Shoulder pain is a common symptom that many of us experience during sport, in the gym, or during activities of daily life. Game Time Physiotherapy has extensive experience in the assessment and treatment of swimming and gym training-enduced shoulder pain, as well as acute shoulder injuries from all rugby codes.
The shoulder joint is a very complex structure, with a number of muscles, ligaments, nerves and soft tissue structures moving and articulating together, to allow efficient, controlled movement.
Common shoulder conditions Game Time Physiotherapy successfully treats everyday include;
Acromioclavicular joint sprains
End-stage frozen shoulder
Referred pain from the spine & active trigger points
Rotator cuff strains/tears/tendinopathies
Shoulder instability (dislocation)
The rotator cuff is made up of 4 small muscles that “suck" the head of the humerus or the arm bone, into the glenoid or socket, to allow smooth, controlled arm movement. The supraspinatus, infraspinatus, subscapularis and teres minor make up the rotator cuff. Injury to the rotator cuff can be either acute or chronic. Acute rotator cuff strains may be provoked by a hard tackle during a game of rugby league or even reaching for the washing on the line in elderly patients. Chronic rotator cuff injuries, or tendinopathies involve overtraining/overloading of the rotator cuff tendons, commonly seen in swimmers and overhead athletes. Pain often refers down the arm and is provoked when lying on the effected shoulder or with internal or external rotation of the shoulder. Patients may also have difficulty with overhead activities or lifting their arm in patients with rotator cuff injury.
Bursa are fluid-filled sacs that are throughout the body, reducing friction between tendons and bones to allow efficient movement. Shoulder bursitis is either caused by repetitive microtrauma to the shoulder from overuse, or acutely from a fall for example. The subacromial bursa is more commonly effected than the subdeltoid bursa and is caused by the impingement of the rotator cuff tendons with the acromion. Symptoms are very common to that of rotator cuff injuries, with poorly localised shoulder pain that is often relieved with the arm by your side or resting above your head.
Shoulder impingement is the intermittant trapping of the rotator cuff tendons and or bursa during shoulder movement. This is caused by either structural (primary) or
dynamic (secondary) causes leading to abnormal shoulder mechanics. Structural impingement is caused by being born with a smaller subacromial space, or due to osteoarthritis of the shoulder joint, creating bony spurs that radiate into the subacromial space. Because of this reduced space, the soft tissues of the shoulder joint are more likely to be compromised, leading to bursitis and or tendinopathy. Dynamic impingement is a combination of muscle weakness, joint laxity and poor upper limb mechanics, causing the soft tissues in the subacromial space to be compressed creating pathology.
The biceps brachii muscle has two heads and attaches into the front of the shoulder, providing anterior support to the shouder joint, as well as shoulder flexion and elbow flexion. Biceps tendinopathy is an overuse injury that commonly effects the long head of the biceps. Injury to this tendon is rarely seen in isolation and is often caused by tendon impingement, trauma, overuse or shoulder instability. Biceps tendinopathy is common in throwing sports, swimmers, gymnasts and occupations that involve heavy lifting and working overhead. Patients often report pain in the front of the shoulder that is aggravated by shoulder flexion, elbow flexion, forearm supination and or working overhead.
The physiotherapists at Game Time Physiotherapy have years of experience in the conservative management and post-operative rehabilitation of glenohumeral and acromioclavicular joint instability through involvement with several rugby teams of all codes. With an increased laxity of the static support structures in the shoulder, it is crucial that dynamic stability of the shoulder joint and efficient movement patterrns are established through physiotherapy to prevent further episodes of laxity.
Shoulder pain also may arise from other dysfunctional areas of the body. Referred pain from the cervical and upper thoracic spine, as well as the neck and shoulder soft tissues is common in desk workers and in the athletic population. Pain may also be predominantly neural in nature, with symptoms caused by dysfunction anywhere along the path of the nerve. Pins & needles, burning pain, numbness or sharp shooting pain are common symptoms in patients who present with neural compromise at or around the shoulder joint.
Pain should never be accepted as 'normal' as it limits our ability to perform at our best and effects the quality of sleep we get. If you have a question about your shoulder pain, send us a message and we will be in contact very soon. To take control of your shoulder pain, book an appointment online now to resolve this common disability for good.
Game Time Physiotherapy
1/449Lytton Road, Morningside QLD 4170