The shoulder is a complex joint. It is one of only 2 ball and socket joints in the body, the other being the hip. It is the most mobile joint in the body, enabling us to put our arm and hands in an amazing range of positions to allow daily tasks. In order to achieve this we need all areas of the shoulder girdle to be working correctly. The shoulder girdle includes the ball and socket joint, the shoulder blade (scapula), and the collar bone joint (clavicle) in addition to the mid back (thoracic spine). Therefore, when a physiotherapist assesses you, they will usually look at all these areas to identify what is contributing to the dysfunction. This could be weakness of the shoulder ball and socket muscles (rotator cuff muscles) or the scapula muscles. It could equally be tightness in the shoulder joint or spine.

Shoulder pain represents a large part of a physiotherapist's caseload. It is one of the leading causes of musculoskeletal disability. However, it is also a condition which research demonstrates overwhelmingly that physiotherapy can help with in the majority of cases. Some common shoulder conditions physiotherapy can help with include frozen shoulder (adhesive capsulitis), rotator cuff related shoulder pain (subacromial pain) and shoulder instability.

What is the rotator cuff and how does it get injured?

The rotator cuff muscles are a group of four muscles that come together as tendons that attach to the anterior aspect of the humerus and the scapula. This allows lifting and rotational movements of the shoulder joint. Correlations with older age and younger overhead throwers/athletes have led to trauma to the tendons of the rotator cuffs causing degeneration, overload and then tears.

Rotator cuff tears can be considered a continuum from normal tendon loading to tendinopathy and overtime can lead to different grades of tears: partial, full thickness, complete tears and massive tears. Degenerative tendons from age related overuse can also cause symptomatically painful shoulders from an acute tear on chronic minor tears or overuse in the younger population.

How can Physiotherapy help?

Based on these assessment findings mentioned above physiotherapists will guide their treatment. This will commonly involve an individualised exercise program including strength and mobility based exercises in addition to manual therapy if required to aid with pain and increase range of movement to allow optimal function.

Evidence based timeframes & expectations for improvement

Research supports the use of physiotherapy including exercise and manual therapy, amongst other modalities for the treatment of shoulder subacromial pain. It is suggested that at least 6 weeks of exercise aiming to restore scapular and shoulder motion is more effective than placebo or no treatment at improving pain and function in the short, medium and long term. Furthermore, In relation to massive inoperable rotator cuff tears studies suggest that 12 weeks of physiotherapy strengthening improves pain and functional use of the arm, particularly when only one tendon is involved (see here).

In relation to frozen shoulder research also supports the use of physiotherapy in certain cases for between 6-12 weeks with the use of exercise and shoulder joint mobilisation/stretching in reducing disability and improving disability, However, this will be dependent on the stage and irritability of the condition. Orthopaedic interventions such as injections are also recommended in the literature, therefore if you'd like to know the best course of action for your frozen shoulder, please come and speak to one of us.

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