Physical Therapy for the Painful Shoulder

People of all ages suffer from shoulder pain. The causes are many and can range from an unknown onset to a traumatic event. Many people develop shoulder pain from performing repetitive type activities for prolonged times. Others will experience pain in the shoulder following a fall onto the shoulder or on the outstretched arm. Sometimes the reason for pain is not as obvious. I see many cases where a person cannot identify what caused the pain in the shoulder. Often times this pain for unknown reasons can occur when someone bumps their shoulder against the door jam in the middle of the night when going to the bathroom. This rather benign action sets off a chemical process in the shoulder that will build up over several days. Eventually this will cause pain in the shoulder. Since the injury occurred several days earlier the person cannot recall any event that started the process. Regardless of the cause of the pain in the shoulder the treatment is often similar from case to case.
Treatment of the shoulder can encompass several different areas. Conservative measures include medication such as anti-inflammatories or pain medications, rest, cortisone injections, and or physical therapy. One aspect of care is often not enough to heal a rotator cuff injury. A combination of treatments is usually most effective in helping to relieve pain in the shoulder.
Often times when you present to your medical doctor with complaints of shoulder pain they will prescribe some medication as described above. It is easy to recommend that a person rest the painful shoulder but it may be difficult to do depending on their occupation or responsibilities at home. Injections for the painful shoulder are sometimes given right away depending on your medical doctor's philosophy. Some MD's would rather you attend physical therapy before considering injecting the painful shoulder. Injections are not the end all beat all and they do not offer relief to all patients that receive them. Often times a well rounded physical therapy program can alleviate shoulder pain and you won't have to consider having an injection.
Physical therapy treatment can consist of the following interventions:
1. Therapeutic exercises: this will consist of range of motion, conditioning, and strengthening exercises. The goal here is to maximize and restore any loss of range of motion, improve the overall endurance of the shoulder blade and shoulder muscles and to improve the strength of these same muscles. Adequate strength of the shoulder blade muscles is just as important as having strong rotator cuff muscles. These two groups must work together in order to restore normal biomechanics and to prevent further injury.
2. Manual therapy: this will consist of hands on treatment that the physical therapist would perform on you. This might consist of joint mobilization (i.e. techniques designed to improve joint motion and relieve pain), or soft tissue massage (i.e. techniques designed to improve muscle and connective tissue flexibility and to relieve pain).

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