Shoulder Pain: Is Surgery Your Only Option?

In my experience, besides back pain, shoulder injuries and pain are some of the most common reasons a patient presents to our chiropractic office.  In fact, I have observed that most of my patients who suffer from chronic neck and upper back issues have at least a minor shoulder condition complicating their case.  The biggest fear with our shoulder pain patients is the dreaded ‘rotator cuff’ injury.  Why dreaded?  Because so many people have been trained to think that he only solution for rotator cuff problems is an invasive procedure.  Generally, the race to expensive, invasive interventions, in my opinion, is largely unnecessary overkill but can include pain management injections, which are generally only temporary and don’t really fix the cause of the pain, and surgery, which has a potential for risk, and recurrence of the condition. Surgery also limits additional future conservative care options in the likely event that the surgery fails.

Your shoulder can experience pain and dysfunction just like your back can.  Acute traumas and chronic stresses can lead to wear and tear on the joint just like they would in the low back.  It reasons then, if a patient can experience an excellent recovery with conservative care of their low back, conservative care of the shoulder is also a viable method of improvement.  So why, when you go to your doctor, do they so often immediately refer you to an orthopedic surgeon?  There are several reasons for this:

1.        Your doctor may not know or understand the nature of a shoulder injury.  The shoulder joint is a complex one with multiple muscular, tendonous, and neurological involvements that can affect areas other than the shoulder.

2.       A lack of understanding of how the body heals if the obstructions to the healing process are removed.

3.       A lack of understanding of the role conservative intervention can play, including chiropractic adjusting of the extremities, in helping the patient to heal themselves.

4.       Surgery is a perceived quick fix (despite the fact that surgery is not without its potential complications and failure rates).

So, you have shoulder pain…now what?  Shoulder pain is not as simple as just ‘rotator cuff damage.’  You have to understand what the mechanism of injury is, what tissues are involved, and whether there are other areas that may be contributing to or aggravating the shoulder region.  There are countless reasons a person can develop pain in the shoulder and rarely is the pain ‘just a shoulder problem.’

Your shoulder joint mechanism is an extremely complex one.  It allows for the largest range of motion of any joint complex of the body.  It has muscular attachments not only to the shoulder joint, but to the neck, rib cage, elbow, and even the low back.  The rotator cuff musculature represents only 4 of approximately 2 dozen muscles that affect shoulder function.  Did you know that the collar bone is the only one that directly attaches the bones of the entire arm to the rest of the skeleton?

In order to adequately diagnose a shoulder problem with the greatest level of accuracy, an MRI of the shoulder may be required.  While many will rely on plain film x-rays to diagnose a shoulder condition, x-rays alone don’t generally reveal the information necessary, especially for a chronic shoulder issue.  An MRI on the other hand will reveal information about all the soft tissues in and around the joint, including the cartilage.  It can even offer information as to whether the injury is acute and whether there is an active inflammatory response currently progressing.

Understanding how the shoulder functions is a key to helping it resolve.  Most injuries to the shoulder are either acute sprains or chronic overexertion injuries.  Either way, most shoulder conditions will improve with conservative care.  Now, many will argue that physical therapy is the best solution for a shoulder issue and I would agree to an extent.  Physical therapy is extremely effective at helping a shoulder condition to resolve.  However, to limit conservative care to only pain management and exercising the shoulder joint may prevent the patient from reaching full resolution of their condition.

Ideally, these factors need to be addressed when caring for a person with a shoulder injury:

1.       Misalignments of the shoulder joints need to be identified and corrected manually.  This requires the expertise of a chiropractor.  There are 3 true joints and 1 potential joint in the shoulder that must be corrected to restore full function before additional care can be rendered.  Exercising or stressing a deranged joint may actually aggravated it and slow your recovery.  The muscles, ligaments, and tendons of the joint rely on proper alignment for their proper function. Your soft tissues cannot function correctly if the skeleton is functioning incorrectly.    Only a chiropractor or, arguably, an osteopathic physician has the training and expertise to identify and correct misalignments in the shoulder with precision.

