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Mark: Hi, it's Mark Bossert. I'm here with Wil Seto of Insync Physio in Vancouver. One of Vancouver's favourite physiotherapy clinics, and we're going to talk about shooting shoulder pain, not pain from shooting something. The pain is shooting into someone's shoulder. How are you doing Wil?
Wil: I’m doing good. Thanks.
Mark: So what were the symptoms that this patient came in with?
Wil: Yeah. So we had a patient that came in to see one of our physios and they'd been recently getting this pain into their shoulder. That was basically going on for the last four months. And they had at the same time, started to do some boxing. And it was a kind of pain that I was curious about what was going on, like, if there was any of that stuff before. There wasn't really a past history of any other shoulder issues. And and it was really interesting because he said that it would come on, like, kind of three quarters into boxing, not initially, but like, I think within two or three weeks of starting up boxing.
And then it would be like basically happening and it would stay there for the rest of the night. But then it would go away the next day. And then the interesting thing that this person told me was that the pain would also be better if they taped it and so that held the shoulder in place. And so there was no pain at all when they did that.
Mark: So what did you deduce or start to suspect there were possible causes were of this pain?
Wil: Yeah, so there's a few things. We need to rule out whether it was coming from the neck. And so there was a component at play here because she also did have a bit of a past history of this tight neck, no, no previous injuries. So that was important to make sure that it was a main cause of it. But like I said, she was tight. And then she also had this interesting thing going on with her neck, where she was weaker in certain spots where it was connected to the whole nerve from the neck that ran down to the network of nerves called the brachial plexus and all the way down.
And so we tested that, and there was some weakness in that whole segment in that system. So that's where we knew that the neck was driving most of this. But as we further assess and looked at her pattern of movement, very restricted in not just the neck, but also the upper back and the shoulder.
And as we're looking at her nerves and how things are moving there. She was extremely tight in her nervous system. So what do I mean by that? So basically there was a lot of tension, like it's interesting to try and think about our nervous system being more tense, like less tense or loose. It's very similar if you think about when we get stressed and your muscles are like really tight. And then sometimes that you feel like, you know, even if you move one way, you're not going to slip, but then you may feel sort of like a fringe or something like that. And it may feel kind of like your whole segment, like from your neck to your shoulder gets really tight.
Well, this is kind of a similar thing, but she was getting stuff going on, like from her neck to her shoulder that was driving this. And then her nervous system was just really tense. And that was the driving factor. As we assessed things, we ruled out any rotator cuff issues which was a concern for her, because she thought, you know I've heard this thing about rotator cuff and how the rotator cuff stabilizes the shoulder.
So she consulted Dr. Google. And was starting to get a little bit of anxiety around there. And then some of her boxing friends had told her, you know, that this could be the case. But it's not. It wasn't. Not from the physio's perspective. And so it was one of these things that it wasn't an acute trauma. Like it kind of gradually happened over time. But it sounded like it was just suddenly one day. You know, suddenly one day, you know, into a boxing session suddenly, right? But it wasn't all of a sudden.
Mark: So what was your diagnosis then?
Wil: Well, it was really a movement pattern dysfunction. So part of that involves a few things. So when it's a movement pattern dysfunction, there's the lack of immobility and not just the joints, but also the muscles. If you look at muscles when they're nice and relaxed, like if you look at your shoulder and your lat, that basically make up the big V muscle here underneath your underarm.
Well, in a relaxed state, your muscles should be like this, the fibres, well, with this person and with a lot of people, when they come with disfunction, they end up being like this. So they're really tight in its relaxed state. So when that happens, then the joint is also a little bit more compressed. And then as you try and move your arm or that joint or whatever motion that you're trying to do, then now you're more limited. And you feel that restriction, whether it's the joint itself or the actual muscle, or a combination of both.
So we wanted to rule things out. We want to make sure that wouldn't come in from, you know, that rotator cuff segment, that there wasn't maybe some underlying instability. Maybe torn ligament that she didn't know about, which wasn't the case. We wanted to make sure that it wasn't coming from the neck in more sinister ways. So with the testing, find out some things related to the neck, like the nerve tension. The nerve tension was positive. And there was some weaknesses associated with that as well.
And so how we also know that, as soon as we started correcting the movement pattern issues, and it's this like simple thing that we do, like manual therapy exercise definitely reinforces that after we do hands on stuff with it. You try and get it moving better, but pretty much right after we did a few adjustments with the neck, mid back and the shoulder, where there was a joint that was stiff, but in particular the muscle, her weakness improved dramatically.
So when we showed her how weak she was originally, she was surprised. And then when we retested her in that same 45 minute session when our physio showed her, her strength was significantly better. She was astonished. And that's the thing with these type of movement pattern dysfunctions.
Mark: So what was the long term course of treatment then? What would that look like?
Wil: Yeah, very good question. So essentially making sure that we reset this pattern always back to a more normal pattern. Because the fact of the matter is that this has been going on for a while, and the body has taken a habit of being in this pattern, and the muscles are going to take a bit of time to retrain, so that's why it's also important when this person comes in, we do things to reset it.
So what does that mean? Resetting manually, whether it's the muscle or the joints, or, you know, with IMS, intramuscular stimulation, or whatever it takes to reset that dysfunctional movement patterns so it's more normal. That's the key goal. And then, reinforcing that with specific exercises. Now that's usually a lot in the first session.
The first session is really about diagnosing and distilling the main causes of this and coming up with a management treatment plan. And then doing one or two things to really kick start it, which we did. And then this person still wants the box. And taping is really good. Let's do this, let's tape it up. And we showed her specifically what to do. And that's going to help her with keeping it supported that way. She's not trying to use a movement pattern that's not optimal.
So it stays into a more optimal movement pattern. And then following back up, then it goes from this like, you know, like this to like, maybe instead of like totally like this, which is like nice and released and relax, maybe it's halfway now because the body is still learning. It's still trying to reset. And so, when you're trying to reset, even though she's had her symptoms for the last four months, it's been going on way before that. You can't reset all the stuff that she developed in one session, let alone two or three. It's going to take a few more than that. And the fact that she showed such good results in the first session, she's going to be very successful.
Mark: If you're having some shooting shoulder pain, and you don't know what it's from, if you're in Vancouver, the people to see are at Insync Physio. You can reach them and book on their website at insyncphysio.com. They have two offices to serve you. One in North Burnaby, one in Vancouver. You can call the Vancouver office to book at (604) 566-9716 as well, or Burnaby (604) 298-4878. Thanks Wil.
Wil: Thank you, Mark.