Shoulder Pain has a Typical pattern, which is more important to recognize than the tissue specific diagnosis.

When a patient first presents to my office with shoulder pain, the first thing I want to know is if this patient has a condition I can treat. There are good orthopedic tests to determine that. However, the next most important thing to figure out is the pattern the patient’s shoulder pain is exhibiting. The usual pattern is pain on forward or lateral movement as the arm is raised upwards. The next question is does the pain occur during the movement or only at the end of the movement.

The typical pattern for shoulder pain is that the pain occurs during movement, reaching up for something or reaching into the backseat of a car, etc. Once this pattern is established, then I want to see if movements in the opposite direction will improve the painful movement direction. We spend a lot of time with our shoulder joints forward and almost never move them backwards, so I test extension first. I will do 1 set of 10 reps of shoulder extension and then see if that improves the ability of the patient to move in their painful direction. For the vast majority this will improve their symptoms right away!!

We will then continue doing shoulder extension mobilizations for a few more sets in the office and then I teach the patient how to do it at home. We will also begin to work on the other issues the patient may have doing on in their neck, mid back, scapula, etc. What is super cool about this method of diagnosing and treating is that it improves symptoms fast!! And it tells us that most of the joint pain we deal with is mechanical in nature, which means it is a movement problem not a structural problem (like arthritis, which doesn’t usually cause pain).

Here is a video of me performing the at home version of the shoulder extension mobilization:

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