Physiotherapy Case Study: Weightlifting related Shoulder Pain Treatment with Online Physiotherapy
by Physiotherapist Dr. Suveda Kothari (PT) (BPT, MPT – Cardio respiratory)
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Online Physiotherapy for Shoulder Pain: ABSTRACT
Heavy weightlifting in the gym over the years led to chronic shoulder pain for Prabhjot (name changed). It started with mild right shoulder pain causing stiff shoulder while working on laptop. He noticed left shoulder pain as well. But he couldn’t take time out of his busy work life for physiotherapy for shoulder pain. Gradually the pain increased and spread to back shoulder pain and stiffness. He made use of the lockdown period when he was working from home. He took online Physiotherapy remotely from his home for shoulder pain and saw quick recovery.
Mr Prabhjot excitedly remarks, “If there is any time to sort out aches and pain, this is it! This work from home period is a perfect opportunity to get some expert help, at my convenient time and in the comfort of my own home.”
Online Physiotherapy for Shoulder Pain: PREFACE
23 years young male, Mr. Prabhjot (name changed) works out regularly to take care of his body and fitness. He had been involved in heavy weightlifting in the gymnasium since he was only 16 years old. He used to get mild shoulder pain while doing arm strengthening exercises with weights. He took it for pain commonly associated with a heavy workout. He ignored the pain & stiffness and continued with his gym routine. [Read about Hacks for Aching Sore Muscles after heavy exercising]
With time, he started sensing a constant right shoulder pain, which later spread to left shoulder too. Gradually the shoulder pain increased and started to interfere with his normal shoulder movements. He found free shoulder movements painful like wearing T-shirt. He found it difficult to pick any object. In the last two years, the pain also spread to upper back making him uncomfortable with back shoulder pain.
Patient’s profession is such that he needs to work for long hours on laptop / computer. He would find it difficult to work longer than one hour. He would have to take break to do some arm stretching exercises to relieve shoulder stiffness around both the shoulder joints. Patient therefore consulted an orthopedic doctor. Based on the results of his shoulder MRI, the doctor advised him physiotherapy for shoulder pain.
Mr Prabhjot could not continue physiotherapy due to his hectic work schedule and the shoulder pain persisted.
During the lockdown he was at his home town, working from home. He decided to use this relatively less hectic time for his long pending shoulder recovery. He searched on the internet and came across Reliva Physiotherapy offering tele physiotherapy remotely to patients. ReLiva also had high customer rating on google (4.8+/5 stars) consistently. He made his choice and contacted ReLiva.
Online Physiotherapy Appointment & Scheduling:
ReLiva scheduling team called him, shared all the details of his video consultation and checked his preferred mode of video consultation. His appointment for physiotherapy consultation was booked as per his convenient time and day for 3 April, 2020.
Online Physiotherapy Consultation:
Shoulder Pain History:
When shoulder pain started interfering in his chores of daily life like wearing T-shirt, picking up items, he consulted an orthopedic doctor. He was advised to do an MRI for his shoulders. MRI scan revealed Gleno humeral joint effusion bilaterally and effusion around right acromio clavicular joint. There was no evidence of rotator cuff abnormalities bilaterally. Simply put there were internal changes in his shoulder joint and there was no rotator cuff injury. The doctor had advised him physiotherapy for shoulder pain.
Mr Prabhjot started physiotherapy but could not continue with the shoulder pain treatment. He could do only one session owing to his hectic work schedule. He continued to live with the shoulder joint pain on both sides.
Online Physiotherapy Assessment: Session 1
As per the schedule, ReLiva physiotherapist Dr Suveda (PT) connected with the patient using Whatsapp Video call. During the consultation, patient was assessed for his complaints on and around shoulder. These included:
- Identifying location of pain using self-palpation technique. Patient was asked to palpate his right shoulder with the help of his left hand and vice versa.
- Ascertaining the Pain score. Pain score at rest was 6/10 on left side and 5/10 on right side. His left shoulder pain was currently more than on the right shoulder.
