A published article by Joe
Why won’t my shoulder pain go away?
By Joseph Sweeney, CMT, NCTMB, ABMP
If you’re anything like the average Joe, you work hard during the week usually performing rigorous or repetitive tasks such as hammering or heavy lifting, typing or even repetitive mouse clicking. Then you come home and relax by sinking into the couch and doing nothing for ten minutes to several hours. Follow that up with spending the weekend performing more rigorous, repetitive tasks such as gardening, laundry or a larger ongoing project like painting the bedroom walls. Or perhaps you use the weekends to play and go skiing or rock climbing.
Then you notice that your shoulder hurts when putting on your shirt or closing a door....or worse, you ache all over, can't sleep at night, hard to lie on your side, can't lift your arm overhead.
You’re not alone. What you are probably experiencing is tendonitis in one or more of the shoulder muscles, which is quite common and can take a long time to heal on it's own or could eventually even turn into a frozen shoulder…….but there is help!
Your shoulders are incredibly flexible joints that allow your arms to move through a large range of motion. They are used in almost every activity and they take a lot of punishment on a daily basis. As a result, they are prone to a wide range of injuries that can cause pain and limit your range of motion. Normally the body is able to heal itself quite well during sleep. Unfortunately the average American is so busy with work, chores, bills, errands etc. that when it’s time to sleep we just stare at the ceiling and think about tomorrow which only keeps us awake and creates more stress and less healing. Many times these injuries are simply caused by wear and tear. For example, a common injury is tendonitis of one of the rotator cuff muscles called the Infraspinatus. This is a small triangular muscle located on the back of the shoulder blade. It covers the lower portion of the scapula and its tendon attaches to the back side of the humerus (large bone of upper arm). Like the other muscles of the rotator cuff, the Infraspinatus is weaker than the surrounding muscles due to its poor mechanical advantage which makes it more susceptible to injury. Through poor posture and/or repetitive overuse such as, reaching behind you into the back seat of your car and lifting a heavy object, swinging a tennis racquet or hastily pulling off your jacket, the tendon develops micro tears and becomes inflamed and painful. The resulting pain can lead to overcompensation from other muscles in the body which leads to chronically tightened muscles and trigger points.
Trigger points are small knots in the muscle tissue that are very common around the shoulder and can refer pain and tenderness into the muscles or joints. The referred pain can mimic other shoulder problems and can feel as if the injury is actually in a completely different area or muscle.
The reason it takes so long to heal:
Without being treated tendonitis can take several months or even years to heal and even then you may not get back your full range of motion. This is due to, as mentioned before, overcompensation of other muscles in an effort to prevent further injury and pain, which can cause chronic tightening of these muscles and can eventually lead to more severe conditions such as adhesive capsulitis or frozen shoulder.
No there isn’t a miracle drug or cream or instant treatment that will make this injury disappear overnight. Chances are it took several years to get to this point and unfortunately it’s going to take some time and a personal commitment to your own healing to reverse it.
Do I need surgery?
I am happy to say NO, you may not need surgery!
If your massage therapist is a skilled neuromuscular therapist and you are willing to be proactive with your own healing you can expect at least a 90% recovery in as little as six weeks without surgery, injections or drugs.
You will need to locate the exact muscle and tendon in need of repair. Your therapist can help you with this by performing a few resisted range-of-motion tests.
The next step is to release the trigger points in the muscle tissue; this will almost immediately relieve some of the pain in the shoulder and possibly in the back and neck as well.
Next it will be necessary to properly palpate the injured portion of the tendon, usually the most tender part, and friction the area using focused cross fiber strokes (this is known as cross fiber friction or deep transverse friction) designed to break down scar tissue and reestablish blood flow, followed by stretching the target muscle.
Finally the muscle must be restrengthened using light weights and/or elastic bands such as a Theraband.
It should be noted here that there are other types of shoulder injuries that deserve special consideration such as sprains and dislocations which typically result from falls. It's natural to reach your arm out to catch yourself when falling, but the impact can strain or tear the shoulder ligaments. If the impact is severe enough, the humerus may be knocked right out of the socket and the shoulder can become dislocated. With a severe trauma, the bones may actually fracture or break. When this is the case the arm needs to be immobilized and a proper diagnosis by a physician will be required.
Sometimes the only option is surgery. The best medicine in this case is prevention. As soon as you develop any pain or discomfort in your shoulder, see your massage therapist or other health care practitioner immediately for assessment and treatment. Don't risk getting this serious and debilitating shoulder condition.
Joseph Sweeney is a nationally certified orthopedic massage therapist who currently holds a level two certification in advanced myoskeletal alignment techniques. He specializes in frozen shoulders and other sports related injuries. He runs a highly successful practice in Louisville, Colorado.