To find the cause of the problem, and exactly which structures are affected we would first note all the details about how the problem came about, timing, daily pattern, aggravating and relieving factors.
We find out how you use your arms and shoulders during work, exercise and other activities. We also ask about any issues with your spine and the rest of the upper limb joints, your health in general, and any significant events in the past such as accidents or surgery.
We then observe your shoulders, back and neck and assess movement in all directions – making note of any restrictions or pain. We will usually perform special tests to assess the nerves, joints, muscles and ligaments in the area and find where the problems are.
Once we have established our working diagnosis we will always take time to explain to you what we found, and let you know how we can help, and whether we need to make any referrals.
We then use specific massage, mobilisation and stretching techniques to improve the flexibility in joints and muscles, relieve tension, improve freedom of movement and mechanics, and ensure good circulation for effective recovery. We may use sports taping to support the injured area as it heals and provide additional stability.
With shoulder injuries, we always ensure that the healthy structures which are unaffected by injury are functioning at their best – supporting the vulnerable joint while the injured structures recover.
During the session, we also provide advice on exercise, posture and other techniques to aid fast recovery and maintain the treatment results.
Exercise and Advice
These are some of the most common techniques and exercises we prescribe for shoulder injuries or pain:
Creating space within the joint for better circulation and healing
Stand and lean on a low table or chair with your good arm.
Let the arm that needs stretching hang loosely straight down, like a pendulum – its weight entirely taken by gravity.
Swing the arm from the shoulder in small movements and circles, gradually increasing them within your comfort zone.
Variation: To increase the space created in the joint, you can add weight to the pendulum by holding a small weight or water bottle, or using a weight around your wrist. Do not do this if there is any suspected ligament injury in the joint.
Improving posture to protect the shoulders, neck and back
You can do this exercise anywhere, sitting or standing, while waiting for the train or at home while watching TV.
Start with your shoulders as relaxed as possible in a neutral position.
Then bring your shoulder blades back and down, as if to make them meet behind your back, or slip into your trousers’ back pockets.
Hold for only a second or two, then relax and start again. Repeat 10-20 times.
Tips: You can start by standing sideways in front of a mirror as you do it, and observe the dramatic change in your posture. As this exercise is designed to change the habitual ’round-shouldered’ or ‘slouchy’ posture, the more frequently it is done the better.
How does it work?
By bringing the shoulders back to their neutral place, beside our chest and not in front of it, we are improving the arms’ ability to move freely in all directions, thus reducing the potential for strains and injuries at the end of their range of movement.
This posture is also better for the back and neck, as it creates better alignment through the spine and reduces demand on its muscles.
Improving freedom of movement through the upper body
Windmills are essentially the upright version of front-crawl and backstroke swimming.
Standing or walking, start with your shoulders relaxed, and swing your outstretched arms in turn to create circles beside you in the air.
Follow each arm with your gaze as they move, to engage the neck and upper back in the movement as well.
Repeat 10 times forward and 10 times back.
If your shoulders won’t allow you to do this exercise comfortably, you can try bending at the elbows and creating circles with the elbows instead, or just rolling the shoulders with your arms relaxed beside you, still following the movement with your head and neck for maximum effect to the spine.
A gentle stretch for a tight, restricted shoulder joint – for example in frozen shoulder or after a fracture
Stand facing a table or counter and place your hands on the surface.
Without moving your hands, slowly back away from the counter as you lean your body forward. Move away from the table as far as comfortable.
When you feel a light pull, maintain the stretch for 20 seconds before returning to your initial position.
Similar to the Table Bow above, encouraging side movement
Stand with the affected side towards a high table.
Place your hand on the table and step away, allowing your shoulder to extend sideways.
Move away from the table as far as comfortable. When you feel a light pull, maintain the stretch for 20 seconds before returning to your initial position.
Improve shoulder range of motion
Stand facing a wall and put the hand of your injured arm against it.
Use your fingers to walk up the surface as far as you can.
When a light stretch is felt in your shoulder, hold your arm here for 10 seconds before sliding your palm back down again.
Tip: To measure progress, you can ‘walk’ with your fingers up a wall next to a picture, and note how far along it you can reach every day. Aim to climb a little further each time.