Shoulder Pain Chiropractic Treatment El Dorado Hills
Shoulder pain is one of the most common injuries we treat at NorCal Spine & Sport. It also can be frustrating, debilitating, and never goes away. However, like elbow pain, once we understand the cause of the pain we will have a much greater chance at healing the injury.
The most common conditions and injuries we see in our clinic include the following:
- Impingement Syndrome
- Tendonitis & Tendonopathy
- Rotator Cuff Tears
- Shoulder Strain/Sprain
- Shoulder Dislocation
- Shoulder Separation
- Bicep Tendon Injuries
- Glenoid Labrum Tears/Cartilage Tears
- Degeneration & Osteoarthritis
- Adhesive Capsulitis/ “Frozen Shoulder”
- Neck Injuries & Pinched Nerves
The Shoulder Design
The shoulder is designed to maximize motion. It is important to understand that the shoulder is attached to our body primarily by muscles, ligaments, and other soft tissue structures. Besides the clavicle (collar bone), the shoulder basically is floating. This allows for maximal mobility. As a result, this mobility also creates an increase risk of instability.
The balance in the shoulder design is vital towards minimizing injuries. Imbalance in the shoulder leads to shoulder pain! Further misalignment and slipping leads to:
- Cartilage Tears
- Rotator Cuff pinching/tears
- Unstable Shoulder
- Joint Spurring/Arthritis
- Scar Tissue Buildup
What stabilizes the shoulder? What holds it together?
The shoulder joint is considered a ball and socket joint. The joint is connected and stabilized by: the rotator cuff muscles/tendons, the joint capsule, and the labrum. All of these soft tissue structures help stabilize and hold the shoulder together. It is very important that these structures remain healthy and strong. If not, imbalance will occur and lead to shoulder pain!
Three ways that you unknowingly cause trauma to your shoulder
- Major Trauma
- Lifting too much weight
- Fall on outstretched arm
- Micro Trauma
- Repetitive activity or overuse (e.g. weight lifting, swimming, throwing, overhead work, typing…etc.)
- Constant Tension (typing at computer)
- Sitting/standing for long periods
Why is your shoulder pain not healing?
We have found that the primary reason why shoulder pain never goes away is due to a failure to address the original cause (or causes). This can be a result of faulty mechanics of activity, postural and ergonomic problems, and/or improper rest and recovery. All of these issues result in repetitive strain to the shoulder and the surround soft tissue structures.
Strain = Tear
That’s right. The achy soreness that you feel after playing sports (e.g. swimming, lifting weights, golf, throwing, etc.) or after an activity (e.g. computer work, cooking, cleaning, etc.) is actually a tear in either the muscle or the tendon of the shoulder. Sometimes there is a lot of tearing and sometimes there is just a little tearing (microtears) that adds up over time.
This tearing leads to inflammation (tendonitis), weakness, soreness, swelling, bleeding and eventually scarring (adhesion / fibrosis). The typical treatments for shoulder pain address only the inflammation and weakness.
The key to fixing shoulder pain, though, is to reduce or eliminate all of the above symptoms plus the adhesions and fibrosis that comes from the tearing process. The adhesions and fibrosis are what keeps the shoulder from healing properly and is usually involved in the high re-occurrence rate of shoulder pain.
What are adhesions and fibrosis and how do they occur?
The formation of adhesions and fibrosis (or scar tissue) is the body’s response to healing a tear. What actually occurs is that the spread of sticky fibrin, which is the sticky substance you feel when you bleed, seeps throughout the layers of the muscle and leads to scar tissue formation. The scar tissue and adhesions that forms are made up of collagen. This creates a strong bond and binds the injured tissue back together.
What goes wrong?
The scar tissue that binds injured tissue back together also binds the healthy tissue together. This causes decreased circulation and tightening of the muscle resulting in inflammation and lack of oxygen to tissues, creating biochemical changes, increasing fibroblasts and resulting in fibrosis and adhesions. More and more fibrosis and adhesions develop within the muscles causing the muscle to become less elastic (like a rubber band) and more leathery (like a belt). The more leathery the muscle becomes the more stress is placed at the tendon (where muscles inserts into bone). Too much load or force can create tearing of the tendon!
Different grades of tearing
There are different grades of tears that occur in the muscle and tendon. The most common is a Type I muscle strain or ‘Repetitive Strain’. This basically consists of micro-tears. The other grades of tearing are Type II and Type III, which can result in complete rupture of the muscles and ultimately require surgery.
How do you determine the degree/grade of tear?
There are many things involved in determining the grade or type of tear that has occurred. In general, the degree of tearing can be based on the extent of bleeding that will create swelling and bruising on the surface. It is important to note that the degree of tearing is NOT based on the level of pain!!!
How can daily activities affect the injury if there is no pain?
Common daily tasks/activities, such as cleaning, picking up milk, combing hair, and more can easily aggravate and create further injury. In other words, a Type I tear can become a Type II and so on.
Treatments – What are your options?
There are many forms of treatments for shoulder pain. They can include:
- Active Release Technique (ART) and Graston Technique
- NSAID’s (Non-steroidal anti-inflammatory drugs)
- Cortisone shot
- Physical Therapy
What is Active Release Technique (ART) and Graston Technique?
ART and Graston Technique address the scar tissue (adhesions and fibrosis) and works to make the leathery muscle fibers more elastic again. It is the most effective way to breakdown scar tissue.
How does ART and Graston Technique work?
The doctor locates the scar tissue and traps the scar tissue with hand/thumb or Graston tool while the patient actively lengthens the involved muscle. The trapped scar tissue is held back as the muscle moves through. ART and Graston technique is so effective because it makes the muscle elastic again and gets to the root of the problem by increasing circulation to the injured muscle and tendon.
Pros and Cons of Traditional Therapies
Clinic Results with Active Release
We have a greater than 90% success rate for all forms of shoulder pain and less than 10% re-occurrence rate. Most people get better and we never need to see them again!
Overview of Ideal Treatment Plan
While ART and Graston Technique is not a cure-all, removal of scar tissue is a key to a majority of cases. It addresses all hindrances to healing such as faulty mechanics of swing, racquet choice, poor ergonomics at work, hobbies (gardening, knitting, woodworking, etc.), and allows proper rest and recovery. Most importantly, ART and Graston technique addresses the scar tissue.