Shoulder Pain

Shoulder pain is one of the most common reasons people seek treatment from our trusted physiotherapists, chiropractors or massage therapists here at Sunup Physiotherapy. In some cases, there is a specific injury that occurs, but more often shoulder pain develops gradually for no apparent reason. In both cases, it is important that you have your shoulder pain assessed by a physiotherapist and or chiropractor. The earlier you seek treatment, the faster you will have pain relief and it is less likely that stubborn compensation strategies take over making it harder to recover.

Seeking treatment with a trusted Physiotherapist, Chiropractor, Massage therapist or having an Ergonomic assessment is a smart way to treat the pain or prevent it before it happens.

Why is the Shoulder Joint Unique?

The shoulder is very mobile area of the body and it functions as result of many joints working in conjunction. These joints include:

  • Glenohumeral- ball and socket
  • Scapular-thoracic joint- shoulder blade to rib cage
  • Acromino-clavicular- attaching your collar bone to the ball and socket
  • Sterno-cavicular- attaching your shoulder, arm and hand to your torso

The joint we think of when it comes to the shoulder is the ball and socket, Gleno-humeral joint. This joint is inherently unstable by design which allows the shoulder joint to have a large range of motion. When you think of this joint, imagine it like a golf ball sitting on a golf tee. It has a large round bone articulating with a shallow small crest. Due to this, the shoulder relies heavily on the strength and co-ordination of muscles, ligaments, and an intact labrum to move effectively and without pain. A centered shoulder is a happy shoulder, and this ball should remain in the centre of the socket as we move. Problems arise when there is poor centering of this ball through range which wears on the soft tissues that hold it in place. This occurs especially overtime with poor postures of the spine and shoulder.

What are the Causes of Shoulder Pain?

Rotator Cuff Dysfunction: This can include strains, tendinopathies or even tears in these four important stability muscles of the shoulder. The rotator cuff muscles include the Supraspinatus, Subscapularis, Infraspinatus and Teres minor. In this injury one or more of these muscles have been overloaded and irritated creating tissue damage.

Bicep Tendinopathy: The bicep muscle links your forearm and upper arm to the front of your shoulder and due to postures or repetitive movement, this tendon can be vulnerable to overload and/or increased friction and irritation.

Shoulder Impingement: As described above, a centered alignment of the shoulder throughout movement is important to prevent injury. If the ball, of the ball and socket joint, is tracking high/forward in the shoulder or if the shoulder blade does not move in a co-ordinated fashion, the muscles and or bursae will be pinched under the bone above. This causes a sharp catching pain as your raise your arm above head. Overtime, if not corrected, it can wear out the tissue and lead to rotator cuff dysfunction or shoulder bursitis.

Shoulder Bursitis: A bursa is a small fluid filled sac found in areas of high friction caused by muscles or tendon movement. Their purpose is to help lubricate the area and provide sensory feedback. If abnormal movement patterns or excessive compression occurs then the bursae can become inflamed. While in an acute inflammatory stage, a shoulder bursitis can cause strong pain, weakness and significant loss in range of motion. In later stages of bursitis, it may appear more like a shoulder impingement or Rotator cuff dysfunction.

Frozen Shoulder or Adhesive Capsulitis: This is one of the most frustrating shoulder injuries because the true cause is unknown and can take six months to two years to resolve and it cannot be clinically diagnosed by imagining. In this injury, the joint capsule of the shoulder is believed to experience an auto-immune reaction that causes it to become inflammed and tighten around the glenohumeral and acromio-clavicular joint. Pain, gradual loss of range of motion and stiffness ensue.

Shoulder Instability and Shoulder Dislocation: The shoulder is inherently more unstable due to its anatomical design. When there is an underlying shoulder dysfunction it can be looser and/or with a significant force applied to the shoulder it can become dislocated. In a dislocation scenario, you will need to head over to the nearest emergency room to have it relocated and the muscles and nerves checked. To avoid this from happening and also rehabilitate this type of shoulder injury, strengthening and stabilization training will be integral to the successful treatment.

Labral Tears: The Labrum a strong tissue seal that surrounds the outside of the socket deepening it and creates an air tight seal to further stabilize the shoulder joint. The Labrum is typically torn after a shoulder dislocation or trauma and therefore once the seal is broken the shoulder has lost a percentage of stability. This is a common injury for surgeons to operate on but research does show that conservative treatment in the form of physiotherapy can help reduce the need for surgery and can lead to a pain free recovery without having to go under the knife.

Shoulder and Neck Pain caused by a Cervical Radiculopathy: The pain that is felt in the shoulder is actually coming from compression or irritation of a nerve from your neck. This also can refer pain down into the arm and hand. If you have this condition, you may also experience pain and/or stiffness at the neck. It is important that you have a thorough assessment performed by your trusted Physiotherapist or Chiropractor to ensure that that you have been diagnosed properly.

How can Physiotherapy, Chiropractic, and Massage Therapy Help Your Shoulder Pain?

