There’s a couple types of shoulder instability which can cause shoulder pain. We have success treating both the anterior shoulder instability cases as well as the multidirectional shoulder instability and microinstability type cases.
Here’s a quick case study: a high school swimmer with shoulder pain. This is a very common type of athlete seen in our office. She had worked with the school athletic trainer, a licensed physical therapist and has consulted a nonsurgical sports medicine physician. Since she was failing treatment it was recommended she consult with the orthopedist to consider surgery. Fortunately, the surgeon explained that for multidirectional instability, surgery needs to be the last option. That’s different compared to an anterior instability, which usually is the result of a trauma like a dislocation. Those, we refer on to ortho under the age of 20.
That said, it was recommended that she consult with me as her last ditch effort. I had a chance to work with this young athlete for a month or two prior to her season and utilizing a whole body type approach to rehabilitation, rhythmic stabilization type exercises, laser therapy and active release technique and she was able to complete her season with minimal issues. Additionally, after the season when she stopped swimming, she reported she’s very glad that she didn’t have a surgery and that her shoulder discomfort is now much more manageable as she continues with the rehabilitation exercises prescribed.
Here is a quick video describing the continuum of rotator cuff problems(from rotator cuff tendinitis to rotator cuff tears). I also show the starting point with the rehabilitation with a couple of exercise examples.
We see a lot of frozen shoulder here. We have a systematic approach to treating this frustrating and painful condition. If you’re reading this you probably have frozen shoulder(adhesive capsulitis) so we’ll keep this post short and sweet and avoid all the risk factors, definitions and so forth. The bad news with this condition is it can take a long time to beat. The good news is, most of these are self-limiting. That means it does get better in time. There is light at the end of the tunnel. We can help reduce pain and speed the progression in any of the three stages. The specific treatment rendered is dependent on the stage. There are clinical tests and historical clues that let us know which types of techniques and exercises to utilize. There is good scientific literature and support for the use of high intensity laser therapy for this condition as well as specific manual therapy techniques including active release technique.
Shoulder impingement is a broad term for anterior(front side) shoulder pain usually worse with overhead activities. There’s a few specific kinds of of impingement (subacromial, subcoracoid and posterior impingement) but the most common is the subacromial type. Some practitioners are getting away from using this term because it doesn’t really tell us which structure is injured. I still use it, but then try to identify the specific area involved. Sometimes we utilize diagnostic ultrasound to look at the rotator cuff, the bursa and some of the other surrounding structures including the biceps tendon. We also look at the intrinsic risk factors for shoulder impingement which include stiffness in the upper thoracic spine, muscle imbalances around the shoulder girdle. Some sports actually require an entire kinetic chain assessment as in baseball players and golfers. We try to be specific for the individual’s impairment and goals.
Shoulder impingement treatments
Specific stability exercises for the shoulder and scapula.
Manual therapy including soft tissue mobilization to the shoulder, thoracic spine and cervical spine.
Laser therapy to speed recovery and decrease pain.
Mobility exercises for the spine and shoulder.
Taping techniques for posture or shoulder positioning