Most of us can recall one or more occasions when the day got off to a rough start because of a stiff neck. This can be explained by the fact that neck pain ranks among the most common types of pain you can get. Statistics vary on just how many people encounter neck pain, but recent evidence suggests that its lifetime prevalence is between 20–70% and that 10–20% of individuals are affected by it at any given time.

Dealing with neck pain can be troublesome and place a strain on everyday life. Typical movements like bending over to pick an item off the ground or twisting your torso when looking to the side might suddenly take more time and make you less mobile in the process. Being regularly bothered by pain and movement limitations will often lead one to wonder what’s causing the pain and what steps can be taken to address it.

The truth is that the specific cause of neck pain is usually difficult to pinpoint, and regardless of its cause, the most effective treatment is usually a comprehensive, individualized course of physical therapy. Nonetheless, there are a few signs that could be a “red flag” that warrants further investigation. To help you better understand what could be causing your neck pain and what to do next, here are the 7 most common causes of neck pain seen by physical therapists and some red flags to be aware of:

The 7 most common neck pain conditions treated by physical therapists

• Sprain: occurs when a ligament in the spine is pushed beyond its limits, which can damage or tear it; typically leads to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
• Strain: involves a tendon or muscle that supports the spine being twisted, pulled, or torn; as with sprains, neck strains usually lead to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
  • Sprains and strains are responsible for most cases of neck pain, particularly in younger patients; these injuries can occur either from a single incident or result from repetitive stress over time
• Herniated disc: a condition in which the softer jelly–like substance of a disc in the spine pushes out through a crack in the tough exterior ring; a “bulging disc” means that the inner layer has protruded outwards, but the outer layer remains intact; herniated discs are more common in the lower back, but also occur in the neck; typical symptoms include a sharp or burning pain in the shoulder or arm, as well as numbness or tingling and weakness
• Spinal stenosis: a condition in which the spinal canal—the space around the spinal cord filled with a fluid that bathes the nerves and nerve roots of the spine—narrows over time, which puts pressure on the spinal cord and spinal nerve roots; spinal stenosis is typically only seen in older adults
• Degenerative disc disease: an age–related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to a herniated disc or other related issues; degenerative disc disease is another one of the most common causes of neck pain
• Osteoarthritis: involves the breakdown of protective cartilage that surrounds the ends of joints and discs in the spine; patients typically experience pain and stiffness, and possibly weakness or numbness in the neck as well
• Cervical radiculopathy: occurs when one of the nerve roots in the neck is compressed or pinched when it branches away from the spinal cord, which is caused by any condition that injures or irritates these nerves; symptoms include a burning pain that starts in the neck and travels down the arm, chest, upper back, and/or shoulders, and weakness, numbness, and/or tingling in the fingers

Red flags

• History of fever, chills, or recent illness (could suggest the presence of an infection)
  • Other signs of infection include pus or fluid, redness, fever, blisters, and worsening swelling
• New episode of neck pain in patients under 18 years or over 50 years
  • For those under 18 years, pain may suggest a congenital defect, spondylolysis, or vertebral fracture
  • For those over 50 years, pain may suggest a tumor or infection
• Bowel or bladder dysfunction (associated with a condition called cauda equina syndrome)
• Extreme bruising, swelling, or throbbing pain
• Significant bone pain (may suggest a bone tumor)
• Persistent swelling and pain that develops without a recent injury
• Compromised immune system
• Recent surgery or spinal injection

In our next post, we describe our top exercises to reduce your risk for neck pain.

Tennis is a great form of physical activity that works out many parts of the body due to its demanding dynamics, but just like every other sport, it also comes with a risk for injury. The most common injury in the sport is called lateral epicondylitis, which is often referred to as tennis elbow.

The lateral epicondyle is a bony bump on the outside of the elbow that serves as an attachment point for several muscles, tendons, and ligaments of the elbow and forearm. When the arm is overworked, a muscle in this region called the extensor carpi radialis brevis (ECRB) gets weakened, which eventually leads to microscopic tears in its tendon, which attaches to the lateral epicondyle. This results in inflammation of the ECRB tendon, which is called lateral epicondylitis, or tennis elbow.