A team of healthcare professionals can personalize your treatments to address your specific injury and help you return to your personal lifestyle goals. Each member of the team has its role. Treatments with a Physiotherapist can include controlling pain with therapeutic modalities, acupuncture or IMS. Physiotherapy and chiropractic can help improve range of motion of the joint with hands on manual therapy or manipulation as well as increase or maintain range of motion, strength and motor control with exercises. Soft tissue release is also important and may require adjunct massage therapy treatment. Education in regards to lifestyle modifications, posture re-education and ergonomic set up are also important. If your shoulder pain has not resolved in 1-2 weeks or is worsening, it is best to be assessed by a trusted health care professional.

How Long Does it Take to Recover from Shoulder pain?

Depending on the cause, severity, duration of the pain and your ability to get the proper treatment, recovery can take a few weeks up to months. It is important to understand what is happening and to seek guidance and treatment from a qualified health practitioner as soon as possible. Remember to be patient and consistent with your exercise program. Keep in mind that your trusted physiotherapist and/or chiropractor sees these types of conditions regularly and will be the best person to advise you on the best route of management. They will inform you if your symptoms are not progressing as expected and if you should book a consultation with a physician for further investigations or treatment options.

What are the Best Exercises to Help with Your Shoulder Pain?

A well-rounded program should address neck, upper back and shoulder range of motion in addition to a graduated shoulder strengthening program. It should also include a daily mobilization and stretching regime. These exercises should be individualized to your particular needs and goals.

Some of the most common exercises are listed below, to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after their performance. For motor coordination please preform them paying close attention to good form, in a slow and controlled fashion and about 3 sets of 10-15 reps.

  • Range of motion (ROM) exercises of the shoulder joint
  • Mobilizations of the thoracic spine and scapula
  • Internal rotation (IR) and External rotation (ER) of the shoulder
  • Abduction in the scapular plane (Scaption) with resistance and control
  • Serratus Anterior activation
  • Middle Fibres of Trapezius (MFT) and Lower Fiber of Trapezius (LFT) activation and strengthening
  • Pectoralis stretches

Muscle Release/Stretching

  • Myofascial release with two balls at juncture between the head and top of the neck
  • Upper Trapezius stretching
  • Flexion of the neck to stretch all the long muscles on the back of the neck
  • Sternocleidomastoid stretching
  • Scalenes stretching
  • Levator scapulae stretching
  • Pectoralis stretching

How to Treat Shoulder Pain at Home?

  • If you have acute pain in your shoulder, you may first want to try ice especially immediately after an injury or specific event. If the pain has developed more gradually or has been lingering for some time then heat to the neck and shoulder might be the better choice. You may also choose to apply both intermittently depending on how they make your symptoms feel.
  • You should also try to figure out the positions and postures that aggravate your symptoms. Pay close attention to the positions that make you feel worse such as working at your computer, sleeping on your sore shoulder, lifting or carrying. Try to modify these positions or avoid them temporarily until you can gradually reintroduce them back into your routine.
  • During early and more painful stages of the injury, try gentle ROM exercises.Start with a shoulder pendulum; hang your arm forward while folding at your hips and let the arm sway side to side, forward and back and in small circles. You can do this several times a day for about 1 minute. It should be pain free and provide you with some relief.To progress, try some active or active assisted range of motion. To perform these, have your thumb pointing towards the ceiling and raise your arm forward and out to the side. If this is painful, try to use your other arm, a wall or a stick (such as a broomstick or cane) to help raise your arm up. Keep these movements within your pain free limits.
  • Whole body exercises that improve core and postural musculature (such as squats, shoulder press, push up, pull up, deadlift etc)

If your shoulder continues to have pain and/or feel stiff, an assessment and treatment with a qualified Physiotherapist, Chiropractor and/or Massage Therapist is highly encouraged. Contact us today !

Shoulder Dislocation

The shoulder is a ball and socket joint, where the ball is the head of the humerus (arm bone) and the socket is the scapula (shoulder blade). A shoulder dislocation occurs when the head of the humerus slides out of the socket, most commonly in the anterior direction. This can lead to instability of the shoulder joint in this direction and cause your shoulder to feel loose and vulnerable to it occurring again.

What Causes a Shoulder Dislocation or Uniplanar Instability?

Shoulder dislocations and instability can occur with or without trauma. A forceful blow to the shoulder or fall onto the arm can cause the head of the humerus to dislocate from the socket. Deficiencies in the ligaments and capsule surrounding the shoulder can lead to hypermobility and instability of the shoulder, increasing the risk of a shoulder dislocation.

How can Physiotherapy and Chiropractic Help with a Shoulder Dislocation or Uniplanar Instability?

Following the reduction of a shoulder dislocation, there will be reduced range of motion, pain, and muscular weakness. There will also be laxity in the ligaments that holds the head of the humerus in the socket. A Physiotherapist and or Chiropractor can help you regain the range of motion, reduce pain and improve muscular strength. They will prescribe you exercises, perform hands-on manual therapy, apply pain-reducing modalities and guide you through the rehab process for optimal recovery.

What Should be Avoided after a Shoulder Dislocation or Uniplanar Instability?

Definitely do not do nothing or it could reoccur! After you dislocate your shoulder you will have shoulder instability until proper rehabilitation has occurred. During the initial stages of healing, a shoulder splint may be prescribed to help protect the shoulder when it is most vulnerable. Following this period, it is recommended to avoid going into painful ranges of motion or extreme ranges. It will be important to perform strengthening exercises and it will be a good 6-8 weeks before you will be able to challenge that shoulder.

