Physical Therapy for Shoulder Pain Relief

Did you know that the shoulder is the most mobile joint in the body? Shoulder pain is very common and can occur both from a traumatic injury such as a fall, but also from repetitive motions such as painting and repetitive weight lifting (when other impairments already exist). The main shoulder joint (glenohumeral joint) is made up of 2 bones (humerus and scapula), 2 main ligaments (coracohumeral & glenohumeral ligament- which has an inferior/superior/middle component), 4 main rotator cuff muscles (supraspinatus, infraspinatus, subscapularis, teres minor), tendons, a joint capsule, a labrum, and cartilage. 

Beyond just the main glenohumeral joint of the shoulder, the entire shoulder region is referred to as the shoulder complex. This includes the:

• Glenohumeral joint
• Acromioclavicular joint (AC)
• Sternoclavicular joint (SC)
• Scapulothoracic joint

The AC joint involves the clavicle and scapular bones as well as several associated ligaments (coracoclavicular, acromioclavicular), a joint disc, as well as multiple major muscles (pectoralis, deltoid, trapezius). An additional small joint also aids in shoulder function; the sternoclavicular joint in the front of the chest at the top of the sternum. The final major component of the shoulder complex is the scapulothoracic joint. This joint is actually composed of the scapula (or shoulder blade) and its movement over the back of the ribcage. This joint and associated movement of the scapula is crucial to overall shoulder function. When the movement of the scapula is altered so is the movement of the main glenohumeral joint. The combination of a lot of motion at the main glenohumeral joint, plus the close relationship of the neighboring joints of the shoulder complex, make the shoulder an area where many different injuries may occur.

If you are currently experiencing shoulder pain keep reading to see how Physical Therapy can help you!

