Shoulder pain

Physiotherapist Amanda talks about common presentations and how to manage shoulder pain and to help improve your pain self-efficacy.

One of the most common problems treated by physiotherapists is shoulder pain. Shoulder injuries are quite common affecting approximately 30% of the general population. Because we use our arms a lot during daily activity as well as work in static postures, the shoulders are susceptible to injury and wear and tear. However, often these injuries can be managed and resolved with specific rotator cuff and scapular-thoracic strengthening programs, to prevent the need for injections and surgery.

Your shoulder is a relatively unstable multi-axial ball and socket joint which is moved and stabilised particularly by a group of muscles called the rotator cuff. The rotator cuff muscles are the subscapularis, infraspinatus, supraspinatus and teres minor muscles. They form a cuff around the head of the humerus and are responsible for securing the head of the humerus into the ball and socket joint, and rotation of the shoulder. The passive structures (capsule and ligaments) are responsible for passive/static stability, and the muscles and tendons are responsible for active/dynamic stability.

Common shoulder conditions treated include:

· Rotator cuff tears and tendinopathy

· Adhesive capsulitis (Frozen Shoulder)

· Calcific tendonitis

· Sub-acromial impingement

· Dislocations and subluxations

· Nerve entrapment and referral pain from cervical or thoracic spine

· Labral tears

· Bicep injuries or tendinopathies

· Fractures of the upper limb including scapula, humerus, clavicle

· AC and SC joint sprains

Things to help reduce pain in the shoulder:

- Reduce overhead activity movement patterns. Lifting your arm overhead for extended periods of time (especially with poor alignment) puts strain on both the passive and active components of the shoulder.

- Minimise repeated activity that involves the shoulder and have regular breaks from repeated activity. Eg. Lifting, throwing, overhead activity, painting,

- Fix any muscle imbalances with an appropriate muscle strengthening and stabilizing program. Many injuries arise due to muscle imbalances in the shoulder, leading to dysfunction, muscle weakness and over-activity of other muscles creating tightness and pain. You need to incorporate specific trunk and mobility exercises in order for your shoulder to work well in the right alignment.

- Stretches help to reduce tightness and allow the shoulder to move through range of motion during activities of daily living, sports etc.

- Sleeping with pillows can assist in offloading the shoulder allowing for a good night's sleep.

- Seeking physiotherapy assessment and treatment as soon as you can will help you regain control of your symptoms and shoulder pain. The longer you take to start rehabilitation, the longer it will take to get better.

A recent study showed that "patients who had said they expected to “completely recover” as a result of physiotherapy did even better than patients who expected to “much improve”. Higher levels of pain and disability were associated with higher levels 6 months later. Lower baseline levels were associated with lower levels 6 months later."

Patients with high self-efficacy (one's belief in one's ability to succeed in specific situations or accomplish a task) also did well with improvement in pain and function.

Several ways to increase your pain self-efficacy

1. Work with your physio! They can help you to understand and manage your symptoms related to your shoulder pain.

2. Practice your exercises together and ask your physiotherapist for feedback, including how to adjust your exercises to make them harder or easier.

3. CHAT with your physio as to what you want with your physio and the activities that are important to you.