Healing Chronic Shoulder Pain

As we get older, years and decades of mechanical stress may lead to deterioration of joints, ligaments, and tendons. This degenerative process, commonly known as arthritis, primarily affects weight-bearing joints such as the hips and knees and those found in the lumbar spine. The shoulder, too, is especially prone to undergo arthritic changes owing to its extreme mobility. The extensive range of motion at the shoulder is built-in to the design of this structure, but the tradeoff is instability. The design of the shoulder sacrifices stability for mobility.

Degenerative disorders of the shoulder typically involve the rotator cuff. This broad, flat structure is composed of the muscle-tendon units of the four rotator cuff muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor. The thick covering of the rotator cuff surrounds the head of the arm bone and supports and strengthens the shoulder joint. But owing to the shoulder's inherent instability contrasted with its great mobility, the soft tissues of the rotator cuff undergo repetitive stress and strain. Ultimately, degenerative changes may occur, leading to the two prominent symptoms of pain and restricted range of motion.

An entire orthopedic sub-specialty focuses on treatment of chronic shoulder pain and includes long-term use of anti-inflammatory medication, corticosteroid injections when medications do not provide sufficient relief, and eventually surgery to repair tears in the various rotator cuff tendons. "Revision" surgery is commonly performed when the benefits of prior surgery are exhausted.¹

The good news is that in many cases, a more optimal approach is available, one that utilizes the body's own natural recuperative powers. For many people, chronic shoulder pain can be reduced and chronic loss of mobility can be improved by engaging in specific activities and performing specific rehabilitative exercises. The goals of rehabilitation are to increase shoulder range of motion and build up shoulder strength. As these goals are accomplished, the likely result is reduction of intensity and frequency of occurrence of shoulder pain.

Engaging in an overall strength training program is an important general approach to managing chronic shoulder pain.^2,3 Strength training should be done progressively, starting with light weights and building up over time. Exercises specific to the shoulder include seated dumbbell or barbell presses, dumbbell or cable lateral raises, seated bent-over rows, and internal and external rotation exercises done with very light dumbbells on a flat bench. If one has experienced an acute shoulder injury, early rehabilitation should precede rehabilitative strength training. Early rehabilitation includes pendulum exercises and finger-walking up a wall in both forward-facing and side positions.

Your chiropractor is experienced in injury rehabilitation and will be able to help you design an effective flexibility and strengthening program for improved shoulder function.

 

 Chronic injuries require specific rehabilitation and a long-term approach. Patience is required and it is important to recall that the problem has developed over the course of years and will not be fixed in a matter of weeks or months. Progress should be obtained in the short-term, but such situations usually require consistent, ongoing attention to achieve a long-term solution.

Performing the appropriate rehabilitative activities is critically important and chiropractic care can be of great assistance in getting the most out of your exercise program. Regular chiropractic care improves the mobility of your spinal column and removes nerve interference which may cause tight, inflamed muscles. The result is a body that is optimized for good health and full function. By enabling maximum spinal mobility and maximum function of your nerve system, regular chiropractic care helps maximize your body's ability to recover from chronic injury.

Please let us know if we can help you improve your health in any way!

(386) 492-4881 or reach us on the web at www.AtlanticChiroFL.com

¹Keener JD: Revision rotator cuff repair. Clin Sports Med 31(4):713-725, 2012

²Lewis JS: A specific exercise program for patients with subacromial impingement syndrome can improve function and reduce the need for surgery. J Physiother 58(2):127, 2012

³Andersen LL, et al: Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain 152(2):440-446, 2011

What's Wrong With My Back?

Not all back problems are created equal. One person may have been working on a home improvement project and injured her back while simultaneously bending and twisting. Another person may have developed back pain as a result of a vehicular collision. Another person may be experiencing back pain as a result of osteoporosis. Yet another person may have a serious illness which causes back pain as a related problem.

Back pain is a problem common to many types of injuries and illnesses. How can you tell the difference - in other words, how can you tell when back pain requires you to take action, such as seeing your chiropractor? A reasonable approach is to use a 48-hour guideline. Your body usually has a powerful ability to heal itself. If your back pain hasn't gone away on its own within 48 hours, then seeking professional assistance is a very good plan.

However, some situations require immediate attention. For example, if you've had an accident, seeing your chiropractor right away is probably the right thing to do. In another scenario, if you begin to experience severe pain without an obvious cause, then seeing your chiropractor right away makes a great deal of sense. Like many things in life, having physical pain requires us to use good judgment. The 48-hour rule-of-thumb applies to most situations, but if you've had an accident or are having an unusual problem, see your chiropractor as soon as possible, today if necessary.

When a person has back pain, it's very important to make sure there are no related problems. Most of the time there aren't, but no one wants to be the exception and it's always better to be safe than sorry. Making your own diagnosis is never a good idea. "Oh, that's been bothering me for months," some people will say. "It's just back pain." Of course, such an approach to one's health violates the 48-hour rule. If the problem really wasn't anything much, it would have gone away within a few days. Something else is going on, and usually the longer a physical problem is left untreated the more difficult it is to deal with. The old expression, "an ounce of prevention is worth a pound of cure" is as true today as it was 100 years ago.

Your chiropractor is an expert in back pain. They know that physical pain happens for a reason.^1,2 Their job is to discover that reason, using the tools of history taking, physical examination, biomechanical analysis, and special tests, if necessary, such as x-rays and other imaging methods. Most of the time, the underlying problem is mechanical in nature, involving the spinal joints and associated soft tissues, including the ligaments, muscles, and tendons. Such mechanical problems cause the vast majority of cases of back pain, and are directly addressed by chiropractic care.³ In unusual circumstances, your chiropractor will refer you to another specialist. The important approach in all situations is to seek appropriate care. Your chiropractor's office is the right place to start.

 
Most people now know the importance of exercise in daily life. The benefits of exercise range from improved strength, balance, and agility to deeper, more restful sleep, improved outlook on life, and heightened levels of creativity. Of course, there's also an additional direct benefit for persons with back pain.
Most cases of back pain are biomechanical in nature. In these circumstances, spinal joints have lost some mobility and spinal muscles have become tight. The long-term result is back pain, which may be mild, moderate, or severe, depending on the extent of the biomechanical dysfunction. Chiropractic care is the specific treatment for problems involving the spinal joints and muscles. Exercise is an important addition to chiropractic care. When you perform challenging activities throughout a full range of motion, as you do when you exercise, you're retraining the joints and muscles of your back. By engaging in such activities on a regular basis, you're helping to restore spinal strength and mobility, enhancing the benefits you're receiving from chiropractic care.

Your chiropractor is an expert in rehabilitative exercise and will be glad to design an exercise program that will work for you.

¹Bakker EW, et al: Spinal mechanical load as a risk factor for low back pain: a systematic review of prospective cohort studies. Spine 34(8):E281-E293, 2009

²Shambrook J, et al: Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging. Pain 157(7):1659-1665, 2011

³Wilder DG, et al: Effect of spinal manipulation on sensorimotor functions in back pain patients: study protocol for a randomised controlled trial. Trials 12:161, 2011