{"id":12737,"date":"2026-02-06T12:26:03","date_gmt":"2026-02-06T17:26:03","guid":{"rendered":"https:\/\/funcphysio.com\/?p=12737"},"modified":"2026-02-06T12:47:55","modified_gmt":"2026-02-06T17:47:55","slug":"getting-shoulder-movement-back-with-a-pt-shockwave-and-mls-laser-case","status":"publish","type":"post","link":"https:\/\/funcphysio.com\/zh-hans\/2026\/02\/06\/getting-shoulder-movement-back-with-a-pt-shockwave-and-mls-laser-case\/","title":{"rendered":"Getting Shoulder Movement Back With a PT, Shockwave, and MLS Laser Case"},"content":{"rendered":"
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Shoulder pain can be incredibly frustrating, especially when it doesn\u2019t go away for months. Recently, I treated a patient who came in with persistent left shoulder pain that started after he twisted his shoulder. Even after more than six months, the pain was still limiting his daily life, such as putting on a jacket.<\/p>\n\n\n\n

Patient History & Main Complaints<\/h2>\n\n\n\n
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  • Male, in his 40s<\/li>\n\n\n\n
  • Left shoulder pain started after a twisting injury<\/li>\n\n\n\n
  • Pain duration: over 6 months<\/strong><\/li>\n\n\n\n
  • Pain with:\n
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    • Shoulder flexion (raising forward and upward)<\/li>\n\n\n\n
    • Shoulder abduction (raising sideway): most painful and most limited)<\/li>\n\n\n\n
    • Horizontal adduction (crossing the arm)<\/li>\n<\/ul>\n<\/li>\n\n\n\n
    • Functional limitation: Putting on a jacket caused pain<\/strong><\/li>\n<\/ul>\n\n\n\n

      Initial Assessment<\/h2>\n\n\n\n

      During the evaluation, I found:<\/p>\n\n\n\n

        \n
      • Shoulder flexion ROM<\/strong>: Almost the same on both sides, but the left side was compensating with trunk\/neck movement<\/strong><\/li>\n\n\n\n
      • Shoulder abduction<\/strong>: Less than 45 degrees<\/strong>, with significant pain<\/li>\n\n\n\n
      • Reaching behind the back<\/strong>: Slightly limited with compensation<\/li>\n\n\n\n
      • Horizontal adduction<\/strong>: Painful and limited<\/li>\n<\/ul>\n\n\n
        \n
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        His neck is shifted to the R to create more space for painful left shoulder<\/figcaption><\/figure>\n<\/div>\n\n
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        No much difference in shoulder flexion<\/figcaption><\/figure>\n<\/div>\n\n
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        The most restricted motion: abduction. The patient could not raise arm up more than 90 degrees<\/figcaption><\/figure>\n<\/div>\n\n\n

        Based on the movement tests and the location of pain, I concluded that the main source of pain was the chronic inflammation of the biceps brachii tendon<\/strong>, along with:<\/p>\n\n\n\n

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        • Reduced subacromial space<\/li>\n\n\n\n
        • Significant shoulder muscle tightness<\/li>\n\n\n\n
        • Altered shoulder mechanics and compensation patterns<\/li>\n<\/ul>\n\n\n\n

          Start Treatment With Rib Cage and Spine<\/h2>\n\n\n\n

          When shoulder pain lasts for a long time, the body often adapts in unhelpful ways. In this case, the patient had developed:<\/p>\n\n\n\n

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          • Cervical (neck) tightness<\/strong><\/li>\n\n\n\n
          • Rib cage and thoracic spine stiffness<\/strong><\/li>\n\n\n\n
          • Altered movement patterns during shoulder motion<\/li>\n<\/ul>\n\n\n\n

            So instead of jumping straight to the painful shoulder, we first worked on:<\/p>\n\n\n\n

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            • Posterior mid-thoracic spine mobility<\/li>\n\n\n\n
            • Upper to lower lateral rib cage mobility<\/li>\n\n\n\n
            • Cervical spine mobility<\/li>\n<\/ul>\n\n\n\n

              Interestingly, his shoulder motion started to improve even before I touched the shoulder<\/strong>, just by restoring rib cage and thoracic mobility. This shows how closely the shoulder is connected to the spine and rib cage.<\/p>\n\n\n\n

              Soft Tissue & Scapular Work<\/h2>\n\n\n\n

              Next, I addressed the significant soft tissue stiffness around the shoulder, especially near the pain source (the biceps tendon area). Treatment focused on:<\/p>\n\n\n\n

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              • Pectoralis major & minor<\/li>\n\n\n\n
              • Upper trapezius<\/li>\n\n\n\n
              • Levator scapulae<\/li>\n\n\n\n
              • Posterior shoulder muscles (infraspinatus, teres major\/minor)<\/li>\n\n\n\n
              • Latissimus dorsi<\/li>\n\n\n\n
              • Serratus anterior<\/li>\n<\/ul>\n\n\n\n

                At the same time, I worked on improving scapular (shoulder blade) movement<\/strong>, because good scapular mechanics are essential for pain-free shoulder motion.<\/p>\n\n\n\n

                Shoulder Joint Mobilization<\/h2>\n\n\n\n

                After reducing soft tissue restrictions and improving scapular mobility, I finally treated the shoulder joint itself.<\/p>\n\n\n\n

                Findings:<\/p>\n\n\n\n

                  \n
                • Subacromial space was limited<\/li>\n\n\n\n
                • Humeral head was shifted anteriorly<\/li>\n<\/ul>\n\n\n\n

                  Treatment:<\/p>\n\n\n\n

                    \n
                  • Joint mobilization to increase subacromial space<\/strong><\/li>\n\n\n\n
                  • Re-centering the humeral head into the glenoid fossa<\/strong><\/li>\n<\/ul>\n\n\n\n

                    Then we used PNF (proprioceptive neuromuscular facilitation)<\/strong> and active movements to help the patient\u2019s muscles maintain the newly gained mobility<\/strong>.<\/p>\n\n\n\n

                    Shockwave (RPW) & MLS Laser Therapy<\/h2>\n\n\n\n

                    To further improve tissue mobility and pain relief, we added:<\/p>\n\n\n\n

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                    • Radial Pressure Wave (RPW \/ Shockwave)<\/strong><\/li>\n\n\n\n
                    • MLS Laser Therapy<\/strong><\/li>\n<\/ul>\n\n\n\n

                      These modalities help with:<\/p>\n\n\n\n

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                      • Pain reduction<\/li>\n\n\n\n
                      • Improving tissue healing<\/li>\n\n\n\n
                      • Reducing chronic soft tissue sensitivity<\/li>\n<\/ul>\n\n\n\n
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