Articles on shoulder

Frozen Shoulder

Anshul Parashar, Physiotherapist
Frozen shoulder, or adhesive capsulitis, is a condition that causes restriction of motion in the shoulder joint. Adhesive capsulitis is common but poorly understood. It was first described by Duplay1in 1872 as a ‘peri-arthritis scapulo-humerale’ and in 1934, Codman first used the term ‘frozen shoulder. Frozen shoulder most commonly affects patients between the ages of 40 to 60 years old, and it is twice as common in women than in men.It can be bilateral, especially in patients  with diabetes. Although it is generally considered self-limiting.No one really understands why some people develop a frozen shoulder. For some reason, the shoulder joint becomes stiff and scarred. The shoulder joint allows more motion than any other joint in the body. When a patient develops a frozen shoulder, the capsule that surrounds the shoulder joint becomes contracted. The patients form bands of scar tissue called adhesions. The contraction of the capsule and the formation of the adhesions cause the frozen shoulder to become stiff and cause movement to become painful.Several systemic conditions such as heart disease and Parkinson's disease have also been associated with an increased risk of developing a frozen shoulder.CausesThe exact underlying cause has not yet been identified but it has been seen that there has been some underlying history of trauma at the shoulder or a weak musculature around shoulder girdle which couldn’t have been able to survive under load sharing.Sign and symptomsShoulder pain; usually a dull aching pain at restLimited movement of the shoulderDifficulty with activities of daily livingPain when trying to sleep on the affected shoulderTreatmentSurgical treatmentWhere pain and stiffness are present, options include manipulation under anaesthesia (MUA), arthroscopic and open release of contractures and hydrodilatation.Nonsurgical treatmentPain control can be achieved with anti-inflammatory medications. These can include pills taken by mouth, such as ibuprofen, or by injection, such as corticosteroids.Physiotherapy treatmentExercise therapy:Shoulder muscles stretchingShoulder mobilisationMyo fascial release techniquesManual therapy ( MWM, Hold-relax )ElectrotherapyMoist heat therapyUltrasoundTens/ IFT as requiredLASERSome studies say that electrotherapy is not more beneficial in frozen shoulderSelf exercises for the patientPulleyShoulder wheelCodman,s exercisesTowel stretchArmpit stretchFinger walk on the wallPrecautions to be maintained as well.

Shoulder Pain - What You Should Know!

Dr. Shekhar Srivastav, Orthopedist
1. How common is the Shoulder problem seen in general population?The most movable joint in the body, the shoulder, is also one of the most potentially unstable joints. As a result, it is the site of many common problems. They include sprains, strains, dislocations, separations, tendinitis, bursitis, torn rotator cuffs, frozen shoulder, fractures, and arthritis.2. What are the common problems seen in the Shoulder Joint? In younger people, the problem is usually trauma related and it can be a feeling of instability or repeated dislocations which can cause pain and prevent the person from pursuing his profession or sporting activity. The shoulder joint frequently comes out of its socket which causes acute pain to the patient and requires medical help to put it back.In older people, the problems are due to degenerative tears of tendons (Rotator Cuff tears) or bony overgrowth (Impingement), Frozen Shoulder or Arthritis which causes pain on movement or even at rest. The pain can sometimes be so severe that it even disturbs the sleep of the patient.3. What are different treatment modalities for Shoulder Problem?The treatment varies according to the problem affecting the shoulder joint. In minor injuries, Sprains, Tendinitis or most cases of Frozen shoulder, the treatment is usually medicines and exercises explained by the Doctor.Problems such as Repeated Shoulder Dislocations or Complete Tendon ruptures require repair which can be done Arthroscopically (Minimally invasive Keyhole Technique).Severe Arthritis of the Shoulder joint requires Shoulder Replacement which gives excellent results.4. How effective are Shoulder Surgeries?Though most of the problems of the shoulder joint can be managed with medicines and exercises, some problems can be tackled only by surgery. Previously, surgeries were done using open technique which frequently led to stiffness & pain later on. But now newer techniques have emerged where joint is accessed by small keyhole incisions (Arthroscopy) through which most of the problems can be tackled. This has revolutionized the understanding and management of shoulder problems.5. What are the advantages of Arthroscopic surgery of Shoulder over open surgery?Arthroscopic surgery is a Technique where the surgeon makes very small holes through which a camera and instruments are inserted into the joint to see the problem and repair it (Fig).Arthroscopy causes minimal blood loss as compared to open surgery. As it is done through only tiny keyhole cuts as compared to open surgery where the whole joint has to be opened, the recovery is much faster. This results in less pain and stiffness, fewer complications, decreased length of hospitalization. The small incisions are closed by single stitch and most of patients are discharged next day of surgery and have faster recovery times.6. Is there a treatment for severe arthritis of the shoulder too?In severe arthritis of the Shoulder joint, where the cartilage is totally destroyed and medicines & exercises have failed, Replacement of the Shoulder joint gives excellent results both in terms of pain relief as well as functions. Now newer implants (Reverse Shoulder) have also come which can restore the Shoulder function even in elderly patients where all the tendons have been ruptured.