  • Glenohumeral- ball and socket
  • Scapular-thoracic joint- shoulder blade to rib cage
  • Acromino-clavicular- attaching your collar bone to the ball and socket
  • Sterno-cavicular- attaching your shoulder, arm and hand to your torso

How Long Does it take to Recover from a Shoulder Dislocation or Uniplanar Instability?

Generally, it can take up to 4-6 months to fully rehab and recover from shoulder instability and dislocation.

What are Safe Home Exercises I can do for a Shoulder Dislocation or Uniplanar Instability?

Below are some common early rehab exercises that will get you on the path to recovery. It is always best to consult with a Physiotherapist or Chiropractor when performing exercises after a dislocated shoulder.

Active assisted shoulder abduction

Active assisted shoulder abductionUsing a stick, guide affected arm up sideways. Do not go into pain. Repeat 10x 3xday.

Active assisted shoulder flexion

Active assisted shoulder flexionUsing a stick, guide affected arm forwards. Do not go into pain. Repeat 10x 3xday.

Active assisted shoulder External Rotation

Active assisted shoulder external rotationUsing a stick, turn affected arm outwards while keeping elbow tucked in. Do not go into pain. Repeat 10x 3xday.

Resisted shoulder external rotation

Resisted shoulder external rotationAnchor a resistance band and hold it on affected side so band is across your body. Turn arm outwards while keeping elbow tucked in. Perform slowly and do not go into pain. Repeat 10x 3xday.

Resisted shoulder internal rotation

Resisted shoulder internal rotationAnchor resistance band and hold it on affected side so band is away from body. Turn arm inwards while keeping elbow tucked in. Perform slowly and do not go into pain. Repeat 10x 3xday

If you have dislocated your shoulder or have a shoulder that feels vulnerable, loose and it could slip out of its socket our experienced Physiotherapists and Chiropractors are here to help you along the rehab process. Contact us for more information.

Multidirectional Instability (MDI) of
the Shoulder (Gleno-Humeral Joint)

Background Anatomy

The glenohumeral joint of the shoulder is a ball-in-socket joint between the head of the humerus (the ball part), and the glenoid (the socket part). This joint relies a lot on the muscles, ligaments, and other soft tissue structures for stability, because the bony part of the joint is actually not very deep at all. In fact, without any help from its ligaments and muscles, this joint is analogous to a golf ball sitting on a tee. The great thing about this joint is that it allows for a lot of movement. However, there is a trade-off between stability and mobility, and in the shoulder, this trade-off favours mobility.

What is Multidirectional Instability (MDI)?

Multidirectional instability of the shoulder is a condition where the head of the humerus has difficulty staying centered in the glenoid. There is excessive movement and poor control of the joint in multiple directions.

What causes MDI?

MDI often presents without any acute trauma, although there may be some gradual micro-trauma that has developed over time. This excessive joint mobility may also be due to looseness in the joint capsule and ligaments around the glenohumeral joint, and weakness or poor control of the muscles around the shoulder.

Who gets MDI?

Generally people in their teens up until their late twenties are most likely to experience symptoms of MDI. This is partly because as we age, our tissues tend to get stiffer and less flexible. Gymnastics, swimming, and baseball are some examples of sports where the prevalence of MDI is higher than in the general population. People involved in work with repetitive overhead positions, and people with a history of previous shoulder subluxation or dislocation are also at increased risk for developing MDI.

What are some common signs & symptoms associated with MDI?

  • General shoulder fatigue
  • Vague location of pain in the shoulder
  • Feeling like the shoulder is unstable, possibly with recurrent subluxations
  • Arc of pain lifting the arm overhead
  • Fear of moving the shoulder in particular directions
  • Presence of clicking, clunking, and/or popping noises with shoulder movements
  • Aggravation of pain and/or numbness/tingling in the shoulder and/or down the arm with carrying heavy objects, pushing heavy doors, push-ups, and throwing activities
  • Achiness in the shoulder at night

What treatment is available, and what is the prognosis for MDI?

Physiotherapy rehabilitation is the preferred first line of treatment for MDI. A physiotherapy program for MDI will often involve postural education, activity modification, supportive taping, pain relieving modalities and manual therapies, as well as an individualized exercise program to help target key areas of weakness which need to be addressed. The majority of patients who respond well to physiotherapy should see significant improvements within three months of starting a physiotherapy program for MDI.

The prognosis for MDI rehabilitation is generally good, although it is dependent on both age and activity level. Younger people, and those involved in demanding sports tend to have a poorer prognosis. In cases where disabling symptoms persist and conservative management is unsuccessful, there are surgical options that can be considered. However, participation in demanding sports will also negatively affect the prognosis for surgical interventions for MDI.

If you are concerned that you might have multidirecitonal instability, or if you have any questions or concerns about this condition, please do not hesitate to contact us today. You can book an assessment with one of our registered physiotherapists, who are very knowledgeable about this condition. We can answer your questions and develop a treatment plan to help get rid of your pain, improve your function, and achieve your goals.

