By Dr. Gary Barone, March 29th, 2023.
The shoulder is one of the most complex joints in the body, and when a shoulder issue is keeping you sidelined, it is also one of the most complex problems to treat. That complexity comes with a wide range of possibility about what can be causing your problems. Conversely, over the last two decades, having explained shoulder issues to hundreds of patients, I have a pretty good guess about what the two most important things are for you to know about shoulder pain.
Fact One: There are Two Joints in Your Shoulder; Don’t Forget the Scapulothoracic Joint
The shoulder girdle (also called the scapulothoracic joint) is where the shoulder blade meets the body. You move it every time you shrug your shoulders. This joint is responsible for about 30 percent of the movement of your shoulder which is incredibly significant. The rest of the movement is in the glenohumeral joint, the ball and socket joint at the top of your arm. The glenohumerel joint is often referred to as the GH joint, shoulder capsule, or just as the rotator cuff.
When we speak about the shoulder joint, we often automatically assume we are talking about the rotator cuff. In fact, my conditions page about shoulder pain is mostly about the GH joint and rotator cuff. It makes sense since 90 percent of shoulder injuries are in the rotator cuff.
The problem is that when the scapulothoracic joint stops moving, this places more strain on the GH joint. In other words, the GH joint is injured because it has move more to compensate for a stiff scapulothoracic joint. The scapulothoracic joint is much stronger than the rotator cuff. It is stabilized by huge muscles like the Trapezius (between the shoulder blades) and chest muscles. Postural stress often makes these muscles tense and consequently we are very prone to getting stiffness in the shoulder blades.
It is not uncommon to see shoulder blades that are immobilized by muscle and spinal stress. When this happens, the rotator cuff is forced to contribute more and move more than it is supposed to. Your GH joint then becomes vulnerable to just about any challenging movement of the shoulder. In particular, any activity where the elbow rises above the shoulders will cause stress to the rotator cuff, and likely result in injury.
This is why the mobility of the shoulder blade at the scapulothoracic joint is so important. Worsening this problem is the fact that most stretches for the shoulder blade will likely injure the rotator cuff. Giving home exercises for the shoulder girdle will likely cause more problems.
The safest way to address issues with the scapulothoracic joint is to have a pro work on it. A sport chiropractor can adjust the spine and ribs to restore normal mobility and nerve function. A chiropractor certified in ART can isolate specific muscles to restore normal mobility in the shoulder blade. ART (Active Release Techniques) is a system of hundreds of techniques to isolate and release tension in specific muscles. ART remains the gold-standard in soft-tissue treatment.
Fact Two: Myelin Protects (Most of) Your Nerves
With all this talk about joints and muscles, it is easy to forget what controls them: your nerves. Nerve irritation can result in weakness and spasm. In other words, nerve irritation can cause stiffness and changes to your coordination. Nerve irritation can therefore cause rotator cuff (and scapulothoracic) problems. The trick is finding the place where nerve irritation is happening. To get great results, we have to find and treat the nerve irritation.
There are two types of nerve irritation. A “compressive” lesion will cause weakness (in a motor nerve) or a decrease in sensation (in a sensory nerve). A “facilitative” lesion is when an injury rubs or chemically irritates a nerve. A facilitative lesion will result in spasm (in a motor nerve) or tingling (in a sensory nerve). In either case, weakness or spasm will change the behaviour of the muscles and joints and contribute to your shoulder problem.
The good news is that the myelin sheath is protecting your nerves in most of your body. Myelin runs the length of most nerves. When there is more myelin the nerve is more protected and your injury has to produce a lot of force to irritate the nerve. Despite this, nerve entrapments can occur in many, often predictable places in the body, including nerves to the shoulder.
The most sensitive areas to compression and irritation are the nerve roots of the spine. A study done at the University of Colorado School of Medicine in the 1970’s revealed that only the weight of a dime on a nerve root will decrease nerve activity by 60% in just a few minutes. This is barely any pressure at all! Chiropractic adjustments are the only treatment with the specific intention of reducing irritation to spinal nerves. This can improve the behaviour of shoulder muscles and improve outcomes in shoulder cases.
A 2012 study analyzed 50 patients who underwent chiropractic treatment for frozen shoulder. The only treatment doctors provided was adjustment to the upper spine:
Of the 50 cases, 16 resolved completely (100% improvement), 25 showed 75% to 90% improvement, 8 showed 50% to 75% improvement, and 1 showed 0% to 50% improvement.
Chiropractic management of frozen shoulder syndrome using a novel technique: a retrospective case series of 50 patients
How to treat shoulder problems
Home stretches and exercises can strengthen the rotator cuff. However, if you have decreased coordination (from nerve irritation in the spine) or reduced movement in the shoulder girdle (scapulothoracic joint), you run the risk of injuring your shoulder further, especially the rotator cuff.
Every practitioner will check the rotator cuff. It is also important to check the scapulothoracic joint and the spine to look for nerve irritation problems that can cause further issues with the movement and coordination of the rotator cuff.
Active Release Techniques (ART) is a system of techniques to isolate and address a wide range of muscle problems, nerve entrapments and joint problems. There are dozens of specific protocols that pertain to the shoulder alone. An ART certified practitioner will help diagnose and treat specific issues for you.
Chiropractic adjustments for subluxation specifically correct nerve irritation and restore movement to the spine. There are many case reports of adjustments helping with the resolution of shoulder problems, and it makes sense, since the nerves to the shoulder originate from the spine. It also makes sense since the spinal nerve roots are so sensitive to spinal injury, and adjustments improve the nerve function by reducing irritation at spinal nerve roots.
Laser therapy accelerates healing and decreases pain. It is worth knowing that Class-4 Laser therapy can help speed up the healing in more challenging cases. Class-4 (also known as “Deep-Tissue Laser) is a newer technology than “cold laser.” Class-4 laser, such as the LiteForce laser I use, penetrates deeper into the body and has treatments that are much quicker.
The place to start is by scheduling an appointment for an initial visit. Your first visit doesn’t include your first treatment. If you are apprehensive about chiropractic care, this is your opportunity to consult us without any obligation. I will provide you with a video report of findings explaining the results of your exam. This exam includes your history, orthopaedic tests, posture screen and surface EMG.
