One of the main health issues we see and treat at Advanced Health is shoulder pain. Shoulder pain can make simple tasks, such as brushing your hair or putting a shirt on extremely difficult. This can make life uncomfortable and very frustrating. Unfortunately, shoulder pain is very common, and the more we age the more likely we are to experience it. The difficulty of treating shoulder pain is that it is not always the shoulder that is causing your pain, it can be from issues from other areas of the body, such as referral pain from a disc issue within your neck, or a compensatory issue from poor posture and the negative effect it has on our bodies.
The two main types of shoulder pain we treat are based around two things, trauma, such as been in a car accident or suffering a sports injury. The other is an overuse injury, due to repetitive stresses that we encounter in our work environment. Trauma is commonly easier to diagnose as there is a specific event that causes the injury, which allows for a more clear understanding of the problem at hand. Repetitive stress injuries can be more difficult to diagnose and treat for several reasons, one is that the problem is usually more of a chronic issue, also that the environment that has caused the issue is an environment that is difficult to change and modify because that is what we are required to do to perform our jobs.
If you have suffered a trauma, such as a contact injury playing sports or have been involved in a car accident, seeking advice from a doctor, such as a chiropractor should be the first step in the process of getting the problem corrected. By seeing an appropriate health care professional such as a chiropractor, you are allowing your self to be evaluated thoroughly enabling you to receive a clear diagnosis of the problem and an effective course of treatment to be put in place for you to get back to doing the things you love. A thorough evaluation of the joint should include range of motion, orthopedic and neurological examinations to determine the extent of the damage, and following the examination and the extent of the findings, possible imaging such as an x-ray and/or MRI.
As soon as you experience the trauma some basic rules should be adhered to, so healing can begin straight away. The simple things that you can do at home, and done immediately after the initial injury and for the following 7-10 days should go as follows;
Rest-try and create less work and load for the shoulder. An easy way to do this is to have the affected arm placed in a sling to create immobilization. Not all injuries require this extent of rest, however, try and do the bare minimum required for you to function on a daily basis.
Ice-Apply a cold pack to the affected joint for twenty-minute intervals every hour or so. This will assist the body in taking care of the inflammation.
Compress-If swelling is present, try and wrap the shoulder with an ACE bandage to help limit the swelling.
Elevate-Try and keep your shoulder above your chest to allow for the body to take away any swelling. Obviously, if you are standing or sitting this is already done for you. However, when sleeping you can use some pillows to support your back so you are sleeping slightly elevated.
After the acute phase has been passed, about 7-10 days, you should immediately start working with a health care provider to restore full range of motion, stability within the joint in all planes of movement and finally strengthening work to strengthen the joint to allow you to return to the activities you enjoy doing pain-free.
The more common type of shoulder injuries we treat at Advanced Health are due to repetitive stresses, such as working in a manual labor type job, such as construction or what we tend to see the most of in our clinic, people who have desk jobs and the compensatory issues we experience from the massive amounts of sitting we have to do in corporate America. The average American is now sitting a total of 14 hours or more on average every single day. The human frame was designed to be upright and to be moving, so the amount of sitting we have to do creates massive amounts of stress on our bodies, especially on our upper extremities like our shoulders. The AAOS states that over two million people per year suffer from shoulder pain from overuse injuries such as extended periods of time sitting.
When we have good posture and we evaluate our posture when looking from the side, a simple checklist can be worked through to evaluate if we are in good posture or not. It goes something like this;
Ears are in line with the AC/shoulder joint.
Shoulders are down and back, shoulder blades are tight to our rib cage and not ‘winging’ out.
Shoulders are in line with our hips.
When we deviate from this, the checklist usually looks something like this;
Head is in front of our chest.
Shoulders are rounded and shoulder blades are ‘winged out’.
Shoulders are slumped behind our hips.
If you did this check in the mirror and follow the last checklist you are essentially in poor posture and are placing your body under a constant state of stress. The most common areas that are affected are the neck and shoulders, which lead to symptoms such as headaches, neck pain, numbness and tingling into our hands and shoulder pain. We have discussed all of these symptoms, their causes and effective way’s to go about correcting them in previous blogs pots.
The main area of the shoulder affected from extended periods of sitting and the poor posture we experience from it is the rotator cuff. A rotator cuff is a group of muscles and tendons that anchor your arm and shoulder together, moving and supporting the joint through many planes of motion. The two main ways this group of muscles and tendons become damaged are through inflammation or tears. Inflammation through daily stresses such as sitting at our desks in poor posture all day causes impingement within the shoulder, creating pain in the joint, especially when moving the shoulder. This can make basic tasks such as picking up your kids or working out difficult and painful. However, the rotator cuff can also become torn. This is more severe as there is usually associated weakness accompanied with it, especially when performing tasks with our arm out to the side or above our heads. There are different degrees of tears, more mild tears can be due to repetitive stresses and are treatable conservatively, however more severe tears are due to traumas such as car accidents or sporting injuries, and can often require surgery.
It is important to address shoulder pain as early as possible because if we procrastinate and let the problem linger we can run into more severe problems such as calcific tendonitis, adhesive capsulitis or even osteoarthritis. Essentially all of these conditions are due to degeneration of the joint and the tissues within our shoulder, leading to thickening and hardening of the soft tissue structures, which limits our range of motion and creates constant pain, which usually requires a course of NSAID’s, steroidal injections or even surgery. At this point we are usually passed the point of being able to get the problem corrected and are only able to manage the pain, creating daily pain and interference with our daily activities.