Rotator Cuff Injuries

Rotator cuff injuries are a common source of shoulder pain. The rotator cuff is a group of four stabilizing muscles that surround the humeral head, the ball portion, of the shoulder’s ball and socket joint.

Rotator cuff injuries can have many different presentations depending on whether the tendons are being pinched, or if there is an irritation or tear in the tendon. The muscles can be injured in a variety of different ways from repetitive overhead work, poor posture, or weight training with poor form. It is also common that as we age we experience some type of rotator cuff dysfunction due to wear and tear of the tendons from our lifestyle and activities.

Your physiotherapist will be able to conduct a thorough and detailed assessment to determine if your shoulder pain is due to a rotator cuff injury, whether other structures are also involved and if there are contributing factors that exacerbate your symptoms or are limiting your recovery.

What is the Rotator Cuff and Why is it Important?

To understand why the rotator cuff is commonly injured around the shoulder and why the rotator cuff muscles are so important, it is helpful to understand the anatomy of the shoulder a bit better.

The shoulder is made up of three bones: (1) the collar bone (2) the shoulder blade which forms the socket and (3) the arm bone also known as the humerus which forms the ball. The socket of the shoulder joint is quite shallow and the ball is very round and thus, the boney structures are not very stable. Without the joint capsule, ligaments, cartilage, muscles and tendons that surround the bones the ball would pop out of the socket frequently.

The rotator cuff is a group of four muscles that connects and holds the ball of the arm bone to the socket of the shoulder blade. The four muscles of the cuff work together to keep the ball centered in the socket and thus improving the stability of the joint. They include, the Subscapularis, Supraspinatus, Infraspinatus and Teres Minor. The most common type of rotator cuff tear involves the Supraspinatus muscle.

How is the Rotator Cuff Injured?

Injuries to the rotator cuff can occur with direct trauma to the arm/shoulder such as a fall onto an outstretched arm, fall onto your shoulder or any direct blow to the shoulder. Rotator cuff tears can also be associated with collar bone separation injuries and dislocated shoulders.

Most commonly, rotator cuff injuries are degenerative in nature and are caused by the gradual wearing down and fraying of the tendon. This slow process occurs when there is repetitive stress to the tendon. This can be perpetuated by repetitive overhead work, weight training with improper form, arthritic changes in the shoulder joint or postural dysfunctions that cause the rotator cuff tendons to be strained or pinched (impingement).

What are the Symptoms of a Rotator Cuff Injury

Injuries to the rotator cuff can occur with direct trauma to the arm/shoulder such as a fall onto an outstretched arm, fall onto your shoulder or any direct blow to the shoulder. Rotator cuff tears can also be associated with collar bone separation injuries and dislocated shoulders.

Most commonly, rotator cuff injuries are degenerative in nature and are caused by the gradual wearing down and fraying of the tendon. This slow process occurs when there is repetitive stress to the tendon. This can be perpetuated by repetitive overhead work, weight training with improper form, arthritic changes in the shoulder joint or postural dysfunctions that cause the rotator cuff tendons to be strained or pinched (impingement).

How can you Prevent a Rotator Cuff Injury?

Rotator cuff injuries can be prevented by the following:

  • Performing regular shoulder, neck and upper back exercises to maintain strength and flexibility
  • Performing rotator cuff strengthening exercises
  • Performing postural muscle strengthening exercises
  • Utilizing proper form and posture when lifting or moving heavy weights
  • Resting the shoulder when experiencing pain
  • Taking adequate rest periods in occupations that require repetitive lifting and reaching
  • Visiting a massage therapist regularly to mobilize your upper back and tight shoulder muscles
  • Visiting a physiotherapist right away if you are experiencing any pain in your shoulder

What are the Best Exercises to Help with a Rotator Cuff Injury?

Before you start to strengthen the Cuff muscles, it will be important to ensure that the muscles around the shoulder blades are strong and stable. There are a number of important muscles that control the shoulder blade including the lower, middle and upper fibers of trapezius, the rhomboids and the pectorals. One other very important muscle around the shoulder blade that should be targeted is your serratus anterior. Watch the video below for some guidance on how to strengthen the serratus anterior.

Once you have developed strength around the shoulder blade and have reduced pain in your shoulder, you are ready to start some rotator cuff strengthening.

Treatment for Rotator Cuff Injuries

Physiotherapy and Chiropractic management of rotator cuff injuries can be very effective.

Treatment may include manual hands on release of tight muscles and structures, laser or ultrasound for cell regeneration and to speed up tissue healing, strengthening and stabilization of supporting musculature, mobilizations to stretch the shoulder joint, taping and acupuncture for pain relief. Shockwave therapy helps breaking tight muscle fibers, scar tissues, and improves range of motion quickly.

Your Physiotherapist and Chiropractor will determine the best course of action based on your specific presentation and the factors that are contributing to your dysfunction. They may refer you for Massage therapy.

In very few cases, surgery may be required. If this is the case, physiotherapy before and after your surgery will be important to achieve the best outcomes. Also, corticosteroid injections can be used to help alleviate symptoms temporarily if you are unable to participate in physiotherapy due to intense pain.

How Long Does it Take to Recover from Rotator Cuff Injuries?

