Shoulder Pain in Athletes
Shoulder Pain in Athletes
Blog Article
It is the most common cause of shoulder pain in athletes occurs due to compression of the rotator cuff muscles by the superior structure (AC joint, acromion) leading to pain an inflammation.
Mechanism of impingement
3 main mechanism that can affect the distance/space of the subacromial space:-
• Loss of control of the humeral head
• Loss of scapular control
• Change to the actual size of structures within the space (Rotator cuff muscle, subacromial bursa for example.
Causes
Compromise of this space is due to: -
Ø Faulty muscle function
Ø Faulty postural relationship
Ø Faulty joint mechanics
Ø Structural abnormalities
Ø Injury to the soft tissue.
A: - Extrinsic causes
· Bony factors
· Soft tissue factors
· Postural/ergonomics
B: - Intrinsic causes
· Degenerative cuff failure
· Traumatic cuff failure
· Reactive cuff failure
Symptoms
· Pain on movement, may feel like it is ‘catching’.
· Painful when lying on the affected side.
· Pain when elevating the arm, particularly if lifting a weight.
· Reduced strength and range of movement due to pain.
Examination
• Examination should start with observation of the patient from the front, behind, and from the side.
• Evaluate Active and Passive ROM of shoulder.
• Posture (forward head, rounded shoulder)
• Rule out thoracic scoliosis, winging scapula.
• Limited internal rotation compared to normal side.
• Greater tuberosity tender to palpation {arm extended}
• Decrease internal rotation common
• About 60% of patients have decreased supraspinatus strength.
• Painful arc (patient reports pain in between the shoulder elevation range (70-120 degrees)
• Atrophy also seen on affected side.
Special test
· Neer’s impingement
· Hawkins Kennedy test
· Job’s test
· Drop arm test
Treatment
Ø PHASE I: Maximal protection - Acute phase
Goals
· Relieve pain and swelling
· Decrease inflammation
· Retard muscle atrophy
· Maintain/ increase flexibility
· Active rest: avoid activity which increases the symptoms.
Treatment
ü Modalities (cryotherapy, ultrasound, TENS)
ü Activity modification (avoid overhead activities, reaching and lifting activities)
ü Range of Motion
ü Stretching
ü Joint Mobilization (inferior and posterior glides)
ü Strengthening exercises-Isometrics (pain-free contraction) for rotator cuff, deltoid.
ü Soft tissue release
ü Kinesio Taping
Ø PHASE II: MOTION PHASE - SUBACUTE PHASE
Criteria for progression to phase 2
• Decreased pain and / or symptoms
• Increased ROM
• Painful arc in abduction only
• Improved muscular function
GOALS
• Reestablish non painful ROM
• Normalize arthro-kinematic of shoulder complex
• Retard muscular atrophy without exacerbation of pain.
Treatment
• Range of Motion
- Flexion and Abduction (pain free)
- L-bar: - Flexion, Abduction, External and Internal Rotation in 45 degrees of abduction progress to 90 degrees of abduction)
- Capsular stretching starts (anterior and posterior)
• Joint mobilization (inferior, anterior and posterior)
• Modalities
• Strengthening Exercises (Isometric exercises, Scapulothoracic strengthening exercises, initiate neuromuscular control exercise)
Ø PHASE III: INTERMEDIATE STRENGTHENING PHASE
Criteria for progression to phase III
• Decrease in pain and symptoms
• Normally A-AROM
• Improved muscular strength
Goals
• Normalize ROM
• Symptom free normal activities
• Improve muscular performance
Treatment
Range of motion
• Aggressive L - Bar A-AROM in all planes
• Continue self-capsular stretching
Strengthening exercises
• Initiate isotonic weight program
• Side lying (Internal and External rotation)
• Prone (Extension, Horizontal abduction)
• Initiate Serratus anterior exercises (wall push-ups)
• Tubing exercise
Ø PHASE IV: DYNAMIC ADVANCED STRENGTHENING PHASE
Criteria for progression
• Full, non-painful ROM
• No pain and tenderness
• 70% of contralateral strength
Goals
• Increase strength and endurance
• Increase power
• Increase neuromuscular control of the humerus and scapula
Treatment
• Initiate endurance drills
• Initiate “Thrower’s Ten” exercise program
• Initiate plyometric
Ø PHASE V: RETURN TO ACTIVITY PHASE
Criteria for progression
· Full non painful ROM
· No pain or tenderness
· Patient exhibit improved strength in appropriate rotator cuff and scapular muscles
· Isokinetic test that fulfills the criteria
· Satisfactory clinical examination (no longer a positive impingement sign)
· Patient can discontinue use of anti-inflammatory medications without a return of pain.
Goals
• Unrestricted symptom free activity
Initiate interval throwing program
• Throwing
• Tennis
• Golf
• Maintenance Exercise Program
• Flexibility exercises
• Can go for “Advance Thrower’s Ten” exercise program
Plyometric exercises
• Medicine ball exercise
1. Chest press
2. Perpendicular throw
3. Ear throw
4. Rotatory straight arm throw
5. Squat to thrust
6. Overhead slam
7. Wood chop
8. Diagonal wood chop
Tubing exercise
• Fly
• Reverse fly
• Shoulder flexion, abduction, extension
• Rotations
• Protraction, Retraction
• Trunk rotation
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