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Pain in deltoid muscle of left arm: The request could not be satisfied


Deltoid Strain Treatment, recovery and rehabilitation

By Brian J. Ludwig, MD

Shoulder pain in an athlete is a very common malady. Pain in the shoulder can be debilitating for athletes of all ages and competition levels. One possible, but relatively uncommon cause of shoulder pain is called a deltoid strain.


What is the deltoid muscle and what does it do? 

The deltoid muscle is a large muscle that encompasses the shoulder joint. The deltoid is divided into three different portions, or heads, the anterior (front), middle, and posterior (back) portions of the deltoid. The deltoid originates on the lateral aspect of the acromion and clavicle and then inserts on the lateral aspect of the humerus. Its major action is to abduct the arm (lift the arm out to the side of the body) as well as assist in forward elevation (lifting the arm out in front of the body). The deltoid is a very powerful muscle and is needed for all types of athletic endeavors. 


Difference between a strain and a sprain 

Strains are injuries to muscles or muscle tendon units. Sprains are injuries to ligaments. Because the deltoid is a muscle, it can be strained, but not sprained.


What other injuries can mimic a deltoid strain? 

There are many injuries in the shoulder that can mimic a deltoid strain. At times, these injuries can be difficult to distinguish one from the other. Some other things that can be injured include: the rotator cuff, glenoid labrum, biceps tendon, acromioclavicular joint (AC joint), shoulder dislocations, shoulder fractures, and soft tissue contusion. Many of these injuries can be treated conservatively, however some of these injuries require surgical intervention and need to be evaluated by a sports medicine physician to determine the extent of the injury.


Why does my Deltoid hurt? 

Deltoid strains can be caused by numerous mechanisms. Most commonly they result from overuse of the muscle without adequate rest. This can lead to discomfort in the area of the deltoid muscle with associated swelling and loss of function. A forced eccentric contraction of the shoulder (lengthening of the muscle belly while contracting), can lead to strain of the deltoid muscle (ie: doing a “negative” while weight lifting). Less commonly, a direct traumatic blow to the shoulder can cause a deltoid strain.


Deltoid strain symptoms

Deltoid strains are diagnosed by looking at the mechanism of injury and the symptoms the patient is having at the time of injury. A physical examination is imperative. Patients with deltoid strains can have pain with palpation of the involved area of the deltoid muscle belly. In more severe cases, with actual tears of the muscle, a palpable defect may be felt. The shoulder is also assessed for swelling and skin changes. Range-of-motion and strength testing are done to help confirm the diagnosis of a deltoid strain and rule out other possible diagnoses.


Imaging studies 

Depending on the mechanism of injury, no imaging studies may be needed. If there is concern for fracture or dislocation, radiographs of the shoulder may be indicated. Additionally, if there is concern for rotator cuff injury or a torn labrum, then a MRI of the shoulder, on rare occasions, may be necessary.


Different grades of deltoid strains 

Deltoid strains are graded based on the severity of the injury.

Grade 1 deltoid strains generally result in mild pain in the affected shoulder. Patients with grade 1 strains are able to use their shoulder and can lift their arms with minimal pain and are able to do push-ups without much difficulty. There will generally be minimal or no swelling.

Grade 2 deltoid strains are the next level of severity. This level of injury represents a partial tearing of the deltoid muscle. A patient with a grade II strain will have increased deltoid pain when lifting their arm. They may have difficulty doing push-ups or lifting their arm. There will generally be mild or moderate swelling.

Grade III strains are the most severe. A patient with a grade III strain typically has tearing of the deltoid muscle belly. The patients typically have severe pain and dysfunction in their arm. They are not able to use their arm for activities and will have moderate to severe swelling.


Treatment of deltoid strains 

In general, deltoid strains are treated conservatively. For Grade I injuries, generally little treatment is needed. Initially, most patients can benefit from sports injury treatment using the P.R.I.C.E. principle – Protection, Rest, Icing, Compression, Elevation. Anti-inflammatory medications can be used to treat the pain symptomatically. Grade II injuries can be treated similarly. A brief period of physical therapy may be helpful to decrease pain and increase motion in the arm. Grade III injuries, the most severe, are treated with physical therapy and restricted activities. Consider shoulder bracing and shoulder ice packs for icing, protecting and resting the deltoid. Only on the very rare occasion would surgery be needed for a deltoid strain.


Deltoid strain K-Tape



Deltoid strain recovery time 

Depending on the severity of the strain, athletes healing time and return to sport can within in a day or two, or up to several weeks to months later. In order to safely return to athletic competition, the athlete must have regained all of their strength, as well as range of motion (ROM). After this has been regained, often sport specific exercises are initiated (such as a throwing program for the throwing athlete). Once the athlete is pain free, has full strength and ROM, and completed their sport specific exercises, if appropriate, then they may return to play without restriction. For minor, grade I, type injuries this can be done very quickly, whereas more severe grade III injuries may need several months of recovery. Return to play decisions should be determined under the guidance of a sports medicine professional and possibly an athletic trainer or physical therapist.


Getting a Second Opinion

A second opinion should be considered when deciding on a high-risk procedure like surgery or you want another opinion on your treatment options.  It will also provide you with peace of mind.  Multiple studies make a case for getting additional medical opinions.

In 2017, a Mayo Clinic study showed that 21% of patients who sought a second opinion left with a completely new diagnosis, and 66% were deemed partly correct, but refined or redefined by the second doctor.

You can ask your primary care doctor for another doctor to consider for a second opinion or ask your family and friends for suggestions.  Another option is to use a Telemedicine Second Opinion service from a local health center or a Virtual Care Service.


SportsMD’s Second Opinion and Telehealth Service

SportsMD offers Second Opinion and Telehealth appointments with a top sports medicine doctor to confirm a diagnosis and/or learn about different treatment options.

Please reach out to us at [email protected] if you need help finding a top sports doctor for a second opinion or Telehealth appointment in NY, NJ or CT.

We’ll do our best to connect you with a top sports medicine doctor who specializes in your injury area.


The deltoid is a muscle responsible for lifting the arm and helping the shoulder to move. Strains and injuries from overuse can lead to pain. In this article, learn about the types of deltoid strain, which range from mild to severe. https://t.co/bZMYspy0Ru pic.twitter.com/T833TlQ7JJ

— Dr. Amon Ferry (@amonferrymd) May 24, 2019

Rotator Cuff Tendinitis: Symptoms, Causes, and Treatments

Rotator Cuff Tendonitis Fundamentals

The rotator cuff is a group of four tendons that covers the humeral head and controls arm rotation and elevation. These muscles and their tendons work together with the deltoid muscle to provide motion and strength to the shoulder for all waist-level and shoulder-level or above activities.

What is rotator cuff tendinitis?

Rotator cuff tendonitis is an inflammation of a group of muscles in the shoulder together with an inflammation of the lubrication mechanism called the BURSA. In fact, ‘bursitis’ should not be considered a diagnosis but rather a symptom of rotator cuff tendonitis.

What causes rotator cuff tendinitis?

This condition is often caused by or associated with repetitive overhead activities such as throwing, raking, washing cars or windows and many other types of highly repetitive motions. It may also occur as a result of an injury. Rotator cuff injuries are the most common cause of shoulder pain and limitation of activities in sports in all age groups. Rotator cuff tendonitis is the mildest form of rotator cuff injury.

The shoulder has a unique arrangement of muscle and bone. The rotator cuff (which is muscle) is sandwiched between two bones much like a sock lies between the heel and the edge of a shoe. In the same way that repeated walking eventually wears out the sock, the rotator cuff muscles fray with repeated rubbing on the bone. As the muscle begins to fray, it responds to the injury by becoming inflamed and painful. With continued fraying, like a rope, it may eventually tear.

What are the symptoms of rotator cuff tendonitis?

The classic symptoms include a ‘toothache’ like pain radiating from the outer arm to several inches below the top of the shoulder. Pain may also occur in the front and top of the shoulder. It may interfere with sleeping comfortably. It may even awaken people from a sound sleep with a nagging pain in the upper arm.

The symptoms are usually aggravated by raising the arms overhead or in activities that require reaching behind the body, such as retrieving an object from the back seat of a car. Furthermore, reaching behind the back to fasten underclothing or to pass a belt may aggravate the arm and shoulder pain.

A clicking in the shoulder may occur when raising the arm above the head.

What are my treatment options for rotator cuff tendonitis?

A thorough history and physical exam will nearly always lead to a correct diagnosis. X-rays will often show changes on the arm bone where the rotator cuff muscles attach, but an MRI provides the definitive diagnosis. This test clearly shows the muscles and indicates if the muscle is inflamed, injured or torn.

Medical treatment options for rotator cuff tendonitis

The following steps should be taken as a conservative approach to treating rotator cuff tendonitis:

  • Stop or markedly decrease the activity that required the use of the shoulder at or above shoulder level.
  • Apply ice to the affected area.
  • Take anti-inflammatory medication to reduce arm and shoulder pain.
  • Begin an exercise program to maintain flexibility.
  • Avoid carrying heavy objects with the affected arm or using shoulder-strap bags on the affected side.

In the early phases, over-the-counter anti-inflammatory medications may provide benefit. However, to allow the inflammation to resolve, it is vital to curtail any repetitive activity and it is equally important to try to keep the elbow below the shoulder level when using the arm.

Daily stretching while in a hot shower is also beneficial. If shoulder pain becomes more severe, prescription strength medication or a cortisone type injection may help.

Cortisone injections can be very effective in the treatment of the pain. When used, injections should be done in conjunction with a home exercise program for flexibility and strengthening, modification of activities and ice. Other pain controlling options include heat, ice, ultrasound and therapeutic massage.

For a young patient under the age of 30 and with a first time episode of rotator cuff tendonitis that is treated immediately with the above protocol, the average length of time for rehabilitation is two to four weeks. For those with recurrent episodes of tendonitis and some risk factors, rotator cuff tendonitis may take months to heal and in rare cases may require surgery.

Surgical treatment options for rotator cuff tendonitis

If symptoms persist, surgery to remove a spur on the acromion can increase the space available for the inflamed tendon and may prevent further fraying or complete rupture. If an MRI shows a complete muscle injury, surgical repair may be required.

