This is something that bugs many in the health field – why do we treat shoulders so differently to many other joints? You might be wondering what I mean by this…I mean that when people come in with say, knee pain, we aim to reduce the pain, increase the movement and then gradually load the joint back up to better than pre-injury levels, or as I like to tell my patients – we calm stuff down and then build stuff back up.
So why don’t we do this with the shoulder?
The shoulder seems to be a voodoo for many therapists across all disciplines. I’ll admit that it can seem to be a complicated joint when you look at every single little thing that could go wrong. It can be overwhelming! Your shoulder moves in many different planes and is incredibly strong, whilst incredibly mobile!
Unlike knees which bend and straighten, shoulders move in all different directions, with many muscles working together, contributing to your movement. Not to mention the role of the scapula, the AC joint, the ligaments, the shoulder capsule…. the list goes on and on. Yes shoulders are and can be quite complex, and many therapists can become overwhelmed when dealing with such a complex joint. But when we really break things down, first things first, much like your knee (and other joints in the body), we need to get your pain under control, before we build it back up again, stronger and pain-free, so you can do what you love with freedom and no restriction!
I think that this may be the reason that it typically isn’t treated effectively and if you’re reading this then I can almost guarantee that you have, or have had, frustrating shoulder pain. So if you’d humour me for a few minutes, let me offer a solution to your pain.
Pain is pain!
Forget muscle pain or nerve pain or joint pain, it’s all pain and it all needs to be dealt with accordingly. We have so much amazing research now, which I won’t bore you with, that gives us the tools to help you decrease and be in control of your pain. Your perceptions about your pain will be far more important than ANY structural damage!
Don’t believe me? I wouldn’t either, who is this chick?
A study in 2013 found NO DIFFERENCE in outcomes between patients given a sham clean out surgery of their knee compared to the real surgery. So what does this mean for you and your shoulder? It means that if you believe in the treatment you are receiving then your pain will decrease! That’s huge.
What about my scans?
Throw them in the bin. Have a look at this fascinating graph below from Adam Meakins (The Sports Physio)
What this shows is that degeneration and pain are not interrelated! In fact, think of degeneration as you think of wrinkles and grey hairs – annoying, maybe; but painful? No!
So let’s put the scan away and focus on what really works…Movement and strengthening!
Your shoulder is built to move!
It kills me when I hear people say, “Ohh I just can’t do that anymore, my shoulder can never get better – my Physio told me to change my lifestyle to avoid certain activities.” This is a nonsense and lazy approach to treating shoulders (99% of shoulders – can discuss frozen shoulders in another blog).
The truth is your shoulder CAN and SHOULD be able to go through the full range of movement and, by avoiding movements, you will develop more stiffness, pain and decrease movement further. Avoid all movements that hurt suddenly doesn’t seem like such great advice anymore does it?