Frozen Shoulder Treatment Tips

Dr. Sanjay kapoor, Orthopedist
What is Frozen shoulder?Frozen shoulder is a condition characterized by shoulder pain and limited range of motion. It typically affects only one shoulder. Although the cause is often unknown, diabetes is a common risk factor.What are the symptoms?Frozen shoulder causes pain or tenderness with shoulder movement, stiffness of the joint, and decreased range of motion.How is it treated?If started early, aggressive physical therapy can help preserve movement and range of motion in the joint. Causes of frozen shoulderThe cause of frozen shoulder is not fully understood and in some cases is unidentifiable. However, most people with frozen shoulder have suffered from immobility as a result of a recent injury or fracture. The condition is common in people with diabetes.Risk factors for frozen shoulder- Age - being over 40 years of age.- Gender - 70% of people with frozen shoulder are women.- Recent surgery or arm fracture - immobility of recovery may cause the shoulder capsule to stiffen.- Diabetes - two to four times more likely to develop frozen shoulder for unknown reasons; symptoms may be more severe.- Having suffered a stroke.- Hyperthyroidism (overactive thyroid).- Hypothyroidism (under active thyroid).- Cardiovascular disease (heart disease).- Parkinson's disease.Symptoms of frozen shoulderThere are three stages of frozen shoulder:* Painful stage - the shoulder becomes stiff and then very painful with movement. Moveme nt becomes limited. Pain typically worsens at night.* Frozen/adhesive stage - the shoulder becomes increasingly stiff, severely limiting range of motion. Pain may not diminish, but it does not usually worsen.* Thawing stage - movement in the shoulder begins to improve. Pain may fade, but occasionally recur.

