People of all ages suffer from shoulder pain. The causes are many and can range from an unknown onset to a traumatic event. Many people develop shoulder pain from performing repetitive type activities for prolonged times. Others will experience pain in the shoulder following a fall onto the shoulder or on the outstretched arm. Sometimes the reason for pain is not as obvious. I see many cases where a person cannot identify what caused the pain in the shoulder. Often times this pain for unknown reasons can occur when someone bumps their shoulder against the door jam in the middle of the night when going to the bathroom. This rather benign action sets off a chemical process in the shoulder that will build up over several days. Eventually this will cause pain in the shoulder. Since the injury occurred several days earlier the person cannot recall any event that started the process. Regardless of the cause of the pain in the shoulder the treatment is often similar from case to case.
Treatment of the shoulder can encompass several different areas. Conservative measures include medication such as anti-inflammatories or pain medications, rest, cortisone injections, and or physical therapy. One aspect of care is often not enough to heal a rotator cuff injury. A combination of treatments is usually most effective in helping to relieve pain in the shoulder.
Often times when you present to your medical doctor with complaints of shoulder pain they will prescribe some medication as described above. Rest will also be advocated although this is not always easy for people to follow depending on their activity levels or their occupations. Injections for the painful shoulder are sometimes given right away depending on your medical doctor's philosophy. Some MD's would rather you attend physical therapy before considering injecting the painful shoulder. Injections are not the end all beat all and they do not offer relief to all patients that receive them. Often times a well rounded physical therapy program can alleviate shoulder pain and you won't have to consider having an injection.
Physical therapy treatment can consist of the following interventions:
1. Therapeutic exercises: this will consist of range of motion, conditioning, and strengthening exercises. The goal here is to maximize and restore any loss of range of motion, improve the overall endurance of the shoulder blade and shoulder muscles and to improve the strength of these same muscles. The muscles surrounding the shoulder blade must be conditioned and strengthened just as the main shoulder muscles would be because the shoulder blade muscles have to work in conjunction with the shoulder muscles in order to restore normal motion and to prevent recurrence of pain.
2. Manual therapy: this will consist of hands on treatment that the physical therapist would perform on you. This might consist of joint mobilization (i.e. techniques designed to improve joint motion and relieve pain), or soft tissue massage (i.e. techniques designed to improve muscle and connective tissue flexibility and to relieve pain).
3. Modalities: this consists of machines that the physical therapist may apply to your painful shoulder to assist in pain relief and healing along with the other treatments mentioned above. Some of these machines are ultrasound, electrical stimulation, TENS, or iontophoresis.
All of these interventions can be used in the treatment of a painful shoulder. It is common in clinical practice to use a combination of these interventions. It has been my experience in treating hundreds of shoulder patients over the years that therapeutic exercise is an absolute in the treatment of the painful shoulder. Treatment of a rotator cuff injury or pain in the shoulder should always include exercises that strengthen the shoulder blade and shoulder muscles. A painful shoulder can persist for years. With the right education you won't have to suffer any longer!
