Crisis Plan Series
Subacute shoulder pain
Continuing my last newsletter on the physical management of acute shoulder pain, I would like to discuss the manipulative physiotherapy approach in the management of shoulder injury in the subacute and chronic (long-standing) stage. As a result of inflammation, the subacromial structures at the tip of the shoulder often become thickened. The capsular ligaments of the shoulder joint become thick and tightened, often with scar tissue adhesions. In severe case, the shoulder becomes 'frozen' . All shoulder movements are restricted. Cervical (neck) and thoracic (upper back) spine movements could also be painful and restricted. In other words, a more simple tendonitis (tendon inflammation) could now develop into a more complicated condition involving joints and soft tissues in the shoulder/neck/upper back complex.
Palpable parts of the thickened soft tissues could be treated by the good old, but often forgotten, deep friction massage. The non-palpable deep parts have to be 'rubbed' by some manipulative grinding techniques. The tight and thickened adhesions will have to be mobilized and stretched. The shoulder joint has to be mobilized by many specific manipulative techniques into all different directions. Such intense treatment may cause pain at the time and treatment soreness after. The patient must therefore be informed and reassured of such 'no pain no gain' approach. Of course, treatment should be progressed gradually to avoid over-treatment and unacceptable discomfort. Home exercises to ensure fastest recovery must be encouraged. This should include the easier exercises as described last time plus:
Wall climbing to full flexion (forward elevation),
Such exercises should be performed as strong as tolerable and as much as possible throughout the day. The success of treating such shoulder problem relies on the doctor's initial medications, onging encouragement and reassurance, the musculoskeletal physiotherapist's torturing manipulative techniques and the patient's perseverance on his exercises!
Luck LI
Musculoskeletal Physiotherapist
Palpable parts of the thickened soft tissues could be treated by the good old, but often forgotten, deep friction massage. The non-palpable deep parts have to be 'rubbed' by some manipulative grinding techniques. The tight and thickened adhesions will have to be mobilized and stretched. The shoulder joint has to be mobilized by many specific manipulative techniques into all different directions. Such intense treatment may cause pain at the time and treatment soreness after. The patient must therefore be informed and reassured of such 'no pain no gain' approach. Of course, treatment should be progressed gradually to avoid over-treatment and unacceptable discomfort. Home exercises to ensure fastest recovery must be encouraged. This should include the easier exercises as described last time plus:
Wall climbing to full flexion (forward elevation),
- Arm above head stretch,
- Horizontal adduction (arm across chest) stretch,
- Horizontal abduction (arm out sideway) stretch.
Such exercises should be performed as strong as tolerable and as much as possible throughout the day. The success of treating such shoulder problem relies on the doctor's initial medications, onging encouragement and reassurance, the musculoskeletal physiotherapist's torturing manipulative techniques and the patient's perseverance on his exercises!
Luck LI
Musculoskeletal Physiotherapist