SHOULDER PAIN

WHAT IT IS

Shoulder pain is most commonly of mechanical nature, e.g., movement, postures, body mechanics. If your shoulder pain changes — for better or worse — with varying movements and positions accompanied by stiffness or loss of range of motion, you likely are suffering from mechanical pain. The question is: is it truly a shoulder problem or is pain coming from a remote location?
Acute shoulder pain is an episode lasting no longer than six weeks, which is more common than chronic shoulder pain lasting longer than three months.

Because the nerve supply to your shoulders and arms stem from the spinal cord within the spinal column, suboptimal cervical spine (neck) mechanics and joint movement can alter the signals from your brain to the shoulder muscles via nerve pathways. Proper movement is vital for joints to receive nourishment and stay healthy. It is not uncommon to experience shoulder symptoms when the neck is the source; in fact, we find it’s the case more times than not!

To be crystal clear, we do not correct tears and arthritis. These are standard labels and diagnoses tagged on patients, which we have successfully treated. The problem with these diagnoses is they simply tell you what it is, not how or why it occurred, nor how to correct it. Furthermore, just because there is arthritis present, does not mean there should be pain present. Millions of people with late stage degeneration have no pain at all. Don’t let an “arthritis” diagnosis let you believe you should have pain.

In rare cases, shoulder pain can indicate a serious medical problem — such as a heart attack — requiring immediate attention.
If you suffered direct trauma to the shoulder, or experience dizziness, double vision, difficulty speaking/swallowing, direct trauma, or unexplained weight loss accompanied by shoulder pain, seek immediate medical attention.

WHAT IT ISN’T

The pain we feel is simply a request from our brain to change. Pain is often not associated with damage, rather a very apparent alert we need to change our physical behavior or else physical impairment will proceed. Mechanical shoulder pain does not have to be debilitating.

Just because you have shoulder pain doesn’t mean you need an MRI. Just Because your MRI shows “tearing,” “degeneration,” or “arthritis,” doesn’t mean it’s generating your pain. And just because you have shoulder pain does not mean you’re broken, needing to be “fixed.” Even if you have a full-thickness rotator cuff tear found on imaging, e.g., X-ray, CT scan, MRI, you’re twice as likely to not have pain as a result of the tearing.

The medical literature is concluding most degeneration and arthritis shouldn’t be scary — it’s nothing more than “gray hair” and “wrinkles” on the inside, similarly as it occurs on the outside.
Furthermore, there’s a high prevalence of interpretive errors between radiologists. So, not only does imaging your shoulder result in a high rate of irrelevant findings, the professionals interpreting them cannot concisely agree upon diagnoses!

In some cases, surgical intervention may be necessary. In most cases, a trial of conservative care is recommended before opting for surgery. This will also depend on who the patient is, for example a professional athlete would likely opt for surgery before an elderly person.

COMMON CAUSES OF SHOULDER PAIN

17 different muscles attach to the shoulder blade, while the only bony connection is the clavicle to the sternum (blue).

Mechanical shoulder pain is most commonly caused by faulty body mechanics, repetitive use without appropriate rest, and poor postural habits. As previously mentioned, most shoulder pain has a cervical spine (neck) component as a source, whether primary or secondary.  Proper neck mechanics and joint function are critical for the system to move cohesively.

Humans are meant to move and move often — not sit in chairs and stare at electronic screens for hours on end. From infancy through the first year of life, we learn to how to move, setting us up for the rest of our lives.

Mechanical shoulder pain can occur suddenly from a particular incident or can gradually over time for no apparent reason.  Chronic poor posture and movement mechanics are sources of cumulative trauma.   The pain can occur from rigorous use during sport, or as simple as lifting a grandchild up for a hug.

Pain from sport or reaching overhead is not because the activity is inherently dangerous, rather accumulated stress results in such an imbalance the brain sends pain as a request for change. Otherwise, a serious structural problem may occur if continuing to ignore the signal.