Surgery for recurrent rotator cuff tendonitis (bursitis) is occasionally performed to:

  • Remove a prominence or spur on the undersurface of the acromion.
  • Remove chronically inflamed, thickened and fibrotic bursal tissue.
  • Inspect the tendons and tidy up and sometimes repair a tear in the tendons.

These procedures are often done in combination. This can be done either through an open or an arthroscopic approach with the start of an early rehabilitation program one or two days after surgery and advancing to a more comprehensive program between two and five weeks after surgery. The initiation and progression of these exercises is dependent upon the patient’s findings at surgery, surgical procedure and rate of healing.

Deltoid Pain – Symptoms, Causes, Treatment & Exercises

Deltoid pain relates to the large deltoid muscle on the top & outside of the shoulder. Although not a common injury, an injured deltoid can result in pain at the front, side or back of the shoulder. A contusion is more common and occurs from direct impact or trauma to the muscle.

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Deltoid muscle strain

  • Symptoms include sudden pain in the deltoid muscle at the front of the shoulder is common.
  • Pain is reproduced when lifting the arm from your side to the front keeping it straight against resistance.
  • Or when you lift your arm from your side up sideways against resistance if the strain is in the mid portion or top of the muscle.
  • Tenderness and swelling where the muscle is torn may also be visible and for very severe injuries bruising may develop.

A rotator cuff strain may have similar symptoms to a deltoid strain and is probably far more common so should always be considered.

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What is a deltoid strain?

The deltoid muscle is the big muscle on the shoulder. It has three parts; the front or anterior, middle and back or posterior. The muscle lifts the arm up sideways. The front part helps to lift the arm up forwards, known as shoulder flexion and the back part helps to lift the arm up backward, known as shoulder extension. Muscle strains are categorised under grade 1, 2, or 3 depending on how bad they are.

Grade 1 deltoid strain

Symptoms – You might have tightness in the muscles. You may be able to use your arms properly or do press ups easily. You probably won’t have much swelling. Trying to lift your arm up sideways or to the front or back of the body probably won’t produce a lot of pain.

Treatment – Apply ice or a cold therapy and compression wrap for the first 24 hours (15 mins at a time) then heat. Light exercises – 4 sets of 10 repetitions 3 times a week (for example). Gradually build up the weight to strengthen the muscles. The athlete should ease down on training for a week or two but it is unlikely they need to stop unless they are getting pain. A doctor or sports therapist can use sports massage to speed up recovery as well as ultrasound or electrical stimulation.

Grade 2 deltoid strain

Symptoms – You probably cannot use your arm properly or do press ups. You may get occasional sudden twinges of deltoid pain during activity. You may notice swelling. Pressing it causes pain. Lifting your arm up to the front, side or back against resistance causes pain.

Treatment – Ice for 3 to 5 days. See a sports injury specialist who can advise on rehabilitation. Apply heat (hot water bottle, hot baths, see a specialist for ultrasound). From day 7 do light, pain-free exercises (4 sets of 10 reps three times a week). Cycling 2 to 3 times a week. Begin stretching (hold stretches for 30 secs, 5 times a day). From day 14 start to slowly get back into sports activities.

A doctor or sports therapist can use sports massage techniques to speed up recovery and advise on a rehabilitation program.

Symptoms – You will be unable to move your arm and likely to be in severe pain. Bad swelling will appear immediately. Contracting the deltoid muscle will be painful and there may be a bulge or gap in the muscle. Expect to be out of competition for 3 to twelve weeks or more.


  • Week 1: You should seek medical attention immediately. P.R.I.C.E. (Rest, Ice, Compress, Elevate.)
  • Week 2: Pain-free static contractions (if it hurts don’t do it). Heat with a hot water bottle, hot bath or ultrasound.
  • Week 3: All of the above plus increase the intensity of static contractions 4 sets of 10 reps 3 times a week.
  • Week 4: Pain-free exercises e.g. light lateral raises and rotator cuff exercises, 4 sets of 10 reps 3 times a week. Cycling 2 or 3 times a week. Start stretching exercises, hold for 30 secs, 5 times a day.
  • Week 5: Build up exercises, 4 sets of 6 to 8 reps 2 days a week. Gradually build up to sports specific exercises.

A doctor or sports therapist can use sports massage to speed up recovery as well as ultrasound or electrical stimulation. In some cases, surgery is required. If you suspect a grade two or three injuries I recommend you see a Sports Injury Specialist immediately.

Deltoid contusion

A deltoid contusion is a bruise in the deltoid muscle. This occurs after a direct impact to the muscle, usually from a hard, blunt object such as a hard ball or an opponents elbow!

Symptoms of a Deltoid Contusion

  • Pain in the muscle after impact.
  • Pain and difficulty when lifting the arm to the side.
  • Tender to touch the muscle.
  • Bruising appears.
  • There may be some swelling.


  • Rest the arm, apply a sling if necessary to relax the muscle.
  • Apply ice or cold therapy products as soon as possible and regularly to ease the deltoid pain, bleeding, and inflammation.
  • In most cases, a deltoid contusion will heal naturally within 1-2 weeks.
  • If symptoms persist visit a doctor to rule out further damage.
  • Also look out for neural signs such as tingling, numbness, and weakness in the arm or hand which may indicate nerve damage.

Read more on Contusions.

This article has been written with reference to the bibliography.

Shoulder Problems and Injuries | HealthLink BC

Do you have a shoulder injury or other shoulder problem?


Shoulder problem or injury


Shoulder problem or injury

How old are you?

Less than 5 years

Less than 5 years

5 years or older

5 years or older

Are you male or female?

Why do we ask this question?

The medical assessment of symptoms is based on the body parts you have.

  • If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
  • If your symptoms aren’t related to those organs, you can choose the gender you identify with.
  • If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Have you had shoulder surgery in the past month?

If a cast, splint, or brace is causing the problem, follow the instructions you got about how to loosen it.


Shoulder surgery in the past month


Shoulder surgery in the past month

Have you had a major trauma in the past 2 to 3 hours?


Major trauma in past 2 to 3 hours


Major trauma in past 2 to 3 hours

Have you had a shoulder injury in the past month?


Shoulder injury in the past month


Shoulder injury in the past month

Are you having trouble moving your shoulder?

Pain and swelling can limit movement.


Difficulty moving shoulder


Difficulty moving shoulder

Can you move the shoulder at all?


Able to move the shoulder


Unable to move the shoulder

Have you had trouble moving for more than 2 days?


Difficulty moving for more than 2 days


Difficulty moving for more than 2 days

Have you had numbness, tingling, or weakness in your arm, hand, or wrist for more than an hour?

Weakness is being unable to use the arm or hand normally no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness.


Numbness, tingling, or weakness for more than 1 hour


Numbness, tingling, or weakness for more than 1 hour

Did the shoulder or collarbone get twisted out of shape or pop out of its normal position?


Shoulder was out of normal position


Shoulder was out of normal position

Is the shoulder back in place now?


Shoulder back in place

Has the shoulder popped out of place before?


History of dislocation

Has sudden, severe weakness or severe numbness affected the whole arm or the whole hand?

Weakness is being unable to use the arm or hand normally, no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness.


Severe or sudden numbness or weakness in the whole arm or hand


Severe or sudden numbness or weakness in the whole arm or hand

Are you having trouble moving your shoulder?

Pain and swelling can limit movement.


Difficulty moving shoulder


Difficulty moving shoulder

Is it very hard to move or somewhat hard to move?

“Very hard” means you can’t move it at all in any direction without causing severe pain. “Somewhat hard” means you can move it at least a little, though you may have some pain when you do it.

Very hard

Very hard to move

Somewhat hard

Somewhat hard to move

How long have you had trouble moving your shoulder?

Less than 2 days

Difficulty moving shoulder for less than 2 days

2 days to 2 weeks

Difficulty moving shoulder for 2 days to 2 weeks

More than 2 weeks

Difficulty moving shoulder for more than 2 weeks

Has the loss of movement been:

Getting worse?

Difficulty moving is getting worse

Staying about the same (not better or worse)?

Difficulty moving is unchanged

Getting better?

Difficulty moving is improving

Is the arm blue, very pale, or cold and different from the other arm?

If the arm is in a cast, splint, or brace, follow the instructions you got about how to loosen it.


Arm blue, very pale, or cold and different from other arm


Arm blue, very pale, or cold and different from other arm

Is there any pain in the shoulder?

Has the pain:

Gotten worse?

Pain is increasing

Stayed about the same (not better or worse)?

Pain is unchanged

Gotten better?

Pain is improving

Does your child seem to be protecting the arm or not using it normally?


Favoring arm or not using arm normally


Favoring arm or not using arm normally

Do you have any pain in your shoulder?

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

How long has the pain lasted?

Less than 2 full days (48 hours)

Pain less than 2 days

2 days to 2 weeks

Pain 2 days to 2 weeks

More than 2 weeks

Pain more than 2 weeks

Has the pain:

Gotten worse?

Pain is getting worse

Stayed about the same (not better or worse)?

Pain is unchanged

Gotten better?

Pain is getting better

Do you think that the shoulder problem may have been caused by abuse?


Shoulder problem may have been caused by abuse


Shoulder problem may have been caused by abuse

Do you think the problem may be causing a fever?

Some bone and joint problems can cause a fever.

Are there red streaks leading away from the area or pus draining from it?

Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?

“Hardware” includes things like artificial joints, plates or screws, catheters, and medicine pumps.


Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area


Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area

How long have you had problems with the shoulder?

Less than 1 week

Symptoms for less than 1 week

1 to 2 weeks

Symptoms for 1 to 2 weeks

More than 2 weeks

Symptoms for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines and natural health products can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

When an area turns blue, very pale, or cold, it can mean that there has been a sudden change in the blood supply to the area. This can be serious.

There are other reasons for colour and temperature changes. Bruises often look blue. A limb may turn blue or pale if you leave it in one position for too long, but its normal colour returns after you move it. What you are looking for is a change in how the area looks (it turns blue or pale) and feels (it becomes cold to the touch), and this change does not go away.

