Treat The Root Cause of Your Shoulder Bursitis
It is too common for Health Professionals to treat only the symptom of a shoulder bursitis – with massage, dry needling, corticosteroid injections – without addressing the underlying cause. The result is a temporary relief of pain which returns shortly.
Shoulder bursitis refers to inflammation of the sub-acromial (underneath the tip of the shoulder) Bursa. The bursa is a fat pad designed to stop friction between the tendons and the bones during movement.
Bursitis is a symptom of ongoing poor shoulder movement. These altered movement patterns may arise from previous injury – typically a rotator cuff tendinopathy – operation, or collective areas of muscle tightness and weakness which compound over time to become problematic.
Altered movement patterns when combined with repetitive movement can inflame the bursa and trigger pain at the tip of the shoulder. A number of factors can increase the likelihood of this condition, such as:
- A pre-existing weakness in the muscles and tendons of the shoulder – related to physical inactivity or previous injury.
- Rounded shoulder postures and lack of postural variety. This can increase compressive load through the rotator cuff tendons which can in turn predispose a sub-acromial bursitis.
- Repetitive movements either recreationally or occupationally. Particularly if there has been a recent increase in shoulder activities.
Bursitis is a Symptom. In the absence of trauma, it is highly uncommon for the bursa to become inflamed without an underlying issue. As such, as a part of your rehabilitation it is important to discover this cause to prevent your pain from recurring.
It is also why we do NOT simply recommend a cortisone injection. These powerful anti-inflammatories can decrease inflammation, but if the underlying cause is not addressed this inflammation will return.
Your physiotherapist will comprehensively assess your shoulder pain. In cases of acute and severe pain, for short term pain relief we can provide immediate relief through remedial massage, joint mobilisation and activity modifications.
For long term resolution of this problem we will strengthen the surrounding muscles of the shoulder, including the rotator cuff. This will stabilise the humeral head (arm bone) in the socket during repetitive movements such as reaching overhead. This will prevent friction of the tendons on the bursa; thereby decreasing inflammation and resolving this pain.
TREATMENT OF SHOULDER BURSITIS
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Stage 1: De-Loading and Symptom Relief
The first goal of your rehabilitation will be to reduce your pain levels. This will firstly require a period of de-loading, where we have to reduce our exposure to heavy loaded activities. Furthermore, we will have to minimise movements that compress the tendon or bursa, such as overhead activities and stretching the arm across the body.
Your physiotherapist will begin to address postural elements that decrease the sub-acromial space, such as a rounded shoulder posture or rounded upper back posture. They may employ techniques such as massage, dry needling or joint manipulation.
Often, anti-inflammatory medication can assist in subsiding your pain at this stage.
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Stage 2: Gradual Strengthening, Adhering to Shoulder Pain Levels
Once your pain levels have decreased – generally to a level below 4/10 – your physiotherapist can begin strengthening your rotator cuff musculature. This will initially involve positions that do not compress the rotator cuff tendons or bursa, such as with your arms by your side.
Prior to beginning rotator cuff strengthening, it is important to be able to activate your postural muscles such as your midback or thoracic spine extensor muscles.
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Stage 3: Progression Into Overhead Activities
Once you have achieved good control with your arms by your side, your physiotherapist will gradually introduce strengthening in positions that gradually work you towards overhead activities.