Persistent Shoulder Pain

Persistent Shoulder Pain: Avoid The Cycle

 

 

Have you had shoulder pain for a while?

 

 

You don’t remember any clear injury, but the shoulder pain just won’t go away!

 

 

At first your shoulder pain was sometimes and tolerable, now your shoulder pain is relentless and impacting your life!

Sound familiar?

 

Does this resonate with you? If so, read on!

 

The Never-Ending Pain Cycle

 

You’ve been stuck in this rut for a while now. The shoulder pain just won’t go away, so you go to see your doctor.

 

You walk out of there with advice to rest the shoulder from all activity and take a cocktail of medication.

 

You rest, avoid doing the things you enjoy, and the things you need to do. Frustration grows, but the pain settles. The journey has come to an end, back to normal life!

 

You begin some activities again that used to aggravate your shoulder, then there it is again, that familiar shoulder pain! Below is a diagram to show what is going on.

 

 

Back to the doctor. FRUSTRATED, ANGRY and FED UP. A scan gets organised.

 

The scan comes back, and there’s all these words: degeneration, arthritis, subacrominal bursitis, rotator cuff tendinitis, rotator cuff tear, and so on.

 

That’s it! That’s the reason! So, a corticosteroid injection is organised.

 

The needle is HUGE, the injection hurts. It’ll all be worth it though! Right? You’re told to rest for another 2-3 weeks. Your shoulder pain either:

  1.       Doesn’t change at all!
  2.       Reduces, but doesn’t go away
  3.       Returns a few weeks later
  4.       Returns a few months later

 

When will this end? The scan said what was wrong, didn’t it?

 

 

What Does My Shoulder MRI Mean?

 

Medical imaging can be a very useful tool in diagnosing certain conditions. However, sometimes they can see a little too much!

 

As we age our body changes. We get greys, we get wrinkles, we get changes to tissues inside the body. These changes are completely normal, and exist in lots of PAIN FREE people.

 

Wait! What?

 

Research is piling up every day of PATHOLOGY seen on imaging in PAIN FREE people, all over the body!

 

One particular study of the shoulder reported 70% of PAIN FREE people had mild shoulder arthritis. They also reported that 90% had mild-moderate subacromial bursitis! Read that again, 90% of PAIN FREE people with NO HISTORY of Shoulder Pain had a pathology.

 

 

What About Rotator Cuff Tears? Surely A Tear Causes Pain?

 

In this same study 60% had either a partial or full thickness supraspinatus tear, and that’s only one of the rotator cuff muscles!

 

Starting to see why the corticosteroid injection may not have worked? The pathology on imaging may not be the reason you experience pain!

 

So what’s the answer?

 

 

Shoulder Anatomy & Human Physiology 101

 

The shoulder joint is made up of two bones, the scapula (shoulder blade) and humerus (arm bone).

 

The shoulder joint is designed for mobility! This is hugely beneficial; it allows us to accomplish many tasks in our daily lives, sports, or jobs.

 

 

But, Having Mobility Requires Stability!

 

Stability of the shoulder joint is provided by two muscle groups; the rotator cuff, and the scapular muscles.

 

The rotator cuff is a group of muscles that provide dynamic stability of the shoulder joint. When their strength and activation is less than what your body needs for the tasks in your life, your shoulder can become prone to irritability.

 

The scapula position and how it moves can also influence how your shoulder joint moves and functions. Stability of the scapula is also integral to a happy and healthy shoulder joint.

 

Starting to make sense why rest hasn’t worked?

 

When our muscles and tissues have prolonged rest, their capacity reduces! If you reduce your capacity, your tolerance to load (daily activities, work, sport) also decreases.

 

 

How Do We Break The ‘Never-Ending Pain Cycle’ At Paramount Physiotherapy?

 

  • Restoration of scapular control
  • Regaining full range of motion for the shoulder
  • Restoration of rotator cuff strength
  • Restoration of shoulder proprioception
  • Restoration of sport specific capacity – strength & power
  • Return to work or sport

 

Mark Walters (APAM) 

Physiotherapist

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