Symptoms of infection may include:

  • Increased pain, swelling, warmth, or redness in or around the area.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Major trauma is any event that can cause very serious injury, such as:

  • A fall from more than 3.1 m (10 ft)[more than 1.5 m (5 ft) for children under 2 years and adults over 65].
  • A car crash in which any vehicle involved was going more than 32 km (20 miles) per hour.
  • Any event that causes severe bleeding that you cannot control.
  • Any event forceful enough to badly break a large bone (like an arm bone or leg bone).

With severe bleeding, any of these may be true:

  • Blood is pumping from the wound.
  • The bleeding does not stop or slow down with pressure.
  • Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may be true:

  • The bleeding slows or stops with pressure but starts again if you remove the pressure.
  • The blood may soak through a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be true:

  • The bleeding stops on its own or with pressure.
  • The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
  • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Pain in children 3 years and older

  • Severe pain (8 to 10): The pain is so bad that the child can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt the child’s normal activities and sleep, but the child can tolerate it for hours or days.
  • Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

  • Passing out (losing consciousness).
  • Feeling very dizzy or light-headed, like you may pass out.
  • Feeling very weak or having trouble standing.
  • Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

  • Passing out (losing consciousness).
  • Being very sleepy or hard to wake up.
  • Not responding when being touched or talked to.
  • Breathing much faster than usual.
  • Acting confused. The child may not know where he or she is.

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Light-headedness or sudden weakness.
  • A fast or irregular heartbeat.

The more of these symptoms you have, the more likely it is that you’re having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, or a strange feeling in your chest or other areas.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Post-Operative Problems

Shoulder pain – Better Health Channel

Shoulder pain is common in our community. 

In younger people, shoulder pain is more likely to be due to an accident or injury. However, as you get older, natural wear and tear occurs in the shoulder joint and the rotator cuff tendon. Over time, this may become persistent pain. 

The good news is that with appropriate treatment shoulder pain will improve so you can get back to doing the things you enjoy.

The shoulder

The shoulder is a complex, highly mobile structure made up of several components. There are two joints in the shoulder:

  • glenohumeral joint – where the upper arm bone (humerus) connects with the shoulder blade (scapula) 
  • acromioclavicular joint – where the top of the shoulder blade meets the collarbone (clavicle).

Strong connective tissue forms the shoulder capsule. This keeps the head of the humerus in place in the joint socket. The joint capsule is lined with a synovial membrane. It produces synovial fluid which lubricates and nourishes the joint. 

Strong tendons, ligaments and muscles also support your shoulder and make it stable.

What causes shoulder pain?

There are many causes of shoulder pain and not all of these are due to problems of the shoulder joints or associated structures.


Cartilage is a smooth, cushiony tissue that covers the ends of bones where they meet in a joint. Healthy cartilage helps your joints move smoothly. Over time cartilage can become worn, or it may become damaged due to injury or an accident, leading to the development of osteoarthritis. 

Inflammation of the shoulder capsule

The synovial membrane of the shoulder may become inflamed – this is called ‘synovitis’. Synovitis may occur as a result of another condition (for example, rheumatoid arthritis) or it may happen as a result of an injury, or the cause may be unknown.

Frozen shoulder (‘adhesive capsulitis’) is a condition that occurs when the shoulder capsule thickens and becomes inflamed and tight. There may also be less synovial fluid to lubricate the joint. As a result, the shoulder becomes difficult to move. 

Frozen shoulder may occur as a result of another condition if the shoulder has been immobilised (for example, due to surgery or injury). Sometimes the cause of shoulder pain may not be known. 

Inflamed bursa

Pain associated with an inflamed bursa is also common in the shoulder.

A bursa is a small fluid-filled sac that reduces friction between two structures, such as bone, muscle and tendons. In the shoulder, the bursa that sits between the rotator cuff tendon and the bony tip of the shoulder (acromion) can become inflamed, most commonly with repetitive movements.

Injuries and sprains

Ligaments are soft tissues that connect bones to bones. They provide stability to the shoulder by keeping the bones where they’re meant to be. If ligaments are injured or sprained, it can cause short term pain. This may be the result of the humerus coming partially out of the joint socket (subluxation) or if the humerus comes completely out (dislocation). 

The flexible tissue that helps keep the shoulder joint in place (labrum) can become torn. This is called a ‘labral tear’. This can occur as a result of an injury (for example, falling onto your outstretched arm) or repetitive actions (for example, due to playing sports that involve throwing, such as cricket).

A direct blow to the shoulder can result in acromioclavicular joint (‘AC joint’) being sprained. This type of injury often occurs in people participating in contact sports such as football who take a blow to the shoulder. It can also occur as a result of a fall.

The group of tendons and muscles that keeps the shoulder stable and positioned correctly for the shoulder and arm to move is called the rotator cuff. Tears to rotator cuff tendons may occur as a result of an injury (for example, a fall or broken collarbone) or happen over a period of time as we age.  

Neck and upper back

Problems with the joints and associated nerves of the neck and upper back can also be a source of shoulder pain. The pain from the neck and upper back is often felt at the back of the shoulder joint and through to the outside of the upper arm. 

Injury to the axillary nerve

This nerve can be injured as a result of a shoulder dislocation or fractured humerus, and cause weakness in moving the arm outwardly away from the body. 

Referred pain

Shoulder pain may also be caused by problems affecting the abdomen (for example, gallstones), heart (for example, angina or heart attack) and lungs (for example, pneumonia).

Note: If you feel shoulder pain that is radiating down your arm or you’re experiencing a tight feeling across the chest and shortness of breath, dial 000 immediately. 

Signs and symptoms of shoulder pain

There may be many causes of shoulder pain. They all have their own unique set of symptoms. 

People with shoulder pain can experience pain deep in the shoulder joint, in the back or the front of the shoulder and the upper part of the arm. Sometimes the pain in the shoulder can be described as a ‘catching pain’. The location and type of pain is likely to relate to the structure causing the pain.

In some conditions there may be reduced movement, and moving the shoulder may cause you to feel pain. A feeling of weakness of the shoulder/upper arm is also common. 

Depending on the condition, there may be a sensation of the joint slipping out and back in to the joint socket, or the shoulder can become completely dislodged (dislocated). Some people may experience sensations of pins and needles (tingling) and burning pain. This is more likely to be associated with nerves from the neck than the shoulder joint itself.

Lack of movement after a shoulder dislocation is usually due to pain. Complete rotator cuff tears and injury to the axillary nerve both cause weakness in moving the arm away from the body. These problems require close clinical examination.

Diagnosing shoulder pain

Health practitioners who treat shoulder pain are trained to investigate and identify the exact cause of the condition or injury causing the pain. They will do this by:

  • asking about your shoulder pain, including potential causes (for example, recent injuries or other health conditions), if you have had shoulder pain before, things that make your pain worse, things that make it better
  • conducting a thorough physical exam.

From this information they can work out the likelihood of particular structures in the shoulder region being involved. Sometimes they will suggest that investigations or tests may be needed. 

It is important to know that many investigations show ‘changes’ to your shoulder that are likely to represent the normal passage of time (even by 45 years of age), not ‘damage’ to your shoulder. An experienced health practitioner can help you to understand the difference.


X-rays provide images of the bones and joints. They can show any changes caused by arthritis in the shoulder joint (for example, bone spurs or narrowed joint space) or fractures. However x-rays do not show any changes or problems with the soft tissues such as muscles and tendons. 


Ultrasounds are typically used to investigate the rotator cuff tendon for inflammation, tears or rupture. While it can be a helpful tool to use, and can provide clues to identify the source of your pain, a diagnosis can’t be made using the ultrasound alone.

If an ultrasound is ordered, then an x-ray will also be arranged. Both tests together will provide more complete information about the state of the joints and the tendon.

CT and MRI

Computed tomography (CT) and magnetic resonance imaging (MRI) scans are usually not the first tests used to investigate shoulder pain. They may be used when a fracture is suspected or an accident is involved. These scans will help determine the extent of injury and whether further assessment and treatment by a surgeon is needed. 

Treating shoulder pain

There are many treatments for shoulder pain.


One of the first treatment approaches for shoulder pain involves physiotherapy and modifying the activities that aggravate the pain. 

Physiotherapy exercise will aim to fix problems such as stiffness and weakness. It will also include retraining the movements or activities related to your sport, work or everyday activities that were aggravating your shoulder so that, wherever possible, you can get back to what you were doing.

Occupational therapy

If your shoulder pain is making everyday activities difficult, it may be helpful to see an occupational therapist. They can help you learn better ways to carry out daily activities such as bathing, dressing, working or driving. They can also provide aids and equipment to make everyday activities easier.

Heat and cold packs

Heat and cold packs may help provide you with temporary relief of pain and stiffness.


Medications such as paracetamol and low dose anti-inflammatories can be helpful in controlling pain while you work to maintain and restore movement and function. If you have high blood pressure or cardiac or kidney disease, be sure to talk to your doctor before using these medications. 

Medications should not be considered as a long-term solution for your shoulder pain. If your pain persists, discuss other treatment options with your doctor. 

For persistent pain, your doctor may suggest a corticosteroid injection. While it’s important to understand that all medications have side effects, for most people an injection to help reduce pain while they recover is well tolerated. The injection may be repeated once or twice, depending on your circumstances. Keeping a pain diary will help you track how effective it is, and if other forms of treatment are required. 

In cases of frozen shoulder, a hydrodilatation may be suggested. This is an injection of fluid (saline and a steroid) into the joint. There is evidence to support this treatment for symptom relief and improved range of motion. Physiotherapy in the days after treatment has been shown to provide further improvements.


For most people, shoulder pain will improve over time with appropriate, conservative treatment. However in some cases surgery may be required.

The work that you have already done to try and resolve your shoulder pain (such as physiotherapy) is important when facing shoulder surgery. Being informed, and maintaining muscle strength and range of motion leads to better results after surgery. Post-surgery rehabilitation is also important for good results.

Surgery may be required for the following conditions:

  • recurring or frequent dislocations
  • acute rotator cuff tears (tears that have recently occurred as the result of an injury)
  • chronic rotator cuff tears (tears that occur as a result of wear and tear as you age)
  • severe joint damage as a result of osteoarthritis and rheumatoid arthritis. 

Surgery for frozen shoulder requires careful consideration as it is a condition that usually resolves naturally over time and can be managed non-surgically. It is not uncommon for pain and stiffness to persist after surgery for this condition. 

