Shoulder pain is a frequently reported complaint within the general population and is one of the most common conditions that we see in our clinics. The shoulder is highly reliant on muscle strength and balance to provide the optimal balance of movement & function. However, if any one of multiple tendons or muscles become weak or cannot function fully, pain can develop which can lead to difficulty using the arm for common daily tasks, hobbies, physical activity & sport.
At Pure Physiotherapy, our team will take a comprehensive history to ascertain key factors that may be linked to the underlying cause of your shoulder pain followed by a full physical examination to test and isolate crucial structures which may be contributing to your shoulder pain.
This may include tailored strengthening exercises to address underlying weakness or to overcome stiffness. Additionally, your Physio will provide advice on activity modification and adjustment of techniques for certain movements and tasks to reduce pain and improve function. Finally, our skilled clinicians will utilise their modalities to help reduce pain and restore full movement.
As other structures such as those in your neck and upper back may contribute to shoulder and arm pain. Your Physiotherapist at Pure will incorporate this into your assessment to screen for their involvement. They may also ask you to perform certain activities that replicate your pain to help better understand the causes of your pain.
Your Physiotherapist may ask you to remove outer layers in order to have a look at your shoulder and surrounding structures so we would suggest wearing a vest top to your assessment or treatment sessions.
Occasionally we may write to your GP or Specialist to request more investigations if we feel that would be required. We work closely with many GP’s and Specialists in the region. For more information on this topic, please see the section of our website related to First Contact Practitioners.
A key component of your rehabilitation will be an individualised exercise programme which may include the exercises highlighted below.
This is the most common cause of shoulder pain. The rotator cuff is a group of four muscles which work together to keep the joint in optimal position throughout movement. The shoulder is a shallow ball and socket joint and subsequently requires significant support from the rotator cuff muscles – among other structures like tendons and ligaments, to maintain stability.
These tendons can show some signs of wear & tear as we age or can become painful if they are exposed to more load than they are used to. Consequently, they can become sore and weak, meaning they offer less support to the shoulder joint. Sometimes this can lead to a mechanical impingement around the shoulder joint as the tendon doesn’t keep the top of the humerus (upper arm bone) centralised against the socket. This can lead to pain in the upper arm, particularly if using the arm away from the body, or lying on the affected side.
Treatment for this is aimed at improving the quality of the tendon and this is done through a graded strengthening programme using exercises shown here:
It may take a few weeks or even a few months to notice a significant improvement in your symptoms, but it is important you persist with the exercises. Your Physiotherapist at Pure will instruct you on how to perform the exercises, how many and how often.
You may also need to modify some of the activities that you are doing that are causing pain or irritation, for a short period of time whilst you build strength back up. This may just mean adjusting the way you move or lift or load, or maybe avoiding lying on the affected side.
Occasionally a patient may receive an injection into structures around the tendon to provide some pain relief. It is important to note that this will not correct the problem with the tendon, but it may provide a window of pain relief for you to then be able to complete your rehabilitation programme with less discomfort.
A frozen shoulder is characterised by progressive pain and stiffness in the shoulder. The cause of it remains unclear despite vigorous investigation within healthcare research. It is most prevalent in females between 40-70 and in patients with diabetes.
There are two types, primary idiopathic or secondary.
A primary or idiopathic frozen shoulder tends to come on gradually. It is often after a mild trauma to the shoulder which leads to inflammation in structures at the front of the shoulder and may cause thickening. The shoulder then becomes painful and movement is restricted, mostly into reaching up overhead and out to the side.
There are generally two phases of a frozen shoulder. The first when the pain is greater than the stiffness and then the second phase when the stiffness is greater than the pain, this is often referred to as the “thawing phase”.
In the early stages it is important pain is managed and the shoulder is kept moving as much as you can manage. Here are some helpful exercises that you may find helps keep the shoulder moving initially:
As this improves, your Physiotherapist at Pure will guide you through a progressive strengthening/loading programme to help improve movement and increase strength which will help you use your arm again for the tasks you have been struggling with.
As previously described, the shoulder is a shallow ball and socket joint (often compared to a tea cup on a small saucer) and relies on soft tissues such as muscles, tendons and ligaments to keep it in the right place to ensure that we can use our arms and hands to interact with the world around us.
In some patients, these soft tissue structures may be very flexible and not always keep the ball part against the socket. Occasionally, this can lead to the shoulder coming partly or fully out of the joint. This is relatively common, particularly in the younger patient and is not a cause for concern. Your Physiotherapist at Pure will take you through a series of individualised exercises to help improve strength of the muscles around your shoulder so that it can more effectively support the shoulder and keep the joint centralised in the socket.
Typically resulting from trauma and again due to how shallow the socket is, the shoulder may be prone to dislocation which may require attending hospital and being under the care of a specialist. At times, the patient may require surgery to help repair any damaged tissues to restore stability. Alongside surgical intervention or any dislocation, it is vital to build strength back up in the soft tissues around the shoulder to help restore mobility and function in the shoulder.
Here are some exercises you may find helpful: