A so-called “ball-and-socket” joint, the shoulder connects the arm to the torso. To get more anatomically specific, it holds together the humerus (upper-arm bone), scapula (shoulder blade), and clavicle (collar bone).
Partially due to its power and exceptional range of motion (ROM), it is one of the most commonly injured joints in the body. And you don’t have to be a major league pitcher to have your daily routine majorly disrupted by shoulder pain; it can affect your ability to do everything from reaching the top shelf at the grocery store to taking Fido for a walk.
The good news is that physical therapy can help. In fact, it may just help you avoid an expensive surgery with a long recovery period.
Comprised of numerous ligaments and muscle attachments, the shoulder joint is a complex structure. In fact, it actually includes three different joints:
- The glenohumeral (GH) joint;
- The acromioclavicular (AC) joint; and
- The scapulothoracic (ST) joint.
One component of the shoulder joint that most people are familiar with—or have at least heard of—is the rotator cuff. This structure contains four muscles that cover, support, and stabilize the shoulder joint. Rotator cuff injuries—including tears—are often the culprit behind shoulder pain and mobility issues.
Other factors contributing to—or causing—shoulder pain and injury include:
- Aging: Older tissues are less resilient and more prone to injury. Additionally, as people age, they often become less physically active; resulting muscle atrophy and weakness can increase the risk for shoulder injury.
- Overuse: Repetitive motion and fatigue (i.e., with certain athletic activities like pitching) can lead to strain and inflammation—and thus, pain.
- Trauma: Forceful contact—sustained during a sporting event, fall, or accident, for example—may cause traumatic shoulder injury and pain.
Some of the most common shoulder-related diagnoses resulting in pain include:
- Tendonitis (i.e., inflammation) of the rotator cuff or biceps
- Bursitis (i.e., inflammation of the bursa sacs that help cushion the shoulder joint)
- Subluxation (i.e., partial dislocation of the shoulder joint)
- Impingement (i.e., dysfunction related to structural abnormality or poor posture)
- Adhesive capsulitis (i.e., frozen shoulder)
Once a patient has received the necessary immediate medical attention (i.e., for a traumatic injury), he or she may be referred to a physical therapist to help alleviate pain and restore function in the shoulder joint.
The physical therapist will determine whether the patient’s swelling and inflammation have decreased enough for the patient to resume movement. Once it’s safe to proceed, the therapist will evaluate the pain, determine the diagnosis (if necessary), and create a treatment plan tailored to the patient’s ability and goals. The initial evaluation typically involves a series of tests designed to pinpoint the patient’s level of pain and functional impairment, including range of motion limitations.
Physical therapy care plans for shoulder conditions may include:
- Aquatic therapy (e.g., moving the joint in water to minimize force and pain)
- Strengthening exercises
- Proprioception training (to help the patient develop awareness of joint position, orientation, and motion)
- Therapeutic massage/manual therapy
- Hot-cold therapy
- Electrical stimulation
- Joint manipulation/mobilization
The therapist will also design a home exercise program to promote care continuity outside of the clinic. This program will include a list of exercises the patient is to perform each day, along with the associated durations and frequencies.
The length of the care plan will depend on a variety of factors, including the patient’s general health, the severity of the pain/issue, whether surgery occurred, and how compliant the patient is with his or her prescribed program. All of that being considered, rehabilitation of shoulder issues can take anywhere from several weeks to several months. The therapist’s goal is always to help the patient resume his or her normal life as quickly as possible, so it is imperative to follow the therapist’s plan and instructions.