Today I’m going to talk to you about one of the most frustrating things in Physio-land.
The sore shoulder.
This particular pain from the shoulder is unique though and I want to spend some time unraveling it for you.
In the shoulder like most things, there’s only a few things that can cause you pain.
Muscle. Bone. Soft tissue like capsule, ligaments or connective tissue. Or referred pain coming from somewhere else (neck disc and nerve or from your diaphragm).
A common mechanism of injury and pain in the shoulder is bursitis.
BUT WHAT IS BURSITIS?
Well the suffix “-itis” means inflammation or swelling.
Tonsillitis. Swelling of the tonsils.
Meningitis. Swelling of the brain and spinal cord.
Tendonitis (this is an outdated term). Inflamed tendon.
Bursitis. Angry bursa!.
The bursa is this fluid filled sac that cushions the space in your shoulder where you shoulder rotator cuff muscles run through.
It reduces the friction of the muscle sliding although the bony parts of your shoulder.
I’d like you to imagine a rope that runs along and down a rocky cliff edge. If the rope was rubbing against the cliff edge it will start to fray and eventually break.
That’s like the shoulder rotator cuff muscles rubbing and causing friction against the bony shoulder complex.
By design, the bursa reduces the friction of the muscles along the bony joint so it slides more smoothly.
WHAT GOES WRONG?
LOTS OF REASONS.
- Lift too heavy
- Had a fall
- Blunt trauma
- Repetitive lifting
That would be the starting point for all Physio sessions for people coming into the clinic looking for help for their sore shoulder.
Straighten up the posture, modify what you’re doing with your shoulder, allow appropriate healing times and manage your load.
Most times 80% of people with shoulder bursitis pain will settle just with that advice.
The remaining 20% you may need more specific rehabilitation protocols to follow and if that fails you might need more help in the form of a steroid injection (cortisone).
But here’s the rub.
People have the injection before they’ve explored their conservative options.
Simply said… they haven’t tried Physio yet.
You see, in my 12+ years of Sports Physio experience those people who try and manage their pain through rehab and conservative measures do better then those who went for the quick fix first.
Sure, the cortisone injection may give you momentary relief from the pain (steroids are strong anti-inflammatory agents) but after it wears off in a couple of weeks (you’d be lucky if it lasts you months) the pain returns.
The underlying problem that caused the bursitis is still there.
Remember the reasons I listed above?
Well, if you get the injection first before addressing those very real factors then guess what? There’s a very high chance you’ll just re-aggravate the same shoulder problem again.
This comparative study in 2017 talks about the benefits of a cortisone injection with respect to rotator cuff disease but my argument remains.
Wouldn’t avoiding the injection and fixing your shoulder through conservative Physio measures be more appealing then paying for an ultrasound guided injection which is both painful and costly?
Sounds like the better plan to me.
I hope that made sense and if you need help with your shoulder pain make time to see us either in our physical locations or via our online Telehealth consulting by booking HERE.
Stay happy & healthy out there!