The shoulder joint is one of the most commonly injured extremity joints that I treat in my practice. Unlike what most may think, it is not seen in athletes only. While many rock climbers, avid weight lifters, and active people used to be the sufferer, today, I see many desk jockeys that suffer from this condition. If you’ve been experiencing shoulder pain and find yourself searching one of these on the list- will shoulder pain go away, will shoulder pain heal on its own, shoulder pain without injury, shoulder pain without exercise, shoulder pain and workout, shoulder pain with barely lifting arm, shoulder pain and clicking, shoulder pain every morning, shoulder pain for weeks, shoulder pain causes, shoulder pain keeps coming back, shoulder pain not going away, and shoulder pain relief– you’re going to want to keep reading!
Causes of Shoulder Pain
What are we talking about when we say shoulder? The shoulder joint is where the arm meets the torso! I say this because many refer to the area above the shoulder blade and across the top of the mid-back as their shoulders! The shoulder joint is a ball and socket joint meaning the top end of the humerus (arm bone) forms a ball that sits inside a socket which is part shoulder blade or scapula and part collar bone of clavicle.
There are tendons attaching each muscle to these bones, referred to as the rotator cuff. These muscles include:
- Teres Minor
Most shoulder injuries often involve these muscles and their tendons, or ligaments connected the three bones. Injuries can range from heavy overhead lifting to falling on an outstretched arm. Some shoulder pain stems from an injury or trauma that took place, but what about shoulder pain without injury? The most commonly injured tendons among the rotator cuff tendons that I treat at my clinic are of Infraspinatus and Supraspinatus muscles. In my practice, I see mostly Supraspinatus muscle injuries without any specific trauma just because of the way it is attached to the humerus. The biggest mistake however is that most people think shoulder joint pain has to do with the rotator cuff muscle(s) and disregard the positioning and function of the shoulder blade in the picture. Shoulder blade stabilizers are the missed component in the treatment of shoulder pain and injuries.
Shoulder Pain Without Injury
Under healthy conditions, which does not include a sedentary lifestyle, the brain is sufficiently activated by the healthy daily activities, and therefore the command to be upright against gravity is sent to the body at all times unless otherwise dictated by the activity at hand. In other words, the brain-body communication is such that the upright against gravity command is at its full function most of the day. After all, effective breathing depends on this posture; let’s slouch and take a nice deep breath!! You see that the two don’t happen together. The upright posture is our posture that we are programmed to have and our lifestyle is in total conflict in most cases. This command center is located in the mid-brain called PMRF (Ponto-medullary-reticular formation) and is in fact is where the command to breathe in and out is is located(Vegas nerve nuclei).
When sitting for extended lengths of time, day in and day out, the demand for the mid-brain to send the upright command goes down. The slouch position means forward flexion of the torso and the rolled forward shoulder. In an ideal position, the “ball” sits in the socket and is centered perfectly, but in most people, their slouching posture demands the ball to be positioned closer to the front of the socket and the joint space gets much tighter than it should be.
This means every time the arm moves, the ball is closer to the front of the socket than it needs to be. A great example to relate this has to do with shopping; you grab a cart that pulls to one side vs straight. After a while of fighting this cart, you either get a new one or you will notice the extra work this ‘misalignment’ causes on your body. When the ball is not sitting centered to the socket, the surrounding soft tissue recognizes the imbalance, tries to pull, push, stretch, tighten and do whatever it can to bring the anatomy of the area closer to how it is supposed to be. This results in muscle stiffness, pain, and restricted range of motion. This isn’t something that just happens overnight. At this point, it’s no longer termed shoulder injury or shoulder pain, but arthritis.
Arthritis is commonly seen in the shoulder joint as a result of this long term misalignment. Let me make something very clear! The most common type of arthritis, Osteoarthritis, has nothing to do with age but everything to do with misalignment of the joint. I so wished they taught us the truth when we went to school!! Here is how:
You can have an old door hanging straight on its frame and after decades, all you see is the aged wood, no wear or tear at the edges. On the other hand, the same door could be hanging crooked on the frame and it is only a matter of time before you start seeing wear and tear at the places where the wood hits the frame. It is NOT the age but the alignment that causes the wear and tear.
In the case of the shoulder joint, the misalignment of the actual joint leads to a decrease in joint space in some parts, improper tone of muscles and tendons surrounding the area which will lead to a tear at the tendon without or hardly any specific incident. It is easy to just play that same volleyball game that eventually leads to severe shoulder pain that later on an MRI reveals a tear of some kind.
Shoulder Pain Treatment
Generally, the first thing is to rule out any dislocation at the Acromioclavicular joint and Glenohumeral joint through a series of tests and palpation. Once that is ruled out, if there is a mismatch of symptoms and findings, I may send the patient out to get an MRI scan. NOT all positive MRI findings lead to surgery.
