How to Treat Shoulder Pain
When it comes to dealing with shoulder pain, many physical therapists commonly treat where the client presents with pain, rather than considering if this is the actual cause of the problem or merely a symptom.
Here, I will focus on the role of the rotator cuff during motion of the gleno-humeral joint and discuss three case studies that involve pain and/or stiffness during abduction in the frontal plane.
When clients present with symptoms to the shoulder joint, the majority of their signs and symptoms will have either a loss of motion or a presenting pattern of pain at some stage of abduction, i.e. between 0-180 degrees. We have to be cautious when our clients have presenting pain that is located to the shoulder and upper limb area as it could be referred from a multitude of areas, for example the cervical spine or visceral (diaphragm, gall bladder, liver, lungs, etc). Clients will tell you that it hurts in the arm, but might have difficulty pinpointing the precise area.
Asking the right questions
An important question to ask is ‘do you have night pain?’. If the answer’s yes, the next question should be ‘can you reduce your symptoms by altering your position?’. If the answer’s no, we can consider this a red flag and refer the client on to the medical profession.
The rotator cuff
Commonly called the SITS muscle group, or active ligaments, the rotator cuff comprises the supraspinatus, infraspinatus, teres minor and subscapularis. Abducting the arm requires the integration of the gleno-humeral joint, scapulothoracic articulation, acromio-clavicular joint (ACJ) and the sterno-clavicular joint (SCJ). If any of these joints don’t behave properly dysfunction will occur.
Before we look at the function of the rotator cuff during abduction, I would like to talk about scapulohumeral rhythm.
This states that when the humerus abducts, the scapula will rotate at a 2:1 ratio. For example, at 90 degrees of abduction the humerus would have abducted 60 degrees and the scapula would have rotated 30 degrees.