Normally soft tissue healing time, provided the right amount of rest and activity, should take few weeks. The rotator cuff is constantly working to hold your ball in the socket. Therefore, it does not get an adequate amount of rest in the early stages of healing and can become easily flared, regressing the healing process. For this reason, it is so important that when you start to feel shoulder discomfort that is not changing or getting worse that you book in with a Physiotherapist, or Chiropractor for proper diagnosis, treatment and optimal outcomes.

All of our physiotherapists, chiropractors, and massage therapists have extensive experience treating rotator cuff injuries and would be happy to help you recover from your injury. Book your appointment today or call us today for more information.

Biceps Tendinopathy

Have you ever felt a sharp pain on the front of your shoulder? Did it happen after doing dips, pull-ups, rows, or on your bench press in the gym? Or did you feel it after a swim in the pool? Perhaps, on impact serving a tennis, squash, or volleyball? What about reaching for your favourite coffee mug up on the highest cupboard shelf? Or maybe you feel it while using your mouse at work?

If this sounds familiar, it is possible you might have a tendinopathy of your Long Head Biceps (LHB) tendon with or without impingement.

What is a Long Head of the Biceps (LHB) Tendinopathy?

A tendinopathy is a general term indicating that there is damage to a tendon (where the muscle connects to the bone). Micro tears, collagen fiber degeneration and/or inflammation can be present. A LHB tendinopathy typically presents as pain over the front part of the shoulder. There are several conditions that can occur with a LHB tendinopathy which include:

  • Long Head Biceps Tendinitis (inflammation of the tendon itself).
  • Long Head Biceps Tendosynovitis (inflammation of the tendon sheath, surrounding the tendon).
  • Long Head Biceps Tendinosis (a degenerated tendon).
  • Long Head Biceps strain or rupture (a tear in the tendon fibers or tendon separation in whole or in part from its tissue or boney attachment).

Commonly, injuries to the LHB tendon rarely present with just one of the above conditions, and often involve a combination of two or more. This is why most are classified under the blanket term, “tendinopathy”.

Causes of a Long Head Biceps Tendinopathy

Commonly, repetitive movements with the shoulder are typically the culprit in causing LHB tendinopathies. The deconditioning and normal aging of the tissue can further compound the injury. Athletes who preform overhead movements (i.e. racket sport athletes, volleyball players, swimmers), or high velocity motions where the arm and shoulder cranks back and releases (i.e. throwing sports like baseball and cricket), are typically susceptible to LBH tendinopathies. Posture can further complicate things in an athlete. For instance, if the athlete is hyperkyphotic (round/hunchback), and/or has excessively rounded shoulders, this can contribute to narrowing the space the LHB tendon needs to move. When joint and tissue space narrows, the LHB tendon can become impinged leading it to become irritated and damaged over time.

Physiotherapy, Chiropractic and Massage Therapy Treatment for Long Head Biceps Tendinopathy

Treatment with a health care professional will help diagnose the injury and start you on the path to recovery. Physiotherapist and Chiropractors will address correcting joint mechanics and posture by using manual therapy and strengthening. They also can use Acupuncture or other modalities such as ultrasound to help to control pain and inflammation. 

Shockwave therapy can eliminate pain, speed up healing, and improves mobility quickly.

Massage treatment addresses many of the surrounding structures around the Long Head Biceps Tendon. General techniques are applied to the neck, upper to mid-back, chest and shoulder to address the long head bicep tendon specifically. It is important to warm up and massage the surrounding structures since there are quite a number of muscles that attach to the shoulder complex and are involved with shoulder movement. Deep, specific techniques combined with shoulder movement (sometimes referred to as Pin & Stretch techniques, or Active Release Techniques), directly over the Long Head Biceps Tendon can encourage tissue mobility, decrease pain, and promote localized circulation important for the healing process. Gentle cupping over the long head biceps tendon can help further bring circulation to the localized area to encourage healing and further tissue mobility in the area.

What are some safe home exercises I can do for Long Head Biceps Tendinopathy?

With any of these exercises, a little discomfort can happen and is okay to work through, but if you notice your symptoms worsen or experience unfamiliar pain, modify the weight and/or intensity of sets/reps as need be. Resistance modifications such as theraband or cables can easily be used instead of a dumbbell to decrease discomfort if experienced during exercise.

Scapular “Scoops”

  • Arms outstretched at 90º
  • Rotate your thumbs down, and then back up, focusing on feeling how your scapula slides up and down the rib cage. Then disassociate your shoulders by rotating your right thumb down and your left thumb up, then reverse and repeat.
  • If you feel your low back compensating (arching your back in order to get the shoulder movement you want), you can do this seated to help eliminate compensatory motions. The idea is to feel your shoulder blade slide upward when your thumbs turn down, and then downwards when your thumb turns back. What you want to also avoid is shrugging your shoulders up as opposed to focusing on isolating scapular movement.

Isometric Hammer Grip Bicep Curl

  • Start with your arm straight and shoulder blade set in a good position. Then bend the elbow to 90º with your palm facing inward and hold.
  • Perform 2 – 3 sets of 5 – 10 second holds.

Isometric Supinated Grip Bicep Curl

  • Same as the Hammer Grip Curl, but with your palm facing upwards, and hold.
  • Perform 2 – 3 sets of 5 – 10 second holds.

