Updated: Nov 16
Shoulder pain can be one of the most annoying pains. It seems like no matter what motion you do, it hurts. The hardest, most frustrating part is getting rid of the pain requires so much work! Postural correction, strengthening, increasing muscular endurance, and managing how your shoulder blade moves (or doesn’t move) will help you get ahead of the pain and prevent further injury to your tendons, ligaments, and joint.
Sometimes exercises and retraining aren’t enough and your shoulder may require surgery. The rehab following the surgery needs to include all of the aspects listed above to protect your shoulder going forward. Most people find that they leave physical therapy after their rehab with more strength, power, and mobility than they had before their injury, which is great news! But, let’s talk about what these shoulder diagnoses mean and the prognosis of each.
What is the difference between a tear and a strain?
Let’s start with the lesser of the two, a strain. Strains are micro-tears in the muscle fibers ranging from grade I being mild damage to grade III a complete rupture of the tendon oftentimes requiring surgical repair. A grade III strain could also be called a tear; however, you can also tear a ligament which is considered a 3rd degree sprain.
A strained muscle or sprained ligament can heal on its own, but will benefit from physical therapy to regain normal joint mobility and range of motion. Also with physical therapy you will focus on strengthening and stabilizing the shoulder to prevent re-injury. It is shown that a strained muscle or sprained ligament may not ever be as strong as it once was and will require assistance from the muscles surrounding it to protect it from further harm. The stabilization portion of your rehab is the most important.
To stabilize the shoulder, the goal is to get several of the muscles surrounding the shoulder to contract together to provide the joint with control. Here’s an example of a stabilization exercise:
Stir the Pot
What is a Labrum and What Happens When it’s Torn?
We have two labrums in our body, one in our shoulder and one in our hip. Both of these joints are called “Ball and Socket” joints which means they are able to move in multiple directions. The labrum is the cartilage located inside the joint that prevents the two bones from rubbing together and decreases friction. In our shoulder, the bicep tendon inserts into the labrum and can tear along with the labrum; this is called a SLAP tear.
People live with labral tears all the time and can function very normally and many times w/out pain. It is when the tear gets in the way when you move your arm or is compressed by the joint that it causes pain and limited range of motion and can require surgery to repair.
Following surgery of a labral tear, the focus of your rehab is to regain full range of motion and then strengthen and stabilize the shoulder to prevent further injury. Most are highly successful with their rehab and recovery and return to their sports and activity with even more strength and power than before.
Over time, the wear and tear on the labrum due to compression in the joint and repetitive strain. It is important to take good care of your shoulders by being aware of your posture and utilizing our muscles to move, reach, lift, and throw instead of straining the joint.
Oh the Rotator Cuff!
The ever so popular rotator cuff consists of four muscles that attach to your shoulder blade and then your shoulder and together they assist with rotation of your arm along with many other movements. Because of their location and path as they travel through the shoulder, there isn’t a lot of room for the tendons before they insert into the top of the arm bone.
When our posture is bad and/or we perform a lot of repetitive movements and strain through the shoulder the tendons can become impinged in the space or rub on the bone until inflammation begins or the tendon tears.
Surgery for a rotator cuff tear is very common and the rehab is not fun! It is long and painful and difficult at times. However, it is most of the time successful and people return to normal daily activities and sports.
The biggest, most important thing you can do to prevent rotator cuff dysfunctions is to be aware of your posture; where are your shoulder blades when you reach, lift, throw, etc? Strengthening the rotator cuff muscles is important, but if you don’t know how to use them or activate the support muscles then it will do you no good.
When Do You Need to Contact a Physical Therapist?
Well, if you are experiencing shoulder pain with activity, in your sport, or even at rest then you absolutely need to reach out. Don’t wait until your shoulder hurts all the time. It is much easier to get ahead of your pain and make progress when you address it from the beginning before your body finds ways to compensate and incorporate other aspects of pain. Check out my post "Not Sure Where to Start or When to Start Physical Therapy: 3 Key Indications" to learn more about if PT is right for your situation.
If you have questions about what is the best step for you or maybe you want to prevent any pain in the future, then you should schedule a time for us to chat about it. I offer No-charge phone consultations which can be scheduled from my website or by clicking here. During the call we will discuss what you have going on, what are some of your goals, and would working together be what is best for you or is there another direction that would be better.