activity they enjoyed before the injury.
Anti-inflammatory medication. If the above-mentioned treatments aren’t enough to get you moving again, your doctor might prescribe anti-inflammatory medications to help the process along.
Cortisone injections. If all else fails, your doctor may prescribe cortisone injections. Cortisone treats inflammation, a common source of pain for many sufferers of chronic shoulder conditions.
If you find yourself battling shoulder pain, you don’t have to suffer in silence. Talk to your medical professional, who can refer you to the trusted physical therapists at ESSMC to guide you on the road to recovery. Or just call one of our convenient offices and ask to be seen by one of our Physical Therapists right away. With Direct Access we can treat most patients without a prescription. There’s no need to see your doctor first!

Being Posture Perfect!

Many shoulder problems can be linked to poor posture, which strains the muscles of the upper back and neck. One way to keep a relaxed, supportive posture is to get up and move around regularly, especially if you find yourself sitting (or standing) in one position for long periods of time. Even if you maintain a good posture, holding any one position for too long can be tiring on your muscles. Furthermore, a good exercise routine that includes aerobic activity will keep your body strong, and strengthening exercises geared toward your back will help promote good posture.

Stretching Exercises To Alleviate Shoulder Discomfort

Our experienced staff will get you on the path to recuperation from shoulder injury. There are a few simple exercises that your physical therapist can teach you to help strengthen and heal your shoulder. Strengthening exercises also work on increasing the flexibility of your shoulder, which will help you get back to normal daily activities like brushing your hair or buckling your seat belt.

A WORD OF CAUTION:

Don’t try these exercises without the supervision of a trained physical therapist, who will ensure that you’re choosing the right exercises for your condition and that you’re performing them correctly. After all, the wrong moves can slow down the healing process or make the situation worse. You definitely want to be careful not to put undue stress on your rotator cuff. This is a sensitive group of muscles that could be easily injured or inflamed, causing more pain. Stretching is the most important part of treatment. Shoulder pain often goes hand-in-hand with shoulder stiffness, and stretching exercises can help loosen the muscles surrounding the shoulder joints. Here are a few techniques your physical therapist might suggest:

Pendulum exercises.

These easy moves are performed by bending forward at the waist and letting your arms dangle toward the ground. Make small circles with your hands, allowing the natural momentum of your movements to take over.

Shoulder rolls.

Drop the shoulders down and roll them back, beginning with small circles and working your way up to larger movements. After completing 10 backward circles, move on to 10 forward circles.
For a full routine of stretching exercises that can help strengthen and heal your shoulder, contact one of our experienced physical therapists.
Shoulder Instability is a common sports related condition. The injury can occur traumatically or develop over time. Traumatic injuries are associated with collision sports such as football and hockey. Overuse instability occurs over time in sports involving repetitive overhead motions, these include baseball, softball, swimming and wrestling.

The terms used to describe instability are dislocations and subluxation (partial dislocation). This occurs when the humeral head (ball) slips out of the socket and either remains out (dislocation) or reduces spontaneously (subluxation). Symptoms include immediate pain and difficulty lifting the arm.

Overuse instability develops with repetitive overhead motions. The repetition causes gradual stretching of the stabilizing structures of the shoulder including the joint capsule and ligaments. Symptoms include gradual onset of shoulder pain with the associated activity.

Current recommendation for shoulder dislocation is rest and immobilization for 3-4 weeks. Physical therapy following immobilization can reduce pain, restore ROM, strength and function. A surgical procedure may be necessary to restore the normal stability of the shoulder. Treatment for subluxation and overuse instability includes stabilizing strengthening exercises and analysis and performance mechanics. Most patients with overuse instability can be treated non-surgically.

If you have any additional questions with regards to shoulder instability, please feel free to call a physical therapist at East Suburban Sports Medicine Center.

Matthew R. Gatesman, MPT, ATC
Inflammation of the rotator cuff tendons is one of the most common problems treated in out-patient orthopedic physical therapy. There are several medical diagnoses used to describe this condition including tendonitis, bursitis and impingement syndrome. The condition involves impingement of one or more of the rotator cuff tendons between the attachment of the rotator cuff tendons at the upper arm and the edge of the shoulder blade or acromion.

