Presentation
This client presented with long-standing, severe right shoulder pain. During gait and standing assessment, I observed that their head consistently tilted to the left. When their head was guided to a neutral position in standing, they felt sharp shoulder pain. In sitting or lying, however, their head could stay centred without discomfort.
Assessment
Further assessment found increased tension through the left abdominal wall and rib cage. In standing, the left lower ribs appeared to be drawn downward, which may have contributed to the head tilt and to uneven load through the neck and right shoulder.
Approach
The session focused on hands-on release of the abdominal wall and surrounding fascia. The shoulder itself was not treated directly.
What was observed and reported
By the end of the session, the client was able to hold their head in a more neutral position in standing, and reported that their right shoulder pain had eased.
Reflection
Shoulder pain doesn’t always start at the shoulder. This case is a reminder that when shoulder pain is persistent and changes with position, the way the trunk, ribs and head organise in standing may be worth assessing. A single case can’t confirm what caused the pain. Shoulder pain that is severe or persistent, or that comes with neck pain, numbness, tingling or weakness in the arm, should be assessed by a GP.
Related case reflections
- Case 34: High Flexibility, Low Stability
- Case 31: Long-Standing Scoliosis and Postural Change
- Case 28: Active Ageing With Arthritis
