Shoulder pain is a very common complaint and can have a variety of causes. The most obvious cause is a trauma to the shoulder after a fall. More common ones are non-traumatic injuries due to overuse or misuse from activities that are performed too often, with too much weight or force, and with poor techniques. Common examples are overhead sport activities, and heavy and prolonged lifting or carrying. Shoulder instability, muscle imbalance and poor posture play one of the most important roles in non-traumatic injuries.
Basic Shoulder Knowledge
The shoulder is one of the most complex joints in the human body. It has by far the greatest range of motion, which makes it a rather unstable joint and therefore more prone to injuries and wear and tear. The shoulder girdle consists of the upper arm bone (humerus), the shoulder blade (scapula) and the collar bone (clavicle), which are all connected by joints. The ball shaped head of the upper arm bone fits into the rounded socket of the shoulder blade. This socket is called the glenoid and is covered by capsular tissue called the labrum, which helps to enclose the head even better.
The most important stabiliser of this construction is the rotator cuff. It consists of four muscles, which cover the head of the upper arm and keep the rotator cuff solid in the glenoid. Injury to the rotator cuff is the most common injury in the shoulder, either in sports or daily activities.
Symptoms Of Rotator Cuff Injury
Injury to the rotator cuff can vary from inflammation of the tendon (tendonitis) after a strain, to more severe injuries like a partial or complete tear. The most common cause for that is an impingement of the tendon between the shoulder roof and the head of the humerus. Repetitive movements and activities with heavy load can also lead to an inflammation. This often happens when the rotator cuff is too weak or the joint is too flexible, which results in instability of the shoulder.
Often, the pain occurs spontaneously without any known reason. It starts with a dull ache after activities, but subsides usually quite quickly. This is the reason why shoulder problems are initially ignored until the ache develops into severe pain, which is present not only during activities, but even at rest and during the night.
Complete tears of the rotator cuff usually give a sharp, sudden pain and are caused by a forceful movement. In this case you should immediately see a doctor. If the tendon is worn out, for instance from intensive racket sports, a complete tear can happen during very light lifting activities but does not result in sudden sharp pains. This happens often to people above the age of 50.
Other shoulder injuries include:
- Frozen shoulder (adhesive capsulitis)
- Shoulder dislocation
- Labrum tear
- Joint arthritis
- Fractured bone
Prevention & Quick Relief Treatments
If you experience pain in your shoulder, either after a trauma or spontaneously, you should follow a few easy rules for quick relief and to ensure it doesn’t get worse. It is important to get rid of the inflammation.
- Rest! Do not provoke the pain with any activity, even if it is only an ache. This leads to further irritation of the tendon and will worsen the inflammation.
- Avoid overhead activities, especially with load.
- Take anti-inflammatories – pain killers can also be helpful, especially when you have pain at rest.
- Ice the shoulder several times a day for 15-20 min. The ice should never be applied directly to the skin, but wrapped with a thin towel.
- Do hourly pendulum exercises to increase the blood flow and maintain range of motion. Bend forward and swing your shoulder very gently in circles clockwise and anti-clockwise.
- Good posture. You should try to be in an upright position with the shoulder slightly pulled back. This will optimise the position of the joint and minimise the risk of further impingement, especially during lifting and computer work.
- Avoid sleeping on the painful shoulder. If you experience pain at night, you should support your shoulder with a pillow underneath it.
If the inflammation is only mild, usually a combination of anti-inflammatories, rest, ice, and light mobilisation exercises (such as pendulum exercises) are enough for you to get better within a week.
Pain not going away? See a doctor or physiotherapist. After a thorough examination, the specialist can pin point the cause of the problem and advice on the necessary treatment. Depending on the severity of the inflammation, the doctor will prescribe either anti-Inflammatory medication or will give an injection into the shoulder to relieve the pain and inflammation. Mostly, if a full thickness tear is present, the tendon will be surgically repaired.
Benefits Of Physiotherapy
Physiotherapy is another very useful tool to help with shoulder pain. To reduce the pain and inflammation, the physiotherapist can use modalities such as Electrotherapy and Ultrasound. Additionally, he can use specific hands-on techniques. But even more important are the active exercises that are aimed towards regaining the normal range of motion and strengthening the stabilising muscles of the shoulder. The physiotherapist is an expert in the anatomy and physiology of the shoulder and will provide you with an exercise program that will help you achieve these goals. This will result is an optimised movement pattern of the shoulder, which will avoid further impingement.
Muscle strains are divided into 3 different grades. Depending on the grade of the strain, the tissue has different healing times.
Grade I (Mild strain): Overstretching of a few muscle fibres with tears that are only on micro level. No palpable defect in the muscle. Movements are usually only sore for a short while and there is no bruising. The healing time is approximately 1-3 weeks.
Grade II (Moderate strain): This means a partial tear of the muscle fibres. There is a definite palpable defect in the muscle belly. Movements are usually still possible and there is moderate pain and bruising. Healing time takes about 3-6 weeks.
Grade III (Severe strain): This is an extensive tear or complete rupture of the muscle fibres. There is a very large palpable depression in the muscle. The muscle may be torn away completely. Movements are very painful and there might be extensive bruising. Healing time after a Rotator cuff repair is about 8-12 weeks. Returning back to racket sports will take up to 6 months.
Preventing Shoulder Re-Injury
Prevention of re-injury is very important because once the tendon is damaged, there will be some degree of degeneration and weakness. There are a few easy guidelines to optimise the condition of the shoulder and prevent re-injury:
- Optimise strength and stability of the shoulder by continuing regular exercises 2-3 times a week
- Again, posture! Protracted shoulders (in a slouched position in front of the computer) can lead to impingements
- Don’t ignore early signs of inflammation
- If you work out at the gym, make sure you get proper instructions for the right exercises to perform them in a correct way.
Don’t take shoulder pain lightly and ignore the symptoms. Treatment of acute shoulder pain usually has a good prognosis. If your complaints haven’t subsided after one week, you should seek help from a medical specialist. Once the pain is chronic, the healing process takes much longer and risks for further, more severe injuries gets much higher.
If you’ve experienced a shoulder injury, please click to find out more about the available physiotherapy treatments. Alternatively, get in touch with your local PhysioActive clinic to arrange an appointment.
Thanks for reading!
This post has been written by PhysioActive director Denis Mecklenburg B.Sc. – Physiotherapist, Sports Therapist, Golf Therapist.
Thoughts or questions?