Acupuncture for Neck, Back & Shoulder Pain

Dr. Gurudatta H K, Yoga and Naturopathy
Neck & shoulder pains are one of the commonest problems for which a GP is consulted across the world. Based on epidemiological  studies; at any given time about 10% of the population suffer from it!!Back pain is one of the most universal of all the diseases affecting practically everyone at sometime or another in one's life across the globe. About 80% of the population suffer from back pain at some point of their lifetime!!The possible common causes of back pain in today's lifestyle are -Lack of exerciseIncorrect postureLong hours of sittingStressOver weightBad dietary habitsImproper exercise without proper guidanceSpasms of back muscles and soft tissuesDisc prolapseDegeneration of joints & bonesOsteoporosisThe effective solutions for the above problems is prevention by -Regular & consistent exerciseAppropriate postureWeight managementHealthy dietary habitsStress managementAppropriate pain medication & Surgery in severe casesPhysiotherapyAcupunctureTCM (Traditional Chinese Medicine) & Acupuncture give us  more natural and long term solutions for the management of back pain. They not only work to relieve the symptoms of back pain but also address the root cause of the disease. In a study conducted at a Swedish Hospital, doctors concluded that acupuncture provides a long term relief along with improvements in physical activity levels, quality of sleep and diminished use of pain medication.It is understood that, according to TCM & Acupuncture there are energy channels called 'meridians' through which 'Qi'  or 'Prana' flows. Excessive stagnation or deficiency in the 'qi' or 'prana' leads to ill health and then to disease when not taken care of at the right time.According to TCM & Acupuncture it is understood that there are 3 most important factors which contribute for neck, back & shoulder pain. They are -Invasion of ColdInvasion of WindLeading to DampnessWhen all three factors are combined, they  lead to accumulation of heat in the channels causing pains, numbness or tingling.Deficiency of 'Qi'Acupuncture through the insertion of needles on the meridians on specific acu-points along the meridians, helps to restore deficiency, expels wind, scatters cold and resolves dampness. At the same time, it will also help to nourish blood.The result of a study published in Clinical Journal of Pain gives us sufficient proof that Acupuncture is quite safe and effective method of treatment in the management of low back pain.Action Mechanism of Acupuncture therapy²Scientific research into the mechanism of action of acupuncture began around 1950 when an important pharmacological study was published by a group at Peking University.They demonstrated that an induction time of 15 to 20 minutes is required for the development of an analgesic effect and proposed the participation of chemical substances in the analgesic actions of acupuncture [4]. Endogenous opioid peptides (EOPs) were considered major candidates for a role in acupuncture’s action.Along with acupuncture, yoga therapy and/or  therapeutic massage could also be recommended by the practitioner for effective management of the complaints.To prevent and sustain the benefits of Acupuncture, it is recommended to -Practice a correct sitting posture, when sitting for long hoursRegular exercise practice like yoga, tai chi orany other recommended exercise by the practitioner. Check out cervical spondylosis exercisePrevent going out in cold weathers without adequate clothing.Avoid strenuous & jerky movements.Stress management.More and more people are finding relief for both acute & chronic back pain through TCM& Acupuncture. Several research studies have proved this, time and again.¹Carlsson C, Sj˜lund B.Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. Clinical Journal of Pain 2001;17(4):296-305²Research Group of Acupuncture Anesthesia: Effect of acupuncture on pain threshold of human skin. Chin Med J 1973, 3: 151–158.Pomeranz B, Chiu D:Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci 1976, 19:1757–1762.

Shoulder Exercise – Let’s Do It Right

Dr. Narendra Mahara PT, Physiotherapist
Dumbbell shoulder pressDumbbell press is one of the pushing exercises to train those big shoulder muscles. It is a great functional exercise for upper body. However, it is one of the most common exercise to develop upper body issues if done incorrectly. To get that right technique and avoid injuries, it's important to understand about shoulder’s axis of movement.There are two axis formed at shoulder joint. First one is body axis and second one is the scapular axis (refer pic 1). Majority of people do all their exercises in body axis, which leads to injuries. Poor posture is another reason for scapular axis to shift further forward and cause injuries.                                                                     Pic 1  – Red line – Body Axis   Green line – Shoulder blade axisThe prime muscle we train with this exercise is deltoids. Other muscle involvedis upper pectorals and triceps and rotator cuff muscle in stabilizing humeralhead.Common mistakes while doing dumbbell press exerciseWrong axis of movementAs explained earlier, if exercise done is in line with body axis, chances of getting impingementare high. Always follow the scapular axis (refer Pic 2) to avoid impingement issues.Pic 2Back HyperextensionIt usually occurs when the weight is heavier than a person’s ability to lift (refer pic 3 & 4). It is a form of compensation to use more pectoral muscle to push the weight up. This can lead to back problems.Wrist not maintained in neutral position or Lose gripIn either case, the line of weight keeps changing reducing control of the movement which can lead to compensation and injury at shoulder, elbow or wrist joint (refer pic 3 & 4)Excessive external rotation at jointIn an attempt to keep the arms straight, many times people rotate their shoulders excessively which causes undue stress on biceps tendon and rotator cuff muscle(refer pic 3 & 4).Pic 3 – Incorrect technique – 1.Back hyperextension, 2. wrist bending 3. excessive shoulder rotationPic 4 – Correct technique – 1. Neutral back 2.neutral wrist 3. no excessive shoulder rotationCrossing over and clashing of weightsAt the end of the pushing movement, avoid clashing or crossing over of weights. This can lead to a jarring movement creating excessive or unwanted movement at the joints. These points also need to be considered for other shoulder exercises such as side raises/military press/arnold shoulder press.Always remember to listen to your body and progress gradually to prevent injuries.

