Shoulder Rehabilitation
How to prevent shoulder pain and injury
As the weather warms up and we pull the bathers out from the bottom drawer or dust off the tennis racquet, I thought it would be a good time to discuss shoulder pain and injuries. At Viva we see a variety of different shoulder injuries so hopefully this month’s blog will help you to understand your diagnosis and how to rehabilitate your shoulder (or prevent an injury from occurring in the first place!) As there are quite a range of shoulder injuries we see, we have categorised these for you and have specifically focused on rotator cuff injuries as these are more commonly seen with over-head sports such as swimming and tennis.
ANATOMY
Firstly, what makes up the shoulder? The shoulder is complex and consists of a number of joints that allow us to move the arm through a large range of movement in different directions. The main joint of the shoulder is the Glenohumeral Joint (GHJ), which is a ball and socket joint. As it is quite shallow, the shoulder requires help from surrounding ligaments, a cartilage ring called the labrum, rotator cuff and scapula (shoulder blade) muscles.
There are four rotator cuff muscles; Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. They hold the humerus (arm bone) in the centre of the shoulder joint as you lift your arm.
As there are a number of causes of shoulder pain, your physio will collect your history and run physical tests to categorise your pain as one of the following;
1. Rotator Cuff Strain or Tendinopathy – Acute injuries of the rotator cuff (RC) include a muscle strain and partial or complete tears of the tendon. Over-use injuries of the RC include tendinopathy. These are common in athletes such as swimmers and tennis players who do a lot of over-head shoulder movement.
2. Shoulder Instability – When the shoulder joint is dislocated this stretches and occasionally tears the ligaments and causes instability. Occasionally the labrum is also torn if there is repeated episodes of dislocation or if the original injury is forceful enough. Shoulder instability can lead to impingement pain due to an imbalance of the surrounding muscles.
3. Shoulder Stiffness – Shoulder stiffness may be secondary to trauma (including surgery) or from injury to the nerves that exit from the neck and run down through the shoulder to the arm. Sometimes shoulder stiffness occurs spontaneously and is referred to as adhesive capsulitis (or “frozen shoulder”).
4. AC joint – The other main joint of the shoulder complex is the Acromio-Clavicular (AC joint). AC joint injuries are very common in AFL football and tend to occur from impact, such as a fall onto the shoulder. Depending on the severity of injury and how much of the ligament is torn then surgery may be required.
5. Referred Pain – Patients often present to the clinic with shoulder pain/tightness referring from the neck and upper back. This commonly is influenced by sitting posture with many of us spending 8+ hours per day seated in front of a computer.
HOW PHYSIO WILL HELP
Once an accurate diagnosis is made, physio will help in the early stages to control pain through hands-on physio plus advice on medication, avoiding aggravating movements and addressing contributing factors such as posture. Your physio may choose from the following treatment options:
1. Shoulder blade Stabilisation – The shoulder blade, or scapula provides the basis for which all shoulder movements rests upon as it creates the socket or the shoulder and the fixation point of the rotator cuff muscles. Here, Bede demonstrates basic scapular stability exercises:
2. “Closed chain” exercises – This term refers to the position where the hand is fixed, and allows the shoulder muscles to switch on more effectively and is particularly useful to retrain “winging” shoulder blades. You can see below, pictures of Bede doing these types of exercises.
3. Plyometric exercises – Sports such as tennis and netball involve power of the shoulder to swing the racquet or throw the ball. Due to the larger range of movement required and strength to control the shoulder they tend to be incorporated later into the rehab and can involve the use of a ball or theraband to mimic the specific sport task. Check out this video of Fiona performing a rotator cuff strengthening exercise using two small weighted balls whilst standing on a BOSU.
4. Rotator cuff exercises – As mentioned above the rotator cuff muscles are important in maintaining the shoulder stability. This video shows Bede performing rotator cuff strengthening exercises:
5. Pilates can be an effective way of rehabilitating the shoulder whilst also addressing any contributing postural issues. Here are a few photos showing Bede in the Viva Pilates studio using the Reformer, Trapeze Table, Wunda Chair and other small equipment to strengthen both the shoulder and the core muscles.
As you can see the shoulder is a complex joint and we have only just scratched the surface of shoulder pain, so if you have any questions please don’t hesitate to contact one of the physios at Viva. You might also like to book an appointment with one of our pain or strength physios.