Show a Frequently Asked Questions

Why does it hurt a little more now?

It is very common for your pain to get a little worse for the first couple of weeks of stretching. As you begin to rehab your scar tissue, sometimes the pain seems worse because as you stretch, you spread out the lactic acid into the surrounding tissues and more acid will build back up into the area. As the connective tissue remodels, the amount of lactic acid in the surrounding tissues will gradually get smaller and smaller until it reaches the point that it no longer causes pain. This is a very critical point because as the pain decreases, it is common to forget to continue with the stretching exercises. If you don’t continue the scarred connective tissue will just come right back and you will have to start all over again.

How soon will I get pain relief?

Most people begin to notice a big difference within the first two weeks. Remember that it is common for the pain to get a little worse during the first 2 weeks, but once you get past that point, the pain will begin to subside quickly. But keep going, it takes 4 months to rehab connective tissue approximately 60% percent and another 4 months to get an additional 20-25%.

Why is my pain worse in the morning ?

When our muscles are “warm” which means that they are full of blood they become more flexible. While we sleep our muscle tissues are inactive and thus less blood flow needed to them. This causes our connective tissues to tighten, so in the morning we feel more stiff and sore. As we get up and move around we stimulate blood flow to our muscles and essentially “warming” them up.

What exercises can I do to strengthen my rotator cuff?

There are quite few anterior and posterior rotation exercises a person can do to strengthen their rotator cuff muscles, but unless you are a professional athlete or have severely damaged them, there is usually no need to strengthen your rotator cuff. What you need is to have flexible rotator cuff muscles so they don’t tear during your normal activities.

What is Frozen Shoulder?

A True frozen shoulder is caused by scar tissue adhesions that form in the shoulder joint capsule ligament after a fall or a dislocation of the shoulder joint. When the shoulder joint is over stretched by trauma it tears this large round ligament that holds it together. The trauma causes scar tissue formation that severely reduces the range of motion of the shoulder which can make it very painful. The only way to get back your range of motion is to stretch it. Unfortunately once you have frozen shoulder it takes months to years to rehab it.

Why does it hurt in the front of my shoulder too?

There are usually 2 reasons to get pain in the front of the shoulder. A) One the rotator cuff muscles has a tendon that attaches in the front of the shoulder onto the humerus (the upper arm bone). When that muscle gets tight you can get tendonitis and you feel the pain in the front of your shoulder. B) When people have a tight Rhomboid muscle it will decrease or completely stop the range of motion of the scapula. So as you raise your arm, the ball and socket joint of the shoulder is pushed to the maximum range of motion often trapping or pinching the tendons of the rotator cuff muscles underneath the collar bone. This is what we call impingement syndrome and often the pain is in the front of the shoulder.

What is a Separated Shoulder?

The end of our collar bones forms a joint with a part of the shoulder blade that is help together with a ligament. A separated shoulder is a dislocation of the collar bone from the scapula (shoulder Blade) that tears this ligament. Usually this happens from a fall where the person lands directly on the shoulder joint, often seen in football injuries.

What is Bursitis ?

A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. There are 160 bursae in the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, hips, and knees. Bursitis is simply inflammation of a bursa. Injury or inflammation of a bursa around the shoulder joint occurs causes shoulder bursitis. Bursitis is typically identified by localized pain or swelling, tenderness, and pain with motion of the tissues in the affected area. Shoulder bursitis is often accompanied by tendinitis of tendons adjacent to the affected bursa in the shoulder. Shoulder bursitis causes focal tenderness of the inflamed tissues. It can also cause a “pinching” pain when the elbow is moved away from the body, referred to as an “impingement” sign.

Why does my shoulder “pop” and “click” when I move it?

When people have a tight Rhomboid muscle (the muscle between the spine and the shoulder blade) it will decrease or completely stop the range of motion of the shoulder blade. So as you raise your arm, the ball and socket joint of the shoulder is pushed beyond the maximum range of motion and will cause a “popping” sound. Of course this is not normal and will cause inflammation and arthritis.

How do I get rid of muscle knots and trigger points?

The only way to Rehab these muscle knots is to stretch them.

What is a Rotator Cuff tear?

The tendons at the ends of the rotator cuff muscles can become torn, leading to pain and restricted movement of the arm. A torn rotator cuff can occur following a trauma to the shoulder or it can occur through the “wear and tear” on tendons, most commonly the supraspinatus tendon found under the acromion process of the shoulder blade.

Rotator cuff injuries are commonly associated with motions that require repeated overhead motions or forceful pulling motions. Such injuries are frequently sustained by athletes whose actions include making repetitive throws, athletes such as baseball pitchers, softball pitchers, American football players (especially quarterbacks), cheerleaders, weightlifters (especially powerlifters due to extreme weights used in the bench press), rugby players, volleyball players (due to their swinging motions), water polo players, rodeo team ropers, shot put throwers (due to using poor technique), swimmers, boxers, kayakers, western martial artists, fast bowlers in cricket, tennis players (due to their service motion) and tenpin bowlers due to the repetitive swinging motion of the arm with the weight of a bowling ball. This type of injury also commonly affects orchestra conductors, choral conductors, and drummers (due, again, to swinging motions).