As we explained in our first post, tennis elbow is a repetitive strain injury that’s caused by repeatedly performing certain movements over a long period. Athletes who play tennis and other racquet sports have an elevated risk for developing tennis elbow, particularly due to the groundstroke in these sports, which directly puts a strain on the ECRB. But tennis elbow can occur in anyone who performs repeated movements that involve the elbow, such as painters, plumbers, and carpenters. When tennis elbow occurs, the most common symptoms are pain and a burning sensation in the outer part of the forearm and elbow that gets worse with activity, as well as weakened grip strength.

Fortunately, 90% of patients with tennis elbow will significantly improve with nonsurgical treatment alone, such as physical therapy. Physical therapists are movement experts who will first perform a thorough evaluation to identify the source of your pain and determine if any of your movements or activities may be contributing factors. From there, the therapist will design a personalized, evidence‐based treatment program designed to alleviate your symptoms and restore your physical function with a variety of interventions.

19 studies are accepted into comprehensive review

A recently published study called a systematic review highlights just how effective physical therapy can be for this condition. For the study, researchers performed a comprehensive search for published literature that evaluated various physical therapy interventions for tennis elbow. This search led to 19 studies being accepted into the review, all of which were published in the last five years. Each study assessed the effectiveness of one or more physical therapy interventions, including therapeutic exercises, manual (hands‐on) therapy, taping, orthotic devices, and pain‐relieving modalities like ultrasound, ice, and heat.

Results showed that the physical therapy techniques analyzed generally had a positive effect on patients’ symptoms and helped to resolve the clinical signs of tennis elbow. The two interventions found to produce the most benefits were strength training exercises and manual therapy—including massage and stretching exercises—both of which also had a very favorable cost‐benefit ratio. Most of the other techniques analyzed were also found to have positive effects on patients with tennis elbow.

These findings provide further evidence that many of the interventions frequently used in physical therapy are beneficial for tennis elbow by helping to alleviate painful symptoms. Therefore, patients who are bothered by symptoms that may suggest tennis elbow should strongly consider consulting a physical therapist for an evaluation that will likely lead to a comprehensive treatment program and an eventual path to recovery.

The carpal tunnel is a space at the base of the palm that contains several tendons and the median nerve, which provides sensation to most of our fingers. If these tendons and soft tissue thicken or any other swelling occurs in the area, the tunnel narrows, which puts pressure on the median nerve and leads to carpal tunnel syndrome. Symptoms usually start with a burning or tingling sensation, but eventually pain, weakness, and/or numbness develop in the hand and wrist, and then radiate up the arm. As carpal tunnel syndrome progresses, symptoms usually get worse when holding certain items, and the weakness and numbness may occur more frequently if pressure on the nerve persists.

Carpal tunnel syndrome affects about 5% of the population, and the greatest risk factor is performing any task that requires repetitive hand motions, awkward hand positions, strong gripping, mechanical stress on the palms, or vibration. Although office work and repetitive typing may be a potential cause, the professions most frequently associated with carpal tunnel syndrome are those that involve sewing, baking, cleaning, and assembly-line work.

Surgery and conservative (non-surgical) interventions like physical therapy are both frequently used to treat carpal tunnel syndrome. Guidelines for carpal tunnel syndrome vary, with some recommending surgery and others recommending different conservative treatments like exercise, orthotic devices, and manual therapy, and there is not yet a consensus on which approach is more effective; however, surgery is the most common treatment approach for carpal tunnel syndrome, despite this lack of evidence.

To shed light on this topic, a study was conducted that compared the long-term effectiveness of surgery to manual therapy, a conservative intervention frequently used by physical therapists. The study was a continuation of a randomized-controlled trial in which 120 women with carpal tunnel syndrome were randomly assigned to undergo either manual therapy or surgery and then followed up for four years.

