February 19

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Shoulder Pain with Wil Seto

By Wil Seto

February 19, 2024

shoulder pain

Mark: Hi, it's Mark Bossert. I'm here with Wil Seto of Insync Physio in Vancouver, BC, Canada, and we're talking about shoulder pain. How you doing, Wil? 

Wil: Yeah, I'm doing well, thanks. 

Mark: Shoulder pain. You guys see a lot of this in the clinic. What's sort of the big picture of what people can have when they have pain in their shoulder?

Wil: Yeah, so having shoulder pain is not always a simple solution to try and figure out what's going on. It may be, not always, right? So there's two ways that you can really get shoulder pain. The first is like from a traumatic injury and whether it's like you do something and you twist your arm funny and you feel something go. 

Or you have other trauma to it where you like fall on it. Or playing sports or even from the motor vehicle accident, from like the seatbelt. So that's obvious trauma. But then I think that the more sort of like difficult, I mean, I shouldn't say difficult, but sometimes it seems like, oh, more benign presentation of shoulder pain is when it comes on gradually. It doesn't go away. 

And we see that tons at our clinic. All our physios bring up, you know, with their cases about people with these type of shoulder injuries. 

And I think what happens is that because the shoulder is a very complex joint and the injuries don't happen overnight. And sometimes when you have the shoulder pain coming on, you know, the thing that you want to do is rest, which is good. Like you do want to rest, but then there's only a certain amount of rest that you can do. 

Then you go like, Oh, you know, and that's mostly when like a week or two later, or even a month later that we see clients coming in where they then, enough is enough. I can't really function properly. I can't put on my jacket. I can't even wash my hair. I can't play the sports that I want to play and is affecting my job now. 

And I think it's really important to assess what's going on and figure out what's causing it. And sometimes like when it first starts off, you know, you can look at sort of the things that contribute to it. There's a whole variety of factors. You know what you're doing at work if you're on the computer all day. Your posture. And then also the type of sports that you're recreating and whether you're a competitive athlete, professional athletes or even just a weekend warrior. So those are really big factors to consider.

We had a patient that came in and saw one of our physios that you know, we were discussing it and basically he just gradually started getting this shoulder pain, no rhyme nor reason. And this patient versus another physio's patient who also had the same, came in because of the pain in the shoulder started up gradually. But a totally different type of injury going on. So you really have to assess it. 

So the first one is someone who's like 40. We're not talking like, you know, 60, 65 or anything like that. This individual was 40 and basically just woke up and started to have gradual shoulder pain and started to grow and grow and grow. It wasn't getting any better. It turned out that this person had really bad bursitis initially. And it just kept building up and building up so it turned into this acute chronic inflammatory thing.

But when the dust settled it turned out that they had an issue with two of the rotator cuffs. And you had, what's called calcific tendinopathy. And so there's more of a chronic condition. And this person also had a desk job and their posture wasn't optimal. And they also like to sleep on that shoulder.

And some of the studies show that that can decrease the blood flow to your rotator cuff. I think those are some factors to consider for sure. 

So versus the other individual who came in that had the same kind of gradual shoulder injury coming on that was getting a little bit worse each day. And then three, four weeks later decided to go in for physio. And they didn't have the acute bursitis.

They didn't have the tendinopathy. This person, it was interesting because, you know, it was a very highly functional shoulder and they wanted to get back into rock climbing. And he just had a lot of imbalances going on in his shoulder. And he doesn't have anything acute happening at all.

He can still do a lot of day to day stuff, but just notice that there were certain points of his movement that were, you know, according to him, stuck and weaker. His whole left side weaker. The other interesting thing is that as it goes on and on, the shoulder issue can start to drive the neck because there's muscles in the shoulder that connect to the neck.

And so it started making his neck a little bit tighter. And there were some issues related to his neck as well, connected to the shoulder. So all that seems to be connected and it's really important that you actually figure out what's causing that shoulder pain to begin with. You know, whether there was an acute issue here, like the bursitis and then there may be other biomechanic things.

So biomechanics being like bio is the biology and mechanic is motion. So the biology of motion. And you start to figure out what's moving correctly, what's not and what's activating correctly and what's super tight. Because when you can start to see those patterns and figure that out, then we know what to work on. Then we can start to look at, you know, client X needs this specifically. So we can do manual therapy to help start that process and give exercises to reinforce you know, mobility pattern that we want. Not just for the joint, but also for the muscles, if the muscles are just like this all the time.

So we want the muscles to be nice and relaxed, and then we want to work on strength. So we want to work on building up, not just strength for like the movement, but stability strength. So where the shoulder is more unique than like say the ankle or the knee, is that the shoulder has this amazing like movement that's a lot more, freer. 

So there's a larger freedom of movement in the shoulder joint, because it's considered a ball and socket versus like your knee. Because your knee is a hinge joint. And so that stability is really more reliant on how the muscles work together even more. 

And with all things considered normal with respect to the ligaments, if those haven't been injured, then these muscles, if they start to be very imbalanced, so for example, if, let's say, I go to the gym three times a week. But I'm not focusing on the stretching routine, I like to work out my lats, let's say, and I like to work out my pecs, and I'm getting imbalanced, and my shoulder blade gets dragged down, and ultimately get kind of pulled forward at the same time.

So you can see there's going to be a tug of war going on, and you can see that in the movement patterns. And so what our physios try and do after they assess that, we look at alleviating those movement patterns. So we want to do things manually that really help facilitate proper movement patterns.

We want to break that pattern and reset it. That's what we do in the clinic and in the manual therapy perspective. So we either do that that way, or even with a bit of IMS dry needling. That's another technique as well. But ultimately, we want to reinforce those moving patterns with proper exercises and mobility exercises for strength.

And then also the final pieces that dynamic stability and how everything works together. What I mean by that, how all the muscles are coordinated. And then the other factor is that if there is more going on in the shoulder, like a chronic condition that's turned into something more pathological. Then we want to work with your family doctor, which we always do, and really look at other options that can help with the full recovery.

Mark: If you're having shoulder pain, the bottom line is get in to see the physiotherapist at Insync Physio sooner rather than later. They'll diagnose exactly what's going on and they'll get you on the path to recovery and a pain free lifestyle. You can reach them at either the North Burnaby office at (604) 298-4878 or you can book online at insyncphysio.com. Same thing in Vancouver. The Cambie office is available at (604) 566-9716, 566-9716. Or you can book online there as well. Insync Physio in Vancouver and North Burnaby. Thanks Wil.

Wil: Thanks Mark.

Wil Seto

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