Shoulder Clinic Tips on Massage, Doing Less, Checking Your ROM and Giving Permission to Move

In this weeks episode we bring you some tips from the shoulder clinic.

In this episode:

00:22 – Shoulder massage and trigger point therapy works
01:45 – Try a self trigger point release at home – learn how
01:58 – Small changes can produce BIG results in the older shoulder
03:03 – Learn how to do a shoulder health check
04:28 – How giving a client permission to move helped heal her proximal humerus fracture

Hi, Luke here with another episode of Shoulder Guy Physiotherapy News.

Now this week, we’re bringing you tips from the clinic, things that we have noticed that have really worked in our clinic this week.

The first big tip, massage and trigger point release works. In my experience, massaging around the scapula and also the periscapular muscles, the rotator cuff muscles really works and, in particular, the trigger point release. Okay? There are trigger points that actually have developed within in infraspinatus and supraspinatus muscles. They are very, very predictable, and I have found that we can find those trigger points very easily. Then with continued release over numerous treatments, we can help to free up the muscle tissue, free up the fascia, allow better mobility of the shoulder blade.

It particularly helps really well with pain relief as well.

Obviously, you are not going to start out with deep tissue massage or trigger point release potentially on your first visit but slowly working into the deeper tissues and the trigger point release can have a great effect on pain, on mobility, and then on muscle activation. Some people actually use dry needling instead of the thumb work. I do a lot of thumb work myself, so I will have to think about doing some dry needling down the track which can really be a great adjunct to the trigger point release therapy. Massage and trigger point release therapy works, so you want to include that in your program somewhere, either whether you are a physiotherapist or you want to start to think about that or whether you are doing things at home. You can do a self-trigger-point release using a golf ball or a tennis ball into those key areas within, around the scapula and also within the rotator cuff tissue as well.

The next tip, doing lists can actually produce big results. Now I have found that in older patients, doing lists actually produces better results. Okay, these people are not meant to be Olympic athletes. They will not have perfect range of motion. They may, in fact, have some pathology, underlying pathology that we do not potentially want to stir up. They may be starting out in a very deconditioned state. We do not want to push them. We do not want to drive them too hard. We do not want to expect too much of them. Now what I have found that doing lists and making small changes actually produces bigger results for these types of clients.

Okay, so that might mean we are going to start out with very light loads. We might do things on alternative days. We might not give them a whole fully-blown program. Okay, we are going to do things gently. We are going to stretch gently, we are going to mobilize gently, and we are going to activate the key muscles very gently. We’re certainly going to do it consistently, but we want to take things nice and easy with the older client.

Okay, the next tip. You want to do a shoulder health check. There are some shoulder conditions that just creep up. They are insidious. They are upon you before you actually realize. Let’s say … let’s take frozen shoulder for example or a mild case of adhesive capsulitis. Now some of the first signs that you’ve got a problem with your shoulder will be a restriction in shoulder motion. One of the best shoulder health checks you can do is actually to look at your range of motion. You might check how far you can externally rotate, to take the hands away from the tummy. You might check that you can put your hand up into a high-five position or bring your arm across to watch the opposite shoulder and also then pulling the arm up behind the back. You might have trouble doing your bra.

You want to compare it to your good side if you’ve got one, but also every now and then if you are using your shoulder a lot, you want to just do a health check. Make sure that you’ve got good shoulder strength. In this case, make sure you’ve got good shoulder mobility because a lack of mobility can increase the forces across the shoulder joint, and it can muscles work harder. Okay, so range of motion is so important. I would encourage you to do a shoulder health check regularly, especially if you were using your shoulder on a regular basis and especially when you are requiring a high-performance output from your shoulder.

Now, I’ve had a patient in the clinic this week who had a major facture to the upper part of their arm, their proximal humerus, and what we really did for her was just to encourage her to move. We gave her permission to move. She was shutting the shoulder down. She had it in a sling. The x-ray was looking good. There were signs of some good bony healing, some good callus formation, and we wanted her to start to move that shoulder because what we know about four-part proximal humerus fractures, they can become quite nasty.

They can become very stiff, and very problematic.

We gave her permission to move, and in doing so, she started to use the arm at home. She started to perform the range of motion exercises more aggressively. Now four and a half to five months down the track, she is doing extremely well. She is very close to full range. She’s got good function, and she’s developing her shoulder strength. Overall, she is a very, very happy patient, so encourage your clients to move when it’s appropriate.

Give them permission to go ahead and move.

Okay, there are the tips from this week. I really hope that they help you.

My name is Luke, and I am the shoulder guy. I will see you again with another episode of Shoulder Guy Physiotherapy News. Bye for now.

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