Reference for image https://www.bmj.com/content/364/bmj.l294 .

Physical therapy should be your first choice for shoulder pain, regardless of what’s causing it because it’s conservative, there are little to no side effects, and recent research suggests surgery is no better.

The shoulder is an incredible joint. As a ball-and-socket joint, it allows for an extremely wide range of motion and is the only type of joint that can rotate in a full circle around its axis. But as a result of its design, it’s vulnerable to injury.  The rotator cuff can be pinched between the ball and a bone above the ball called the acromion.  Also since the shoulder ball is much bigger than the socket, it makes the cartilage labrum around the socket also vulnerable to injury.

The issue is that the ball of the joint (the end of the upper arm bone, or humerus) is much larger than the socket (a structure called the glenoid fossa). Due to the major difference in size, the shoulder is considered an unstable joint, and the ball can slip out of the socket to cause pain and dysfunction. The good news is the rotator cuff helps actively hold the ball and socket together. One other feature of the shoulder that helps prevent dislocation is the labrum, which is a band of cartilage around the edge of the socket that adds depth and keeps the humerus in place. But despite this added protection, shoulder injuries are still quite common.

Two Diagnoses that Might (Yes, We Said “Might”) Cause Pain

Shoulder impingement occurs when the rotator cuff tendons, primarily the supraspinatus tendon, is pinched between the humerus, subacromial bursa, and the acromion.  See the above image to try to orient yourself.  Imagine what could happen if the arm bone (the humerus) was raised overhead and pinched the rotator cuff and blue bursa that’s below the acromion bone.  That’s what happens with shoulder impingement.  It’s common but as indicated in the main image of this article at the top, recent research suggests that surgery isn’t better than conservative care.

While we agree that conservative care, especially provided by one of our professionally trained and licensed musculoskeletal experts, is the best thing to do first, we’ve also seen a number of patients that have had surgery and good outcomes as well.  Bottom line, research often doesn’t adequately summarize all possible outcomes.  Nevertheless, we agree with the research – you should first try conservative care before you have any surgical procedures.

Similar Research Suggests Conservative Care First for SLAP Lesions Too

A SLAP (superior labrum, anterior to posterior) tear is an injury to top of the labrum (or superior), from its front to back (anterior to posterior). SLAP tears can come about from a single incident, such as falling on an outstretched arm or shoulder, or from doing lots of overhead activities on a regular basis. Participation in overhead sports like baseball or tennis, or lifting heavy objects repeatedly can all increase the likelihood of experiencing a SLAP tear. In other cases, they result from the labrum gradually losing strength over time as a natural part of the aging process.

Typical symptoms of a SLAP tear include pain when moving the shoulder, a sensation of locking, popping, or catching, a decrease in shoulder strength and flexibility, and a feeling that the shoulder will suddenly “pop out.” If you’ve been experiencing these symptoms, a SLAP tear my be possible, and some medical professionals might recommend getting an MRI to confirm the diagnosis. While MRIs can be helpful, they should not be relied upon too heavily in these types of situations. Research has shown that the MRIs of many patients—particularly older individuals—with no shoulder pain will actually reveal the presence of a SLAP tear. For example, one study of 53 individuals between the ages of 45-60 concluded:

There is a high prevalence of superior labral tears diagnosed by MRI in the asymptomatic shoulders of middle-aged people. These findings suggest that superior labral tears noted by MRI may not be the cause of symptoms in this patient group with shoulder pain.

Regardless of whether a SLAP tear is responsible for your shoulder pain, physical therapy is the best first step to address it in nearly all situations. A physical therapist will work with you to identify the specific ways your condition is limiting you, and then create a personalized treatment program to address these impairments. Every program is different, but most will include the following:

• Flexibility exercises to stretch the shoulder capsule that surrounds the joint
• Strengthening exercises for the muscles that support your shoulder
• Manual therapy from the physical therapist to increase shoulder range of motion
• An analysis of your movement patterns and correction of any overhead faults
• Heat, ice, and/or electrical stimulation

Before you get an MRI of your shoulder in order to find out exactly what’s wrong, see a physical therapist. While specific diagnoses are helpful in some cases, they can also be distracting and take away from time that can be better spent getting treated and working your way back to full strength.