Depending on the findings, shoulder pain treatment can consist of the following but not in those orders:
- Postural Neurology
- Dynamic Neuromuscular Stabilization (DNS)
- Active Release Technique (ART)
- Cold Laser
- Chiropractic Adjustment of the shoulder, and collar bone
- Scapular Mobilization
- Passive physiotherapy modalities (for new injuries or post-surgery only)
Since unless directly injured as a result of trauma, all shoulder issues are the accumulation of shoulder stabilizer, neck, and collar bone not working together. The key is to address the cause of issue AND to address what feeds the cause!! That’s like cutting a tree off but unless what feeds the root is eliminated, the next year, a new shoot comes out!
If movement is a concert, your body parts are the musicians and the brain is the conductor. For a great concert to take place, not only do the musicians need to be knowing their musical instruments but also know when to chime in. Clearly, the conductor needs to have the correct musical notes in front of it.
The musical note analogy is what HOMUNCULS is all about. That is the map of the brain with regards to movement and sensation that we are born with but is finalized during the developmental stages of movement. We are all wired to meet these milestones by a certain age (with an exception of few genetic disorders of course). If we don’t use body parts due to injury or lifestyle, this map becomes compromised. The end result is the musical note in front of the conductor that is not the right one. It’s as if, we want to play Fur Elise but the notes have parts of Ave Maria!
Through postural neurology we find out what parts of homunculus is compromised and through postural neurology exercises, those parts are strengthened.
Using cold laser to assist in some of the pain and inflammation is warranted in some shoulder pain cases but not necessarily applicable to all. What is a must-do part of the treatment is Functional Rehab. modalities such as ART and mobilization are used to bring some degree of mobility into the joints that are going to be asked to perform. Here is an example of the correct postural neurology exercise for those with the midbrain, PMRF weakness for instance, and the one that we all should do on a daily basis for a few minutes.
To practice the timing of the ‘musicians’ when it comes to their concert performance, we do Developmental Kinesiology or Functional Movement exercises such as DNS or Dynamic Neuromuscular Stabilzation. A mouth of but in short, it is what we all did as newborns until we started moving and right before we got involved in our ‘one-sided’ sports for instance.
If the world was a petri dish, every single baby developing from being helpless to running is a clear success testament to the experiment. Meaning, we all accomplished the movement milestone the same way no matter what part of the world we are from or what gender we have. That is because we are programmed to follow those stages!! Why not re-walk the same path when we need to fix a movement problem?!!
We all know that taking medication does not fix anything. It simply takes away the pain for a short while at best. Chiropractic adjustments do not fix anything but simply activate the nervous system into becoming more alert and attentive to the area. It won’t last long because that is similar to a teacher coming into the class telling students she has something important to say. If what comes next is not important or nothing is said after that, the kids go back to the bored self again. What happens after the adjustment is the key and if it is not the right ‘story’, we don’t accomplish much.
Then we have the physical therapy where we isolate the area or maybe just attend to what is very close to the injured area and then leave it at that. It makes no sense to treat the area in isolation when the problem is in movement. Of course, if damaged enough, the problem will end up being present at all times. By then, no physical therapy is going to do a long term positive impact- period.
Shoulder Pain Relief Exercises
As stated above, Dynamic Neuromuscular Stabilization is applying the movement patterns of babies, developing movement from just 3 months of age all the way till they start walking, to reestablish the movement patterns in people with failed posture and pathological (wrong) patterns of movement. Watch the video below for an explanation of this and a great exercise that most babies do at just 7 months of age, but for most adults, this is a difficult move.
Remember, it is easy to ‘mechanically’ do a move but that only leads to creating the pathological patterns of movement vs biological patterns of movement. If your goal is to feed yourself, you can either bring the spoon to your mouth or your mouth to the spoon. We both know that with the second example, it is only a matter of time before we will develop pain and tension in the neck and arm!
Once again, in the concert example, there are times that all musicians play in the background while the spotlight is on let’s say the pianist. When it comes to movement, all muscles are to do their primary job while the ‘performing’ muscle showcases its work. When we don’t follow the correct patterns of movement, everything is out of order, in essence, no wonder there are issues to address. Remember, the muscles move, the joints follow and the skeleton gets from one point to the next. When that order is not maintained, the brain has to do its job, to get you from point A to B so it moves a different area, to mechanically put you where you need to be to get the joint moving. For instance, many times, we use our neck and upper back to perform what the arm muscles lack. When this becomes a repeated pattern, we create a problem that leads to the exhaustion of the neck and upper back muscles (in this example) which now have their own job and the job of something else. Sort of as if you have your won work responsibility but someone else at work is absent and you now have that person’s job load on top of yours!
The video below is how we moved as a baby to strengthen not only the correct muscles but to practice its performance while the rest of the body holds its main job simultaneously. A world-class performance!
Now that you understand what it takes to have a shoulder pain, you reverse engineer it to treat it effectively. Remember, you are the Designer and the Director of your own life so design and direct it the way you wish to live it.