If you are suffering from any of the shoulder pain we have discussed above, and it is not from trauma, as we have discussed the best way to approach this, then chances are you are suffering from a repetitive stress issue. The first place we must look and address is our work environment.
If you sit for a living, how you sit and for how long is of the utmost importance. It must start with your ergonomic set up your work station. Essentially good posture should be maintained throughout our working day and in order to do this, we must sit appropriately in our chair and be allowed to work in a minimally stressed position. I would first start with having HR perform an ergonomic work set up for you and have them provide the resources for you to be able to be ergonomically sound throughout the day. If your HR department is not set up for this, head to our YouTube channel and check out this video of how to sit properly at work.
To make your day less stressful, we should all be looking at how we can not sit for long periods of time, so the repetitive stress of sitting is minimized. This is where getting a stand-up desk at work becomes very beneficial. Stand up desks offer many health benefits, which include lowering your risk of musculoskeletal injuries at work, such as shoulder pain. It also lowers the risk of weight gain, heart disease, increased blood sugar levels and improves general mood and productivity. The goal is to be able to split your work day up so you spend half of it sitting <4 hours and half of it standing > 4 hours. I would not recommend doing this immediately, however, work up to this by starting at standing for the last ten minutes of every hour and increase the time you do this in five-minute intervals. If you do not have a stand-up desk, most companies are now on board with providing you one through HR. However, if your company is a little less forward thinking any physician who is in line with modern research and the data that comes with the negative effects sitting has on our bodies will be able to provide you a specific work form, which will provide medical necessity for you to have a stand up desk, which should then create less of an issue for you been administered one at work.
Once we have minimized the constant stress been placed on our shoulders from poor posture and the accumulative and negative effect it has on our body, we must also counteract the compensatory patterns we develop from being in poor poor posture, such as addressing a very common issue caused ‘upper cross’ syndrome. We have discussed at length in previous blog posts that when we sit for a living, develop poor posture we also develop compensatory patterns, where essentially all of the big muscles in our shoulders, such as our traps and levators become extremely dominant, and overpower all of the intrinsic muscles, like the rotator cuff, which are designed to stabilize the shoulders. When the big muscles dominate through overuse, the smaller muscles, which are very important for stabilizing the shoulders become weak. So when we use the shoulder without the appropriate support the bigger muscles essentially have to compensate and work too hard. This, over time, breaks them down and leads to pain and dysfunction.
A great way we can counteract all of these negative forces breaking us down is by becoming pro-active at work and start to build in healthy habits such as ‘postural breaks’. We should all be spending time between breakfast and lunch, lunch and home time for a minimum of five to ten minutes working on activating these muscles through basic exercises at work. If we spend the time, energy and effort during the day, making sure these muscles are been used to the bigger muscles don’t overcompensate we can save ourselves massive amounts of the same resources by having to see a qualified medical professional get the issues corrected, which always exhaust our most precise resource, time. If you sit or stand for a living try doing these two exercises during your work day to make sure you are been proactive about your health.
If you have have been reading this blog and have already implemented the changes to your work environment and have been proactive when at work following through on some of the postural break exercises that we have discussed, however are still experiencing pain and dysfunction in your shoulders we strongly suggest seeking help from a health care clinic such as Advanced Health Chiropractic and seek treatment with a reputable and well-reviewed physician to begin a course of treatment to get you out of pain and back to the things that you love.
Our first objective should be to improve the range of motion within the shoulders. When we have compromised ROM, this increases the load we put into the joint and tissue, which in turn breaks us down. Here is a great, yet technical exercise we use at AHC to start working on improving your shoulder ROM.
Next steps at AHC we focus on breaking down the ‘adhesion’, which is essentially scar tissue and acts like chewing gum in a muscle. When adhesion is present it must be broken down in order to continue to improve the ROM within the shoulder joint, but also to break down the tissue down that creates weakness and instability. Unfortunately, this is a common area that is misdiagnosed and poorly treated by many health care providers unless done by a qualified professional such as the Drs at Advanced Health. Here is a treatment video of how we do this in our clinic offering our patients superior results.
Once the first two objectives have been achieved, which are restoring full ROM and stability to the joint, we then must stable the joint to allow you to return to your normal activities. Here is a great exercise we use at AHC to do just that.
If you have spent the time reading this blog and are suffering from shoulder pain we strongly encourage you to reach out and get set up with a new patient exam so we can begin your journey of getting this problem corrected. Unfortunately, the longer we leave things alone the worse they get. Health issues do not resolve themselves on their own, yes the body is an amazing machine that will find ways for you to function around the problem, however, as discussed in this blog the compensatory and negative effects this has on our bodies only make the problem worse over time. At Advanced Health we use the most cutting edge diagnosis and treatment tools to treat your case individually and create a plan designed to get you out of pain and living without restriction fast and effectively without the use of drugs or surgery. If you are ready to get back to living and doing the activities you love we are looking forward to seeing you in the clinic and be the solution you are looking for.
Dr. Luke Stringer DC.