Hands-On Treatment Techniques For Shoulder Pain
Posted By: Andy Barker
In this blog I will discuss some of the common problems that face New Grads when treating patients and athletes with shoulder pain.
I’ll admit how I got it wrong as a New Grad, treating shoulder pain in both private practice and sport…
…and share some simple advice to help you better manage shoulder pain including my most commonly used treatment technique.
Without question, the shoulder is the one area New Grad’s struggle with the most.
Its the joint I get the most questions about and is an area of the body that New Grad’s struggle to get their head around and lack the confidence when treating.
This lack of confidence reflects in your clinical practice.
Because you lack the conviction and confidence treating shoulder pain patients, you are unsure about what to do, what treatment techniques to use and in turn, you don’t get the results you want.
One of the main issues I see is when therapists use hands-on techniques to help resolve a patients pain and improve range of movement, but because they lack the understanding about the shoulder and what is going on with their patient…
…they just treat everything.
This ‘kitchen sink’ approach rarely works.
And even if it does help, you are left wondering what technique actually helped, because you did that many!
The next session you may want to do a bit more hands-on but because you don’t know what techniques improved patient symptoms, rather than being able to use one or two techniques…
…you end up just repeating what you did in the last session and treat everything again.
Wouldn’t it be great if you knew the best technique that made the most difference, so you could go straight to that and save yourself wasted time and effort.
If you spend too much time on hands-on, this may leave little time for rehab, and also by doing loads of hands-on you may set yourself up…
…as patients gain an expectation that hands-on treatment is what they need, which can lead to poor adherence to rehab, as they become dependant upon you for treatment for their shoulder pain.
I made this mistake as a New Grad.
I used to spend approx 90% of a treatment session using hands-on treatments and only 10% of the appointment slot for rehab.
Patients and athletes would feel great after a session, but would frequently be back the next session asking for the same because the treatment effects had ‘worn off.’
Sometimes they would come back the next day…
…or even the same day, maybe after the gym or training when I was working in rugby.
Nowadays I treat very differently.
I still use hands-on techniques in almost every patient or athlete I see with shoulder pain.
I’ll generally use more hands-on during the early sessions, to help reduce pain and improve range of movement, to provide a window for rehab.
But once range of movement has been restored and the pain has gone, my sessions are all rehab.
If I treated in the same way I did as a New Grad now and spent 90% of every session just doing hands-on work I’d be in a bad way…
…I genuinely don’t think my hands, fingers and thumbs could take it!!!
I’m not suggesting you don’t use hands-on techniques…
…in fact the opposite.
You can get great results using your hands, often much quicker than when using rehab alone.
The key is when you use hands-on techniques you need to be more effective with what we are doing.
Pick the right muscles to treat…
Stop treating everything…
…cut down the amount of effort and time…
…and use techniques that actually improve symptoms…
…and allow yourself the time you need to spend on rehab.
Understanding What Muscles Do What
When you are asking the subjective questions to your patient the answers you receive are crucial.
A lot of patients with shoulder pain will talk about activities that they struggle with.
Lifting overhead is a common complaint.
That could be in the gym, like a shoulder press, or a builder at work getting pain when working above head height or someone at home struggling to put plates away in a high cupboard.
Firstly, think about what is happening when that patient lifts their hands above their head.
Certain muscles will be working to perform that task.
The big players around the shoulder are the pectorals, the lats and the deltoid.
Keep this in the back of your mind…
When you work through your objective assessment you will likely see common presentations with shoulder pain patients…
Pain mid-range (painful arc) with shoulder flexion or shoulder abduction, maybe both.
Pain with resisted internal rotation is very common, particularly with anterior shoulder pain.
You might also commonly see pain with active or passive shoulder external rotation.
Going back to what we said before…
The main players around the shoulder are the pectorals, the lats and the deltoid.
The main problems we see relate to shoulder flexion, abduction and shoulder rotation.
Is there a structure that is involved in ALL these movements?
Wouldn’t it be great if there was?
If we could treat one muscle and fix more than one problem…
Pectorals – The BIG Player In The Shoulder
The pectorals are made up of the pectoralis major and minor.
To keep it simple we will refer to them just as the pectorals.
The pectorals actively contribute to the movements of shoulder flexion and internal rotation…
…whilst the fibres of the pectorals have to stretch during the movements of shoulder abduction and external rotation.
In short, these muscles are involved in ALL the main problems we discussed above!
Therefore it would make great sense to treat a muscle group like the pectorals.
Given its role in so many actions around the shoulder it has a big impact on how the shoulder functions and treating this muscle group can have a big impact on shoulder pain and restoration of pain-free shoulder movement.
How To Treat The Pectorals
Whilst there are many different ways to treat the pectorals I am a fan of pin and stretch type techniques.
One big reason for this related specifically is that if I am trying to improve shoulder movement i.e. shoulder flexion or abduction (common problems we see with shoulder pain patients) I can both…
…treat the muscle and…
…improve movement at the same time.
By applying my technique to the muscle and by moving the arm during the treatment technique I am both treating the muscle and providing movement.
I am treating the muscle and at the same time applying a passive mobilisation during the same technique, just like in the image above.
To conduct this technique…
– Position you patient supine on the bed
– Pin your thumb into the pectorals
– Then with your other hand holding your patients wrist, guide their arm into the required shoulder movement i.e. flexion or abduction.
If there was one technique I use the most with shoulder pain patients and athletes it is this technique.
The pectorals have such a big impact on shoulder function and effective treatment techniques can quickly reduce pain, improve movement and allow you that window to then rehab your patient to make your improvement stick.
Understanding What Muscles Do: To select the correct treatment technique for any injury you need to understand what muscles do what role, so when you identify a problem e.g. lack of range of movement, you understand what muscles might be contributing to that problem.
Pectorals: The BIG Player In The Shoulder: The pec minor and major make up the pectorals and have a big function at the shoulder.
How To Treat The Pectorals: Pin and stretch style techniques can be very effective for patients with shoulder pain as they provide direct treatment plus a passive mobilisation at the same time.
The New Grad Physio Mentor
>>>Do you want to learn more about shoulder hands-on injury techniques?
>>>Do you want to learn more about how to link your assessments, special testing to your treatment and rehab you prescribe?
If so, let me know.
Email me at firstname.lastname@example.org with the subject ‘Shoulder’ and I’ll get right back to you and help you out.
There is much more to a great shoulder injury management plan and I’d love to share this with you so get in touch!