Tag Archives: shoulder pain

Shoulder Pain and Dry Needling

This past Friday we thought we’d have a little fun and treat out Shannon’s shoulder pain as part of our weekly in service.  This is a great way for all of us to put our heads together and solve some of our more challenging cases.

Check out the video below to see how we did:

It’s always cool to see significant improvements in range of motion and decreased shoulder pain – especially when the changes are immediate!

There is quite a bit more work to do here to get that shoulder moving right again but dry needling in combination with electrical stimulation can be the kick start that’s needed.

If you’ve been struggling with shoulder pain – and wondering if there is anything that can be done about it – give us a call (231 421-5805).  We’ve been able to help numerous clients with acute and chronic cases of shoulder pain (including those that have had PT elsewhere without success).

Or email questions to Joe@elitepttc.com

If you’re interested – check out the muscles/trigger points with their corresponding referral patterns below:

Rotator Cuff Trigger Points

Teres Minor Trigger Point

Teres Minor Trigger Point

For more information on shoulder pain and trigger points, please refer to a couple previous articles on our blog:

Trigger Points and Shoulder Pain

Trigger Points and Shoulder Pain – Part II

Trigger Points and Shoulder Pain – Part II

originally posted on SportsRehabExpert.com

Joe Heiler PT

Shoulder pain is such a common diagnosis that we’ll see here at Elite Physical Therapy, and there are a number of structures that can be pain generators to the shoulder and arm. Last month I talked about trigger points in the posterior rotator cuff (Infraspinatous and Teres Minor) along with their common referral patterns. Another common shoulder muscle to find active trigger points is the supraspinatous. Active trigger points in this muscles can refer pain to the deltoid and down the lateral aspect of the arm.

Check out the typical trigger points and referral patterns below:

Supraspinatous Trigger Point Referral

Check out the video below for a demonstration of dry needling to the supraspinatous:

Case study:

Feel free to check out this case study but it was originally written for physical therapists and chiropractors. Ultimately the point is that a combination of dry needling and soft tissue mobilization, in addition to corrective exercises, can significantly decrease pain while improving range of motion and movement.

Current patient of mine presents with lateral arm pain of 3 months duration. No known cause of injury but diagnosed with tricep injury/tear.

Pre-Treatment

SFMA dysfunctional non-painful patterns:

  • all cervical patterns (mobility)
  • R shoulder medial rotation extension (mobility) – FN to the L
  • MS rotation R (motor control deficit) – FN to the L.

    SFMA dysfunctional painful patterns:

  • R shoulder lateral rotation flexion
  • MS extension (R UE pain)

    Special tests:

  • Hawkins + on the R
  • Passive shoulder IR 20 deg.

    Palpation:

  • Tenderness with palpation of both trigger point in the supraspinatous with referral of pain down the lateral upper extremity to the wrist (indicates that is the pain he gets into the upper arm)

    Treatment on Day 1 consisted of Functional Dry Needling to the supraspinatous (x2) with electrical stimulation followed by more superficial Graston technique to the R upper trap, supraspinatous, infraspinatous, and teres minor along with light strumming at the supraspinatous insertion. Corrective exercise included 3pt. thoracic rotation (UE positioned in internal rotation – hand behind the back) with manual assist to hold/relax work until pt. was able to control the full available range.

    Post-Treatment

    Functional Non-Painful patterns:

  • R shoulder medial rotation extension
  • MS rotation B

    SFMA dysfunctional non-painful patterns:

  • all cervical patterns (mobility)

    SFMA dysfunctional painful patterns :

  • R shoulder lateral rotation flexion
  • MS extension (R UE pain)

    ***both are still painful although intensity has decreased while motion has increased***

    Special tests:

  • Hawkins + on the R but much less intense
  • Passive shoulder IR 50 deg.
  • Graston Technique – Treating the Painful Shoulder

    Here is the video I promised using Graston Technique to treat soft tissue dysfunction in the posterior shoulder girdle using and in particular the trigger points that can refer pain to the front of the shoulder and down the arm.

    If you haven’t read the previous article discussing why we would want to treat this area, you can check that out here:  http://www.elitepttc.com/blog/trigger-points-and-shoulder-pain/

    If you have any questions concerning Graston Technique, Dry Needling, or shoulder pain please contact us at 231 421-5805 or Joe@elitepttc.com

    Trigger Points and Shoulder Pain

    There are a number of manual therapy techniques we use here at Elite Physical Therapy and Sports Performance, including Graston Technique and Trigger Point Dry Needling, to address muscular pain.  What many people don’t realize is that taut bands of hyperirritable muscle (a.k.a. trigger points) can cause local and referred pain.