Self-management of shoulder pain

Most people with shoulder pain will recover from their condition. Committing to an exercise-based rehabilitation program can help. It may also be necessary to make modifications to lifestyle and work practices that aggravate your shoulder pain. Talk with a physiotherapist and occupational therapist for advice. 

When to be concerned about shoulder pain

It can take some time for shoulder pain to settle, perhaps weeks or months. In general, if your shoulder pain has not begun to settle in a week or two, or if it worsens over time, then it may be worthwhile seeing an experienced doctor or health practitioner. 

If you find that you need stronger medication to manage your shoulder pain, discuss this with your doctor. You may need a referral to a specialist.

Note: Shoulder pain or discomfort around the front of one or both of the shoulders can be a sign of a heart attack. It is often described as an ache, heaviness or pressure sensation spreading from the chest to the shoulders. This requires immediate medical attention. Call 000 immediately if you are experiencing these symptoms.

Long-term outlook for shoulder pain

Most people with shoulder pain will find the condition will settle over time. Working with your healthcare team and using self-management techniques will lead to the best outcomes. This treatment may require an experienced physiotherapist to guide you through a comprehensive rehabilitation program. 

Where to get help


Thanks to the following organisations whose pain experts helped create and review this content. 

Why Is My Shoulder Pain Worse at Night?

There are basically three conditions that can cause shoulder pain to worsen at night: bursitis, tendonitis, and rotator cuff injuries. This is because the inflammation involved in each can pull on the shoulder joint, especially when the area is compressed (as when laying on your side in bed).

This can make your shoulder feel stiff and painful. You may also experience muscle spasms, numbness, or tingling that radiates down to your fingers.

Shoulder pain that worsens at night may be caused by the following:

  • Bursitis. This condition is caused by an inflammation of the bursa, a fluid-filled pad that cushions joints. Once bursitis develops in the shoulder, you are subjected to a vicious cycle of swelling, pain, and more swelling, leading to more pain … until you appropriately treat the condition. Bursitis in the shoulder is a common culprit of nighttime shoulder pain because laying on your side can compress the bursa, increasing the level of pain you’d normally feel with the bursitis.
  • Tendonitis. This also is an inflammation-due-to-repetitive-use type of injury. When it occurs in the shoulder, the tendons that attach muscle to bone become inflamed and irritated, causing pain and stiffness in the area. Pain usually worsens at night, making it difficult to go to sleep or stay asleep at night. This may be because the effects of gravity when laying down cause the muscles and tendons in the shoulder to settle in a slightly different position, decreasing blood flow to the area and aggravating the pain of tendon issues like tendonitis.
  • Rotator Cuff Injuries. The rotator cuff consists of muscles and tendons that connect the upper arm to the shoulder blade. The rotator cuff stabilizes the shoulder and enables smooth movement of the joint. Damage to the rotator cuff of the shoulder is a common overuse injury that can also result from a fall, lifting too heavy an object, or a car accident. It causes swelling and pain in the shoulder that can worsen at night because your position in bed – especially if you lay on your side – can further irritate and inflame the damaged muscles and tendons of the rotator cuff.

What to Do About Nighttime Shoulder Pain

If one shoulder hurts when sleeping, try laying on the other side. While people often do not control their bodies while asleep, you could try building a wall with pillows to prevent rolling over onto the injured shoulder while asleep. If that doesn’t help, try sleeping semi-upright either in a chair or by propping a few pillows under the upper body to alleviate pressure on the affected shoulder. Ask your doctor for a list of stretches that can be done to loosen the shoulder; these may be especially beneficial to do before going to bed.

However, if shoulder pain is a fact of life for you, it may be time to seek treatment.

Your orthopedic doctor will physically examine your shoulder, assess your medical history, and may order tests that can help with a diagnosis and identifying the cause of your shoulder pain. In general, an X-ray can identify structural issues such as bone fractures or spurs or the presence of arthritis; for soft tissue assessment, an MRI may be required.

Depending on your diagnosis, your doctor might prescribe corticosteroid injections to counter the effects of swelling. Specific exercises or stretches may be recommended and, if all else fails, surgery may be necessary to fix the problem. Most shoulder repairs can be done arthroscopically, requiring small incisions in a relatively quick procedure that involves less trauma to surrounding healthy tissue than is typical in traditional “open” surgeries. In some cases, a joint replacement surgery may be the best way to treat your pain for long-term symptom relief.

The Orthopaedic Associates of Central Maryland offer all manner of orthopedic treatments under one roof. If your shoulder has been aching and shows no sign of improvement, schedule your appointment by calling (410) 644-1880 or use the request an appointment form. We look forward to seeing you.

Shoulder Pain at Night

One of the most common complaints I hear in my office is that a patient cannot sleep due to shoulder pain from sleeping.  They tell me that no matter what side they try to sleep on, it still hurts.  Some patients report stiff or dull pain that becomes worse when they raise their arm or shift from side to side.  Other symptoms may include numbness and tingling in your fingers or a muscle spasm.

What’s going on?

The shoulder is one of the most agile joints of the body, allowing movement in all directions. Because of this, it can be more susceptible to injury. Painful conditions may also arise from overuse due to a specific activity or shoulder motion that you make repetitively. Any repetitive shoulder motion can cause an overuse injury, but racket and ball throwing sports are common culprits.

Typically, shoulder pain that gets worse at night may be caused by bursitis, tendinopathy or an injury to the rotator cuff.

Bursitis is an inflammation of the bursa, which is a fluid-filled pad that provides a cushion to the bones of the joint. When injured, fluid in the bursa increases and this swelling can be painful.

Biceps Tendinopathy is usually the result of long term overuse and deterioration of the biceps tendon that connects muscles and bones in the shoulder joint. Tendons may also get less flexible as we age, and more prone to injury. Tendinopathy is often part of the aging process. Biceps tendinopathy can give sharp pains in the arm with certain motions like reaching behind you.

Rotator cuff injuries usually involve a tear in these tendons. The rotator cuff includes four muscles that come together as tendons and connect your humerus bone to the shoulder blade. The cuff provides shoulder stability and enables movement. Damage to any one of the four muscles could result in inflammation,  swelling and general pain in shoulder.  Rotator cuff tears are a very common problem and may result from a fall or lifting something too heavy, too fast. But most tears occur as the tendons wear down over time.

Before you see the doctor

The first course of action is to reduce the swelling and pain. Things you can try at home include:

  • Take anti-inflammatory medications such as ibuprofen, naproxen or acetaminophen
  • Sleep in a recliner
  • Apply ice or heat
  • Wear a compression sleeve
  • Discontinue any activities that may have contributed to overuse of the shoulder

If the shoulder pain doesn’t go away or worsens, see an orthopedic specialist. It’s important to see a doctor who specializes in shoulder care to properly diagnose your condition to ensure you’re getting the best treatment. The doctor will evaluate your X-ray or MRI and determine a care plan. Non-surgical treatments may include activity modifications, physical therapy and/or a cortisone shot to ease the pain. Newer treatments involving regenerative medicine may also be an alternative. This is typically the use of your own blood platelets or stem cells to heal the injured area. More information on these types of treatment can be found at our sister practice Regen Orthopedics.

If there is no improvement in your strength or the injury worsens over time, surgery may be the best option to restore function and alleviate pain.

We’re here to help

We would be happy to evaluate your shoulder condition or provide a second opinion. Call 844-SHOULDR (844-746-8537) to schedule an appointment.


The Cleveland Shoulder Institute treats patients with all types of shoulder and elbow disorders resulting from traumatic injuries, arthritis, instabilities, rotator cuff and sports-related injuries. Led by nationally recognized Orthopedic Surgeon Reuben Gobezie, MD, the institute provides both surgical and non-operative treatments.

Dr. Gobezie is one of the country’s top specialists in advanced arthroscopic and open surgical techniques to restore damaged joints, ligaments and bones. He is also one of the most experienced and highest volume shoulder surgeons in the country. A number of studies have shown that surgical volume, the number of surgeries a surgeon performs each year, is a strong predictor of patient outcome. The more surgeries that a doctor and his surgical team performs, the better the results for patients.

Dr. Gobezie is Founding Director of The Cleveland Shoulder Institute , Regen Orthopedics and PT Genie.

90,000 Muscle pain. Causes, self-diagnosis :: ACMD

A few words about the causes of muscle pain.

Pain in the lower back, shoulder girdle or knee? Why does muscle pain occur? Probably one of the most common causes of muscle pain is muscle spasm. We all know this very well!

But where does the spasm come from? I would like to suggest that you consider two concepts of the onset of muscle spasm:

I compensatory muscle spasm

Let’s imagine that you are a football player playing in a team where each of the 11 players performs their function.The game turns out to be well-coordinated and all team members are equally tired by the end of the match. But suddenly, the referee removes several players from the field for gross violation of the rules. You, as an attacker, have to return after each attack and perform the functions of defenders, in which case by the end of the match you will get much more tired, since, in addition to your functions, you also performed others. Approximately, the same thing happens with the muscles …

When the arm is pulled to the side, the main driving force is the force of the deltoid muscle (Fig.one). If, for some reason, its function is disrupted (violation of innervation, injury to the muscle itself, etc.), and you still move your hand, performing daily habitual movements, the nervous system “redistributes responsibilities”, placing the main responsibility for abducting the hand on other muscles (most often the trapezius muscle and supraspinatus muscle). As a result of the performance of additional functions by the muscle, it is overloaded, spasms and hurts.


1. If you feel pain in the shoulder girdle, stand in front of the mirror, close your eyes and move your arms to the sides (up to 90 degrees), open your eyes and see if the position of the shoulder has changed.If the shoulder lifted up along with the arm, it means that the trapezius muscle was also involved in the execution of the movement.

2. Take a deep breath. If, with a deep breath, the shoulders rise strongly, the trapezius muscle compensates for the dysfunction of the abdominal diaphragm.