To Learn More about How We can Help, Call Us at: (559) 733-2478

When someone says you have a rotator cuff tear, you might automatically think that it should be repaired or fixed.  While that might seem to be common sense, fact is you don’t need to rush into surgery for a rotator cuff tear.

For tears of the rotator cuff, physical therapy may be just as effective as surgery according the the research, and we here at Bacci and Glinn Physical Therapy have treated many rotator cuff tears.  If you are looking for rotator cuff tear treatment in Visalia, and you don’t want to go through all of the risks and challenges of surgery, you should consider trying natural and conservative care first.

More on the Rotator Cuff

The rotator cuff is a crucial component of the shoulder that allows it to function. It connects the upper arm bone (humerus) to the shoulder blade (scapula) with four muscles, each of which has a tendon that attaches to different parts of the scapula. These tendons form a “cuff” around the head of the humerus, and all the muscles work together to control and stabilize the shoulder.

As a ball-and-socket joint, the rotator cuff helps secure the “ball” portion of the joint—the humerus—as the arm moves and rotates within the “socket” (the scapula). It plays an extremely important role in keeping the shoulder stable when performing many overhead movements, such as reaching, throwing, and picking things up. Unfortunately, because these movements are so common and the rotator cuff is used so frequently, it’s also quite vulnerable to injury.

When any of the tendons of the rotator cuff becomes injured or torn, the tendon becomes detached from the head of the humerus, and the injury is called a rotator cuff tear. Some rotator cuff tears occur after sudden injuries like falling on an outstretched arm or lifting a heavy object, but most develop gradually over time after the tendon gradually loses its strength. Athletes involved in overhead sports like baseball, tennis, and weightlifting, and those who are older than 40 are at a greater risk for rotator cuff tears.

If you happen to experience a rotator cuff tear, it’s important to understand that surgery is not the only option available. For many patients, physical therapy can lead to similar results as surgery, but at a much lower cost and with far fewer risks for complications. Similar outcomes between surgery and conservative treatments have been found in a number of studies, one of which—published in 2017—concludes with the following:

There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality (for these patients).

Whether or not surgery is needed depends on the seriousness of the injury, the age of the patients, and several other factors. If it is determined that physical therapy is appropriate, a typical treatment program will consist of:

• Stretching exercises: intended to increase flexibility that has been lost
• Strengthening exercises: intended to build back strength in the shoulder
• Passive treatments: includes ice, heat, and ultrasound to alleviate pain
• Activity modification: your therapist will teach you what positions and movements to avoid or modify to reduce aggravating your shoulder further

So if you’ve recently experienced a rotator cuff tear and are wondering what to do next, visit a physical therapist first before anything else. Taking this step will get you started on a treatment program and on your way to recovery right away, and will also help you reduce the chances of unnecessary tests or procedures down the line.

If you have pain in your shoulder, there’s a strong chance shoulder impingement syndrome is responsible

If you look at an x-ray or an MRI of your shoulder, and the doctor tells you that your rotator cuff and bursa are being pinched, you may think that the only shoulder impingement treatment in Visalia is a knife.  Let me share another natural option.

The shoulder is a complex joint consisting of numerous tendons, ligaments and muscles that allow the arm to move in several different directions. These structures help keep the shoulder stable and are crucial for its flexibility, but they also make it vulnerable to a number of injuries. This is one of the main reasons shoulder pain is so common, especially in individuals who perform lots of overhead movements. In most cases, this pain is due to a condition called shoulder impingement syndrome, but the good news is that physical therapy can help, regardless of its cause.

The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The humerus and scapula are surrounded and connected by the rotator cuff, which is a group of muscles and tendons that keeps the shoulder stable and allows for the ball-and-socket movements of the joint. There is also a fluid-filled sac called the bursa between the rotator cuff and a bony prominence on the top of the scapula (acromion), and its function is to provide a cushion during movement.

