Shoulder Pain Archives - Page 10 of 11

Category Archives for "Shoulder Pain"

Shoulder Impingement Pain? Scapula Muscle Strengthening and Activation

Begin with tall neutral spine posture. Then bring a resistance band around the back of your thorax and wrap it around both wrists and into both hands. Have your palms face up in the start position with the elbows at about 90 degrees and broaden the shoulder blades. Then punch your hand forward pointing your thumb towards the ceiling and return it to the start. Repeat this 10 times for 3 sets and do it for the other side too! This is a great exercise for shoulder impingement pain caused by weak and poor scapula muscle activation.

Shoulder Impingement Pain? Scapula Muscle Strengthening and Activation

Scapula Control With Core Stability Retraining

Using a ball lie on your stomach with your inner core engaged by pulling the waistline up from the pant line. Keep the core engaged the entire time. Start with bringing the elbow up so the arm is at 90 degrees with the fist clenched. Keeping the upper arm and wrist still bring the forearm up parallel to the floor and back down slightly. Repeat this for 30 seconds 3 sets twice daily. This exercise is great for retraining the motor control of the scapular muscles in conjunction with core stability strengthening. Excellent to do in the strengthening rehabilitation phases of any kind of shoulder injury. Great for swimmers, baseball, tennis, volleyball, basketball or ultimate players.

Shoulder Stretch

Start by lying on your side with your shoulder at 90 degrees and your elbow at 90 degrees and gently push your arm towards the yoga mat and hold for 30 seconds. Repeat three sets, do it twice per day.

Supraspinatus Rotator Cuff Stretch

This is a stretch for the supraspinatus muscle. You’re going to step into the door with the left foot, throw the towel behind the back with the left hand and reach up behind with the right arm and pull the towel upwards with the right shoulder propped up against the corner of the doorway. You want to hold this stretch for 30 seconds, three sets, maintaining neutral spine and posture.

Scapula Strengthening

This exercise is to help strengthen the muscles of the shoulder blade. It’s really good for conditions for the rotator cuff in terms of impingement or strain or anything to do with shoulder dysfunctions regarding imbalances or injuries. So in the four point position, you want to start to bring the shoulder blades together without pinching them, that’s called retraction, and then bring them wide apart and wings band called protraction. You’re going to hold it for 30 seconds and do four sets.

Posterior Capsule/Deltoid Stretch

This exercise is great to increase the mobility of the posterior shoulder capsule and deltoid muscle after injuring your rotator cuff & having scar tissue in the posterior shoulder capsule. Begin by lying on your back with your knees bent. Bring your arm up and across your chest and lean your weight onto the scapula of the same side. With your other hand pull the arm above the elbow across the chest. Hold this for 30 seconds doing 3 sets twice per day.

Shoulder Impingement Syndrome

What is it?

Injury to the rotator cuff tendon(s) when there is narrowing between the head of the humerus and the coraco-acromial arch (the arcomion & the coracoacromial ligament attaching to the coracoid process) thus causing subacromial crowding. ^[1,2,3,4]
Resulting in micro trauma, ischemia, swelling / inflammation further impingement
Primarily affects the supraspinatus tendon but can also affect the infraspinatus^[1,2,3]

Causes of Subacromial Crowding^[1,2,3,4]

Congenital Variations

Size or shape of the coracoid or acromion processes (boney areas)
Coracoacromial ligament / subacromial bursal thickness
Degree of mid-back ‘thoracic’ kyphosis; excessive curve further facilitates rounding of the shoulder blade ‘scapula’ thus decreasing subacromial space

Developmental or degenerative Factors

Post traumatic / post surgical rotator cuff scarring
Post trauma ‘sprain’ of acromialclavicular joint separation, laxity in ligaments
Osteophyte formation
Calcium deposit in rotator cuff tendon

Traumatic factors

Disruption of ligament, cartilage and rotator cuff or biceps tendons in shoulder
Shoulder subluxation / dislocation

Biomechanical factors

Weakness of depressors of glenohumeral head (rotator cuff muscles) due to nerve injury or disuse
Capsular restriction due to tightness / adhesions
Weakness of shoulder blade muscle stabilizers altering alignment / movement
Rotator cuff muscle imbalance
Adhesive capsulitis ‘frozen shoulder’

