shoulder physiotherapist

Do you suffer from shoulder pain?

Shoulder pain is one of the most common complaints of people seeking treatment at a physiotherapist. Often it is a referred symptom coming from the vertebral segments of the neck or upper back and it is an important task of the therapist to differentiate if this is the case or if it is coming from structures in the shoulder joint itself. Neck related shoulder pain is more a vague pain at the top of the shoulder as it comes up toward the neck, difficult to pinpoint and is described often as an ache or tension. This is normally one sided and reproduced by movements of the neck, e.g looking down or up or to the side. A functional movement that may bring it on would be like looking in your blind spot when driving.

Pain emanating from the shoulder joint itself could involve structures such as the rotator cuff ( four muscles that work together to keep the head of arm bone well positioned in the socket), the labrum (functions to deepen the socket to provide stability), the tendons of the various muscles that attach at the joint, the ligaments (e.g the acromio-clavicular ligament particularly at risk of sprain) not to mention the complex network of nerves and vessels that arise in that area in order to supply the upper limb.

The shoulder is prone to injury due to the inherent instability that arises as a result of being able to have such a wide capacity for movement. Compare this for example to the hip joint which has much stability but at the cost of a loss of range of motion. Therefore the musculature of the shoulder is paramount. Not only do the muscles that control the scapula need to be activated and strong but also need to be well balanced against their antagonists. Many injuries result from an imbalance (whether due to overuse in a certain posture or deliberate hypertoning in order to create an aesthetic effect) which pushes the humeral head forward and rotates it inward. This creates the perfect conditions for an impingement of the rotator cuff tendon as it passes under the acromion. This causes pain in the upper arm especially when the arm is lifted to the side about 90-120 degrees (painful arc). The therapist will assess the cause of the impingment and address the training or postural factors which are contributing which can be muscle imbalance (as mentioned) but possibly also a stiff thoracic spine, tight pectoral muscles, a tight joint capsule etc.

Compliance with home exercises is vital to retrain the correct movement patterns of the shoulder joint. Often these are simple strengthening exercises done with a resistance band and may include a few stretches as well.

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