Condition Series: How To Treat Shoulder Pain

If you’re like me and you’ve ever had aching shoulder pain before, it can be super frustrating. Now, as humans, right, we depend so much on our hands. So what’s important is our hands are attached to our arm, which is attached to our shoulder. So anytime we are going to grab something, pull, reach, push, do what humans do, it becomes very frustrating when you have an achy or painful shoulder.

Now, this can be dealt with in a very easy, systematic way, if you know what to do.

Hi, my name is Dr. Antonio, I am the owner here at Live Loud Chiropractic and Coaching with my wife, Dr. Nichelle. We are based out of Lafayette, Colorado in Boulder County. Our aim and our focus is to help guide you to the adventurous life you are made for. And we do that through a number of different ways ranging from chiropractic and coaching. Now, in that middle is really where the magic happens, because that’s where we come together as a team to make a plan on how to actually dive in and deal with some of these common conditions such as lower back pain, neck pain, and in this case, shoulder pain.

Now, what’s important to understand about shoulder pain, and this is the same thing we say, with all the other issues that come into our office is outside of significant trauma, there’s a reason why you have pain.

What does that mean? Well, in the case of shoulder, we’re looking at repetitive use injuries. So in this case, or an example we might say is, “Well, I started having shoulder pain after joining a new a bootcamp class or CrossFit class, or some sort of workout class.” okay, well, we see a change in the amount of load in which the shoulder was actually experiencing. So it would make sense that that might be part of the problem. So we have to address treating something, i.e. like a shoulder injury, we have to understand the mechanism of how it actually started. Because if I simply just rub on the tissues, work on adjustments, and help you deal with the pain, what’s going to what’s going to prevent it from coming back, if you don’t address how it actually started in the first place?

if we take a step back, ask you about your lifestyle, ask you about your recovery, ask you about how what you’re doing for training and working out, how intense is it. all of these other factors that actually have more to do with your shoulder pain than simply what your spinal alignment looks like, that’s going to give us way better of an idea of what to do in the program and the plan to set you up with to actually deal with your shoulder pain. Okay?

Now, one thing that I do want to add to that is we are very much about maintaining momentum, right, you’re coming into us because you’re frustrated, you’re not able to work out, you’re not able to pick up your kid, you’re not able to get up and down off the floor, whatever that might be. And you feel like you’re not able to keep moving forward with life and/or you might be even moving backwards. we want to help you maintain that momentum. So we are going to encourage you to keep moving, to keep exercising as best as you can. But what we’re going to be able to do for you and help you through the coaching and the chiropractic assessment model, is help you look at the things that we know to be the main triggers for you, so that we don’t keep spinning around in this pain cycle.

Right. If we can break the pain cycle and get you out of there, then we’re going to be able to layer on top of that, better movements, better rehab, better strength, better mobility, whatever applies to you. And then on top of that, layer in our soft tissue skills, whether that’s dry needling, MRT or cupping, as well as adjustments so that we can maintain the proper range of motion and joint mechanics that you need for your body and especially your shoulder.

So if you have had shoulder pain before, or you have a chronic achy shoulder that you just can’t seem to get over, and or if you have a loved one that’s been dealing with a shoulder issue, constantly reaching over grabbing their shoulder, This video is going to be very helpful.

Alright, so we’re gonna be walking you through what a shoulder evaluation and you know, expedited treatment would look like. So essentially, what we’re going to be deciding through our evaluation, obviously, your history is going to be determining the direction of where we’re going, as indicated in the intro to this video, when we see a peak or a spike or a change in load, or a change in exercise program, whatever that is, we’re gonna see common areas that are aggravated more.

And those are typically impingement type of syndromes, bicep tendonitis, rotator cuff irritation, those are going to be your three kind of primary focuses. Now the reason why those are happening, that’s what we have to decide and dive into. We’re trying to determine the underlying causes of those, it’s very easy to diagnose what is irritated, but it’s harder to figure out what are the actually precipitating factors that led us to that.

Looking at range of motion, proper range of motion for the shoulder blade, shoulder, thoracic spine and the neck are going to be our most critical things to look at.

