I'm Dr. Molly with Your Goals Physical Therapy, are you currently trying to decide whether or not you need to have a cortisone shot or go to physical therapy for a shoulder impingement? I'm assuming if you have a diagnosis like shoulder impingement, you went to your doctor because you're having pain with certain motions. You're probably freaking out because it is very scary when it hurts to get dressed, it hurts to sleep. You can't find a comfortable position walking around your arm because it really doesn’t like just hanging. You can have pain putting away dishes, vacuuming, all sorts of things. And it's all the time, especially if it's your right arm and you're right-handed, you have to use your arm all the time so everything reminds you that your shoulder doesn't feel very well. Most of us, we're able to ignore that pain for a while because… “it'll just go away on its own”.
If you've gone to the doctor and the doctor is talking to you about whether or not you need a cortisone shot that's probably a pretty scary place to be because you're thinking the absolute worst. You're afraid that, if this cortisone shot doesn't work, you're going to need surgery. Or there's some other major thing waiting around the corner. That's going to tell you that your shoulder is going to be messed up for a very, very long time. You just want this pain to go away. And so this doctor is offering you a cortisone shot, which based on what the doctor is telling you will get rid of your pain in a couple of days.
But you're also curious what a non-invasive item would be like physical therapy and what would the differences be?
So let me go over that. First, a shoulder impingement, just so that we understand what we're talking about, is the mechanics of your shoulder are not working properly. That means that your arm bone, or your humerus, sits in a very shallow little cave, and your rotator cuff helps keep your arm bone in place, along with some other items. When the rotator cuff works correctly, it pulls your arm bone down enough so that you can clear the little hat that sits over here, it's just called your acromion. If your rotator cuff is not strong enough, or isn't coordinated, it's not recruiting itself properly, then what happens is that the arm bone doesn't depress enough to clear the acromion. Then you get this pinch. You can feel like your arm just doesn't go any farther. Now some people can get it to go farther. There's just a lot of pain for a second. And then you have a little bit more range depending on how long you've been dealing with it. You could have had more motion a few weeks ago. And now you just can't even raise your arm without a huge amount of discomfort. That's what the impingement is. The impingement is when the mechanics are off and it's causing your arm bone to actually hit another bone pinching, your rotator cuff. The negative effects of that over time is eventually you can actually tear your rotator cuff. Those two bones hitting each other will eventually bore a hole through your rotator cuff, possibly requiring surgery intervention later, later on.
The nice thing about cortisone shots is that they get rid of the inflammation, it’s a high powered anti-inflammatory, kind of like an ibuprofen only with a whole lot more strength. And it’s a lot more exact because you're not taking it orally. They're actually going to inject it right into the shoulder joint right where the tissue that needs it the most. Where it hopefully has more bang for its buck. For the people that this works for, which is quite a few it's obviously not a hundred percent, there is some really good benefits.
There are a lot of good benefits to taking a cortisone for getting rid of that inflammation, especially related to pain. Your doctor will, or should, tell you that you can only have so many of them, because what attacks the bad tissue, that's the inflamed and irritated tissue that's causing the pain, will also attack good tissue, which can make your muscle a little bit weak, and more unstable. They won't let you have more but you then a certain amount before they call it quits on giving you cortisone shots. So cortisone shots do an amazing job of getting rid of the inflammation.
So what does physical therapy do and why would you even bother with that if you're going to get rid of your pain? I mentioned the actual definition of the shoulder impingement is that the mechanics in your shoulder are not great.
Guess what physical therapy does? Physical Therapy helps fix and get rid of that mechanical problem. By looking at your posture. By looking at which muscles are not as strong as maybe the opposing muscle, causing a little bit of imbalance. By looking at the flexibility of certain arms and other muscles in your chest, your upper back and your neck. There can be a very evident reason as to what's going on and causing this dysfunction movement in your arm bone. And honestly, this is gonna be something super slight, something that nobody, other than a very trained professional, can figure out. A slight change in where your arm is sitting inside of its joint can make a huge difference because there's not a whole lot of space in there. We're talking millimeters, not centimeters. And so just having a little bit of something off balance and off-kilter can cause a huge amount of pain. Having a specialist, somebody who specializes in shoulder joints, somebody who specializes in how muscles move and how to correct posture and how to look at your workspace. Sometimes it could be something that you're doing at your job that you've been doing for years that just eventually caused a problem.
There can be so many reasons why people have shoulder impingements and they don't have to be devastating and they don't have to last. That's literally what I do all day. I help people fix their posture. I help people figure out, by problem solving, which muscles are affected. Then we restore that proper balance with very specialized exercises and some hands-on techniques that help you properly align your shoulder joint and help you to get the right amount of muscle recruitment, to get everything to work correctly.
Those are the differences between a cortisone shot and physical therapy. If you have any questions about your specific situation and what's going on with your shoulder, feel free to contact me. Either send me a direct message through the site or send me an email. I'll talk to you later.
WE HELP ACTIVE ADULTS OVERCOME THEIR ACHES AND PAINS TO GET THEM BACK TO THEIR FAVORITE ACTIVITIES WITHOUT MEDICATION, INJECTIONS OR SURGERIES.
Dr. Molly McDonald