Shoulder Pain responds to Neck Exercise

An old friend recently told me about her Physical Therapy for a Rotator Cuff Repair. She stated she had received 35 Physical Therapist visits, and her co-pay for each visit was $40. Her total cost out of pocket was $1,400.  She was compliant with all of her home exercise program, but she never gained back her full range of motion for her operated shoulder. She reported being diagnosed with frozen shoulder several months after surgery, during the process of receiving Physical Therapy since she was still quite stiff in her shoulder. Finally, she was discharged from rehab because her surgeon and Physical Therapist did not seen any further rehab potential.

As a McKenzie MDT practicing Physical Therapist, of course the first thing I did was assess her neck. I established baselines, which showed her right shoulder flexion (forward elevation) was 60%. She was lacking the ability to reach overhead. She reported having neck fusion surgery several years ago for disk problems in her lower neck. I showed her how to do neck retractions as an exercise, and she did 3 sets of 10 neck retractions in sitting. Then she stood up and we re-checked her baseline, which was active flexion of the right shoulder. Her new range of motion for right shoulder flexion was 90%.

To clarify, her ability to raise her arm overhead improved from 60% to 90% within two minutes of doing a neck exercise. Her next words were: "You helped me more in a few minutes than 35 visits of regular Physical Therapy!"

McKenzie MDT (Mechanical Diagnosis & Therapy) is a method of assessing spine and joint disorders in order to determine the source of symptoms and the mechanical (movement) solution. It is not uncommon for shoulder, arm, or hand pain to be originating from pinched nerves in the neck. Similarly, pinched nerves in the low back often cause leg symptoms in the high, thigh, knee, lower leg, foot, or toes.

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Rotator Cuff Tear: Can It Be Prevented?

The rotator cuff includes the tendons of four muscles which start at the shoulder blade and attach to the upper arm, by the shoulder. These muscles do the rotation of the shoulder and stabilize the shoulder joint.

How do you get a rotator cuff tear?
It can come from a traumatic injury or can be progressive (shoulder impingement, rotator cuff tendonitis, rotator cuff tendon tear).

How can you prevent shoulder trauma which could cause a rotator cuff tear?
Prevent falls, avoid lifting heavy objects overhead, avoid twisting shoulders when they are overhead, maintain good shoulder strength (including rotator cuff strength), rest days between sports activities, practice good body mechanics with strenuous upper body activities (such as moving heavy objects), sufficient warm-ups and stretches before playing sports.

How can you prevent progressive shoulder problems which could lead to a rotator cuff tear?
Modify activities that continually cause shoulder pain, early treatment/rehab of minor shoulder injuries (especially impingement and tendonitis), regular shoulder and rotator cuff strengthening, good body mechanics during daily activities (with shoulders in safe positions), good posture (which affects the spine, shoulder blade and shoulder positions).

Who is at high risk for a rotator cuff tear?
1. Those who play sports
2. Those who are elderly
3. Those who do heavy labor
4. Those who have a history of chronic shoulder problems
5. Those who do repetitive overhead lifting

Preventing Shoulder Pain 101

Good news! The best way to prevent shoulder pain is to use proper body mechanics. This is something you have likely heard about for the back, but it is just as important for your the rest of your body. So here are a few tips on how to protect your shoulders and prevent shoulder pain/injury.

1. Before you raise your arms up overhead, turn your thumbs upward.

2. Before you raise your arms overhead, sit/stand up tall.

3. Avoid lifting heavy objects higher than shoulder height (use a step stool if needed).

4. Be careful not to twist your shoulders when you are holding something heavy (especially with one hand).

5. Your shoulders are in their most stable position when your arms are down, with your elbows close to your waist. This is the position they should be in if you are lifting or carrying something heavy.

6. Avoid repetitive overhead lifting of heavy objects (this can be a big problem at work, if your work station is not ergonomic).

7. In general, practice good posture, which aligns your spine, shoulder blades and shoulders. When sitting or standing upright, your shoulders should be be resting in a vertical line below your ears.

8. If an activity starts causing you shoulder pain, stop it immediately. Then modify how you do that activity the next time. If it is hurting and you continue to do it the same way, it will likely get worse and may cause more serious tissue damage. 

Tune in tomorrow for more shoulder tips.

Do you have any comments about shoulder pain you have experienced in the past and what helped you?