Shoulder Pain Treatment – Trade Secrets Revealed

Shoulder Pain Treatment & Your Ribs

The shoulder joint and the shoulder girdle is made up not of one joint but a series of joints. The shoulder is also made up of numerous muscles and multiple layers of complex connective tissue known as fascia. It is relatively common knowledge about shoulder pain treatment that it often needs to be directed at the soft tissues of the shoulder. The soft tissues of the shoulder girdle are a major ‘source’ of shoulder pain and are therefore a major consideration in the treatment of many shoulder pain cases.

A far less common piece of knowledge about shoulder pain and its treatment is that it is often profoundly connected to the movement and wellbeing of the upper rib cartilages.

Each of your ribs starts at the front of your body with a small knuckle sized joint that connects the rib to a bony ‘plate’ called your sternum (breast bone). The rib then moves around to the back of your body in an arch and eventually meets its spinal bone. In the same way it attached to the sternum each rib also has a small joint that attaches it to the spinal bone at the back. It is the small hinged movements of all your ribs at the sternum (front) and spine (back) combined that allows them to move when you breathe, stretch and do Zumba.

image depicting the suffering of shoulder pain which needs treatment,

Shoulder pain… it will never kill you but it can be extremely frustrating to live with.

A major major shoulder pain treatment secret that few are aware of (even amongst professionals) is that the upper ribs are nearly always  locked up and in serious need of mobilisation. When the upper ribs lock up next to the spine they can have 2 major roles to play in generating shoulder pain. The first way that the ribs can effects shoulder pain is by creating the sense of an extremely stubborn knot behind the shoulder blade. The second way that the ribs can create shoulder pain is by limiting space for the rotator cuff tendons to perform their task without impingement. The true underlying cause of most instances of impingement is ribs that have become locked up due to stubborn postural patterns.

One of the most consistently effective methods for treatment of stubborn and persistent shoulder pain is mobilisation of the ribs. Shoulders that have been through countless failed treatment cycles frequently undergo nearly miraculous increases in mobility once the ribs are released. It can be a great relief to have your ribs mobilised as part of your shoulder pain treatment plan.

 

Shoulder Pain Treatment & Tears

The rotator cuff tendons are like fingers that reach around the glenohumeral joint (ball & socket) to stabilise it. The reason the rotator cuff does this favour is that the glenohumeral joint is so mobile that it needs more support than the fascia and connective tissue alone can provide.

In order to help stabilise the shoulder, the rotator cuff tendons need to squeeze into a tight gap between the acromion (end of shoulder blade) and the humerus (upper arm bone). There is limited space for the rotator cuff tendons to function between the 2 bones. The space between the 2 bones is most compressed during overhead movements, especially in people who have less than perfect posture. If you have pinching of the tendons over a long period of time eventually you may suffer a tear of the rotator cuff tendon.

shoulder impingement image showing lack of space in the glenohumeral joint..

The lack of space in the glenohumeral joint is a major cause of rotator cuff tears and of shoulder pain.

There are 2 sneaky little secrets that not alot of people know about shoulder pain treatment for these rotator cuff tears. The first is that rotator cuff tears in a healthy tendon are extremely hard to do and generally don’t happen in a one off instance. This needs to be taken into account with treatment of the shoulder as longer term rehabiliation and strengthening is warranted. The second sneaky secret regarding rotator cuff tears is that often tears can be completely painless, and can even survive quite nicely in the long term without the need for surgery.

If you are willing to do the work of correcting your posture and making your rotator extremely strong and supple you could potentially avoid surgery for a rotator cuff tear and suffer no ill effect long term. Similarly there are instances where surgery is absolutely warranted.

An excellent rule of thumb when it comes to shoulder pain treatement is to be as conservative as possible, which basically means being reluctant to be given a general anaesthetic and cut open if it can be avoided; but to be very aggressive and determined when it comes to the right exercises in the longer term. Shoulder pain treatment is certainly not a 1 size fits all kind of party but there are some general rules to oberve that often lead to good outcomes.