Basic Shoulder Range of Motion

1. Take both arms straight up overhead. We’re looking for 100 degrees of flexion. And ABduction as she comes up, and we want to see if she can get that nice and vertical. We’re also looking for any catching points, or painful parts within that arc.
2. Next we’re looking at internal-external rotation and extension of the shoulder. So she’s going to take this hand, reach behind her head and touch this opposite shoulder blade. So we want to again, look at nice vertical arm here.
3. Right arm underneath over to here. Great. So now we’re looking at internal rotation of her shoulder and extension. And we want to look at shoulder blade movement here.
4. Left side underneath over to here and we’re looking to see you know, comparatively side. Do we need symmetry? No. You do not need to chase making sure both sides are symmetrical. We are asymmetrical human beings.

5. Tip the chin down, touch her sternum.
6. Extend back, as far as you can.
7. Look over your right shoulder. Awesome, look over left shoulder.
8. Ear to shoulder, tipping side to side. Wonderful.
9. Stand feet together. And she’s going to look over her right shoulder. And then she’s going to twist her whole body to the right. I’m looking at ankles, hips, low back, mid back and neck with this gives me a good global range of motion. Good, back to neutral look left, turn left.

10. Keeping legs straight, toe touch, we want to look for thoracic spine flexion here.
11. Come back up, arms up overhead, and then lean back as far as you can. So we want to look to see what our extension looks like.

Modified Sphinx

1. Come up on your hands and knees. Cat cow. we’re getting a good global assessment of how the spine moves.

2. Move your feet forward just a little bit. Sit your butt back towards your heels. Now move your hands back a little bit, this is going to be you can go back a little bit further. By moving her hips back, that locks the lower back from being able to move more.

3. Now in this position, because again, we’ve locked out the lower back, we can go through the other ranges of motion. So obviously, we get a little bit of hip shift, but from here, I can really start to see how the spine bends side to side. So we’re kinda like windshield-wipering the spine here and going side to side.

4. Now next is we want to look at rotation again. So there’s a way for us to isolate more about the rotation that we want to see from the mid back. So from here, you’re going to put one hand behind your neck, and then your other elbow is going to drop down.

Now, as indicated, right, some of the main things that we run into bicep irritation and impingement type of syndromes. And impingement is something that will happen with range of motion as you come up overhead, it’s the level that how it’s a level of impingement that could be created in an issue as dictated again by the scapular limitations that we might see.

Looking at How the Shoulder Blades Move

So what we’re going to look at here is how the shoulder blades should actually be moving. So as we already were showing, as this arm comes up overhead, we want to see how far this goes. Now, if that shoulder blade is pulled down, and back or too tight, she’s not going to be able to, to raise it as high. So we’ll test this right just as a as a proof of concept. So if I hold her shoulder blade, and I say now take your arm up overhead, you can see how it just kind of stops, right. So we oftentimes do this unintentionally, because we’ve been queued, keep your shoulder blades down and back, thinking that’s the more stable position. But in doing so that actually limits your range of motion. So if I’m locking this down, because I was acute, or I think that’s the better way to do it, and this is coming up and over, you’re basically banging your your arm or your humerus, the ball up into the socket roof. And that creates impingement sensitivity, whether it’s a rotator cuff, the bicep tendon, so on and so forth. So we want to make sure that that shoulder blade is moving well, this is this is one of the primary things that is oftentimes overlooked, we focus on massaging bicep tendon, working on the rotator cuff, the upper trap, and not knowing that we actually have to queue and promote that scapular range of motion.

So some of the things that we talk about is making the arm long. So if she’s here, and let’s just say for instance, she was actually having a pinch here, one of the cues that helps prevent that and or improve her symptoms is by simply asking her to make her arm long. So I’ll say, hey, try to reach out. So in doing so, you’re actually going to promote scapular protraction. And that’s this lateralization of moving away from midline, as opposed to pointed down and back.

Now, this is still stable. Yes, pulling down and back is stable for rows and other things like this. But we have to now train this. So if she was to make a fist, and now to say, make your arm long, and now resist me, she’s craving stability through a protracted shoulder blade position. Okay? Now, this is critical, because more times than not is we just don’t have the stability out there. So we think pull down and back to make us tighter. So that’s something that we have to we have to test out and make sure that that is an appropriate position. Now, this is also important for the rotator cuff because the rotator cuff muscles, they all start from the shoulder blade. So the relationship from the rotator cuff from the shoulder blade to the actual ball, right your arm, the head of the humerus, needs to be defined and improved.