Causes of Shoulder Pain

Dr. M.Kaushik Reddy, Orthopedist
Your shoulder is one of the most overused joints in the body and thus is at a higher risk of contracting an injury. Shoulder pain may lead to mobility issues where moving your arms may become extremely difficult. The shoulder consists of three parts, viz. the shoulder blade, collarbone and the upper arm bone. Shoulder pain may result from an injury to any of these areas.The various causes of shoulder pain are:Impingement: Impingement of the shoulder muscle occurs when the top of the shoulder impinges on the rotator cuff muscles. This condition can lead to severe pain in the shoulder.Bursitis: Bursa is a fluid filled sac that cushions the bones and help in preventing friction. Bursitis is a disorder that results in inflammation of the bursa, thus resulting in shoulder pain.Tendinitis: Tendinitis is a condition that is characterized by gradual wear and tear of the tendon. Usually the rotator cuff tendons in the shoulder are affected by this condition.Instability of the shoulder: Shoulder instability is a disorder of the shoulder wherein the upper arm bone dislocates from its socket. This can cause excessive pain in the shoulder.Fractures: A fracture in the bones of the shoulder results in excruciating shoulder pain.Arthritis: Arthritis is a disorder that leads to inflammation in the joints, thus resulting in pain and impaired movement of the joint.Treatment: The treatment for shoulder pain consists of medications and physiotherapy. You may also be asked to discontinue any strenuous activity that requires shoulder movement. Medications such as NSAIDs are prescribed to help in controlling the pain. Various stretches of the shoulder are also recommended to improve shoulder flexibility and mobility.Tips: Do exercises such as the overhead press with light weights to improve your shoulder strength. Also make sure to include certain external rotation exercises to strengthen the rotator cuff muscles.

Frozen Shoulder & Physiotherapy

Dr. Biju Nirmal Jacob, Physiotherapist
Frozen shoulder or adhesive capsulitis, a condition due to which it is difficult to comb your hair, difficult to put your dress on and pain if lying to the affected side. Usually it affects people between 40 - 60 years of age, ladies are more affected and it start with pain while doing activity or lifting heavy objects or a heaviness to shoulder.  This is commonly seen in patients with diabetes, after heart surgery or a history of previous shoulder injury.It is always better to take pain medication or muscle relaxants to reduce to severe pain.  you can apply heat fermentation at night to reduce discomforts.  Positioning of the hand is very important to reduce worsening of condition. Unique Physiotherapy Exercise for Frozen ShoulderPlease do this exercises twice daily, make sure to do a heat fermentation before and after the exercises. Manual Therapy for Frozen ShoulderMyofascial release to the rotator cuff muscles and trigger point release to subacapularis, infraspinatus and teres minor muscles helps to reduce pain and improve functions of shoulder. Shoulder joint mobilization with mulligan belt, maitland internal rotation mobilization helps to improve range of motion.To Reduce Pain due to Frozen ShoulderUltrasound therapy to the shoulder capsule helps in reducing adhesive tissues.TENS (Transcutaneous Electrical Nerve Stimulation) & IFT helps in reducing and and improving muscle strengthPositioning of hands to reduce worsening of the conditionsRange of Motion Exercises for Frozen ShoulderWand exercises, active assisted exercises, pully exercises are useful in improving ROM. Myofascial stretches of rotator cuff muscles and other muscles of shoulder girdle helps in improving the ROMStrengthening Exercises for Frozen Shoulder Exercise using exercise band, weight cuffs etc. helps in improving shoulder girdle strength. Home exercise program are also important to reduce pain and improve functionIt takes 3 weeks of physiotherapy sessions for proper improvement of frozen shoulder conditions.

