Tel: 01 283 4303When asking yourself "Why do I have Shoulder Pain?" I suggest you don't waste much time agonising about how it happened but rather focus on how you are going to relieve your pain and achieve a speedy recovery. Do not leave it too long before receiving treatment. It is normal to rest an inflamed or irritated muscle but timing and type of treatment along with doing specific shoulder pain exercises will be necessary for a quick recovery.
As an example of the importance of timing there are three stages to consider in the development of a frozen shoulder condition. Depending where along one of these stages you might be should partly determine your tailored treatment plan and how long it takes to recover from frozen shoulder.
How to cure shoulder pain quickly will depend on how soon you get help and how committed you are to following the treatment plan provided by your Physiotherapist.
Are you asking yourself these questions?
I've already had 10 sessions of Physiotherapy so why is my shoulder still sore?
I’ve spent hours doing lots of complicated exercises, even though I’m not sure if I’m doing them correctly, and still no improvement.
What we, the Physiotherapists, should be asking ourselves
Are we missing the point and overcomplicating treatment?
Is evidence-based practice failing us?
Are we getting to the source of the problem or skirting around the edges?
Different treatment approaches
When it comes to treating a stiff and sore shoulder, the approach taken will be likely to vary from one Physiotherapist to the next. This is partly due to the fact that there is no ‘gold standard’ evidence-based approach to the treatment of shoulder pain. Another factor is of course that each person's shoulder problem is likely to be different in nature and therefore require a different approach. This makes consulting a Physiotherapist a little different to consulting a dentist, where you have a good idea what to expect.
A good Physiotherapist will perform an assessment on the shoulder and come up with a diagnosis based on their educational and experiential background. The more shoulders the Physiotherapist has treated over their many years, the more likely he or she will be able to fix the problem. When it comes to evidence-based practice, clinical experience is often overlooked as an important factor in the clinical decision making process. Too often we get hung up on what the ‘latest research’ is telling us we should be doing with shoulders. This information is important to a point but should be interpreted with caution while remembering that it can't be a one size fits all solution. Another key factor when taking an evidence based approach is to consider the patients expectations and beliefs. Put this all together and we have a thorough, more complete approach.
Functional approach
In my practice I place great emphasis in a more functional approach to the treatment of shoulders. Simply speaking this means that mechanically we know how a shoulder should function and most problems occur when ‘normal’ function is disturbed in some way. This may then lead to some of the more common diagnoses such as rotator cuff impingement and subacromial bursitis for example. If normal function can be restored, more often than not the pain symptoms often settle, regardless of the diagnosis.
A simple example would be if the normal ‘rolling and gliding’ effect which takes place within the shoulder joint as you elevate the arm is not working properly. This could lead to closing of the small space through which the rotator cuff tendons leave the shoulder joint area and lead to compression/ impingement and irritation.
Solution? Fix the roll and glide.
There are many ways to do this and sometimes a combined approach is needed. Personally I find a simple mobilisation with movement technique (Mulligan, 2003) very effective in facilitating normal movement. Your Physiotherapist's assessment will determine the precise set and range of shoulder exercises suitable for your unique condition.
The repetition of appropriate and well performed exercise enables the shoulder to re-learn how it should be moving. Once this process is successfully established an impingement issue for example often resolves itself, as does the pain.
Conclusion
Your stiff shoulder and related pain may develop into a more complicated condition if left untreated, potentially requiring months of rehabilitation to restore full range of movement and complete pain relief. I must also point out that simply adopting a set of 'shoulder exercises' found on the internet may do more harm than good if you push your shoulder through a range of movement past where it is ready to go. Rather than take the chance I recommend you get assessed by your Chartered Physiotherapist as soon as possible and receive tailored, professional advice.
by Simon Coghlan
