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  4. What could be the cause of my shoulder pain, by Chris Brooks, Osteopath, Worthing

What could be the cause of my shoulder pain, by Chris Brooks, Osteopath, Worthing

Shoulder pain can be difficult to shift. Due to the highly mobile nature of the shoulder and the fact that the shoulder has less integrity than many other peripheral joints (ie the muscles of the area are primarily responsible for its integrity), there is increased risk of injury to the structures of the shoulder. The good news is osteopathy can help with many of the symptoms of shoulder injury/dysfunction, and can also help manage the associated pain.

Anatomy

I don’t want to bog you down with too much detail, but there are some interesting facts relating to shoulder anatomy. Firstly, there are four joints in the shoulder complex, but more often than not when we are talking about the shoulder we are principally looking at two. The first is the acromioclavicular joint (the connection of the shoulder blade and the collarbone) and the second is the glenohumeral joint (made up of a shallow depression on the lateral aspect of the shoulder blade and the top of your arm bone). There are 17 muscles that attach to the shoulder blade to both keep it adhered to the ribs and move it in ways that enable it to function appropriately when moving the arm, etc. The four muscles that pass between the shoulder blade and the upper arm are the rotator cuff muscles, and these enable all the fantastic movements that we can do – literally everything from brushing our hair to throwing a ball.

Hence dysfunction of the shoulder blade or muscles of the area can cause immediate problems with movement. And where there is inappropriate movement, generally pain follows not far behind.

Let’s focus a little more on a few of the most common reasons for shoulder pain.

 Postural

We often use our bodies repetitively and inappropriately at work. Sometimes this can lead to shoulder and neck pain. For example, holding prolonged postures (for example, sitting at a desk all day) can lead to shortening and chronic contraction of some muscles and lengthening and weakening of others. This often results in muscular pain.

This muscular pain may lead to restrictions in movement and can occasionally irritate the nerves passing through the shoulder and chest that supply the arm. This may cause pain, numbness and/or pins and needles in the arm or hand.

At the Broadwater Osteopathic Practice we are experts in the assessment of posture and will be able to diagnose the source of your pain and its cause, and provide you with effective treatment to decrease your symptoms.

Rotator cuff

The rotator cuff muscles are the muscles in your shoulder responsible for orientating the position of your arm.  They are very active throughout the day, and are therefore prone to overuse injuries and strains.

Rotator cuff pain will commonly be felt at the front or side of your shoulder. As the shoulder joint relies so much on the rotator cuff for its integrity, imbalance in these muscles can lead to lots of pain, joint restriction and often to night pain. These symptoms are not dissimilar to the early symptoms of a ‘frozen shoulder’. However, the prognosis with a rotator cuff injury is far better.

Despite the complexity at the shoulder, its reliance on muscular balance makes it very responsive to osteopathic treatment.

Frozen shoulder

Adhesive capsulitis commonly known as ‘frozen shoulder’ is a condition that leads to inflammation and adhesions within the shoulder joint. These adhesions lead to shoulder restrictions and pain. Frozen shoulder has three stages, which on average span over 18 months. Osteopathic treatment can help with the pain and adaptions relating to the decreased available movement. Treatment is more likely to work if it the issue arises from associated musculoskeletal conditions of the shoulder and neck, rather than as a truly isolated occurrence. In the case of the latter, it may not be possible to change the longevity or the physiology of the condition.

The good news is lots of more common shoulder issues (which are more responsive to osteopathic treatment) are often misdiagnosed as frozen shoulder. If you are suffering with shoulder pain which has been diagnosed as frozen shoulder it is always worth getting a second opinion.

Moreover, the decreased shoulder movement in a condition like frozen shoulder will cause the muscles of the shoulder to shorten, which in turn will lead to compensation in the upper back and neck and will be likely to increase localized pain. Therefore, it is advisable to have these areas worked on to maintain function and prevent any additional symptoms.

Thoracic outlet syndrome

Thoracic outlet syndrome (TOS) is a condition that leads to irritation of the nerves or compression of the vascular vessels near the shoulder joint causing pain and sometimes neurological symptoms into the shoulder, arm and hand. Altered sensation, pins and needles, numbness, weakness and muscle twitching are all symptoms you want to look out for with TOS.