Patients assigned to the manual therapy group received one 30-minute treatment session per week for three weeks. The session consisted of the therapist performing a series of mobilization techniques with their hands that targeted sites that could potentially trap the median nerve, as well as tendon gliding exercises and mobilization techniques to the upper spine. Patients in the surgery group underwent a surgical procedure called carpal tunnel release and were then educated on how to perform the same exercises as the manual therapy group. All patients were assessed for the level of hand pain before the study began and then periodically for the next four years.

Of the 120 original participants, 97 (81%) completed the four-year follow-up. In the original trial patients in the manual therapy group reported greater decreases in pain intensity than the surgery group at 1, 3, and 6 months. At the one-year and four-year follow-up, there were no significant differences between the manual therapy and surgery group. There were also no significant differences between groups in the rate of surgery over four years, and patient’s self-reported scores on their perceived improvements were similar as well.

These results suggest that surgery and manual therapy lead to similar outcomes over four years for women with carpal tunnel syndrome. It is therefore advised that patients with carpal tunnel syndrome first attempt a trial of conservative treatment that includes interventions like manual therapy before considering surgery, which runs counter to the current trend of most patients receiving surgery. Patients should also be aware that surgery is typically associated with greater costs and potential risks, whereas physical therapy is universally regarded as a safe and effective treatment with minimal risks.

In our next post, we summarize a study that reviewed the most effective physical therapy interventions for tennis elbow.

Most people don’t realize just how much they rely on their wrists and elbows to function properly until a problem arises. This is often the case for anyone with wrist or elbow pain, which can cause daily life to become a series of obstacles to overcome, often leading many patients to skip many activities altogether to avoid aggravating pain. This in turn can cause performance issues at work or in sports, which may equate to lost wages or fitness impairments over time.

Therefore, it’s important to take steps to reduce your risk for wrist and elbow pain in the first place. Many people are unaware that their profession itself could be contributing to this type of pain, especially if repetitive movements&like typing on a computer, cutting hair, working on an assembly line&are involved. While we would never recommend changing your professions unless the circumstances were dire, there are some ways you can reduce your risk for repetitive strain injuries, such as adjusting your posture and the positioning of your hands and wrists, trying to avoid repetitive and straining movements, and modifying your workstation positioning and habits. In addition, we strongly recommend the following exercises for boosting your strength and flexibility, which will in turn help you avoid injury:

Our top 3 exercises to prevent wrist or elbow pain To see videos of each exercise, go to www.MyRTR.net and enter prescription code XGXLMGKL

1. Resisted Elbow Extension with Weight
   • Lie on your back with one elbow supported by the opposite arm
   • Hold a small dumbbell (2–5 lbs) in one hand
   • Straighten your elbow against the resistance of the weight
   • Hold for 5 seconds
   • Complete 2 sets of 12 repetitions for each arm, two times per week
2. Resisted Hammer Curls with Weight
   • Stand with your arms by your side with your thumb facing forward
   • Hold a small dumbbell (2–5 lbs) in one hand
   • Bend your elbow, leading with your thumb
   • Hold for 5 seconds
   • Complete 2 sets of 12 repetitions for each arm, two times per week
3. Resisted Elbow Flexion: Palm Up
   • Stand with your arms by your side and palm facing forward
   • Hold a small dumbbell (2–5 lbs) in one hand
   • Flex your elbow while bringing your hand toward shoulder
   • Hold for 5 seconds
   • Complete 2 sets of 12 repetitions for each arm, two times per week

In our next post, we’ll break down a study that highlights the benefits of physical therapy for carpal tunnel syndrome.

In a typical day, you use your hands, wrists, and elbows extremely frequently. From vigorously brushing your teeth in the morning to switching the lights off before bed and during most other actions in between, these joints are very often in a state of movement. But over time, performing certain tasks on a repetitive basis can go on to damage some of these structures and lead to injury.

A repetitive strain injury is a potentially disabling condition that results from overuse of a body region or structure—usually the hand or wrist, and sometimes the elbow—after performing the same movement over and over. Repetitive motions, like typing on a computer, cutting hair, working on an assembly line, or even using a cellphone can all cause increase stress and fatigue of different structures, resulting in pain and other symptoms in these regions.

