[alophysio]

Hi,

I thought your treatment sounded Australian! I don't know your physio but i know of a David Berg down there and his wife who i can vouch for. If you are hapy with your physio, then keep going there!

Ok, How is your internal rotation (IR) range-of-motion (ROM)?? Tightness in the posterior inferior glenohumeral ligament can cause translation of the humeral head leading to excessive strain on the anterior shoulder - in other words, a tight shoulder capsule can be causing your pain. Testing the IR ROM is done in supine (on your back), shoulder is 90degABD, elbow 90deg, then into IR. There is a good article by Burkhart et al in Arthorscopy Journal 2003 - get your physio to look it up if they haven't already. It has a lot of information over three articles on biomechanics of the shoulder, SLAP lesions and exercises for the shoulder.

The acupuncture might be addressing the muscles and capsule issues.

Hydro is not bad but my gut feeling is that it will not be the saviour you might hope it to be. I think you have been quite diligent in your exerises - if you have been using theraband, the resistance can be as mild as water resistance.

The scapula dumping is probably overactive levator scapula. You will probably need to work on upper traps and lower traps to get the shoulder rotating upward to help clear the acromion.

The first and second rib problems are likely to be scalenes overworking to try get your shoulder in position to work efficiently.

An interesting exercise would be to assess the stability of your cervical spinal column - you will need your physio to assess this if you don't know what i mean...

1. Lie down. Hold your articular pillar (the bony bit of your neck laterally) using your left hand on the right side of the neck.
2. Lift your right arm straight to the ceiling and then straight out to the side.
3. A stable C/S will not have any lateral shift in the neck during arm movement, especially as your arm gets closer to bed level.

How did the injury start in the first place?