There is a bonus trade secret that you might some day benefit greatly from knowing. There is high quality scientific evidence that shows key hole surgery generally works no better than a placebo.

 

Shoulder Pain Treatment & Posture

So many of us don’t feel good about our posture, how it makes us look and how it makes us feel. Correcting posture is not an easy task but we do have a tendency to make it even harder by ‘winging it’. The good news is that there are effective ways of managing your posture, and that when we do we can expect a lot less shoulder pain.

Good posture and bad posture are both made up of the same basic ingredients.

  • Bone alignment
  • Muscle activity
  • Joint movement
  • Connective tissue tone
  • Brain activity

When your standing and sitting posture is well aligned, all of the structures and functions on the list to express full health. When our posture is compromised however, the tissues in shoulder can suffer through excessive tightness, excessive weakness or excessive compression. This is where shoulder pain and even shoulder injuries are won and lost.

The most obvious and well known dimensions of poor posture are the classic weakness in the upper back and excessive tightness through the chest which comes through lots and lots of seated tasks like computer work. There are however numerous other changes that can occur in cases of shoulder pain that require treatment. 

When our posture suffers the rotator cuff can become strained and weakened, the fascia can become shortened and tightened, joints can suffer wear and tear and the brains connection to the body can become sloppy. For those of us looking for shoulder pain treatment that is  effective and brings long lasting relief we need to potentially need to be willing to tackle the difficult topic of postural correction. 

Shoulder pain treatment that is comprehensively directed at the posture is a combination of hands on treatment, home exercises, supplemental gym exercises and coaching for better postural habits.

 

Shoulder Pain Treatment & Sleep

Sleep is supposed to be a chance to rest no only for you and your poor itred brain but also for the tissues of your body and the shoulder is no exception. When you sleep the muscles and soft tissues get to have a well deserved break from all the yanking and pulling and pressure they go through in the day. Sleep is also the time for the body to do much of its repair, we inflict constant microtrauma on our body in countless ways and this requires constant repair work within the bodies cells.

If you do sleep in a position that is biomechanically sweet az the strain in your bodies tissues can spill over into your precious regenerative sleep time. One of the most classic sleep habits that can contribute to shoulder pain is sleeping with an arm over the top of your head, another classic that can cause shoulder pain is a naughty sleeping on the tummy habit.

If a sleep posture or habit is causing your shoulder pain a major part of the recipe for successful treatment will obviously be making an adjustment to your sleep position.. Not easy perhaps but probably not as hard as you are thinking either.

At our clinic we coach people on how to make gradual changes to their subconscious programs that determine sleep position, its a process but it does work. I have never met anyone who struggled to change their sleep position once they had decided that they really wanted to and had the right tools at their disposal.

One sneaky little life hack for those of you needing shoulder pain treatment due to sleeping with one arm up over the head is the following. Put a fairly large t shirt on and shove the offending arm inside the t shirt like a 1 arm straight jacket… that’ll keep it under control.

 

Shoulder Pain Treatment & Impingement

One of the most common underlying factors behind stubborn shoulder pain is ‘impingement’. Impingement is the correct term for what happens when the rotator cuff tendons get pinched or trapped between the humerus (upper arm bone) and the acromion (tip of the shoulder blade).

If you have shoulder pain that ‘catches’ or ‘twinges’ when you perform overhead movements or when elevating your arm the chances are you have some kind of impingement occurring. The most classic sign of impingement is when elevating the arm triggers pain but full elevation of the arm isn’t too bad, there are other patterns however. These types of pain can be very frustrating and have a tendency to limit certain activities and hobbies until they are resolved.

