Shoulder pain is a common symptom in middle-age active adults. It has been ranked as the third most common musculoskeletal condition affecting productivity and time spent enjoying leisure activities. The American Academy of Orthopedic Surgeons reported over 11 million visits to the doctor's office for shoulder pain in 2010 alone. Individuals with shoulder pain are a common sight in my practice. Many report pain with olympic lifts, bench press, front rack, biking, pull ups, reaching overhead, and reaching to the back seat. The most rewarding experience as a therapist is to watch my clients get back to their sport/recreational activity after previously believing they had to give it up. Although I enjoy working through "myths" face to face with my clients, I felt it was appropriate to share this info with the broader ADAPT community.
Myth 1: I should avoid all movement and exercise because of my pain.
If basic activities cause pain, then why in the world would exercise and movement be of any benefit? I know it sounds like a contradiction, but hear me out. The pain you may experience with movement is a complex and dynamic process. Whenever you experience pain, your nervous system processes the information emotionally, mentally, physically and in turn you may get movement adaptations (Loss of range of motion, pain with reaching overhead, difficulty performing functional activities).
Initially, the pain serves as a protective mechanism and the nervous system will shout "danger"! It will sound the alarm. Muscles will guard to create a natural splint or become relaxed to protect the area (aka inhibition). This can affect how muscles in the shoulder may function to help you perform basic tasks.
How does movement help? Loading tissues below their painful threshold can help with desensitizing the system. This can improve the mental and emotional part of the pain experience by having you associate movement without pain. In the absence of activity or loading, the shoulder may remain hypersensitive to movement and can weaken.
It' all about graded exposure here, my friend.
Performing gentle isometrics have been shown to improve symptoms associated with tendon injury. An isometric contraction is when you create muscle tension without moving the joint (see examples below). These contractions are easy to do and less stressful on your joints. I know these exercises are simple and boring compared to your workout, but the goal is to get you back to moving weight---- safely!
Here are a few isometric examples:
You can push gently into the towel (staying below the pain threshold) holding for a 3-5 second count before releasing.
Myth 2:I NEED an MRI before I begin therapy
Advanced diagnostic tests are very useful and needed in healthcare. Magnetic resonance imaging (MRI) is a tool used to show pictures of soft tissues (brain, muscle, spinal cord, and ligaments) to help physicians evaluate your condition. I like to think of diagnostic tools as resources to help diagnose or rule out sinister conditions (tumors, ruptures, bony/cartilage changes).
Healthcare providers, including physical therapist, are trained to take your subjective history (mechanism of injury, demographics, lifestyle, daily demands, physical goals, etc), perform a thorough examination and utilize this data along with research to provide you with a diagnosis and treatment plan. The image can help assist in the development of this plan; however, it isn't the single determining factor.
MRI's are expensive, time consuming, and can be over-utilized. These images don't always dictate function- which is what physical therapy can be used to assess and address.
If you have a nagging injury that you've been working through-- a PT can evaluate without an MRI.
If you've had surgery, but still having difficulty with certain overhead tasks, a PT can evaluate without an MRI.
If you're struggling with mobility and function --- a PT can evaluate without MRI.
These images aren't "needed" for a therapist to perform an evaluation. Each of us have been trained to assess for "red flags" and refer when needed.
Myth 3: I wasn't referred to physical therapy so I wouldn't benefit
As stated before, people are seeing their doctor for shoulder pain frequently. It is unknown how many of these people received a referral for therapy or if they were aware of how it can help.
I've asked people randomly if they think physical therapy can help them with their injury, and sadly they assume therapy is reserved only for people with "complex" issues like: injuries sustained after an accident, individuals who are unable to walk, the elderly who have difficulty maintaining their independence, etc.
Yes! Physical therapy is a broad profession that is still not completely understood by the masses-- and that's ok.. I'm here to let you know that I can help you with that hurdle you're facing no matter how "small" it may seem to you in comparison to another person's condition.
In a study looking spinal pain and the timing of physical therapy for nonsurgical injuries, it was found that starting therapy first was less expensive versus the "wait and see" with opioid prescription model and did not compromise patient outcomes. Another study by Fritz revealed that only 7% of patients with low back pain were referred to physical therapy within 90 days of onset.
If you've given the "wait and see model a try", if you've swallowed pain pills like skittles, if you've tried to exercise it out without improvement: click the link below to schedule your FREE discovery visit--
AND THAT MY FRIEND--- IS FREE GAME.
Dean, B. J., Gwilym, S. E., & Carr, A. J. (2013). Why does my shoulder hurt? A review of the neuroanatomical and biochemical basis of shoulder pain. British Journal of Sports Medicine, 47(17), 1095-1104. doi:10.1136/bjsports-2012-091492
Hodges, P. W., & Smeets, R. J. (2015). Interaction Between Pain, Movement, and Physical Activity. The Clinical Journal of Pain, 31(2), 97-107. doi:10.1097/ajp.0000000000000098
Information about Musculoskeletal Conditions. (2019). Retrieved from https://www.aaos.org/CustomTemplates/Content.aspx?id=6406&ssopc=1
Struyf, F., Lluch, E., Falla, D., Meeus, M., Noten, S., & Nijs, J. (2014). Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders. European Journal of Applied Physiology, 115(2), 225-234. doi:10.1007/s00421-014-3059-7
Zale, E. L., & Ditre, J. W. (2015). Pain-related fear, disability, and the fear-avoidance model of chronic pain. Current Opinion in Psychology, 5, 24-30. doi:10.1016/j.copsyc.2015.03.014
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