Shoulder Pain – Soft Tissue or Motor Control Problem?

Is your shoulder issue being caused by a soft tissue restriction or a motor control issue? An important question to ask in regards to finding the best treatment option. Today we’re going to take you through the process and show how easy it can be to improve shoulder range of motion and function.

1. Screen

The first things we need to do is assess overall shoulder range of motion. In this video we demonstrate the ‘Apley’ screen for shoulder movement.

In this video, our model, shows a pretty common imbalance (especially for right handed individuals). She can easily touch her fingers behind her back when her right hand over and left arm over. It becomes difficult with her left hand over and right arm under.

2. Active vs. Passive Range of Motion

One of the easiest ways to determine if a movement limitation is being caused by a soft tissue restriction (ie. a tight muscle) or a motor control deficiency is to take the joint through its active and passive range of motion.  For the previous finding we want to isolate and check shoulder internal rotation and extension (the arm under movement) in their active and passive ranges. There are three scenarios that can happen.

• If active range of motion is normal, then there is no need to follow up with passive.
• If active AND passive range of motion is limited then we’re most likely looking at a tissue restriction (and soft tissue therapy to release tissues would be the best treatment).
• If active range of motion  but passive range of motion is normal, we have a motor control issue (and finding a good exercise would be most beneficial). 

In our example, shoulder internal range of motion is normal. However, there are limitations with active extension. But passive extension shows normal range of motion. So what do we conclude? We need a good exercise to improve shoulder extension and not endless soft tissue therapies.

3. Correction

Since we’ve now determined that the limitation in shoulder movement is being caused by a motor control deficiency into extension, and NOT a soft tissue injury we can apply the best treatment.