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Welcome to Rory Holiday Physiotherapy September Newsletter!
Here we are again for another edition of my monthly newsletter. This month I will be talking about shoulder pain and the symptoms and treatments available. There is also another "Exercise of the Month" to have a go at.

Enjoy reading and feel free to ask me questions, send me feedback on the newsletter or suggest improvements. Don't forget to share this with your friends!

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A SHOULDER TO CRY ON
 
If there was a list of parts of the body that physios find particularly confusing and difficult to treat, then the shoulder would probably be at the top! Sacrificing stability for mobility, the shoulder is a common source of pain for all age groups, types of work and leisure pursuits - even couch potatoes!
 
In my experience, problems can be created gradually with no clear cause as frequently as obvious mechanical injuries are sustained. Those individuals with occupations that place excessive demands on the shoulder in positions of relative weakness are definitely at high risk (as the plastering climber will attest to!).
 
Like all synovial joints of the body (joints containing a lubricating liquid), the shoulder has a joint capsule that creates the deepest layer of support. Specific thickened bands within this capsule can be regarded as ligaments and provide greater stability in certain directions and positions of load. Peripheral expansions of the cartilage, called the labrum, serve to deepen the “socket” of the shoulder, creating further stability.
 
                 
         
 
So far, this description has focussed on the glenohumeral ”ball and socket” joint of the shoulder, yet there are also joints where the collar bone attach to the chest and shoulder blade (acromio clavicular and sternoclavicular joints). The shoulder blade and its motion over the rib cage is also considered a joint of sorts (scapulothoracic joint). Close by all of this considerable anatomy are some significant nerve bundles. Close by as well is the frequently involved sub acromial bursa. This little lubricating pouch of synovial fluid sits on top of the ball of the joint between the rotator cuff and the bony bit of shoulder blade, called the acromium, which projects over the corner of the shoulder. On top of the capsule is a thin layer of stabilising muscle and tendon called the rotator cuff.
 
Most superficial of all are the larger “moving” muscles of the shoulder that create the motions with power that that are stabilised by the deeper structures. Most superficial of all are the larger muscles which actually move the shoulder joint and create the power. All of these structures are capable of dysfunction giving the frequently reported capsular and labral tears or laxity issues, muscle and tendon problems (tears or tendinopathies) and impingements of the bursa or rotator cuff tendon.

Of this brief description of things that can go wrong, impingement is probably the most common presentation. Although several of the above issues coexisting is most likely.

 
 

 


PHYSIOTHERAPY

 
Although there are various types of dysfunction causing a functional impingement, a common and powerful part of the problem is the development of stiffness in the back of the joint. This could be just the capsule, just the muscle or a bit of both. A lot of the manual therapy I do with these is to release and loosen this stiffness. The technical term for this finding is the GIRD (Gross Internal Rotation Deficit).Treatment and exercise that reduces this deficit is often effective at managing if not curing the problem.

It goes without saying, that no shoulder problem is easy to diagnose and treat. This is usually just one facet of a person’s problem. As those who have listened to me before will know, I can talk for hours about this stuff, so I will not bore you with all the possible eventualities!

Here’s a quick test if you have a shoulder problem. Slide the good hand up behind your back, now compare the bad side. Is there a significant difference on the bad side? If so, you may have a GIRD (although there are some better, more accurate tests for this).

A popular exercise for those with GIRD is the “sleeper stretch” detailed in the "Exercise of the Month".

A big note of caution, even if you do think you have an impingement and a GIRD, you must take care not to push into pain with this stretch. Although this targets the stiff tissues well, it also pushes the humeral head up into the acromion thereby causing more impingement!

EXERCISE OF THE MONTH!

"The Sleeper Stretch"

 
Lying on the affected side, bring the shoulder to a 90 degree angle so the arm is straight out in front of you. Bend the elbow to a 90 degree angle. Press the wrist toward the floor until discomfort is felt.

Sustain the stretch for 30 secs or pulse for 30 if too painful to sustain.

Repeat 3-4 times per session.

Do this each day so long as there is no lasting increase in pain.


It’s useful to note the angle you can get to so you can compare with the opposite side to see what you are roughly aiming for eventually.

The advice I’ve given will no doubt help if you fit the right criteria but nothing beats a full physiotherapy assessment and treatment session.

If you have a shoulder impingement, or something else that you would like to consult me on then please contact me on any of the following:

Mobile - 07854870865,

Email -
mail@roryhollidayphysiotherapy.co.uk.

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