Shoulder Pain: Which treatments are right for you?

In my two previous articles, I described the anatomy and physiology of the rotator cuff as well as the process involved in evaluating a suspected cuff injury.

Taylor Sipos

Let’s say you’ve developed shoulder pain and subsequently decide to complete an assessment at the Orthopaedic Therapy Clinic. Your physical therapist has taken your history, completed an objective examination and diagnosed you with a rotator cuff injury. What’s next? Which treatments are going to decrease your pain and allow you to return to your activity of choice? The most effective treatment options include exercise therapy, manual therapy and acupuncture.

Exercise Therapy

A recent study from the Journal of Sport and Orthopaedic Physical Therapy (JOSPT) that evaluated the current scientific literature on rotator cuff related injuries concluded that exercise therapy should be strongly recommended as a front-line treatment technique in the management of such injuries (1). Exercise therapy can be used to improve your shoulder mobility, posture and strength.

Exercise Therapy to improve shoulder mobility

In the acute phase of your rotator cuff injury, you may notice a decrease in range of motion in your injured shoulder. In particular, it might be difficult to lift your arm overhead without experiencing pain. Using external tools such as a broomstick (FIGURE 1) or even a wall at your home (FIGURE 2) will allow you to complete mobility exercises to help rebuild pain-free shoulder range of motion. In turn these can be used to help you with functional tasks at home and work.

Active-assisted shoulder flexion
1: Active-assisted shoulder flexion
Wall Slide
2: Wall Slide

Exercise Therapy to improve posture

In some cases, posture may be a contributing factor to the development of shoulder pain. A typical posture that may be involved with shoulder pain is shown in (FIGURE 3) and includes rounded shoulders, a slouched mid-back and a forward head posture. Maintaining a posture like this can put excess stress on your cuff which may predispose it to injury. Postural exercises targeted at the neck (FIGURE 4), mid-back/thoracic spine (FIGURE 5) and shoulder blades (FIGURE 6) may help reduce this stress and subsequently shoulder pain.

Typical poor posture that can be associated with shoulder pain
3: Typical poor posture that can be associated with shoulder pain
Chin tuck exercise
4: Chin tuck exercise
Thoracic Extension Stretch Exercise
5: Thoracic Extension Stretch Exercise
Shoulder blade retraction exercise
6: Shoulder blade retraction exercise

Exercise Therapy to improve strength

Very rarely do rotator cuffs fully tear. The majority of the time a partial thickness tear exists wherein there are viable muscle fibres capable of completing the cuff’s normal function of stabilizing the shoulder. In rotator cuff rehab it is important to treat the “donut” and not the “hole” (FIGURE 7). We treat what is intact in the cuff to make up for any tears that may exist. There are many rotator cuff exercises that range from beginner (FIGURE 8) to advanced (FIGURE 9). Collaborating with your physical therapist is important to determine which of these exercises would be suitable for you at your given recovery point.

In shoulder rehab, it is important to focus on the remaining intact shoulder musculature
7: In shoulder rehab, it is important to focus on the remaining intact shoulder musculature
Beginner rotator cuff strengthening exercise
8. Beginner rotator cuff strengthening exercise
Advanced rotator cuff strengthening exercise
9. Advanced rotator cuff strengthening exercise

Manual Therapy

In the same JOSPT article mentioned above, the authors also strongly recommend that manual therapy be completed in addition to exercise therapy. Manual therapy can be utilized to reduce pain and improve mobility in the shoulder complex. Soft tissue massage and joint mobilization to the shoulder, mid-back and neck can be used in early stages of recovery. Towards the intermediate and advanced stages of recovery, manual therapy should be more active and may include techniques such as mobilization-with-movement (FIGURE 10).

Mobilization-with-movement technique to improve overhead mobility
10. Mobilization-with-movement technique to improve overhead mobility

Acupuncture

Similarly to manual therapy, Acupuncture is a technique that can be used in the earlier stages of recovery to help reduce pain and can be applied to the shoulder, neck, arm and hand. This technique can be used in conjunction with exercise, as the temporary pain relief provided by acupuncture may allow you to complete mobility, postural and strength exercises with more comfort, allowing for a greater degree of improvement with exercise therapy.

In conclusion, there are many strategies that you can employ to improve your shoulder pain. Contact me at the Orthopaedic Therapy Clinic, 416 925 4687 or tsipos@orthophysio.com and I will work with you to develop a precise rehab program based on your assessment and your personal activity goals. I look forward to helping you!

This service pro­vides gen­eral infor­ma­tion and dis­cus­sion about therapy, health and related sub­jects. It is not meant to replace advice and/or treatment from your health care professional.