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The Shoulder Guide

Most shoulder problems can get better naturally.

Shoulder pain affects around 30% of adults at any one time. Rotator cuff disorders are the most common cause of shoulder pain.  

If you have shoulder pain, you know how it can affect just about everything you do with that arm. Reaching overhead to put a plate in a cabinet; getting dressed; trying to sleep; exercising - all of these can hurt when you have a shoulder problem.

The good news is that most shoulder problems can be helped without medications, injections or surgery.  

If you want the best information about your shoulder fast, click below for more information on the Free Shoulder Analysis.

More information

The main causes of shoulder pain

and how to get relief without medications, injections or surgery. 

Information on the FREE Video Series

Most shoulder problems won’t get better on their own. 

Learn how most shoulder problems start with a similar cause.

 Once you understand what is causing your shoulder pain, you can start the process of getting better naturally.

What if I just ignore my shoulder problem?

Because of the anatomy of the shoulder, many shoulder problems just don’t get better on their own. Most people end up avoiding the activities that hurt, hoping that the shoulder will get better. Sometimes this helps the pain to subside for a while. But when you try to do those activities again, it starts to hurt all over again.  

For some people, the problem just keeps getting worse until they end up with a frozen shoulder. That’s a difficult condition and one that usually requires extensive rehab. 

Should I get a shoulder injection?

Some people opt for an injection. But the problem with shoulder steroid injections is that they usually just give temporary relief. 

The underlying problem usually isn’t addressed by an injection and so many times the injury comes back worse after the injection has worn off.  

In addition, there are a number of risks associated with steroid injections into the shoulder. These include: joint infection, nerve damage, thinning of skin and soft tissue around the injection site, temporary flare-up of pain and inflammation in the joint, tendon weakening or rupture, thinning of nearby bone (osteoporosis) and death of nearby bone (osteonecrosis).  

Given the lack of evidence showing long-term effectiveness of steroid injections and the potential for these risks, it is clear that someone should think very carefully before they have an injection. It is probably best to get 2 - 3 opinions from different types of shoulder specialists.  

For more information about natural treatment alternatives, click here.

When should I consider surgery?

When you have severe pain that really limits your activity, it is understandable to think,  

  “I’ll just have surgery and get this fixed once and for all!”  

When a doctor tells you, “You have a rotator cuff tear”, it is tempting to think you need surgery. After all, if something is torn, you have to repair it, right?  

Well, often that is not the case. The reality is that the overwhelming majority of rotator cuff tears don’t require surgery.  

In fact, most people will eventually tear their rotator cuff. I know, that sounds hard to believe. But recent studies show that tears in the rotator cuff may be considered a normal part of aging.  

Usually, the best process to get better is to try a period of expert Physical Therapy first. As you will read below, just because you may have tried Physical Therapy, that does not mean that you received the correct care that your shoulder needs to get better.  

If you did receive the right Physical Therapy for your condition, and there was not significant improvement, then it may be time to talk to an Orthopedic Surgeon about whether surgery may be something to consider. It’s often helpful to get a second opinion.  

I tried Physical Therapy already. 

But did they do this?

From time to time we meet people who have tried Physical Therapy for their shoulder but it just didn’t help in the long term. Usually it was because the therapy didn’t include some key part of treatment.  

In so many patients, structures outside of the shoulder are causing a large part of the problem. Unless these structures are addressed, the pain will keep coming back.  

Here are the key areas that should be assessed in expert shoulder Physical Therapy:  

1. Neck and spine  

Did you know that it is common for neck and spine problems to cause shoulder pain and even cause Rotator Cuff problems?  

For this reason it is essential that the neck and spine is assessed by an expert to see if that is playing a part in the problem. If so, you will want that neck or spine problem to be addressed with the right hands-on care.  

2. Collar bone  

The collar bone actually intersects with the shoulder joint. In many patients we see that there is a problem with the collar bone which is preventing the shoulder pain from getting better. Usually the treatment for collar bone problems is very quick. Often just one treatment of the collar bone can make a huge improvement in movement and pain.  

