16th September 2015 - On the subject of Fighting Pain and Physio

Thought for the day: "There is a species of antelope that is capable of jumping higher than the average house!! This is partly due to the antelope's powerful hind legs, but mainly due to the fact that the average house cannot jump"

Been away for a while : starting to try and get the shoulder back into shape - so mainly for my own reference I have decide to add my exercise regime so I can review progress.

About the injury 

The shoulder is a ball and socket joint. Most of the shoulder movement occurs where the ball at the top of your arm bone (‘humerus’) fits into the socket (‘glenoid’), which is part of the shoulder blade (‘scapula’). The arm is normally held in the socket by the soft tissue which fits over the joint liked a sock. This is
stabilised by fibrous tissue in the capsule, and by the muscles and
tendons that rotate the arm.
Dislocation occurs when the ball is wrenched out of its socket. The force required to do this can also tear or partially tear the muscles, ligaments and/or shoulder capsule surrounding the joint.

Phase 1
This phase starts after the shoulder has been put back into its socket. The
polysling will help to keep your shoulder comfortable. It should be worn for a maximum of two weeks, unless you have also broken your shoulder, when you
have to wear it for up to six weeks.

Pain can be a problem particularly in the first 2-3 weeks. Your doctor may give you a prescription to help with pain relief, or you can control the pain with basic painkillers, such as paracetamol.
Also, you may benefit from putting an ice pack (e.g. a bag of frozen peas in a damp towel) on the sore area for 10-15 minutes.
Your physiotherapist will give you some gentle movements for the arm, out of the sling, to help reduce stiffness and relieve some of the pain.


Phase 2
The main focus of this phase is to increase your range of movement further, increase your muscle strength, especially your rotator cuff, and to re-establish the muscle balance in your shoulder. Your progress will depend on the nature and severity of your injury.

The rotator cuff is a group of muscles that rotate the arm, and form a cuff or sleeve around the  shoulder joint and capsule. These must work together to keep the shoulder still whilst moving the arm. The physiotherapist will identify any weakness in these muscles and give you exercises from this booklet to strengthen them.

The scapula is supported by two important muscles, the trapezius muscle and the serratus anterior muscle. These muscles must be strong to control the shoulder blade as the shoulder joint moves. The physiotherapist will assess the muscle control of the scapula and give you an appropriate exercise programme as necessary.

Phase 3

The aim of this phase is to make progress towards functional and sporting activities, by helping you to regain the neuromuscular control of your shoulder. This is achieved by exercising the unstable shoulder in positions that challenge the shoulder muscles fully.
This also re-trains your proprioception, which is your body’s awareness of where a limb is in space. This works by messages relating to joint position awareness being sent to the brain via receptors in the shoulder.
When these receptors detect a situation of potential tissue damage, the muscles are caused to contract by the brain. This then causes the joint to move, so decreasing the mechanical stress on the surrounding areas.

So - the exercises:

and so we have it ...