Common wrist and elbow conditions vs red flags

Carpal tunnel syndrome is by far the most common and well-known repetitive strain injury in these areas, as it affects up to 5% of the adult population. But there are several other repetitive strain injuries that can also affect the wrist or elbow. Below, we break down some of the most common conditions that can produce pain and limit movement in the wrist and elbow, all of which can be effectively treated by a physical therapist. This is followed by some key red flags to be aware of that may suggest a bigger issue is present:

• Carpal tunnel syndrome: a repetitive strain injury that is likely caused by tasks that involve repeated hand motions, awkward positioning of the hand or wrist, vibration, or excessive gripping; individuals who work in industries like manufacturing, food processing, and textiles are likely at the highest risk; over time, these movements can cause the median nerve within the carpal tunnel to be compressed, which leads to pain, tingling, weakness, and/or numbness in the hand or wrist
• Wrist tendinitis: a condition in which one or more tendons in the wrist becomes inflamed and irritated, which leads to pain and disability; tendinitis can occur at any age but is more common in adults; as tendons age, they become less elastic and can tolerate less stress, which makes it easier for them to become damaged
• De Quervain’s tenosynovitis: this is a type of tendinitis that develops on the thumb side of the wrist; it causes pain and tenderness in the wrist or below the base of the thumb and often gets worse with repetitive hand or wrist movements; as with other types of tendinitis, tenosynovitis is more common after the age of 40
• Dupuytren’s contracture: an abnormal thickening of tissue between the skin and tendons in the palm, which may limit the use of the fingers or eventually cause them to be pulled in towards the palm in a bent position; the causes of this condition are unknown, but it’ more common in men over the age of 50
• Ulnar tunnel syndrome (Guyon’s canal syndrome): this condition is similar to carpal tunnel syndrome, but it involves compression of the ulnar nerve, which leads to a tingling sensation in the ring and little fingers; it’s particularly common in weightlifters and cyclists
• Golfer’s elbow (medical epicondylitis): this condition results from repeated bending of the wrist, which damages the muscles and tendons in the elbow and eventually leads to inflammation; it’s most common in golfers, but can occur from other sports and activities that strain the elbow, and the clearest indication is pain on the inside of the elbow that’s most noticeable when performing any type of gripping activities
• Tennis elbow (lateral epicondylitis): a repetitive strain injury caused by repeatedly performing the same movements—in tennis, other racquet sports, or one’s profession—over and over; common symptoms are pain and a burning sensation on the outside of the forearm and elbow that gets worse with activity, as well as weakened grip strength

Red flags

• Signs of infection or septic arthritis (eg, pus or fluid, redness, fever, blisters, worsening swelling)
• Constant pain, including pain at night
• Deep, intense pain
• Pain associated with unexplained weight loss and/or fever
• Suspected fracture or dislocation from severe trauma to the wrist or elbow
• Known or suspected cancer (eg, significant bone pain, which may be suggestive of a bone tumor)
• Persistent swelling and pain without any recent injury
• Severe muscle spasm

In our next post, we’ll provide you with our top picks for exercises that can reduce your risk for developing wrist or elbow pain.

One of the few common shoulder diagnoses that does not directly involve the rotator cuff is adhesive capsulitis, or frozen shoulder. This condition occurs when scar tissue forms within the shoulder, causing the shoulder capsule to thicken and tighten around the shoulder joint and reducing the amount of space for the shoulder normally. Although frozen shoulder affects up to 5% of the population, the reasons why it develops are not yet clear. Common consensus suggests that not moving the shoulder normally for long periods is a leading factor, as most people who get frozen shoulder have kept their shoulder immobilized due to a recent injury, surgery, or pain. People between the ages of 40–60, women, and patients with arthritis, diabetes, cardiovascular disease, and other health conditions are also more likely to develop frozen shoulder.