3. Shoulder blade  

The shoulder joint that we usually think of is a ball and socket joint. Do you know that joint only provides just over half of the total motion needed? So where does the rest of the motion happen? A lot of it is caused by movement of the shoulder blade.  

Guess what happens when the shoulder blade isn’t moving like it should? That’s right, the shoulder joint has to do more, which can cause damage and stops injuries from healing like they should.  

Therefore it is essential that your shoulder blade is assessed. We need to make sure that it is moving correctly. And if it isn’t, then we can usually fix that with hands-on techniques and the right exercises.  

4. Ribs

What have the ribs got to do with it?  

You might be surprised to learn that your ribs move a lot during breathing and also when you lift your shoulder up. But it is common for one or more ribs to get stuck in position. When that happens, the shoulder has to do more work to get up overhead. This can lead to pinching of the rotator cuff or bursitis.  

Luckily, a stuck rib is usually a pretty easy thing to spot and to fix. But you have to be looking for it. Unfortunately, very few health care professionals actually assess the rib cage to make sure that it is functioning with the shoulder correctly.  

Click here if you would like us to check if any of these four areas are part of your problem. It's FREE!

Frequently Asked Questions

1. Why does the pain in my shoulder restrict my reach?

Usually the same thing that is causing your shoulder pain is also restricting your reach. This is one of the most common causes of shoulder pain:  

If your posture starts to slump (even just a little bit), often the position of the shoulder blade will worsen. This worse shoulder blade position usually contributes to the shoulder pinching the Rotator Cuff and Bursa, which is very painful and can cause damage to these structures. Because the shoulder is being pinched, it can't stretch to reach as well as it should.

Here's a video that explains this issue.

2. Why do I have pain in my shoulder at night when I sleep on my side?

If you have a shoulder problem, it can hurt at night whether you are lying on it or on the other side.  

When you are lying on the affected shoulder, that can push the shoulder up into socket, thereby compressing the Rotator Cuff and Bursa. When you lie on your good side, your arm will usually hang across, in front of you. That can cause a stretch load on the Rotator Cuff. So if your Rotator Cuff is injured, that will hurt.  

3. What kinds of shoulder problems merit a trip to the Physician or Physical Therapist?

It is possible that shoulder pain can be a symptom of a heart attack. If your shoulder pain is accompanied by tightness in the chest or difficulty breathing, you should call 911 immediately.  

If your shoulder pain is related to an injury, accident or fall and any of the following is the case, you should ask someone to drive you to Urgent Care or the Emergency Room:  

a) a joint that appears deformed b) inability to move your arm away from your body c) intense pain d) sudden swelling 

In addition, we generally feel that it is worth getting the opinion of an expert Physical Therapist or Physician if any of these apply:  

a) the pain is severe and it is not getting better b) you have had the pain for 2 weeks or more c) you were involved in an accident or a fall d) you are noticing weakness in the arm e) there is swelling or redness f) there is tenderness and warmth around the joint  

4. What are some things a person should do to avoid a shoulder injury?  

There are 7 things that we believe assist in preventing shoulder injuries:  

1. Maintain a comprehensive exercise program that includes progressive strengthening. 2. Warm up well before lifting or exercising. 3. Find out if you have tight shoulder muscles and commence an appropriate stretching program. 4. Maintain very good posture. 5. Maintain a healthy weight. 6. Mantain good balance. 7. Don't keep doing something if it hurts. 

If you would like assistance with any of these, click here to schedule a Free Consultation.

5. What strengthening exercises can be done to strengthen all the shoulder muscles?

When someone has a shoulder problem, we need to determine which of the smaller muscles are weak and then prescribe the correct exercises to strengthen those muscles without aggravating the injury. That can be a complex process.

However, for someone without any shoulder pain or problem, the following exercises should be sufficient to keep the surrounding muscles strong:

Lateral raise, front raise, rear deltoid raise, overhead press, chest press, incline press, lat pull down, seated row, scapula squeezes, band external rotation.

It is very important that these exercises are done correctly and safely. If you are not 100% sure how to do them correctly, seek expert advice. If you have any pain with these exercises, stop right away. In addition, stretching exercises should also be done consistently.

If you would like any guidance with these exercises, click here to schedule a Free Consultation.

