Physical Therapy for Arm Pain: Get a Grip on the Right Treatment

The causes of arm pain can be wide-ranging and include injuries to muscles, tendons, nerves, joints, and bones. Because arms have a large range of motion and many joints that move in different directions and at different angles, it’s a good idea to see a physical therapist if a patient experiences ongoing arm pain. Physical therapy for arm pain then depends on the cause and the location of the pain.

What Conditions Cause Arm Pain?

Just like the rest of our bodies, our arms are vulnerable to injury, overuse, and deterioration. We use them for every activity, from cooking dinner to typing on a keyboard to doing push-ups to carrying children. Wrists have eight tiny bones, while the ball-and-socket joint of the shoulder is intended to move in every direction. A ball-and-socket joint improves function and range of motion, but it also creates a higher possibility of injury or damage.

Obvious sources of arm pain include broken bones, cuts, wounds, burns, and rotator cuff injuries. Other sources of arm pain can include:

• Carpal tunnel syndrome
• Nerve damage
• Stoke
• Muscle strains or tears
• Tendonitis
• Arthritis
• Herniated disks in the spine
• Infection
• Overuse of a joint
• Poor posture
• Reduced blood flow
• Tennis elbow

Physical therapists may encounter any of these conditions when seeing patients complaining about arm pain. Because the causes can be subtle and hard to determine, it may be helpful to involve other medical professionals in doing a thorough analysis of the source of arm pain to determine the right method for reducing that pain and restoring normal function. Imaging like X-rays and MRIs, blood tests, CT scans, ultrasounds, or muscle and nerve tests to uncover the underlying cause of arm pain.

Forearm Pain Treatments

Forearm pain can be the result of any of the conditions listed above. Patients will generally seek out physical therapy when home remedies, such as heat, ice, and rest, do not bring relief. Physical therapy for forearms can relieve pain, restore range of motion, and rebuild strength, all with the goal of returning the patient to normal activities and function.

Some common physical therapy treatments for forearm pain include:

• Manual therapy. This includes massage or joint mobilization that improves flexion or reduces tension with the support of the therapist.
• Stretching. Extension and flexion of the wrist will stretch the forearm muscles.
• Strength building. Using elastic bands, light dumbbells, or gym equipment can gradually improve strength in the forearms and prevent reinjury or recurrent pain.
• Nerve glides. Increasing nerve mobility can, in turn, reduce pain and inflammation.
• TENS machine electrical stimulation. Low levels of electrical signals block pain and improve circulation.
• Ultrasound therapy. This process creates heat that improves blood flow and heals muscles.
• McKenzie Method. Exercises and posture corrections that centralize the pain in the body.
• Instrument-assisted soft tissue mobilization (IASTM). Stainless steel instruments are used to break up scar tissue.
• Dry needling. Thin needles are inserted into areas of muscular tension.

Shoulder Rehab and Arm Stretches

Patients are often referred to physical therapy after shoulder injuries or surgery, but there are a variety of other reasons they may experience chronic shoulder pain. Bursitis, tendonitis, frozen shoulder, and shoulder impingement all cause pain and can be improved through physical therapy stretches and mobility programs.

Just as with forearm pain, the goals of physical therapy for shoulder pain are to decrease discomfort and restore normal function without the need for invasive surgery. Exercises that are commonplace in shoulder physical therapy include:

• Pendulum swings. Swinging the arm back and forth, across the body, and in circles improves range of motion.
• Shoulder stretches. Stretching the arm across the body, overhead, or against a doorway can reduce tension and pain and relax the muscles around the joint.
• Wall slides and pushups. These strengthen the muscles and improve stability of the shoulder joint.
• Scapular squeeze. The health of the shoulder blade directly impacts discomfort in the shoulder joint.
• I-Y-T. From a bent-over position, the patient moves their arms in the shape of an I, Y, and finally T. This mobilizes the joint and improves range of motion.
• Isometric holds. Contracting a muscle and holding that contraction builds strength with little resistance.
• Strength building. Once pain is reduced and mobility restored, weight or resistance can be added to the exercises to improve strength and prevent repeat injuries.

What Can Physical Therapy Do for Arm Pain?

Physical therapy is a great place to seek pain relief, improved mobility, and increased strength for the arm. It’s non-invasive, effective, and can build good habits and skills that will last a lifetime. For many people with arm pain, physical therapy can negate the need for surgery in the future.