II antagonist muscle spasm

The reason for such a spasm is the principle of muscle work – “ALL or NOTHING”. Each muscle contracts with tremendous force that can injure joints, bones and tendons.This is prevented by the presence of the antagonis muscle

ta, and the peculiarities of the nervous organization of muscle work. An antagonist is a muscle that is opposed to a muscle performing a movement. Let’s take a look at the shoulder muscles as an example. (Fig. 2) When the arm is bent at the elbow, the biceps muscle of the shoulder strains concentrically (that is, the places of its attachment come closer), and the antagonist muscle – the triceps muscle of the shoulder, strains eccentrically (that is, when stretching, the places of attachment move away).

Imagine that two people of the same strength are pulling a rope.With an equal effort, the rope will be motionless, but as soon as one of them shows weakness, the rope will immediately be on the side of the “strength”, while the applied effort has not changed. If the manifestation of weakness was sharp enough, then the person on the opposite side may even fall and be injured, although he is not to blame, nothing has changed in his actions. So what happens? Is the stronger one suffering?

The same pattern can be traced in muscle work. If the triceps brachii muscle is functionally weak and cannot provide adequate resistance to the contraction of the biceps brachii, the latter will contract excessively, causing spasm and pain.

What would you like to add at the very end. We, as a communist party, often struggle with strength, not weakness. If the cause of functional muscle weakness is eliminated (violation of innervation, disruption of communication with internal organs, infectious diseases, etc.), then compensatory overworked muscles should establish their usual tone, freeing themselves from unnecessary stress …

If you have any questions – you are welcome

90,000 SHOULDER PAINS: trigger points of the deltoid muscle | SLAVYOGA – health and yoga

The deltoid muscle (musculus deltoideus) can cause pain in the shoulder joint, limiting its function.

Recommended for viewing

The deltoid muscle: anatomy

This superficially located human muscle consists of three parts: anterior, middle and posterior.

Above, the anterior part of the deltoid muscle is attached to the outer third of the clavicle, the middle part to the acromion of the scapula, and the posterior part to the outer part of the spine of the scapula. At the bottom, all parts of the muscle come together and attach to the deltoid tuberosity of the humerus.

The deltoid muscle: functions

What are the functions of the deltoid muscle?

All parts of the deltoid muscle

The main function of the deltoid muscle, in which the anterior, middle and posterior parts of it are activated, is to abduct the shoulder in the shoulder joint.

Deltoid: Anterior

The anterior deltoid is also involved in shoulder flexion.

The anterior part of the deltoid muscle takes part in the horizontal adduction of the shoulder.

The anterior part of the deltoid muscle is involved in medial (internal) rotation (rotation) of the shoulder in the shoulder joint.

As noted above, the anterior deltoid muscle is involved in shoulder abduction in the shoulder joint.

Deltoid muscle: middle part

The middle part of the deltoid muscle takes part in shoulder abduction, as well as, together with the front part, in shoulder flexion in the shoulder joint.

Deltoid muscle: posterior part

The posterior part of the deltoid muscle, in addition to abduction of the shoulder, participates in horizontal abduction.

The posterior bundle of the deltoid muscle is involved in the extension of the shoulder in the shoulder joint.

The posterior part of the deltoid muscle is involved in lateral (external) rotation (rotation) of the shoulder in the shoulder joint.

Deltoid muscle: trigger points

Myofascial trigger points in the deltoid muscle are found in a large number of people.If the triggers are located in the anterior part of the muscle, then the pain is reflected in the anterior and middle deltoid region.

When the trigger points are in the back of the deltoid, pain occurs at the back of the shoulder joint, sometimes spreading over the entire back of the shoulder.

Trigger points located in the middle of the muscle cause pain at the site of their localization, sometimes involving adjacent areas.

The deltoid muscle has one important feature.The fibers of the anterior and posterior parts are spindle-shaped and the trigger points in them are found in the middle of the muscle bundles in the places of the end plates – the areas of contact of the motor nerve with the muscle spindle. The fibers of the middle part have a feathery structure and trigger points can be located along its entire length.

One of the reasons for the development of trigger points in the deltoid muscle may be a shoulder injury during physical activity or sports competitions. Pain occurs most often with arm movements, but it can also occur at rest or asleep.The presence of multiple triggers in the deltoid muscle is accompanied by a significant decrease in strength and the development of physical instability in the shoulder joint. Depending on the localization of the myofascial trigger points, there will be problems with arm flexion, arm abduction, and arm extension.

The front of the deltoid muscle can be injured when firing a firearm, carrying significant weight on the shoulders, or any repetitive work that involves prolonged shoulder flexion, such as manually sorting mail in mailboxes.If the anterior part of the muscle is damaged, the person cannot perform the “rub back” test; put your hand behind your back and move it left and right.

The posterior part of the deltoid muscle can be affected by trigger points as a result of excessive physical exertion, for example, during skiing, when the shoulder is constantly extended as a result of working with ski poles.

Sometimes vitamins, antibiotics or, for example, diphtheria vaccine are injected into the deltoid muscle region.If the substance enters the latent myofascial trigger point, then its activation may occur with the development of a pain symptom, therefore, before the injection, it is imperative to examine the shoulder area for the presence of muscle seals.

In the presence of trigger points in the back of the deltoid muscle during the circumferential girth test, which is also used to diagnose the lesion of the deltoid muscle, which I mentioned in this video,

people, due to severe pain, can only reach the crown …

The midsection of the deltoid muscle can be affected by trigger points as a result of any repetitive, monotonous abduction activity, such as daily fanatical dumbbell work in the gym.

The simplest method for diagnosing the location and treatment of trigger points of the deltoid muscle at home is the following. Take a small massage roll or massage ball and, going up to the wall, press it on the deltoid area using your body weight.If you have both of these myofascial release tools, then I recommend first working on a small massage roll for a few minutes on all parts of the muscle, preparing the muscle and fascial tissue.

Having found areas of compaction and soreness, carry out more intensive mechanical action on the massage ball on these points. Apply pressure for one to several minutes.

After that, be sure to pull out the affected muscle fibers (see the video at the beginning of the publication).If the anterior part of the muscle and the anterior bundles of the middle part of the muscle are affected by the trigger points, then stretch it for 1-3 minutes in the doorway, placing the shoulder at the level of the shoulder joint or slightly lower. If you practice yoga, then for stretching you can use, for example, dhanurasana (bow pose). You can also stretch the same muscle fibers and restore its function by putting the affected hand behind your back, trying to grab the hand of the problem hand with the opposite hand raised up. Due to limited range of motion in the shoulder joint, begin traction using a towel or sock.By working systematically and regularly, you will end up being able to link both brushes. In yoga, in order to stretch these muscle bundles, asanas with a wrist lock behind the back are used. After working in one direction, be sure to do the exercise in the other as well.

In case of damage to the posterior part and posterior bundles of the middle part of the deltoid muscle, grab the elbow of the affected hand with the hand of the opposite hand and take the elbow to the side, pressing the hand to the chest.

In yoga, for example, bhuja swastikasana (dragonfly pose) can be used to stretch these parts of the deltoid muscle.


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Damage to the rotator cuff of the shoulder – Federal Center for Traumatology, Orthopedics and Endoprosthetics of the Ministry of Health of Russia (Smolensk)

Damage to the rotator cuff.
Allocate fresh rotator cuff injuries, chronic, degenerative and impingement syndrome.

The rotational cuff of the shoulder consists of the muscles that strengthen the shoulder joint: supraspinatus, infraspinatus, subscapularis, small round.Rotator cuff tears are more common after age 50 due to age-related changes in the tendons. Such damage can also occur in a young person due to the effect of significant force. The closer to fifty years, the greater the likelihood of an avulsion fracture of the greater tubercle of the shoulder along with the supraspinatus muscle. Rotator cuff rupture can occur when the arm is suddenly lifted forcefully against resistance, or when trying to soften a fall, or when lifting heavy objects or falling on the shoulder.In the elderly, cuff rupture is possible with minimal trauma.

Rotator cuff rupture can be at any point, but most often it occurs at the attachment of the supraspinatus muscle to the greater tubercle. The rotator cuff ruptures from compression between the head of the humerus and the junction of the clavicle with the process of the scapula. The decrease in strength in the injured arm becomes noticeable if more than three fibers of the tendon are torn.

Clinic. It rarely happens that a patient without any preliminary symptoms of a lesion of the shoulder joint immediately develops a detailed picture of the injury with acute pain and inability to raise the arm. When the rotator cuff ruptures, the patient complains of pain in the shoulder joint when moving. Pain can spread to the elbow joint or the insertion of the deltoid muscle. Some people report an increase in pain at night. The relationship between the degree and type of damage to the rotator cuff and the intensity of pain has not been established.However, with an objective examination of patients, almost all of them show an increase in pain when the shoulder is abducted to an angle of 60 ° and 120 ° (a symptom of an arc of painful abduction). Palpation (pressure) over the place of attachment of the tendon to the large tubercle increases the pain, although the defect of the “cuff”, even with its complete rupture, is not palpable. With old and stale lesions, crepitus (crunching) may be felt in the area of ​​the large tubercle, especially during movement. When studying the range of motion in the damaged joint when trying to actively (independent) shoulder abduction, the shoulder girdle rises upward (Leclerc’s symptom).Active abduction of the shoulder is possible up to an angle of 40 ° due to the action of the scapular-costal articulation. With an increase in the range of motion, the shoulder is lifted only together with the scapula. The symptom of a painful obstacle arises when the shoulder is abducted to the horizontal level – 90 °. Perhaps the most characteristic of these patients is the symptom of a “falling hand”: it is impossible to independently withdraw the arm to the horizontal level and keep it in this position. This is especially characteristic of patients with a “frozen shoulder”, the main reason for which is prolonged immobilization in the position of adduction of the hand.This test is performed as follows: raise the hand to an angle of 90 ° and ask the patient to hold it in this position. Light pressure on the lower forearm or wrist causes the arm to fall suddenly.

If a rupture occurs in the postero-upper part of the cuff, then the pain increases with abduction and internal rotation of the shoulder, while a rupture of the anterior-upper part causes pain with abduction and external rotation of the shoulder.

Diagnosis is carried out using ultrasound or magnetic resonance imaging.

