The shoulder consists of many different structures (tendons, bursa, capsules, ligaments and more) and each of these structures create different sensations when problematic. This can make treating shoulder issues seem complex and confusing from a patient’s perspective. The number of tests, yet lack of specificity, sensitivity and in some instances, unreliability of MRI scans are create some significant problems with the shoulder. To simplify things for the patient, we ask a couple of straightforward questions.
Is it torn, stiff or irritable?
To question the quality of pain you can simplify it to three terms – torn, stiff and irritable. Once we get an idea of what kind of pain and where you are suffering, the job of a therapist is to change that. Reduce the pain, improve the motion and ensure it’s unlikely to happen again. The practitioner will need to seek out the pain causing structure and determine the best cause for reducing the load. This can be as simple as removing an activity or altering a strengthening exercise.
Is it strong enough to do what it needs to do?
This second question enables us to determine how much and where we need to build the strength of the shoulder, to enable it to do the tasks you want it to. Those tasks can be simple day to day things like hanging clothes and cleaning, or as difficult as overhead lifting for roofing.
Yes, there can be an issue with being too simplistic when considering a complex joint. However here in lies the failure of the current understanding where often diagnosis of “impingement” or “rotator cuff” and prescribing exercises for “scapular stabilisation” are not helpful enough and does not provide sufficient information. As mentioned above, they all are unreliable on testing and MRI. A lot of therapists can over complicate a very difficult joint, but the easier it is for you as a patient to understand the more effective you can be with your exercise. Which is a brilliant thing for getting you back playing tennis, carrying little ones or serving pizza!