2.       Pain must be controlled.  While rendering care, there is the temptation to jump right into exercise to rehabilitate the area.  True, studies have shown that the earlier you introduce exercise, the better the long term recovery, but this has to be done within reason.  Applying stress to a guarded and deranged joint experiencing debilitating pain may aggravate the condition.  Additionally, the person is most likely not using the damaged tissue when they are in exercising the area and are, instead, recruiting other tissues to compensate for the loss.  Getting your pain under control is a critical step to rehabilitation.

3.       Exercise is critical.  Ultimately, you will have to add active exercise to strengthen the affected soft tissue damage.  Because your body lays down new tissue and builds up existing tissue according to the stress you place upon it, stressing the joints and soft tissues within reason is a critical component to resolving a shoulder issue.  It will be very difficult to expereince a full recovery without eventually adding a structured exercise regimen.

4.       Don’t ignore other associated areas.  Often, when you feel shoulder pain, you think it is necessarily only a shoulder problem.  In fact, it may not even be a shoulder problem at all.  Neck issues, upper back problems, postural issues, elbow dysfunction, and even low back pain can contribute to derangement in the shoulder.  They can both cause pin in the shoulder and aggravate a shoulder condition.  So, it’s critical that ALL these areas that interact with the shoulder also be addressed when helping you recover.

Conservative care for most mild to moderate shoulder conditions can be extremely effective.  When cared fro properly, I generally see a 90% recovery in our office in 90-120 days, depending on the type and nature of the shoulder injury.  The biggest detriment to a person’s improvement with conservative care, though, is their own impatience.  Healing takes time.  Conservative intervention for these types of shoulder injuries should at least be attempted before any invasive medical intervention is considered.

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Unrealistic Expectations: Are You Standing In Your Own Way?

Generally, there is very little guesswork in staying healthy.  If you eat a healthy diet, get adequate exercise, manage your stress, minimize your toxic exposure, and maintain the health if your nervous system function by visiting your chiropractor regularly, you should significantly decrease your risk of disease.  Likewise, doing the same by changing your lifestyle from generally poor habits to excellent behaviors should reverse certain chronic illnesses that many people just assume are inevitable.  Essentially, so-so habits will give you so-so results.  Excellent habits, though, can change your life.

In most cases, you have the control over whether you are sick or not.  Unfortunately, many people believe or, rather, have been trained that disease is inevitable, an unstoppable force we are destined to collide with at some point during our lifetime.  The reality is, however, that the choices you make now will impact not only whether you will have a long life, but whether you have a quality life.  Less a matter of genetics, chronic illness is more impacted by the poor choices we make, neglect, and missed opportunities for health that we allow throughout our lifetime.

While the road to health is a journey, not a destination, one of the largest obstacles standing in a person’s path to true health is unrealistic expectations.  Now, I’ll be clear.  I don’t think it’s unrealistic to have full health as a goal even if you are suffering from chronic illnesses like high blood pressure and diabetes.  I’ve seen enough patients with everything from asthma to sleep apnea experience full resolution of their condition over the years to know with certainty that your body is an amazing healing machine capable of miracles.  What is unrealistic, though, are the artificial time frames, illogical conclusions, and nonsensical methodologies employed to accomplish those goals.

When looking at your health goals, there are several factors you must consider:

1.        Is your time frame realistic?

Many people, when expecting improvement for a chronic condition, are completely unrealistic with their time frames for improvement.   Much of the chronic illnesses that are rampant in older populations are the results of years of neglect.  Still, I work regularly with patients who expect to be well in a matter of days or weeks.  You cannot accumulate the effects of aging for decades and then expect immediate recovery.

Getting sick takes time, as does becoming well.  Your body is a self healing machine with incredible capacity as long as it’s given adequate fuel and proper maintenance.  Unfortunately, unrealistic expectations cause too many people to give up on improving her health, often long before the beneficial effects of their lifestyle change begin to take effect.