The rotator cuff consists of 4 muscles – the supraspinatus, infraspinatus, teres minor and subscapularis. They form a cup around the ball of the shoulder or the head of the humerus. The rotator cuff’s main function is to stabilize the ball in the socket with movement of the shoulder joint. Often times the cause of rotator cuff tendonitis is due to a relative weakness of the rotator cuff muscles vs the larger shoulder muscles.

The onset of rotator cuff tendonitis is often associated with overhead activities such as painting, wallpapering, throwing activities and swimming. Symptoms appear as a dull aching sensation in the shoulder and upper arm. Patient’s chief complaints are increased pain associated with overhead movements and difficulty sleeping because of increased shoulder pain.

Treatments for rotator cuff tendonitis include anti-inflammatory medication, physical therapy, corticoid steroid injections and occasionally surgery. Anti-inflammatory medication prescribed by your doctor can reduce inflammation and pain. Physical therapy treatment includes modalities to increase circulation to the rotator cuff tendon to encourage healing. These include moist heat, ultrasound, electrical stimulation, iontophoresis, and ice. Exercises are prescribed to strength the rotator cuff restoring the balance between the muscle groups to avoid impinging the rotator cuff tendons. Activities to improve posture and thereby improve joint biomechanics are important as well. In some cases there is a mechanical compression of the rotator cuff tendons that can not be resolved by exercise and treatment. In these cases, referral is made to an orthopedic surgeon who can assess the need for surgery to relieve mechanical pinching, etc.

Internal shoulder impingement:

Internal shoulder impingement is produced when the tendons of a group of muscles called the rotator cuff get pinched by the humerus as the arm is lifted above the head. It is a gradual injury that is common in younger athletes involved in repetitive activities with the arm above the head (baseball, tennis, volleyball, etc.). Pain is usually located in the back / top part of the shoulder and is aggravated with any overhead movements. Symptoms other than pain include shoulder tightness and weakness.

This injury can be treated with rest and modified activity, in addition to a thorough physical therapy program. Physical therapy treatment would include the use of modalities (moist heat, electrical stimulation, etc.) to calm down symptoms, therapeutic exercises and stretching to regain strength and range of motion in the shoulder, and manual therapy techniques performed by the therapist.

The staff at ESSMC specializes in managing this condition and the results speak for themselves!

Pilates and neuromuscular control exercises in Shoulder Rehabilitation:

Pilates and neuromuscular control exercises are incorporated into the rehabilitation of the shoulder girdle in addition to traditional strengthening exercises. IN order to have a healthy shoulder, one must have good control of the shoulder blade muscles. The rotator cuff muscles stabilize the shoulder joint, and misalignment of the shoulder girdle may result from weakness in this muscle group. Our staff is highly skilled in evaluating shoulder muscle imbalances.

Changes in posture affect ideal movement and function. Imbalances between the force couples of the shoulder may lead to decreases in ideal motion. A physical therapist can evaluate the mechanics of shoulder movement to determine if there are specific muscle imbalances present. The best way to isolate the appropriate muscles for strengthening is to place the body in a position that puts opposite acting muscle at a disadvantage.
In addition to traditional strengthening, neuromuscular control is an important aspect of rehabilitation that is commonly overlooked. If the patient presents with good strength but has positional and functional deficits the motor firing of the muscle may not be optimal. Our staff utilizes neuromuscular exercises in order to restore proper muscle balance of the shoulder girdle. These exercises assist in subconscious control of muscle activity. This concept is a large portion of Pilates exercises as well.

Joseph Pilates developed a theory of exercises that centered on mind over matter in order to accomplish muscular control using minimal resistance. With Pilates, resistance equipment is used initially for learned movement patterns, but muscular control is mastered independently of resistance equipment. In Pilates, the core includes the shoulder girdle, and strengthening begins with the core and radiates to the arms and legs.


 

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