Isometric Supinated/Hammer Grip Bent Elbow Shoulder Flexion

  • Start with a lighter weight than above (<5 lbs) by your hip, and raise it to 90º of shoulder flexion in front of you and hold. Switch between a supinated and hammer grip to challenge the tendon in different positions/angles.
  • Perform 2 – 3 sets of 5 – 10 second holds.

Single Arm Preacher Curls

  • The incline is used to ease the pressure off the LHB tendon, and focus on the eccentric control or extension of the elbow movement, using a count of 3 – 5 seconds to help guide the pace of the controlled extension.
  • Perform 2 – 3 sets, 12 – 15 reps.

These are just general exercises that work for some. However, we always recommend seeing a qualified health professional so they can assess you and provide you with individualized corrective exercises that are unique to your specific needs and goals. 

To get relief from your shoulder pain today, contact us !

Frozen shoulder (also known as adhesive capsulitis) is a condition that causes pain and stiffness in the shoulder and can significantly interfere with daily activities.

Frozen shoulder typically has a sudden onset, often people literally wake up with it, and it is sharply painful to move with almost all shoulder movements. There may be some pre-warning signs such as the feeling a mild ache in the shoulders or some mild stiffness. It can also develop from a shoulder injury especially if you have been too afraid to move your shoulder after the injury.

It is suspected that an auto-immune reaction in the body causes joint capsule of the shoulder to literally “shrink wrap” the joint and a chemical reaction of inflammatory indicators invades the joint.

After the onset of frozen shoulder, it can be broken up into three phases; the freezing phase, the frozen phase, and the thawing phase.

Stage 1: Freezing

The “freezing” stage typically lasts from 6 weeks to 9 months. During this stage, pain increases and your shoulder loses range of motion. Sleeping can also be quite painful during this stage.

Stage 2: Frozen

The “frozen” stage typically lasts from 4 to 6 months. During this stage, painful symptoms may actually improve but stiffness remains. Daily activities may become very difficult to complete.

Stage 3: Thawing

During the “thawing” stage, shoulder motion will slowly improve and pain will be gone. It can take from 6 months to 2 years to return to normal strength and motion.

Who gets Frozen Shoulder?

Frozen shoulder is most common for individuals between the ages of 40 to 60 and occurs more commonly in women compared to men.

The exact cause of frozen shoulder is unknown, however there are few known factors that may make you more susceptible to it. Frozen shoulder often occurs as a result of a shoulder injury, such as a rotator cuff tear, shoulder surgery, or a bone fracture affecting the shoulder joint. It is also more common in individuals who have been immobilized for prolonged periods of time, post-menopausal women, individuals who have had a stroke, Parkinson disease, people who have diseases affecting the thyroid gland and individuals with Diabetes.

Treatment of Frozen Shoulder

If you suspect a frozen shoulder you should seek treatment from a physiotherapist or chiropractor as soon possible. Here they can assess your shoulder, gauge what stage your shoulder is in and form the best treatment plan to suite your individual goals.

The rehabilitation treatments will vary depending on what stage you are in:

The Freezing Stage

Physiotherapy, chiropractic and massage therapy will focus on pain relief during this stage. They may choose to use some pain-relieving modalities such as, ultrasound, interferential current, acupuncture or gentle mobilizations. It is important to gently move the shoulder in pain free ranges as much as possible with range of motion exercises prescribed.

Shockwave therapy can eliminate pain, speed up healing, and improves mobility quickly.

The Frozen Stage

The frozen stage is more stable, with persistent pain levels and unchanging stiffness. Patients are often quite frustrated by this point but it is important to stay positive and continue to move the shoulder through range of motion exercises. Physiotherapy, chiropractic and massage treatments focus on stretching the shoulder joint and other adjacent joints, managing pain as needed, using acupuncture or other modalities more aggressively than earlier and starting to teach gentle stabilization exercises to build muscle control around the joint.

The Thawing Stage

During the thawing stage, there is less and less pain and the shoulder once again starts to move. Therapeutic interventions such as physiotherapy, chiropractic treatment, and massage therapy can help to progress through this stage faster and it is highly recommended at this time. Most people eventually regain full or nearly full movement, but some have residual stiffness that persists for several years. During this stage, your physiotherapist and chiropractor will use more aggressive manual therapy, mobilization and stretching techniques around the shoulder and adjacent joints. They will also advise you on exercises that will build strength and get your shoulder back to functioning the way it did before this condition developed.

By seeing a trained professional, you will learn exercises to help your shoulder condition, you will learn pain management strategies and they will use hands on techniques that will speed up the recovery process and help prevent a secondary frozen shoulder from developing

Best Exercises to Help with Frozen Shoulder?

Shoulder Pendulums

With your body bent forward at your hips, let your sore shoulder fall limp with gravity. From here use the initial momentum to let your shoulder swing forward/back, side to side and in small circles. This will help lubricate the joint and provide pain relief.

Perform these for up to 1 min several times a day.

Active Assisted Range of Motion

Move your sore shoulder slowly using the assistance from a wall, stick or your other hand to help move. Move in the forward, side and rotational directions. Perform 10 reps in all directions 3x/day.