TOS typically occurs due to mechanical issues such as tight muscles, rounded shoulders and poor posture. Luckily this means that it is responsive to osteopathic treatment. TOS is common due to the sedentary nature of many jobs and the increase in use of laptops, tablets and phones.

Acromioclavicular (A/C) joint

This is the joint between your clavicle (collarbone) and scapula (shoulder blade). There are two main causes of A/C joint pain – impact injuries causing displacement of the clavicle due to trauma to ligaments and/or muscles supporting the joint, or degeneration of the joint itself.

In the event of displacement, it is often advisable to obtain an X-ray to elicit the extent of the problem. Often the advice is to leave the area to heal, although therapy may be needed later to increase functionality and advise on strengthening.

With regards to degeneration and osteoarthritis of the A/C joint, the pain will often be felt on the top of the shoulder and sometimes more widely into the lateral upper arm (deltoid area). Pain will generally be increased with adductive movements (reaching the arm across the body) and/or above the shoulder level. Repetitive use or historical injury are often factors in later presentation of A/C degeneration. Therefore, those who work overhead or repetitively with their arms are often more likely to develop a problem.

Dislocation

In cases of traumatic dislocation it is advised to visit hospital to have the shoulder relocated under X-ray. This helps to avoid any complication with nerve impingement and can rule out any fracture or large labral tear that may have been caused during the trauma.

It is common for patients to experience significant pain in the shoulder region after a dislocation due to the strains placed on the integral tissues. The Broadwater Osteopaths are experts in diagnosing which tissues are leading to pain and can provide effective treatment, and, if necessary, can advise on the rehabilitation needed to relieve any symptoms.

It is common for a shoulder to dislocate more easily after the initial dislocation. Therefore, it is advisable to obtain and practise some shoulder rehabilitation and strengthening. Where necessary, our osteopaths will be able to guide you through, and provide you with, tailored rehabilitation programmes aimed at getting the shoulder back to full function – decreasing any pain and strengthening the musculature to prevent future dislocation.

Other conditions

There are many other common conditions we see frequently at the Broadwater Osteopathic Clinic that can cause shoulder pain. If you have any pain or restriction in or around the shoulder, then please think of us first.

It is worth adding that the shoulder is an area that can have pain referred to it from the heart, lungs, gall bladder, stomach etc. Our osteopaths are highly trained to screen for any signs of visceral or systemic issues, so you are always in safe hands at the Broadwater Osteopathic Clinic.

arthritis, dislocation, frozen shoulder, osteopath, osteopathy, pain, rotator cuff injury, shoulder, tendonitis, worthing
09/11/2018

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Broadwater Osteopathic Practice

6 hours ago

Broadwater Osteopathic Practice

If you are unable to make an appointment, without notice, a Full Fee will be charged. A covid screen and reminder text is sent or calls made, 24 hours prior to all visits, so this allows ample time to call and let us know if you are unable to attend.

Missed appointments at this time are very frustrating. We need to allow more time for each patient appointment, to screen, clean, aerate and risk assess your visit. For this to happen we need to allow at least 15-30 minutes extra for your allocated appointment. We have a waiting list of patients who would also love your appointment if you cannot make it.

Please consider other people and make that call. Save yourself a missed appointment fee, but most importantly, allow someone else to take your appointment.

Many thanks

Team BOP
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Broadwater Osteopathic Practice

1 day ago

Broadwater Osteopathic Practice

In this second installment on running injuries, Chris looks at common problems below the knee that we encounter and advise upon in the clinic.
Going the extra mile – part 2: The most common running injuries, their causes, symptoms and how to help yourself.
Shin splints
Location of the pain
Along the inside of the shin.
Symptoms
Recurring pain in the middle and inner aspect of the tibia (shin bone). Often described as an aching or a sensation of increasing pressure that intensifies until the pain forces the person to cease activity.
The detail
In summary, it is the inflammation of the connective tissues joining the muscle to the inside of the tibia. It is caused by overuse or too sudden increased activity levels. Running on surfaces that are hard and/or an upwards gradient probably can also contribute.
Self-management

Use ice to decrease localised inflammation.