In shoulder impingement syndrome (SIS), the tendons of the rotator cuff become compressed—or “impinged”—as they pass through the narrow space beneath the acromion. Over time, this causes the tendons to become irritated and inflamed, and will lead to bothersome symptoms like swelling and tenderness, loss of strength, restricted shoulder movement and shoulder pain at rest, when moving the shoulder overhead and/or when sleeping.

SIS is most common in individuals that regularly perform lots of overhead activities like golfers, swimmers, and baseball and tennis players, as well as painters and construction workers. If the condition develops, it’s strongly advised to receive physical therapy as soon as possible in order to prevent it from progressing further. Physical therapy for SIS typically consists of the following components:

• Activity modification/functional training
• Stretching exercises
• Strengthening exercises
• Hands-on (manual) therapy
• Posture education

A recently published study investigated the effectiveness of eccentric strengthening exercises—a treatment commonly used in physical therapy programs—for patients with SIS, and the results were very encouraging. The conclusion states:

An eccentric program targeting the external rotators was superior to a general exercise program for strength, pain, and function after six months. The findings suggest eccentric training may be efficacious to improve self-report function and strength for those with subacromial pain syndrome (another term for SIS).

Shoulder symptoms from SIS can severely impair your abilities to perform your job or just get through the day without pain, but it doesn’t have to be this way. If your shoulder is bothering you, contact your local physical therapist first and fast, and begin on your path to a pain-free future.

If you are looking for a shoulder specialist in Visalia, because of a rotator cuff injury (a common cause of shoulder pain), seeing a physical therapist first can help you avoid unnecessary treatments like surgery.  This article provides common sense reasoning as to why we can help.

What’s the Rotator Cuff ?

You’ve probably at least heard of the rotator cuff—especially if you play or watch sports—but what you may not know is just how important of a structure it is. The rotator cuff is a group of muscles and tendons in the shoulder joint that allows the arm to lift and rotate.  In addition to permitting movement, it also stabilizes the shoulder and helps the joint maintain good alignment and posture during many daily activities.  So any time you experience one of the countless displays of flexibility in your shoulder, you have your rotator cuff to thank.

Because the rotator cuff serves such an important role and is used so frequently, it’s also a common site of injury.  Injuries to the rotator cuff most often occur in people who repeatedly perform overhead motions in their profession or recreational activities. Some examples of those affected by rotator cuff injuries include painters, carpenters and athletes involved in tennis, baseball—especially pitchers—and swimming.

Repeated Overhead Activity Leads to Injury Which Might Mean You Need to See a Rotator Cuff Rehab Specialist

When these activities are performed regularly for a long period of time—or through the aging process—the rotator cuff tendons eventually become inflamed from over-stretching or repetitive stress, which can lead to pain or injury.  The most common injuries seen are rotator cuff tendinitis (or shoulder impingement), shoulder bursitis and rotator cuff tears.  The primary symptoms of a rotator cuff injury is a dull ache deep in the shoulder that makes it difficult to reach behind the back or lift the arm.

To investigate just how many people in the general population have rotator cuff injuries, one study (click for the reference) examined the shoulders of 683 individuals, some of which had shoulder pain and others who did not. This is what they found:

• Overall, 20.7% of participants had a rotator cuff tear
• 36% of participants with shoulder symptoms had a rotator cuff tear
• 16.9% of participants without shoulder symptoms had a rotator cuff tear
• The risk factors for a rotator cuff tear were trauma to the arm and older age

This study shows that rotator cuff tears are very common, and in many cases, a tear may exist even if the individual does not have should pain or other symptoms. Unfortunately, if you have a rotator cuff injury and go to a doctor first for an evaluation, there’s a chance that you may be instructed to have unnecessary treatments like an injection or surgery if they find a tear. But as you can see, tears are present in many people who aren’t even in pain, and surgery is rarely needed to treat it. Surgery is also very risky and expensive.

Why Seeing a Physical Therapist First Makes Perfect Sense…

On the other hand, if you see a physical therapist for your rotator cuff injury first, in most cases they will treat you right away regardless of whether or not you have a tear. As a result, you can begin your path to recovery through various exercises, manual treatments and other interventions during your first session, while avoiding expensive and potentially dangerous treatments in the process.

