SHOULDER PAIN AND OSTEOPATHIC REHABILITATION FOR THE SHOULDER: Erkan Cetin, Osteopath

One of the reasons I became an osteopath was experiencing my own shoulder injury – a trauma induced reoccurring subluxation After multiple dislocations I eventually opted for an arthroscopic labral repair.  The surgery was successful, but I did suffer with adhesive capsulitis (aka frozen shoulder) afterwards. This led to me developing a fear of moving the shoulder and confusion about what I could or could not do. Fortunately, with excellent treatment and hard work, my shoulder injury resolved.  The whole experience also gave me valuable first-hand experience with shoulder pain, rehabilitation and healing.

WHAT DO WE MEAN BY “THE SHOULDER”?

Before writing about common shoulder injuries it is helpful to understand what we mean by “the shoulder” and what its function is. The shoulder joint, also referred to as the gleno-humeral joint, is one of the most mobile joints in the human body. Its movement involves the action of several other joints to maximise and control the movements available. The other joints involved in healthy movement are the sterno-clavicular and acromio-clavicular joints. They act together with the scapulo-thoracic and supra-humeral articulations. Good shoulder function also relies on muscular integrity for stability – particularly the rotator cuff.

In this article, I will look at the common reasons for pain in the shoulder and how osteopathy can help. If, however, you just want to see a specialist and book a treatment click on “book treatment” in the menu above.

SHOULDER INJURIES.

The injuries covered in this article are:

• An acute tear or pathology of the rotator cuff
• A Dislocated or unreduced shoulder
• Frozen shoulder. Aka. Adhesive capsulitis
• Pain over the top of the shoulder

ACUTE ROTATOR CUFF TEARS AND PATHOLOGIES

WHAT ARE THE ROTATOR CUFF?

Shoulder pain may be the result of damage to the muscles that support and guide the shoulder in its normal movement. There are 4 primary muscles (if we don’t include the long head of the bicep tendon) that are responsible for the delicate balance and positioning of the gleno-humeral head in it socket. These are called the rotator cuff.  These muscles stabilize the upper arm and allow for the full range of motion at the shoulder joint.

ROTATOR CUFF INJURY

Shoulder pain in this area can also be caused by rotator cuff tendinopathy, also called sub-acromial shoulder pain, tendinitis, impingement, bursitis or supraspinatus tendinopathy.  Tendonitis or Tears are generally the two common types of injury to the rotator cuff.

Inflammation in the muscles or tendons of the rotator cuff can lead to an impingement or a pinching in the space between your arm and clavicle. Tears to the tendon or muscle can occur from a fall, general wear and tear, repetitive movement in sports such as tennis or cricket, weightlifting or something as simple as overhead motions while painting or cleaning.

 SYMPTOMS OF A ROTATOR CUFF TEAR

• Reoccurring shoulder pain, particularly when doing certain things, such as lifting your arm over your head or out to your side.
• Pain that stops you from sleeping on your injured side.
• Crepitus when moving your arm.
• Loss of your normal range of motion.
• General loss of strength in your arm.

HOW CAN WE HELP? 

OSTEOPATHIC DIAGNOSIS OF SHOULDER INJURIES

We can usually establish the cause of your shoulder symptoms from the way you describe them and observing what functional movements you have lost. Sometimes we might refer you for a shoulder scan, but in most cases it is very safe to treat osteopathically. As well as diagnosing the cause of your shoulder symptoms, we will also look at what else might be preventing you from getting better such as having poor thoracic mobility or are sitting for long periods hunched over your desk. Your osteopath may help improve function and restore balance in these areas. Also your osteopath will check for the involvement of other joints, and any potentially overlooked systemic issues that could also be the source of the pain in the shoulder.

OSTEOPATHIC TREATMENT FOR SHOULDER INJURIES

Osteopathic treatments can help to reduce pain, and inflammation through targeted soft tissue release, massage and guided articulation not only to the shoulder but also to the upper back, and cervical spine. Osteopaths are also trained to prescribe targeted rehabilitation exercises and a strengthening program.

OSTEOPATHIC MANAGEMENT FOR SHOULDER INJURIES

When we develop a management plan for your shoulder we always take account of your goals and expectations as well as the demands of your occupation, sports and hobbies may have on your shoulder. Questions about the duration of your pain, when it started, what alleviates or exacerbates your pain will all help to determine the kind of treatments that are required and how much time you’ll need to commit to your rehabilitation program for the shoulder.

The outcome for shoulder muscle strain or injury is usually very good and the osteopaths at Hampstead osteopathy have many years of experience treating shoulder injuries. Below are some tips we recommend for a structured return to function.

