Dr. Riley Explains Common Shoulder Injuries and How to Treat Them
As a chiropractor, I work on shoulders every day. I treat chronic injuries that have been present for many years in my patients and they come to see me when the pain gets so bad that they lose their normal range of motion and they can no longer sleep on their sides due to the pain.
I also treat acute injuries for patients which have lifted something too heavy, or when they used poor mechanical posturing and pinch segments of tendons and muscles in their shoulders.
Very frequently I will see injuries to a muscle tendon named the supraspinatus. The supraspinatus is tasked with raising the arm straight out away from the body and is used primarily when the thumb is down. If a patient is struggling to be able to lift their arm up to 90 degrees with their thumb pointing down, I am suspicious that the supraspinatus tendon has been pinched underneath a hook of bone called the acromion. As their greater tubercle of humeral head raises up it creates a sharp pinch point for the biceps tendon, the subacromial bursa, and the supraspinatus.
It is easy to diagnose these different problems, but treating them is always individualized to the particular patient’s presentation. I will frequently begin with a week of ultrasound and ice therapy to shrink down inflammation. Patients will take ibuprofen at home and ice for the first week. Once they have the inflammation under control and their pain level is down to ~4/10 we can start the important work of mobilization and repositioning of the humeral head.
The patient is lying down face up on my treatment table and their arm is in my hands. I anchor the shoulder so that I can direct my force into the humerus and drive it inferiorly down toward their toes. This is not a fast adjustment. This is a very slow and careful joint manipulation as I drive the head of the humerus down away from the impingement point. Patients report that this therapy is not painful. After a 20 minute session of stretching the lower ligaments of the shoulder which hold the arm bone into the socket formed by the shoulder blade, patients report increased range of motion and decreased pain. Since the muscles are being stretched and some delicate injured tissues are involved, I will typically incorporate an ultrasound treatment after the shoulder manipulation in order to minimize swelling and to speed healing.
I typically see a patient twice a week for two weeks and at the end of the fourth session I see a 50% restoration of pain free range of motion. If I fail to see that improvement, I order the MRI to see if there is any bone spurring or calcific tendonitis, labral tearing, or pathology that may be complicating the case which I was not able to see on the intake x-rays.
If the patient is down to 2/10 pain levels I begin my shoulder strengthening protocol for making the rotator cuff muscles strong and coordinated once again. This involved PNF diagonals and tubing exercises and graduate up to free weights as the shoulder is at full pain free range of motion.
Patients report that this approach saves them time and money in resolving their shoulder injuries. I love seeing these results in patients as we treat them without drugs and without surgery