Treatment. Conservative therapy gives good results in only 50% of patients. In young people with complete ruptures of the cuff, early surgical treatment is indicated. Surgery is generally not recommended for older people who are more relaxed. They should start passive motor exercises with a significant range of motion as early as possible. Arthroscopy of the shoulder joint is indicated for patients with suspected rupture of the rotator cuff of the shoulder or, if necessary, to clarify its type and degree.

Surgical treatment. In case of significant gaps, conservative treatment is futile, since the torn ends simply cannot grow together.

Partial injuries, despite the fact that the function of the torn tendon is to some extent taken over by the adjacent tendons and movements in the joint are practically painless, they also require timely surgical treatment.

Operation shown if:

  • there is a complete rupture, which makes movements in the shoulder joint impossible or limits their volume;
  • there is a partial tear that restricts movement, causes pain;
  • conservative treatment was unsuccessful.

During the operation, the torn tendon is pulled, returning it to the place of attachment, and sutured using special materials. It is worth saying that if several weeks pass from the moment of rupture, then the muscle whose tendon has come off gradually shortens, and in old cases it can be very difficult to stretch the muscle to its original length so that the end of the tendon returns to its place. As a rule, the most effective from this point of view are operations performed no later than 2-3 months after the rupture.

The essence of the operation is that the rupture is sutured, and if the tendon is detached from the place of fixation, then the suture is performed using special “anchor” clamps. Removal of all non-viable, degeneratively changed tissues of the rotator cuff is mandatory. Then the area of ​​the humerus, where the rotator cuff was torn or torn off, is cleaned of soft tissue residues so that the tendon is subsequently firmly fixed with scar tissue. After that, the severed tendon is directly fixed.As a rule, after the operation, it is necessary to wear a special fixation bandage. For full recovery to take place, you must undergo a special rehabilitation program.

Tendonitis of the shoulder joint

This is an inflammatory process and subsequent degeneration of the tendons in the shoulder joint. The tendon of the biceps of the shoulder, the supraspinatus muscle, can be involved in the process. Pathology can develop in any person, at any age, is more common over the age of 40 or in young people who are professionally involved in sports.The shoulder joint differs from other joints in a flattened glenoid fossa, a large range of motion, so tendon structures are affected quite often.


According to the localization of inflammation, tendonitis is distinguished:

  • supraspinatus muscle;
  • biceps;
  • rotator cuff.

With the disease, not only degenerative changes in tendons are possible. Allocate calcifying tendonitis, which is characterized by the deposition of salts in the affected areas.In this form of the disease, movements are accompanied by a characteristic crunch.

The course of the disease can be acute or chronic.


The disease usually develops as a result of trauma. People doing hard physical labor, athletes performing active hand movements are prone to inflammation of the tendons.
The causes of pathology also include prolonged immobilization, cervical osteochondrosis.

The ligamentous apparatus is often affected in women during menopause.This is due to hormonal changes in the body. Even moderate physical activity leads to microtrauma and inflammation of the soft tissue structures.


The first sign of a tendon injury is pain when making certain movements with your hands. Unpleasant sensations can occur not only during intense physical exertion, but also when performing simple household activities, at night when turning in bed.

The range of motion in the joint decreases over time, contractures develop.

Taking anamnesis, examining the affected joint, assessing the range of motion in the diseased joint, and comparing it with a healthy one helps to make a diagnosis. CT, MRI, and radiography are used as additional diagnostic methods. The survey allows you to determine the amount of changes, the presence of calcification sites.

Treatment of tendonitis of the shoulder joint

What to do if your shoulder hurts? See a doctor as soon as possible. Early therapy allows you to completely eliminate the problem, prevent the development of irreversible changes.

During treatment, the load on the joint is excluded until it is immobilized; sports should be temporarily stopped. In the acute stage, non-steroidal anti-inflammatory drugs, muscle relaxants, vascular drugs are indicated, blockades with anesthetics and corticosteroid drugs are performed.

Physiotherapy allows restoring the function of the joint, accelerating the restoration of damaged anatomical structures. A good effect can be obtained from a magnetic laser, magnetotherapy, UHF, electrophoresis with novocaine.

In the rehabilitation period, acupuncture, therapeutic massage, exercise therapy are prescribed. Special exercises allow you to restore the range of motion in the joint, do not lead to an overload of the diseased joint.

In case of severe contractures, cicatricial changes, surgical treatment is indicated. The operation allows you to remove the changed areas, restore the range of motion. Both classical access through a surgical incision and manipulations using endoscopic equipment are possible.


The main measures for the prevention of shoulder tendonitis:

  • avoid heavy loads;
  • Warm up muscles before sports training;
  • give rest to hands during monotonous work with the use of the shoulder-scapular joint;
  • avoid injury;
  • if pain occurs, stop physical activity and consult a doctor.


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Shoulder pain.Brachialgia. Shoulder-scapular periarthritis.

Patients are asked to massage their shoulders and arms, they do not even assume that they need more serious measures. Sometimes they have hope that manual therapy will help.

There are several reasons for shoulder pain, and one of the main ones is cervical osteochondrosis. A very common manifestation of it is humeral-scapular periatritis, characterized by the presence of prolonged aching and breaking pain in the shoulder and arm. This pain can also intensify when the hand is inserted behind the back or pulled to the side, and also spread along the arm, to the scapula and cervico-occipital zone.I would especially like to note the strong weakness of the shoulder muscles, in particular, the deltoid muscle, and often numbness in the fingers, “creeping creeps” and numbness of the hand in a dream is felt. But there is also a phenomenon that is popularly called “frozen shoulder syndrome”, when the patient cannot even raise his arm.

The reason for this is the instability of the acromioclavicular joint, as a result of which, first of all, the middle portion of the deltoid muscle is turned off. And to compensate for the weakness of this muscle, to raise the arm, the upper portion of the trapezoid is turned on.And when the upper trapezius muscle tries to somehow keep the unstable joint, it begins to shorten and hurt.

Normally, this joint should be supported by the posterior and anterior parts of the deltoid muscle, taking part in its stabilization. If they weaken, the acromioclavicular joint begins to loosen up. But why doesn’t the deltoid muscle turn on? The reason for this must be sought in what happens in the supraspinatus, infraspinatus and subscapularis muscles, whose function in abducting the head of the humerus is slightly to the side.And if there is a problem with the infraspinatus muscle, its hypotension, then there is no increase in the distance between the articular surfaces of the humerus and scapula, and as a result, the hand cannot rise up. That is, the deltoid muscle simply cannot start working.

Another factor that influences the appearance of pain in the shoulder with periarthritis of the shoulder scapula is a violation in the supraspinatus muscle. If there is instability of the acromioclavicular joint, then when the humerus turns, the tendon of the supraspinatus muscle is compressed, causing its damage.

There is also a violation in the tendon of the long head of the biceps. With weakness of the muscles that should fix the scapula from behind, the scapula is displaced to the side. The shoulder is tucked forward and inward, and with it the humerus is tucked in. Because of this twist, the biceps tendon of the arm either slips and is not in its groove, or changes its position. As a result, due to a change in its position during its contractions, this tendon begins to rub hard against the area in which it should move freely.And this leads to the destruction of this tendon. Then, over time, all this can lead to adhesions in the joint capsule, which, in turn, causes even more restriction of movement in the shoulder joint.

Many people go to polyclinics, but when they come to an appointment, they complain that the measures prescribed by the doctor do not help. The first step is to stabilize the acromioclavicular joint. To do this, it is necessary to restore the anterior and posterior portions of the deltoid muscle. Then see if there is any weakness of the infraspinatus muscle and shortening of the subscapularis.It is this violation that causes limitation of mobility in the shoulder joint.

So, if your arm does not go back well, then this is a problem of the infraspinatus subscapularis muscles. If the hand is poorly retracted to the side, it is most often the instability of the acromioclavicular joint. Normally, the tubercle of the humerus should slide under the acromial process of the scapula when the arm is abducted. And with humeral periarthrosis, the tubercle of the humerus, on the contrary, wedges into the acromion. And since the shoulder cannot rise because of this, then you have to lift it together with the whole hand.

Finally, it is important to make sure that there is no infringement of the supraspinatus tendon that occurs just below the acromion. Again, this happens when there is no stability in the acromioclavicular joint. When the acromion and the coracoid process of the scapula then diverge, then converge, then in the process of such movements they pinch the tendon of the supraspinatus muscle. Therefore, first there are inflammations, tendinitis, tendinosis, and in fact, this tendon is destroyed. Why is there such a discrepancy between the acromion and the coracoid process of the scapula?Because there is instability of either the clavicle or the scapula, or instability of the muscles that fix the acromion and the coracoid process of the scapula.

But where does clavicle instability come from? The reason for this is the weakness of the subclavian muscle. And it can also cause dysfunction of the sternocleidomastoid muscle. This can be seen by how the head will be constantly tilted to one side and more difficult to turn. Instead, a group of other muscles will turn the head to the side.

But there is another reason for the weakness of the subclavian muscle. This is the compression of the nerve that innervates this muscle. When this nerve is clamped at the level of the intervertebral foramen or at the level of the scalene muscle, the nutrition of this nerve and the conduction of the nerve impulse along the nerve, that is, its main function, occur.

Instability of the scapula may be due to dysfunction of the serratus anterior muscle. And there are a number of other factors that influence this.

However, in order to get rid of pain in the shoulder and from restriction of movement in the shoulder joint, as well as to cure periarthritis of the shoulder scapula, you must first determine the reason why certain muscles do not work, and what is the weakness of each of these muscles.And since it is very often associated with a violation in the neck, it is necessary to restore the muscles of the neck, normal mobility between the joints of the vertebrae. And after that, start doing special exercises.

Do not self-medicate. Consultation of a specialist is required.


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Deltoid muscle

Deltoid muscle – in human anatomy – the superficial muscle of the shoulder, which forms its outer contour.Takes part in flexion and extension of the shoulder, abduction of the arm to the side. The name “deltoid” comes from the similarity of the triangular shape of the muscle with the Greek letter Δ.
The average human muscle weight is about 192 grams. In many animals, for example in cats, it is known as the common shoulder muscle.

1.In human anatomy
Anatomically, three bundles are distinguished in the deltoid muscle:
middle lateral
However, according to the results of electromyographic studies, at least seven groups of fibers can be distinguished in it, functioning independently of each other.

