Shoulder Injuries Simplified

Damian Wyard Physiotherapist talks about shoulder injuries in this blog. He combines Physiotherapy and Pilates for rehabilitation in Downtown Toronto. You can read more about this unique approach here: Physio-Pilates

You don’t have to be involved with sports to suffer a shoulder injury. I’ve recently been treating someone who developed a rotator cuff injury from just siting at a computer all day!  In this blog I am going to talk about how shoulder injuries can be simplified into three broad categories. I will also discuss the treatment for each group. Unfortunately in the physiotherapy world we tend to complicate things for patients and the shoulder is an example where simplicity can be just as effective. There are some difficulties with the shoulder, but this is the same as any other injury. With most shoulder rehabilitation the process just takes time. A lot of shoulder injuries do not need surgery and do well with the right rehabilitation.

Traumatic shoulder injuries:

I am not going to go into detail on these types of injuries as they deserve a separate blog. Fracture and large muscle or tendon tears need to be seen by an orthopaedic surgeon with X-rays and MRI etc. Significant loss of movement and the mechanism of injury will determine the right care. Any traumatic injury should be followed for possible fractures, tendon ruptures and large soft tissue tears. A dislocation is a severe trauma and should be followed in emergency so the shoulder can be repositioned in the joint.

Most shoulder injuries that can be treated in the clinic can be grouped into the three categories below:

  1. Weak and Painful

  2. Stiff and Painful

  3. Weak and Unstable

I have borrowed these groups from a British Physiotherapist (Adam Meakins) who does a great job in simplifying how we approach shoulder injuries. It makes much more sense to group shoulder injuries by their primary movement problem. It’s very difficult to determine in the clinic which specific structures are causing pain. By determining the primary movement problem, I can be more effective with the treatment options.

The Weak and Painful Shoulder:

In this group I include rotator cuff strains. These are the small stabilizing muscles in the shoulder joint. In the younger population this could be caused by lifting weights. If these muscles are overloaded beyond their strength, they can tear. Degenerative rotator cuff problems start in the 50’s and are the result of weakening in the tendons. In the clinic the shoulder will test weak and with pain as the damaged tissues are stressed. Sometimes these can be caused by repetitive use or a sudden overload into the muscle-tendon unit.
Most of these muscle-tendon injuries need strengthening. The rotator cuff gets activated with lots of different movements so there are plenty of options. When pain is high I find ways around this. Resistance bands and light weights are good for starters. In the gym setting pulleys are ideal. The pulley rope can be adjusted so that the rotator cuff muscles can be worked in different positions. Keeping it functional is key so that the exercises mimic normal movement patterns.
Shoulder injuries from lifting weights usually involve a tear or strain of the rotator cuff. Overloading the shoulder is the main cause. Gym goers really have to pull back on the weights and build up again. The rotator muscles and their tendons need to be reloaded again with lighter resistance.

The stiff and painful shoulder:

In this scenario there are obvious limitations in movement with pain. The two common conditions in this category are the arthritic shoulder and frozen shoulder. The arthritic shoulder is one where there are limitations of movement due to joint degeneration. Sometimes the soft tissue around the joint become tight. There may some pain moving into the stiffness.

The frozen shoulder is another entity. This is where there is severe loss of movement in all directions and a lot of pain. There will be pain at night and with movement. We don’t know why a frozen shoulder occurs in some people. Sometimes it is caused by an underlying initial injury that produces inflammation.

For the stiff arthritic shoulder the treatment is to mobilize the joint using manual therapy and mobility exercises. The soft tissue restrictions can be mobilized with a general program of strengthening. Every shoulder is different depending on how stiff they are.
For a frozen shoulder, the treatment may last at least six months. It is important not to be too aggressive initailly to avoid aggravating it and causing more pain. It is one of the most challenging shoulder injuries to manage as the pain is quite high. I tend to use a mix bag of treatment techniques as each shoulder will respond differently.

 The Weak and Unstable Shoulder:

These shoulders tend to be the result of repeated dislocations. If dislocation becomes chronic then surgery is usually indicated. Regular dislocations tend to occur in contact sports. If surgery is not indicated then rehabilitation is aimed at strengthening the stabilizing muscles of the shoulder joint. Certain movements have to be avoided to reduce the risk of further dislocations.

Shoulder Gym Workouts: What exercises should I do?

EMG studies show that the rotator cuff muscles are activated with general shoulder movements. General pushing and pulling will activate both sides of the rotator cuff. Arm raises to the the side activate both. I still think it is a good idea to do some specific rotator cuff exercises as well as the larger movements. Pulleys and elastic bands are good for targeting these muscles.
Whatever level you are in the gym, the key is to build up slowly so to not cause injury.

Physiotherapy and Pilates for the Shoulder in Downtown Toronto:

In our Toronto Physiotherapy and Pilates clinic we use the classic Pilates equipment for rehabilitation. You just cannot beat the equipment for targeting the rotator cuff and scapula muscles. The variety of resistance, from springs to body weight, allows progression from acute to return to sport. You can read more about why this combined approach is so effective here: Why is it so effective?

If you have any questions about this blog you can email me at info@pilates4physio.ca. If you need specific advice about an injury, it is best to seek advice from a trained health professional. You can also contact me for advice about incorporating shoulder exercises into your workouts.

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