So, you have pain in the front of your shoulder and you’ve been dealing with it for a few weeks/months.
You’ve been to the Physical Therapist, Doctor, Orthopedist, chiropractor or massage therapist and all have hit you with a diagnosis of “biceps tendonitis”, “impingement”, “subacromial bursitis”, etc. or some combination thereof.
All are fair diagnoses that can occur in the shoulder. But really all you got was a fancy title slapped on your shoulder pain. Your shoulder still hurts but now you know what to call the pain.
You still don’t know the WHY?
Or maybe you don't like healthcare providers (nothing wrong with that) and skipped all of those steps and went to a local stretching company for that shoulder pain.
You inform them of your shoulder pain and need for treatment and you're on your way to pain free living! But you didn’t receive an evaluation or formal assessment. Did you fill out anything regarding your past medical history? Your surgical history, if any? Any questions about old injuries to the area in question?
You didn’t even get a fancy name to call your pain, for crying out loud!
Simply put you’re asked where you hurt, you point at a body part or parts and they get to work. A corporate office-dictated, cookie cutter treatment plan for each part of the body.
Complaint: Pain in the front of the shoulder
Solution: Punish the tissue on the front of your shoulder.
Complaint: Low back pain
Solution: They stretch the crap out of your hamstrings and dig into your hip flexors.
Complaint: Mid-back pain
Solution: They manipulate (crack) your neck and mid-back and then leave you to relax with some heat and electrical stimulation.
Are all of these things going to get you to walk out of the office feeling temporarily better?
Are all of these things going to buy you a temporary window of relief which may allow you to run/lift/walk better?
Are ANY of these things going to fix the source of your symptoms for long term relief?
Honestly, consider that business model.
This is why you have to go indefinitely.
**Quick story of why the above model of having passive treatment done TO you is flawed**
I once treated a client with low back pain for 14 total visits, over the course of several months. Prior to our working together she had been seeing her chiropractor "3 times a week for 17 (seventeen) years" for the same back pain she and I resolved in 14 visits. She had only been getting temporary relief from the chiro visits over the nearly 2 decades of treatment.
You. Must. Load. The. Tissue. Not just DO stuff TO it.
**Back on track**
Being seen once a week visit to the “stretch place” may feel good and is cheap on the front end. The idea of being seen indefinitely without a game plan for a long-term solution is going to result in a much higher price tag over time. This can be in the form of cumulative “treatments” or in one giant event when tissue fails completely and you end up needing surgery to reattach/repair the area that kept getting stretched, manipulated or dry needled.
This is my wheel house. If you have pain in the front of the shoulder, the last place I’m going to treat on the first visit is the front of your shoulder.
But why not?
Because you have pain there! It will not feel good if I dive right into working through the tissue that’s already giving you the middle finger.
What I will do is look at the areas that can contribute to “front of the shoulder pain”. Neck and upper/mid back stiffness can result in your shoulders not moving well. Poor head position can limit how the shoulder blades move as well. These are only a few things that must be assessed. Focused strength testing is also a part of the assessment as certain muscles that may also be contributing factors to your symptoms. There are other details that go into the overall assessment and other considerations that are made along the way before beginning treatment.
I will not simply dive into irritated tissue with hands-on, dry needling, scraping, stretching, etc. without first assessing the system.
All of the systems must be addressed and function well in order for the machine (you) to express movement and strength in a competent and efficient way.
"Our bodies are a complex system of systems" -Kelly Starrett
Thanks for reading! WD