Cheer for Team India, Play Like Team India- Let Us Help You Avoid Injuries!

Dr. Meeta Nanda (P.T.), Physiotherapist
As they say, “Cricket is a religion in India” which makes World Cup a mega festival. Looking at Team India’s such a Brilliant and hard working performance, lets talk about the probable injuries that may occur as a side effect of this hard work-Top 5 Cricket InjuriesHamstring StrainWhat is a Hamstring Strain?A Hamstring Strain is a tear in the muscle tissue. Hamstring strains tend to affect all cricketers regardless of position and account for around 15% of all cricket injuries. Hamstring strains occur during explosive sprinting activities such as bowling, taking a quick single or fielding a ball.What should you do if you suffer a Hamstring Strain?If you have a Hamstring Strain follow the RICE protocol - rest, ice and compression and elevation (never apply ice directly to the skin). If you have to apply ice at home, an Ice Bag is recommended. This is a safe method of ice application to avoid the risk of an ice burn.Seek advice from a doctor or Chartered Physiotherapist regarding rehabilitation . Most Hamstring Strains will be fully healed by 6 weeks, but recurrent problems can occur when a return to play is attempted too early.Low Back PainWhat can you do to prevent Low Back Pain?Fast bowling in cricket requires a combination of bending backwards together with rotation and side bending of the trunk. When repeated continuously this puts excessive stress on an area of the vertebra called the Pars Interarticularis and this is where a stress fracture develops.What should you do if you suffer Low Back Pain?A soothing Heat pack can reduce back pain and back muscle spasm. Once diagnosed, stress fractures of the lower back usually require 6 weeks of rest to allow the bone to heal. During this period, an exercise programme under the supervision of a Chartered Physiotherapist can be started . This focuses on exercises to increase the muscular stability in the lower back.Research has shown that poor muscular stability in the lumbar region can lead to low back pain. Core stability exercises target certain specific muscles which give the spine much better support. This prevents postural faults which can cause low back pain.Side StrainWhat is a Side Strain?A Side Strain is fairly common in cricket, where it typically occurs in bowlers. A Side Strain refers to a tear of the Internal Oblique, the External Oblique, or the Transversalis fascia at the point where they attach to the four bottom ribs.In cricket the bowlers suffer the Side Strain on the non bowling arm side as a result of a forcible contraction of the muscle on that side while they are fully stretched as the bowling arm is cocked for bowling.What can you do to prevent a Side Strain?Core strength exercises on an Exercise Mat using a Swiss Ball and Resistance Bands can improve muscle function across the trunk and pelvis and this can help to reduce the risk of a Side Strain.The number of overs bowled per session should be increased gradually and adequate rest periods should be provided to prevent fatigue.What should you do if you suffer a Side Strain?In the early stages an Ice Pack can be applied for twenty minutes every two hours. A Cohesive Compression Bandage can be applied to help to limit bleeding in the tissues. More active rehabilitation can be started under the supervision of a Chartered Physiotherapist, once the immediate pain resolvesShoulder PainWhat is Shoulder Pain?Shoulder pain is common in cricket because of the repeated actions of throwing and bowling. The Rotator Cuff muscles are small muscles situated around the shoulder joint, which can become damaged due to overuse during cricket.Rotator Cuff injuries often begin as inflammation caused by repeated irritation. If the cause of the inflammation is not addressed, partial tears may develop in the cuff that could eventually become a tear all the way through one or more of the Rotator Cuff muscles.What can you do to prevent Shoulder Pain?Correct throwing and bowling technique can help to reduce injury risk. Shoulder stabilization exercises under the supervision of a Chartered Physiotherapist can also help prevent damage to the Rotator Cuff tendons.It is important that any increase in the amount of training or competition must be gradual in order to prevent overload of the Rotator Cuff muscles. In particular, bowling and fielding practice should be increased gradually to allow the Rotator Cuff tendons to adapt.What should you do if you suffer Shoulder Pain?Physiotherapy treatment can reduce acute (short-term) inflammation and chronic (long-term) degeneration of the cuff where a tear is not present. The objective of physiotherapy treatment is to limit inflammation using Ice Therapy. Anti-inflammatory medication prescribed by a doctor is often helpful.Sprained AnkleWhat is a Sprained Ankle?A Sprained Ankle is damage to the ligaments and soft tissues around the ankle, usually as a result of the ankle being twisted inwards. The ankle ligament and soft tissue damage produces bleeding within the tissues and an extremely painful, swollen ankle.What can you do to prevent a Sprained Ankle?Research has shown that bracing or taping the ankle can help to reduce the risk of a Sprained Ankle.What should you do if you suffer a Sprained Ankle?Immediately following a Sprained Ankle you can follow the PRICE protocol - Protection with an Aircast Walker, Rest, Ice Therapy, Compression with a Cohesive Bandage and Elevation of the ankle to reduce swelling.Rehabilitation with a Chartered Physiotherapist significantly improves the outcome following a Sprained Ankle. Wobble Board training improves balance and proprioception.

