Shoulder Pain: The proactive approach
If you’re like me, at one or more points throughout your life, you’ve had an injury that just doesn’t seem to go away. After it happened for the first time, it got “better” only to return a few weeks later as an annoying ache that lingered for weeks or months.
We’ve all been there and you may even be there right now. Our goal for this post is for you to understand the RIGHT way to handle an injury that doesn’t seem to resolve.
Being proactive about an injury is the best way to move past it. Having someone on your health team who understands the way YOU move can be the difference between living with a reoccurring injury, and putting it in your past for good.
Let’s begin with one of the most common injuries we see which tend to linger, shoulder pain.
Understanding the shoulder
Shoulder pain is one of the most common types of persistent injuries. To understand why that is, we must understand how the shoulder works.
The shoulder is made up of the humerus, the shoulder blade (scapulae), and the clavicle. The three of these bony structures give rise to several muscles which give your shoulder the mobility and stability to function.
You may have heard of your rotator cuff. It is made up of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. In addition, your shoulder has many support structures which play into the overall functioning of a health shoulder. Some of these are your pectoralis muscle group, latissimus dorsi, deltoids, biceps, triceps, and serratus anterior muscle groups.
Your body is a system of mobile joints connected by stable segments. Shoulders are the most mobile joints of your body. They depend on both the mobility of your thoracic spine, and the stability provided by your scapulae to function optimally.
Poor posture, muscle imbalances, and poor spinal mobility can be major factors in recurrence of an injury. In fact, these are the major causes which we find to complicate the recovery of shoulder pain.
Posture
For every inch, your head rests in front of your shoulders, there is an additional 10 lbs. placed on your lower spine. As the stress increases, your spine will adapt to create greater stability, which reduces mobility, or ability to move. This directly affects your body’s ability to function properly.
Your shoulders rely on your spine to function optimally. As your spine loses it’s ability to move, your shoulders are forced to adapt to make up for the lost movement. This happens by sacrificing the stability of your scapulae.
Once the stability of your scapulae becomes compromised, the muscles of your shoulders must change the way the function too. This slight change increases the risk of injuring your shoulder. This can begin as popping and clicking or maybe even stiffness or tightness felt throughout your upper back and shoulders.
Muscle Imbalances:
Muscles imbalances can be good or bad, depending on the person. Imagine Tom Brady’s right arm vs his left arm. Odds are there is a significant muscle imbalance side by side, but this may enable him to throw a football the way he does. This is an example of a good muscle imbalance. Now lets consider a bad imbalance. A person who sits most of the day at a computer has overtime developed a muscle imbalance between their chest muscles and their mid-back muscles. Normally your chest and back muscles should be equally engaged. What happens when you sit at a computer all day is your chest becomes tighter and your shoulders get pulled forward. Overtime the muscles of your back become stretched and can become weak.
This change in your posture from this muscle imbalance can lead to multiple issues including shoulder pain. Other symptoms of this imbalance can be neck and back pain, chest and rib pain, numbness and tingling in your hands and fingers, and headaches.
Before we stated that both your chest muscles and your back muscles help contribute to stabilize your shoulders. An imbalance in either or both muscle groups can lead to altered shoulder function which can lead to pain and injury. This is just one example of a muscle imbalance that can affect your shoulders. Each muscle of your shoulder needs to work in harmony with one another constantly to perform its job.
Trigger points, muscle adhesions, fascial adhesions, and joint restrictions are all very common in the shoulder as well. Having a skilled practitioner who knows what they are looking for can reset the muscles around your shoulder. One of the most important concepts to remember is that your spine and shoulder work together and both structures can cause pain to one another.
How we evaluate & treat shoulder pain
Here’s a quick video showing part of our examination process and treatment for shoulder pain.
Other causes of shoulder pain:
There are a few other causes of shoulder pain worth mentioning which need to be considered during the examination process.
arthritis
sprain/strains injuries
tendonitis and bursitis
anatomical variations in the shape of the joint
Depending on the type of injury and the way shoulder pain occurs, diagnostic imaging may be necessary.
X rays provide a look at the bony structures of your shoulder.
MRI provides a look at the soft tissue of the shoulder and can be used to diagnose a tendon, laberum, or muscular tears among other things.
Diagnostic Ultrasound is becoming more popular option to view the surrounding shoulder tissue.
What NOT to do about your shoulder pain
Prolonged rest
Resting or immobilizing your shoulder can end up making your problem much worse. Frozen shoulder (adhesive capsulitis) is a common result of prolonged rest. Once your body alters it’s movement mechanics to avoid pain, your brain re-wires itself to establish a “new normal.” Retraining your brain to move in the correct way once your pain is gone is difficult and you’ll likely need help.
Opt for surgery without exploring conservative treatment first
Surgery is an AMAZING life saving option for so many different problems. Obvious reasons to get surgeries do exist and we would never tell someone not to have surgery if they need to. However, we believe that you should always do whatever you can to avoid a surgical procedure if possible. Once you’re cut open and your structures are altered, there is no going back. A bigger problem with opting for surgery right away is answering the question, “why did this happen in the first place?” If you fix a broken piece in a broken machine, the odds of that piece or another one breaking are pretty good. The moral of the story is: fix the underlying problems first and then re-assess the situation. Seek out a conservative opinion from a chiropractor or physical therapist. The worst case scenario is learning that you definitely need the surgery.
Corticosteriod shots for your shoulder pain
We frequently encounter people who have received a corticosteroid injection that temporarily relieved their pain, only for it to come back. There is a growing body of evidence to suggest that corticosteroid injections cause more harm than good. When it comes to the shoulders, knees, hips, and spine, corticosteroids are directly linked to cartilage damage and bone weakening. Again, the question of why did your problem happen in the first place? will not be solved using corticosteroid injections.
Why we're the right place to help you solve your shoulder pain
We specialize in working with people get to the root cause of their problems. This means we fully examine the way you move and live to determine the REAL reasons why your shoulder pain happened in the first place. Our examination process looks at your whole body and how it works, not as separate moving parts.
Whether you’re a desk worker, a CrossFit athlete, golfer, tennis player, or any other person struggling with shoulder pain, we can help.