- Understanding the range of motion at both shoulders. Patient could perform full range of motion at both shoulders with altered biomechanics and pain score on movement was 9/10 on both sides.
- Observation of various arm and shoulder movements revealed that patient also had weakness in specific muscles which hold the shoulder blades against the thoracic wall (Serratus Anterior muscle).
- On further discussion, patient explained about the normal and altered biomechanics of his shoulder joint and possible source of shoulder joint pain.
Online Shoulder Physiotherapy
Based on the assessment, physiotherapy was first focused on reducing the shoulder pain. The patient was advised accordingly:
- Hot water fomentation at a specific frequency during the day
- Demonstrated comfortable sleeping positions, with painful shoulder
- Tips to control shoulder pain – the Do’s and don’ts to avoid increase in pain
- Specific shoulder movements using a ball (something that was readily available with him at home)
- Targeted exercises for different muscle groups around both shoulder joints (flexor, abductor and extensors).
Shoulder Pain Treatment: Online Physiotherapy Session 2
In the next session, patient reported much lesser shoulder pain. He had 50% reduction in pain and the movements were much easier. Hence, we progressed with assisted shoulder movements in lying down position as well as in standing position.
While doing exercises, the exercise dosage was kept low as the patient complained of quick fatigue in shoulder muscles. Special effort was made to communicate that “Exercise is Medicine” and that it should be taken in the prescribed dosage and frequency religiously. Since he was a gymmer, he has been instructed to stop upper limb activities which involves weightlifting, for the time being.
Patient was very happy with his progress in just 2 sessions and signed up for 6 weeks of supervised online exercise sessions with ReLiva.
Shoulder Pain Treatment: Online Physiotherapy Session 3
Once shoulder pain relief had been attained, we progressed to the next goal – improving shoulder movement. The patient wanted to be able to do his daily chores without pain.
At the start of the session, the patient’s recovery on pain and shoulder movement was reviewed. Patient had pain only at specific angle while doing overhead shoulder movements. Accordingly, we continued with assisted shoulder movements in different positions. New strengthening exercises for shoulder and upper back muscles were initiated.
Home exercise prescription was revised. The patient was already seeing improvement due to regular exercises as per the specified dosage. We re-iterated to follow the dosage, and not over do with other movements. Afterall ‘Exercise is medicine.’
Shoulder Pain Treatment: Online Physiotherapy Session 4 & 5
In physiotherapy sessions 4 and 5, further progression in strengthening exercises was done by increasing the repetitions and hold time. Patient could also perform active movement of shoulder with minimum pain in session 5.
Online Physiotherapy Treatment: MAINTENANCE
We have already seen rapid shoulder pain relief and improvement in shoulder movements for this patient. We continue to work on improving his shoulder strength. Since the problem is chronic, the treatment is now focused on improving strength of shoulder joint. Alongwith that, we will also look at stabilizer muscles of shoulder and scapula to improve overall functioning of the complex joint that is shoulder joint.
Online Physiotherapy for Shoulder Pain: CONCLUSION
Thus, Online physio (tele-rehab) is proving very helpful for patients to achieve pain relief and complete their long-awaited recovery, who are seeking professional help but could not get it due to various reasons:
- Usually busy work life and no time for visiting physical clinic
- Unable to take in person physiotherapy due to lockdown (outbreak of Covid 19 pandemic)
- Want to maintain social distance and take treatment remotely
Patient Review about about Shoulder Pain Treatment
Mr Prabhjot excitedly remarks, “If there is any time to sort out aches and pain, this is it! This work from home period was a perfect opportunity to get some expert help, at my convenient time and in the comfort of my own home.”
Patient was very happy with his progress in just 2 sessions and signed up for 6 weeks of supervised exercise sessions with ReLiva Online physiotherapy.
If you, or someone you know would benefit from physiotherapy treatment and you do not have access to it right now, please register for an online physiotherapy session here or simply call us at +91 99209 91584 and we will connect you with a physiotherapist best suited for your requirement.
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