So if I’m again, retracting, but yet this is wanting to come out, well, you see this battle between the rotator cuff muscles, the shoulder blade is being held back, the arms trying to go up and the rotator cuff muscles don’t know what to do, they’re not able to stabilize and adequately hold on to the shoulder if we’re having these opposing forces. So this is another reason when we’re looking at rotator cuff injuries, that we have to improve the scapular mechanics to improve the whole relationship on how everything is moving.

Now, outside of that, if we’re looking at rotator cuff issues, we’re going to do our standard testing of hey, resist here, resist here, fine. This helps us again, determine the exact tissue or the exact area that is angry. Again, that is the easy part that it’s very easy to find, hey, this is the this is the issue that everything’s kind of stemming from, but we have to understand and know why. And more importantly, what are the things that we’re consistently doing on a routine basis, whether it’s at home, whether it’s in your workout, whatever that is, that’s consistently insulting the tissue and making that wound or injury quote unquote, fester and linger. So that’s more important than actually understanding the site of pain. of understanding what you should and should not be doing from an acute injury to a sub acute injury or a chronic injury to allow you to progress further forward to be able to do more things.

Compression

Make a fist. Scaption is going to be about 45 degrees off the midline. Now, what that simply means is the head of the humerus is going right in line with the socket, and the shoulder blade from this position.

So this essentially gives the rotator cuff and a lot of the muscles the best force tension relationship, meaning it’s at its strongest point, right.

So for compression, all we’re starting with here is just hey, resist me, I’m gonna push down against her as she fights this. And this is a compressive load into the shoulder. So this allows us to first initiate what a conversation of compression resistance actually looks like. And then we would put her under load, such as a bottoms up carry, or in a plank position, anything in which I’m pushing into her body through a compressive force, and she has to resist that and maintain the shape and the positioning that we want.

Now, you might feel shaky in these positions, and that’s okay, that’s your body’s, that’s your body working with your muscles to figure out how much load or how much strength that it needs to present with what it’s being asked to do.

Distraction

Trust fall. you’re just gonna lean back. Okay, so from here, you can see that there’s traction from her shoulders, right. So if we had a suspension trainer or something set up, go ahead and pull your hips towards me a little bit. Now just bend your elbows and do a row. So pull up right now lean back, right. So this is just a mock kind of what a row would be on a suspension trainer, a TRX. So this is perfect, though, because I’m creating distraction from her shoulder. And she has to resist her body being or her arm being pulled away from her. This strengthens the rotator cuff more than almost anything else that we can do outside of these like just single exercise of internal external rotation.

So these are phenomenal to be able to build more resilience than strength, because we have to be able to pull ourselves up from the ground, or we have to be able to push ourselves up on the ground and starting with these basic exercises are wonderful for rehabbing and retraining the shoulder complex.

Now outside of that, what we’re also going to do is carries, right. we talked about distractive loads, if I was to just grab a couple of weights, couple dumbbells, couple kettlebells, that’s constant distractive load down into my arm. And if I just simply resist that, and walk for distance, as if I was like carrying a wheelbarrow, that’s a great exercise for building a lot of strength and load into the shoulders, and not compromising ways that might be pinching or adding to that.

Downward Facing Dog & Plank Exercise

A full plank has a lot of compressive load. Now what a lot of people have trouble with shoulder pain is getting up into that position. So we can train this by going through compressive loads into a downward facing dog position. So from here, all she’s going to do is lift her hips up towards the ceiling. Right? Now we see a somewhat vertical position here.

So I can retrain an overhead position that might be troublesome with the dumbbell or pressing weight through a compressive load that she’s able to control. Then she’s gonna come back to a plank, right? And now she’s in control.

Conclusion

So if this is something you’re dealing with shoulders are pesky, right?  it’s a ball and socket, so it gives us a great amount of mobility. But because of that, it makes it more complex when dealing with these injuries. Especially if you’re someone who’s hyper mobile, we oftentimes just hear “Stretch, stretch stretch,” you’re oftentimes going to see the need for doing more stability training so that the shoulder feels comfortable while going through ranges of motion. And then we can layer in mobility on top of that.

So if you found this to be helpful, and you’re dealing with the shoulder injury, please do not hesitate to reach out to us. If you have a family member again who’s dealing with something like this and they’ve just kind of been put through the wringer. We’d love to have a conversation with you or that family member or a friend to help them regain shoulder mobility and function so that you guys can live a loud, adventurous life. Thanks for tuning in guys.