• Rotator cuff tears: Tears of any of the 4 rotator cuff muscles can occur during both heavier lifting or repetitive movements with lighter weights. Commonly, these tears occur while performing a movement where the arm is extended forwards, backwards, or rotated and extended beyond the movement that the shoulder usually does. One example of a situation when this can occur is lifting a heavy bag of concrete mix or groceries then suddenly moving it out to the side of the body, which heavily stresses the rotator cuff. There are partial rotator cuff tears, when only a certain portion of the muscle fibers or tendon is disrupted, or full tears when the entire muscle may be ruptured or torn off of the bone it attaches to. Physical therapy includes use of numerous special tests, proven by research, which help to identify which rotator cuff muscles may be torn and to what extent. 
  • SYMPTOMS: Rotator cuff tears are normally accompanied by substantial pain levels at the shoulder, and in some cases can refer pain all the way to the elbow. The pain may be sharp or feel like an ache. In some cases, usually associated with a full tear, the shoulder may actually have minimal pain but severe weakness. Lifting the arm above waist height may seem nearly impossible in those cases.
• Tendonitis:  The typical muscles associated with shoulder tendonitis are: supraspinatus, infraspinatus, and biceps. These injuries are usually overuse in nature, and often are associated with a muscular imbalance around the shoulder as well as an altered position of the shoulder joint. 
  • SYMPTOMS: Dull/achy shoulder pain that gets worse with repeated motions, decreased strength/power/endurance of shoulder muscles, restricted shoulder motions (especially reaching overhead and behind the back),  and popping/clicking at the top or front of the shoulder.
• Shoulder Impingement Syndrome: Shoulder impingement is more of a blanket term, covering several possible sources of pain. Potential causes of this include: excessive stiffness of the bicep or rotator cuff muscles, weakness of the muscles around the shoulder blade, and degenerative changes around the AC joint. Independent of the cause, impingement syndrome is characterized usually by either impingement of the supraspinatus tendon as it crosses beneath the AC joint or impingement can occur at the back of the shoulder joint via compression of the back of the shoulder joint against the tendons of the rotator cuff muscles. Physical therapy will determine which structure is impacted, and the movement impairments that are causing it.
  • SYMPTOMS: An ache or sharp pain when lifting the arm overhead out in front or out to the side. These movements are sometimes accompanied by the feeling of a "pinch" or "click." Often these symptoms will occur at a specific, consistent point during the lifting motion of the arm overhead (referred to as a painful arc). With posterior impingement the ache or sharp pain usually occurs at the back of the shoulder, whereas anterior impingement occurs in the front or top of the shoulder.  
• Torn Labrum: The labrum is a thick piece of cartilage which lines the inner side of the glenohumeral joint. This structure adds stability to the inner side of the joint, and also serves as an attachment site for some of the rotator cuff tendons and a part of the bicep. A torn labrum can occur from a traumatic event such as catching a heavy object when it is falling or a tear can occur via repetitive movements over time while the shoulder is in poor alignment- referred to as a degenerative tear. Degenerative tears can be seen sometimes with longtime throwing athletes and tradesmen who do repetitive lifting/movements overhead.      
  • SYMPTOMS: Usually a labral tear comes with the feeling of instability in the joint. Movements that used to feel normal and strong now feel weak and difficult to perform. Sometimes a "catching" or "locking" feeling can occur as well while lifting the arm above shoulder height or while carrying heavier objects.
• Frozen Shoulder: Also referred to as adhesive capsulitis, frozen shoulder is a condition at the main glenohumeral joint which results in inflammation of the joint capsule- a fibrous tissue that surrounds the joint. This condition can occur randomly- in some cases the person will wake up one morning with severe shoulder pain. The hallmark symptom with frozen shoulder however is a severe restriction of shoulder motion.  Additional research is ongoing to examine the exact mechanisms, but risk factors for developing frozen shoulder include a traumatic injury such as falling on the shoulder, prolonged immobilization of the shoulder (such as after a recent surgery), and even recent vaccinations or shots into the same arm.
  • SYMPTOMS: Strong ache or sharp pain anywhere around the shoulder in combination with a severe lack of movement when trying to lift the arm overhead or behind the back. The shoulder usually feels "frozen" or locked up, and in many cases stretches at home will seem ineffective at restoring the movement.
• Arthritis: Inflammation in the glenohumeral joint or AC joint leads to shoulder pain and joint stiffness. Arthritis is more chronic in nature and has a higher incidence with older individuals; however, arthritis can arise prematurely due to traumatic injury (rotator cuff tears, shoulder dislocations).
  • SYMPTOMS: Generalized achiness/soreness, swelling, tenderness to touch, redness, worse with prolonged activity, worse in the morning, decreased shoulder ROM, difficulty pushing/pulling with the arm.
• Surgery:  Typically surgery is the last resort for most Orthopedic Practitioners. We typically see: Rotator cuff repairs, labral repairs, bicep tendon repairs/debridement, reverse total shoulder replacement,, arthroscopic debridement, clavicle fractures, and shoulder joint dislocations.

Based on physical therapy examination findings, your physical therapist will design an individualized treatment plan based on the patient's goals. Shoulder pain relief can be achieved through a combination of the following treatments:

• Education on Pathology, including Healthy Habits to Improve Posture and Safe Movement. 
• Exercises to Strengthen rotator cuff, neck, and scapular muscles
• Stretches to Improve Muscle Flexibility and Joint Mobility
• Hands on Deep Tissue Massage
• Integrated Dry Needling
• Instrument Assisted Soft Tissue Mobilizations (Graston Technique)
• Cupping Therapy
• Heat, Ice, or Electrical Stimulation

1. Physical Therapy starts with a patient interview and a review of past medical history.  
2. The Physical Therapist will perform a complete physical assessment to find the source of your knee pain.
3. Working with the patient, realistic and obtainable goals are designed by the physical therapist.
4. A treatment plan is designed based on the patient's goals, abilities and personal preferences. 
5. Molly, Dylan and Jared work closely with local pain management clinicians, orthopedic surgeons, and primary care physicians. If additional consultation is required, we pride ourselves with helping direct patient care.