Shoulder Physiotherapy

Shoulder Physiotherapy

Shoulder

The shoulder is the most complex and most dynamic mechanical structure in the body. The reason for this is the entire stability is provided by soft tissue in order to create a large range of motion. The large range of motion in the shoulder creates significant susceptibility to a range of injuries.

The shoulder is the most complex and most dynamic mechanical structure in the body. The reason for this is the entire stability is provided by soft tissue in order to create a large range of motion. The large range of motion in the shoulder creates significant susceptibility to a range of injuries.

Shoulder Pain

Shoulder pain is another one of the most common complaints in our practice. It’s important to diagnose the source of the pain and then target the cause. Remember, pain is a symptom, and it’s always a sign of a dysfunction. Therefore, reducing pain is part of the treatment not the goal.

Shoulder physiotherapy focuses on the biomechanics of the shoulder and the reason for any malfunction.

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Sports injuries can be classified into two large groups:

Traumatic Injuries

Injuries with specific, high intensity and usually immediate symptoms, such as a high impact ankle sprain with immediate pain and a large amount swelling.

Insidious Injuries

Injuries with a gradual onset, usually not from one specific moment,

for example, gradual onset of shoulder pain from playing tennis.

Why You Should Engage A Physiotherapist For Shoulder Pain?

Shoulder physiotherapy should be considered as a first resort when shoulder pain occurs. As ongoing pain is a sign of malfunction and repetitive damage to the soft and hard tissues in the joint.

The physiotherapy approach toward shoulder injuries is primarily to diagnose the condition and identify the injury’s structures. Then designing a customised intervention to treat the condition though manual therapy, and a customised exercise regime.

The exercise regime consists of a program to increase stability and stretch while ensuring full range of motion is achieved.Therefore, the three elements of range (flexibility, stability and stretch) are the objective measurers in any the shoulder injury exercise program.

The program is designed based on the nature of the pain and injury, the client’s lifestyle and goals.

Different Types of Shoulder Injuries

Frozen Shoulder

Frozen shoulder or adhesive capsulitis normally occurs in people aged 40-60. In most cases it follows a traumatic shoulder injury or shoulder surgery.

It is a thickening and stiffening of the shoulder joint capsule, which surrounds the joint and therefore range of motion and movement is severely reduced.

The condition can last from 12-18 months in some cases, however with treatment the symptoms can be reduced.

Occasionally treatment can involve surgery, however it mostly involves stretching and joint capsule massage and mobilisation to improve the shoulder range of motion. Strengthening can also help to reduce the symptoms slightly.

Frozen shoulder is something that physiotherapists are constantly trying to avoid having to treat, as preventing the condition is much easier than treating it. It can happen spontaneously in some cases however it mostly occurs after failed shoulder rehabilitation of other shoulder conditions.

Tips to avoid Frozen shoulder:

  • Follow your shoulder rehab plan and program as prescribed by your physiotherapist
  • Keep active
  • Do not avoid shoulder movements because they are difficult or tiring
  • Do your exercises!

 

Shoulder Dislocations

Due to the shallow socket (glenoid fossa) of the shoulder joint, the shoulder can be very prone to dislocations.  The most common type of dislocation is an anterior or frontal dislocation and it happens in most cases due to direct trauma to the shoulder or upper arm.

It is one the most common traumatic sports injuries. Sports such as rugby and hockey see a lot of these injuries.

The dislocation will always be associated with some degree of cartilage, bone and/or ligament damage. At the very least there will always be some straining of the ligaments that hold the shoulder joint in position.

In most cases the shoulder will be reduced or put back in place at the hospital after an x-ray to check for any associated fractures.

Rehabilitation from this point depends on the degree of damage following the dislocation. In some cases surgery is required to repair the damaged labrum or associated ligaments.

If dislocations happen in younger people there is a greater chance that they may have re-dislocations, which can lead to chronic instability in the shoulder. This is where having a structured strengthening program becomes very important, particularly if the person want’s to continue their sport or activity.

If you have chronic shoulder instability or have had shoulder dislocations in the past, get in touch so one of our physios can get you started on a shoulder stability strengthening program.

 

Rotator Cuff Injuries

Rotator cuff injuries are by far the most common shoulder injury seen in the general population.

The rotator cuff is a group of four muscles which stabilise the shoulder joint. They attach to the front and back of the shoulder blade and the humeral head and their main role is to help keep the ball of the shoulder, centered in its socket (the glenoid fossa) to help avoid shoulder dislocations.

Through overuse and with age, the tendons of these muscles become weak and frayed, leading to tendon conditions such as, rotator cuff tendinitis, bursitis and in more severe cases, tendon tears and ruptures.

These injuries can cause of a lot of discomfort and pain with everyday tasks such as reaching for cupboards, getting dressed and combing your hair.

Treatment for rotator cuff injuries depends on the severity of symptoms and the degree of dysfunction, as well as lifestyle factors such as age, health and occupation.

Some full thickness tears will require surgical repair, but in most cases treatment is conservative.

All rotator cuff injuries will at some point involve some postural correction. Keeping the shoulder blades in a good position is vital for proper rotator cuff functioning and repair, as well as for future prevention.

Strengthening of the injured rotator cuff muscle will commence once there is pain free movement available at the shoulder and ensuring that it does not re-damage the healing tendon.

 

Acromioclavicular (AC) Joint Injuries

Acromioclavicular or AC joint injuries usually occur from blunt trauma to the point of the shoulder. This can happen as a result of a fall onto a hard surface, or more commonly, from a collision in sports such as rugby.

The injury occurs when the ligament, which protects the joint between the collar bone and your shoulder blade, tears or is strained. In severe cases the ligament can rupture completely causing a “step deformity”, which looks like a bump on the point of the shoulder.

Treatment for the injury is the same as for most ligament injuries.

RICE – Rest, ICE, Compression and Elevate for the first 2-3 days.

Reducing inflammation and restoring movement to the shoulder are the most important goals of treatment.

Strengthening will usually occur later but is dependent on what the patient needs to get back to; sport, activities etc.