by Dr. Dan East OSTEOPATH
A painful shoulder can be tricky, frustrating and extremely common. Around 1 in 5 of the general population are affected by a shoulder complaint throughout their life (Pribicevic, 2012), which unfortunately often persist. Even as professionals we admit this to be true. Shoulder pain symptoms can persist for longer than expected, activities which we love doing often have to be modified or avoided, and pain can even finally disappear only to pop up again once we start getting back into routine. This kind of stubbornness is not a great quality for a joint we use all day every day!
Many joints make the shoulder
The complexity of the shoulder ultimately lies in the large number of joints, muscles and other structures which are at play in the region.
The joints include:
Glenohumeral joint – a ball and socket joint between your humerus (bone of your upper arm) and glenoid cavity (part of your shoulder blade).
Sternoclavicular joint – between your clavicle (collarbone) and your sternum (breastbone) at the front of your chest.
Acromioclavicular joint – between your clavicle and the tip of your shoulder blade.
Scapulothoracic joint – an ‘articulation’ between the scapula and posterior aspect of your ribs and mid back.
These joints are all acted upon by various muscles, which change depending on whether you’re in a static position or working dynamically (in motion). Everything needs to be working efficiently and firing at just the right time to allow for smooth shoulder movement and adequate strength. With the amount of joints, combined with over 10 major muscles for the shoulder and other structures including bursa, ligaments and labrum, you can see how issues could arise.
So, shoulder pain has recently begun, or is still niggling after months (or even years). What to do?
First of all
It’s important to know that your shoulder is likely to not require an X-Ray, Ultrasound or MRI. Most shoulder issues do not need imaging, and remember that this can always be considered down the track anyway if things aren’t going to plan. Gill et al (2014) points out that relevance of findings of shoulder pathology on MRI scans is questionable, as many findings are even evident in asymptomatic patients (those without any pain at all).
Cortisone injections and/or surgery
These shouldn’t be the first port of call in most cases either. The recent evidence suggests corticosteroid injection provides significant but temporary pain relief, which most often does not outweigh the combination of safety and pain relief seen with manual therapy and exercise. Unless the shoulder injury is quite severe, conservative treatment such as a strengthening and stretching program is generally considered the first line therapy. Injection can always be seen as a plan B if our program fails.
The focus initially should be on a 6-12 week shoulder strengthening program devised with your health professional. They will be able to assess any weaknesses you have and help devise a program suited to you and your condition. They will also be able to make sure you are completing your exercises effectively and safely.
To strengthen the shoulder complex, we at Total Balance like to start out by focusing on 2 main (and simple) components:
- Rotator Cuff strength – the rotator cuff (RC) is a group of muscles which surround your glenohumeral joint and activate movement of the shoulder.
- Scapula (shoulder blade) control – to allow the rotator cuff to work efficiently during motion, and to avoid impingement due to narrowing of the shoulder joint space, the scapular needs to be controlled and positioned effectively.
To strengthen these areas, Heron et al (2017) suggests that the best outcomes result from using a combination of open-chain and closed-chain exercises. (In an open–chain exercise, the body is stationary while the limb moves. In closed–chain exercise, the limb is stationary while the body moves). Below are 3 basic exercises, shown in the video, which can be used in the early stages of strength progression:
Exercises for Rotator Cuff strength
Prone Y Arm Lift
Interval – 3-4 sets of 10-15 reps.
Load – nil to begin. Gravity will be adequate!
Sidelying Glenohumeral (Shoulder) external rotation
Interval – 3 sets of 12 reps
Load – begin with 2-4kg dumbbell. May need to increase
Exercise for Scapular control –
Wall push up
Interval – 3 sets of 8-10 reps
Load – nil
Stop these exercises if your pain becomes sharp during any motion. Your health professional can then assess your movement during the exercise in your next consult and may need to modify accordingly.
Do you have shoulder pain? Book an appointment with one of our Osteopaths. They can address your symptoms with hands-on treatment a tailored rehabilitation program for you.
This blog post is an educational tool only. It is not a replacement for medical advice from a registered and qualified doctor or health professional.
Brukner, P., & Khan, K. (2016). Brukner & Khan’s Clinical Sports Medicine: Injuries (Vol. 1). McGraw-Hill Education Australia.
Gill, T. K., Shanahan, E. M., Allison, D., Alcorn, D., & Hill, C. L. (2014). Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. International journal of rheumatic diseases, 17(8), 863-871.
Heron, S. R., Woby, S. R., & Thompson, D. P. (2017). Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial. Physiotherapy, 103(2), 167-173.
Pribicevic, M. (2012). The epidemiology of shoulder pain: A narrative review of the literature. In Pain in perspective. IntechOpen.
Image 1: pic @ https://www.pinterest.com.au/pin/476537204307049671/
Image 2: pic @ https://www.pinterest.com.au/pin/506795764289694097/