Importance of physiotherapy for shoulder pain. These given injuries can lead to pain in not only the shoulder, but refer pain to neck, upper back, arms and hands due to the fact that the brachial plexus (nerves connecting the neck to the arm) can be directly affected from an injury to the shoulder. It is crucial to deal with these problems right away as later problems can evolve to conditions that become very difficult to treat, i.e. frozen shoulder, rotator cuff disorders, and various forms of arthritis. A doctor’s typical approach to shoulder pain are anti-inflammatory medication, corticosteroid injection, and in some cases surgery. It is known that an appropriate shoulder pain physiotherapy at home can be equally effective, if not more, for various shoulder conditions and without the long term risks and costs associated with medications or surgeries.
Causes of shoulder pain. There are not too many causes for shoulder pain, yet the most common are a direct blow, overextending the arm, lifting heavy objects or reaching for things repetitively, trauma such as a vehicle accident, fractures, dislocated shoulder, excessive swelling and overuse of the muscles. The shoulder is a very intricate joint, modifiable but unstable. It is because of this that the shoulder is one of the most mobile joints in the body, but in turn makes it very easy for other injuries to occur.
Causes of Shoulder Pain
Recent literature reviews are showing that there is no one cause for shoulder pain, but that it is usually a combination of factors, commonly something tightening or irritating soft tissue, resulting in the inability of the highly mobile shoulder joint to move freely. Shoulder pain commonly experienced usually has specific causes. These causes can be onset by an injury or trauma, repetitive strain, or it can develop from an underlying condition such as arthritis. In a study released by Yau et al. (2010), there was a direct association with the severity of shoulder rotator cuff tendinopathy and age, up to the 60-69 year old age group. Another demonstration of a specific cause of shoulder pain was displayed in a cross-sectional study of 300 patients in an Australian hospital, in which 40% of patients presented with neck pain and 60% presented with shoulder pain. After a process of dual elimination, it was evident that the shoulder pain was commonly referred from the neck.
Importance of Physiotherapy for Shoulder Pain
Physiotherapy has also proved very beneficial for patients who have suffered a stroke. It has been an integral part of their recovery process. Ambulation and range of motion exercises that are done by the therapist to the patient has been believed to be very beneficial for the restoration of normal movement of the affected shoulder. The impairment related to the integrity of a joint due to ligament rupture, tendon rupture or a fracture heal with a better functional result when it is managed with physiotherapy. This negates the chances of future joint degeneration. A technique known as the electrotherapy is used by physiotherapists for patients with frozen shoulder or adhesive capsulitis. This is an energetically loaded formulation of ultrasound and interferential current to the shoulder joint. A local application of heat to your shoulder before such treatments to make musculature more relaxed and to increase blood flow will be more beneficial. This increases the blood flow to the deep lying tissues in the body. Recent research has shown that it gives good patient outcomes as compared to supervised neglect. So we can safely conclude that physiotherapy is more effective than mere supervised neglect in patients with a painful shoulder due to soft tissue disorders.
Physiotherapy is an important treatment modality for those who are suffering from shoulder pain. Treating shoulder pain with physiotherapy is more effective than surgical procedures. Often post-surgery there are complications and the recovery time is long. It is very important that you take the opinion of a physician about the extent of the injury and plan for physiotherapy the same as it would be a treatment for a quick recovery.
Physiotherapy Exercises for Shoulder Pain at Home
If you have shoulder pain, your pain might come from the muscles around your shoulder or from the joint itself. If your shoulder pain is from the muscles, stretching is the best exercise for your shoulder. This is because the pain is likely to be due to a buildup of tension in the muscle, which will decrease the elasticity of your muscle, thus decreasing the functional strength, and it will be constantly pulling on the insertion of the muscle at the joint causing discomfort. By stretching the muscle, the tension will be reduced, with the main goal of increasing the length of the muscle which will help to increase the functional strength of the muscle. The overall aim of stretching is to increase the quality and the health of the muscle. If the pain is from the capsules and ligaments of the shoulder joint, shoulder movement will cause a pinching feeling or a sharp pain. The shoulder is a ball and socket joint, and the most movement which occurs in the joint compared to any other joint in the body. If the shoulder has been injured and is causing inflammation and swelling, movement needs to be restricted to allow the inflammation to relieve. In the case that your doctor or physiotherapist says that it is okay to move your shoulder, there are a few exercises which help to restore the pain-free range of movement of the shoulder. Between any of the exercises, only do them within the pain limits of your shoulder. As you regularly do these exercises, the pain in your shoulder should start to ease. A physiotherapy session at this stage can provide electrotherapy such as ultrasound, which will help to reduce pain and inflammation of your shoulder to further allow movement.
Stretching Exercises
Stretching of the shoulder muscles is essential to the treatment of shoulder pain. At the start, stretching should be performed gently and gradually increased over time. Each stretch should be held for 15-20 seconds and repeated 4-5 times. Ensure that the stretches are done slowly and carefully, and that no movement is done through jerky movements. Stretching exercises are best done after heat has been applied to the area, for example, after a hot bath or shower. These warm the muscles up and make them more receptive to the stretch. Alternatively, apply a heat pack or hot water bottle to the area to be exercised for 15-20 minutes. This will also warm the muscles and make them receptive to the stretch. The heat pack can also be used after the stretching exercises to ease any delayed discomfort. Avoid excessive stretching and painful movements. This will only aggravate the condition. If pain is severe on any of the movements, stop the exercises and consult a physiotherapist.
