When you have clients and patients that come to see you with aggressive chronic shoulder pathologies, there are a number of areas that it can originate from. It can come from repetitive overuse injuries which can lead to tendinopathies, it can come from bursitis, or the shoulder pain can arise from less complex tears and strains or the more complex adhesive capsulitis. As you can see there is a whole plethora of issues that we have with the shoulder. 

Approaching Shoulder Pathologies

What we normally do in the clinic is look at our clients active and passive range of movement. When we do active range, instruct your patient to actively go through their normal shoulder range, up and down (elevation of the humerus). We look at their humeral external and internal rotation, abduction and adduction, and listen for what they’re feeling, what they tell us, as well as their body language.

We also check the scapulohumeral rhythm which is where they can feel restrictions and/or pain of the humerus and its joint capsule. If they have pain often called the painful arc it is between 45 – 120 degrees and greater than pain felt at the top of range. That can give us an indication that our glenohumeral joint is not sitting in its functional space, rather become more restrictive. The shoulder can become inflamed within the bursa, mostly the pain felt is associated when there’s compression on one of the bursa protecting the joint.

Assessing passive range movement is best achieved when the patient is lying down on the table. Usually, I draw my attention towards what I feel when I’m palpating. Can I feel the head of the humerus sitting slightly forward, which indicates there’s less space at the anterior portion of the GH joint? We can apply a bunch of treatment maneuvers that will include myofascial release techniques, some glides and mobilization techniques, but what can we give them for home care, that will really make a difference? 

Causes of Shoulder Pain

Shoulder pain can be a very uncomfortable feeling. Let’s look at the different factors that may lead to shoulder pain.

The most common cause is rotator cuff tendonitis which is condition due to swollen tendons. Another cause of shoulder pain is impingement syndrome wherein “the rotator cuff gets caught between the acromium and humeral head”. (Pietrangelo, 2012)

Shoulder pain may also be the result of another injury in the body, “usually the neck or the biceps.” (Pietrangelo, 2012)

According to Pietrangelo (2012), other causes of shoulder pain include:

• Arthritis
• torn cartilage
• torn rotator cuff
• swollen bursa sacs or tendons
• bone spurs (bony projections that develop along the edges of bones)
• pinched nerve in the neck or shoulder
• broken shoulder or arm bone
• frozen shoulder
• dislocated shoulder
• injury due to overuse or repetitive use
• spinal cord injury
• heart attack

Treatment 

So, you’ve got a couple of different apparatus that you can use, you can use tubing, you can use Thera bands, but whatever you use, you must make sure it has a nice stable base. Also check that the equipment hasn’t worn and tethered, because if you’ve had something that’s been in the garage for four years, it’s most likely lost its capacity for strength and may rip or tear during any exercise. We don’t want that to occur because we’re putting quite a deal of force at the proximal head of the humerus, and we don’t want to have part of the tubing smack you in the head as it snaps in half. 

• Take the thera tube and position it under your foot, on the same side that is having questionable shoulder range.
• Take the tube up and over the shoulder at the proximal region, and have it sit about 4-5 centimetres from the proximal head at the humerus– and not the shoulder joint.
• Raise the arm laterally, and then keep it in that position.
• When you have a nice and firm base, gently pull down on the thera tube with your other hand. You should feel some distraction. This will make some movement with the humerus in that restricted space.
• Repeatedly pull down, then relax for a good minute. You can make use of your deeper back muscles (latissimus dorsi) to help with the movement. This will open the stiff joint capsule. 
• Repeat this movement until you are feeling better range in the shoulder. 
• As that the tubing tension is reduced (shoulder comes up), allow the muscles, joints, and bones feel like they are in full rest, it gives time for the nervous system to calm and for the client to be more interoceptive though the movement which may assist in a better resting position once the exercise is complete. 

Different Treatments for Different Patients

You’ll always show this in the clinic first, to really make sure that they’ve got a good handle on what they’re doing. Check the elbows and wrists to see that they are not being overloaded. This can address issues with so many shoulder pathologies, though it would be a contrary indicator if you have got unstable or hypermobile joints, or if there has been dislocations or subluxations or recent fractures. If this is the case we need to give it strength, support, taping in the clinic and strength and exercise work at home. Want to see more treatment options? You can find loads more videos on rotator cuff strength that I’ve got on the website. 

For a better understanding of the technique please watch the video below.

References:

Photo – Yodiyim of iStockPhoto

Pietrangelo, A. (2012, September 17). Why Does My Shoulder Hurt? Healthline; Healthline Media. https://www.healthline.com/health/chronic-pain/shoulder-pain#diagnosis