Shoulder pain can be very debilitating. Tasks that were once small and simple can now seem tedious and painful. And if you enjoy being active, shoulder pain and impingement can prevent you from doing many of the things that you love!! So Where Do I Start?
First, we have to differentiate between two broad types of shoulder pain - there are MANY shoulder conditions out there but we're going to keep it simple and keep it broad.
What was the mechanism of injury? Suffering a Fall or Direct Blow to the Shoulder If you first started noticing your pain after suffering a fall or a direct blow to your shoulder then this post may not be for you. I recommend at least undergoing an x-ray to make sure that you haven't fractured any bones. You don't necessarily need an MRI and it doesn't matter if you tore your RC (minor tear vs major tear - major tears require surgery but most minor tears do not). However, you MUST find out if you did any damage to the bone before exercising - otherwise, you may delay healing to the bone and this can lead to surgery later on down the road.. so please seek care from a healthcare professional if you fit in this category. Gradual Onset Of Pain That Progressively Worsens Over Time On the other hand, if you are unsure when you injured your shoulder but the pain appeared to start gradually and is getting worse and worse every day then this article is for YOU! The longer you wait, the more at risk you are for developing compensatory movement patterns which will lead to more and more pain.
Anatomy & Physiology Of The Shoulder
Okay.. Let's back it up a bit and start with the anatomy. The picture shown below can be a bit intimidating but hopefully after this post you'll have a better understanding of the topic.
There's no better way than taking charge of your own health rather than relying on medical professionals to diagnose and treat you.. unfortunately, the way our health care system works today if you rely on someone else then you may be poorly advised. Especially if you're only with that person for 5-10 minutes at the most! So take the time now to educate yourself and get to know YOUR body :) Key Concepts Your shoulder is a ball-in-socket joint - picture it like a golfball on a tee. The golfball (humeral head) is bigger than the tee (glenoid fossa of the scapula). Because of this, your shoulder has LOTS of motion and mobility - more than any other joint of the body. But because of this, the shoulder can easily become unstable which can then lead to dislocations, rotator cuff/labral tears and impingement. Back to the ball-in-socket model: The rotator cuff consists of 4 muscles (subscapularis, supraspinatus, infraspintus & teres minor) that, when working properly, assist with centering the ball on the socket. This prevents the bad stuff from happening as discussed in the previous paragraph. When the rotator cuff isn't working properly (this can be due to a number of reasons) then it will have difficulty centering the ball in the socket which can then lead to pain - typically by upward migration of the ball (humeral head) that hits the acromion process which causes pinching (impingement) of the muscles. When these muscles are pinched, they tend to get inflamed and are inhibited. That leads to muscles imbalances and even more pain.
See why this cycle is so nasty??
Now that you know a little more about the anatomy of the shoulder, let's move on to treatment!
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A great exercise for opening up the mid-back is laying vertically on a foam roller. Make sure your tailbone and head are resting on the roller. Then bring your arms by your side to get an added stretch on the pectorals.
Perform this stretch for 5-10 minutes after work and/or before your workouts. If this is too much of a stretch, start with a towel roll. Get a regular sided towel from home and roll it up vertically then perform this same technique. |
# 3 Shoulder Mobility
It's very important that you address thoracic mobility BEFORE shoulder mobility. You can do as many shoulder mobility and flexibility exercises as you like but if you have poor posture and your thoracic spine is restricted it will be impossible to have full shoulder mobility - unless you compensate elsewhere, such as the low back or if you're have significant ligamentous laxity.
Since you've addressed your thoracic spine already (follow @missphysiofit for more thoracic spine mobility exercises), now let's move to shoulder mobility.
My favorite exercise is repeated shoulder extensions. We typically spend a lot of time in a neutral shoulder position or shoulder flexion (such as reaching forward or overhead) but we rarely spend time in shoulder extension (as pictured).
