It may seem hard to believe but despite growing concerns over sedentary lifestyle and obesity, a fair chunk of population continues to live an inactive lifestyle in United States. For example, according to a latest research (1), more than 67% adults in America enjoys at least 9 hours per day in sedentary activities such as watching television or sitting in front of a computer/ tablet or video games. It has been statistically proven that lack of engagement to a more functional lifestyle is a frequently reported cause of musculoskeletal disorders such as shoulder pain, neck pain and backache (2). However, it is also imperative to keep in mind that a number of dynamic individuals are at high risk of developing chronic shoulder pain due to overuse or abuse injuries.
In order to reduce the risk of shoulder pain and other related musculoskeletal conditions, it is very important to learn the causative agents and pathophysiology of shoulder pain to devise functional and effective exercise/ physical activity regimens.
Pathophysiology of Shoulder Joint Pain:
Shoulder joint is a complex ball and socket joint that is formed by three primary bones (clavicle, scapula and humerus) to offer 3-dimensional motion. The joint cavity is supported by several groups of muscles, ligaments, tendons and connective tissue components to stabilize and strengthen the joint capsule.
Due to 3-dimesionsional motion across the shoulder joint, the risk of injuries is pretty high, especially in some susceptible individuals; such as:
– Highly dynamic Individuals: Professional athletes or sports personnel perform persistent repetitive musculoskeletal activities.
– Obese individuals: Research indicates that obesity significantly increases the risk of wear and tear related damage to the cartilage; that significantly increases the risk of injuries.
– Sedentary office workers: Study reported in peer reviewed journal Ergonomics (2) suggested that individuals who spend more than 7 hours (per week) in front of a computer are at high risk of developing postural issues, chronic neck and shoulder pain and upper back discomfort. The prevalence of neck pain lasting more than one-month is 34.7% in females and 23.1% in males.
Other frequently implicated risk factors in the pathogenesis of chronic neck pain are; history of injuries to the shoulder joint, a positive personal or family history of inflammatory joint conditions or genetic disorders, congenital or acquired deformities of shoulder joint and personal history of major surgery at the shoulder/ neck region.
What are some common causes of shoulder joint pain?
Here are some frequently reported causes of shoulder joint pain:
– Muscular pain: The muscles in the shoulder may undergo damage or injury; thereby presenting as the pain and discomfort. Most common injuries are, muscular sprain/ strain, biceps tendinitis, rotator cuff tear/ damage, triceps tendinopathy etc.
– Connective tissue disorders: Inflammation or injury to the joint capsule is usually a result of persistent, repetitive motion at the shoulder joint (such as elite basketball or baseball players). Additionally, inflammatory or degenerative injury to the ligaments, joint capsule and surrounding connective tissue is also seen in the setting of accidents, assaults, history of falls and road traffic accidents. Frequently reported examples are, frozen shoulder, capsular degeneration, shoulder dislocation etc.
– Bone related disorders: Shoulder joint fracture, dislocation or arthritis can also present with shoulder pain and discomfort. Unlike most connective tissue disorders, almost all cases of bone disorders have an acute presentation with a clear history of trauma or direct impact of severe force on the shoulder joint. Bony spur formation due to constant rubbing or friction like activities along the degenerated joint cartilage can also present with severe shoulder pain, stiffness, rigidity and muscle spasm. Physiological aging and abnormal joint mechanics are the most frequent causes of bony spur formation.
– Secondary Causes: Due to integral location and dynamics of upper limb, the shoulder joint is also a source of secondary or referred pain. Approximately 5% of all cases of shoulder pain are due to secondary reasons; such as thoracic outlet syndrome, spinal stenosis, lung cancer, liver cancer, cervical spondylosis, cardiac ischemia etc.
Indications of Seeing a Chiropractor for shoulder pain management:
If you are experiencing these sign and symptoms, you should see a chiropractic professional for the long term management of shoulder pain:
– Persistent or non-specific shoulder pain that is not resolving with conservative management (such as analgesics, ice-packs, hot packs)
– Deterioration of shoulder pain in terms on intensity, duration or extra-articular manifestations (such as referred pain to upper back or chest region, paresthesia, numbness etc.)