1.1. In human anatomy Beginning and attachment
The anterior fiber group starts from most of the anterior edge and upper surface of the lateral third of the clavicle.
Lateral group – from the acromial part of the scapula.
Posterior group – from the lower part of the posterior edge of the spine of the scapula along its entire length to the medial edge.
Further, all three bundles are connected and pass into a common tendon, which is attached to the V-shaped tuberosity of the deltoid tuberosity, tuberositas deltoidea on the outer surface of the humerus.

1.2. In human anatomy Blood supply and innervation
The deltoid muscle is supplied with blood by the posterior artery, the circumflex of the shoulder a.circumflexa humeri posterior.
Innervated by the axillary nerve n.axillaris from the brachial plexus, formed by the anterior branches of the fifth and sixth pairs of cervical spinal nerves C5 and C6.

1.3. In human anatomy Function
With the simultaneous contraction of all muscle bundles, it causes the arm to be abducted in the frontal plane. The greatest effectiveness of this movement is achieved in the position of the hand by rotating inward.The antagonists in the abduction of the hand are the pectoralis major and broadest muscles of the back.
The anterior bundles are involved in lateral abduction of the arm during external rotation of the shoulder. In shoulder flexion, their role is small, but they help in this movement of the pectoralis major muscle, the elbow just below the shoulder. Promote the muscles of the subclavian, pectoralis major, and broadest back during internal rotation of the shoulder.
Lateral bundles are involved in lateral shoulder abduction when it is positioned in internal rotation and in horizontal abduction during external rotation, but practically do not participate in horizontal shoulder extension during internal rotation.
The posterior bundles take a large part in horizontal extension, especially due to the small participation of the latissimus dorsi muscle in this movement in the horizontal plane. Other horizontal extensors – the infraspinatus and the small round muscles – also work together with the posterior portion of the deltoid muscle as external rotators, antagonistic to the internal rotators – the pectoralis major muscles and the broadest. The posterior portion of the deltoid muscle also plays a large part in the overextension of the shoulder, supported by the long head of the triceps.

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90,000 how to get rid of back pain on your own.

Author – doctor-vertebroneurologist-manual therapist Korovkin Mikhail Alexandrovich.

Back pain, as a possible manifestation of many, often dissimilar diseases, is today such a common complaint among our environment that it seems that almost everyone suffers from the same sore. This feeling is quite close to the truth – indeed, 85% of the world’s population suffer from back pain, but the source of this pain is different.

Unquenchable pain will surely appear at some stage of the oncological process in the spine itself, and only fatigue will manifest itself after not traumatic, but monotonous and prolonged physical work in a healthy person. It can sharply aggravate after an awkward lifting of a large weight, so much so that for several days it will be impossible to walk to the toilet on its own. In an absolutely amazing way, which defies any reasonable explanation, the back can hurt after a strong nervous shock, and how can you not think about someone’s curse, evil eye or damage? Both rheumatism and some infectious and viral diseases can lead to it.It may be “reflected” and indicate a disease of some internal organ, or, which is quite natural, it may simply be the result of a direct injury to the back. Therefore, the complaint “Back hurts …” sounds both in the office of a traumatologist and in the offices of a neuropathologist, gastroenterologist, orthopedist, surgeon and many other doctors more often than other, specific complaints with which patients turn only to a surgeon or only to a neurologist. To paraphrase the classic, we can say that all healthy people are equally healthy, but sick people each get sick differently.

Many-sided, understandable and incomprehensible, it can appear in a perfectly healthy person due to a long stay of one of the joints in the extreme position of flexion or extension.

It is quite possible that you had to whitewash the ceiling in your apartment, after which, the next day, your neck probably hurt at least a little. Why did this pain occur? Because of illness? Well no. Simply by throwing your head back for a long time, you brought the joints of the cervical spine into a state of excessive extension.The joint capsules were unnecessarily stretched in an unusual direction for them, as a result of which pain arose in a healthy joint.

The true source is sometimes so carefully disguised with a variety of symptoms that, imitating other diseases, it causes serious diagnostic difficulties for doctors.

An incomprehensible patient, a young man of twenty-six years old, appeared in the trauma department of one of the Moscow clinics. In the department, he treated his complex fracture of the leg, which he received while drunk.The bone fragments were compared and the fracture healed safely. However, a week after admission, he began to complain of severe pain in his back and right side, turned pale, and began to moan. The nature of the patients in the trauma departments is quite typical – most often they are people who have received their injuries “drunk”, so the attending physician, accustomed to such a turn of the matter, suspected delirium tremens in his patient (a common thing) and called a psychiatrist-narcologist for a consultation.

The overweight and short-sighted narcologist rejected “his” illness from the doorway and, having talked with the sick guy for a couple of minutes, wrote a whole novel in the history of the disease in an unreadable handwriting, from which it followed that the patient had no delirium tremens.Meanwhile, the next temperature measurement showed an increase to 37.3 ° C, and the area of ​​the focus expanded somewhat.

Having smoked a couple of cigarettes in the resident’s office, an impromptu consultation, consisting of two traumatologists and an anesthesiologist who accidentally ran into them “for the light”, decided to call a urologist for a consultation. The urology professor came accompanied by two assistants and ten students. The consultation was carried out in the ward with all the luxury of a theatrical lecture, as a result of which the diagnosis was affirmatively renal colic.However, objective studies conducted an hour later refuted this diagnosis.

The situation was becoming alarming. The head of the trauma department joined in solving the problem. With a sweeping gesture, he summoned his friends-managers – a therapist and a surgeon – for a consultation. Imbued with the seriousness of the problem, not wanting to get into an absurd position, as an overly self-confident urologist, they examined for a long time, questioned and groped the patient, studied the analyzes accumulated by that time and thoughtfully “clicked” with their tongues.

The therapist threw up his hands, and the surgeon suggested a developing inflammation of the pancreas (“After all, a drinking guy …”). However, here, too, objective research methods did not confirm this assumption. The “drinking guy” was heavy in front of his eyes, his back pain intensified, his temperature kept at the same alarming and suspicious numbers. He moaned softly, and grimaced heavily, swearing wearily.

The next day, the venerable society of all the leading specialists of the hospital gathered in the smoky trauma resident’s room.We drank tea with cognac, played chess, smoked, recalled youth, made profound assumptions about a strange patient with a wild mixture of Latin and truly Russian expressions, prescribed tests, and after waiting for their results, made new assumptions. Elderly doctors, tired of the hospital routine, accepted the incomprehensibility of the disease as a challenge to their professionalism.

A vascular surgeon invited from the central venerable clinic suggested the development of thrombosis (obstruction) of the arteries supplying the intestines, and the orthopedist respected by the whole country suggested a prolapse of an intervertebral disc herniation, which appeared simultaneously with a leg injury, but this, like many other things, was refuted by X-ray data, ultrasound and ingenious blood tests.

After a couple of days the doctors were in complete bewilderment, the problem was resolved by itself – on the skin of the back, where the patient had pains, rashes of shingles appeared.

As you can see, the problem of a sore back can be so ambiguous that it can be difficult to understand it even for a whole council of highly qualified doctors. Therefore, in this book we will not talk about diseases, but about that banal back pain that can appear when doing routine household chores, long sitting at a student’s desk or computer, and an uncomfortable tilt of the body.In other words, let’s talk about pain that is concentrated in the ligaments and muscles of the back.

A bit of history

Traditionally, since the Old Testament times, a banal back pain that appeared after an unsuccessful turn or lifting weights was treated by a chiropractor. In the writings of ancient Rome, there is a story about a famous free gladiator named Kazanasta, who suffered from a pain in his shoulder after falling from a chariot. He was cured by the famous Claudius Galen, a doctor of gladiators, who, according to today’s table of ranks, apparently could be attributed to traumatologists.Galen crushed his patient’s back, tugged at the neck, massaged his shoulder, after which the pain passed, and Kazanasta returned to his sweet occupation. From this and many other narratives, it follows that the doctors of the ancient world were quite successful in coping with the problem.

The active Christianization of Europe prevented the spread and improvement of this skill. In the Middle Ages, during the era of the Holy Inquisition, curiosity was considered heretical and all curious people, usually on Saturdays, with a general gathering of people, in the main square, were burned at the stake.Therefore, in those twilight times, many scientific directions stopped in their development. Nevertheless, due to constant traumatic epidemics – wars, the need to eliminate pain in joints and muscles was extremely high. That is why certain techniques of chiropractors were nevertheless preserved in the hands of medieval doctors who knew how to correct dislocations of the joints of the extremities, and who considered it exclusively their professional work.

In a more foreseeable era, when a cohort of orthopedists and traumatologists emerged from universal doctors, work on the joints and muscles of the extremities became an obligatory part of their narrow specialization.However, the conservative, therapeutic treatment of the back remained the lot of the clandestine work of healers.

Not long ago, about thirty years ago, a patient with a chronic back problem was the most unloved patient among neuropathologists. We, today, have only to wonder at the amazing limitation and deformation of the then professional consciousness, which rejected the real methods of eliminating back pain.

At the end of the seventies, an elderly, well-known throughout the country professor-neuropathologist received a patient in her office in the presence of several residents, novice doctors.The patient was a young man of about thirty-five who complained of constant pains “radiating” to the right buttock and thigh. His suffering lasted for several years, during which he managed to be treated by many neurologists, but the disease, having stopped a little, continued to torment him and each time with a new passion. “Nice!” – the professor told him after the examination – “Darling! And don’t try anymore … It’s not fatal, but It will never go away. It will always hurt, so stop worrying and do not think … It will be a little better, a little worse, but it will not let go to the end … So stop going to the doctors … “

Protected by regalia, position and age, the professor said aloud what any neurologist would like to say to such a patient, but did not dare.I would like to say this because it is a thankless task to deal with chronic chronicity with drugs and massage, the main weapon of a neuropathologist. I didn’t dare say it because to say it out loud is to sign my professional inconsistency. It must be said that a neurologist who is not involved in manual therapy still has a dislike for this category of patients.