6. How can I tell if the pain is coming from my shoulder or my neck?

That is a really difficult thing to determine without a clinical evaluation. We recommend scheduling a Free Consultation at one of our clinics for that to be assessed.  

However, we provide a FREE Video Series that may help you work out if your neck is part of your shoulder problem. 

For more information about these online videos, click here.

7. Does shoulder pain impact my balance or cause dizziness?

The systems and structures in the human body that are responsible for balance are intricate and easily affected. It is possible for a shoulder problem to affect balance and dizziness. For example, some shoulder pain can cause spasm in the trapezius muscle. This can lead to the neck becoming stiffer. Spinal stiffness can cause abnormal balance reactions and therefore promote a feeling of being unsteady and off-balance. Over time, neck stiffness can accelerate arthritic change, causing pinching of the spinal nerves. This can reduce the transmission of nerve signals that are required for normal balance.  

8. Can shoulder stiffness and pain be hereditary?

We tend to have similar shaped bodies to our parents. So if they were prone to specific shoulder problems because of their anatomy and biomechanics, we may be too. The good news is that, like many attributes that have a hereditary component, there are things that we can do to minimize that effect. By staying strong, flexible, healthy and in good posture, it is very likely that we can overcome much of the hereditary effect for shoulder pain.  

 So just because your dad suffered with bursitis, that doesn’t mean that you have to.  

 9. How is rotator cuff pain different from other shoulder pain? 

Unfortunately it is very difficult for an individual to determine if their pain is due to the rotator cuff as opposed to another structure such as a bursa, a different tendon or a different muscle, a neck problem or arthritis. To make that distinction would require a clinical examination.

If you would like to learn about our Free Shoulder Analysis, click here.  

10. Once there is evidence of rotator cuff weakness or inflammation, can it be addressed with Physical Therapy & exercise to perhaps prevent the need for surgery?  

Yes. Frequently, surgery can be avoided for Rotator Cuff injuries, weakness, inflammation and even tears. The key is getting the right expert care to ensure that there is consistent improvement and healing occurring. One wrong move or exercise could make a Rotator Cuff problem worse.  

11. What types of self-help activities can people do at home to alleviate shoulder pain?  

It is understandable to want to do what you can at home to relieve your shoulder pain. See FAQ 3 (above) for when you should seek expert advice instead. Here are a few things that people try that sometimes can be effective:  

Moist heat This usually helps muscle pain that has been present for at least 2 days. The heat should not be used for more than 15 minutes at a time. Also, care should be taken so that the skin is not burned.  

Ice packs These normally help inflamed joints feel some relief. There is some evidence that continued use of ice packs can actually prevent the body from healing itself optimally. Therefore, seek expert advice if using ice packs repetitively. The pack should not be used for more than 15 minutes at a time. Also, care should be taken so that the skin is not frozen.  

Topical ointments These usually help by numbing the area or by causing the skin to feel cool and then warm. These feelings on the skin distract you from feeling the aches/pains deeper in your muscles, joints, and tendons. Some of these products should not be used on children younger than 12 years without a doctor's advice.  

Exercises Some shoulder conditions may be helped by doing certain stretches or exercises at home. 

To find out which exercises are best for you, schedule a Free Shoulder Analysis by clicking here.

12. When should I exercise and when should I rest? Is it OK to ‘work through the pain’?

We use the following rule of thumb: If you are starting an exercise and there is only mild discomfort, try to continue for 3 - 5 more reps. If the pain is starting to subside, then continue with the exercise as long as the pain continues to subside.  

If at any time there is moderate to significant discomfort, you should stop the exercise immediately. At that point you should seek advice from your Doctor of Physical Therapy or Physician.  

13. Why do shoulders get “frozen” and how can we avoid it?  

When there is shoulder pain, even if it is only mild, most of us will tend to use the shoulder less. This often happens without even realizing it. That is no problem for a short period of time. However, if we limit movement for a longer period, problems can begin.  

One of these problems is Frozen Shoulder Syndrome. Generally our bodies follow the rule that “if you don’t use it, you lose it.” So if we aren’t using the full motion of the shoulder, the capsule, ligaments and muscles start to tighten up so that we are then unable to take the shoulder into that motion that we are not currently using.  

