Dr. Valerie Girard
Shoulder Pain? Treat the Neck!
So many patients present with “shoulder” pain. They point to their shoulder joint, down their upper back and down their arm, calling it all shoulder pain. They are unaware that there are a variety causes for this pain. It is sometimes useful to understand the different diagnoses that chiropractors need to make to then be able to successfully treat the shoulder pain symptoms.
I like to describe the shoulder joint as such: a baseball ball hanging from a tea saucer. It is a miraculous but tenuous joint that allows us to pitch a baseball, rock climb and carry heavy items. It is amazing to me how well it works – most of the time.
Most of the shoulder pain that I treat originates from the lower cervical spine. Why? Because most of us spend a significant time on the computer, using a mouse, perhaps sitting with incorrect posture and leaning forward to visualize our work on the computer. Heads shift forward, the lower neck is compressed and misaligned which then compress the lower cervical nerves, leading to radiating nerve pain called neuralgia or radiculopathy. This may cause fairly severe pain and specific orthopedic tests will diagnose this issue immediately. Once the correction is made in the neck, the orthopedic test will be negative and the patient in on their way to a painless shoulder. Exercises are then given to counteract the effects of “computeritis”.
Bursitis is an inflammation of the bursa or cushion of the shoulder. It may progress to a frozen shoulder, in which the patient is unable to lift the arm into certain positions without extreme pain. The test for this: neither the doctor nor the patient can lift the affected arm without eliciting pain.
This treatment will then consist of correcting the alignment of the shoulder and the neck, lasering the inflamed bursas, balancing the tonicity of all shoulder muscles to each other and possibly diet changes. Exercises are also given to help break up any adhesions that may have formed. Hot and cold applications may reduce inflammation. The application of topical ointments like Traumeel and the use of heat and ice can be very helpful as well. Anti-inflammatory medicines or supplements are often useful as well.
There are many aspects of the shoulder itself that can be misaligned: the head of the humerus, the clavicle or collarbone, the shoulder blade, the bicipital tendon as well as the AC joint. Sometimes, just aligning these components of the shoulder allows an immediate increase in range of motion.
Tendonitis is defined as inflamed tendons and is diagnosed by the doctor, not the patient, being able to lift the arm without eliciting pain. Again, the innervation to the shoulder must be corrected, the tendons healed with laser therapy and special exercises given. All the muscles around the shoulder joint must be strengthened and balanced with each of the other muscles. Again, diet, supplements, heat and ice are critical in the speedy recovery of tendonitis. Taping can also be extremely helpful in maintaining the alignment work as well as protecting the joint as it heals.
The shoulder can be sprained, which means that the ligaments have been strained or mildly torn and the joint itself is out of alignment. An A/C separation happens when a force separates the clavicle (collarbone) and part of the scapula called the acromion. Sometimes the bicipital tendon slips out of its groove. The head of the humerus can also be aligned too anteriorly or posteriorly and movement will cause discomfort. These aspects of the shoulder joint may easily be realigned and then taped for support. If the shoulder is dislocated, then it must be reduced by a reduction procedure, often bringing instant relief.
The four supportive rotator cuff muscles are often vulnerable to overuse or injury. These muscles (teres minor, infraspinatus, supraspinatus and subscapularis) may strained or tear. When there is a substantial tear, surgery is highly recommended. However, if the tear is minimal to moderate, chiropractic, physical therapy, acupuncture and exercise therapy are indicated for recovery.
How to best treat a rotator cuff tear:
1. Restore proper innervation to the four muscles for maximum function.
2. Strengthen all muscles of the shoulder. Release any muscles that are in spasm.
3. Restore the functional relationship between all antagonist and agonist muscles to realize full range of motion.
4. Laser the insertions of the torn muscles to aid in healing.
5.Adjust the neck and shoulder joint to increase shoulder strength, mobility and function.
6. Utilize exercise therapy to accelerate healing, both strengthening and stretching.
7. Use nutritional diet and supplements to accelerate recovery.
In the past, shoulder injuries were often difficult to treat and thereby long lasting. Many of my patients have averted having surgery by not only the care they received but by adopting different strategies in their work and play.