Can Exercise Help Relieve Shoulder Pain?

By Drs. Marc-Olivier Dubé, François Desmeules and Jean-Sébastien Roy

It is estimated that close to 70 per cent of the population will experience shoulder pain at some point in their lives.

This pain would not pose a problem if it disappeared as quickly as it appeared. Unfortunately, shoulder pain tends to persist over time. In half of patients, the pain lingers or reoccurs one year after its initial appearance. It can even persist for several years in some cases.

Approximately 70 per cent of shoulder pain episodes requiring consultation with a health-care provider can be identified as rotator cuff related shoulder pain. This refers to pain and loss of function in the shoulder, mainly during movements requiring the arm to be lifted. Although a number of effective options are available to patients, a third of them will not experience any significant improvement in their condition, regardless of the interventions used.

There are several possible reasons for this limited success. Exercise selection and some psychological and contextual characteristics specific to each individual have been identified as potential hypotheses.

As experts in the field of shoulder pain, we propose to shed light on the effectiveness of various interventions for the management of shoulder pain, and the role that some variables may play in the resolution of this pain.

Our research team therefore set out to find out:

1. Whether one type of exercise should be prioritized over another in the management of shoulder pain.

2. Whether the addition of exercises (the pet peeve of many people who consult a rehabilitation provider) lead to additional benefits compared with an intervention comprising only of education and advice to foster pain self-management.

3. Whether some psychological and contextual characteristics, such as participants’ expectations of the intervention effectiveness and pain self-efficacy, are associated with a better prognosis.

Pain self-efficacy is the level of confidence someone has in their ability to carry out their activities and achieve their goals despite pain.

What We Found

In our new study published in the British Journal of Sports Medicine, 123 people with shoulder pain lasting for more than three months were randomly assigned to one of three 12-week interventions:

1. Education

2. Education combined with motor control exercises

3. Education combined with strengthening exercises

Questionnaires were used to monitor changes in participants’ condition over time, particularly in terms of their pain and functional capacity.

Before the start of the intervention, we also used questionnaires to measure participants’ expectations of the effectiveness of the intervention they were about to receive, as well as their level of pain self-efficacy.

Education: Participants in this group received two sessions of education and advice with a physiotherapist. The information was about the shoulder and pain, and the advice included strategies for the self-management of their condition.

Participants were also told about the importance of being active and adopting a healthy lifestyle to optimize the management of persistent pain, including proper diet, hydration, stress management and sleep hygiene.

Finally, participants were asked to watch six short videos on these themes. Here’s one:

After viewing, they were asked to identify the aspects they felt were important and those that raised questions in order to discuss them with the physiotherapist.

Education combined with motor control exercises: Participants in this group completed a 12-week program that combined education with exercises.

The exercises included modifications in the way they performed their movements to enable them to move their arm with less pain. These modifications were integrated with exercises reproducing gestures involving the shoulder during daily activities.

Education combined with strengthening exercises: Participants in this group received the same education component, along with  a shoulder muscle strengthening program to be performed daily for 12 weeks.

At the end of the study, participants in all three groups showed improvements in pain and function. However, the addition of exercises (motor control or strengthening) to the education intervention did not lead to additional benefits.

People recruited into the study whose symptoms were considered resolved following the 12-week intervention had more positive expectations regarding the effectiveness of their intervention and had higher levels of pain self-efficacy.

Key Takeaways

Adding strengthening or motor control exercises to an educational intervention did not result in additional benefits compared to an approach based solely on education and advice. For some people with persistent shoulder pain, education and advice focusing on pain self-management may be sufficient to promote symptom resolution.

Exercise, in any form, remains a highly relevant intervention for shoulder pain management, as well as for maintaining independence and optimizing long-term health.

Participants’ pain self-efficacy and expectations of the effectiveness of the intervention they receive may play a role in the prognosis of their shoulder pain.

When you’re experiencing shoulder pain, it can be beneficial to temporarily reduce certain activities that can aggravate your pain. However, it’s important not to delay gradually reintegrating these activities into your daily routine.