TOP 5 TIPS FOR RECOVERING FROM SHOULDER INJURIES

• Start with isometric work. This is a safe way to activate and challenge different positions with the least threat to joint structures. The goal is to stabilize and strengthen without pain (which could trigger avoidance behaviors).
• Once confident, explore your pain free ranges of motion, alone or with the guidance of your osteopath. Your osteopath can help remove tension from areas that may be guarding against movement or may have become tense or overworked. Your osteopath can also take your arm safely into ranges you are unconsciously avoiding. Daily controlled articulations will help keep the cells inside the joint healthy while reminding your brain to keep mechano-receptors active and up regulated. Remember what you don’t use you start to lose.
• Although I personally only use these as either a warm up or at the very early stages of shoulder rehab there is utility in using Thera-bands to work on internal and external rotation as part of a rehab program.
• Once you are feeling more confident it is crucial to begin to integrate the entire body into your shoulder rehabilitation. This means understanding the role of the core and lower body in shoulder function. Particularly when returning to racket sports or martial arts. Timing, stability and strength exercises can be given to you by your osteopath.
• We also advise taking one of our mobility and strengthening programs to do at your gym to help bring you back into structural balance.

A DISLOCATED OR UNREDUCED SHOULDER

A dislocated shoulder refers to the separation of the humeral head (top of the arm) from the socket it sits in. A shoulder dislocation is usually very painful and can cause a variety of long lasting issues especially if it isn’t managed correctly or if it happens to re-occur. If the shoulder dislocated because of a trauma or impact and didn’t reduce (relocate) by itself then you should go straight to A&E.

It is common for people to say they felt it pop out and had a sudden relief when it relocated or popped back in. It is highly possible for a dislocation to cause the capsule of the shoulder joint to over stretch potentially damaging the supportive ligaments, tendons, muscles and even nerves. Please come and see us If you feel your shoulder is unstable and would like some advice on how to fix this without surgery or if you’d like an assessment to see if it can be helped with osteopathic treatments.  (see article on return to function for an unstable shoulder)

FROZEN SHOULDER. AKA. ADHESIVE CAPSULITIS

WHAT CAUSES A FROZEN SHOULDER?

The exact causes for why people get frozen shoulder are still unclear but it can happen as a result of reduced movement after a shoulder surgery, or in some cases as a result of diabetes. Adhesive capsulitis is when the inner layers that surround the shoulder joint known as the capsule shrink and become tighter and ‘stickier’. This often leads to a loss in the range of motion of the shoulder and in most cases can cause pain when trying to move the arm. The condition is usually self-resolving however there are things to do to help the pain and recovery.

OSTEOPATHY TREATMENT FOR FROZEN SHOULDER

Your osteopath can help with assisted stretching and work on your posture. Strength exercises are also advised but need to be tailored specifically to each individual case. Frozen shoulder can take a long time to heal and resolve so it’s a condition that needs long-term management. The best advice is to keep it moving. You might also want to try using heat on the area as some people find this gives symptomatic relief

PAIN OVER THE TOP OF THE SHOULDER:

DIAGNOSING AC JOINT INJURIES

Another common site of pain in the shoulder is around the boney hard bit at the top of the arm. This is known as the acromio-clavicular joint. As mentioned earlier this is a key component of the health and function of the shoulder joint. The acromio-clavicular joint may also be damaged by trauma from a fall or from a sporting tackle. If you are in a lot of pain here after an impact or fall you may have a fracture or a break in the clavicle.  This is often seen or felt as a new boney lump and should be scanned before any treatment. Patients often report tenderness when pressure is applied over this area or may feel pain and soreness in the shoulder when doing a shoulder shrug. Symptoms may also be painful when the arm is pulled across the chest.

It is also important to remember that shoulder pain may also be from arthritis, this can be accompanied by a loss of movement and stiffness in this area. Please see our article on arthritis and how we can help.

Although we haven’t covered all the reasons for shoulder pain, below is a more extensive list of what could cause shoulder pain.

• Dislocations – A/C, S/C, G/H
• Painful arc – Tear of supra-spinatus / Tendonitis of supra-spinatus
• Calcification of supra-spinatus / Sub-acromial bursitis / Fracture
• The greater tuberosity / Impingement syndromes
• Frozen shoulder – Adhesive capsulitis
• Biceps tendonitis
• Triceps tendon tear
• Cervical spine pathology, e.g. discal damage
• O/A or R/A
• Tumors
• Heart – left-sided pain
• Liver – right-sided pain
• Diaphragm and lungs
• Cancer – especially breast or lung
• Injuries to the labrum
• Glenoid labrum tears- SLAP lesion, Posterior labral, Bankarts Lesion (Ab + ER), Hill-Sachs Lesion

Erkan Cetin is one of the osteopaths at Hampstead Osteopathy and has a special interest in shoulder rehabilitation