The shoulder is the most mobile joint in the body. The main shoulder joint (the glenohumeral joint) is a ball-and-socket joint, which allows a very wide range of movement. It’s surrounded by a tough fibrous sleeve called the capsule which helps to hold the joint together. The inner layer of the capsule (the synovium) produces a fluid which nourishes the cartilage and lubricates the joint. A group of four muscles and their tendons make up the rotator cuff, which controls movement and also helps to hold the joint together.
There’s also a smaller joint (the acromioclavicular joint) where the top of the shoulder blade meets the collarbone.
There are several possible causes of shoulder pain, including:
- inflammation or damage to the muscles and tendons around the shoulder
- inflammation in the sac of soft tissue (bursa) that normally allows the muscles and tendons to slide smoothly over the shoulder bones
- damage to the bones and cartilage, which can be caused by arthritis
You should see your doctor as soon as possible if:
- you develop severe pain in both shoulders
- you also have pain in your hips or thighs
- you also feel feverish or unwell
The Therapy Rooms are very successful at reducing and in many cases stopping shoulder pain all together. We do this by applying various massage techniques that encourage relaxation of the muscles surrounding the shoulder girdle are a mainstay for massage approaches. Simple techniques, such as effleurage and broad cross-fiber sweeping strokes, are useful. Because the muscles often become fibrous and shortened due to the limited range of motion in the shoulder, restoring their proper movement is an important aspect of addressing this problem.
When muscles are unable to move through their full range of motion, restoring proper movement can be challenging. In this case, active engagement techniques work well. One method is to ask the client to hold their arm in an horizontal position (isometric contraction) in the pectoralis major and then slowly let it go. As the client releases the contraction, the practitioner performs a longitudinal stripping technique on the pectoralis major fibers.
Myofascial trigger points in muscles such as the subscapularis may also play a role in the perpetuation of capsular adhesion. These trigger points can be treated with static compression methods or compression with active movement . During compression with active movement, the practitioner maintains pressure on the trigger point while the client moves through as much of the range of motion as possible (internal and external shoulder rotation).
Another goal for us at The Therapy Rooms is to encourage elongation of the adhered capsular tissues. This is accomplished with various stretching procedures. However, do not expect results to come quickly. In addition to - or in conjunction with - massage techniques, stretching methods should emphasize the motions of external rotation and abduction, and will get the best results when performed slowly to stretch the adhered tissues. For example, with a passive stretch in lateral rotation, the client is taken just to the point where discomfort starts and then held there (see Left Figure). While in this position, the client is encouraged to breathe deeply and relax the shoulder as much as possible. After holding the stretch for 20 seconds or more, the client is slowly brought back to the neutral position. The procedure can be repeated several times.
Adhesive capsulitis (Frozen Shoulder) can be debilitating and cause long-term impairment. Proper treatment can mean the difference between several-days-weeks of disability or one of several weeks or even several years. Even with therapeutic results, this condition may require a long rehabilitation.
Our knowledge of this condition will be highly valuable to as a client when you start to learn more about your own bodies and what you can do to return to optimum health.
There are several ways that you can help yourself if you have shoulder pain.
PainkillersSimple painkillers or anti-inflammatory tablets and creams that you can buy at the chemist can be helpful, but don’t use them for more than 2 weeks without seeking medical advice.
Read more about painkillers and non-steroidal anti-inflammatory drugs (NSAIDs).
IceIf your shoulder is inflamed (warmer to touch than the other side), an ice pack may be helpful. Leave the ice pack in place for 10 minutes or so, making sure you protect your skin from direct contact with the ice by wrapping it in a damp towel.
Rest and exerciseAim for a balance between rest and activity to prevent your shoulder from stiffening. Try to avoid the movements that are most painful, especially those that hold your arm away from your body and above shoulder height. However, it’s important to remain generally active even if you have to limit how much you do.
When raising your arm, you can reduce the strain or pull on your shoulder by:
- keeping your elbow bent and in front of your body
- keeping your palm facing the ceiling when reaching up
Another good exercise is to use your good arm to help lift up your painful arm. Some people find that placing a cushion or rolled towel under the armpit and gently squeezing it can ease the pain.
You can also download a selection of exercises that are designed to stretch, strengthen and stabilise the structures that support your back.
Download our shoulder pain exercise booklet (PDF).
Read more about exercise.
PostureDon’t sit leaning forwards with your arm held tightly by your side. This position can make shoulder pain worse, especially if some of the pain is coming from your neck. Keep a pillow or cushion behind your lower back when you’re sitting down, with your arm supported on a cushion on your lap.
If your shoulder is painful to lie on, the following positions may reduce the discomfort:
- Lie on your good side with a pillow under your neck. Use a folded pillow to support your painful arm in front of your body. Another pillow behind your back can stop you rolling back onto your painful side.
- If you prefer to sleep on your back, use one or two pillows under your painful arm to support it off the bed.
- When vacuuming, keep your upper body upright with the cleaner close to your body, and use short sweeping movements.
- Only iron essential items, and make sure the ironing board is at waist height.
- Use a trolley or a backpack to carry shopping, or divide the weight between two bags and carry one in each hand. Alternatively, use bags with long straps and carry them with the straps crossed over your body from shoulder to hip.
- Try to maintain a good posture when sitting or standing. Avoid holding your neck in fixed or twisted postures.
- If you use a computer make sure the keyboard and monitor are directly in front of you, so you don’t have to turn your head or twist your body. Keep the mouse within easy reach so you don’t have to stretch.
- When using the phone don’t trap the receiver between your head and your shoulder.
- Avoid any manual work that hurts while you’re doing it.