Frozen shoulder usually comes on slowly and gets progressively worse over time with more pain and loss of motion. It is typically divided into the following four stages:

• Stage 1: consists of the onset of symptoms, which gradually get worse over 1–3 months
• Stage 2: the “freezing” stage, which generally occurs 3–9 months after symptoms begin and is very painful
• Stage 3: the “frozen” stage, which involves the shoulder becoming even more stiff and difficult to move
• Stage 4: the “thawing” stage, which occurs within 12–15 months and involves pain decreasing significantly and range of motion starting to improve

Physical therapy is commonly recommended for frozen shoulder because it is an effective intervention that addresses symptoms at every stage; however, certain questions about the exercises used in physical therapy remain unanswered. Therefore, a comprehensive study called a systematic review and meta–analysis was conducted to 1) compare the effectiveness of exercises alone and exercises in combination with other interventions and no exercises and 2) determine what kind of exercises are most effective for frozen shoulder.

33 studies evaluating exercise therapy for frozen shoulder are reviewed

To conduct the study, researchers performed a search of three medical databases for relevant studies about the effectiveness of exercise therapy for frozen shoulder. This led to 33 studies being accepted into the review, which saw patients treated with a variety of exercises, including individually prescribed exercises and those prescribed as part of a comprehensive treatment program. The findings of all included studies were then reviewed and analyzed with the goal of answering the two stated research questions.

Results showed that exercises—both on their own and as part of a program—improved range of motion (ROM), function, disability, and pain, and the type of exercise performed had little to no impact on these improvements. Also, adding physical modalities—like ultrasound, ice, or heat—to exercises did not provide any benefits to treatment outcomes, and programs that included exercises resulted in larger active ROM gains than programs that did not. These findings support the effectiveness of physical therapy for frozen shoulder and suggest that the type of exercises performed and whether they are done alone or combined with other interventions may not be important, so long as they are featured in a rehabilitation program.

Therefore, if you’re currently dealing with symptoms that sound like frozen shoulder, we strongly recommend contacting us to schedule an appointment and getting started on a path to recovery.

As we discussed in our first post, nearly 85% of shoulder conditions involve the rotator cuff, and among the most common of these is shoulder impingement syndrome (SIS). SIS results from the rotator cuff tendons becoming compressed—or “impinged”—as they pass through a small bone on top of the shoulder blade called the acromion. Over time, this causes the tendons to become irritated and inflamed, which eventually leads to bothersome symptoms like swelling and tenderness, loss of strength, restricted movement, and pain.

SIS is most prevalent in individuals that regularly perform lots of overhead activities like golfers, swimmers, baseball and tennis players, as well as painters and construction workers. The condition can also result from an injury that compresses the structures of the shoulder—like a fall—or from frequently sleeping on your side. Sleeping in this position regularly can strain the shoulder and cause impingement over time.

SIS is closely related to rotator cuff tendinitis and subacromial pain, and in some cases, the terms are used interchangeably. When any of these conditions develop, the best course of action is a comprehensive physical therapy program, which helps patients work through their pain to regain strength, flexibility, and physical function; however, many patients still opt to undergo a surgical procedure called arthroscopic subacromial decompression (ASD) to treat their shoulder pain. An abundance of research has shown that this procedure does not lead to any significant benefits, but it remains one of the most frequently performed procedures in the world, and some professionals still advocate for it. To better understand the outcomes of these patients, a study was conducted that compared the return–to–work rates for patients with subacromial pain who underwent different interventions.

Study periodically monitors more than 200 patients for 5 years

A total of 210 patients with subacromial pain for more than 3 months were enrolled in the study and randomly assigned to one of three treatment groups: exercise therapy, diagnostic arthroscopy, or ASD. Patients in the exercise therapy group underwent a supervised, individually designed physical therapy program that included daily home exercises and 15 visits to a physical therapy clinic. Patients in the diagnostic arthroscopy group underwent a “sham” procedure in which an examination of the shoulder was performed with a small camera inserted surgically, but no repairs were made to the shoulder. Patients in the ASD group were treated surgically with the ASD procedure, which involved the careful removal of some portions of bone and a structure called the bursa. Patients in the diagnostic arthroscopy and ASD groups also participated in a postoperative physical therapy program. All patients were assessed at the beginning of the study and then again 2 years and 5 years later.

