A Guide to Stiff and Sore Shoulders

What does the evidence say for shoulder rehabilitation?

Shoulders in a pinch?

Perhaps you’ve tried a few injections, some exercise that you can’t seem to get quite right, or maybe it’s new for you and you just can’t seem to move right without stiffness or pain. 

Finding the right exercises and knowing what to do can be a difficult task, especially when it comes to shoulder pain.

In this blog, we will cover what you need to know about where we are at with shoulder pain and how we manage and care for it (with a heavy focus on the movement and exercise side of things) based on the most contemporary evidence. 

Firstly, a quick look at terminology:

While this is not something that usually means much to you as a client, it’s worth brushing over where the literature is at with terminology for shoulder pain. Terminology is important to have accurate, as it is a reflection of our understanding of a given condition or cluster of symptoms. 

In past years, many incidences of shoulder pain were diagnosed as ‘impingement’ – this was due to the belief that the head of the humerus (the arm bone) would run into the top of your shoulder blade and cause inflammation and damage, leading to pain. 

We now know that this isn’t the case, and shoulder pain is usually more nuanced than this. There is even evidence to suggest that those with ‘impingement’ like symptoms have MORE space between their arm and shoulder bones, leaving this terminology being misleading and somewhat scary to hear. 

A better term that is being laned towards is ‘rotator cuff related shoulder pain’ – which better encompasses the nature of the symptoms felt, and recognises that an ‘impingement’ is likely not the cause of the pain. (1)(2) 

Now why am I telling you this?

Because the way pain is understood by you, the client, is super important. While you don’t need to know the ins and outs, it’s important to understand that your shoulder structures aren’t slamming into each other every time you move, and movement certainly isn’t wearing away your structures in your shoulder like the term impingement might allude to. 

In fact, movement and exercise are the best things you can do for a cranky shoulder when done well!

Should I Get Massage?

The short answer… not unless you want to.

When looking at massage and general shoulder pain, we see the effects it has are limited. When exercise is given, there are no differences in pain or function when massage is given as well. (3)

This isn’t to say it’s a big nono, but just that massage has limited effects. 

Think of massage as a symptom reliever, something you get because it’s nice and makes it feel good in the short term (like a heat pack, a warm bath, a few small stretches… you get the idea). 

Just know, it unlikely gives a specific effect, and can be more costly than other symptom relieving treatments. 

What do my scan results mean?

There are a few specific examples where a scan will provide a very specific diagnosis with a very specific rehabilitation plan (fractures, dislocations and tumours are the main three)

But a large collection of other findings may just be a part of normal aging or something that was present in your shoulder before the pain began (and not necessarily the primary cause of the pain itself)

This is really nicely reflected in the research, with one study in particular jumping out – when we scan both shoulders in those with only ONE symptomatic shoulder, we see high rates of the same abnormalities in BOTH the symptomatic and asymptomatic shoulder (including rotator cuff tendinopathy, AC joint arthritis, Sub acromial bursitis, labral lesions, humeral head cysts, partial rotator cuff tears…) (4)

This isn’t to say we totally disregard your scan findings, but it is to say that pain is often not dictated by the physical appearance of your shoulder. Pain is more nuanced than that, and the more we learn the more we find these ‘abnormalities’ are usually quite normal.

So if you’ve had something picked up on a scan that seems to fit the mold of the above, have hope! You can think of them as wrinkles on the inside, a normal part of having a shoulder, and a pain that will come and go regardless of if the ‘abnormality’ resolves.

What Do I Do To Get These Shoulders Silky?

For most cases of shoulder pain, rehabilitation is quite simple (please keep in mind, some cases of shoulder pain are serious and need more specific advice – if you are unsure or if your symptoms are worsening, it is important you consult a healthcare professional). 

While there are some complexities, we ca break it down to these simple steps to start your shoulder rehab journey:

  1. Find what movements your shoulder can tolerate; even if it’s tiny! Whatever it can tolerate, do. If you’re at the gym and pulling causes no pain but pushing does (for example), keep rowing, cut back on pushing
  2. Find what movements your shoulder can not tolerate; and avoid doing them FOR THE SHORT TERM – we’ll build them back in, don’t you worry! Working in to small amounts of pain is okay (2-3/10), but if you have any apprehension or if pain is significant, leave it for the time being and return back to it later
  3. Gradually re-expose the movements that are harder to tolerate over time; Add a few degrees or kilos to your exercises as tolerated. Keep checkin in, every 3-4 days try a movement that was previously painful at a lower intensity than you usually would.
  4. Have a hopeful outlook: This seems like a funny one to include in a rehab plan, but it’s importance can not be overlooked! Expectations of a good recovery influence how you come out the back of your recovery. If you feel not confident, or have a negative view of your recovery, consult a healthcare professional that will help guide you through what’s best for it, and (most importantly) help build your confidence to rehabilitate it.

Unsure where to start with all of this? Finding the right concoction of exercises can be difficult, as can finding someone you trust to build a program around your sore spots.

We at Tailored health can help – for Tailored advice and a clear recovery plan for your sore shoulders, book in at the link below the references, call us on 0434 451 226 or email us at info@tailoredhealth.com.au

References:
  1. Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther. 2016 Jun;23:57-68. doi: 10.1016/j.math.2016.03.009. Epub 2016 Mar 26. PMID: 27083390.
  2. Lo CN, van Griensven H, Lewis J. Rotator Cuff Related Shoulder Pain: An Update of Potential Pathoaetiological Factors. New Zealand Journal of Physiotherapy. 2022 Jul 1;50(2).
  3. Paraskevopoulos E, Plakoutsis G, Chronopoulos E, Maria P. Effectiveness of Combined Program of Manual Therapy and Exercise Vs Exercise Only in Patients With Rotator Cuff-related Shoulder Pain: A Systematic Review and Meta-analysis. Sports Health. 2023 Sep;15(5):727-35.
  4. Barreto RP, Braman JP, Ludewig PM, Ribeiro LP, Camargo PR. Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. Journal of shoulder and elbow surgery. 2019 Sep 1;28(9):1699-706.

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