Shoulder tendonitis occurs when the tendon that connects muscle to bone becomes inflamed. A physical therapist can determine exactly which tendons are injured, but the tendons of the rotator cuff and the biceps are usually involved. Most cases of tendonitis result from poor shoulder mechanic,s caused by weakness in muscles needed for proper stabilization. Physical therapy can address the pain, loss of motion and weakness that is often associated with shoulder tendonitis.
Control Pain
The first step is to decrease pain and inflammation in the joint. When tendonitis results from an acute injury, this step consists of rest, ice and medication to provide the tendons time to rest and heal. It is important to avoid activities that cause pain and place strain on the shoulder, such as overhead lifting. Although it helps the healing process to avoid aggravating activities, continuing to move the joint in pain-free ways is just as important. When the cause of tendonitis is from chronic poor use of the shoulder, then it is harder to move out of the inflammatory phase because simple activities done with poor mechanics can continually aggravate the tendon. Physical therapy can use ice, heat, ultrasound and electrical stimulation, along with postural education, in order to relieve the inflammation.
Restore Range of Motion
Initially, therapy will focus on restoring full passive range of motion, and then move into active movement. Neck and upper back range of motion is vital to proper shoulder mechanics, so those areas may need to be addressed if there is a movement limitation. It is important to have full range of motion before starting a strengthening program so that the muscle is strong through its entire movement. The therapist can perform manual mobilizations of the shoulder joint and the surrounding soft tissue in order to restore pain-free motion.
Stretch
Often there are muscles in the shoulder complex that are tight, which interfere with normal shoulder mechanics. The upper trapezius, which runs from the base of the head down the side of the neck and attaches to the tip of the shoulder, is a strong and tight muscle that needs consistent stretching in order to maintain neutral posture of the shoulder. The pecs are another muscle group that are often too tight to allow for normal shoulder movement. The physical therapist will determine if there are muscles that need stretching during the evaluation, and guide the patient in appropriate stretches.
Stabilize
The most important aspect of care in order to prevent injury in the future is stabilization to the entire shoulder complex. This involves strengthening the supportive shoulder muscles that help with movement of the scapula, in order to take pressure off the muscles that connect to the shoulder joint. Stabilization exercises focus less on strength and more on endurance and proper mechanics in order to protect the joint.
Strengthen
Once normal range of motion is restored and the shoulder complex is supported through proper scapular stabilization, then strengthening can begin. It is important to strengthen all aspects of the shoulder in order to avoid muscle imbalance. If the patient cannot maintain proper mechanics, then the exercise is too difficult to perform and may cause reinjury. There should not be any pain associated with strengthening exercises, beyond muscle soreness. The physical therapist will provide home exercises to improve strength, and to guide the patient's return to activities.