Classification of impingement in 3 stages^[1,8]

Stage 1

Any age: (usually under 30 years) repetitive shoulder use “overhead athletes”
Reversible rotator cuff injury
Local tenderness to palpation
Restricted range of motion and weakness
Tendinosis / tendinopathy of rotator cuff tendon which can become fibrotic

Stage 2

Usually 30 to 40 years of age
Pathology not reversible by time or / and modifying activity alone
Local tenderness to palpation and with movement, crepitus with movement
Loss of active & passive range of motion

Stage 3

Usually greater than 40 years
Some degree of irreversible pathology
Continued increase pain on palpation and with movement
Loss of active range of motion greater than passive motion
Atrophy ‘loss in size’ of rotator cuff and shoulder musculature

Signs & Symptoms to look out for^[1,2,3,4,8]

Pain in lateral upper arm, deltoid insertion, subacromial area (below boney process)
Can be from repetitive arm, shoulder use (athletics: tennis, swimming, throwing overhead, computer use, overhead motion)
Inability to lower arm from 90 degrees slowly or smoothly with or without pain
Painful arc: catching of swollen rotator cuff tendon(s) or bursa

Other Possible Diagnosis^[1,2,3.4]

Torn labrum (cartilage)
Instability (due to torn ligament)
Rotator cuff / Long head Biceps tendonitis, Bursitis
Cervical (neck) pathology: disc / nerve root
Adhesive Capsulitis (Frozen Shoulder)

Treatment & Management

Research studies, using randomized control trials, reveal that treatments consisting of manual therapy, using joint mobilizations, and specific prescribed Physiotherapy exercises are most effective for recovery versus strengthening exercises alone.^[3,5,6]Treatments are aimed towards restoring joint alignment and mobility by breaking up joint capsule restrictions (scar tissue) and correcting muscle imbalances and kinesthetic & proprioceptive awareness.^[5,6] Activity modification can also aid in the management of or / and further prevention of the pathology from occurring.

The use of non-corticosteroid medication & corticosteroid injections has a role in the treatment of inflammation and pain control.^[7]

When conservative treatment fails and the shoulder impingement is causing considerable pain & dysfunction, arthroscopic surgery followed by manual therapy and exercise has shown to be effective.^[8]

For more information about shoulder impingement or shoulder injuries please contact InSync Physio.

References

^ Pyne. Diagnosis and Current Treatment Options of Shoulder Impingement. Current Sports Medicine Reports. 251 – 255, 2004 March.
^ Fu et al. Shoulder Impingement: A critical review. Clinical Orthopaedics and Related Research. 269: 162 – 173, 1991 August.
^ Kamkar et al. Nonoperative Management of Secondary Impingement Syndrome. Journal of Orthopaedics and Sports Physical Therapy. 17(5): 212 – 224, 1993 May.
^ Payne et al. The Combined Dynamic & Static Contributions to Subacromial Impingement: A Biomechanical Analysis. The American Journal of Sports Medicine. 25 (6): 801 – 808. 1997.
^ Senbursa et al. Comparison of Conservative Treatment with & without Physical Therapy for patients with Impingement Syndrome: A prospective, randomized clinical trial. Knee Surgery, Sports Traumatology, Arthroscopy. 15(7): 915 – 921. 2007.
^ Bang et al. Comparison of Supervised Exercise with & without Manual Physical Therapy for patients with Shoulder Impingement Syndrome. The Journal of Orthopaedic and Sports Physical Therapy. 30(3): 126 – 137. 2000.
^ Akgun et al. Is Local Subacromial Corticosteroid Injection Beneficial in Subacromial Impingement Syndrome? Clinical Rheumatology. 23(6): 496 – 500. 2004.
^ Brox et al. Arthroscopic Surgery versus Supervised Exercises in patients with rotator cuff disease (stage 2 impingement syndrome): A Prospective, randomized, controlled study in 125 patients with a 2-½ year follow-up. Journal of Shoulder and Elbow Surgery. 8(2): 102 – 111. 1999.