Calcifying Tendinitis

Dr. Uday Bapusaheb Pote, Orthopedist
What does it mean?Calcify- calcium deposition, Tendin- tendon, itis- inflammationPresence of macroscopic depositis of Hydroxyapatite crystals (crystalline calcium phosphate) in any tendon.Which tendons are affected?Any tendon which is under stress can be affected by calcium deposition in them but its very commonly seen with supraspinatus tendon (tendon of your shoulder joint).Where exactly is this tendon?Supraspinatus and other Rotator Cuff musclesIs it normal to have calcium in tendons?Even normally supraspinatus tendon may contain minute amounts of calcium deposits.Calcific deposits are present in 3-20% of painless shoulders. Its mostly a chance finding. Out of these only 7% are painful.Degenerative tendons which are ruptured contain more calcific deposits and are more painful.Why does it occur?Unknown. Not caused by trauma or any other systemic disease.Whats the progress of these calcific depositis?Most of them resolve spontaneously and heal. (hurray!!)Its rarely associated with tears..(double hurray!!)It occurs in viable non-necrotic tissue as against dystrophic calcification- which is a different etiology, presentation and treatment. (that’s where an ortho consult helps to differentiate it from other types of problematic calcifications).Degenerated Tendon with calcium depositCLINICAL STAGES-Formative phase : Unknown trigger à portion of tendon undergoes fibrocartilaginous transformation à leads to calcification à deposits enlarge à resembles like chalkResting phase : may or may not be painful. If deposits large enough then mechanical symptoms may occur.Resorptive phase : After variable period à inflammatory reaction present à macrophages and multinuclear giant cells (these are inflammatory cells) absorb deposits à toothpaste like consistency à it leaks into subacromial bursa à painful symptoms.Post calcific phase : calcific deposits resorbed and collagen pattern containing fibroblasts present.What problems do they cause?(Let me tell you again) It's mostly asymptomatic and can be a chance finding.Common age group of patients is 30-50yrs.Common in femalesRight shoulder is commonly affected than left. 15-47% of time both shoulders may be affected.Symptoms-Chronic, mild pain, intermittent flares similar to presentation of impingement syndrome à formative phase.Mechanical symptoms : large deposits à block elevation of shoulder.Severe acute pain : its an inflammatory response of resorptive phase.Pain pattern : Point of shoulder to deltoid insertion ; less frequently to neck ; pain increases on elevation of arm above shoulder level or lying on the same side. Pain may awake patient from sleep.Complains of : stiffness/ snapping/ catching/ weakness.Range of movement is reduced,Painful arc – 70 to 110 degrees of forward elevation is painful.Tests of impingement are painful.Crepitus (crept like sound) may emit from shoulder on movement.Pain may be extremely severe in some cases when movements are reduced and tenderness is marked.What investigations are required?X-ray : only if the deposits are calcified we see it on x-ray. (symptoms if deposit size >1.5cm is not always true)X-ray showing calcifying tendinitisTwo types of deposits seen on an xray :Well defined limits à formative or resting phaseDiffuse or homogenous, amorphous, fluffy à poorly defined periphery à acute symptoms à resorptive phase.MRI : 95% accuracy in finding calcification.(Reduced signal intensity on T1W images. T2W images : Resorptive phaseà oedema present showing as increased signal intensity—not toconfuse with oedema due to tear)USG : finding depends on the skill of the radiologist.Its more accurate than an x-ray for soft/fluffy calcific deposits (still to have calcium deposits)Treatment Options?NSAID’s (anti-inflammatory medicines)- medicines help in reducing the inflammatory markers which give you pain in resorptive phase.  Needling / aspiration / lavage- yes it involves needles. It helps to reduce pain as well as the calcium deposits can be completely removed in the resorptive phase.Needling, lavage and aspirationInjection Depomedrol- a very mild steroid injections can be used in the resoptive phase to reduce the inflammation and pain.Formative phase/ resting phase- mild/ chronic pain à Extracorporeal shock wave therapy is useful (its just like therapy to use high frequency shock waves to break the kidney stones. It is painful so may require anaesthesia.)Physiotherapy – Accupuncture therapy helps in relieving the muscle spasm. Exercises help to maintain and regain range of motion and strength.Surgical removal of the calcium deposits. It can be done either by open surgery (rarely done nowadays) or by using an arthroscope.Arthroscopic removal of calcific depositsNewer studies have suggested the outcome of such tendinitis is very favourable without intervention as it’s a self limiting problem. Intervention is needed only when episodic pain is severe and frequent.

