Athlete’s Shoulder

Athlete’s Shoulder - Resolving Shoulder Injuries with Active Release Techniques (ART)

By: Dr. David Westmacott

Athletic activities require a considerable amount of strength, coordination, and flexibility from the shoulder.  As a result, athletes participating in sports such as swimming, paddling, golf, baseball, and tennis, commonly develop shoulder injuries.  Unfortunately, when shoulder injuries occur they not only prevent optimal performance, but they often progress to the point of preventing competition and training altogether.  To make matters worse, many of the most common shoulder conditions are slow to respond to traditional types of treatment and often result in months of frustration for the athlete.

Fortunately, a new treatment technique known as Active Release Technique (ART) is proving to be a very successful method to combat many common shoulder problems and get athletes back in the game quickly and effectively.  But before we talk about why ART works so effectively, first we need to understand how the shoulder becomes injured in the first place.

Shoulder Basics – The high cost of mobility

The shoulder joint consists of the round head of the upper arm connecting to the flat surface of the shoulder blade.  This “round-on-flat” relationship is different from most other joints in the body, and as a result is capable of providing a great deal of movement.  For example, most joints allow only one direction of movements (i.e. ankle, knee, elbow, fingers).  In comparison, the architecture of the shoulder allows us to reach up overhead, back behind the body, across the chest, and into internal and external rotation.

Over time the muscles become strained and develop small scale injury known as micro-trauma.  Initially this micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles.  Although only small, the damage still needs to be repaired.  The body responds to tissue injury in a very predictable way – by laying down new tissue to repair the damaged tissue.  With micro-trauma the body repairs the strained tissue by laying down small amounts of scar tissue in and around the injured area.  The scar tissue itself is not a problem – in fact it is a normal and necessary part of healing.

The problem occurs when the shoulder is repeatedly subjected to the same high force athletic movements.  This in turn causes the same muscles to become strained and subsequently repaired over and over again.  Over time scar tissue will build-up and accumulate into what we called adhesions.  As these adhesions form they start to affect the normal health and function of the muscles.  In fact, they will often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.

As these scar tissue adhesions accumulate in the shoulder region, it places more and more strain on the muscles as they must now stretch and contract against these adhesions in an attempt to move and stabilize the shoulder.  This places even further strain on the shoulder muscles, which in turn leads to more micro-trauma.  Essentially a repetitive injury cycle is set-up causing continued adhesion formation and progressive shoulder dysfunction.

As the cycle progresses the ability of the muscles to contract properly is affected and the stability of the shoulder becomes compromised.  At this point it is not uncommon for the muscles to give way, resulting in a more severe and debilitating pain.  In fact, many athletes come into our office explaining how they have hurt their shoulder during a routine task that they have done thousands of times before.  When further questioned these athletes almost always describe some mild pain or tightness in their shoulders that has been building over time.  As you can see from the explanation of the repetitive injury cycle, these types of injuries build-up over time and the more acute injury is often just the “straw-that-broke-the-camels-back”.

How are Shoulder Injuries Best Treated?

The Traditional Approach

In the attempt to relieve shoulder, a variety of treatment methods are used, either on their own, or in combination with other methods.  Some of the more common approaches include anti-inflammatory medications, rest, ice, ultrasounds (US), muscle stimulation (E-Stim), steroid injections,  stretching, exercise, and when all else fails, surgery.  Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases, provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.  This can be a huge problem as athletes often want and need to get back to training and competition as soon as possible.

The main reason these traditional approaches are often ineffective is they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues.  It is these adhesions that are binding the tissues together, restricting the normal movements, and interfering with the normal flexibility, and contraction of the muscles in the shoulder area.

Passive approaches, such as medications, rest, ice and steroid injections, all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction.  More active approaches, such as stretching and exercises, are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions.  In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from the shoulder condition.

One of the best things about ART is how fast it can get results.  In our experience, the majority of shoulder injuries respond very well to ART treatment, especially when combined with the appropriate home stretching and strengthening exercises.  Although each case is unique and there are several factors that will determine the length of time required to fully resolve each condition, we usually find a significant improvement can be gained in just 4-6 treatments.  These results are the main reason that many elite athletes and professional sports teams have ART practitioners on staff, and why ART is an integral part of the Ironman triathlon series.

To book an appointment to see if ART will be able to help with your elbow injury, simply call our office at 403-278-1405.

Frozen Shoulder Explained

Written By: Dr Evan Steinke, DC

Frozen shoulder, also known as adhesive capsulitis, is characterized by pain and a progressive loss of motion in your shoulder joint. You may have experienced this as beginning with shoulder pain from an unknown cause that made your sleep difficult and became increasingly painful over the coming weeks. Frozen shoulder is caused by inflammation of the shoulder joint resulting in adhesions and stiffening of the surrounding structures. As a result, the shoulder begins to become painful and lose its mobility. This is more commonly seen in people over the age of 40 and is slightly more common among women with both diabetes and thyroid disease being known risk factors.

Frozen shoulder is known to have a particularly long recovery time without treatment of 18-24 months. Due to the long duration of the condition is often divided into three phases.

Phase 1 – Freezing: Pain in the shoulder as it begins to tighten over several months. It may be particularly noticeable at night and progress to being painful at rest.

Phase 2 – Frozen: The structures around the shoulder are now adhered to each other and mobility is limited in most or all directions, however, pain may begin to diminish in this phase. This phase can last for up to a year.

Phase 3 – Thawing: The structures around the shoulder begin to loosen and allow for a gradual return of shoulder mobility over 6+ months.

Your doctor will be able to determine which phase you are in with a physical examination, there is no need for x-rays or other forms of imaging. Management of frozen shoulder depends on the phase you are currently in but will often include a wide range of physical therapy approaches aiming to improve your range of motion and providing relief. These can include the following:

Muscle release techniques: These techniques aim to help ease pain in the surrounding shoulder muscles and reduce muscle tension to allow for improved movement.

Exercises and Stretches: A variety of programs can be performed at home that aim to improve muscle strength, improve flexibility, and provide improved joint stability.

Mobilization: Working with the shoulder joint directly your therapist will help mobilize the joint to improve range of motion.

Activity Modification: Depending on your specific needs your doctor may also make modifications to your daily routines and activities to ease the load and stress on your shoulder joint.

In severe cases that do not respond to conservative care your therapist will be able to evaluate and direct you for a shoulder injection or discuss other options for your particular situation.

If any of these symptoms sound familiar call Active Sports Therapy at 4032781405 to book your shoulder assessment today.