The most common way that impingement occurs is through a combination of chronic poor posture and some kind of overhead movement. The most common pattern we see is when someone with stubborn shoulder issues does wide grip shoulder presses at the gym that they don’t have sufficient mobility for. This is preventable through postural rehab and shifting to narrow grip presses with dumbells. People with relatively good posture can suffer with impingement pains if they do lots and lots of overhead actions, like painting ceilings or practicing a tennis serve.

If you have true shoulder impingement pain, treatment involves a combination of hands on methods that assist soft tissue healing and postural rehab. It is also sometimes necessary to make small lifestyle and ergonomic adjustments.

Human shoulder pain with the anatomy of a skeleton shoulder

 

Shoulder Pain Treatment & Burstitis

Bursae are small, fluid-filled sacs  that exist nthroughout the body in places where there is a lot of friction. Bursae act as lubricated pads between bones and soft tissues, and help limit friction during movement between the shifting muscle tendon and bone.

Bursitis is a condition where the bursa becomes inflamed and sometimes enlarged due to excessive friction being placed upon it. Bursitis can lead to shoulder pain, and reduction of pain free movement in the shoulder.

The classic explanation for bursitis is one of  straight forward ‘overuse’. The reality is though that there is always a million other people just like you overusing their shoulders, and not getting bursitis. This is because the true cause of bursitis is postural imbalances and poor movement habits that put excessive compression and friction on your bursa. 

The other commonly myth about bursitis is that having an enlarged bursa on you ultrasound scan means the bursa is definitely the cause of your pain. The far more complicated truth is that many people with enlarged bursae in their shoulder do not have bursae pain, their bursa is enlarged but it’s soft tissue pain that they are experiencing. The fact is hinted at by the extremely hit & miss nature of cortisone injection into the bursa as a treatment for shoulder pain.

The primary secret to successful shoulder pain treatment when there is an enlarged bursa is correct diagnosis through special movement tests. The secondary secret to shoulder pain treatment for bursa issues is to work on correcting the posture and taking pressure off the bursa. 

 

Shoulder Pain Treatment & Stress

Of all the boxes that there are to check on a health history form, by far the most common is the one for stress and depression type disorders. In terms of health we have great healthcare, warm housing, nutritious food and excellent sanitation and yet the one cause of chronic sickness that still seems to affect so many of us is stress. Stress can impact the body in many ways, for some people stress hits their gut, for others their skin suffers, others get headaches and of course shoulder pain triggered by stress is also common.

Stress has a way of accelerating shoulder pain and neck pain all of its own accord, even without sedentary work. In a world where the most common way to male a living is by sitting in front of screen for more than 6 hours a day shoulder pain was always going to be an issue for some of us.

The most obvious way that stress can impact the expression shoulder pain is via the increase in muscle tension through the neck and shoulders. Chronic tension in the shoulder muscles if it is present day after day eventually creates irritatiion in the soft tissues of the shoulder and results in pain. A less obvious factor that we have come to learn in relation to stress and shoulder pain is ‘pain centralisation’. Pain centralisation is the term that we use describe over activation of the pain centres in the brain and spinal cord, if these centres become chronically over active shoulder pain can take on a life of itsa own and become very stubborn. Shoulder pain caused by central sensitisation tends to be caused by extreme forms of stress and by full blown trauma.

Treating shoulder pain that is being driven by stress can be extremely tricky. Significant, active stress patterns in the body can completely interrupt shoulder pain treatment protocols that usually work very reliably.

The secret to managing shoulder pain that relates significantly to stress is to be willing to treat both the bodies tissues that are expressing the pain AND develop strategies to either eliminate or become more resilient to the stress itself.

Success in this area requires a patient approach, for many of us our patterns of stress can be traced back to habits of thought and action that go all the way back to our childhoods. If you want to have a conversation about how to manage stress that seems to be causing you pain email me at toby.fpcnz@gmail.com.

 

Shoulder Pain Treatment & Muscle Wasting

Your shoulder is easily the most highly mobile articulation in the human body. Having a large range of motion is extremely handy for bowling etc. but it makes for a far less stable joint. The more mobile a joint is the more opportunities there are for strain and injury. 

