Category Archives: Shoulder Problems

Kinesiotaping: Managing Your Pain Like A Pro

One of the latest trends in healthcare over recent years has been the use of kinesiotape for managing pain and injuries. Professional and amateur athletes alike are turning to the tape in increasing numbers to help manage soreness in muscles and joints as well as accelerate healing.

Not familiar with kinesiotape? You should be. It’s an excellent alternative to potentially risky medications for the management of acute and chronic pain. It can be used on just about any part of the body and risks of any side effects are fairly low.   It doesn’t contain any medication and can be effective for a broad range of conditions, from sprains and strains to arthritic pain.

Kinesiotape is, basically, just a cloth tape with a skin adhesive. Unlike a traditional athletic tape, kinesiotape does not restrict movement but, instead, moves with your body. Full range of motion is still possible with application of the tape. The skin over the affected area now works with the kinesiotape to help improve function in an affected area and decrease pain. How does it work? Well there are several theories:

  1. Improved proprioception – Now, this is one of those fancy health terms but, basically, the tape improves your body’s ability to sense and respond to the environment. Applying the tape to the skin acts as a minor stimulus to heighten the sensitivity of the soft tissues to movement (improved proprioception).   Increased soft tissue sensation allows the body to respond and adapt to stress better, including additional stresses to the joints and tissues. It will also decrease the likelihood of additional injury.
  2. Lifting the skin off the affected area – In many instances, the inflammatory processes that produce pain lie below the skin. When taped properly, contraction of the kinesiotape will help to lift skin off the affected area and decrease pressure of more superficial tissues on the affected area, leading to decrease deep tissue irritation.
  3. Improved circulation – As you move the tape expands and contracts with the skin according to your movement. This will help pump new blood supply into the area and encourage a decrease in swelling. The tape improve oxygenated blood supply to the area but also increase vein activity to draw fluid, including swelling, away from the affected area. Improved circulation will also decrease muscle spasming and will bring in immune cells to help repair the damaged tissues.
  4. Improved lymphatic flow – Your lymphatic system is you “other circulatory system.” Consisting of a series of vessels and lymph nodes distributed around the body, your lymphatic system helps to remove cellular waste from the tissues, including lactic acid which can cause pain. Like your veins, the lymphatic system requires movement to accomplish lymphatic flow. Kinesiotaping helps to improve lymphatic flow, drawing inflammatory products away from the injured area. Additionally, because the lymphatic system is a critical component of the immune system, improved lymphatic flow will improve the body’s ability to heal.
  5. Gate theory – Most patients with chronic pain are familiar with a TENS (Transcutaneous Electrical Nerve Stimulation) unit. A tens unit works by electrically stimulating mechanical nerve receptors for the tissues and joints. By stimulating those receptors, you can trick nervous system into paying less attention to pain sensitive nerves (nociceptors). In a similar fashion, kinesiotepe stimulates these receptors mechanically, desensitizing the pain sensitive portion of the nervous system.
  6. Shifted load – Because kinesiotape is an elastic tape, taping over the area will shift some of the physical stress load off the soft tissues and onto the tape. While it is not generally intended to restrict movement, the tape does have some bracing effect by supplementing your soft tissues.
  7. Mobility reatraining – The Tape can be applied in such a way as to retrain a joint to move and function differently according to how the tape is a applied.   Accomplishing this may require additional training by the person applying the kinesiotape.

While taping is not generally indicated for joint restriction, there are some instances where you can accomplish stability with kinesiotape, including taping the shoulder blade into position or taping an extremity joint to minimize motion, such as an ankle or wrist.

Will kinesiotape replace physical therapy or chiropractic care? No. The tape is simply a tool used to improve a soft tissue’s ability to function while managing pain. In many cases, rehabilitative care is still necessary and taping will not substitute for spinal adjusting, exercise therapy or practical prevention. Kinesiotaping is a low tech simple approach to managing pain without harmful chemical side effects of medications.

There are some contraindications to taping. This includes taping over a rash or skin irritation, application over a sun burn, open wounds, specific contraindications to bracing, and in patients who have sensitivities to adhesive bandages. Out of the hundreds of patients to whom I’ve applied tape, I’ve only seen a few patients with any negative reaction to the tape at all, generally a mild skin irritation. That being said, kinesiotape is an excellent choice for the following applications:

  1. Neck and back injuries
  2. Shoulder injuries
  3. Knee injuries
  4. Sprained ankles
  5. Joint swelling
  6. Muscle tightness
  7. Joint stiffness
  8. Point tenderness
  9. Trigger points
  10. Scoliosis

The tape can be left in place for up to 10 days. You can shower and swim with it. Just be sure not to rub it dry as it may rub off the tape. Occasionally, some residual adhesive may remain on the skin when the tape is removed. Baby oil is a simple solution to remove any residual. You may experience some itching with the tape but my experience has been it is more due to improved circulation than any allergic reaction. Again, negative reactions to the tape are extremely rare.

Before kinesiotaping, I would recommend a thorough evaluation by a healthcare provider who works extensively with musculoskeletal conditions and injuries, to rule out serious issues that may require more intensive intervention. This is especially important in conditions that don’t improve or are worsening, pain that does not respond to kinesiotaping or medication, pain at night, or excruciating pain. Kinesiotaping is not intended to substitute for evaluation or adequate rehabilitative care for a serious injury.

Kinesiotaping is safe for most adults and children, including the elderly.   In my office, I’ve used it effectively on kids with sprained ankles and seniors with knee swelling. It’s also excellent for tightness in the shoulders and low back pain. To be most effective, it does take some training to apply properly. There is a bit of an art-form to the taping procedure. I would recommend working with a healthcare provider who has the expertise and training to properly apply the tape for therapeutic benefit.

If you are an athlete, have a regular workout, suffer from chronic pain, or have recently had a sprain type injury, kinesiotaping may be an excellent way to help manage your condition and accelerate your recovery. Talk to your healthcare provider today about getting taped!

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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.