One way to restore shoulder mobility is by working in the opposite direction that you typically stay or work in. Take a golf club, broom or yard stick and perform the exercise as pictured. Perform 20 reps with 5 sec hold. Make sure you're standing up tall. Don't allow yourself to lean forward to performing this exercise. |
# 4 Shoulder Flexibility
You might hear the term "mobility" and "flexibility" used together. Some people use them to mean the same thing.
However, in the therapy world Mobility refers to motion within the joint. If a joint is hypomobile then it's stiff and restricted. If a joint is hypermobile then it's loosy goosy. Flexibility refers to the length of the muscles surrounding the joint. For example, tight hamstrings is a flexibility issue, restricted hip capsule is a mobility issue.
However, in the therapy world Mobility refers to motion within the joint. If a joint is hypomobile then it's stiff and restricted. If a joint is hypermobile then it's loosy goosy. Flexibility refers to the length of the muscles surrounding the joint. For example, tight hamstrings is a flexibility issue, restricted hip capsule is a mobility issue.
Mobility = intra-articular restriction (inside the joint)
Flexibility = extra-articular restriction (muscle restriction outside the joint)
Flexibility = extra-articular restriction (muscle restriction outside the joint)
Similar to addressing the thoracic spine BEFORE the shoulder... you should also address mobility restrictions BEFORE flexibility restrictions. If the hip joint is restricted, you can stretch your hammies until the cows come home but you won't make a difference at the hip joint.
But since you've already address your thoracic and shoulder mobility.. let's move on to shoulder flexibility exercises. The #1 culprit(s) I see primarily involved in restricted overhead motion is the Latissimus Dorsi (AKA the Lats) and Teres Major.
But since you've already address your thoracic and shoulder mobility.. let's move on to shoulder flexibility exercises. The #1 culprit(s) I see primarily involved in restricted overhead motion is the Latissimus Dorsi (AKA the Lats) and Teres Major.
When there is pain at the shoulder, both muscle groups tighten up as a protective mechanism. However, if the issue at the shoulder isn't addressed quickly, then they can cause further problems.
The Lat is a powerful and broad muscle group that span from the shoulder to the pelvis. It's a powerful extender of the shoulder as well as adducts and internally rotates (IR) the arm (adducts = brings it in toward the body, IR = rotating the arm inward). The teres major is a small muscle that attaches to the blade and the "ball" part of the shoulder, it also adducts and IR the shoulder.
My favorite exercise to restore flexibility of the lats and teres is to foam roll them (see above video). Now this doesn't restore flexibility permanently, nor does it "break up scar tissue". However, it can temporarily restore some muscle length so that you can do the strength and stability exercises in the next section. Once strength/stability is restored to the shoulder joint then the flexibility issues are usually no longer a problem. As stated previously, the muscles get tight and restricted to compensate for the lack of stability.. restore the stability issues and the muscles will naturally elongate over time.
Foam roll for no longer than 5 minutes. I usually foam roll each segment 20-30 second 1-2 times each before performing the strength/stability exercises.
# 5 Rotator Cuff/Scapular Stability
We've discussed avoiding staying in the same position for a prolonged period of time -which usually involves the forward head position. Then we discussed thoracic and shoulder mobility and moved on to flexibility. Now let's get to the fun stuff!
I see trainers do this all too often.. they start with the strength & stability aspect and then end with flexibility/mobility. However, they're missing out on key aspects into recovery which can cause further pain, injury and aberrant movement patterns.
If you attempt to strengthen a muscle crossing a joint that lacks mobility and/or flexibility or even an adjacent joint (such as the thoracic spine) then this WILL lead to further compensations due to the restrictions.
So please don't skip over the previous sections because they're boring or don't seem as effective. They are the bread and butter in restoring full shoulder motion and abolishing pain.
As far as strength & stability goes, you want to focus on the posterior rotator cuff (the muscles on the back of the shoulder) as well as the scapular stabilizers (the muscles that connect to the shoulder blades).
