At Life’s Work Physical Therapy (LWPT) we look at the shoulder as a complex, not as a single joint, which helps us consistently show superior results when treating patients complaining of shoulder pain. Normal function of the shoulder requires cooperation of movement from the sternoclavicular joint, the acromioclavicular joint, the scapulothoracic joint, the glenohumeral joint, the thoracic spine and associated ribs, as well as needed stability and function of the cervical spine. A great number of muscles assist in the coordinated movements of these joints, which must have appropriate strength and function in order for the shoulder to function effectively and efficiently.
Have you ever tried raising your arm up while maintaining a slouched posture position? Or, have you tried raising the arm up fully when starting the motion with a shoulder shrug first? Both of those actions will make it difficult to raise the arm fully, but are common observations that patients present with, either secondary to postural habits or compensatory strategies for arm raising secondary to pain. When raising your arm while slouching, your thoracic spine is unable to extend and rotate, your ribs cannot effectively move, the shoulder blade is unable to retract and rotate as needed, and your shoulder joint has to pick up the slack to try raising up your arm fully which can jeopardize the health of your rotator cuff musculature.
Patients with a history of shoulder pain frequently adopt compensation patterns, such as shoulder shrugging, in order to raise their arm for various tasks. Initiating motion with a shrug fires the upper trapezius and deltoid muscles, which affects normal shoulder movements and further jeopardizes the rotator cuff muscles and neck. These compensation patterns occur as a result of the body trying to avoid using the painful muscle(s) for movement, but have a deleterious effect over time, as they can cause further harm and prevent actual healing of the affected tissue.
At LWPT, we not only want to find out what structure around your shoulder is actually causing the pain, but we want to find out ‘why’. We want to know why your pain is not improving on its own, or why other attempts at treating it have failed. Is the pain coming from the shoulder, or from somewhere else (such as being referred from the neck)? Is the problem postural, structural, or habitual? We will want to find out what the history to that shoulder and arm, neck, thoracic spine, etc. is, and see if there are associated issues that are leading towards the onset of your shoulder pain. We also understand that there are age-related changes to various muscles around the shoulder that occur, and degenerative rotator cuff tears (which can become painful over time) are common in our population and may be your source of pain. Research has shown that conservative treatment for rotator cuff tears is as good as surgery in treating rotator cuff tears, making conservative treatment (i.e. physical therapy) being considered the primary treatment for this condition.
Shoulder pain treatment typically consists of postural retraining of the thoracic and cervical spine, which allows for improved functioning of the shoulder complex. Manual therapy (including mobilizations and/or manipulations) to the shoulder complex joints and spine improves the biomechanics, and can improve the muscle coordination involved in shoulder movements. We use research-based strategies to improve the healing of affected muscular (or other soft tissue) tissue, and progressively advance your home program towards functional activities, in order to get you back to normal function and self-management of your shoulder for long-term success. If you are experiencing shoulder pain, contact Life’s Work Physical Therapy today for an evaluation from one of our expert clinicians, and begin to get on the road towards normal functioning again.