Shoulder pain is one of the most common presentations in a chiropractic office. This malady is responsible for nearly 5 million physician visits each year. Contrary to public opinion, there is no rotator cuff fairy that randomly taps a patient on the shoulder with lasting gifts of dysfunction and pain. Years of repetitive strain, sports, traumas, and poor posture are the primary contributors to shoulder dysfunction. Rotator cuff problems almost always begin with scapular dyskinesis, then anterior impingement syndrome, and eventually progress to rotator cuff syndrome if the causative factors are not corrected. This degenerative cascade affects the shoulder in a very predictable pattern. The only variable is the date at which the patient develops symptoms.
Luckily there is ONE critical contributor that all chiropractors can address in the treatment of shoulder pain. Watch Dr. Steele describe this simple concept in the following video.
Yamamoto et al. (2015) studied a cohort of 525 participants without shoulder pain. Then, using ultrasound, his team identified those patients with asymptomatic rotator cuff tears; 24.5% showed a tear in one shoulder, and 11.9% had tears in both. (1) Yamamoto then subdivided this population into four groups based on their postural classifications as defined by Kendall. (2)
The researchers correlated each posture to the likelihood of rotator cuff tear and found that postural abnormalities are an independent predictor of rotator cuff tears. “Prevalence of rotator cuff tears was 2.9% with ideal alignment, 65.8% with kyphotic-lordotic posture, 54.3% with flat-back posture, and 48.9% with sway-back posture. Logistic regression analysis identified increased age, abnormal posture, and past pain as factors associated with rotator cuff tears. It is difficult to conclude whether postural change represents a primary or secondary phenomenon due to rotator cuff tear. However, patients with ideal posture experience rotator cuff tears relatively rarely, so keeping the spine in ideal alignment would appear helpful as a measure for preventing rotator cuff tears as well as in rehabilitation therapy for shoulder disorders.” (1) Based on our understanding of scapular mechanics and upper crossed syndrome, it is logical to conclude that posture is a risk factor for developing rotator cuff tears. This paper demonstrates the importance of correcting posture in four steps:
- Educate your patients about the long-term detrimental effects of posture and stress the importance of good posture for their future ability to move pain-free. Scaring patients is not generally successful, but having an intelligent discussion on the long-term effects of their posture may lead to behavioral change.
- Have your patients focus on ideal posture during painful movements. Correcting habits is difficult and time-consuming – often taking months. However, if you can demonstrate pain-free shoulder motion with good posture, it may be exactly the positive feedback your patient needs to change their habits.
- Your patient’s poor posture is usually the result of an imbalance from excessively tight pecs and upper traps with reciprocally weak antagonists (lower traps and serratus). Prescribing specific exercises to correct this upper crossed posture is the key to long-term success.
- Demand ideal posture during rehabilitation exercises. How can we expect shoulder pain to subside if we continually stress the glenohumeral joint in an un-centrated orientation, secondary to an upper crossed syndrome?
This paper illustrates how simple clinical pearls can have a significant effect on our ability to thrive in an outcomes-based world. ChiroUp is your virtual knowledge bank of clinical pearls. We know it’s hard to remember every variable needed to successfully treat every orthopedic condition. Fortunately, ChiroUp condition reports never forget. Check out this sample rotator cuff condition report that can be customized and delivered to your patient in 20 seconds.
- Yamamoto A. et al., The impact of faulty posture on rotator cuff tears with and without symptoms J Shoulder Elbow Surg (2015) 24, 446-452
- Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: testing and function, with posture and pain. Baltimore, MD: Lippincott Williams & Wilkins; 2005.
About the Author
Dr. Brandon Steele
DC, DACODr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.