Two years after these interventions, 78% of patients in the exercise group, 80% of patients in the diagnostic arthroscopy group, and 82% of patients in the ASD group were found to be actively working. Five years after the intervention, these figures were 66% for the exercise group, 69% for the diagnostic arthroscopy group, and 67% for the ASD group, meaning there were no significant differences between the three groups at both 2 years and 5 years after the interventions. Therefore, based on these findings, physical therapy can be considered just as effective as ASD for helping patients with subacromial pain recover and maintain their improvements in the long term. Given the fact that exercise therapy is also safer and less expensive than surgery, it’s clear why it continues to be the recommended option for most patients with SIS and why surgery should be avoided.

If you’re dealing with symptoms that sound like subacromial pain, please take the first step in your path to recovery by giving us a call and scheduling an appointment.

In our next post, we’ll break down another study that underlines the beneficial effects of physical therapy for frozen shoulder.

Shoulder pain can be an extremely bothersome issue in your life. Although you may not realize it, you use your shoulder on a frequent basis every day, since it permits many of the movements that involve your arms. Therefore, if a problem arises that leads to pain and prevents your shoulder from moving normally, it can become a major burden to your daily life.

As we discussed in our last post, there are many conditions that could be responsible for shoulder pain. In some cases, the cause may be a single, traumatic event like a hard fall to the ground or sports-related injury. Other patients will experience a gradual onset of shoulder pain due to repeated damage from overhead activities, which is often the case in rotator cuff tendinitis, shoulder impingement syndrome, shoulder instability, and bursitis.

If you’re concerned that you may develop shoulder pain–perhaps because you play an overhead sport or have a job that involves overhead movements–you may be wondering if there’s anything you can do to reduce this risk. The good news is that yes, it may be possible to avoid some types of shoulder pain with a dedicated approach. There is no single, foolproof way to stop all shoulder pain from occurring because numerous variables are involved, but one of the best steps you can take is to regularly perform shoulder exercises. Doing so will improve the strength and flexibility of muscles and joints surrounding the shoulder, thereby making the joint more stable and less prone to injury. With that said, here are our top 3 exercises to prevent shoulder pain:

Shoulder pain can be an extremely bothersome issue in your life. Although you may not realize it, you use your shoulder on a frequent basis every day, since it permits many of the movements that involve your arms. Therefore, if a problem arises that leads to pain and prevents your shoulder from moving normally, it can become a major burden to your daily life.

As we discussed in our last post, there are many conditions that could be responsible for shoulder pain. In some cases, the cause may be a single, traumatic event like a hard fall to the ground or sports-related injury. Other patients will experience a gradual onset of shoulder pain due to repeated damage from overhead activities, which is often the case in rotator cuff tendinitis, shoulder impingement syndrome, shoulder instability, and bursitis.

If you’re concerned that you may develop shoulder pain–perhaps because you play an overhead sport or have a job that involves overhead movements–you may be wondering if there’s anything you can do to reduce this risk. The good news is that yes, it may be possible to avoid some types of shoulder pain with a dedicated approach. There is no single, foolproof way to stop all shoulder pain from occurring because numerous variables are involved, but one of the best steps you can take is to regularly perform shoulder exercises. Doing so will improve the strength and flexibility of muscles and joints surrounding the shoulder, thereby making the joint more stable and less prone to injury. With that said, here are our top 3 exercises to prevent shoulder pain:

Our top 3 exercises to prevent shoulder pain

To see videos of each exercise, go to www.MyRTR.net and enter prescription code MKGD8BSV

