Shoulder Injury: When to Call In the Physical Therapist
Physical Therapy for Your Shoulder
Does Your Shoulder Need Physical Therapy?
Shoulder pain and injury can be experienced at any age. Acute injuries to the joint and surrounding tissues can occur from a fall, a hard impact during a game or in response to a sudden and unexpected force. Other shoulder injuries develop over time with repetitive use, wear and tear. Whether you can pinpoint the exact moment when your symptoms began or you noticed them developing over time, a physical therapy assessment can help you determine the cause and a plan of action to treat it.
A QUICK TUTORIAL ON THE SHOULDER
The shoulder joint is a ball and socket joint. This configuration allows a great deal of mobility so you can reach overhead, behind your back, across your body and in several other directions to perform all your daily tasks. While a certain amount of flexibility is needed to perform everyday tasks, some sporting activities require increased ranges of motion at the shoulders. Gymnasts, acrobats, and baseball pitchers are examples of athletes who often have hypermobility in some or many planes of shoulder movement.
With all this movement available the body has to control it. Joint capsules, ligaments, and fascia stretch across and around the joint providing boundaries to its mobility. Lack of appropriate stability at the shoulder can contribute not only to pain or injury at the shoulder itself but can lead to dysfunction in areas of the body above and below. Wrist, elbow or neck pain may originate from movement, mobility or strength impairments at the shoulder.
There are also several muscle groups that act on the shoulder. The rotator cuff consists of four muscles--the supraspinatus, infraspinatus, subscapularis and teres minor-- that help elevate, and rotate the upper arm. The large deltoid muscle at the top of the shoulder helps to elevate and extend the shoulder. Several other muscles that originate near the spine such as the rhomboids and trapezius muscles help to move and stabilize the scapula (shoulder blade) while the large muscle in the back called the latissimus dorsi stretches to the upper arm to help extend and rotate the shoulder.
HOW DO I KNOW IF I NEED PHYSICAL THERAPY?
While occasional soreness or pain that resolves quickly may not be of great concern, it is a good idea to talk with your physical therapist about any symptoms that are moderate to severe, persisting, recurring or unusual to you. Numbness, tingling or changes in sensation can signal nerve compression. Loss of flexibility or mobility in the shoulder may be caused by injuries to the muscles or conditions affecting the joint itself. Sharp or throbbing pain, swelling, warmth or heat often indicates an acute injury that needs attention. Clicking, catching or feelings of instability may point to an intra-articular injury. Any shoulder pain or discomfort that occurs consistently with a certain motion or activity should be evaluated by your physical therapist.
WHAT SHOULDER CONDITIONS CAN MY PHYSICAL THERAPIST TREAT?
Adhesive Capsulitis (Frozen Shoulder):
Loss of movement and worsening pain caused by scar tissue formation around the joint are characteristic of this condition. The actual cause of adhesive capsulitis is a matter of debate but may be a result of inflammation in the synovial lining of the joint or of an autoimmune process that causes the body to attack the tissues of the shoulder joint. In some cases it may be preceded by a recent shoulder injury such as a rotator cuff tear, tendinitis or bursitis or after immobilization following a surgery or fracture.
There are 4 stages of Adhesive Capsulitis:
Pre-Freezing (1-3 months of symptoms): increasing sharp shoulder pain with movement and aching at rest.
Freezing (3-9 months of symptoms): progressive loss of shoulder movement and increased night pain. Range of motion is limited by both pain and stiffness..
Frozen (9-14 months of symptoms): Significant loss of shoulder range of motion. Pain with any movement is common early in this stage while pain at the limits of your mobility is more common late in the stage.
Thawing (12-15 months of symptoms): Pain, especially at night, is significantly decreasing. Range of motion is still limited but your ability to use the shoulder to complete daily tasks is improving rapidly.
Early rehab for this condition will focus on managing pain and maintaining as much range of motion as possible. Range of motion exercises and manual therapy techniques along with modalities to reduce pain and inflammation such as heat/ice, electrical stimulation or ultrasound are common. In later stages stretching and strengthening are added to your routine to help progress the return of shoulder mobility.