So if your shoulder is bothering you and preventing you from functioning normally, make the smart choice of seeing a physical therapist first for the best possible outcome.

Click here to visit our Contact Page, then give us a call to learn more about how we can help.

A 2016 clinical trial confirms what we here at Bacci & Glinn Physical Therapy have been doing for years. If you are in need of shoulder pain treatment in Hanford, then this research may be pertinent to you.  In a study of office workers that suffered with shoulder pain, physical rehabilitation involving hands-on treatment was found to be an important part of a conservative treatment program.

Long-term computer use can lead to muscle dysfunction and disorder

Approximately 90% of white-collar workers use computers for more than four hours per day.  Over time, sitting and working at a computer can lead to a dysfunction of muscle stability and other disorders of the region, which may result in shoulder and neck pain, as well as a decreased threshold for pain.  One of the main reasons for shoulder pain is hyperactivity of an upper back muscle called the upper trapezius, which results in decreased control of two other muscles and instability.  To treat this muscle instability, several physical therapy interventions may be used, including manual therapy.  In manual therapy, the physical therapist performs various manipulations and mobilizations on the painful area in order to bring about tissue changes that will lead to less pain.  Manual therapy may therefore be helpful for office workers with shoulder pain, and to evaluate this possibility, a study was conducted.

Middle-aged office workers with pain serve as the study group

Individuals between the ages of 30-40 who had shoulder pain and worked on a computer for more than eight hours a day were invited to participate in the study and screened to determine if they were eligible.  This process led to 38 individuals who were accepted, and then randomly assigned to either the manual therapy group or the shoulder stabilization exercise group.  Both groups underwent treatment during two 40-minute sessions per week for six weeks.  In the manual therapy group, the therapist applied manipulations and mobilizations to various muscles in the back, chest and neck for three minutes each.  In the shoulder stabilization group, patients were instructed to perform a series of stretching and strengthening exercises for muscles in the same area.  All patients were assessed before and after undergoing treatment for pressure pain threshold (PPT) of certain muscles, which measures the minimum force applied that causes pain.

Manual therapy leads to greater improvements

After completing treatment, participants in both groups experienced significant improvements with an increased PPT of several muscles of the upper back; however, the manual therapy group showed greater PPT improvements in these muscles than the shoulder stabilization group.  This is likely due to the pain-relieving properties of manual therapy, as it increases blood flow and decreases the activity of muscles in such a way that it changes the length of tissues and results in less pain.

Here’s an excerpt from the abstract published on Pubmed.org:

The manual therapy group showed greater improvements than did the shoulder stabilization exercise group in the splenius capitis on both sides, left upper trapezius, middle trapezius on both sides, and right lower trapezius. [Conclusion] The results of this study suggest that manual therapy for shoulder pain is feasible and suitable for office workers and may be useful in clinical rehabilitation.
Reference: https://www.ncbi.nlm.nih.gov/pubmed/27799661

These results show that while both shoulder strengthening exercises and manual therapy appear to be effective for office workers with shoulder pain, manual therapy is even more beneficial for improving their threshold for pain.  Individuals currently dealing with this type of pain should therefore seek out the services of a physical therapist for appropriate treatment.

Diagnoses we’ve successfully treated – Check our medical library

There are a number of shoulder conditions that we regularly treat.  Here’s a link to our medical library where you can learn more about physical therapy for shoulder pain that we provide here in Hanford (and Visalia as well).

If you have questions about your shoulder pain, just give us a call.  Chances are we can help.   Click here to visit our contact page for more information.

-As reported in the September ’16 issue of  The Journal of Physical Therapy Science

Recovering from frozen shoulder often takes a while, but if you are looking for frozen shoulder treatment in Visalia, our physical therapy treatment can help every step of the way.

The shoulder is a ball-and-socket joint, with the upper arm bone (humerus) serving as the “ball” and fitting into the “socket” of the shoulder blade (scapula).  The bones and other structures of the shoulder are surrounded by a structure called the shoulder capsule, which is made up of strong connective tissue that keeps the shoulder stable.  Adhesive capsulitis, or frozen shoulder, occurs when scar tissue forms within the shoulder.  This causes the shoulder capsule to thicken and tighten around the shoulder joint, which means there is less room to move the shoulder normally.