Orthopedists of the seventies also disliked patients with chronic back pain. They, orthopedists, are surgeons by vocation, serious and dashing guys.They were the first to feel one of the causes of the problem in the literal sense of the word – operating on the spine for intervertebral hernias. Surgical access to the hernia of the spine in those years was carried out through the abdominal cavity. This means that in order to “crawl” to the hernial protrusion it was necessary to open the abdominal cavity, move the intestines and then … The operations were difficult, but interesting, with a lot of complications. However, if there was nothing to operate, the orthopedist automatically lost all interest in the patient with a backache and referred him to the neurologist.

Unsettled by the explanation that “This will never pass,” offended by the negligence of neuropathologists and orthopedists, the patients went to the healer who was engaged in bone-setting. Legends were passed from mouth to mouth about the supernatural ability to heal the back, some village attendants or healers, who always live in the Darkness-Tarakani, who receive their patients in complete secrecy and raise sick people literally from their deathbed. At what level these folk healers worked is actually unknown.Probably, there were also skillful ones among them, who intuitively did not do stupid things, but there were others … Perhaps the number of positive results of their work was covered by the same number of failures or complications. Nevertheless, the very fact of pain relief, after manipulations on the joints and ligaments of the spine, aroused interest among professional doctors, and the technique of these manipulations preserved in the healers’ hands made it possible to overcome the zero cycle of medical ignorance in order to further improve and develop methods of conservative treatment of the patient. back.One of the ways to self-relieve back pain will be discussed in this book.

New hand doctor – chiropractor

So, the specialist who deals with the treatment of back pain is today called a chiropractor. Manus – in Latin, means “hand”. Hence the name – manual, that is, one that heals with his hands.

The first graduation of certified doctors – chiropractors in Russia fell on 1982.For many years, the status of these specialists, within the medical “get-together”, was very vague, and only in 1998 the chiropractor was officially included in the register of medical specialties and became a full-fledged doctor, such as a neuropathologist, therapist and surgeon.

There are over 18,000 chiropractors in Russia today, and this army continues to grow as the demand for back pain relief increases every day. According to American chiropractors and osteopaths (as chiropractors without medical education are called in America), in the United States, over the past 10 years, the need for specialists to eliminate back pain has increased 163 times! There is no reason to think that in Russia this need is less.

In Russia, unlike in many countries of the world, only a doctor can be a chiropractor. The spectrum of knowledge is very large and is of an integrative (systemic) nature. Due to the fact that manual medicine is at the intersection of neurology, orthopedics, rheumatology and physiotherapy, the need to master the basics of these disparate disciplines is at the center of their training. The difficult task is facilitated by the fact that doctors who come to manual medicine, as a rule, already have specialization and work experience in one of these disciplines.

A good chiropractor is not just a healthy, muscular guy who can crunch his vertebrae, but a clinician with a broad professional outlook and deep clinical thinking. This medical specialization provides the seeking physician with the opportunity to realize the Art in his work. Unfortunately, many other narrow specialists were forced to forget about the art in medicine, whose professional freedom is enslaved by a huge amount of diagnostic and therapeutic equipment, in which they are simply laboratory assistants.Unlike the elements of industrial, computerized medicine, live, skillful, warm human hands of a chiropractor cannot be replaced by anything!

The technique that this book is devoted to, developed by chiropractors, is used by them both as a separate type of treatment and as preparation for manipulations on the spine.

Pain problem

One of the obligatory symptoms of back pain is muscle tension.At the moment of exacerbation, the patient himself says that he cannot relax, that is, relax entire muscle groups, tense with the will of some evil fate. At this moment, his posture takes on a strange, bizarre configuration, which is supported by tense muscles. This protective reaction of the muscle sheath is similar to a splint that is applied to the fracture site in order to prevent the fragments from moving.

It follows that a muscle is not a fool to strain just like that – it starts to work in such an exhausting mode when a certain, painful impulse comes to it – a sign of the vital need to limit the range of motion in a certain place of our body.In this case, after a few hours, the muscle itself becomes the main source of pain.

From ancient times, long before the ancient Hippocrates, it was found that by mechanical stretching of a tense muscle, a person can independently get rid of pain. Most people know how to relieve pain in the gastrocnemius muscle, which often occurs during prolonged swimming. To do this, the swimmer grabs the toes and pulls them in such a way as to bend the foot towards the front surface of the lower leg. With this movement, the soleus (gastrocnemius) muscle is stretched along the length, as a result of which the pain that has arisen in it disappears.

This method is suitable for any muscle in our body, therefore, knowing certain points of application of your efforts, you can significantly alleviate your back pain, at least until the moment you see a doctor.

Principle of elimination of pain in tense muscle

It’s very simple. In any case, none of my patients had any problems with mastering these simple techniques, but first it is necessary to understand the very principle of manipulation.

A muscle with its ends is always attached to various bones in order to contract, causing them to converge.The bones are connected to each other by a joint, which is the center of this movement.

Painful, contracted muscle, always shortened, and stretching it is painful. But if you first cause a slight tension of this muscle, without its contraction in length, and then its relaxation and slow stretching, then the painful tension in it will disappear.

However, when pathological, that is, disease-causing processes occur, not one muscle contracts, but a whole complex of the most diverse and often quite distant muscles.Therefore, for the most accessible description of the methods of getting rid of pain, we will not delve into the anatomy and physiology of muscles, we will focus on the presence of certain symptoms.

Perhaps this approach is oversimplification, but an ordinary person, not burdened with knowledge of medical terms, very quickly gets tired of a thorough description of anatomical and physiological parameters, laws and conditions that are not interesting to him. For an ordinary person, the main thing is to quickly achieve a result, in this case, an anesthetic, and those who are especially interested, I would refer to professional literature.

Now let’s move on to studying the subject.

Imagine throwing a square gusset over your shoulders with the ends up, down, and to the sides. The projection of the tissue that covered your shoulders and the triangular flap – part of the neck and back, corresponds to the so-called trapezius muscle. This muscle throws the head back, pulls it to the sides, raises the shoulders, raises and lowers the shoulder blades. She begins to hurt when articular problems arise, both of the cervical spine and the thoracic.The pain is very characteristic and many are probably already familiar with it: it arises and worsens when the head is tilted forward, it can stretch from the middle of the back to the back of the head, and it can “stretch” part of the neck when tilting to the opposite shoulder, and even “give” to the upper part of the scapula …

What to do

The procedure is best performed in a sitting position.

While exhaling, put your hands locked in a “lock” on the back of your head and with your own hands slightly tilt your head forward until an unpleasant pulling pain appears in the back of the neck or the symptoms I have just described.

Begin to inhale slowly, at the same time slightly unbending your neck, but preventing this extension with your hands. As a result of this confrontation, tension will arise in the trapezius muscle, but movements, that is, extension of the neck, at this stage, should not occur.

Holding your breath for 5-7 seconds, you must exhale slowly. Together with a slow exhalation, also slowly relax, while tilting your head down with your hands, until the level at which pulling pains appear again on the back of the neck or between the shoulder blades.

With the beginning of the next inhalation, repeat everything, but with an exhalation, try to lower your head a little lower than the last time. If done correctly, this should happen by itself. As the trapezius muscle relaxes, you will be able to move more, and since the pain begins to recede, you can painlessly lower your head much lower than at the beginning of the lesson (but do not get carried away – not below your own knees!).

A few notes on

With what force to press the back of the head on your hands, and with what effort to resist your own head with your hands? With a similar question, but regarding professionally performed manipulations, my colleague once turned to the patriarch of manual medicine, a Czech professor, Karel Levit.In response, Levitus rested his index finger on his relaxed shoulder and pressed lightly, while his finger, significantly plunging into the relaxed deltoid muscle of the shoulder, slightly bent at the joint of the nail phalanx.

However, many readers will not understand this vague description of effort: what does slightly mean? And where to look for this deltoid muscle, and who is this “phalanx”?

Try to bend the auricle with your index finger until it touches the skin of the temple – this is that effort.This effort can also be likened to a light morning sip on the first day of a long-awaited vacation. However, for those who will not be satisfied with these comparisons, I propose to exert muscle tension of such force, as if you were not being paid for it.

There is one more clarification that will significantly affect the effectiveness of your independent and implacable struggle with pain. While inhaling, you need to raise your eyes up, as if you want to look at the ceiling, which your lovely neighbors flooded from above yesterday.This small addition will qualitatively improve the extension movement itself, and it will not strengthen it, but it will improve it – the movement will become more solid and organic.

You can feel the importance of this friendly eye movement with a simple exercise. Turn your head to the side until it stops in such a way that further, by muscular effort, the head could no longer turn. But one has only to look in the same direction over the shoulder, and the head will turn a few more degrees. In addition, with the help of a friendly movement of the eyes, the image of the characteristic movement is “imprinted” into the brain, which significantly increases the effectiveness of the procedure.

The same applies to breathing during muscle tension and relaxation. To feel the importance of friendly breathing, try the above exercise without using your hands or straining your muscles. Relax your neck so that it hangs limply over your chest. Take a slow, deep breath and feel the muscles in the back of your neck tighten slightly and your head lift slightly as the air draws into your chest. With exhalation, this tendency will be reversed – pulled by gravity, the head will drop even lower than before, stretching the already relaxed neck muscles with its weight.

And now, having made sure of the effectiveness of the friendly movement of eyes and breathing, feel how all these movements are harmoniously combined: inhalation, extension, “eyes to the ceiling” and subsequent exhalation, bending and “eyes to the floor”.

The last but very important update

The muscle relaxation phase in all muscle relaxation procedures should be very smooth and evenly slow. Rapid or uneven relaxation will drastically reduce the effectiveness of the procedure.

All of these clarifications have a significant impact on the effectiveness of your pain management. Observe them. Otherwise, small deviations will negate all your big efforts.

A small addition to the basic procedure that eliminates pain along the back of the neck can be two more exercises that are desirable to perform after the manipulations described above.

The first exercise is to mobilize the joints between the occipital bone and the first cervical vertebra.Mobilization, in this case, means improving mobility. To do this, it is necessary, while sitting, to take the starting position: without bending your neck, turn your head to the side until it stops, and your eyes should look straight. From this position, make a quick, short nod downward, simultaneously with exhalation and lowering the eyes “to the floor” and immediately return to the starting position.

Similarly, from the same starting position, a nod is made upward, followed by inhalation, moving the eyes “to the ceiling” and quickly returning to the starting position.