Archive for shoulder pain
Therapeutic Exercise and Orthopedic Manual Therapy for Impingement Syndrome
Since I treat a lot of shoulders in my practice this one strikes home. Sometimes common sense ain’t so common in medicine. Almost every shoulder patient I have seen in my office at some point had been given exercises to do. So long as they did them religiously, the problem stayed at bay. As soon as the exercises stopped the symptoms returned. It seems quite obvious to me that this is not fixing the problem–it is just compensating for it. Soft tissue techniques aimed at reducing scar tissue and restoring normal biomechanics is essential. I remember one patient with a complete tear of the supraspinatous tendon. With careful attention to the biceps tendon, this patient has full pain-free use of his shoulder despite the full tear.
Shoulder pain sucks. Work, sports and even sleeping are affected. But is visiting a chiropractic and wellness center for frozen shoulder symptoms a good idea?
Before we answer that question, we need a little overview.
The human shoulder is capable of a wide degree of movement. Unfortunately, this comes with a price– the shoulder is very prone to injury. Couple this with poor posture, prolonged periods of time sitting in front of a computer and sedentary lifestyles and you begin to understand why shoulder problems are so common.
At the far end of the spectrum of shoulder problems is a condition referred to as frozen shoulder, aka adhesive capsulitis. Frozen shoulder occurs from avoiding motion in a painful shoulder. Shoulders love to move. Less moving = less movement. Ultimately, you realize that you’ve lost a large chunk of the movement your shoulder used to be able to perform.
At this point, procedures such as manipulation under anesthesia may be a good option.
Before patients develop frozen shoulder, they are often given a diagnosis of tendonitis and / or bursitis. The “itis” component means that inflammation is present and creating the pain. But, when looked at under a microscope, inflammation is not often present.
So what gives?
“Tendonosis” is the description that more likely fits your shoulder condition. This is NOT an inflammatory condition, and so anti-inflammatories and most prescriptions will have little effect. As a matter of fact, using anti-inflammatories at this point may very likely make things worse.
The “osis” in tendonosis is a Latin word for pathology (in other words, something is just not normal). So, tendosis refers to the presence of scar tissue within the tendons of the shoulder.
When we suffer any type of injury, there is inflammation created. This can occur easily:
- As a result of a sports injury
- An injury that occurs every so often from home improvement projects
- As a repetitive stress that occurs on a daily basis such as computer work.
What about other things that you do on a daily basis that you may not factor in to your shoulder problem? Like sleep..
This particular study looked at sleeping side of people who had one sided shoulder pain. Researchers found that the side that was bothering the patient was more likely to be the affected side. Leads to a potentially very simple therapy–switch sides of the bed…
So what happens after this injury?
- As the body heals from an injury, it will not heal at 100%
- Scar tissue forms
- Scar tissue is more prone to re-injury, recycling the process and depositing more and more scar tissue as time goes on
- Given enough time, tearing of weakened scar tissue portion of the rotator cuff tendons becomes much more likely, and even quite common.
As a matter of fact, a large percentage of women over 50 have rotator cuff tears that they aren’t even aware of (meaning they are pain-free rotator cuff tears).
For this reason, just because an MRI shows a tear does not mean that it wasn’t already present before you painted that ceiling last weekend. That means that it is likely that a rotator cuff tear may have been present even before an injury, and that an injury just worsened what had been present for a long time.
If tendonosis with scar tissue is present, no amount of rehab stretching and strengthening, ultrasound, massage or interferential will change that. Unless the scar tissue is addressed the shoulder isn’t really fixed. Tendonosis requires a different soft tissue approach.
So what can be done? Luckily, there are many things that can be done to help with your shoulder pain.
- Studies have should that chiropractic manipulation can speed along recovery.
- Advanced soft tissue techniques like Graston technique can help address the scar tissue.
- Facial Manipulation
- And, as mentioned early, try switching the side of the bed you sleep on to reduce chronic stress on the affected shoulder.
So what did you do that helped your shouder pain the most?