The general protocol used at Southeast PT is based around an approach that accomplishes 3 things:
1. Reduction and desensitization of current pain
2. Restoration of normal function to the tissues/joints
3. Prevention of future pain
The initial focus should be to desensitize tissues and reduce overall discomfort. This is where people tend to get stuck. They focus so hard on bringing symptoms down to a manageable level and once there, forget to or aren't interested in fixing the things that brought on the pain and discomfort.
Getting pain and discomfort under control allows for the secondary goals to be managed far more easily. This is the perfect time to start working on fixing suboptimal movements patterns, muscle imbalances and generally improve the way our shoulder(s) function.
Sometimes pain is purely protective, meaning that no actual tissue damage has occurred but rather the brain is interpreting a position, movement or load to be potentially injurious and is limiting motion or position in an attempt to protect you/the tissue. The brain utilizes the same pathways for both pain AND movement. Meaning that as we work on getting the shoulder moving better and muscles performing their intended tasks the brain's perception of the movements, positions and loads also improves.
I often equate this to having to convince your brain that a certain movement or pattern is not a threat through performance of scaled exercises.
So as perception improves and pain decreases, we move into the prevention piece of the protocol. It involves testing and retesting various inherent positions and then utilizing corrective exercises to optimize the positional demands.
The shoulders are designed to be used for the full extent of our lives (~100 years) and worked hard in the process. Shoulder pain isn't a random, spontaneous event. Barring some major event (macrotrauma) sometimes the shoulder tissues can become sensitized and painful because of small insults to tissue (microtraumas) due to suboptimal patterns that have gone on for weeks, months and even years. I'm sure this sounds like a complicated undertaking to address and ultimately fix but it's not! There are things you can do to address the low hanging fruit which often resolves a lot of the tissue issues before they can go nuclear.
That being said, we are a system of systems! So, in utilizing the 3-step protocol, we have to appreciate multiple layers of systems that must all function well together. If one system is deemed lacking, it has the potential to bog down and detrimentally affect the other systems.
This systems approach allows us to appreciate the whole picture. In assessing you we're asking and answering questions regarding certain systems:
Movement Quality: How do you move? Are you willing to move? Is it good technique? Could the technique use some work? Do you have work around/compensatory strategies? Believe it or not, your quality of movement (or lack thereof) affects your pain!
Muscular System: How do you move your shoulder? Do you limit shoulder motion and use other areas more to work AROUND the shoulder? What we've found is that tissues above and below the affected area are often significant contributors to symptoms. Often the rotator cuff gets the blame for shoulder pain (and sometimes it is the problem) but what usually gets overlooked is an overreliance on other muscles or tightness in adjacent muscles that no amount of rotator cuff strength can work through.
Sliding Surfaces: A connective tissue issue! Do tendons and muscles move effortlessly and appropriately when performing certain movements? All tissues should be able to slide, move and glide past and over one another with ease.
Joint Capsule: At every joint in your body there is a bag of tissue that binds the respective bones to one another. Sometimes that tissue can get stiff and bogged down, loosening it up can improve your motion and diminish pain.
Environmental System: Super important but frequently overlooked within healthcare. How are you sleeping? What's your nutrition/hydration like? Even your belief system in regard to how you view your pain and the resiliency/fragility of your system plays into your overall level of pain.
Typically, ALL of these things don't need to be addressed. Instead of viewing all of this information as a maze, view it as a network of connected systems. Improving 2 or 3 factors may result in resolving a lot of other seemingly daunting tasks.