Shoulder Pain

Dr. Narendra Mahara PT, Physiotherapist
The shoulder joint is the most complex joint in the human body. It is tasked with giving you both the mobility to move your arm 360 degrees, as well as the stability that allows all the bones, muscles, tendons, and ligaments that make up the shoulder to work together.With all of parts that make up the shoulder, it’s common to experience pain or loss of mobility due to injury. If you are experiencing shoulder pain, try these exercises to help relieve your pain. Remember to always see a doctor if you experience shoulder pain that is not relieved by several days of rest, ice, massage, and elevation.1. Arm-across-Chest Stretch – Hold your right hand out in front of you, keeping it near your waist. Reach your left hand behind your elbow, pulling your right arm to the left and across your chest. If you feel pain in your shoulder, lower your arm until the pain subsides. The goal is to be able to pull your right arm across your chest without feeling any pain. Hold for 30-60 seconds then relax and repeat with your left arm. Repeat 3-5 times.2. Neck Release – Sit up straight then slowly bring your chin toward your chest until you feel the stretch in the back of your neck. Try leaning your head to the left to stretch your right shoulder or leaning your head to the right to stretch your left shoulder. Hold the stretches up to one minute in each direction, breathing deeply as you concentrate on relaxing. Repeat 3-5 times.To progress the stretch, elevate your arm as you pull it across your chest until it is the height of your shoulder.3. Chest Expansion – Put an exercise band, rope, strap, or even a tie behind your back and grasp it with both hands. While holding the strap, draw your shoulder blades toward each other and gently lift your chin toward the ceiling. Breathe deeply for 10 to 15 seconds and release. Repeat 3-5 times.To progress the stretch, move your hands closer together on the strap.4. Seated Twist – Sit straight up in a chair with your knees together. Twist your torso to the right, placing your left hand on the outside of your right thigh. Relax your shoulders as you look towards your right, gentling pushing on your right thigh. Breathe deeply for 10 to 15 seconds and release. Repeat with your left side. Repeat both sides 3-5 times.5. The 90, 90 Shoulder Stretch – Stand in a doorway, holding your arms up so your elbow is at a 90 degree angle and your arm forms a 90 degree angle to your body at the shoulder. Place each hand on one of the sides of the door frame, placing one foot forward as you stand up straight aligning your neck with your spine. Lean forward as you brace yourself against the door frame. Hold the stretch for 20-30 seconds. Repeat 2-3 times.