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FREQUENTLY ASKED QUESTIONS

Why does my shoulder hurt?

WHAT IS ROTATOR CUFF RELATED SHOULDER PAIN?

Rotator cuff related shoulder pain (RCRSP) is pain arising from the rotator cuff/bursa of your shoulder. It is the most common condition that causes shoulder pain. This term is beginning to replace "sub-acromial impingement" due to recent research. The rotator cuff is a collection of 4 muscles that fuse together to stabilise the shoulder. As such they play a vital role in shoulder function. They are also vulnerable to injury and overuse due the large mobility of the shoulder. Often, to restore function and remove pain, the rotator cuff has to begin to work properly again. This is the aim of physiotherapy for RCRSP.

WHAT IS SHOULDER INSTABILITY

Shoulder instability can arise from a number of different means. For simplicity, it is best to think of it this way: torn loose, worn loose and born loose. The torn loose group refers to those who have a significant trauma that results in a shoulder dislocation, common in young footballers. Number 2 is worn loose. This results from repetitive strain and use of the shoulder that can lead to laxity and loosening of the supportive tissue - this is common in throwing athletes. The third category is born loose. This group comprises those who often don't need a significant trauma for the shoulder to dislocate and are born with loose and stretchy ligaments generally. Please see blog for more detailed discussion.

WHAT IS FROZEN SHOULDER?

Frozen shoulder is an enigmatic condition. It results in a painful shoulder that progressively becomes stiff over time. Eventually it gets to pain where the shoulder becomes useless if left unattended. It seems to affect those in the age bracket of 40-65 and can affect women slightly more than men. It is linked with diabetes and hypothryoidism. Structurally there are contractures and fibrosis that forms on the shoulder capsule that causes a limitation of movement. It is imperative that this condition is diagnosed early and appropriately. This can help lead to the implementation of a successful management strategy that may reduce the time course of the condition.

WHAT IF I HAVE A TORN ROTATOR CUFF, CAN PHYSIOTHERAPY STILL HELP?

The short answer is yes. We now know for certain that many people have rotator cuff tears BUT have no pain. The location, size and how the tear was sustained are far more important than tear itself. Recent research also suggests large rotator cuff tears can be managed successfully with appropriate physiotherapy. Rotator cuff tears are a sign of ageing on the inside, and should not be viewed as unfixable and the end of your career in sports that require shoulder use.

HOW CAN PHYSIOTHERAPY WORK FOR A TORN ROTATOR CUFF?

As established in the above question, a rotator cuff tear is surprisingly prevalent (approx. 40% of those in their 50s). However, it is more common to have a tear and NO pain than a tear with pain. So what happens if you have a tear and pain? The mechanism of action of physio and targeted exercise therapy is a phenomena known as mechanotherapy. This is basically a physiological response of the body that converts a mechanical stimulus (the exercise) into a cellular response which ultimately results in structural change. This means that mechanical loading can promote a targeted healing response in the injured area. It mar also work from a psychological perspective and remove fear of movement from the person with the painful shoulder. It will also condition the musculotendinuos complex of surrounding uninjured tissue and promote broad neuromuscular changes both locally at the site and centrally in the brain. 
So, while exercise may sound like a simple intervention, the affects are actually quite complex and widespread.