In recent weeks I find myself treating more and more shoulder injuries. Most of the time it presents the same way. The patient comes in, points to the front of their shoulder, and says I have biceps tendonitis. They rested and took anti-inflammatories and still the pain returns.
First off just because you have pain at the front of the shoulder, it does not mean you automatically have problems with your biceps tendon. The muscles of your rotator cuff can also be the issue. Especially if you have been doing multiple overhead movements and pushing movements. The muscles of the rotator cuff come across the scapula and attach the the top of your arm. These contract and act as a pulley system on the arm to take it through external and internal rotation. Nine times out of ten when a patient comes in with the front of the shoulder pain, I can pin-point an area near the back of the arm pit that is very tight and recreates the pain at the front of the shoulder. This should be the area we need to treat.
So how do we treat this? If caught early and not ignored, this is typically an easy fix. We need to make sure the muscles and tendons of the injured area are moving through the joint space with ease. You can stretch a muscle all day, but if the muscle fibers, the fascia around the fibers, and even the skin above are not moving independently of each other, pain and dysfunction will continue to arise. Techniques like A.R.T (Active Release Technique) and Graston can help release these muscles and tendons and void any adhesions in them. Along side this we can speed up the healing process. TENS is one way to help speed this process by stimulating the muscle fibers to heal quickly. Another treatment that has been shown to greatly speed up the process is using a cold laser therapy (K-Laser). This can also be beneficial to many other types of soft tissue injuries.
Now that the shoulder is healed, we need to make sure the injury does not recur. The most common way to do this is to strengthen the muscle of the rotator cuff. The system we use and in my opinion the best program on the market is the Crossover Symmetry. The next thing and the most often ignored is fixing the faulty movement that created the injury in the first place. We need to have a movement evaluation to find out what ranges of motion are hypo or even hypermobile and fix this. We also need to make sure we are putting the joints in the correct position to be able to perform the activities needed.
The purpose of this post is to not ignore even the most minor discomforts and to know that you cannot chase pain. Just because an area hurts, does not necessarily mean that is the area to treat. Find the cause, the root of the issue. Fix that then correct what caused it in the first place.
There are no bad movements, there are only bad movement patterns.
Dr. Brady DeClerk, D.C., CF-L1