Treating Shoulder Pain

The Ultimate Rotator Cuff Training Guide Review

I have been a physical therapist for 17 years specializing in the treatment of musculoskeletal/orthopedic pathology. Over the years I have treated countless patients with shoulder related pain due to a number of different pathologies including bursitis, tendonitis, adhesive capsulitis, impingement syndrome, AC joint problems, dislocations and general muscle weakness and imbalances. What this means is that I have a great deal of experience in this area.

Shoulder pathology is not often easily treated for a variety of reasons and patients don't always recover quickly or fully, also for a variety of reasons. My experience has shown me that a person with shoulder pathology is likely to improve or has a greater chance of improvement if they follow the treatment advice of an expert in the field with a proven system of intervention that has shown results over the years.

The Ultimate Rotator Cuff Training Guide is such a system. Brian Schiff, PT has done an outstanding job in compiling this collective work of his knowledge and experience in treating patients with shoulder pathology. His years of applying the exercises and techniques found in his eBook have allowed him to create an effective, simple to apply and useful strategy for patients with acute or chronic shoulder pain. The strategy outlined in his book can be applied to a variety of pathologies causing pain in the shoulder region and they are equally effective in a variety of situations.

This work is well written and easy to read. It is very informative and full of useful tips and suggestions to alleviate shoulder pain and then to maintain that recovery once it is achieved. He includes several descriptions and photographs that detail all of the exercises outlined in the program, making it very easy to use and replicate.

There are several aspects of the book that are notable and one in particular is Brian's ability to point out common exercise mistakes that patient's make that may put the rotator cuff at risk of injury. He also does a great job in teaching his readers how to modify these exercises so they can be performed correctly without risk of injury or reinjury.

In The Ultimate Rotator Cuff Training Guide Brian Schiff, PT has combined practical clinical experience working with shoulder patients with evidenced-based research in developing a sound intervention that will produce results. I've treated 100's of shoulder patients over several years as a Physical Therapist. It is nice to have that collective knowledge summarized and compiled into an easy to use and effective system that can be applied to any of my patients with shoulder pathology. I recommend this work to anyone suffering from shoulder pain and to medical and fitness professionals that treat patients with shoulder pathology.

Discover your way to a painfree shoulder!

How to Treat Shoulder Pain

People of all ages suffer from shoulder pain. The causes are many and can range from an unknown onset to a traumatic event. Many people develop shoulder pain from performing repetitive type activities for prolonged times. Others will experience pain in the shoulder following a fall onto the shoulder or on the outstretched arm. Sometimes the reason for pain is not as obvious. I see many cases where a person cannot identify what caused the pain in the shoulder. Often times this pain for unknown reasons can occur when someone bumps their shoulder against the door jam in the middle of the night when going to the bathroom. This rather benign action sets off a chemical process in the shoulder that will build up over several days. Eventually this will cause pain in the shoulder. Since the "injury" occurred several days earlier the person cannot recall any event that started the process. Regardless of the cause of the pain in the shoulder the treatment is often similar from case to case.

Treatment of the shoulder can encompass several different areas. Conservative measures include medication (anti-inflammatories, pain medications), rest, cortisone injections, and/or physical therapy. All of these methods can be effective in helping relieve a painful shoulder especially when they are performed in combination with each other.

Often times when you present to your medical doctor with complaints of shoulder pain they will prescribe some medication as described above. Rest will also be advocated although this is not always easy for people to follow depending on their activity levels or their occupations. Injections for the painful shoulder are sometimes given right away depending on your medical doctor's philosophy. Some MD's would rather you attend physical therapy before considering injecting the painful shoulder. Injections are not the end all beat all and they do not offer relief to all patients that receive them. Often times a well rounded physical therapy program can alleviate shoulder pain and you won't have to consider having an injection.

Physical therapy treatment can consist of the following interventions:

1. Therapeutic exercises - this will consist of range of motion, conditioning, and strengthening exercises. The goal here is to maximize and restore any loss of range of motion, improve the overall endurance of the shoulder blade and shoulder muscles and to improve the strength of these same muscles. The muscles surrounding the shoulder blade must be conditioned and strengthened just as the main shoulder muscles would be because the shoulder blade muscles have to work in conjunction with the shoulder muscles in order to restore normal motion and to prevent recurrence of pain.

2. Manual therapy - this will consist of hands on treatment that the physical therapist would perform on you. This might consist of joint mobilization (i.e. techniques designed to improve joint motion and relieve pain), or soft tissue massage (i.e. techniques designed to improve muscle and connective tissue flexibility and to relieve pain).

3. Modalities - this consists of machines that the physical therapist may apply to your painful shoulder to assist in pain relief and healing along with the other treatments mentioned above. Some of these machines are ultrasound, electrical stimulation, TENS, or iontophoresis.

All of these interventions can be used in the treatment of a painful shoulder. It is common in clinical practice to use a combination of these interventions. It has been my experience in treating hundreds of shoulder patients over the years that therapeutic exercise is an absolute in the treatment of the painful shoulder. Well rounded exercises that target the shoulder blade and shoulder muscles are the mainstay of any good physical therapy regimen for the treatment of shoulder pain.

A painful shoulder can persist for years. With the right education you won't have to suffer any longer!

Shoulder pain is a common affliction that affects many people on a daily basis. Depending on the severity of the pain this type of problem can have a significant, negative impact on performing your occupation and your activities of daily living. There are several ways that shoulder pain can develop and I will discuss those below.

