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Why is my shoulder hurting? What your doctor may have overlooked!

Posted on June 14, 2015 by fcspine Leave a comment

shoulder pain chiropractor jacksonville fl arlingotn

Is your shoulder giving you problems? Have you tried seeking treatment for your shoulder to no avail? Are you sick and tired of dealing with that constant nagging ache? Maybe you thought you’re getting older, and your shoulder will never feel fully healthy again. It’s time to take a second look at that shoulder and what may be causing your pain!

The prevalence of shoulder pain in the general population is estimated to be 15.4% in woman 24.9% in men according to a recent epidemiology study (Pribicevic, 2012). Injuries and dysfunction of the shoulder falls into four categories; fractures, joint injuries, muscular injuries, and functional imbalances. Fortunately the first three categories are easily identified with orthopedic testing, x-rays, MRIs, and most often can be successfully managed. The problem is that when you fall into the fourth category, functional imbalances, you shoulder problem can be easily overlooked. The medical community at large has focused mostly on pathologies of the shoulder and less on imbalances. It is these functional imbalances of the shoulder that can plague a lot of us, sending us in circles from one treating provider to another with no help. It’s time to understand what is going on!

Let me first start by giving you a brief anatomy lesson of the shoulder region. The shoulder is comprised of three bones, the humerus, scapula, and clavicle. The humerus, the upper arm, fits like a ball and socket into our scapula aka shoulder blade. This is called the glenohumeral joint. The scapula connects to our backs and forms the scapulothoracic joint. The clavicle, aka collarbone, connects to the scapula at the acromion, a bony process that extends outward from the scapula. This union between the acromion and clavicle forms the acromioclavicular joint, better known as the AC joint. At the other end of the clavicle is the sternum, aka breast bone. This makes up the bones and joints of the shoulder. Then you have your rotator cuff muscles that provide stability and mobility to upper arm at the glenohumeral joint. The glenohumeral joint, has more mobility that any other joint in our body.

Surprisingly, most shoulder functional imbalances are not located at the shoulder but the muscles surrounding the shoulder. Commonly people have what is known as upper cross syndrome. The shoulders that are rolled inward, a head that protrudes forward, and a rounded back. It’s no surprise with today’s culture of tablets, cell phones, and increase work at a desk, we are seeing a rise in the prevalence and early onset of this functional imbalance. When you carry your body this way, you chest muscles, the pectoral muscles, become contracted pulling the shoulders forward and inward. You muscles in the front portion of your neck become inactive and your head slumps forward. You actually decrease your lungs capacity and the ability for you to breath deeply. Your back muscles, rhomboids and serratus anterior, which are responsible for holding the scapula firmly against the back turn off. The traps and levator scapula become tight, and the scapulae migrate up, outward, and internally rotate. This is what we call an anterior tilted, lateral translated, internally rotated scapula. This is functional imbalance of the shoulder, it’s a problem, and many of you reading this are experiencing this to some degree now.

The joints of the shoulder, the glenohumeral and acromioclavicular are now wearing at each other. The space under the acromion has become diminished and inflammatory processes, swelling, and degeneration start to set in. Left uncorrected the degenerative changes continue to erode at the shoulder and rotator cuff repairs, acromioplasty, and shoulder arthroscopy may become common procedures for some. Most of this can be avoided if the problem is address early and restorative measures and begun to return the shoulder and body back to balance. Corrective exercises, stretches, adjustments, and myofascial release can reduce and correct these functional imbalances. Having a knowledgeable physician, doctor, or therapist familiar with treating functional imbalances is key when choosing a provider. We are especially good at identifying and correcting functional imbalances of the whole body at our chiropractic office here in Jacksonville, Florida. It’s what we do.

Some great first steps to take if you suspect you may be suffering from upper cross syndrome is start some corrective exercises. You can see some being demonstrated here; https://youtu.be/7l2TLBkFnP0. If you feeling extra charged up, you can also try these scapula mobility exercises done here; https://youtu.be/hzozw2Aso3M. Doing these will help not only help you stand up taller, but also reposition the scapula and shoulder, reducing the functional imbalance and providing some much needed relief.

Remember there are many conditions that can affect the shoulder, but in summary, if neither of the first 3 categories are an issue, you fall into the fourth category of functional imbalance. Please see someone familiar with treating these type of issues and at minimum start trying some of the exercises I have linked above. There are may other videos on YouTube you may find useful for correcting functional imbalances of shoulder and body. Kelly Starrett’s channel is a great place to start. I hope you enjoyed learning about the shoulder and remember to enjoy the day!

