Shoulder problems are some of the most vexing for therapists to treat. This is because the shoulder itself is a floppy complicated joint held together largely by its surrounding plait of muscles, with anchorage largely through the movable base of the shoulder blade.
The other important reason that shoulder problems are difficult is that undiagnosed neck problems are usually the cause. It's often hard explaining this to patients. A painful shoulder feels . . . . . well, like you've got a problem shoulder.
It's always best to have a proper professional assessment before you start exercising willy-nilly, since some common shoulder exercises make the problem worse!
At Sarah Key Physiotherapy Sydney we take you through an assessment to find out what exactly is wrong, since it's always better for you to know what you are dealing with at the start.
After we've treated you hands-on, we will give you a suitable exercise program to restore length and parity to the shoulder muscles and stability to the shoulder blade - the first essentials of recovery for a shoulder problem.
Yes, you really do need to be started off with a proper assessment and diagnosis. We can do this for you. The neck has to be assessed and treated, as well as the shoulder. And then both need to be carefully treated, before you can start doing things yourself.
Even slight irritation of one of the nerves coming out of the neck can cause the muscle supplied by that nerve to develop 'raised tone'. By this we mean the muscle develops a constant, low-grade clench that makes the shoulder and the muscles around it feel painful, as a sort of a low level, achey cramp. The discomfort makes you want to keep massaging it with the other hand, digging your fingers in to get relief. You often 'work your arm around' to try to loosen things off.
Yes, the shoulder can be both the result of the neck problem - even when you’re unaware you have a neck problem - and then become a problem in its own right.
When you have a neck problem, even a sub-clinical or undiagnosed one, the muscle clench around the shoulder makes it less floppy and extensible, so it's easier to hurt. The most mundane action like twisting a door knob can yank the shoulder; it can be so painful you almost see stars. Then you're in a situation when you've strained the shoulder, as well as having pain referred there by the neck.
Lifting like this, hauling up the left shoulder, actually causes a shoulder problem . . . . . sorry!
As we have seen in many aspects of the orthopaedic world, the evidence of pathology is not necessarily significant in terms of being a pain source.
The rotator cuff is like a plait of muscles and tendons around the shoulder joint that holds the ball and socket joint together. With poor use of the arm – usually hauling the whole arm and shoulder blade up and using the neck muscles to lift things - these structures get frayed as they are forced to squeeze under the ledge of bone at the tip of the shoulder (the acromium).
An extraordinarily high number of people over the age of 50 have complete tears, erosion and frank holes in the rotator cuff, yet suffer no pain. Conversely, you may have a dreadfully painful shoulder that has nothing to do with a torn or worn, or partial or complete tear of the rotator cuff. Remember that point.
You might like to take the time to listen to this podcast; an interesting physio-to-physio conversation about diagnosing shoulder problems, featuring PhD shoulder-treating physiotherapist, Dr Jeremy Lewis. Amongst other things, he makes it clear that it's not possible to diagnose what structure is causing pain in a shoulder. He explains categorically how there is no link between so-called 'structural failure' (particularly of the plaited rotator cuff muscles) and pain. He says that top flight American base-ballers, who can pitch a baseball at 170kph can have 'pretty substantial rotator cuff tears yet feel no symptoms'
Just to be on the safe side, we will look into both your shoulder and your neck. We will also be showing you how to change your lifestyle and your habits of lifting, since ‘weak arm lifting’ is the main cause of rotator cuff wear and tear and neck problems.
This long slender muscle and its tendon at the top of the shoulder are the most at risk with abrasion of the rotator cuff muscles under the acromium, the bony tip of the shoulder. Once again, the focus of treatment at Sarah Key Physiotherapy will be on restoring the background strength of the arm by stabilizing your shoulder blade and keeping your neck long as you lift, so that you don't keep abrading and wearing holes in the the rotator cuff.
Read more about Shoulder Physio here. Shoulder problems are some of the most difficult musculo-skeletal disorders to treat, and believe it or not, they often get better of their own accord.
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