    This article is one I wrote for SportsRehabExpert.com awhile back showing how trigger points in the back of the shoulder, specifically the muscles of the posterior rotator cuff, can refer pain to the front of the shoulder and down the arm.

    If you have shoulder pain that has not responded to other types of treatment, then check out this article and please contact us with any questions you may have!

    Manual Therapy Technique of the Week – Treating the Infraspinatous and Teres Minor 

    Joe Heiler PT

    I’ve become much more familiar with trigger point referral patterns and treating these out the past couple years since taking the Kinetacore Functional Dry Needling course.  A couple of the more common trigger points I end up dry needling and/or using Graston Technique to treat in the shoulder are the infraspinatous and teres minor.  Active trigger points in these muscles can refer pain to the anterior and middle shoulder, and on occasion will also refer pain down the arm.

    Check out the typical trigger points and referral patterns below:

    Infraspinatous Trigger Points and Pain Referral Pattern

    Infraspinatous Trigger Points and Pain Referral Pattern

    Teres Minor Trigger Point and Pain Referral Pattern

    Teres Minor Trigger Point and Pain Referral Pattern

     

    Case Study

    Current patient of mine presented with R shoulder and scapular pain of 2 year duration.  MS rotation limited to 50% bilaterally (DP) and R shoulder medial rotation extension (MRE) reach only to L4 (DP).  Palpation of the infraspinatous trigger point (most superior and lateral) referred significant pain to the anterior shoulder and slightly down the lateral arm reproducing her typical pain.  The teres minor trigger point referred pain to the middle deltoid area.

    Post trigger point dry needling of these trigger points the patient’s MS rotation improved to 90% (dysfunctional still but non-painful) and R shoulder MRE to T9 (still DP but much less pain).

    It’s not always this dramatic but this is also not the first time I’ve seen the great results like this.

    I’ll get a video up soon showing how we use Graston Technique to treat the posterior shoulder to reduce this type of pain and improve shoulder function.

    In the meantime feel free to contact us with any questions:  231 421-5805 or Joe@elitepttc.com

    Exercise of the Week – Single Leg Overhead Press

    Finding new ways to unload an athlete but still get in a good amount of work is always a challenge.  Finding lifts the athlete can do in a single leg stance position would be one way to do that.

    I’m not claiming that I’m going to create any monsters (as Charlie Weingroff would say) with lighter weights here, but I am looking for ways to incorporate an injured limb with increased demands for trunk control and an expression of upper body strength.  This is a great way to bridge the gap in rehab back to the weight room.  It can also be a great way to unload an athlete from time to time to prevent over training.

    Check out the video below for tips and progressions of the single leg overhead press:

     

    Couple prerequisites:

    • full shoulder range of motion – you should be able to lie on your back with knees bent, low back flat on the floor, and arms should lie flat on the floor overhead.
    • hold single leg balance with a level pelvis 20-30 seconds statically

    Now at Elite Physical Therapy – Functional Dry Needling

    Functional Dry Needling is a very effective manual therapy technique that I’ve been wanting to learn for some time now, and was recently trained though Kinetacore.  I’m very excited to be using this new technique and I’m already seeing some great results.

    In this week’s blog post, I want to give some very basic background on what Dry Needling is, and is not.  The article below doesn’t mention this but I want to make it quite clear that this is not acupuncture.  The only similarity is the use of the same type of needle.  Dry Needling performed by a physical therapist requires a thorough musculoskeletal evaluation, and placement of the needle into specific taut bands of muscle (a.k.a. trigger points) that are pain generators and creating dysfunction within the system.

    My knowledge of acupuncture is somewhat limited but generally speaking the points that are treated in the body are mapped out along ‘meridians’.  Needles are placed into these preset points and left for a certain amount of time.

    There is a lot more to it than just this, and I think it is important to understand that there are differences.  The description of Functional Dry Needling below comes from the Kinetacore website.  It’s a quick primer on the technique.  If you want to see it in action, check out the video at the bottom of the page featuring Terry Bradshaw.

    “Dry Needling is a general term for a therapeutic treatment procedure that involves multiple advances of a filament needle into the muscle in the area of the body which produces pain and typically contains a ‘Trigger Point’.   There is no injectable solution and typically the needle which is used is very thin. 