Please watch the video below for some of my favorite rotator cuff and scapular stabilization exercises.
I see trainers do this all too often.. they start with the strength & stability aspect and then end with flexibility/mobility. However, they're missing out on key aspects into recovery which can cause further pain, injury and aberrant movement patterns.
If you attempt to strengthen a muscle crossing a joint that lacks mobility and/or flexibility or even an adjacent joint (such as the thoracic spine) then this WILL lead to further compensations due to the restrictions.
So please don't skip over the previous sections because they're boring or don't seem as effective. They are the bread and butter in restoring full shoulder motion and abolishing pain.
As far as strength & stability goes, you want to focus on the posterior rotator cuff (the muscles on the back of the shoulder) as well as the scapular stabilizers (the muscles that connect to the shoulder blades).
Please watch the video below for some of my favorite rotator cuff and scapular stabilization exercises.
I hope you've found this helpful! Do NOT perform these exercises if they cause you pain. Please seek further help from a local physical therapist or physician of your choosing.
And If you're local to the Nashville area, I provide FREE Discovery Visits and Phone Consultations. I would love to talk with you and explain how I can specifically help YOU and YOUR pain.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at [email protected] or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at [email protected] or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
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Have you been experiencing pain for one week, one month, or over a year? Maybe over 10 years?? Maybe you know someone in your family that has been suffering with the same injury for what seems like decades.
Have you (or they) been to countless physician appointments, taken prescription medications like it's your job, and possibly even undergone surgery?
Maybe you're afraid of that cycle because you've seen your Aunt Bessy go through it and you're afraid that you're going down that same destructive path.
First thing to note:
Our healthcare system is broken.
The days of speaking with your MD or Specialist are over. Now we have become reliant upon assistants and other practitioners. That's not to say that they don't do a fine job. However, physicians are now in charge of seeing their patients and overseeing the patients of PAs (physician assistants) and NPs (nurse practitioners).
You can see how it would be easy to overlook someone's problem or unintentionally let people slip through the cracks. I don't blame the practitioners for this.. I blame the insurance companies and greed - but that's a topic for another day.
Let's get to my point:
Low back and neck pain are key contributors with the rise in opioid use. Many will go to specialist after specialist, undergo countless imaging and testing, along with injections... without any relief in their pain. For many people, their pain actually INCREASES.
And this is where it starts.. for many, it may have started at the very beginning. Their physician gives them a prescriptions for anti-inflammatories and pain killers. When that doesn't work then they start with the injections over the course of several months which then eventually leads to surgery.
Throughout this entire process, physicians continue to prescribe pain killers because what else can be done? Might as well try to help them numb the pain until it can be "fixed" with surgery, right? And don't forget about their caseload.. alot of practitioners don't have time to think about anything other than referring a patient to a specialist or performing surgery.. when was the last time you spent more than 10 min with your physician?
After surgery, the pain still continues... then what happens?
Typically they will refer these patients to other "specialists"..
and so the cycle begins...
AGAIN.
I have a BIG problem with this cycle..
First of all.. IT NEEDS TO END.
Secondly.. How do we do that?
We have to determine the underlying cause of the pain. Pain doesn't happen randomly and for no reason.
This is our body's way of saying.. "I'm not a big fan of what you're doing here.. something's just not right!" If not, then we would continue to do further damage without knowing it.
BUUUTTT..
That's EXACTLY what our painkillers are doing..
They kill the pain. Quite literally.
You might be thinking to yourself, "Well I'd rather not be in pain so what's the harm in taking them for the time being?"
Because it's disrupting your body's normal alarm system. It's quieting it down or shutting it off completely. And just because the pain goes away (or is decreased) that doesn't mean it's getting better. Many times, you'll end up doing more harm because you can't feel what you're doing.
You won't feel the pain when sitting at your desk at work. You won't feel the pain when picking up your kiddo or grandkiddo. You won't feel the pain when picking something up off the floor.