Frozen shoulder affects up to 5% of the population, but it’s not clear why it develops.  In general, it’s believed that one of the leading factors is not moving the shoulder normally for a long period of time.  People between the ages of 40-60, women and those with arthritis, diabetes, cardiovascular disease and other health conditions are also more likely to develop it.

Frozen shoulder usually develops slowly and gets progressively worse with more pain and loss of motion over time.  This is typically broken down into the following stages:

• Stage 1 (pre-freezing): symptoms start and gradually get worse over 1-3 months
• Stage 2 (freezing): generally occurs 3-9 months after the start of symptoms; any movement of the shoulder causes pain, which is even worse at night
• Stage 3 (frozen): occurs within 9-14 months; the shoulder becomes more stiff, making it more difficult to move and rotate it
• Stage 4 (thawing): occurs within 12-15 months; pain decreases significantly, especially at night, range of motion begins to improve, making it easier to move

This shows that frozen shoulder follows a long course of development and eventual recovery, but following a physical therapy treatment program can expedite this process.

The goal of physical therapy is to control pain and increase strength and flexibility, and physical therapists have specific treatments that are designed to help patients improve at each stage of frozen shoulder.  In general, treatment consists of stretching exercises, manual (hands-on therapy), strengthening exercises and returning to daily activities.

The following findings from a 2007 study clearly identify the value of physical therapy for treating patients with frozen shoulder:

When you are looking for shoulder pain treatment in Visalia, physical therapy is your best bet to help you bounce back!

The shoulder is the most flexible joint in the body, and it allows the arm to move in wide range of directions so that we can perform many of the dexterous tasks needed in daily life.  Unfortunately, this extreme flexibility comes at a price, as certain movements, postures and habits can cause damage to the shoulder and result in pain.

The shoulder is not actually a single joint, but a ball-and-socket made up of two joints, which combine with other structures in the region to allow the arm to move as it does.  Just about every movement that requires the use of our arms also involves the shoulder in some way, and it’s particularly important for reaching tasks and overhead activities.

Shoulder pain includes any pain that arises in or around the shoulder.  It may originate in the joints themselves or from any of the surrounding muscles, ligaments or tendons that make up the shoulder.  Most shoulder problems that result in pain are due to a tear or inflammation of a tendon, instability, arthritis or a fracture.  One of the most common causes of shoulder pain is when the tendons of the rotator cuff—an important structure that keeps the shoulder in place—become trapped under a bony area of the shoulder, which is called rotator cuff tendinitis.  Other conditions that can cause shoulder pain include shoulder impingement syndrome, frozen shoulder, tendinitis and bursitis.

NOTE: Quick Reference Guide to Shoulder Conditions We Treat

People who perform lots of overhead activities on a regular basis like painters, carpenters swimmers and baseball players are all at an increased risk for developing shoulder pain, and bad posture can lead to its development as well.  Most shoulder pain will dissipate within a few weeks with some rest and avoidance of activities that may aggravate it, but for pain that’s more severe or lingers for awhile, physical therapy may be necessary.  Physical therapy is one of the most proven effective methods to treat all types of shoulder pain, and treatment typically consists of the following:

• Heat, ice, massage and other pain-relieving remedies
• Stretching exercises to improve flexibility
• Strengthening exercises to build back strength
• Posture training for sitting and standing
• Activity modification to help you avoid movements that make the pain worse

The use of physical therapy to treat shoulder pain is also supported in the medical literature as an effective way to foster improvements.  In one recent study on subacromial pain syndrome, another term for shoulder impingement syndrome, the conclusion states:

Exercise therapy should be the first-line treatment to improve pain, function and range of motion. The addition of mobilizations to exercises may accelerate reduction of pain in the short term.
Reference: https://www.ncbi.nlm.nih.gov/pubmed/27288517

Shoulder pain can be a real inconvenience, especially if it prevents you from participating in sports, but we are here to help.  Contact us to find out how we can address your shoulder pain and get you back to full strength as quickly and safely as possible.