    Most patients will not even feel the needle penetrate the skin, but once it has and is advanced into the muscle, the feeling of discomfort can vary drastically from patient to patient.  Usually a healthy muscle feels very little discomfort with insertion of the needle; however, if the muscle is sensitive and shortened or has active trigger points within it, the subject may feel a sensation much like a muscle cramp — which is often referred to as a ‘twitch response’.

    The twitch response also has a biochemical characteristic to it which likely affects the reaction of the muscle, symptoms, and response of the tissue. Along with the health of the tissue, the expertise of the practitioner can also attribute to the variation of outcome and/or discomfort.  The patient may only feel the cramping sensation locally or they may feel a referral of pain or similar symptoms for which they are seeking treatment. A reproduction of their pain can be a helpful diagnostic indicator of the cause of the patient’s symptoms. Patients soon learn to recognize and even welcome this sensation as it results in deactivating the trigger point, thereby reducing pain and restoring normal length and function of the involved muscle.

    Typically positive results are apparent within 2-4 treatment sessions but can vary depending on the cause and duration of the symptoms, overall health of the patient, and experience level of the practitioner. Dry needling is an effective treatment for acute and chronic pain, rehabilitation from injury, and even pain and injury prevention, with very few side effects. This technique is unequaled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits.”

    If you have further questions about the technique, or feel that this technique may work for you then feel free to contact us:  joe@elitepttc.com or 231 421-5805231 421-5805.

    Elite Physical Therapy Exercise of the Week – Wall Posture Shoulder Mobility

    originally posted on SportsRehabExpert.com

    This article was originally written for physical therapists and other clinicians dealing with shoulder pain and loss of motion so excuse some of the medical terminology.  I know a number of them read this blog so I’m leaving the article as is. 

    The jist of this article is as follows:  most of us have too much extension (arch) in our lower spines, and we go into even more extension any time we try to raise our arms overhead.  Over time this can lead to shoulder pain and low back pain.  The article below describes a great warm-up exercise to improve shoulder mobility while controlling spinal posture. 

    As always if you have any questions feel free to email me:  joe@elitepttc.com

    Joe Heiler PT, CSCS

    This is a great correction for the shoulder mobility movement patterns and also for the shoulder flexion component of the MS Extension pattern.  The lumbar spine frequently contributes excessive extension to the shoulder patterns when the shoulder itself is limited.  Mobility work is required to free up the shoulder, but this pattern will continue if motor control is not imparted to lock in the new range of motion.

    I would not want to be her low back right about now!

    The ‘wall posture’ as I describe it to the patient is an attempt to get the entire spine to touch the wall.  By having the feet out in front and knees slightly flexed it makes it easier to get the lumbar spine flat onto the wall which is really just a less extended, and probably more neutral position, for most folks. If you’re concerned that it is too much flexion, or if it is not well tolerated due to back pain, and towel roll/lumbar support could be used but contact must be kept at all times.

    The cervical spine is a little trickier when it comes to proper positioning.  I will cue to get the spine to the wall, but to a point.  That cue will usually bring the chin down and back (into cervical retraction) which again will bring most folks to a more neutral posture.  Too ‘straight’ is not a normal position either and could affect the shoulder mobility component of this corrective so don’t force it.  If their forward head posture is so severe that their head won’t touch the wall without going into extension, then place a towel roll behind the head and require them to hold the towel in place as the arms go overhead.

    Maintaining the proper positioning throughout the movement is the most important factor here.  The shoulder motions in the video are a challenge to that positioning.  When posture is lost, the movement is done.

    Breathing is critical here as well.  My preferred way of cuing the breathing is to inhale at the bottom and slowly exhale during the overhead motion.  The more the ribs stay down in the front the better.  This can be incredibly hard for many people, and especially so for many overhead athletes, weight lifters, dancers, and gymnasts.

     

    The order in which the motions are presented in the video go from easier to most challenging:

    1)  Shoulder Flexion
    2)  Shoulder Abduction (snow angels)
    3)  Shoulder Abduction with External Rotation

    If following the SFMA’s 4×4 matrix, this would be considered a level 4 posture, unloaded but with assistance (the wall as the positional cue) so 4:1.  Competency must be attained in each of the previous postural levels:  1)  supine/prone, 2)  quadruped, 3)  tall or half kneeling.

    Progressions per the matrix:

    4:2 – shoulder mobility work without the postural cuing or any activation
    4:3 – loaded with cuing or activation.  Shoulder Flexion/Extension (reciprocal patterning) or pressing overhead with the spine against the wall or a corner (I prefer a corner to allow the shoulders to move more freely).
    4:4 – loaded without cuing or activation – Shoulder Flexion/Extension in standing, any type of pressing.