Shoulder Pain: Posterior Deltoid and Capsule Stretch

Shoulder pain can be caused by many things going on with the shoulder complex. One of the things that can cause shoulder pain is an impingement problem of the rotator cuff due to a tight posterior deltoid muscle or posterior shoulder capsule. To stretch this out find the angle that it is most tight in the back side. Then, lean your shoulder blade firmly against a wall to stabilize the shoulder blade to isolate the stretch. It’s important to place your shoulder blade firmly against the wall to stabilize it. Otherwise, the stretch will be more into your rhomboid muscles on the inside of the shoulder blade. Gently pull the arm across the body and hold this stretch for 30 seconds. Repeat this for 3 sets.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

Exercises to Improve Shoulder Mechanics

As you can see from the image above, the shoulder joint is a very complex joint. In fact, each shoulder blade has 19 different muscles that attach to it in some way. And that’s just muscles! That does not include all the ligaments, nerves, blood vessels and bursa that also inhabit the area. Your shoulder has the capacity for many degrees of freedom, and since it can move in all sorts of directions and ways, it can also be pretty unstable, and is susceptible to poor mechanical habits.

Mobility exercises:

First we’ll look at mobility exercises. The muscles in front of the shoulder tend to get tight, but the rotator cuff is also a likely culprit for over-active and unbalanced muscles activity. When we consider mobility, we want to think about freeing up the more tense or over active muscles that may be causing a restriction in the range of motion of the shoulder.

1. Self release of pectoralis minor and major with lacrosse ball, tennis ball or acupressure ball:

Standing near a wall, place a ball between you and the wall (just inside of the point of the shoulder joint). Push into the ball and move it around a bit, focusing on tender areas. This can help to release tension in the front of (or anterior) shoulder.

2. Self release latissimus dorsi/subscapularis:

Using the same technique as above, roll the ball between you and the wall on the side of your body (just below your armpit). If you are using a foam roller, lay on your side on the ground, arm above your head and roller at about the armpit level.

3. Self release rhomboids/trapezius:

Again, using that same ball, place ball between you and the wall, but this time on your upper back in the space between the shoulder blade and the spine. Focus on tight areas. You may wish to bring ball higher on your back to get into the upper trapezius muscle fibers.

4. Chest opening stretches:

These focus on opening the chest, and in particular, the pectoralis muscles. This can be done against a wall or doorway, or on a foam roller (as below).

5. Roll the ball up the wall:

Exactly what it sounds like, grab an exercise ball and roll it up the wall as far as you can. You can do this on one side at a time or both arms together.

Stability and Motor Control Exercises

The other piece to our shoulder puzzle involves stability of the joint as well as motor control of the surrounding muscle tissue.

1. ITYW:

Resting your hips/abdomen on a stability ball, raise your arms in an I pattern (arms above shoulders), a T (arms level with shoulders), Y (similar to I, but arms slightly outspread from head) and W (with elbows bent and hands around shoulder level). Move slowly and use gravity as your resistance.

2. Supine Arm Bar:

This may not look like much at first, but it challenges all the small muscles around the shoulder joint to work together to stabilize the shoulder joint. Laying your back, lift a somewhat heavy for you (you want it to be challenging, but not feel like your arm will buckle under its weight) dumbell or kettlebell straight up to the ceiling. Try not to lock your elbow in place too hard. Hold this position and try to keep the weight right over the shoulder joint. Not as easy as it looks hey?

3. Down Dog:

Yogis are all too familiar with this one. Done properly and with good technique, the downward dog yoga pose can be an excellent means to build shoulder stability. This will require that you already have adequate mobility in the shoulder joint. In this position, keep fingers wide and do not lock your elbows. Think about sliding shoulder blades down your back, but not sinking into the shoulders (you should feel like you’re pushing the ground away). Hold this position.

4. Plank:

Oh yes. I’ve said it once and I’ll say it again – physios love planks! They challenge so many muscles at once; they are an excellent tool. In your plank, make sure your spine and head are in natural alignment (do not collapse in your head or low back). Do not collapse into your shoulders. You want to feel like you are pushing the ground away. Then push it all the way away (this is the plus position). The plus position pushes your shoulders blades away from one another and engages your serratus muscles which help hold the shoulder blade (or scapula) in place. For an added challenge, try alternating bringing a hand to touch the opposite shoulder.

These are of course just a small selection of available exercises. For more ideas and for an individualized shoulder performance plan, please see your physio!