For patients presenting with shoulder pain, research shows that physical therapy is just as effective as other, more invasive treatments. Physicians often offer those complaining of shoulder pain corticosteroid injections for short-term pain relief or shoulder decompression surgery for long-term relief. A 2020 review of studies found that shoulder exercises and manual treatments were just as effective as other treatments, were less expensive, and carried none of the potential negative side effects.

There is a wide range of therapies that are available to physical therapists to work with patients before referring them to more invasive procedures with higher side-effect risks. Exercise and manual manipulation have provided great results for many with shoulder pain, particularly when used together. Postural taping can also help to create better movement patterns. For those who do not see improvement with these measures, Low Level Laser treatments can be used to reduce inflammation and promote healing.

Treatments for Arm Pain

The treatment recommended for arm pain varies depending on the location and reason for the pain, the extent of the injury or damage, and the results achieved with minimal intervention. While there is no “one size fits all” approach to dealing with arm pain, it’s best practice to approach it from least invasive to most invasive treatment options. This, of course, would only be necessary if there is no obvious damage to the arm including broken bones, burns, damaged skin, and more. The order of hierarchy for treating arm pain is as follows.

• RICE method: Rest, ice, compression, and elevation which can all be done at home
• Over-the-counter pain relievers: Medication like ibuprofen also reduces inflammation
• Stretching: Use any of the -stretches as pain and mobility allows
• Physical therapy
• Injections: Corticosteroids are used by a doctor and injected into the affected area
• Immobilization: A cast, splint, or brace may be recommended to keep the arm from moving and allow additional support for healing
• Surgery: This invasive procedure is used when a bone, muscle, or tendon needs to be repaired or a joint needs to be replaced

Best Practices for Treating Arm Pain

After completing a comprehensive review of a patient’s history and the origin and exact location of the arm pain, a progressive approach to rebuilding flexibility, range of motion, activity, and strength is recommended. You’re an expert in human anatomy and can support patients as they learn or relearn correct form, posture, and movement patterns that will keep their muscles, bones, and joints healthy for the long term.

Just like other body parts, starting with basic movements and progressing to more strenuous stretching and strength moves gives patients time to adapt to new movements and build good habits. Gradually incorporating other equipment (resistance bands, light weights, pulleys, etc.) as time continues can help progressively increase range of motion and muscular strength and endurance.

If you’re part of a team of clinicians treating a patient, remember your role in the process and how you work with the rest of the team. You can work with them in clinic and assign a home exercise program as well. Following through with this regimen outside of physical therapy appointments means better and faster results.

New Research on Physical Therapy for Arm Pain

Our musculature and bone structure don’t change, but the research and innovative approaches to physical therapy keep coming at a rapid pace. Here are just a few of the newest ideas and research-based approaches to physical therapy for arm pain.

• Stroke patients are often referred to physical therapy for hand and arm function. A new study shows that the best time for this therapy to start is 60-90 days after the stroke. Waiting six months or longer to start hand and arm therapy results in few improvements over the long term.
• In another study of stroke survivors, a device was implanted that sent electric stimulation to the vagus nerve to help with moving impaired limbs. This, paired with physical therapy, created new neural pathways that led to better recovery for arm and hand movement.
• Robot-assisted therapy is another new technology that is being pioneered currently. For those who experience weakness in their limb due to injury or stroke, robot-assisted therapy gives them the support to participate in arm therapy and allows for repetitive motions when they don’t have the strength to do so independently.
• Bioinductive implants are being used more often to support patients who need rotator cuff repairs. These are collagen-based structures that fill in the gaps in the joint and eventually integrate into the natural structures of the body. These implants are placed during surgery and support the joint permanently.
• Virtual reality games create a new way to improve grip strength, range of motion, and dexterity. Hand and arm therapy is often recommended for those with multiple sclerosis. Experimental virtual reality games with an arm band are used to precisely control resistance and measure results. Patients experience greater grip strength and forearm supination and express satisfaction with the methodology.

Optimizing Physical Therapy for Arm Pain in Your Practice

As a physical therapist, you’re likely to work with patients who are looking to reduce pain, increase range of motion, or restore strength in their wrist, forearm, or shoulder. This can include elite athletes who experience injuries, laborers who develop repetitive motion injuries, stroke patients, or children who have accidents. Nearly any person of any age or physical ability may experience arm pain at some time in their life. Your ability to understand the source of that pain, identify where improvements need to be made, and develop programs that achieve those results will create a great reputation for your clinic in the community and provide better, lasting results for your patients.