After experiencing a severe rotator cuff tear, minimally invasive surgery is needed in order to repair the torn tendon. After surgery, the rehabilitation of the rotator cuff is necessary in order to regain maximum strength and range of motion within the shoulder joint. Physical therapy progresses through four stages, increasing movement throughout each phase. The tempo and intensity of the stages are solely reliant on the extent of the injury and the patient’s activity necessities. Once the tendon is entirely recovered, stretching exercises can be implemented. stretching exercises of the shoulder are movements that are used to increase stability, strength and range of motion of the Subscapularis, Supraspinatus, Infraspinatus, and Teres minor muscles within the rotator cuff.

What is a muscle knot or trigger point

A muscle knot is formed by scar tissue on the connective tissue of the muscle that holds the muscle fibers together and extends all teh way through the muscle to form the tendons. The scar tissue usually forms after a trauma or from repetitive stress motions.

What is the best way to take strain off my neck at work?

Correct workstation ergonomics!. Too many people these days are using laptops and tablets that cause a tremendous amount of strain on our neck and shoulder muscles.  The Head weighs 12-16 pounds, as much as a bowling ball. When you look straight ahead and your eyesight is level to the desk the weight of your head is distributed into the bones of your neck. If your monitor is too low or if you use a laptop or tablet, you tilt your head down and the weight of your head  is now over your lap causing your neck and shoulder muscles to hold the weight of the head.  Very quickly these muscles get tired lactic acid builds in them causing the burning and achy pain that will cause the muscles to shorten and become tight.

What causes muscle knots or trigger points?

Muscle knots or trigger points are from scar tissue in our connective fibers. These connective tissues are made of collagen. Collagen fibers hold our muscle fibers together and extend outward to form the tendons. When we are born all of these connective tissues are made of yellow collagen which has a striated construction pattern that makes the muscles elastic and flexible. Injuries and repetitive stress motions cause tears in these connective tissue and triggers the inflammatory response.  Inflammation triggers the healing process. and during the healing process the new collagen fibers heal with a cross hatched construction pattern referred to as scar tissue or white collagen.  These scar tissue fibers form the muscle knots and are no longer flexible and hold sections of the muscle in a spasm state 24/7

Why does my shoulder burn and ache?

Quite simply  “lactic Acid”.  Scar tissue holds sections of your muscle in a spasm state which causes the muscle cells to over produce lactic acid.  This acid pools outside of the cells in the intracellular space that is in between the cells.  Unfortunately this is where the nerves are.  Once enough lactic acid has pooled, it will burn the nerves giving you the achy burning pain that you feel.

What are the Rotator Cuff muscles?

he four muscles of the rotator cuff are over half of the seven scapulohumeral muscles. The four muscles are the supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle.

The rotator cuff muscles are important in shoulder movements and in maintaining glenohumeral joint (shoulder joint) stability. These muscles arise from the scapula and connect to the head of the humerus, forming a cuff at the shoulder joint. They hold the head of the humerus in the small and shallow glenoid fossa of the scapula. The glenohumeral joint has been analogously described as a golf ball (head of the humerus) sitting on a golf tee (glenoid fossa).

During abduction of the arm, moving it outward and away from the trunk, the rotator cuff compresses the glenohumeral joint, a term known as concavity compression, in order to allow the large deltoid muscle to further elevate the arm. In other words, without the rotator cuff, the humeral head would ride up partially out of the glenoid fossa, lessening the efficiency of the deltoid muscle. The anterior and posterior directions of the glenoid fossa are more susceptible to shear force perturbations as the glenoid fossa is not as deep relative to the superior and inferior directions. The rotator cuff’s contributions to concavity compression and stability vary according to their stiffness and the direction of the force they apply upon the joint.

Despite stabilizing the glenohumeral joint and controlling humeral head translation, the rotator cuff muscles also perform multiple functions, including abduction, internal rotation, and external rotation of the shoulder. The infraspinatus and subscapularis have significant roles in scapular plane shoulder abduction (scaption), generating forces that are two to three times greater than the force produced by the supraspinatus muscle. However, the supraspinatus is more effective for general shoulder abduction because of its moment arm. The anterior portion of the supraspinatus tendon is submitted to significantly greater load and stress, and performs its mainfunctional role.

How long do I hold the stretches on my shoulder muscles?

30 seconds minimum for each muscle and for each set.  All of your muscles have muscle tone as you stretch the muscle, the muscle tone needs to relax before you are actually stretching and rehabbing the connective tissue. In large muscles that takes some time to accomplish. For the first 2 weeks it is common for your pain to get a little worse as it loosens.


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