Shoulder Pain Treatment Program
Rotator Cuff tears are a very common culprit to pain and should have special orthopedic testing to determine if tear is suspected before shoulder pain treatment is started. These four tiny muscles are crucial for the stability of the shoulder. Let’s take a look at what the rotator cuff does so we can understand why we need to approach the shoulder the way we do. The shoulder is a ball and socket joint which means this joint will give up stability for mobility. The added mobility of this joint leaves the shoulder joint vulnerable to injuries. One of the many structures that can get injured is the capsular ligament. This is a fibrocartilagenous ligament that can tear or weaken. This ligament is considered one of the static stabilizers of the shoulder. A static stabilizer is any ligament or fibro-cartilagenous structure that connects the apposing bones and keeps stability. Another commonly injured structure in the shoulder joint is the labrum. In the shoulder the labrum is fibrous and deepens the shoulder cavity by 50% which adds some stability to this extremely mobile joint.
Capsular ligament: is broken down into superior middle and the inferior complex.
- The Inferior is broken into anterior, posterior and inferior.
- This is the most important static stabilizer.
Static Stabilizers of Shoulder= Ligaments / Cartilage
Dynamic Stabilizers of Shoulder= Muscles
The 4 Ps of Shoulder Pain Treatment Plans
- Protector- These are your four rotator cuff muscles and part of you dynamic stabilizers (supraspinatus, teres minor, infraspinatus, subscapularis)
- Pivitor muscles- all of your scapular stabilizers (rhomboids, serratus anterior, levator scapula, trapezius)
- Positioner- The 3 different heads of the deltoid
- Propellor- Powerful movement muscles (pectoralis major/minor and Latissimus Dorsi)
The most commonly torn rotator cuff muscle is the supraspinatus. A proper shoulder pain treatment needs to place special attention on the supraspinatus. The job supraspinatus is to suck the head humerus into the shoulder joint capsule so that the deltoid muscle can function. The supraspinatus works with the labrum which is designed like a suction cup thats keeps the shoulder joint very stabile during motion. When the labrum gets torn, it breaks the seal of the suction cup causing more stress and unwanted motion to occur in the shoulder. This places increased stress not only on the static but also on the dynamic stabilizers of the shoulder causing not only shoulder pain but limited range of motion. Once you get micro tears of supraspinatus the shoulder due to chronic stress starts rising up in the joint and now you can’t raise your arm as high because the humerous is sitting higher in glenoid cavity. This is why we design our shoulder pain treatment around strengthening the supraspinatus and making sure we prevent any instability.
What is Bad For the Shoulder?
- Narrowing of the subacromial space (the space that’s needed when you raise your arm to allow full motion). You have the subacromial and sub deltoid bursa. In the space below the acromiom we have the supraspinatus and the biceps tendon and bursa. If we have a weak rotator cuff and we abduct or flex the arm then we have superior migration of humerous and impinging the soft tissue between two boney structures.
- 70-110 degrees is maximum length tension through this range.
The usual sequance of events is:
- Weakness in you dynamic stabilizers causes increase stress on your static stabilizers (weak muscles are causing ligaments to do more work)
- Static stabilizers start to lose their effectiveness
- Rotator cuff has to take on more load and duty and eventually causes tendinitis.
- Leads to rising of the humerous head
- Ligaments weakened, called attenuation.
- Ligament Sprain Grading
- Grade 1- stretch but no disruption of fibers
- Grade 2- some disruption of fibers
- Grade 3-stretch and complete tear
- Ligament Sprain Grading
Road to Recovery Shoulder Pain Treatment Exercises
1) Full Range of Motion- (pain free)
- Wall Walks
- Wall Cleaners
- Over the Door Pulley
2) Strengthen Protector and Pivitor muscles
- Interior Rotation Band
- External Rotation Band
- Push Up +
- Rhomboids Scapular Squeeze
- Lower Trap Squeeze
- Pectoralis Major Doorway Stretch
- Pectoralis Minor Foam Roll
3) Include positioner and propellor muscles into exercise routine
- Lattisimus Dorsi Pull Downs
- Push up with the +
- Side Raises
- Front Raises
- Empty Can