This is part 2 of our Shoulder Series Blog, and today we’ve got a bit of a treat for you- in today’s blog I’m going to be answering your TOP 4 most common shoulder pain questions. These are going to be questions I get in on a day to day basis in clinical practice and from my telehealth sessions with patients.
These questions each can have nuanced answers, depending on the situation, and depending on the type of person and patient that I have in front of me. However, I’ve chosen the most common questions whereby the answers can hopefully provide you with a more experienced and balanced insight into questions that you might be thinking or asking yourself regarding your own shoulder pain.
Question: I’ve hurt my shoulder. Is it muscle, or tendon?
When it comes to pure anatomy- the tendon is a form of soft tissue which connects the muscle to the bone. Its purpose is to transfer force from the muscle contraction to the bone to move the specific joint that the bone is part of. To put it simply, for most cases of shoulder pain, you can treat and approach them the same, regardless of whether or not it’s a muscle or tendon injury. There are instances where the location of the tear plays a part in directing the treatment, as well as a differentiation in terms of the time frame for healing depending of whether it’s a muscle or tendon. However, for most cases, rehabilitation of the muscle or tendon is a matter of expediting healing through appropriate load management and protecting the injured muscle/joint from further irritation/ injury.
Question: Should I ice or heat my shoulder?
It usually doesn’t have the biggest impact long term on your injury- so it doesn’t matter too much! Try it, if it helps, keep going- otherwise, you don’t have to do it! It’s not a deal breaker for injury healing.
The general guideline that works for most people is to ice intermittently (alternating on/off) for approximately 15 minutes for the first 48-72 hours for swelling and inflammation control. Heat is often preferred for those with subacute/ persistent pain issues relating to muscles and often are good for bringing temporary relief in those situations. But if you prefer one over the other, give it a shot! Just make sure you avoid ice/heat burns to the skin by placing a towel underneath to prevent skin burns/irritation/ sensitivity.
Question: I do a lot of stretching for my shoulder- but it still hurts. Why?
There is a general misconception among the general population that stretching is going to be helpful and that it should fix your pain. Unfortunately a lot of the shoulder injuries require much more than just “stretches.” Shoulder pain is sometimes very simple- sometimes it’s due to overworking it, or overloading it, and sometimes the reason is complex, isn’t very clear, and doesn’t have an obvious explanation. (But that doesn’t mean we can’t help it or make a significant impact on your shoulder! Will discuss this in a future blog.)
But one thing relating to stretches is that do not help with improving your body’s capacity to withstand external load. If the problem relates to your body’s inability to tolerate the strain of a particular task- for example, serving a ball overhead in tennis, you’ll need strength exercises to increase your tolerance to withstand the pressure of serving overhead. With the guidance of a physiotherapist, he/she will be able to provide you with an appropriate exercise program and plan that will build your shoulder’s ability to perform.
Question: Do I need to get scans of my shoulder?
My recommendation is to see a Physiotherapist and request a professional opinion relating to your shoulder pain and limitations. Typically, mild to moderate soft tissue injuries involving shoulder sprains and strains do not require any imaging- even when pain is persistent. A study out of Michigan by Girish et Al., in 2011 showed 96% of asymptomatic (painfree) shoulders had abnormal findings in 96% of their subjects who underwent ultrasound scans. So don’t always trust everything you see on an imaging report when it comes to shoulder pain.
However, in cases where nonsurgical management has failed and conservative options have been exhausted, or in situations where the pain is unrelenting or worsening, imaging and further investigation may be warranted.
So that’s part 2 of our Shoulder Series! Hope you guys found that helpful. As always, if you have shoulder pain and you’d like to have your shoulder assessed and treated by a Registered Physiotherapist, reach out to us at Vancity Physio.
Tim Fung, Bsc.Kin, MPT