1. Scapular W’s with Resistance Band
   • Anchor a resistance band at shoulder height
   • Stand with good posture, arms out to your side at shoulder height, and your elbows bent at 90 degrees
   • Pull your arms backward against the resistance of the band and squeeze your shoulder blades together
   • Hold for 5 seconds
   • Complete 2 sets of 12 repetitions, every other day
2. Resisted Horizontal Abduction with Band (Hip Hinge)
   • Stand with a resistance band anchored under both feet
   • Hold one end of the resistance band in each hand and cross the band
   • Lean forward slightly at your hips, keeping your spine straight
   • Raise your arms straight out to the side against the resistance of the band
   • Hold for 5 seconds
   • Complete 2 sets of 12 repetitions, every other day
3. Resisted PNF D2 Flexion with Band #2
   • Stand holding a resistance band in both hands
   • Move one arm up and out against the resistance of the band while rotating your thumb upward
   • Follow this hand with your eyes
   • Hold for 5 seconds
   • Complete 2 sets of 12 repetitions, every other day

In our next post, we’ll break down a study that highlights the effectiveness of physical therapy for shoulder impingement syndrome.

Shoulder pain is an extremely common complaint. Up to 26% of the population is currently affected by it, and it ranks third—behind back pain and knee pain—in musculoskeletal conditions that lead people to consult their doctor. About 1% of the population visits a doctor for shoulder pain each year, and while the specific backstory may vary from patient to patient, most cases follow a relatively similar progression.

The causes of shoulder pain can generally be categorized into two groups: 1) traumatic (acute) injuries that damage certain structures of the shoulder immediately, and 2) overuse injuries, which occur gradually over time due to continuous strain on the shoulder. In both cases, those who are most likely to experience shoulder pain are individuals who regularly perform overhead movements. These types of movements are necessary in professions like painting and construction, and in sports like baseball, swimming, and tennis, making those who are involved in these activities vulnerable to several types of shoulder issues.

Any component of the shoulder can be damaged in an acute or overuse injury, but most shoulder conditions—about 85%—involve the rotator cuff. The rotator cuff is an important group of four muscles that surround the bones of the shoulder. Each of these muscles spans from a different part of the shoulder blade (scapula) to the head of the upper arm bone (humerus) to form a “cuff” that controls and stabilizes the shoulder. Several problems can affect the rotator cuff or other structures within the shoulder to cause pain, stiffness, or other symptoms that lead to movement restrictions and activity limitations. To help you get a better sense of what can go wrong, here are six of the most common conditions that affect the shoulder:

6 most common shoulder conditions

• Shoulder bursitis: a bursa is a fluid–filled sac that acts as a cushion to prevent structures from rubbing against each other; the subacromial bursa in the shoulder is the largest bursa in the body, and when it becomes inflamed—often from regularly performing too many overhead activities—the result is shoulder bursitis; the most common symptom is pain at the top, front, and outside of the shoulder that gets worse with sleeping and overhead activity
• Rotator cuff tendinitis (shoulder tendinitis): the most common cause of shoulder pain, this condition results from irritation or inflammation of any of the rotator cuff tendons, which occurs gradually over time; the main symptoms are pain and swelling in the front of the shoulder and side of the arm, usually while raising or lowering the arm
• Shoulder impingement syndrome: a condition in which the bursa or any rotator tendons are trapped (or impinged) by the two main bones of the shoulder—the humerus and a piece of the scapula called the acromion—which is usually due to an outgrowth of bone (bone spur); symptoms include shoulder pain and weakness, and difficulty reaching up behind the back
  • Note: Over time, shoulder impingement can lead to shoulder tendinitis and/or bursitis, and in some cases the names of these conditions may be used interchangeably
• Rotator cuff tear: this injury is the result of one of the rotator cuff tendons detaching from the bone, either partially or completely; it can occur either traumatically due to a single incident, or gradually over time, which is usually the case in older patients; the most common symptom is pain during the day and at night, and when lying on the shoulder or lifting or lowering the arm
• Frozen shoulder: a condition that occurs when scar tissue forms within the shoulder capsule, another structure that helps to keep the shoulder stable; this causes the shoulder capsule to thicken and tighten around the shoulder joint, which means there is less room for the shoulder to move normally, eventually causing it to “freeze;” symptoms include pain and stiffness that makes it difficult or impossible to move the shoulder
• Shoulder dislocation: an injury in which the ball of the shoulder (humerus) pops out of the socket (glenoid); this is typically due to a forceful motion, and the dislocation can be either partial or complete; symptoms include pain, swelling, and difficulty moving the shoulder

