Where You Are Going WRONG With The Shoulder

Posted By: Andy Barker

There is nothing worse than doing loads of great work with your patient…

Only for them to return for their next appointment no different…

Sometimes with their pain even worse.

If this happens at one joint more than any other, it’s the shoulder!

The shoulder is more complicated in many ways than other joints like the knee or ankle.

But that does not mean you can’t still get quick results…

Results that stick and results that mean your patients symptoms don’t return just hours after they leave your clinic room.

In this blog I cover some super simple strategies you can use to help you better manage patients with shoulder pain…

To organise your shoulder treatment sessions better…

So you can not only spend time on treatment…

But you are not left rushing your rehab at the end of the session before your next patient is due to come in…

And actually start getting results that are NOT just short lived and allow your patients to keep progressing session after session.

Spend Time On The Right Things

Now, I’m sure you are already giving shoulder rehab for the patients you see with shoulder pain.


How much time are you actually spending in your session on rehab?

When I speak to both students and new grads struggling with shoulder pain cases I ask them this very same question.

Those that are honest say very little.

They often spend most of the session using their hands-on treatment techniques…
Then rush the last 5 or 10 minutes of the session on rehab.

Rehab is clearly very important to the management of any injury, least of all the shoulder.

So why do you be devalue rehab and NOT give yourself enough time to go through your patient’s rehab exercises during your sessions?

I’m not saying don’t use treatment techniques.

Quite the opposite.

I use my hands with just about every shoulder pain patient I see.

But I also ensure I have enough time in the session to go through their existing rehab and have enough time to progress and change their rehab as needed.

And you should too!

If I am working to a 30 minute follow up session this is what my treatment session will look like…

Patient Welcome & Subjective (5 mins)

Patient Assessment (5 mins)

Treatment (5 mins)

Rehab (10 mins)

Questions & Notes (5 mins)

Note this is a guide and the time spent on treatment and rehab will vary depending on patient symptoms and progress.

Generally speaking, the amount of time spent on hands-on treatments will reduce as your patient progresses from session to session, where as the amount of time spent on rehab will increase.

In most cases it does NOT take 5 mins for the subjective and assessment, meaning I have more time for my treatment and rehab.

Where You Are Going WRONG With The Shoulder
I work to this format with every patient I see.

It ensures I keep to time…

Have enough time to focus on what is actually going to help my patient…

And I am never left rushing my patients out of my door…

And left with no time to write my notes.

What does your appointment structure look like?

Do you have one?

If not, have a think.

Use my format if you like, amend it of your sessions are shorter or longer in length.

The big thing is that you start to think about WHAT you are trying to achieve in each session…

Then you will be more focused on your treatments and rehab and…

You will start to see your patients improve, even with more complex issues, like those you might see in the shoulder and every other injury you see!

Focus On ONE Thing

Is it a scapula problem?

Is it the glena-humeral joint?

Or what about rotator cuff?

One big problem with the shoulder is that there can be many different problems that can be contributing to your patients pain and loss of function.

But the answer, is NOT trying to treat them ALL.

Even if they genuinely have more than one issue contributing towards their symptoms, you need to pick one.

The one you pick is the the issue that makes the BIGGEST change to their symptoms.

But how do you know this?

You use your assessment to identify what you suspect is causing their issues.

You might notice a ‘winging’ scapula as part of your objective assessment…

Or identify a painful arc during range of movement testing suggesting a glena-humeral joint issue….

Or assess that when loading the patients cuff i.e. with resisted testing, it brings on their symptoms, which might suggest a ‘cuff’ injury.

Once you have a suspicion then you can test to see what interventions are going to help your patient.

You do this by doing your intervention i.e. scapula stability exercise or isometrics or posterior rotator cuff strengthening work…

Then you re-test your patient.

Test > Intervention > Re-test.

Has your intervention improved their symptoms?

If it has you know you are on the right track…

Focus in on this.

The error that most New Grads make is trying to fix EVERY problem they identify.

Pick the biggest issue and get to work with that.

Identify what ONE thing improves their symptoms the most and focus your attentions on that ONE thing to start.

As your patient progresses you can fix up the other issues if they are still a problem…

But often you will see, that when you fix the BIG issue first, the other issues also improve and are less of a problem at all and in some cases, they are have stopped being an issue at all.

Then you need to plan the right rehab plan…

Is Your Rehab Plan Realistic?

The best rehab plan is a rehab plan that your patient actually completes.

How much time does your patient have per day?

What equipment does your patient have access to?

The best plan is a waste of time if your patient does not do it.

Clarify with your patient the above and identify exactly what they can do and how much time they can commit..

Then set them on their way…

With rehab they can do with the equipment and access they have and that actually fits in with their day.

Fancy videos or glossy paper given to your patient or athlete makes no difference whatsoever if they don’t do its just a waste of your time, your patients time and a waste of paper.

Hope this helps


PS. Do you sometimes struggle with shoulders?

Is it a challenge to get of your patients shoulder pain and restore their range of movement?

Do you struggle to know when to progress your patients and lack confidence as to when they are ready for that next step in their rehab or to let them back in gym or return to sport?

Do some exercises irritate your patients shoulder when in theory they shouldn’t…

Leaving you not quite sure what to do next?

If so, you need to check out my FREE shoulder PDF…

‘5 Breakthrough Steps To Confidently Treat The Shoulder Right Every Time, Avoid Mistakes & Stop You Feeling Less Adequate Than Other New Grads’

Any questions about the shoulder or if you are having trouble getting hold of the shoulder PDF just drop me an email at andy@newgradphysio.com and Ill get right back to you.