2.       Is what I’m doing helping or harming?

You have to ask yourself whether the solutions you are relying on are helping you, making no difference, or may even be hurting you.   We live in an age of limitless options, where there seems to be an answer for everything.  The problem is that often the solutions you’re given are just empty promises.

For example, many people who drink soda with choose a ‘diet’ option because they perceive it to be a healthier alternative to sugar.  Besides the fact that soda has almost no nutritional value, the artificial sweetener they are consuming may be linked to cancer or is toxic to the nervous system.  This ‘healthier’ choice is probably worse than a regular soda.  The better alternative is to avoid consuming soda altogether.

And there are countless other shortcuts and changes that people make that they perceive are better for their health like margarine versus butter or pool exercises versus weight bearing exercises.  Even your medications that you take to control your symptoms come with a price.  Mark Twain once said to “be careful of health books, you may die of a misprint.”  It still rings true today.

3.       Is this a fix or a cover-up?

On the topic of medication, a common unrealistic expectation is that your pharmaceuticals are somehow making you healthier.   You have to understand that if you are taking medications to begin with, you are not healthy.  The medication only chemically alters normal bodily function to produce a desired effect, decreased symptoms and risk factors.  The problem is that you’re just as sick while taking them.  You just don’t feel it because your symptoms have been suppressed.

There is not a medication out there for chronic illness that reverses any type of disease.  Granted, they will help you feel better and may prolong your life, versus not taking them, but they are by no means a pathway to health.   The results of taking medication are also temporary.  Meaning, if you stop taking the medication, the symptoms of the disease return relatively rapidly.

In my experience, I would also argue that taking medication for your condition means you have a suppressed disease process that you may not be realistically and directly addressing in a more meaningful way.  Unless you take real action to improve your lifestyle and the causes of your illness, you will have a hard time truly being well.

4.       Have you corrected some of the bad habits and neglect that contributed to this condition in the first place?

Albert Einstein said “the definition of insanity is doing the same thing over and over again and expecting different results.”  Chronic illness is not a matter of luck but a matter of choice.  The pains and illnesses a person develops as they age are the result of the decisions they’ve made.  Essentially, you become a picture of the good or bad choices you’ve made up to that point.  In order to maintain and improve your health, you have to move away from the bad habits and behaviors that keep a person sick.  You can’t expect to continue to eat poorly, get no exercise, and have high levels of stress but remain healthy.  In the case of a person with chronic illness, you have to begin incorporating healthy choices into your regimen while eliminating the bad.  To change your health, you have to change your lifestyle.

Are you willing to make the difficult changes necessary to improve your health?  If you are, maintaining realistic expectations in the face of disease may be a critical factor in whether you improve the way you should or not.  Often, a person may never realize their true health potential because their unrealistic vision of improvement prevents them from attaining their goal.  How?  Because the person who thinks recovery should be fast and easy is more likely to give up on trying all together when they realize recovery is long and hard.  They are also more likely to prematurely stop an effective intervention before realizing the pull potential of that change.  Does a difficult road mean that you should give up on health altogether?  Many do.  Unfortunately, the end result is an opinion that illness is inevitable and uncorrectable…an opinion based merely on unrealistic expectations.

To change your health, you have to become realistic with your expectations.  To change your life, you have to commit to the difficult path, that may seem hard at first, but is worth your commitment in the end.  You’ll be able to make sizable changes in your quality of life and may even extend your life.  The choice, however, is up to you and your ability to be realistic with your expectations.

Exercise: It’s In Your Genes

Having been in practice for about 15 years, one of the most difficult aspects of delivering patient care is getting them to become an active participant in their own recovery.  In my experience, most patients want health handed to them without having to do any work or make the difficult choices needed in order to become healthy and stay that way.   They also expect a speedy recovery despite the fact that it may have taken them years to get to their current health state.