The secret to lots of movement without constant injury in the shoulder injuries is the shoulder girdles stabiliser muscles. The strength of the rotator cuff combined with additional support from the muscles of the upper back and chest is what enables a large range of movement without constant injury.

Many shoulders with stubborn pain are full of muscular ‘pressure points’ (the sore spots you feel in muscles) and muscle spasm. In many of these cases releasing these points is the key to pain relief and restoration of movement. While using exercises to bring the muscles back to full strength is the key to successful longer term management.

Maintaining healthy muscle mass in the back of our shoulders is one of the ways in which we prevent postural collapse and premature loss of mobility later in life. Its also an integral component of shoulder pain treatment.

Picture of a patient needing shoulder pain treatment.

Shoulder pain is super frustrating, often muscle strengthening is a major key to successful treatment.

 

Shoulder Pain Treatment & Scar Tissue

It’s common knowledge that scar tissue can result from traumatic injuries. It is far less well known that there are kinds of scar tissue that can build up slowly, usually in response to stubborn stresses and strains in the body. You might not be familiar with the concept behind this type of scar tissue but you will most definitely have seen it’s affects.

Picture the average office worker type round shouldered posture. It starts off as a habit but you might have noticed that there is actually a kind of change in physical shape over time. If you sit in a hunched way ultimately you become hunched, and eventually you can’t sit up straight even when you try. A major component of this change is fibrous build up of scar tissue in the spine and shoulders. And it is a major factor in many cases of stubborn shoulder pain. 

Desk work or other work that involves prolonged sitting is the most classic and effective way to develop scar tissue in the shoulder and spine. Many of life’s tasks and activities can also however contribute to the build up of scar tissue and to shoulder pain.

The secret to shoulder pain treatment when the pain relates to scar tissue build up is to break up the scar tissue. This can be done through special kind of stretching ad through scraping using blunt massage tools. Once the scar tissue is broken up working on the strength of the postural muscles is they key to longer term relief of shoulder pain.

 

Shoulder Pain Treatment & Stretching

When we spend a lot of time sitting our bodies change and adapt to those sitting postures. This is a major part of why people become more hunched as they get older, adaptation to postural habits. One of the main forms of adaptation that we undergo over extended periods of sitting is shortening of muscle and connective tissue.

It is pretty much common knowledge that there is great value in stretching muscle and connective tissue, especially when we have pain. Shoulder pain issues tend to go along with tightness at the front of the chest and upper arms. Regularly stretching out the pecs, upper arms and front of the body in general is an excellent addition to most shoulder pain treatment protocols.

A great tip for effective stretching in the upper chest is to use time as opposed to effort to stretch. Assume your favourite chest or pec stretch and hold it at a level of 4/10 stretch for up to 3 minutes at a time, this will feel like quite a while. Gentle persistent, patient stretches create more flexibility than forcing a stretch.

 

Shoulder Pain Treatment & The Bicep Tendon

The bicep is the muscle at the front of the upper arm. The biceps primary job is to bend the elbow and in order to do this you need to have a strong anchor point (or in fact 2 of them) at the front of the shoulder. These strong anchors provide the basis for being able to do dumbbell curls at the gym and all sorts of other cool stuff.

The bicep tendons attach right at the front of your shoulder joint so closely that when they hurt heaps of people think they have joint pain or rotator cuff pain. A significant number of the people I treat each month have bicep tendon pain that is the cause of their shoulder problems. Very few are aware that is what they are suffering with when they first show up.

The secret to successfully treating shoulder pain coming from the bicep tendon is to break up the microscopic scar tissue that traps the tendon in its sheath. This can be done by a professional using a blunt massage tool and scraping deeply into the tendon attachments. This kind of treatment is not fun but it does work extremely well.. And usually very quickly. 

 

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