The presence of pain, especially when it persists over time, is not necessarily a sign that your condition is deteriorating. It could simply indicate that the gestures or activities performed exceed the shoulder’s current ability to tolerate the load imposed on it.

In any case, don’t hesitate to consult a health professional, such as a physiotherapist, who will be able to help you “shoulder” the responsibility of managing your condition.

Marc-Olivier Dubé, PhD, is a Physiotherapist and Postdoctoral researcher in rehabilitation at Laval University.

Francois Desmeules, PhD, is a professor in physiotherapy and musculoskeletal health, School of Rehabilitation, University of Montréal.

Jean-Sébastien Roy, PhD, is a professor at the School of Rehabilitation Sciences, Laval University.

This article originally appeared in The Conversation and is republished with permission.

Pilot Study Shows Stem Cells Effective in Treating Shoulder Pain

By Pat Anson, PNN Editor

A single injection of stem cells has shown promise as a treatment for shoulder pain caused by rotator cuff disease, according to the results of a small pilot study conducted by the Kessler Foundation.

Ten wheelchair users with moderate to severe shoulder pain received an injection of adipose stem cells derived from their own fat tissue. The participants all had spinal cord injuries and chronic shoulder pain for at least six months that did not respond to conventional treatment.   

The stem cells were micro-fragmented using minimal manipulation to preserve fat clusters and the cells’ regenerative properties. This micro-fragmented adipose tissue (MFAT) was then injected into shoulder tendons under ultrasound guidance.

The study findings, recently published in the Journal of Spinal Cord Medicine, showed nearly 80 percent of participants had a significant decrease in pain symptoms, and all but one reported improvement in pain and function. Symptoms steadily improved over the course of a year, suggesting the injections have long-lasting effects. There were no significant adverse events.

"These results show that the minimally invasive injection of micro-fragmented adipose tissue is a safe and efficacious option for wheelchair users with shoulder pain caused by rotator cuff disease," said Gerard Malanga, MD, a founder of the New Jersey Regenerative Institute and a visiting scientist at the Kessler Foundation.

“We feel there is great potential for this therapy to help people with shoulder pain manage their symptoms and improve their quality of life.”

In addition to their regenerative properties, MFAT stem cells are believed to provide cushioning and to fill-in structural defects when injected into damaged shoulder joints.

Malanga and his colleagues are currently conducting a larger Phase 2 controlled study with 24 participants that will compare MFAT injections to corticosteroid injections for treating pain caused by rotator cuff disease or tears.        

Shoulder pain is a common occurrence among wheelchair users with spinal cord injuries because they rely solely on their upper limbs to perform everyday tasks. The pain is often caused by soft-tissue injuries such as inflamed rotator cuff tendons. Pain medication and physical therapy are typically used to treat shoulder pain, with surgery as a last resort – not a good option for someone with a spinal cord injury.

The New Jersey-based Kessler Foundation is a global leader in rehabilitation research and employment programs for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord.

New Treatment Significantly Reduces ‘Frozen Shoulder’ Pain

By Pat Anson, PNN Editor

Preliminary results from a small study show that an experimental treatment for adhesive capsulitis -- also known as “frozen shoulder” – dramatically reduces pain and quickly improves function in patients.

Frozen shoulder occurs when ligaments and connective tissues surrounding the shoulder joint become sore and inflamed. The inflammation gets so painful that many patients have difficulty using their arms. The resulting lack of use makes the shoulder joint even more stiff and inflamed – a vicious cycle that “freezes” the shoulder in place.

About 200,000 people annually in the U.S. develop frozen shoulder, mostly middle-aged adults. Several years ago, I was one of them. The pain was so bad at times, it felt like someone whacked me in the the shoulder with a baseball bat. I had trouble putting on a shirt or sleeping in the same position for more than a few hours.

Frozen shoulder is usually treated with physical therapy, massage, joint injections or pain medication, until the symptoms resolve in a few months or perhaps even years. Thankfully, that’s what happened to me. More serious cases can result in rotator cuff surgery.  