As hard as it will be for you really keen runners, it may be necessary to stop running for a prolonged period. You can of course maintain cardiovascular fitness by diversifying into non-weight-bearing exercise, such as cycling or swimming.

Consider foot and gait analysis to see if there is an underlying predisposing factor such as dropped medial arches of the foot and resultant tibial torsion.


Achilles tendonitis
Location of the pain
In the Achilles tendon itself, but also felt in the back of the heel where the tendon attaches.
Symptoms
An ache in the Achilles tendon that is often made worse with activity. Continuing to run through the discomfort can make the micro-tears associated with tendonitis worse and result in a longer recuperation period. The injury may also cause redness or swelling around the tendon and a sensation of tightness within the lower calf. Where there is a palpable lump within the tendon or an audible snapping sound, this may be due to a build-up of scar tissue due to a longer period of successive micro trauma.
The detail
The Achilles tendon is what connects your calf musculature to your heel. It is the biggest tendon in your body, and it needs to be, as it has to deal with large forces when walking, let alone running or jumping. The problem will often begin as a mild ache in the area after sporting activity. Prompt action can reduce the length of time needed to rehabilitate the area. Many factors are thought to predispose someone to Achilles tendonitis, including an increase in the intensity of activity, poor running technique, inappropriate footwear.
Self-management

Ice the area, especially after activity.

A small heel lift may be helpful in reducing discomfort in the tendon itself – the lift slightly shortens the calf musculature and so reduces pull and stretch on the Achilles.


Plantar fasciitis
Location of the pain
Underside of the foot.
Symptoms
Tenderness, stiffness or even a sensation of bruising in the sole of the foot. It often begins around the base of the heel. Stiffness in particular may be more evident upon weight-bearing for the first steps of the day or after a period of inactivity. Discomfort is also more likely when barefoot or wearing unsupportive footwear.
The detail
The plantar fascia is an extremely strong band of connective tissue that supports your foot arches. Its main purpose is to absorb much of the impact of heel strike and help to reform the foot arches after toe-off. With micro-tears in the fascia we get discomfort. Some people appear to be more prone to this and it is likely that there are several predisposing factors such as increased weight, inappropriate footwear, lack of stretching and increased activity.
Self-management

It is possible to continue running through the discomfort for a prolonged period, but doing so will cause an exponential increase in healing time.

While applying a moderate amount of pressure, roll the sole of the foot over a rolling pin for around five minutes a time, up to five times a day. This can also be done with a frozen water bottle if you wish to combine the benefits of icing with the facial stretch.

Stop wearing any non-supportive footwear such as flip flops, sandals, etc.

Liberal foam rolling of the calves and stretching of the calf muscles can be of benefit when suffering from plantar fasciitis.

Ankle ligament sprain
Location of the pain
On the side of the ankle.
Symptoms
Swelling, bruising, instability, pain and difficulty weight-bearing fully on the affected side, depending on the severity of the sprain. Often it may just be mildly uncomfortable with residual stiffness. However, when severe, all the above symptoms will present themselves in the days following the injury. It is also worth noting that pain, swelling and inability to weight-bear can be a sign of a fracture, so if you are worried you should visit A&E as soon as possible.
The detail
Inversion strains (when you roll on to the outside of your foot) are fairly common. Most people have experienced this to some extent, perhaps after losing their footing in a pothole, or during sporting activity where they have had to change direction quickly. Severity can range from a mild tear to a complete rupture.
Self-management

Rest

Ice the area regularly – for up to 10 minutes at a time.

Compression bandages can help with the initial swelling.

Elevate the ankle from time to time to aid with the reduction of swelling.

Once the initial discomfort and swelling have reduced, proprioceptive exercises that help your body control the movement of your ankle can be undertaken in order to decrease the likelihood of further sprains.


Hopefully these two blogs on common running injuries have helped to give you an insight into how to self-manage. Of course, it is always a good idea to get the problem looked over by a musculoskeletal expert, such as an osteopath.
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