– Onset of new symptoms (such as increasing disability, limited range of motion or loss of shoulder flexibility)
– A visible or cosmetic deformity of shoulder joint
– Onset of infection, redness, swelling, and fever
– Appearance of new bruising around the shoulder joint
Why see a chiropractor for the management of Shoulder Pain?
Appropriate and accurate diagnosis is the key to effective and permanent resolution of symptoms. Most conventional healthcare professionals employ traditional remedies to resolve the symptoms of pain and discomfort. This includes pain-killers or anti-inflammatory drugs. However, it is imperative to understand that most traditional pain remedies are ineffective at resolving the chronic inflammatory musculoskeletal pain. Long term use of NSAIDs is a leading cause of gastritis, duodenal or gastric ulcers, esophagitis and real impairment. Likewise, surgical modalities are also less effective at resolving the shoulder discomfort.
Chiropractors on the other hand evaluate each case independently to define core problems. According to a study reported in the peer reviewed The Journal of the Canadian Chiropractic Association (4), about 8.6% of all the patients who report to chiropractors complaints of moderate to severe shoulder pain. Based on the pathophysiology, chiropractors advice:
Rest: it is important to take limit the mobility and motion across the upper limb if the symptoms of shoulder pain and discomfort are due to inflammation. Chiropractors may advice slings, arm supports and other assistive devices to maintain functional independence without overburdening the inflamed joints.
Application of heat and ice: Alternate use of cold and hot packs helps in alleviating joint swelling, inflammation and pain. Application of cold packs reduce swelling and numb pain causing signals, whereas hot packs promote tissue circulation and optimize healing.
Stretching and strengthening exercises: Active stretching of muscles may elicit pain in acute inflammation, which is why stretching may not be a good idea in acute injury situations. However, in chronic musculoskeletal disorders, where shoulder pain is mainly due to adhesions or stiffness, use of passive stretching exercises helps in mobilizing painful joints. Effective stretching and strengthening exercises not only promotes joint healing and recovery (by re-establishing joint circulation) but also minimizes the risk of recurrence.
Chiropractic Manipulation and mobilization: In certain cases (such as adhesive capsulitis) or chronic tendinopathy and related disorder), manipulation or chiropractic adjustments are highly effective in restoring natural anatomy of shoulder joint.
Other frequently employed modalities by trained chiropractors are:
– Therapeutic massage (to improve tissue circulation and optimal healing)
– TENS (transcutaneous electrical nerve stimulation) for pain relief and resolution of swelling
– Cryotherapy
– Ischemic compression
– Trigger point release technique (used by approximately 90% chiropractors for optimal pain relief)
– Active Release Therapy (ART)
References:
1. Harvey, J. A., Chastin, S. F., & Skelton, D. A. (2013). Prevalence of sedentary behavior in older adults: a systematic review. International journal of environmental research and public health, 10(12), 6645-6661.
2. Nilsen, T. I. L., Holtermann, A., & Mork, P. J. (2011). Physical exercise, body mass index, and risk of chronic pain in the low back and neck/shoulders: longitudinal data from the Nord-Trøndelag Health Study. American journal of epidemiology, kwr087.
3. Straker, L. M., Smith, A. J., Bear, N., O’Sullivan, P. B., & de Klerk, N. H. (2011). Neck/shoulder pain, habitual spinal posture and computer use in adolescents: the importance of gender. Ergonomics, 54(6), 539-546.
4. Hains, G. (2002). Chiropractic management of shoulder pain and dysfunction of myofascial origin using ischemic compression techniques. The Journal of the Canadian Chiropractic Association, 46(3), 192.
5. Myburgh, C., Lauridsen, H. H., Larsen, A. H., & Hartvigsen, J. (2011). Standardized manual palpation of myofascial trigger points in relation to neck/shoulder pain; the influence of clinical experience on inter-examiner reproducibility. Manual therapy, 16(2), 136-140.