Isometric Rotator Cuff Strengthening

With your arm at your side and elbow bent 90 degrees in front, place your other hand first on the inside to apply resistance out, then on the outside to apply resistance in. As you do this keep your arm in the starting potion, do NOT let your arm move, and feel the muscles that surround your shoulder become engaged to keep it in place.

Warning- Do not perform this maneuver if painful or scale back on the amount of pressure until it is pain free.

Preform 10x 5sec holds 3x/day.

What Should be Avoided with Frozen Shoulder?

frozen shoulderIt is important that you listen to your body and symptoms. You want to work within movements that are challenging for your shoulder but not above your pain threshold. Pushing through too much pain will only lead to a longer recovery.

How can you Treat a Frozen Shoulder from Home?

It is very important that you keep moving you shoulder daily within its pain free range, it will prevent a prolonged recovery.

Performing a daily rehab exercise routine, like the one above, will help your shoulder to progress, be forewarned it will be slow. Your patience will be tested.

How Long Does It Take to Recover from Frozen Shoulder?

Frozen shoulder is a stubborn condition to treat and can take several months for each of the three phases to fully resolve. The “freezing” stage typically lasts from 6 weeks to 9 months. The “frozen” stage typically lasts from 4 to 6 months. The thawing phase can take from 6 months to 2 years to return to normal strength and range of motion. The average total time for recovery from frozen shoulder is 24 months. It is important to note, that if you do nothing at all, you will still get better from the frozen shoulder. It will just take longer to reach full recovery.

If you are experiencing a painful and/or stiff shoulder joint we recommend that you have a qualified professional look at it to determine the best course of action. Our physiotherapists, chiropractors, and massage therapists will all work together to help you with your frozen shoulder if that is your diagnosis. Each practitioner has unique strategies that can help you manage the pain and will help you progress through each stage faster. Contact us today to book your initial consultation.

Glenoid Labrum Tears

The shoulder is a very mobile joint; most things that you do with your hands and upper extremity require some degree of shoulder movement. Because of this, there is not a lot of bony stability at the shoulder joint. The shoulder joint mostly relies on surrounding musculature (the rotator cuff) and other soft tissues to maintain proper alignment and stability as it moves. One of these soft tissues is the glenoid labrum. The labrum is a ring of smooth cartilaginous tissue that surrounds the socket of the shoulder joint, deepening the socket to give increased stability while maintaining mobility.

What is a Glenoid Labrum Tear?

A glenoid labral tear is a rip in the cartilage that deepens the shallow socket of the shoulder and helps hold the ball of the shoulder joint (humeral head) in place. They are typically caused by a traumatic shoulder injuries like a dislocation or separation, or by repetitive overhead movement. There a many types of glenoid labrum tears and the type you get will depend on the nature of the injury that caused it.

What are the Symptoms of a Glenoid Labral Tear?

If the labral tear is caused by one distinct event there is generally a sharp pain, pop, or catching sensation in the shoulder followed by a deep joint ache. Your shoulder may feel loose, as if you do not have complete control of the joint when you move it. Repetitive movements, especially throwing, can also injure the labrum. It is a very common injury seen in baseball players. Generally, it is diagnosed through a physical exam and can sometimes be seen on an MRI or CT scan. Often, labral tears can be hard to see clearly on MRI or CT so the official diagnosis is often confirmed with arthroscopy (using a tiny camera inserted into the joint).Types of Glenoid Labrum Tears include

  • SLAP tear is a tear of the superior labrum from the anterior to the posterior aspect
  • Bankart tear is a tear at the front (anterior) labrum of the shoulder
  • Posterior labral tear is a at the back of the labrum of the shoulder
  • Combination of SLAP, Bankart, or Posterior
  • Pan labral tear (circumferential lesion) is a 360-degree tear of the labrum

Depending of the type of labral tear your symptoms may present differently so it important to start your recovery by visiting a health care professional like a physiotherapist or chiropractor. They will ask questions about your symptoms and perform tests that will give them a clear picture of your specific injury. If there is any grey area or concern, they will refer you to a physician who can send you for the appropriate diagnostic testing.

How do Glenoid Labral Tears happen?

Anything that puts excessive force through the shoulder joint can cause a labral tear. Some examples of this include:

  • A fall on an outstretched hand
  • A shoulder dislocation or separation
  • Sports that cause overuse and repetitive loading through the shoulder joint such as baseball or weightlifting
  • Suddenly lifting an object that is too heavy
  • Repetitive overhead movements

Treatment of Glenoid Labral Tear

Treatment depends on the severity of the tear. Many labral tears can be treated conservatively with physiotherapy or chiropractic care to decrease inflammation and restore proper movement and strength in the shoulder joint. A more severe tear may require surgery which will be followed by a period of rest and then a course of physiotherapy or chiropractic treatment so that you can achieve optimal function in your shoulder.

It is important to note that some parts of the labrum have better blood supply then others. Also, once a tear has occurred it will never bridge back attaching to the bone. It should scar down and become thicker but the detachment from the socket will most likely remain.

