Shoulder Pain Holding You Back? Let’s Find Out Why

Other times you start noticing pain for no obvious reason and it can present in a multitude of different ways; a deep ache when sleeping at night, a shooting pain when you reach into a cupboard, pain or stiffness when washing your hair, or limitations with overhead sports or swimming. Sometimes shoulder pain can coincide with less common symptoms such as numbness, pins and needles or burning pain. Many of these symptoms can start small, however can progress and start to interfere with your daily life.

The reason for these diverse pain presentations is due to the complexity of the shoulder. The shoulder is part of a system that involves many different muscles and joints. Twenty different muscles are required to smoothly coordinate your spine, collar bone, shoulder blade and humerus so that you can raise your arm above your head. The lower back and legs also play a role in allowing smooth shoulder movement, especially in sport where the body requires precise orientation (consider the body coordination required to hit a tennis ball!).

This complex set up means that the shoulder provides the most movement of all our joints allowing us great diversity in how our hands interact with the world. It also means that issues with any of these different muscles or joints can result in shoulder pain. There are even times where shoulder pain is referred from other areas entirely (a pinched nerve in the neck can often cause symptoms down the arm!).

This is where a thorough assessment to investigate the root cause of shoulder pain is important. The assessment needs to be specific and detailed. At Pure Physio we complete a comprehensive assessment which gives our clinicians an understanding of each person’s unique shoulder pain. 

Once the key issues are identified, treatment is tailored to your requirements and what you need out of your shoulder. The treatment for a gymnast, for example, will look very different to that for a power lifter or tennis player!

Below is the process we use at Pure Physio to evaluate your shoulder:

Subjective exam – an in-depth conversation about your shoulder concern and general medical history, including:

• Any injury mechanism
• When/ what triggers your pain
• Symptom pattern – how long it lasts, severity, diurnal pattern
• Exercise, sport, work and home life including any limitations due to injury
• Personnel goals 
• Previous/ current medical and injury history. 

Objective assessment – a physical assessment looking at the way you move including:

• Postural assessment- standing and sitting
• Functional and sport related movement assessment
• Range of motion of the shoulder, back, neck
• Review of other areas (if appropriate)
• Strength testing 
• Symptom modification testing- can we improve your test results with some movement tweaks?
• Video analysis – this can be a great way to help you understand the movements that have contributed to your injury.

Rehabilitation – treatment and exercises

• Hands on treatment – massage, dry needling, joint mobilisations (treatment type depends on the presentation and client)
• Re-test important objective measures post treatment – gauge improvement
• Set up a personalised exercise program targeting objective and subjective findings and what we find after treatment – ultimately working towards your goal.
• Management of shoulder load and postural education
• Discuss diagnosis and prognosis What is it? How long will this take to fix?
• Guide your return to activity whether it is a particular sport, work postures, or activities around the house.

Shoulder pain is complicated and requires a thorough assessment from an experienced physiotherapist to get to the root cause. Treatment needs to be personalised and relevant to your goals and aspirations so that you can get back to the things you enjoy!

If you are experiencing shoulder pain, book an appointment to see me at Pure Physio.

 

About the Author

Steven White — Senior Physiotherapist

Steven has worked with a range of different clients including athletes, runners and weekend warriors, and take a holistic approach to his treatment, that focuses on client goals and personalised treatments.

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