Eventually, you will have to take more medication to have the same effects and that's when it can become scary.
The people getting addicted to opioids aren't the men and women who are living on the streets...
It's the average person trying to get by. Trying to continue working without going on disability... Trying to tackle all of the responsibilities of being a parent... Trying to live an active lifestyle... You get my point.
You won't feel the pain when sitting at your desk at work. You won't feel the pain when picking up your kiddo or grandkiddo. You won't feel the pain when picking something up off the floor.
Eventually, you will have to take more medication to have the same effects and that's when it can become scary.
The people getting addicted to opioids aren't the men and women who are living on the streets...
It's the average person trying to get by. Trying to continue working without going on disability... Trying to tackle all of the responsibilities of being a parent... Trying to live an active lifestyle... You get my point.
What needs to happen is the first line of access should be seeing a Physical Therapist
If you don't know one.. then find one! Do your research. Don't just go to the Physical Therapist that is the closest to your work or home.
Finding a true Musculoskeletal Specialist that isn't bogged down by all of the paperwork as well as being overworked and underpaid may be difficult, but it's not impossible.
But you would do this when researching a Neurosurgeon.
You wouldn't pick the first one that pops up on Google or one because they have a hospital closest to your home.. at least I hope not! :)
I understand that surgery on the spine can be very dangerous so you'll want the best! And I'm not saying Physical Therapy comes with the same precautions as surgery. However, if you see a PT that doesn't perform a thorough comprehensive assessment and establish a treatment progression based on YOUR specific needs then you will slip through the cracks unnoticed and be on the track for surgery.
And get this.. you may have surgery on something that ISN'T the primary cause of your pain. You complain of back pain and symptoms down the leg.. then go in for an MRI to show horrid things.. "oh my! I have degenerative WHHAATT? Well of course I need surgery!"
Let me break it down.. just because you have signs (or actually have) degenerative disc disease or joint disease does NOT mean that you automatically HAVE to have surgery. And just because someone says your joint is "bone on bone" doesn't mean you HAVE to have surgery!
Does it mean that you will never require surgery?? Of course not.
But why not give the conservative route (AKA Physical Therapy) a try? What harm could it do? You can ALWAYS have surgery..
And most importantly, I have helped many people return to active and healthy lifestyles without requiring surgery.. And . yes, these are people who have been told, "You have the worst spine I've ever seen" and "You're bone on bone. There's no way you'll be able to play with your grandchildren".
So there is still hope!
Finding a true Musculoskeletal Specialist that isn't bogged down by all of the paperwork as well as being overworked and underpaid may be difficult, but it's not impossible.
But you would do this when researching a Neurosurgeon.
You wouldn't pick the first one that pops up on Google or one because they have a hospital closest to your home.. at least I hope not! :)
I understand that surgery on the spine can be very dangerous so you'll want the best! And I'm not saying Physical Therapy comes with the same precautions as surgery. However, if you see a PT that doesn't perform a thorough comprehensive assessment and establish a treatment progression based on YOUR specific needs then you will slip through the cracks unnoticed and be on the track for surgery.
And get this.. you may have surgery on something that ISN'T the primary cause of your pain. You complain of back pain and symptoms down the leg.. then go in for an MRI to show horrid things.. "oh my! I have degenerative WHHAATT? Well of course I need surgery!"
Let me break it down.. just because you have signs (or actually have) degenerative disc disease or joint disease does NOT mean that you automatically HAVE to have surgery. And just because someone says your joint is "bone on bone" doesn't mean you HAVE to have surgery!
Does it mean that you will never require surgery?? Of course not.
But why not give the conservative route (AKA Physical Therapy) a try? What harm could it do? You can ALWAYS have surgery..
And most importantly, I have helped many people return to active and healthy lifestyles without requiring surgery.. And . yes, these are people who have been told, "You have the worst spine I've ever seen" and "You're bone on bone. There's no way you'll be able to play with your grandchildren".
