Shoulder Pain Relief

Shoulder pain relief from conservative care includes decreasing inflammation with cryotherapy (ice), restoring normal range of motion, manipulating the associated joints, and strengthening the rotator cuff and scapular stabilizers through rehabilitative exercise.

Prevention includes teaching young and older athletes proper biomechanics and strengthening exercises. Chiropractors could also provide post surgical rehabilitation to shoulders that have been repaired.

The treatment goals include reestablishing full ROM, synchronizing the firing of the rotator cuff and periscapular muscles, and reestablishing normal glenohumeral and scapulothoracic kinematics. The program should be performed in positions avoiding both impingement of the rotator cuff tendons on the overlying acromial arch and further stress on the rotator cuff.

If the posterior capsule is considered tight and then treated, this will decrease the obligate antero-superior translation of the shoulder, which minimizes contact between the rotator cuff and the acromion. Once stabilization of the rotator cuff is achieved any failed screens should be addressed and treated.

The first line of treatment in full thickness tears should be conservative care. This process is aimed at decreasing inflammation initially. The decrease in pain will allow for the clinician to start restoring function to the shoulder and rotator cuff. Restoring function starts with increasing the ROM of the shoulder.

Eliminating contractures decreases the risk of subacromial impingement. Once this occurs, rotator cuff strengthening allows the intact and functioning cuff musculature to compensate for the torn tendon or tendons. If conservative management fails, many believe, that recovery from surgical rotator cuff repair is easier in a shoulder that was supple preoperatively than one that was stiff.

Once surgery is completed to repair the rotator cuff a chiropractor could provide the post-operative rehabilitation. The chiropractor can provide the necessary manipulations to the upper thoracic spine and cervical spine needed to restore function.

Upper thoracic spine extension is essential in shoulder patients. The goals of post op surgery are to achieve healing of the cuff while restoring pain-free motion and function. The rehabilitative process can be broken down into phases with different goals and may take up to 16 weeks to complete.

Conservative management and rehabilitation is important for a successful outcome in shoulder pain relief and should be continued for at least 3-6 months or longer after which 60-90% of cases will have resolved.

Treatment should start with swelling, pain and inflammation reduction. A good way to achieve this is with cryotherapy when the injury is in the acute stage. The patient or athlete should use the 20 minutes on 20 minutes off method of cryotherapy.

In the case of impingement syndrome significant time must be spent evaluating the function and stability of the scapula and first costovertebral joint. The chiropractor would then assess the specific joints of the shoulder looking for any dysfunction.

Once the dysfunctional scapula is stabilized, rotator cuff strengthening can be started staying away from the impinging position. Once strengthening is achieved in the rotator cuff proprioceptive training or sport specific exercise can begin.

Rotator cuff tendonopathy almost always gets treated by conservative providers for shoulder pain relief. Treatment should be initiated with the goal of eliminating pain, and restoring motion.

Meister and Andrews suggest a four phase rehabilitation program for rotator cuff tendinopathy. The first phase normalizes motion and retards any muscle atrophy and rotator cuff strengthening of the external rotators as well as the scapular stabilizers. The goals of phase 2 are progress strengthening exercise and restore muscle balance.

At this time core strengthening and stability should begin. Phase 3 consists of aggressive strengthening progressing to neuromuscular control while improving strength, power, and endurance. Phase 4 is the return to activity phase such as throwing or getting back to working. Plyometric exercise for athletes can be introduced during phase 4.

Other ways to get shoulder pain relief

SBI!