Foothills is a group of locally-owned Phoenix physical therapy clinics that provide hands-on therapy and rehabilitation to patients all over the Valley. If you’re in need of physical therapy, you can go online to schedule a free consultation today. To learn more about physical therapy techniques and our services, check out our blog.
KT Creech has a doctorate in physical therapy and is certified in ASTYM and Trigger Point Dry Needling techniques. As a specialist in post-surgical and sports injury rehabilitation, she talks about what causes shoulder pain and how physical therapy can help reduce or eliminate discomfort.
The shoulder is one of the more complex joints in the human body. It has distinct characteristics that enable it to be the most mobile joint in the body, which inherently makes it the most unstable. The main function of the shoulder complex is to stabilize the arm and hand so they may interact with their environment. Injury to this joint can have drastic consequences. From the most basic tasks like getting dressed or brushing your hair, to more complex movements like lifting weights or throwing a ball, the shoulder plays a major role in everyday function.
To understand the complexities of the shoulder, we must first examine the anatomy. The shoulder is made up of three bones: the humerus, clavicle, and scapula. It has three joints: the acromioclavicular (A-C) joint, the sternoclavicular (S-C) joint, and the glenohumeral (shoulder) joint. It also has one “pseudo” joint called the scapular-thoracic joint where the shoulder blade rests against the ribcage. The shoulder has other structures including ligaments, cartilage, and muscles that work to move and stabilize the arm as it travels throughout all planes of motion. One such structure, the rotator cuff, is vitally important to shoulder function.
The rotator cuff is comprised of four small muscles that act as a stabilizer of the shoulder joint. The shoulder joint is classified as a ball-and-socket joint. Think of it as a golf ball sitting on a tee. The rotator cuff contracts during motion of the arm to compress the head of the humerus into the socket. In other words, the rotator cuff acts like four rubber bands holding the golf ball on the tee. Without the coordination of movement that these muscles perform, the arm does not maintain its contact with the joint and we see mechanical breakdown of the shoulder— the golf ball wobbles on the tee. This breakdown can happen for a number of reasons, including a rotator cuff muscle tear, tendonitis, chronic inflammation, or shoulder weakness. All of these injuries can be treated with physical therapy.
Another dysfunction, known as impingement syndrome, is the most common cause of shoulder pain. People with shoulder impingement often complain of pain with reaching overhead, across the body, or behind the back, and may have difficulty lying on the injured side. Shoulder impingement could be a result of poor posture, weakness, age, or repetitive overhead activities and can usually be resolved with specific strengthening exercises to improve shoulder mechanics.
Faulty scapular mechanics is caused by a muscular flexibility and strength imbalance at the shoulder blade. This imbalance may cause scapular winging, a condition where the shoulder blades protrude out, rather than resting flat against the rib cage. Poor posture of the upper back and neck can also lead to mechanical breakdown at the shoulder. This condition can occur with athletes, particularly those who participate in overhead sports such as volleyball, baseball, or swimming, due to the repetitive movements that take place at the shoulder. There is also an increased incidence of shoulder injury in people whose jobs require prolonged time working at a computer.
A physical therapist can perform a comprehensive evaluation of the shoulder to determine the underlying cause of shoulder pain. Tests performed are geared towards identifying faulty mechanics, assessing strength and range of motion of the shoulder, and performing special tests to rule out more serious injuries that may require additional medical intervention. Once a physical therapist has evaluated your shoulder they can establish a plan of care based on exam findings. This may include a specialized strengthening program targeted for the rotator cuff and postural re-education, flexibility training to address muscular imbalance, manual therapy to restore proper joint mobility, and pain management interventions. A physical therapist will provide you with a customized program including education on proper body mechanics for lifting and postural alignment, as well as activities or positions that should be avoided or modified to allow you to transition back to the gym, return to sports, or just resume normal daily activities with optimized shoulder function.