So there is still hope!
Musculoskeletal Specialists will provide you with a comprehensive total body assessment
This will involve a detailed history of YOUR PAIN. Each session should be 45-60 minutes long and should be heavily manual based.. meaning they work on your _____ fill in the blank by using manual techniques.
Through their assessment, they should be able to develop a plan of care that tackles the underlying cause of your pain.
Remember that children's song.. "The leg bone's connected to the knee bone, the knee bone's connected to the thigh bone..?"
Well, its true!!
Your body is a kinetic chain.. meaning that everything works TOGETHER.
When one part moves, the other part stabilizes. Therefore, if you have an injury or source of pain in one area of your body.. then you'll certainly develop aches and pains in other areas of your body.
And when you add painkillers into the mix you can see how that can be a toxic concoction.
Through their assessment, they should be able to develop a plan of care that tackles the underlying cause of your pain.
Remember that children's song.. "The leg bone's connected to the knee bone, the knee bone's connected to the thigh bone..?"
Well, its true!!
Your body is a kinetic chain.. meaning that everything works TOGETHER.
When one part moves, the other part stabilizes. Therefore, if you have an injury or source of pain in one area of your body.. then you'll certainly develop aches and pains in other areas of your body.
And when you add painkillers into the mix you can see how that can be a toxic concoction.
One thing that I do want to note is that if you are currently dealing with pain and are discouraged.. DON'T LOSE HOPE!
I have seen, firsthand, how resilient the body is. Just because you've been told, "that's the worse (insert body part) I've ever seen" or "it's bone-on-bone" or even "you have degenerated discs and joints, you shouldn't do xyz.." doesn't mean it's true!
I have had MANY people overcome pain that they thought they would have to deal with the rest of their life.. Is it easy? Heck no!! Is it possible? Heck yes!!
Now depending on how long you've been dealing with the pain and how many body parts are involved, it might take longer than you like. Unfortunately there are no quick fixes in life.
If someone tells you they can fix something in one session then you might want to walk the other way. That's not real life.. However, if you are dedicated to overcoming your pain and will do anything to get back to a healthy and active lifestyle then, by golly, you can!!
Where to go from here?
Over the next few weeks I will be discussing common injuries (starting with back pain) and ways to treat them!
If you're local to the Nashville area, I provide FREE Discovery Visits and Phone Consultations. I would love to talk with you and explain how I can specifically help YOU and YOUR pain.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at [email protected] or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
If you're local to the Nashville area, I provide FREE Discovery Visits and Phone Consultations. I would love to talk with you and explain how I can specifically help YOU and YOUR pain.
I also offer Money-Back Guaranteed after 2-4 sessions if you're not completely satisfied with the results. I 100% believe in what I do. I have seen people's lives transformed by making minor modifications to their daily routine. You will be surprised what the body can overcome if you are able to address the real reason behind the pain.
And please subscribe to my newsletter to get email reminders for my upcoming posts! I'll also send you my FREE Back Pain Guide!
I would also love to hear any questions that you may have! Please email me directly at [email protected] or comment below!
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
www.amplifyphysio.com
Insurance can be very confusing! There are many terms such as deductible, co-pay, max out-of-pocket, in-network vs out-of-network... and there's not a lot of resources out there that break in down and give it to you straight.
You may be wondering why I'm even writing about this...
The reason is because I have had several potential patients seek Physical Therapy elsewhere because they were thrown off by the fact that my clinic is "Out-Of-Network" with their insurance without fully understanding what that means.
First of all, this does NOT mean that I don't take your insurance!
But before we get into the nitty gritty let me break things down a bit:
Deductible = the amount of money you pay out of your pocket until your insurance will cover part or all of the expenses
This can range from $500 - $10,000!
This can range from $500 - $10,000!
Until your deductible is met, you are paying ALL of the medical expenses regardless if you're going to an "In-Network" or "Out-Of-Network" clinic.
