A mother of 3 in her early 30’s presented at my clinic. Her main issue was pain in her right shoulder and a headache both registering 7-8/10 on the pain scale. Her doctor had advised her that she had a rotator cuff problem and that this included bursitis and tendinitis. She had been having these issues for 4-5 months and had numerous physiotherapy treatments and also remedial massage. The majority of the treatment had been focused on the shoulder and upper back. She had been advised that perhaps the next step was corticosteroid injections into the shoulder joint.
When a new client comes to me I take the time to get a full picture of the problem and also the history leading up to her visit to me.
Her youngest child was 9 months old and she carried him mostly on her left hip. The older children were 3 and 5 years old, she worked part-time in an office environment and had recently returned to work. Since the third trimester of her first born she had lower back pain, mostly on the right but sometimes across the entire lower back and up between her shoulder blades. This would come and go with regular physiotherapy and massage. She always felt tight across both of her shoulders and up her neck into the base of her skull and would suffer from headaches at least twice a week. Panadol and other pain relief tablets helped, along with the use of a heat-pack.
My initial assessment of a new client is very comprehensive;
I check hip alignment and movement through the sacroiliac joint (SIJ), hip, shoulder and thoracic rotation and I also assess whether the vertebrae and ribs can move independently with gentle pressure. The results of these tests will give me a clear path to follow to realign the spine and release the ribs and relieve muscle tension and associated pain. This mother of 3 had a lateral pelvic tilt to the right and the left hip was also anteriorly rotated, she had decreased thoracic rotation to the left and both her right hip and right shoulder had decreased internal rotation compared to the left.
My treatment was to have her do some low load muscle activations on her right gluteus medius; left gluteus maximus and right rhomboid muscles and I also released her piriformis muscles on both sides. Note there was no work done directly to any of the muscles that make up the rotator cuff.
At the end of the treatment her hips were correctly aligned, there was a marked increase in her ability to rotate her torso to the left and the right, there was increased movement in her hip and shoulder joints and most importantly there was a marked decrease in the pain in her shoulder. She no longer had a headache and she felt light and loose across the top of her shoulders and upper back
I found the hole in her roof and plugged it! The muscle groups not performing correctly in her hips and buttocks were the reason why her shoulder treatments were unsuccessful. These stabilised over the following week with take home low load muscle activation exercises and then follow up sessions identified her pectorals and trapezius muscles as being contributors to her shoulder problem.
After the initial appointment she had 2 weekly follow up sessions and then returned after 4 weeks to check on progress. She sees me about 6 times a year to ensure that any niggles or twinges do not become significant areas of dysfunction and pain.