The most recognized way for pain to develop in the shoulder is through trauma. This could consist of something obvious like falling onto your outstretched arm causing your shoulder to jam or trying to push or pull on a stuck object. A less obvious traumatic event could be forcefully using the muscles of the shoulder over time and then pain occurs. This could happen during activities such as chopping firewood, hammering, or exercising in a repetitive fashion. The first traumatic event is identified as a macrotrauma meaning it's a large and obvious event. The second situation is termed a microtrauma meaning it's less obvious and occurred with repetitive insults to the muscle tissue. One does not necessarily occur more than the other, but both can cause significant injury and pain.

The macrotraumatic event can lead to injury of the muscle by causing a major tear in the muscle fibers. A muscle tear is exactly what it sounds like. The muscle fibers actually rip apart and become separated from each other or where the muscle tendon inserts on a bone in the shoulder. You can have different size tears and these are usually termed partial, full or full thickness tears. It is important to remember that just because a muscle tear is present that doesn't always mean you will have to have surgery. Signs that a shoulder muscle is torn include but are not limited to pain, weakness, and loss of motion.

A microtraumatic event or repetitive overuse can lead to injury of the muscle by causing minor tears in the muscle fibers. These are small in degree but enough to cause an inflammatory process to occur which leads to pain. This is a condition that we would commonly term as tendonitis (an inflammation of the muscle or tendon). It is not the same as a partial or full tear. The muscle fibers do not actually separate from each other. This type of event can cause significant pain and dysfunction. Signs that a shoulder muscle is inflamed include but are not limited to pain, weakness, and loss of motion.

Another common cause of shoulder pain is bursitis. A bursa is a fluid filled sack that sits between muscle and bone. The bursa is designed to protect the muscle from scraping against the bone, thus it protects it from becoming irritated against the bone. The bursa has a lot of nerve endings in it. If the bursa becomes inflamed we term this bursitis and it can be very painful. A bursitis can occur in the shoulder as the result of a macro or microtraumatic event as described above just like a muscle tear or tendonitis can develop. Signs that a shoulder bursa is inflamed include but are not limited to pain, weakness, and loss of motion.

These are three of the most common pathologies that cause pain in the shoulder. You will notice that the symptoms that you may experience as a result of these conditions are very similar. So how do you tell which problem you may have? Well, to determine that you should consult a competent Physical Therapist in your area that specializes in the evaluation and treatment of musculoskeletal and/or orthopedic pathologies. They will be able to successfully diagnose the source of your pain and treat the problem appropriately.

Learn how I have helped hundreds of patients with shoulder problems overcome their pain and get their life back!

Shoulder pain is a common problem that affects the majority of the population. Most people will experience some degree of pain in their shoulder at some point. The causes of the pain and the degree of the intensity of the symptoms will vary from person to person. The recovery and return to normal function will also vary from person to person for a variety of reasons. But how do you tell what is causing your shoulder pain? This article addresses some common ways that the various pain generators of the shoulder are diagnosed from the perspective of an experienced Physical Therapist.

Three common pain generators of the shoulder are the rotator cuff muscles and tendons, the bursa and the shoulder capsule. The purpose of the rotator cuff muscles and tendons is to move our shoulder in a rotating fashion (hence their name) and to help up elevate our arms over our head. The purpose of the bursa or bursal sac is to protect the muscle from scraping on the edge of the bone. So the bursa sits between the muscle and the bone and acts like a cushion. Without it the rotator cuff muscles would repeatedly scrape on the edge of the bone and become easily irritated. The shoulder capsule offers added stability to the shoulder joint. Any one of these structures can become a pain generator if they are inflamed or injured. Often times they will be inflamed in conjunction with each other.

It can sometimes be tricky to diagnose the exact pain generator because the symptoms that are experienced by people with these pathologies are typically very similar to each other. More often than not these pathologies will cause symptoms of pain, weakness, and loss of motion. The pain is typically felt in the shoulder region and is often felt in the upper arm above the elbow. People with shoulder pain will commonly feel an increase in pain when they are trying to raise their arm overhead or out to the side. So if these pathologies are so similar in nature how can we tell them apart?

Well, in physical therapy there are some simple tests that can be performed that will help distinguish between the different pathologies described above. I will describe them here briefly.

1. Rotator cuff tendonitis: if one or more of the rotator cuff muscles is inflamed this is termed tendonitis. This is diagnosed by simple manual muscle testing where the physical therapist will resist specific motions of the shoulder that the rotator cuff is responsible for. If the patient experiences pain during a manual muscle test this is indicative of a tendonitis.

2. Bursitis: this can pose a challenge for the therapist to diagnose but if they are well trained they can more easily identify this as a problem. The tests start with manual muscle testing as described above. If one of the manual muscle tests is painful the Physical Therapist can then perform a Pull Test. This is a specific test that is specific to the bursa. If it is positive then it is likely that the person has a bursitis of the shoulder.

3. Adhesive capsulitis: this is also commonly known as frozen shoulder. To make a diagnosis of adhesive capsulitis the Physical Therapist must passively test the motions of the shoulder. Remember as I mentioned above that any one of the pathologies discussed here can present with a limited range of motion. Adhesive capsulitis presents with a very specific limitation in motion that will likely differ from the limited motion seen in tendonitis and bursitis.

If the symptoms of these pathologies can be so similar then why do we need to be so specific in the diagnosis? The reason is that although symptoms are similar the treatments for these conditions can vary slightly from each other. Some things that I may do for an adhesive capsulitis I might not do to treat a tendonitis and so forth. So a specific diagnosis can help guide the Physical Therapist toward a specific plan of treatment for the pathology in question.

A well-rounded treatment plan will lead to positive results in improving your painful shoulder. Discover how to improve your pain NOW!