Rebalancing your shoulder

Physiotherapy underpins the treatment of the vast of majority of shoulder conditions. The shoulder is the most flexible joint in the body because the socket is quite flat, like a very shallow dish. This means that a physiotherapist can help with the fine control of muscles, which is very important to keep the shoulder ball centred on the socket.

Correction of shoulder blade position and posture will also have a big impact. Physiotherapists are also very skilled in preventing the impact of a shoulder condition on other parts of the body, particular the neck and spine.

Many chronic shoulder conditions, such as wear and tear rotator cuff problems or arthritis, are caused because of a long-term muscle imbalance. In most cases, the pectoral and anterior deltoid muscles are pulling on the shoulder too forcefully, overpowering the other counter balance muscles.

Thankfully, due to research, we now know that this is often because of the subtle differences in the natural shape of some of our shoulder bones. Experienced shoulder surgeons have long noticed that the x-rays of some people’s shoulders look more ‘aesthetic’ than others. It turns out that there is a scientific basis for this observation!

The golden ratio, sometimes known as the divine proportion, has been associated with beauty since the time of the Ancient Greeks. It describes the size proportion between two objects and is very often seen in nature, for example in the distribution and size of the petals of a pretty flower.

The shape of bones in the shoulder is no different. At Thames Shoulder and Elbow we have pioneered research which has shown that people with an even space between parts of their shoulder blade and their shoulder ball, that fits the golden ratio, are very rarely affected by a chronic shoulder condition.

Conversely, when the space is too small a rotator cuff tear will eventually develop, and when the space is too big arthritis will occur. This discovery is very exciting as it allows us to build a detailed biomechanical picture of every patient’s shoulder so that we can best inform how a condition is likely to progress in the future, and how the progression can be slowed or reversed for the future by physiotherapy or surgery or both.

When the shoulder is injured, or subject to surgery, the body tends to quickly produce a lot of natural scar tissue as a protective mechanism to stop the joint from moving excessively.

Following a soft tissue injury, such as a dislocation or tendon tear, it is important to see a physiotherapist as soon as possible to prevent stiffness setting in. This will not damage the shoulder further. In fact, if shoulder surgery is eventually required this will speed up rehab as the joint will be more mobile beforehand.

After a fracture a short a period of rest may be required, typically not more than three to four weeks, until the bones are healed enough to allow movement.

After having any kind of shoulder surgery it is important to follow a proper rehabilitation programme to rebalance your joint and support the healing process.

Whatever procedure is performed, detailed advice on post-surgical care should be provided, both immediately after the procedure and in the weeks and months to follow.