Got Shoulder Pain? Read This

In the last few months, I’ve worked on two very interesting cases of individuals with shoulder pain.

One of the cases was a woman in her mid-40s who slipped and fell on the stairs and banged her shoulder. The other was a woman in her late 50s, who had shoulder pain slowly creep up on her for a few months before turning into a frozen shoulder.

In both cases, surgery was recommended as the solution. And in one case, months of physical therapy and cortisone shots were tried with no improvement.

In the end, it turns out:

Neither of them needed surgery and they gained back full function.

In this article, I will share the approach I’ve used for the last 20 years to rehabilitate shoulder injuries—and yes, in many of these cases, they were told "surgery was the only option."

Don’t get me wrong…

Let me start by saying there is a place for surgery.

I’m not someone who believes surgery is never a good option. In some cases, it’s a great option.

That being said, in my experience, over 90% of the individuals I’ve worked with who were told surgery was the only option were successfully rehabilitated without it. And in the cases where surgical repair was necessary, the surgery still didn’t address the reason there was damage in the first place!

To truly be empowered to make educated decisions on any condition or circumstance you find yourself in, you must have some understanding and basic knowledge of the circumstance.

When it comes to physical injuries, it’s important to be informed about your body. You don’t want to be left in the dark when someone’s recommending a drastic solution like surgery to you.

It's like bringing your car to a mechanic without knowing ANYTHING about your car or how it works. The mechanic can tell you that you need a new "flux capacitor" and you’ll say, "Sure, sounds good!"

In the case of your car, you may just be losing a few thousand dollars. But when it comes to your body, the stakes are much higher.

For these reasons, I do my best to educate my clients about their bodies and explain what’s causing their specific issues. My goal is to empower each individual with the knowledge to become capable of caring for their bodies.

So on that note, let's talk about the shoulder complex.

The Three Regions of the Shoulder Complex

When talking about shoulder injuries—specifically rotator cuff injuries and frozen shoulder—there are three regions to define.

The first region is the glenohumeral joint.

The glenohumeral joint comprises two bones: The humerus and the shoulder blade.

These two bones meet up to create the glenohumeral joint. A joint is simply a region where motion takes place. The glenohumeral joint is specifically called a ball and socket joint, or multiaxial joint. This gives this joint a high level of movement capacity.

It’s also the area where most people feel shoulder pain.

The second important region is the scapulothoracic joint.

This region consists of the scapula (shoulder blade) and the rib cage, which attaches to the mid back, or thoracic spine.

The scapulothoracic joint is called a “non-anatomical joint” or "floating joint" because there’s no bony attachment between the scapula and the rib cage.

It’s responsible for translatory motions, which allow the scapula to move in one of eight directions: elevation-depression, protraction-retraction, upward rotation-downward rotation, and scapular tilting up and down.

The third region is the thoracic spine.

The thoracic spine comprises 12 vertebral bodies, which comprise 11 joints in total. The thoracic spine is where the ribs connect, creating additional joints that innervate into the thoracic spine for another 24 joints (12 on each side) called the costovertebral joints.

Onto the Rotator Cuff

Now that you know the major regions of the shoulder complex, let's talk about the rotator cuff.

The rotator cuff is a group of 5 muscles that go from various places on the shoulder blade to the top of the humerus—crossing the glenohumeral joint.

The infraspinatus, teres minor, and teres major all sit on the back of the shoulder blade. The supraspinatus sits on the top of the shoulder blade and the subscapularis sits underneath the shoulder blade, closest to the ribcage.

The rotator cuff, as a whole, is designed to provide stability throughout the glenohumeral joint and facilitate finer movements, such as rotation.

When one of the rotator cuff muscles tears (most commonly the supraspinatus), it’s a result of the muscle being asked to do too much, which leads to common shoulder pain. Anytime a muscle is asked to do too much, it’s usually because another muscle or region isn’t doing enough.

This is when accessing the three regions of the shoulder girdle is critical.

But first, we have to understand this:

The Body Was Designed to Move From the Inside Out

In general, the joints closer to the body's midline can move more. As you go out from the midline towards the end of the extremities, you will encounter joints that don’t have as much gross movement but can do the finer movements.

If you would like an example of this, just try signing your name with your belly button as opposed to your hand 😜

When you look at these three regions of the shoulder complex, the glenohumeral joint is furthest away from the midline, and the thoracic spine is closest to the midline. This also puts the insertion points of the rotator cuff at the furthest distance from the midline.

In the case with the shoulder complex, and many others, the region furthest from the midline is often the area that is compromised—and with rotator cuff injuries, that is the case. This makes the two other regions essential when evaluating and designing a treatment plan for shoulder injuries.

Unfortunately, this is not usually evaluated when you go to traditional health professionals.

The standard treatment and approach for these ailments focus mainly on the glenohumeral joint. Exercises like internal and external rotation are prescribed to strengthen the rotator cuff muscles, along with directions to stretch specific muscles that cross that joint, like your pecs and/or lats.

Although these prescriptions can be a part of rehabilitation, I have found them to be less than 10% of an effective program.

In fact, I didn’t use any of these approaches when rehabilitating the two women who had a rotator cuff tear and frozen shoulder.

What I did find with both of these women was significant restriction in both their scapulothoracic and thoracic regions.

I performed some precise bodywork on all of the soft tissues that innervate the scapulothoracic joint and the thoracic spine. Specifically, I intended to restore the eight different motions of the scapula on the rib cage and facilitate thoracic extension. Once I was able to create those motions in isolation, I then integrated them by coaching the movement from the thoracic spine through the scapulothoracic joint and into the glenohumeral joint.

The results in both cases were restoration of full range of motion and no surgery.

What to Do If You’re Suffering From Shoulder Pain

So the key things to remember if you’re suffering from shoulder pain and/or have been diagnosed with rotator cuff tear or frozen shoulder are:

• Make sure thoracic and scapulothoracic motion are assessed

• Have a skilled bodyworker work the soft tissues to facilitate healthy motion through those areas

• ​Integrate the motions of these three regions into the shoulder girdle complex by initiating the movement from IN(Thoracic Spine) THROUGH (Scapulothoracic Joint) to OUT (Glenohumeral Joint)

• ​Assess whether the range of motion improved globally and if there is a decrease in pain

In summary:

If you’re suffering from shoulder pain, please understand that there is a time and place for orthopedic surgery. But it’s often prescribed as the solution way too often and way too quickly. In my professional experience, there are other methods to try first.

If you would like to read an article from the more traditional perspective, the "Mayo Clinic Q&A: Rotator Cuff Injuries & Surgery" by Cynthia Weiss, is a good one. But take note: she doesn’t mention anything about the regions you read about in this article when it comes to treatment.

Yours in Vitality,

Matt

P.S., If you want to hear more about the case studies I mentioned in today’s article, check out this podcast. I go in much more depth about the evaluation I took my patient through, the thought process behind the treatment, and what we specifically did to rehab her shoulder back to full range of motion—pain-free and without the need for surgery.