Biceps Tendinopathy: Pain at the front of the shoulder with repeated overhead movements or when reaching across your body or behind your back may be a tendinopathy of one of the bicep muscle tendons--most commonly the long head that stretches over the head of the humerus and attaches to the labrum that lines the socket portion of the shoulder joint.
Repetitive compression, tension or rubbing of this tendon can lead to irritation, swelling and pain. It may feel achy after activity and muscles around the shoulder may feel weak. Treatment of this condition involves identifying and treating contributing factors such as muscle weakness, poor biomechanics of the shoulder during repetitive motions and flexibility impairments. This condition typically responds very well to physical therapy.
Dislocations/Subluxations: A shoulder dislocation refers to separation of the head of the humerus from the socket of the scapula. A partial dislocation is called a subluxation. Dislocations are typically a result of a sudden traumatic force such as a fall. In persons with joint hypermobility or laxity or those with a history of dislocation, shoulder dislocations and subluxations can happen more easily, sometimes while performing everyday tasks. A shoulder dislocation requires immediate medical intervention to restore normal joint alignment and assess for any resulting fractures or soft tissue injuries that may require surgical intervention. With an acute dislocation your physical therapist will help you to manage pain and maintain available range of motion. As you progress in your healing or for those with chronic joint laxity or instability, a physical therapy program optimizing muscle length and strength, biomechanics and joint and muscle retraining is common.
Labral Tear: A ring of cartilage called the glenoid labrum lines the socket portion of the joint to help keep it in place. Fraying, tearing or disruption of the labrum can cause pain, catching, clunking, instability or in severe cases, dislocation. The cause may be traumatic or nontraumatic. Small tears may be asymptomatic but larger tears typically require surgery. If symptoms are minor and the joint is still stable a physical therapist can apply manual therapy techniques to normalize joint motion and reduce pain and teach you stretching, strengthening and postural re-education techniques to help you return to normal activities.
Rotator Cuff Tear: As mentioned above, these 4 muscles help move the shoulder joint but also play an important role in stabilizing it. An injury to the muscle or tendon of the rotator cuff can disrupt normal movement and stability of the joint and may be the result of an acute injury or of chronic wear and tear. Pain or weakness in the shoulder, especially when trying to reach overhead or behind the back is a common symptom. Your physical therapist can perform special tests to help pinpoint which muscle is injured. In some cases surgery is necessary to repair the tear but physical therapy is an important part of your recovery in either case.
Impingement: Pain when sleeping on your shoulder or with moving the arm overhead or out to the side may be shoulder impingement syndrome. In this condition the bursa, tendons or ligaments of the shoulder are repeatedly compressed or “impinged” under the acromion of the scapula. Restricted shoulder motion and weakness may develop over time. Rehab for this condition will include techniques to reduce painful symptoms, however the main focus is on improving the biomechanics of shoulder movement to lessen the impingement and prevent its recurrence in the future.
Acromioclavicular Joint Injuries: The acromioclavicular or AC joint is located where the end of your clavicle meets the acromion, the bony extension of the scapula at the top of the shoulder. A small ligament stretches across this joint to connect them together. Most often a trauma, such as a fall onto the outside of the shoulder causes an injury to this joint but at times it can be an overuse injury. Mild to severe joint separation occurs during this injury and dictates the necessary treatment protocol. Pain with reaching across the body or overhead, visible swelling and tenderness or a lump over the top of the shoulder, loss of range of motion and shoulder strength are all indicators of a possible AC joint injury. Initially reducing pain and minimizing stress to the joint will be the focus of your physical therapy treatments. As the ligaments heal your physical therapist will apply hands on manual therapy to help restore normal range of motion and joint mobility and prescribe strengthening, stretching and motor control exercises to progress you back to your normal everyday activities.
Whether your shoulder symptoms are new or chronic, there is no reason to put up with them in the long run. A physical therapist at Evolve is ready to help you get to the root of your problem, construct a plan to improve your symptoms, empower you to get back to your normal routine and educate you on preventing these same problems in the future.
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Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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