Have you ever experienced shoulder pain while training in the gym or playing a sport, and found yourself trying to find a diagnosis on google? It can be overwhelming isn’t it? Your coach, PT or GP might say that you have shoulder impingement? or bursitis? Or a rotator cuff tear? It’s possible that you may have any one of these pathologies, but they are all frequently misdiagnosed and even more frequently mismanaged or neglected.

The shoulder is an area that can be commonly injured and the consequences can be quite debilitating. Our hands are only able to move and carry out tasks with such precision because of the large range of movement afforded to them by our shoulders. Therefore, when a problem occurs in the shoulder, it can restrict the use of our hands and arms and affect our day-to-day activities as well.

What are the common causes of shoulder pain?

1. Rotator cuff injury: The rotator cuff is a group of muscles and tendons that help stabilize and move the shoulder joint. Injury to the rotator cuff can cause pain and weakness in the shoulder and in more severe cases prevent you from being able to lift the arm. Rotator cuff strains can be caused by an injury such as a fall or straining when lifting something heavy. They also commonly occur with aging, with at least one-third population over the age of 60 having some degree of tearing without any significant associated injury. The grade of severity decides the management protocol. 
2. Bursitis: Bursitis is the inflammation of the bursae due to friction or rubbing from the surrounding structures during movements. Bursa is a small pocket of fluid that cushions our joints. Bursitis often presents with pain when lifting your arms above your head, worsening pain at night and inability or increased pain when lying on that shoulder. 
3. Tendinopathy: Tendinopathy is a pathology of the tendons surrounding the joint. Tendinopathy can cause pain when laying on that side at night or performing repetitive activities. It tends to present as a problem after an increased training load or with overuse. 
4. Arthritis: Osteoarthritis is inflammation that occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Symptoms include pain, morning stiffness, and clicking or grinding noises in your shoulder joint. 
5. Shoulder instability-i.e dislocations and subluxations. It usually occurs while playing sport or as a result of a fall. This can occasionally lead to a fractured bone in the area which is why it is always a good idea to get it looked at by a doctor or physiotherapist. It can also be a result of cumulative trauma to the joint, especially in the hypermobile/flexible population. 
6. Frozen or stiff shoulder: Frozen shoulder is a condition in which the joint capsule that surrounds the shoulder joint thickens and tightens, causing a stiff and painful shoulder. The patient goes through a 3-phase process with the pathology- freezing, frozen and thawing. Physiotherapy is most important in the thawing stages of frozen shoulder. 

How can GRIT physiotherapy intervention help in shoulder pain?

1. Understanding the structural source of the pain and its nature, through a detailed assessment is what helps make an accurate diagnosis.
2. This subsequently helps with educating the population about management options and lifestyle changes that might assist with recovery.
3. Utilising appropriate software to get accurate measurements of the patient’s strength in the affected muscle groups and tracking their progress through the stages of rehab. 
4. Pain management techniques (mobilisations, soft tissue release, dry needling, taping).
5. Appropriate exercise prescription for rehabilitation that addresses the problem by helping change the biomechanics of the shoulder through strengthening, stretching and posture changes.
6. Help with graded return to sport/gym/work.
7. Prevent future injuries and worsening of current presentation.
8. Work in conjunction with GP and other health professionals, coaches, PT to ensure the best-practice care and outcomes for our patients.

At GRIT Physio, our team is well-equipped with the skillset that is required for assessing and treating shoulder injuries; and would be very glad to help you through your journey of recovery. If you have any questions relating to shoulder pain, go to the GRIT physio page or book in to see us today.