If you’ve ever had shoulder pain you know it’s no laughing matter. Often we see people at the clinic with shoulder pain who have been given a diagnosis that their shoulder pain is related to their rotator cuff. They often have been told they may need an injection or surgery. So what is the best solution for shoulder pain ?
Exercise and physiotherapy is an effective solution to rotator cuff tears and shoulder pain.
First the good news and most important bit of information i can give you. The solution to your shoulder may not be as drastic as needing surgery or injections and may be as simple as this 4 part process;
- Settle the pain down.
- Identify the cause of your shoulder pain.
- An effective and progressed exercise program to strengthen the weak movements.
- Stay consistent and be persistent with your rehab.
What is your Rotator cuff ?
The rotator cuff is a group of 4 muscles that surround the shoulder and are important in the control and stabilisation of the joint. The muscles are:
- Teres Minor
Check this video out to learn more :
Shoulder pain diagnosis
If you have shoulder pain and have had a scan its not uncommon to find you have been given the diagnosis of one of the following conditions.
Rotator cuff tear.
These are very common finding on imaging and can be divided into partial thickness tears or full thickness tears. The good news is that you can have a tear and no pain. The most common tendon in the cuff to tear is the supraspinatus tendon.
It appears to be true that a tear in the rotator cuff will not repair itself like a ligament or muscle tear but Fun fact – you can have a tear but not have pain.
Around 25% of 50-year olds have a tear in the rotator cuff but have NO pain and for every decade older we get the incidence of tears get higher in people with NO shoulder pain.
That’s awesome news as it shows we can have a healthy fully functioning shoulder that may not be in pristine condition under the surface, (a bit like a car I used to own!).
Calcification in rotator cuff tendon.
These are small focal areas in the tendon that are probably the tendon just trying to repair itself… badly! They are a fairly common finding on imaging and generally are a result of underlying impairments in the cuff.
The bursa is a fluid filled sac in the shoulder that helps your joint move freely. When the bursa gets inflamed it’s called bursitis and creates pain, some would argue considerable pain.
The good news is that all these shoulder conditions share a common feature that is critical in their recovery. That means there’s a long-lasting solution that doesn’t require surgery or injections as well.
What does the shoulder pain diagnosis mean for you ?
Shoulder pain can be simplified into 3 categories
Painful and weak shoulders
Painful and stiff, (read more here about frozen shoulders )
Painful and unstable shoulders
The rotator cuff tears, bursitis and calcifications of this world generally fall into the WEAK and PAINFUL category. This results in the shoulder having the following issues;
- Poor or altered movements that irritate the structures around the cuff including the bursa or tendon.
- Lack of strength endurance in the cuff that affects the ability to perform repetitive movements or tolerate repetitive work.
So the best approach to take ,and the one that has shown results equal or better than surgery in some cases, is a progressive exercise program that;
- Improves the quality of movement of the shoulder , make it a smooth operator so to speak.
- Increase the strength of not only the rotator cuff but also the muscles at the shoulder blade, elbow and grip.
- Strengthen up the specific movement patterns that you struggle with.
Exercise as an alternative to rotator cuff tears and shoulder pain.
Strengthening for the rotator cuff related shoulder pain.
That’s where a progressive exercise program that gets it moving smoothly and then builds up its strength and endurance comes into play.
This is the long-haul part and in reality your exercises in the first 12 weeks will need to be progressed in 3-4 weekly intervals as you improve.
After that you should be progressively strengthening it for 4-8 months from onset to get a long lasting successful shoulder.
Strengthening can take the form of :
- bodyweight exercises
- Using TheraBand or elastic resistance bands.
- weights, dumbbells’ , kettlebells, etc
- TRx suspension trainers.
that NEED to be progressed in difficulty and weight in order for you to get the best result. We like to use a combination of all these exercise types to keep it interesting and effective.
Stretching and rotator cuff related shoulder pain.
Occasionally there is a need for stretching to help improvement around the back of the shoulder, or the front at the chest muscles.
Here is a look at some of our favourite shoulder rehab exercises from the early stage rehab right up to some late stage loading;
Is surgery or injection ever an option for rotator cuff tears or shoulder pain ?
To suggest that surgery or injection is not warranted in some shoulder conditions is not realistic.
There are certainly shoulders that require surgical intervention as they will have a far better outcome than with rehab alone.
When it comes to rotator cuff issues the following are influential in who requires surgical intervention;
- site and size of the tear.
- age of the individual.
- failure or poor response to rehabilitation or other interventions.
Check out this post for more information about when to consider shoulder surgery
Next in this series we will have a look at the shoulder blade what it s role is in shoulder movement and clear up some of the mythology surrounding it.
Any further questions feel free to contact us or book in to see us at the clinic here