A Real Pain In The Shoulder

By Stephanie Matsunaka
Interviewed by Rasa Fournier
Wednesday - August 18, 2010
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Stephanie Matsunaka, Mspt
Physical Therapist at REHAB

Where did you receive your schooling and training?

I did my graduate work in physical therapy at Pacific University in Oregon. I knew I wanted to go into physical therapy when I was at University High School here in Hawaii.

How long have you been practicing?

Almost 20 years. I worked on the in-patient hospital side for 12 years and have been here at REHAB at Nuuanu out-patient clinic for the last eight years.

Can you describe your work?

Physicians refer patients to us for rehabilitation with diagnoses including stroke, spinal cord injury, brain injury and vestibular issues where they have vertigo or dizziness. We also see orthopedic patients including sports medicine, post-surgical joint replacements and those with strains, pains and functional limitations of the back, ankle, foot, knee, hip, neck and shoulder. We customize each evaluation to the patient to determine the cause of the problem. Sometimes it is simple and clear, sometimes it is very complex and the effects of many years of abnormality. We use multiple hands-on techniques and customized exercise programs to help stretch, alleviate and strengthen the body back to its optimal state.

What is the most common reason people come to you with shoulder pain?

The most common diagnosis with shoulders that I see is called “frozen shoulder” or adhesive capsulitis. It’s a catch-all term for whenever there’s pain and inflammation that decreases a person’s ability to move the shoulder or limits their range of motion. The actual cause can be quite complex - it could be a small muscle tear, abnormal joint movement, a muscle strain or a combination of all three. It could also be postural, meaning it could be things going on structurally in other parts of the body such as the back or neck that slowly begin to impact the shoulder.

Stephanie Matsunaka performs a scapular stabilization with core activation on Ed Nagamine, who suffers a ‘frozen shoulder’

Is there a gender or age component to frozen shoulder problems?

I see it more often with middle-aged women, but it can be anywhere from the late 40s to 80s. I also see it more often in people with desk-type jobs.

How do you treat frozen shoulder?

I look at integrating the whole body using a technique called Total Motion Release to rebalance the body. It evaluates the body as a whole and identifies problems other than the shoulder that might also be causing the shoulder problem. Total Motion Release, along with Structural Integration - which uses manual massage techniques to realign the body - can help correct many of the malfunctions in the body that manifest in pain. I also use Pilates, which integrates the whole body to strengthen and reinforce correct mechanics.

Working on the whole body rather than just the shoulder fixes the root problem?

It depends on what we find in the evaluation. We start with a historical intake, so I may ask if you’ve been injured in other parts of your body, or if you’ve had surgery - anything that may play a part in your shoulder pain. Then we do a physical examination that looks at your range of motion, strength and posture. If there are no indicators that the lower body is involved, then I evaluate from the waist and work my way up. If there are problems in the waist, then I take a closer look at the lower part of the body before getting to the shoulder.

Often I start by having the patient engage in a movement pattern that causes pain or is restrictive in the shoulder. Then I address the lower body or the trunk with the goal of addressing the shoulder problem. If the area I’m treating is one of the causes that’s limiting the shoulder, that movement pattern they selected earlier will be better right away. That’s how we tell to what degree the shoulder pain is associated with other parts of the body.

Do you check whether daily activities might be causing the pain?

We always try to identify activities that people do that could be causing the pain or causing an imbalance in other parts of the body that lead toward the shoulder pain. This speeds recovery, because they can avoid that activity or change the way they’re doing things.

Can you tell us more about your Pilates program?

Our Clinical Pilates program is targeted to all types of patients from elite athletes recovering from a muscular injury to elderly stroke patients in the rehabilitation process. Our fully equipped, customized Pilates studio is part of our newly renovated clinic. Many of our therapists have gone through extensive formalized Pilates training, some for years.

Does Clinical Pilates differ from regular Pilates?

We use Pilates in the healing process whereas most Pilates studios are focused on fitness. We combine our medical knowledge base with the principles of Pilates to take a patient from injury through recovery. Because this is part of their therapeutic program, it is covered by medical insurance.

When might surgery become necessary?

Most patients try conservative methods before going the surgical route. However, there are many patients who feel they’ve tried everything they can and need a more aggressive approach to correct the problem.

Do active elderly people tend to have fewer shoulder problems?

A common theory is the “move it or lose it” idea. But when it comes to the shoulder, it seems the more active they are, the more problems they have simply because they’re putting more demand on the joint. Overuse or bombarding one part of the body can lead to injuries over time, so we always teach correct alignment and ways to balance the body to remove the strain or have them modify their activities to prevent stressing the shoulder and body.

Do you often see chronic conditions?

Yes, people tend to ignore minor aches and pains in the hope that it’ll go away by itself and manage it with pain medication. It’s important to remember that this doesn’t address the injury or cause of the injury, which can intensify if not corrected.

It’s important for people to come in as soon as they have pain. The longer they wait, the more inflammation will build up and will restrict their range, and then it’s harder to treat. If they come in within two to three weeks of having this problem, then it should recover fairly quickly. Don’t wait too long.

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