After spine pain, shoulder pain remains consistently tied for second (along with knee pain) as the top reason why patients travel from all over Chicagoland to see us at our Carol Stream office.
The shoulder joint is rather complex, and pain arising from the shoulder region can affect simply day-to-day activities and sport alike. This article aims to help guide you through some of the myths surrounding shoulder pain and narratives frequently discussed in healthcare facilities and gyms.
Now, if you are like most people, you might be curious about whether chiropractors even treat shoulders. I can assure that the chiropractic physicians at our office (and many others in 2022) are committed to treating PEOPLE with body aches - not just PARTS of the person, such as the spine, shoulder, knee, etc.
So, yes, we treat shoulder pain and quite effectively I might add. The reason we can confidently (not arrogantly) say that we can effectively treat shoulder pain is because we treat it regularly, know how 90-95% of all our patients are going to respond to our treatment methods AND how to properly assess the shoulder based on the patient’s specific pain presentation alongside their desired goal. Said differently; we aren’t just looking at a shoulder joint.
The sad part is that many people spend a lot of time, energy and money when they have shoulder pain by following the medical establishement’s advice. Just a simple internet search of “shoulder pain” shows that the leading and internationally recognized orthopedic surgeons and healthcare organizations start their treatments of shoulder pain off with “pain medication.”
What’s worse is that these websites immediately assume that shoulder pain is caused by arthritis, degenerative joint disease, or (and this is the worst of them all) impingement.
This type of evaluation has been dubbed, “the issue is in the tissue” as a model of healthcare. The only problem with this ideology is that it exclusively evaluates the painful area and attributes the cause of the pain to be due to that area. Maybe said differently, there is no consideration that the pain experienced could be caused by another region of the body.
For example, our office recently had a patient arrive with ~6 months shoulder pain. He had received 8 weeks of a trial of conservative care, which consisted of 2-3 appointments a week with a physical therapist. (This is NOT a diss on the PT, who was given the script for “PT” by the medical doctor and was fulfilling on the referring recommendation).
First, Rule Out The Neck
This patient showed no improvement and was sent back to the MD for a follow up. The MD wanted to perform trigger point injections into the area of the pain, which didn’t sit right with our patient. After growing frustrated with both the pain and the process to relieve the pain, the patient started asking friends and family for advice. One friend put him in touch with our office, where he promptly downloaded our FREE Neck & Shoulder Report.
After reading through the Report, he decided to book a new patient appointment with us. After he gave us a thorough recap of his health history, exercise history, as well as a detailed discussion about his short and long-term goals, we began our investigation into WHY he was not seeing the results he was so desperate to achieve. He also stated that his biggest fear was needing a shoulder replacement, which his dad had to get and it immediately affected his ability to workout, lift his arm overhead and also get on the ground and play with grandkids. He wanted nothing more than to avoid the same path his dad went down.
(We call it an investigation, because in an investigation details matter. We’ve also found that most providers don’t pay attention to the details…)
After about a 45 minute evaluation, whereby we assessed the full spine, shoulder, jaw, rib cage and lower body, we came to the conclusion that the shoulder was perfectly healthy.
This is where things get interesting….
You see, all of the assessment what focussed on the shoulder, so it makes sense that all of the treatment would be focused on the shoulder as well.
What if I told you his shoulder pain was not coming from his shoulder but his neck?
By focusing our attention on a thorough assessment, we were better equipped to identify the most likely cause of this gentlemens pain generator. Once we identified the cause of his shoulder pain, it made the treatment that much more effective by actually treating the cause not the symptom.
The best part of this story is that this guy’s shoulder pain was 50% improved within a week, and 90% resolved within 3 weeks. By the time he completed his plan of care, he was 95% improved and had fully returned back to working out (including CrossFit!)
Do NOT Assume it Just Needs to be “Stretched Out”
The shoulder also requires an equal amount of stability when performing the physical demands. In our experience, most overhead athletes have swung the pendulum too far into the stretching, mobility and flexibility direction and need to come back towards stability.
A key definition of physical stability is simply a part of the body which is able to return to its original positioning without any extra force required when disturbed. The throwing motion is quite a disturbance! So, it is important to be able to withstand the disturbance and not get injured. If we end up not being able to withstand the disturbance, can we stretch our way towards relief? In our experience, it is our view that patients cannot sufficiently stretch their way through a stability issue. So, therefore, our advice has been to not rely exclusively on stretching to relieve shoulder pain.
AVOID Surgical Interventions (As Long As Possible)
Being a chiropractor, I cannot legally prescribe medications nor can I perform any medical procedure which could be categorized as a surgical procedure. I can pierce the skin, but only with a solid, filiform needle during acupuncture or dry needling.
So this recommendation needs to come with a caveat. I cannot advise you to get surgery or to not get surgery. My aim in making this recommendation is to simply share with you the data and the current evidence (including outcomes) of some of the best studies which investigated this very topic in recent years.
One of the narrative’s surrounding shoulder pain was originally thought to be stemming from this “impingement” issue. Impingement has become the most frequently described cause of pain in the shoulder, especially when pain was experienced overhead, since the 1970s.
In 1972, an orthopedic surgeon named Dr. Charles Neer hypothesized that the supraspinatus tendon might become “impinged” under the acromion process during certain movements. He found this phenomenon during an examination of 100 cadavers and found that “11 revealed alterations attributable to mechanical impingement.” That’s right, an entire surgical intervention was developed and thrust into healthcare because 11 out of 100 cadavers had alterations outside of what the textbook says it should look like.
His solution to this impingement problem was, you guessed it, a surgical intervention! He proposed to take off the front portion of the acromion to clear up space for the supraspinatus tendon to move without any compression resistance.
To be fair, though, if the intentions were pure and the innovative procedure turned out to be effective, I would admit that my skepticism about the 11 cadavers was shortsighted on my part. So, what does the data show about the procedure?
Another article in 1972 showed the results of Dr. Neer’s proposed impingement procedure. He writes a summary of 50 operations conducted on 46 patients. He performed post-operative follow-up with patients anywhere from 9 months to 5 years. (If you are like me, then this sounded strange to read because it is strange in research to wait 5 years for follow-up).
The two strikes I have against this article is that #1). There was no control group, as the only intervention discussed was the impingement procedure. How were we to know the procedure was effective if there was no control group? #2). The length of time for the post-operative evaluation brings into question the potential for a natural history explaining the recovery process (not the intervention).
Not satisfied with just looking at Dr. Neer’s research, I found a 2017 article which demonstrated a similar study but did include an exercise control group.
This study, done by Ketola, et al compared the surgical intervention plus exercise to an exercise-only group for shoulder impingement. The researchers followed up at 2 and 5 years (Again, 5 years!)
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