Strengthening Exercises
Make sure the Theraband is of light resistance and the hand holding it does not move from the starting position. The band should be level with the ground.
Involved side: Place a pillow under the upper arm to keep it in contact with the trunk. Push the hand of the involved arm into the wall. Hold for 5 seconds, repeat 10 times. This exercise can also be done using a Theraband by fixing it to a point on the wall at waist height and holding the other end of the band.
Isometric strengthening exercises: Lie on the uninvolved side. Using a rolled towel as a pillow and with the elbow bent to 90 degrees, place a small cushion under the head.
Strength training involves the strong contraction of a muscle against some form of resistance. It is used to increase the strength, anaerobic endurance, and size of muscles. Patients with shoulder pain, who were given strengthening exercises for the muscles of the shoulder, demonstrated better results than those given no exercise or other forms of exercise. Patients with impingement syndrome demonstrated significant improvements with shoulder internal rotation and horizontal adduction. Eccentric external rotation has been shown to be effective for patients with rotator cuff tendinosis. The following section is on isometric strengthening exercises for the shoulder. In all the exercises it is important to read the notes at the bottom of the page before commencing. Isometric exercises are static exercises where the muscle contracts but there is no movement of the joint.
Range of Motion Exercises
Range of motion exercises can often be very uncomfortable, especially in the initial stages. However, it is vital that they are done as without them, the shoulder will lose its mobility. Depending on the nature of your shoulder pain, it may be wise to apply a heat pack or have a hot shower before you start the exercises. This can help to relax the shoulder and ease the discomfort.
Range of motion exercises are used to improve the shoulder’s ability to move in multiple directions. These exercises will help keep your shoulder from “freezing up.” This is often a problem, as the instinctive reaction to shoulder pain is to protect the shoulder by holding it still. By doing that, the shoulder will eventually lose its ability to move as scar tissue will form around the joint and severely limit movement.
Ultrasound Treatment for Shoulder Pain in Singapore
Ultrasound treatment for shoulder pain involves using high frequency sound waves. In this context, applying ultrasound to soft tissue is said to produce ‘micro-massage’ effects which can help to reduce pain, swelling, and increase the range of motion. Using a repetitive motion of sound which is above the range of human hearing, an invisible stream of high frequency sound waves is produced. When these waves are applied to an injured area using a probe, the vibration it creates can cause changes in the cells which can help to increase blood flow and repair damaged tissue. The increase in tissue relaxation, local blood flow, and scar tissue breakdown are all direct effects of the increase in temperature from the ultrasound waves. It is these effects which produce the pain relieving and therapeutic benefits of ultrasound treatment. This can be especially useful in the case of shoulder impingement, where an excess amount of scar tissue in the sub-acromial space can cause the tendons to stick to the bone, resulting in a painful movement of the shoulder. Ultrasound can help to speed up the natural healing process for this injury, reducing recovery time and the effects of pain.
How Ultrasound Helps Alleviate Shoulder Pain
Ultrasound is a passive modality, which is most commonly used in the treatment of acute or chronic soft tissue conditions, as well as injuries related to the muscle-tendon unit. Deep heating effects and cavitations are the primary effects of ultrasound. Ultrasound produces an increase in tissue extensibility, which can be useful in the treatment of contractures and scar tissue. The long-term heating effect is thought to induce an increase in blood flow, which can be beneficial in the sub-acute, chronic, or proliferative phase of the tissue repair process. The increase in blood flow induced by ultrasound can help reduce local swelling and chronic inflammation, and aid in the absorption of extrinsic or intrinsic pathologic agents. Aggressive scar tissue breakdown and rapid tissue remodeling can lead to a weakening of the tissue; this can be prevented by immobilization and the use of ultrasound to promote the tensile strength of the new tissue.
Benefits of Ultrasound Treatment
Due to the fact that it is non-invasive and requires less time spent, the alternative of an ultrasound for shoulder pain is preferable to some patients when compared to other treatments such as surgery. An ultrasound session can be completed in less than half an hour, and the patient is able to drive themselves to and from the appointment. This is very useful for the busy individual, or for patients that are unable to take much time off work. And as the human and economic costs of lost time become an increasingly large burden, this makes ultrasound a very attractive option. Another benefit of ultrasound treatment is the minimal and often non-existent side effects, allowing patients to avoid the potential long-term costs and recovery time associated with more invasive procedures. During an ultrasound treatment, the only sensation is a mild warming feeling, or in some cases slight vibration. Patients do not have to have anesthesia, and there is no risk of aggravating the injury, as it is a no-touch procedure. Warriors and fearers of needles will be joyful to avoid an injection.
Availability of Ultrasound Treatment in Singapore
The availability of ultrasound treatment in Singapore has greatly served the needs of Singaporeans in treating shoulder pain. It has now become more convenient as it is no longer offered only by hospital physiotherapy departments. In fact, ultrasound therapy is offered by many physiotherapy and sports injury clinics, some with a very good standard of services. Consumers have the choice of selecting a clinic close to their homes; they are not restricted to only receiving treatment in hospital-based departments. This has brought about an increase in competitiveness of services provided, forcing physiotherapy providers to improve their services. In addition, this has also led to physiotherapy clinics providing specialized expertise in areas of sports injuries, women’s health, hand therapy, etc. With better expertise, consumers are getting better value for their money and are able to quicken the healing process, creating efficiency in the healthcare system and sending patients away from the already overcrowded hospitals. This is indeed a good development for those seeking ultrasound treatment in the fight against shoulder pain.