Genetically, we’re designed as humans to live a “hunter-gatherer lifestyle.”  Meaning, we are genetically programmed to spend most of the day foraging for food and hunting for our dinner.   Think about how humans lived 10,000 years ago, when there were no televisions, computers, or cell phones.  People didn’t spend all day sitting on their butt knowing they can just swing through the drive-through on the way home for dinner.  They had to keep moving or die.

Nowadays, in this era of convenience, we expect life to be easy and, after all, exercising is inconvenient and requires work.  I even had one person tell me one time that they didn’t like to exercise because “they got hot and it made them sweat.”  It was no wonder that the patient has in generally poor health.

The most common excuse for not exercising that I hear on a daily basis is, “I’m too busy.”  I say ‘excuse’ because it’s never about time.  It’s about priorities.  We fill our days with countless tasks so that it seems as if we’re almost constantly busy.  However, when you actually sit down and evaluate your day, you’d be surprised how much time you waste or even how much time is spent on low priority tasks.  Those same patients who “don’t have time” will spend 2-3 hours a day watching television or are unwilling to get up an hour earlier to exercise early in the day.  Their television show is more important than exercise.  Getting that extra hour of sleep is also more important than investing in their health.

The American Medical Association recommends 30 minutes of exercise 3 times per week but when you realize how much exercise we are genetically programmed to get, about 12-16 hours per day, you can see how 90 minutes a week is a vastly inadequate amount of movement to stay healthy.

Look at tribal communities around the world.  Did you know that their instances of heart disease, diabetes, and chronic back problems is almost non-existent?  People living a tribal lifestyle, as we are built to, don’t suffer from heart attacks and sleep apnea, at least not like we do in industrialized countries.  They die from Ebola or injured in traumas.  So, living in a country like we do where the risk for severe infectious disease or being maimed by wild animals is rare, we really choose to experience the general declines in health that many suffer as they age.

Think about your average day.  The average person likely:

1.  Wakes up in the morning and gets ready for work then grabs a quick bite and heads out the door (limited standing and sitting).

2.  Spends 30 minutes in a commute to work (sitting).

3.  Spends 8-10 hours sitting in front of a computer at work, sitting in meetings, or sitting on the phone.

4.  Spends 30-60 minutes commuting home (sitting).

5.  Prepares dinner then watches 2-3 hours of television, all the while taking care of their kids and other committments (mostly sitting).

6.  Finally, goes to bed (laying).

It literally seems like we’re resting ourselves to death.  No one ever became healthy by spending all day on their butt.

Now, say you do get the 90 minutes of exercise recommended by the AMA, is that enough to counteract the 166 remaining hours in the week that you are largely immobile?  I think the answer speaks for itself.

You need to exercise for series of reasons:

1.  It helps improve your health and circulation.  Your heart is a muscle and your need to work it out.  Studies consistently show a direct correlation between exercise and a decrease in heart disease.  Increasing your respiration also helps with oxygen delivery to your tissues to decrease fatigue.

2.  In helps improve immune function.  Exercise stimulates lymphatic flow and improves function of the lymph nodes.

3.  It helps improve digestion.  Movement helps contents move through the gut.

4.  In strengthens your muscles and maintains bone density.  Regular exercise helps boost your endurance, increases your energy, and decreases the degenerative effects of aging like arthritis.

5.  It will help you sleep at night.  Physically exhausting your body will encourage healthy sleep.

6.  It helps to keep your nervous system healthy.  Your nervous system is a sensory and motor processing machine that requires constant mental and physical input and output to stay at peak function.  Exercise has been linked to decreases in pain, depression, and degenerative neurological conditions.

The question becomes are you getting enough exercise to maintain minimal health?  Are you willing and able to make the sacrifices necessary to become healthy and stay that way?  Staying well is a journey, not a destination, that requires constant work and attention.  With unlimited potential but a vast minority of Americans who have a structured exercise regimen, are you, and your unwillingness to change, the only thing standing between you and being well?