Understanding red flags that could suggest an underlying problem

Regardless of what shoulder condition is present, in most cases, the best course of action is a comprehensive course of physical therapy. Physical therapists are movement experts whose goal is to guide patients back to full strength and function with an exercise–based approach. However, in rare cases, patients with certain urgent or severe conditions will require the care of another healthcare provider. To help you determine whether seeing a physical therapist is the right call, here are some potential red flags to be aware of if you’re dealing with shoulder pain:

• Deep, intense pain
• Pain associated with unexplained weight loss and/or fever
• Constant pain, including pain at night when the shoulder is at rest
• Signs of infection or septic arthritis (eg, pus or fluid, redness, fever, blisters, worsening swelling)
• Severe trauma to the shoulder that may have resulted in a fracture or dislocation
• Known or suspected cancer (eg, significant bone pain, which may be suggestive of a bone tumor)
• Persistent swelling and pain without any recent injury
• Severe muscle spasm

If you notice any of these red flags, see your primary care physician as soon as possible or—for traumatic injuries—go to the emergency department or urgent care clinic immediately. But in the absence of any red flags, we strongly recommend seeing a physical therapist for your shoulder pain as soon as possible to get started on a comprehensive treatment program that will help you regain your abilities over time.

In our next post, we’ll provide three of the best exercises to help keep your shoulders strong and reduce your risk for pain.

Myofascial pain syndrome and dysfunction of the muscles that support the upper spine and shoulders can lead to a variety of symptoms in these regions, including neck pain. The reasons neck pain develops are complex and often difficult to pinpoint, but research has shown that posture and muscle activation patterns are potential risk factors.

Patients with chronic neck pain—meaning pain lasting more than three months—have been found to display differences in the way muscles like the trapezius, levator scapulae, and rhomboids behave. These patients also have less muscle strength and activity than healthy individuals. Therefore, exercises that strengthen and stabilize these muscles to regulate their activity are recommended for patient with chronic neck pain, but the amount of research on this topic is limited. For this reason, a study was conducted to evaluate the effectiveness of various strengthening and stabilization exercises for patients with chronic neck pain.

Three groups of patients assessed before and after 6–week interventions

For the study, patients with neck pain for at least three months were recruited and screened to determine if they were eligible. This led to 72 patients being included, who were randomly assigned to one of three groups: the neck exercise training group, combined training group, or the control group. In the neck exercise training group, patients completed a training program under the guidance of three physical therapists 3 days per week for 6 weeks, with each session lasting 40–60 minutes. The program consisted of three strengthening and stretching exercises that targeted the muscles of the neck.

In the combined training group, patients completed the neck exercise training program plus a scapular stabilization training program. The scapular stabilization training program included 7 strengthening and stretching exercises that targeted muscles in the scapular region that are associated with chronic neck pain.

Patients in the control group participated in a session in which they were taught a home exercise program that mainly instructed them on proper body posture for daily activities like lifting, pressing, and pulling tasks, as well as office ergonomics. All patients were assessed before and after completing these interventions with various outcome measures, including pain, neck range of motion, scapula downward rotation index (SDRI), and forward head angle (FHA). SDRI and FHA are used to assess posture and muscular dysfunction in the upper spine and torso region.

Results showed that pain, SDRI, and FHA decreased in both the neck exercise training group (except SDRI) and combined training group. Neck range of motion also increased significantly in the combined training group. Overall, patients in both the neck exercise training group and combined training group improved compared to the control group, but the combined training group reported significantly greater improvements than the neck exercise training group. Therefore, this study suggests that both neck exercises and scapular stabilization exercises is beneficial for patients with chronic neck pain, and combining these two interventions can lead to even greater benefits in pain, flexibility, and posture.

If you’re dealing with myofascial pain syndrome, chronic neck pain, or any other movement–related issues, we strongly urge you to consider scheduling an appointment with one of our physical therapists, who can diagnose your condition and get you started on a comprehensive rehabilitation program right away.