-Dr. Colt Andrea D.C.

National Board Certified Chiropractor located in Jacksonville Fl.

Mario Pribicevic (2012). The Epidemiology of Shoulder Pain: A Narrative Review of the Literature, Pain in Perspective, Dr. Subhamay Ghosh (Ed.), ISBN: 978-953-51-0807-8, InTech, DOI: 10.5772/52931.

Have you ever wondered why your pain never goes away?

Posted on June 3, 2015 by fcspine 2 comments

myofascial pain jacksonville chiropractor arlington

Ever have aching pain in your muscles that seems to never go away? You tried taking pain medications, but realize you are only getting temporary relief. Maybe you’ve been adjusted by a chiropractor or seen a physical therapist and yet the pain keeps coming back! You might have even had X-rays or MRIs, yet the source of your pain remains a mystery. You might have myofascial pain syndrome.

Did you know that myofascial pain could be the root cause of most chronic pain cases! Researched showed that among 283 consecutive admissions to a comprehensive pain center, 85 percent were assigned a primary organic diagnosis of myofascial syndrome (Fishbain et al., 1986). This diagnosis was made independently by a neurosurgeon and a physiatrist based on physical examination for soft tissue findings as described by Travell (Travell and Rinzler, 1952; Simons and Travell, 1983). Another study suggested that 31% of visits to internal medical group practices for acute pain were actually myofascial pain (Skootsky, 1986). So what exactly is myofascial pain syndrome?

Simply stated, myofascial pain syndrome is a chronic pain disorder. Pressing on sensitive spots within your muscles causes pain locally and or pain in areas that appear to be unrelated. Anatomically speaking, myofascial is a strong, dense, flexible, connective tissue that covers all the muscles and bones of our body. It aids in support of our musculoskeletal system. Underneath this fascia covering, trigger points can form. A trigger point is a localized contraction of muscle fibers in the muscle belly. To explain this further, if the whole muscle was to contract, we would call that a cramp or muscle spasm. When just a small portion of the muscle spasms, we call it a trigger point. They usually range from the size of a pea to a large marble and can be felt just underneath the skin, palpable in the muscle. When this small patch of localized muscle contracts, it cuts off its own blood supply and becomes toxic, full of lactic acid and metabolic waste, unable to release. Nerves located at the surface in and around the area become hypersensitive and create large amounts of noxious pain. When a collection of these trigger points form in a given area, we now call this myofascial pain syndrome. Cumulatively, this generates feelings of aches, burns and other strange sensations that generally make you feel a surprising amount of discomfort, irritation, and overall yuck.

You may be asking yourself why we get trigger points in the first place? The formation of trigger points can come from repetitive strains, poor posture, overloading a muscle, and injury. A lot of us have jobs where we perform repetitive motions daily, not to mention, while spending large amounts of time in a seated position.

Fortunately, treating myofascial pain syndrome can be quite effective if the doctor or therapist is knowledgeable and utilizes a hands on approach. All too often, patients will end up having trigger point injections done when a more simple and cost effective therapy could have been done. When in the right hands, the release of trigger points can be done with myofascial release and other soft tissue techniques. An example would be a combination of direct pressure, and moving a particular muscle through its full range of motion. This will cause the trigger point, that focal tight constricted muscle, to release and resume normal healthy function. This can be done several times in an area to help remove the trigger points and resolve myofascial pain syndrome. It can also be done at home once the patient has a understanding of the basics and what they are trying to accomplish. Typically a few sessions will resolve most myofascial pain syndromes. In cases where more work is needed, outside exacerbating factors may need to be addressed.

Like always, I hope this read has been a informative and entertaining. If you or someone else you know is suffering from what you suspect is myofascial pain syndrome, please refer them to us or someone else capable of helping them. And always, if you liked this article please share! Thank you.

-Dr. Colt Andrea D.C.

National Board Certified Chiropractor located in Jacksonville Fl.

Fishbain, A.A., Goldberg, M., Meagher, B.R., Steele, R., and Rosomoff, H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain 26:181-197, 1986. [PubMed]

Skootsky, S. Incidence of myofascial pain in an internal medical group practice. Paper presented to the American Pain Society, Washington, DC, November 6-9, 1986.

Travell, J.G., and Rinzler, S.H. The myofascial genesis of pain. Postgraduate Medicine 11:425-434, 1952. [PubMed]