2 Simple Tips for Treating Shoulder Pain

Shoulder pain is second only to back pain for visits to a doctor.  The good thing is that evidence-based chiropractors are uniquely positioned to treat shoulder dysfunction better and faster than any other health care professional.  Not because we are gurus, but because the research supports our approach. Manual therapy, ADL advice, joint manipulation, and specific rehabilitation are proven methods to reduce shoulder pain.  Tissue injury and the resultant pain are consequences of sustained compression or repetitive stress to sub-acromial structures in nearly all shoulder pathologies.  Two primary factors resulting in tissue injury are:

1. Loss of humeral inferior glide

2. Decreased shoulder stabilization form the rotator cuff

Nearly 100% of non-traumatic shoulder pain is due to these two factors! Today, Dr. Steele will discuss the shoulder dysfunction continuum as it relates to loss of inferior glide and weakness in the rotator cuff.   He will also explain how a failure to address these components will lead to ongoing complaints.

The glenohumeral joint is designed to have significant ranges in all three planes of motion. Unfortunately, increased mobility comes at the expense of stability.  The head of the humerus is a round structure contacting the minimally concave surface of the glenoid. Normal scapulohumeral motion maintains the humeral center of rotation directly above the concave scapular glenoid throughout the shoulders range of motion. This integrated motion between the scapula and humerus provides efficient function and joint stability. When this rhythm is disrupted by abnormal scapular motion, the resulting disproportionate humeral shift creates increased stress on the shoulder capsule and rotator cuff.

Scapular Dyskinesis leads to Shoulder Impingement creating Rotator Cuff Tendinopathy and resultant Rotator Cuff Tears.

Rotator cuff dysfunction is now considered more degenerative than inflammatory- wherein a typical inflammatory reaction is histologically absent. Instead, there is degenerated and disorganized collagen fibers; signs associated with a failed healing response. Rotator cuff tendon degeneration may precede impingement in a self-perpetuating cycle of dysfunction. The process starts when an insult damages the tendon and leads to tendon degeneration. This weakens the tendon and diminishes its ability to oppose superior shearing force produced by the deltoid during arm abduction. The tendon becomes impinged, producing further insult. As tendon fibers fail, the enduring fibers remain under tension, thereby increasing the load and likelihood of failure. 

Stress to the coracoacromial ligament (CAL) due to uncontrolled superior migration of the humeral head also results in calcification. The coracoid and acromion act as a roof the humerus. That's right, type II and III acromions occur secondary to glenohumeral instability.  Surgery to remove the acromion results in poor long-term outcomes as this further destabilizes the shoulder.

Function precedes structure until ultimately structure determines function. 

Wang et al. (2019) found increased coracoacromial ligament deformation and thickening of the supraspinatus in an overhead athlete population secondary to shoulder instability.

Here are the ChiroUp rehab exercises that you can use today to help strengthen the rotator cuff and stabilize the humeral head to prevent superior humeral migration.  These exercises promote stability. Prescribe them to patients suffering from re-occurring MSK shoulder conditions (impingement syndrome, rotator cuff syndrome, biceps tendinopathy, SLAP lesions, etc.)

Three Shoulder Stabilization Tips

1. Strengthening exercises should focus on scapular retraction, thereby increasing serratus anterior and lower trapezius activation.

2. Patients demonstrating weakness in the hip abductors or core musculature may require proximal stabilization before implementing more specific scapular stabilization.

3. Scapular mobilization may help assist in restoring scapulothoracic mobility. The use of manipulative therapy is a “preferred” treatment that may accelerate recovery.

Are you ready to prescribe strengthening exercises to your patients? Here’s what you can expect to show up on the report:

1. Lay Description of the Condition

2. In-Office Treatment Descriptions

3. Pertinent ADL’s

4. Exercise Tutorial Videos

If you like what you see, there’s more where that came from. ChiroUp subscribers can build & customize reports (like the attachment) for 100 different conditions… in SECONDS.

• References

  1. Wang SH, Yu TY, Lin YC, Liao PC, Tsai WC. Deformation of coracoacromial ligament during overhead movement as an early indicator of subacromial impingement in elite adolescent badminton players. Phys Sportsmed. 2019 Apr 26:1-6

  2. Neer CE III. Impingement lesions. Clin Orthop. 1983;173:70–77.