Researchers at the Vascular Institute of Virginia used a less invasive procedure called Arterial Embolization of the Shoulder (AES) to reduce blood flow into the shoulder of 16 patients with adhesive capsulitis. Physicians inserted a catheter through a pinhole-sized incision in the patients' wrists that was used to feed microscopic particles into six arteries leading into the shoulder.

"Patients with frozen shoulder are essentially told to tough it out until their symptoms improve, but considering the significant pain and decreased function many experience, we looked to determine if this treatment model of embolization, already in use in other areas of the body, could provide immediate and durable relief," said lead author Sandeep Bagla, MD, director of interventional radiology at the Vascular Institute of Virginia.

It may sound counter-intuitive, but decreasing the flow of blood into shoulder tissue significantly reduced the patients’ pain and inflammation.

"We were shocked at the profound and dramatic improvement patients experienced in pain and use of their shoulder," says Bagla. "We are early in the investigation of this treatment but are inspired by its effectiveness in reducing pain and range of motion in patients' shoulders."

The treatment was conducted on an outpatient basis and takes about one hour. Nine patients reported minor side effects such as skin discoloration.

The findings were recently presented in a research abstract during a virtual session of the Society of Interventional Radiology. The authors note that AES is still investigational and that conservative therapies for frozen shoulder should still be considered first.

Oska Pulse Reduces Knee, Shoulder and Back Pain

By Pat Anson, Editor

A wearable device that stimulates the release of natural pain-relieving endorphins provides significant relief to patients with chronic knee, shoulder or back pain, according to the results of small clinical trial.

The Oska Pulse uses Pulsed Electromagnetic Field technology (PEMF) to dilate blood vessels, which increases blood flow, reduces inflammation, and releases the body’s endorphins to reduce joint and muscle pain.

The double blind, placebo-controlled study involved 30 patients who were recruited from two San Diego area pain clinics. Participants were given either an Oska Pulse or a placebo device and asked to wear them several times a day for two weeks, while completing a daily log to track their pain, stress and usage.

The study findings, first published in Practical Pain Management, found that the majority of participants who used the Oska Pulse had a significant decrease in pain levels. Some also reported a decrease in stress.

oska wellness image

“There was significantly more reduction in pain in the OSKA Pulse group after 14 days of use than placebo. These results suggested that the OSKA Pulse may be an effective tool in pain attenuation,” wrote lead author Joseph Shurman, MD, an anesthesiologist at Scripps Memorial Hospital in La Jolla, CA.

“Data analyses showed interesting trends in subjective pain scores, including a slight increase in pain in the placebo group after day 7, while the OSKA Pulse group, on average, reported a decline in pain intensity.”

Previous studies have found that PEMF therapy can be used to treat a variety of chronic pain conditions, not just simple muscle aches and joint pain. A recent survey of Oska Pulse users found that half had some type of pain for more than five years.

"I've had RSD/CRPS in my left leg for 21 years and tried many meds and treatments over the years, including 10 years of ketamine infusions," said Tracey M., an Oska customer quoted in a news release. "I started using Oska Pulse nine months ago and my pain was reduced more than ever before. I recently danced at my daughter's wedding. Before Oska, I wasn't even sure if I'd be able to attend."

PNN columnist Arlene Grau, who lives with rheumatoid arthritis and fibromyalgia, was at first skeptical about the Oska Pulse. But after trying it for several days, she found the device gave her some temporary pain relief.

“I originally thought the Oska Pulse was not going to work for me, since I'm used to the TENS unit shocking my body and actually feeling something happening. You don’t really ‘feel’ anything when the Oska Pulse is on, but I felt a difference after every use,” Arlene said. “I wouldn't necessarily compare it to the relief I get from opioids, but it was enough to make me feel like I didn't need to take prescription drugs every 4 hours. Which is a triumph.”  

Before using the Oska Pulse, it is recommended that cancer patients, or those who are pregnant, nursing, or have a pacemaker or defibrillator, should consult with their physician.

The Oska Pulse is available on Amazon for $399.