In-Network Provider = the provider (physical therapy, physician, dentist, etc.) has contracted with your insurance company to provide negotiated (discounted) rates
On average, once the deductible is met, the insurance company pays for 80-100% for the cost of service being provided.
On average, once the deductible is met, the insurance company pays for 80-100% for the cost of service being provided.
Out-Of-Network Provider = the provider (physical therapy, physician, dentist, etc.) has NOT contracted with your insurance company to provide negotiated (discounted) rates
On average, once the deductible is met, the insurance company pays for 50-70% for the cost of service being provided.
On average, once the deductible is met, the insurance company pays for 50-70% for the cost of service being provided.
So why would I ever go to an Out-Of-Network Provider?
Most of my patients have such high deductible that they will not come close to reaching it with my services. So regardless if they are going to an "In-Network" or "Out-Of-Network" Physical Therapy clinic, they will be billed the SAME (meaning all out-of-pocket until the deductible is met).
However, for those who HAVE already met their deductible, most "Out-Of-Network" insurance plans cover at least 50-70% of costs.
Anddd..
Due to the In-Network negotiated rates, most outpatient clinics see 2-4 patients per hour! They also see the average patient for 2-3 times a week for 8-12 weeks (I used to work in an In-Network clinic so I know this from firsthand experience).
At my clinic, I typically see patients 1-2 times a week with an average of 5-8 sessions TOTAL.
If you do the math, the total costs average out to be very close if not LESS going to see me Out-Of-Network.
Another Anddd..
You don't need a physician's referral to schedule an appointment with me! You can see me directly and avoid the tedious appointments that can be both time-consuming and expensive!
However, for those who HAVE already met their deductible, most "Out-Of-Network" insurance plans cover at least 50-70% of costs.
Anddd..
Due to the In-Network negotiated rates, most outpatient clinics see 2-4 patients per hour! They also see the average patient for 2-3 times a week for 8-12 weeks (I used to work in an In-Network clinic so I know this from firsthand experience).
At my clinic, I typically see patients 1-2 times a week with an average of 5-8 sessions TOTAL.
If you do the math, the total costs average out to be very close if not LESS going to see me Out-Of-Network.
Another Anddd..
You don't need a physician's referral to schedule an appointment with me! You can see me directly and avoid the tedious appointments that can be both time-consuming and expensive!
My passion is helping adults and athletes (of all ages) get back to what they LOVE doing without relying on pain medications, injections, or surgeries!
SOOOO...
Now is the time to take control of YOUR health and break from this nasty cycle that health care professionals have put you in. Your pain will no longer be overlooked!
Click on the link below for a super quick list of questions to ask your insurance provider!
Insurance Benefits Worksheet
If you've found this article helpful please let me know! I would love to hear feedback from you! And if you have any questions please feel free to shoot 'em my way!
www.amplifyphysio.com.com
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
Now is the time to take control of YOUR health and break from this nasty cycle that health care professionals have put you in. Your pain will no longer be overlooked!
Click on the link below for a super quick list of questions to ask your insurance provider!
Insurance Benefits Worksheet
If you've found this article helpful please let me know! I would love to hear feedback from you! And if you have any questions please feel free to shoot 'em my way!
www.amplifyphysio.com.com
Dr. Katie Spruell, PT, DPT, CSCS
Amplify Physio, LLC
Dr. Katie Spruell, PT, DPT, CSCS
I am a licensed Physical Therapist and Certified Strength & Conditioning Specialist practicing in Maryville, TN. I started a small private practice - Amplify Physio, LLC - in April 2018. Recently I moved my practice to Maryville, TN.
My hope is to take Maryville by storm and challenge the current healthcare system! I believe Physical Therapists should be the first line of treatment because who better to treat you than a musculoskeletal & movement specialist?!
I want to help people decrease their pain and live a high quality of life. When you're living in pain, life can seem hopeless and I want to show people there is hope!
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