A few weeks ago I attended a further education course on shoulder pain & dysfunction and how best to manage this from in a chartered physiotherapy setting. My aim in attending this course was to learn how to better treat shoulders, helping my clients recover more quickly from injury.
Here are ten highlights:
- Treat the client, not the shoulder - every client is an individual and should be managed accordingly. Physiotherapy is not a one size fits all approach.
- Listen to their story - often a physiotherapist will be able to make a diagnosis based on just the patients’ subjective history. This is the most important part of the assessment and it is where the physiotherapist will obtain the most information from the patient.
- The client needs to feel that the physiotherapist is open and understanding to their condition so they feel comfortable during each session. Thus ensure the management of the shoulder problem is a joint decision between the physiotherapist and the client.
- Is it the neck? - often shoulder pain can originate in the neck. It is important to ask the relevant questions and complete a full physical assessment to determine the source of the pain.
- Is it weak, stiff or unstable? - pain will often be a symptom of an underlying shoulder problem. Shoulders can become stiff in conditions such as frozen shoulder or osteoarthritis; weak with rotator cuff tendinopathy or subacromial dysfunction; and unstable with dislocations. Identifying the type of shoulder complaint will help guide the treatment.
- Avoid rest, get moving - while a certain amount of rest from aggravating activities may be required, the shoulder and arm should still be kept moving in pain free motion as soon as possible to avoid the joint stiffening up.
- Exercises should be relevant, challenging and fun - all exercises, while aiming to restore normal function, should challenge the patient and be fun to perform. This will improve compliance and will be more motivating to the patient.
- Work on strength - deconditioning can be a huge part of shoulders problems and as sedentary lifestyles are becoming more prevalent, getting stronger has become both more essential and more of a challenge. Improved strength can help the patient to function better with daily activities.
- Remain vigilant - on rare occasions, there may be a more sinister pathology present that is causing the shoulder pain. Physiotherapists should monitor potential red flag signs or symptoms for the duration of the patient management and arrange for medical investigation if needed.
- Give good advice and education - it is important to make sure that the patient leaves their physiotherapy session with a complete understanding of what is wrong with them and how it will be managed. The physiotherapist must therefore discuss treatment options with the patient and together both parties should be clear about the rehabilitation process.
By Graham Widger MISCP