After attending a great neck and shoulder event at the Northern Integrative Health Practice (NIHP) in Durham recently, a lot of thoughts came rushing to my head.
- The shoulder is an interesting joint
- Shoulder rehabilitation is also interesting
- Shoulder theories are conflicting!!
First let’s cover some basics about the body…
Muscle: a soft tissue that contracts when stimulated by a nerve impulse.
Tendons/Fascia connects muscle to bone.
Ligaments connect bone to bone.
Joints two or more bones coming together.
Fascia a sheet of fibrous tissue which envelopes the whole body, separating muscle layers, organs, nerves etc.
Bursa a soft sack like structure near or within a joint which contains fluid to reduce friction.
Red flags are signs and symptoms that would indicate the problem is not musculoskeletal and that the problem may need further investigation.
Symptoms indicating red flags
- Persistent night pain that’s link to unexplained weight loss
- Breathlessness and arm pain
- Trauma car accident, sports injury as heavy rugby tackle associated with shoulder neck pain.
- Shooting pains from neck to hand with weakness and sensations changes, with or without trauma.
- Any unusual lumps associated with loss of appetite.
We all agree at NIHP that we would be referring you to your G.P. for blood tests or imaging if these where symptoms that you came into clinic with.
What can cause shoulder pain in this ball and socket joint that can be treated in clinic and home?
Bursitis inflammation of the bursa, the soft like structure that cushions the joint between the head of the humerus and acromion.
Pain increases with overhead movement, reaching from a high cupboard or raising the arm out to the side can increase symptoms.
Posture is a great place to start, roundness of the shoulder increases internal rotation of the arm which reduces the space between the arm and shoulder roof the acromion, less gap means squashing the bursa.
You must keep the shoulder mobile but not in painful ranges.
Ice can help with inflammation and for some works wonders: perform 3 to 4 times per day for 10 to 15 minutes each time.
Heat after 24 hours can help to improve circulation, oxygen and removal of waste products.
And yes, posture should be addressed when pain allows. This can be assisted by taping techniques in the early stages of treatment.
We should start to see some improvement within 5 to 7 days and will ask you to return to clinic one week later.
Introduce passive mobilization exercises, keeping the shoulder immobile my increase the likely hood of frozen shoulder.
Introducing passive movement will aid in recovery as long as you stay out of painful ranges. You should notice improvement in range within a few days as long as you follow the above.
Question: How long can I expect before my shoulder returns to normal and I can return to sport/activities?
This depends on lots of factors like age, activity you are returning to, length of time you have had the problem. I also look at how well you look after yourself; smokers heal slower than non-smokers for example.
So all I can say is it depends.
Soft Tissue and Exercise Therapist
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