Physiotherapy and Chiropractic Treatment will include manual therapies to restore mobility and modulate pain. Prescriptive exercise will also be a focus in order to improve strength and stability within the shoulder as the movement is restored. The best physiotherapists and chiropractors will also take the time to educate you on what to expect, what to avoid and how to modify your lifestyle for optimal recovery. Other modalities such as acupuncture, Gunn IMS, dry needling, ultrasound and electrical stimulation may prove to be beneficial in your case. Your health care provider will make a recommendation based on their assessment findings and your treatment goals.

Best Exercises to do when you have a Glenoid Labral Tear

Exercises to help with recovery from a glenoid labral tear will consist of strengthening the rotator cuff and scapular stabilizers to optimize your shoulder stability and biomechanics.

Proprioceptive Exercises for the Shoulder

Hold a medium sized ball onto the wall in front of you with an outstretched arm. Close your eyes and slowly move the ball in small circles and progress to larger movements. Pay close attention how it feels to maintain the humeral head centered in the shoulder socket.

Rotator Cuff Strengthening

Start in neutral with your elbow at your side and as you become stronger progress to have you elbow at 45 degrees and then finally 90 degrees abduction.

Scapular stabilizers Strengthening

Build muscle strength of the middle and lower trapezius and serratus anterior muscles groups.

What Should be Avoided with Glenoid Labral Tears?

Any movement that makes your shoulder feel unstable or clunky. You will have a gut feeling of apprehension to these types of movements.

You want to avoid heavy weights, throwing, or any activity that requires power around the shoulder.

How Can I Treat Glenoid Labral Tears at Home?

Truth of the matter is, you can’t.

You can work on the exercises described above but you are most likely going to need some form of treatment by a healthcare professional to get you back to full functioning.

How Long Does It Take to Recover from a Glenoid Labral Tear?

The recovery time for a labral tear will depend greatly on the severity of the tear and its prognosis.

If your injury is one that responds well to conservative treatment in the form of Physiotherapy or Chiropractic Care then estimate 6-12 weeks. This will have to entail your commitment to exercise and also lifestyle modification.

If your injury is more severe and requires surgery you can expect it to take 6 months or longer until you are back to your lifestyle.

It can seem a bit intimidating and you might feel hopeless if you have sustained a Shoulder Labral tear. However, many clients go on to lead normal, active lives with some guided treatment. One of our physiotherapists and/ or chiropractors can help you fully understand what is going on in your shoulder and ensure that you receive the proper care from start to finish. Contact us today!

Acromioclavicular (AC) Joint Sprains
and Dislocations

AC joint sprain or dislocation occurs most often when there is a fall or trauma to the outer portion “the point” of the shoulder. This area of the shoulder is where the clavicle (collarbone) meets the shoulder blade at the top outside corner and can often be felt rather easily. The injury itself occurs when you have a separation of the clavicle away from the shoulder blade. This means that there is an actual tear to the ligaments that support the AC joint. Depending on the amount of trauma the injury has different severities and is classified by using a grading system. Depending on the grades there are different methods of treatment.

Grade 1 AC Joint Injury

Most common AC joint injury. A minor displacement of the joint. The AC joint ligament may be stretched or partially torn. Recovery is about 2 weeks.

Grade 2 AC Joint Injury

A partial dislocation of the joint but displacement may be seen on imaging. The acromioclavicular ligament is completely torn, while the coracoclavicular ligaments remain intact. Recovery time is about 6 weeks.

Grade 3 AC Joint Injury

A complete separation of the joint. Usually, the displacement is obvious on clinical exams and the shoulder tends to sag downwards under the weight of the arm. Recovery time is approximately 12 weeks.

Grades 4-6 AC Joint Injuries

These are less common and are more severe in nature. These are often surgical cases due to the involvement of other structures.

Chiropractic, Physiotherapy or Massage Therapy Treatment Options for AC Joint Injuries

Treatment options for grades 1 -3 are usually done with conservative therapy carried out by a physiotherapist, chiropractor or massage therapist. Treatment will usually consist of stabilizing the joint as best as possible, followed by bringing blood flow to the area to enhance healing of the ligaments involved. Treatment can include icing (initially), taping, acupuncture, anti-inflammatories, soft tissue treatment to surrounding muscles and shockwave therapy.

Best Exercises for Recovery from AC Joint Injuries

The best exercises for recovery from an AC joint injury vary depending on the stage and degree of injury. As a general rule of thumb you want to have free range of motion of the shoulder before getting started with strengthening exercises. Thus, it is a good idea to avoid any strengthening or overhead exercises until this is achieved. Some exercises that can be started once this is attained are shoulder pendulums, isometric shoulder strengthening and resistance band work. To know exactly what exercises to carry out and when, you can consult our knowledgeable staff at Rebalance Sports Medicine with any questions or concerns.

AC Joint Injury Prevention

Once an AC joint injury is healed and you have returned to sport or physical activity, it is crucial to remember to continue with proper maintenance of the shoulder. This includes the correct strengthening exercises and mobility drills to ensure the best shoulder health. This may also include using the necessary bracing if needed.

Overall an AC Joint injury or separation can be a complicated injury as the shoulder is a very complex joint, but if diagnosed correctly by knowledgeable health care practitioners it can save you a lot of frustration and enhance your recovery time. Contact us today!