Body Mechanics

The shoulder needs efficient body mechanics as it relies primarily on its supportive musculature for function. The shoulder joint is a very shallow ball-and-socket — like a golf ball on a tee — and the only bony connection to the torso is where the collarbone (clavicle) meets the chest (sternum)!  This fact is why proper muscle and surrounding joint movement is vital to smooth shoulder function.

For various reasons, we have upper trapezius dominance: the propensity to hike the shoulders up toward our ears when utilizing push/pull functions during work or exercise.  Think of how hunched we sit at a desk for 8+ hours a day.  Over time, our traps think this is normal and this posture becomes engrained into everything we do.  Shoulder hiking is extremely inefficient where accumulative stress causing mechanical neck and shoulder pain is one of the most common causes.

COMMON TREATMENTS FOR SHOULDER PAIN

The most common treatments are rest, medication, physical therapy, chiropractic, acupuncture, massage, passive modalities, e.g., ultrasound, laser, and other various conservative therapies. Furthermore, it’s difficult to demonstrate if positive outcomes from treatments mentioned above are the result of the therapy itself or simply time.

While most acute bouts of shoulder pain will resolve on its own within a few weeks, the risk of recurrence is very high as influencing behaviors and habits are often ignored. The greatest risk for injury is the previous injury — if you’ve done it once, it’s very likely to happen again.

Though conventionally accepted, few individuals need surgery for shoulder pain. Have a SLAP (Superior Labrum Anterior-to-Posterior) tear? Be careful: a positive outcome from surgery of repairing the labrum may be nothing more than an invasive and expensive placebo.

If you have intense and unrelenting radiating pain down the arm with progressive muscle weakness, unable to lift and hold the arm above shoulder level without pain, or specific structural problems not responding to conservative therapy, surgery may be warranted.

WHAT YOU CAN DO ABOUT SHOULDER PAIN

With all mechanical pain, there’s a ‘what’ and a ‘why’ — what the problem is and why it’s occurring in the first place. To achieve resolution, it’s crucial to not only identify and correct the problem at hand but address the behaviors which lead to the issue’s occurrence. Here are some self-help tips:

• Keep moving
• Work with Dr. Annas to learn proper shoulder and lifting mechanics
• Avoid sitting for longer than 30-minutes at a time
• Sit with upright posture with lumbar support
• Take micro-breaks: stretch, take a stroll, grab a snack, move around
• Take mental notes of what you are doing when your pain feels better or worse to identify any behavioral patterns
• Control inflammation with proper diet and nutrition
• Exercise regularly, and properly.
• Start the morning with this range of motion exercise:Here

STILL STRUGGLING WITH SHOULDER PAIN? WE CAN HELP!

Our approach isn’t to just “fix” the problem, rather understand what it is and what it isn’t, so the correct treatment is applied to the right problem — only then can we achieve a solution. Why use a hammer if you’re not positive it’s a nail? The last thing you want is to hammer away at a screw!

Dr. Annas at Nexus initiates treatment for shoulder pain by utilizing evidence-based diagnostic and treatment protocols, including FMS, FAKTR, or Mckenzie Method (MDT). MDT is a proven system of examination, treatment, and classification of spinal, joint, and other musculoskeletal pain, backed by years of research, evidence, and practice. These systems have been shown to be low cost, fast, and effective even for chronic pain.

After thorough assessment and repetition, we can understand how your pain behaves.

If a mechanical force caused the problem, then it is logical that a mechanical force may be part of the solution. Once we identify the mechanical problem, eliminating the guessing game, we develop a plan to correct or improve the mechanics, thus decrease or eliminate the pain and functional problems.  The treatment could range from cupping, to adjustments, to repetitive motions, all based on you individually.

The goal is for you to be able to understand and control your pain yourself, not needing your doctor/chiropractor on a repetitive basis. If your problem is something we are unable to treat, we will know this within the first few visits, and then we recommend the next best course of action to find you a solution.