Shoulder pain is one of the most common musculoskeletal complaints. It can occur in any age group for various reasons. Most frequently pain results from trauma and overuse of the shoulder joint and surrounding tissues. Postures as well as ergonomics are also key factors in developing pain. Because of its unique anatomy, versatility and overall importance of the scapulo- humeral complex ( shoulder joint articulation) the treatment needs to be multilateral. Combining various medical disciplines is essential in order to achieve long-lasting positive effects.
The structure and functionality of this joint are very unique. The anatomy of this joint is in fact the highlight of human evolution. The versatility and mechanics of motion is far more complex than of any existing precision machine. This most complex joint is one anatomical structure that showed marked morphological changes, compared to the corresponding area in closely related animals.
The evolution of the human arm anatomy is intimately connected with development of human posture and locomotion. The posture and locomotion depend on neuromuscular coordination of scapulo-humeral girdle muscles as well as muscles connections with the spine and as far as contralateral hip. These develop in parallel, one slightly preceding another, during the postural ontogenesis that takes place in the first months of infant’s life mirroring the lengthy process of the human evolution. The stability of the scapula-humeral articulation during this time defines future posture and locomotion. In fact, the child is not able to walk until he can lift his arm above 120 degrees.
It is a scientific fact that anatomical structures and functions, acquired the latest during the evolution, are the most fragile and prone to failures. The human arm is a vivid example of that. The enhanced ability to perform complex multilateral movement has developed at the expense of diminished osteo-ligamentous stability, which is so important for all other joints in human body. Strong bone-and-tendon composition of the joint is replaced by an intricate, if delicate, muscular support mechanism known as the rotator cuff.
The rotator cuff is designed to reinforce the otherwise unsupported joint and hold the ball-shaped head of the (humerus) in the glenoid fossa, the socket of the scapula.The cuff is made up of four muscles that originate from the scapula surface and are connected to the upper humerus forming a tight elastic blanket of muscle tissue over the joint of the arm holding it together. Without the cuff support, the head of the humerus would freely ride in and out of the shallow glenoid fossa, rendering the joint inoperable.
Rotator cuff is not limited to structural support. Besides keeping the joint intact, it assists in movement of the arm. During a throwing motion, for example, muscles undergo series of rapid eccentric contractions (they are lengthened under tension) decelerating the arm and softening the impact of the exertion. Diverse functionality of this joint puts considerable stress on the tendons of these muscles making them susceptible to overuse and injuries. Relatively poor ability of the soft tissues in glenohumeral complex,to withstand excessive forces is frequently exacerbated by inadequate postural support of the glenohumeral and scapulohumeral muscles.
The pain due to cuff tear, tendonitis, various arthritic inflictions and overuse are the price we pay for exchanging structural stability for mobility and motor versatility.
Abnormal morphology (aberrant development of shoulder anatomy)
The function of this complex articulation depends not only on the integrity of rotator cuff muscles and sinews, but also on the stabilization of the scapula and its communication with the spinal engine. The ideal position of the scapula is achieved when the spine is erect. Poor posture impedes scapular stability, disturbs motor control generating excessive loads to the rotator cuff tendons.
For example: Try to lift your arm sideways after slumping your thoracic spine or protruding your chin forward and then compare the results to the range of motion of the same movement during the erect spinal position. When you are slumped you will not be able to get your arm as high as when your spine is erect.
Clinical examination allows diagnostic certainty while further radiological investigation by diagnostic ultrasound, and/or MRI allows diagnostic precision.
The combination of specific shoulder physical therapy and rehabilitation exercise constitute scientifically proven and sound methods for shoulder pain treatment. Majority of these conditions respond well to a combination of extracorporeal shock wave therapy and proper shoulder pain physical therapy. Whatever the condition is at stake the combination of any of the above described methods and measured exercise brings the best results.
Surgery is only necessary when the conservative therapy fails or after a destructive traumatic event. It is a responsibility of a conservative care clinician to make a timely referral for the surgery.
At DNR we use combination of physical therapy exercises, DNS (Dynamic Neuromuscular Stabilization) exercises and regenerative Shoulder pain treatment such as extracorporeal shockwave therapy. Depending on the diagnosis, individualized treatment plans are developed on an individual basis consisting of limitless combinations of the above-listed therapies.
Most conventional shoulder pain therapy is based primarily on strengthening of the rotator cuff muscles. DNS approach is different in a way that the treatment begins with restoration of the motor control and muscular synergies before strengthening the cuff muscles. Doing this allows reestablishing muscular balance that is imperative for the ideal function of the this joint. Muscle synergies that are established during the early childhood development serve as foundation of human posture and movement. During early development muscular synergies around the arm must develop first to ensure stability, which is critical for establishment of the first point of support by the child. DNS reenacts these muscular synergies, reestablishing muscle balance, responsible for ideal function of the joint prior to strengthening of the cuff.
Professional athletes use DNS shoulder pain therapy and DNS exercises to prevent injuries and, should an injury occur, expedite post-traumatic recovery. There are numbers of elite athletes who use DNS therapy exclusively for rehab, injury prevention as well as performance enhancement. Roger Federer, Patric Haas, and Jaromir Jagr to name a few. Also few professional baseball teams use DNS therapy as prevention of arm injuries so common to baseball. However, the general application of DNS therapy extends far beyond sports medicine and is equally effective for all patient groups.
Regenerative treatment is a form of stimulation of body’s own regenerative abilities by different physical or biological agents introduced into the injured area.
ESWT – extracorporeal shockwave therapy is a treatment used for subacromial bursitis, rotator cuff tendonitis or shoulder calcific tendonitis. Please click here to explore our ESWT page…
DNS specific shoulder pain physical therapy; as well as post-surgical rehab is a revolutionary approach available only in our clinic.
We use above described methods in combination with ART (Active Release Therapy) in case there is an adhesion in the fascia of the scapula-humeral complex. At DNR we use focused low energy ESWT unit in combination with radial EPAT unit for myofascial pain syndrome as well as for recovery of muscle tissue in athletes. Treatment of pain at the scapulohumeral or glenohumeral articulations must be multifaceted and timely because reduced arm swing can affect gait through contra lateral oblique chain inhibition, which disturbs gait by reducing opposite hip extension thus causing further damage to the locomotor system.