Rotator cuff pain: Treatment of Ben B.

Chronic pain, Neuromuscular therapy, Rotator cuff, Shoulder pain, Stretching (Active Isolated method) / Monday, May 25th, 2009

The first treatment of rotator cuff pain in the case of Ben B. targeted five muscle groups and treated them with Neuromuscular Therapy techniques.

First, the four rotator cuff muscles needed to be treated to loosen up the shoulder joint. This is usually the heart of the problem. When they hold the top of the arm bone (humeral head) so tightly, there is no room for movement. The bones begin to rub on each other and on the tendon (supraspinatus) under the outer tip of the shoulder (accromion). This is what causes the clicking and sharp pains.

The second goal was to treat the accessory muscles. When the rotator cuff muscles and the accessory muscles that move the arm and attach the shoulder to the body loosen up, so does the joint. Now then, the arm can move without contacting the bones around it or irritating the tendons and bursa and away goes the pain!

Because Ben couldn’t raise his arm, the muscles that lift his shoulder (upper trapezius and levator scapula) were being overused and heading for malfunction. After those were examined, I checked the muscles that bring his arm across his body (coracobrachialis, subclavius, pectoralis major/clavicular head). Last but not least came treatment of other muscles that attach the upper arm to the shoulder (biceps, triceps, deltoid, teres major), the body to the arm (latissimus dorsi, pecoralis major and minor) and the shoulder to the body (serratus anterior, rhomboids, lower and middle trapezius).

Ben was sore for a couple of days from the release of waste products that had been stored in these muscles, but had increased his range of motion (ROM). He was given specific stretching instructions to do at home using the Active Isolated Stretching protocol and instructed to ice the area of the bursa.

The second session involved deeper treatment of the same muscles and the multiple trigger points being harbored by them. The joint had formed scar tissue that needed to be released, so the end of the treatment involved painful stretching. The increased range in just this one treatment was impressive.

After ten Neuromuscular Therapy treatments
, he had only occasional “tweaks” with movements and had increased his daily functioning and ROM to a level that is satisfactory for his age. It is now his choice whether to spend more time increasing his range to normal or just maintaining it at this satisfactory level. He likes his sports, so I think he will continue on a reduced schedule. After all, the Summer is coming!