This condition can progress without us consciously being aware of the problem until one day we are barely able to move the shoulder without pain. At that point you have Frozen Shoulder.  

To avoid Frozen Shoulder, it is important to get help earlier. We recommend if you have shoulder pain for more than a few days that is not getting better, you should schedule an appointment with your Doctor of Physical Therapy.

 If you would like to do that, click here.

14. How can we know the difference between a simple strain and something more serious?  

This is a very difficult question. A strain occurs when some fibres of a muscle are damaged. If more fibres are damaged and to a larger degree, that strain can be more severe. The most severe classification of muscle fibre damage is a tear.  

Because we all feel pain in different ways and because different muscles and different parts of the muscle have varying sensitivity to pain due to the presence and location of nerves in the muscle, it is very hard to determine the level of muscle damage by pain alone. To really know how much muscle has been damaged, or if something else has been damaged, you should schedule an appointment with your Doctor of Physical Therapy or Physician.  

15. Why does my shoulder hurt when I’m using my hand?  

Just about any time we are using our hand, the muscles closer to the body are involved to help stabilize the hand. The muscles of the shoulder, including the Rotator Cuff, are included in this group.  

If we have a problem with one of the shoulder muscles, it will often hurt when we are using our hand because that muscle is having to contract to stabilize the shoulder. In addition, if the Rotator Cuff is damaged or weak, it will often allow the ball of the shoulder joint to rise up into the socket, thereby pinching structures, causing pain. 

16. If I play a throwing sport, which muscles should I strengthen?  

For your shoulder to function optimally, all the muscles around your shoulder need to be strong, coordinated, flexible and have the right ratios of strength compared to each other. See FAQ 5 (above) for an overview of the basic exercises that most of us should be doing.

In addition, most upper-extremity athletes should be doing exercises specifically for the Rotator Cuff muscles. These muscles are skinnier and usually don't have the endurance naturally that is required for the repetitive effort of these sports. Beginner Rotator Cuff exercises that can be done with bands and that are easy to start are: serratus anterior press, shoulder external rotation (with scapula retracted) shoulder internal rotation (with scapula retracted) and "empty can" abduction to just 15 degrees.

If you would like some FREE guidance on how to start your athletic shoulder strengthening program, click here.

17. What is proper stretching technique and what are the most crucial stretches for the shoulder?

The error that most people make when stretching is not holding the stretch for long enough. As long as there is no pain or strong discomfort, you should hold the stretch for at least 30 seconds. It usually takes that long for the muscle to stretch and lengthen. It is also important when stretching to progress slowly and carefully. At no time should there be pain or strong discomfort.

For most people with shoulder pain, the first stretch that we teach them is a modified pec stretch in a doorway. Usually we have to train the shoulder blade to sit back where it belongs. If the pectoralis major is too tight, it will be difficult for that to happen. We don't recommend someone trying this stretch on their own. It is possible to do this incorrectly and hurt the shoulder. So if you woud like to be shown how to do this stretch correctly for your shoulder situation, schedule a Free Consultation here.

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What Others Have Said

"Before I started, I was having serious trouble loading a 32 pound canoe on the roof of my car. Now I can load a boat 23 pounds heavier without any hesitation. Everyone here at STAR PT is great!"  

Dirk Van Duym - Covington

“When I shattered my shoulder, I thought I was never going to do the normal things in life like cooking, mopping, or even household tasks in general. I even thought I would not be able to do my crafts which are my relaxing time. With the help of everyone at STAR PT, I started to see the light at the end of the tunnel. Thank all of you from the bottom of my heart.”  

 Lisa Garza - Slidell

"I sustained a fall in my home and fractured the top of my right arm in two places. Since I am right-handed, I was not able to wash myself or even comb my hair. My sister stayed with me to help with my daily activities. After I attended Star Physical Therapy for a while, I was able to accomplish these tasks on my own. The staff is marvelous, and I enjoyed the activities. Someone was always readily available to offer assistance if needed. I would definitely recommend Star Physical Therapy! It was a wonderful experience!"  

Joyce Perryman Bunch - New Orleans

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