Do you experience difficulty carrying out routine activities, like putting your arm into your coat, brushing your hair, or reaching up to put something in a cupboard? Shoulder pain can be extremely frustrating! Every time you attempt to do simple movements with your arm, you get a sharp pain, your arm feels weak, and something feels like it is getting caught, preventing you from moving the joint above a certain number of degrees.
This is a common problem that effects people with shoulder pain and is referred to as a ‘painful arc of movement’. If you are exhibiting any of these signs and symptoms, you will be wondering what exactly is causing the problem? There are many causes of shoulder pain, including frozen shoulder, osteoarthritis, impingement syndrome, tendinitis, rotator cuff tears and bursitis.
As a physical therapist part of my job is to find out what is causing your shoulder problem. Forming an accurate diagnosis is a process which will include taking a full case history, which would include questions about your general health followed by an examination to look at all the factors that have created the shoulder dysfunction. For example, observing your posture for signs of a forward curve (kyphosis) in your upper back (Thoracic spine), is one important factor to consider. A kyphotic or rounded shoulder posture can predispose to shoulder pain because it can affect the mechanics of the shoulder joint, leading to an impingement of the tendons.
Physical therapy treatment:
I have a particular intertest in treating patients with shoulder pain. I use a method known as the Neil – Asher Technique (NAT), that focuses on specific tigger points (TP’s) on the muscles surrounding the shoulder joint and the scapula (shoulder blade). TP’s are areas within muscle tissue that have specific characteristics that can be identified through touch (palpation). They are felt as nodules or taut bands within muscle tissue, that often appear spontaneously after trauma. TPs are exquisitely tender when pressure is applied to them. TPs also tend to show common areas of referred pain within the body. For example, if pressure is applied to a TP in the shoulder blade, it may result in pain being felt both at the point that is being pressed but also with pain felt in the arm. Another common feature associated with TP’s is a twitch response that can be seen within the muscle fibres.
The importance of treating these TP’s is for the following reason. It is proposed that TP’s cause a kind of barrage of nociceptive (neurological pain/ nerve impulses) that project from the periphery to the spinal cord and the central nervous system. It is thought that the body forms TPs as a protective mechanism.
- Firstly, the cause of your shoulder pain needs to be ascertained
- Your posture is assessed, looking at the alignment of the neck and upper back, in relation to the position of the shoulders
- Gentle manual osteopathic techniques are used to articulate the joints of the vertebral column, to help balance the curves of the cervical and thoracic spine.
- This treatment helps to position the shoulders in a more neutral position and to take tension away from the muscles and tendons
- The key to successful treatment is looking at the underlying causes of the problem and not simply addressing the symptoms or ‘rubbing the painful bits’. The body is treated as ‘a whole’, rather than treating the shoulder in isolation
Benefits of the treatment
The treatment has minimal side effects compared to pain killers and anti – inflammatory medications. It is also aimed at treating the cause of the problem and not just the symptoms. Treatment is non-invasive and could prevent the need for surgical intervention.
What to expect
There may well be increased feeling of soreness post treatment. This is to be expected as the body adjusts to treatment and the natural inflammatory, healing process takes place. It is a misconception that inflammation should be suppressed, and the situation may get worse before it gets better. Recovery is also a process that happens over time; therefore, it is realistic to expect resolution of the problem to occur with a course of treatment.
This may well require 6 treatments over a six-week period or more. It is vital to be realistic about what can be achieved in terms of pain reduction and return to function. The aim is to gain lasting results and not quick fixes. Adherence to treatment needs to be followed to reach the end goal. Don’t be surprised if ‘it doesn’t work’, if you don’t stick the course. Some activities may need to be modified in the short term to allow the tissues to heal. Specific exercises may also be prescribed to assist in the recovery process.
Pricing
1hr (first session) – £60
45 min follow up – £55
