26/04/2024
An Osteopathic approach to Shoulder injuries including Thoracic Outlet Syndrome
Why do shoulder problems seem to go on and on and cause so much frustration to the afflicted?
It’s because we use our arms all day, every day in varying activities, and if we can’t perform those occupations like hanging out the washing, reaching up or forward for an item eg changing gears in a car or putting your hair up or reaching around your back to do your bra up - this can result in supreme annoyance at being unable to change or achieve those functions. Pain is often a factor in the decline of the shoulder function and can progress to a ‘frozen shoulder’ fairly quickly. Depending on the causative factor, ‘frozen shoulders’ can take up to 18 months or longer to recover. Frozen shoulders are also referred to as adhesive capsulitis. First there is pain caused by inflammed tissues, then the body responds by stiffening the joint to prevent movements which cause pain and finally recovery (that is a slow return of movement). However with targeted treatment the recovery time can be significantly reduced and the client can get back to their usual activities keeping in mind to avoid any actions that aggravate the shoulder or thorax.
Anatomically the shoulder is similar to the hips, the biggest difference being the hip has larger muscles to guide it like the Gluteus muscles but can have limited flexibility. However the shoulder has smaller muscles but has a much wider range of motion. That can be positive or negative according to how you are wanting your shoulders to perform. An sportsperson for instance will often attempt challencing workouts that may stress the shoulders, for example repetitive wall balls or handstand push-ups or a person swimming large kilometres. The structure of the shoulders are often compressed and intorstioned with people who perform a lot of hours at the computer, this picture in particular is becoming quite common due to the increased use of computers and devices. Poor posture can cause the thorax and shoulders to sag and compress. Over time this may lead to Thoracic Inlet syndrome due to extremely tight anterior neck and chest muscles, impeding head and thorax drainage - vascular and lymphatic. This often leads to Carpal Tunnel syndrome. Golfers and Tennis elbow are again cause by structural injuries and poor technique or overuse of the shoulder/arm and forearm. There may be no initial problem with the shoulder function but with increased weights, high repititions, poor posture, over-use injuries to the joint, muscles, tendons, bursa’s, vascular, neural or endocrine dysfunction can develop into a larger problem quite rapidly. Once damage has occurred, a holistic approach is the ideal recovery:
1. Perform a diagnosis using a detailed history, Orthopaedic testing and visual/functional assessment of the shoulder and thorax
2. Perform any additional test as required. E.g., Xray, refer to General Practitioner if ultrasound, CT or MRI is indicated (vital if you suspect Rotator Cuff or Labrum tear).
3. Apply Osteopathic techniques to improve the structure and function of the shoulder and thorax
4. Work with the client to organise an exercise programme to improve the function of the shoulder and thorax that they can continue at home.
5. Re-assess regularly to ascertain what is beneficial and what is not working or lagging in the process
6. It’s imperative treatment is applied as soon as possible to prevent adhesions and lengthy recoveries
7. Consider a Musculoskeletal Physician referral if the dysfunction is slow to repair or requires a more aggressive form of management i.e., Prolotherapy or PRP injections.
Personally I enjoy working on client’s shoulder/thorax dysfunctions. Any improvement in structure and function is gratefully accepted and once the improvements occur, as does the client’s belief in their ability to heal. This ensure you have a client invested in being a part of their healing journey.
