Each and every one of us at some point in our lives are going to find ourselves laboring with some discomfort in our shoulders. The level of pain can be anything from an annoying minor niggling sensation with a certain action or excruciating stabbing pain with barely any movement at all.

As an osteopath, not only have I had to deal with literally thousands of shoulder complaints but have on three separate occasions suffered incapacitating pain in my own right shoulder. Personally, it was a great opportunity to learn about what I had read only in expensive Orthopaedic text books. It helped me to empathise with patients in trouble, which gave them some sense of assurance that I genuinely understood where they were coming from (especially in terms of the pain!)

Undoubtedly, the most ubiquitous condition as far as the shoulder is concerned is a Rotator Cuff tear. Almost 2 million people went to their doctors with this condition in the USA back in 2013.

I could go into a lot of anatomical details about the bones and muscles that make up the shoulder and the cuff and what is injured, but as I found out for myself, all I wanted to know immediately was what could I do to make the pain go away.

It is important that you go to a doctor or Orthopaedic specialist or an osteopath to get an accurate diagnosis of what your shoulder is about, before proceeding with some beneficial activity to help it. In more severe cases the wrong treatment or self-help could exacerbate the problem.

Of my own condition which began back in January 2017, it became increasingly uncomfortable to sleep on my right shoulder. Initially, I thought it was something that would right itself and go away. Like most people, when you lead a busy life, there is simply not enough time in the day to go messing around with a niggling pain.

However, after a couple of months, it got to the point where it was starting to interfere with any action where I had to lift or press down on my hand for support, or even dressing myself would initiate a sharp twinge of discomfort. More worryingly, I was able to palpate a specific area around the back close to the top and outside of the shoulder bone. To be anatomically precise, I could feel that my right supraspinatus muscle and tendon were inflamed. I don't how you feel about using anti-inflammatory drugs. Personally, I try not to use them more than necessary. However, in my case I gave in and had an Ibuprofen.

Bluntly, it gave me a modicum of relief. In times like this, it is useful if you possess an ice-pack which is capable of being molded around the offending limb. So, I placed a cold pack on the back of my shoulder over the inflamed spot.

Now, this did help a little. Do be careful about these cold packs as they drop to -10 deg. C in the freezer, so do put the pack in a thin sock, or you could end up burning your skin especially if your circulation is not what it use to be. It is the same as putting a swollen ankle in a bucket. For those who may have seen Riverdance, all the tap dancers had their feet and calf muscles in icy buckets of water. It is the best thing for any inflamed muscle or tendon. Quite rapidly, I found that I could move my arm and shoulder with relative ease.

Cold is a simple way to reduce the inflammation which in turn reduces the swelling and tension in the muscle tissue. Cold provokes the body to warm up the area, so that means pumping some nice fresh hot blood from the interior. By doing this, it can help to drain the damaged tissue of what are referred to as "Pain factor substances". These are natural chemicals that the nerves produce when the body has been traumatized. Pain is chemically mediated and this is because you have a pain gene for the very purpose of letting you know that your body is in trouble. There are certain individuals who are born without this gene. Ironically, although you might think how lucky they are, it can lead to many more problems than just a pain in the shoulder.

Another simple way to help is having a hot // cold shower. A few years ago I had a pump put in as the water pressure was minimal so that I could have a therapeutic shower. When beset with a painful shoulder, differential bathing ie the use of hot and cold water can be quite relieving. Again, as with the cold pack, it is about boosting the local circulation. Let's not forget our blood is a sophisticated rich mixture of chemicals and specialized body cells that has the job of attending to damaged tissue. The body is gifted with the natural capacity to heal itself. Hydrotherapy has been used for centuries to aid the body's healing mechanism.

It is important to alternate the hot / cold shower 3/4 times giving 30s to each and ALWAYS finishing on the COLD. To capitalize on this treatment, if you happen to have some deep heat cream, or menthol and eucalyptus oil, rub these agents as well as you can manage into the problem area. It is worth taking advantage of the improved local circulation after the hot / cold shower as the agents will be taken to the target area more easily.

If, as in my case the shoulder condition is not too severe, after the shower and cream try to move the arm to those positions that provoke pain. You may find that you can go a little further. It is very important to do these actions slowly and gently. Rather like athletes with injuries, aggressive movements will not only cause further trauma, and also create a mental apprehension. This can undermine your confidence and induce a subconscious fear which generates more tension in the shoulders. That in turn undermines the healing process.

Finally, it is important to find a suitable activity that can engage your shoulder muscles. The rotator cuff is group of four muscles that come together as tendons and the form a cover over the shoulder. They attach the long bone in your arm (humerus) to your shoulder-blade (scapula), so they are very important stabilizers. So, it goes without saying, that exercise is of paramount importance in the longterm. A strong well toned muscle will support not just your shoulder joints but every other joint in your body.

One of the best activities for improving shoulders and everything else is swimming. Even if you can only paddle, it does not matter. Water has the benefit of supporting your limbs and reducing the sense of gravity, so less weight to carry. Another bonus, water has a certain viscosity which provides enough resistance to tone the muscle. So as you move your shoulder you are pumping the muscles which gets the heart pumping and an extra benefit is that you start producing those feel good chemicals, the endorphins. Water can promote a win- win situation.

This is how I started myself on the road to recovery and since then I have joined a sports center where I have been able to work with specific weight machines to focus on the muscles that assist in all the movements of the shoulder.

There are shoulders that do need surgical intervention, and when this is the case, everything that has been mentioned so far is very important when rehabilitating the problem.