Every osteopath has their own treatment style, some prefer using gentle articulations to stretch muscles and mobilise joints, others prefer using manipulations to release joints. Personally I utilise both as well as medical acupuncture and sports taping to relax muscles and support the area.

Today I want to talk you through a typical treatment with Wokingham Osteopaths, along with the thinking that follows. I’m going to use myself as a patient, as it is difficult to gain consent for taking photos with existing patients and provide an effective treatment at the same time.

On an early April Thursday afternoon, midway through treating a full roster of patients I realised that my right shoulder was painful when I lifted it up.

Symptoms:

• There was no particular cause, it came on idiopathically.
• The pain occurred when bringing my arm away from my side between 60′ and 120′ up to the ceiling. No pain was produced on neck movement.
• No visible inflammation.
• Soreness upon palpation (touching) of the top of my shoulder blade.
• No neurological symptoms into my hands (numbness, weakness, shooting pain, pins and needles), this means that the nerves in the arm are not likely to be involved.
• There was no discolouration or markings signifying trauma to the area.

First, was it ligament damage? Unlikely as I hadn’t suffered any trauma like a fall or car crash that could have sprained or torn a ligament.

Secondly, was it a fracture? Equally unlikely; I hadn’t fallen over, nor did I have any form of bone-weakening condition such as osteoporosis that would leave me vulnerable to fractures from smaller impacts. If I was in a high-risk category I may have regarded a fracture as being more likely, even without trauma.

Thirdly, was it a muscle strain or inflammation? The pain was present with muscular contraction because I felt it when I moved the area. I picked up the right arm with the left arm, so the muscles weren’t contracting, and the pain did not reproduce.

This led me to believe that the pain was caused by a muscle, but which? Given the movement hurt on raising the arm laterally (away to the side) it could be one of two muscles, the medial deltoid or the supraspinatus.

The supraspinatus is responsible for assisting the deltoid with lateral flexion between 60’ and 120’, which was the region I was experiencing pain, so this seemed to be the muscle most likely to be giving me problems. To confirm my diagnosis I performed several clinical tests which test for supraspinatus tendonitis, all of which were positive.

I have had similar issues in the past and when a musculoskeletal issues happens once it is likely to happen again, especially if the underlying issues are not addressed. Osteopathy is a very physical job so I clearly need to pay attention to my shoulder.  This lends credence to the diagnosis of a supraspinatus muscle issues and is why it is so important to take a case history of a patient at the beginning of an initial consultation.

The most likely cause is inflammation of the tendon of the supraspinatus muscle. My treatment plan was to relax the tight muscle and reduce inflammation.

Massage and medical acupuncture, or dry needling, would reduce the tension on the tendon, with sports tape helping the support the area post-treatment.

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I performed gentle massage into the supraspinatus muscle to start relaxing it off, then performed medical acupuncture.

Medical Acupuncture is thought to work by encouraging the release of endorphins to act as a pain reliever and muscle relaxant.

I haven’t had medical acupuncture for any musculoskeletal conditions before this, only as part of our training and was pleasantly surprised at how quickly it made a difference.

After the acupuncture I got on with the sports taping, which helps to reduce inflammation in the area underneath the tape, as well as support the area after treatment.

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Within 10 minutes of having started treatment I was able to lift my arm in a nearly pain-free manner. The last time I suffered with this the symptoms took three days to ease off as I was only able to use massage, so to have such instantaneous relief was quite a thing.

If neurological symptoms were present, or there was pain on neck movement I would have examined my neck and felt for any tight muscles or joint restrictions. If any were found, a treatment plan involving gentle joint articulation and massage into the neck muscles may have been more beneficial.

One of the maintaining factors may have been that I carry a very heavy treatment couch in and out of patients houses 3 days a week as part of Visiting Osteopaths. In order to reduce the likelihood of recurrence my goal is to either alternate the shoulder with which I carry my couch, or get a trolley to reduce the strain on the right shoulder. Self-massage is always a useful tool to prevent a musculoskeletal disorder from recurring

If you have any questions or wish to make a booking call us on 0118 380 0385 or fill out the contact form in the sidebar.

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