Shoulder Pain Guide
Dr. Ryan Hosler & Dr. Jen Hosler
Your Guide to Shoulder Pain Recovery
1. We Understand Your Frustration.
First and foremost, we understand how much shoulder pain sucks. Shoulder pain can be a very tricky problem to deal with. And if left untreated, it can continue to cause nagging problems for several years to come.
Having shoulder pain can seriously impact your daily life and productivity. And it definitely affects your ability to train in the gym and fully partake in sports. Not to mention the impact it has on simple daily tasks such as reaching overhead in cabinets!
We’ve treated several patients with shoulder pain in our office. In fact, treating shoulder pain is a large part of our practice and the third most common complaint we treat (behind low back pain and neck pain). Shoulder pain is so common that some studies report that nearly 50% of the population has experienced shoulder pain in the past year.
But just because shoulder pain is so common, doesn’t mean you have to live with it and accept it as “a part of life.” Having shoulder pain is something you can recover from!
You’re much more stronger and resilient than you may think. You will get through this and conquer your shoulder pain. You won’t live with shoulder issues for the rest of your life. You may just need some professional assistance and guidance along the way. And that’s the purpose of this guide. To help you along your journey of overcoming your current shoulder pain complaints and getting you back to the life you want and deserve.
2. Common Causes of Shoulder Pain.
Before we get into the common causes of shoulder pain, let us reiterate something: you’re not alone. Nearly two-thirds of the population will experience some sort of shoulder pain in their life. But guess what? Not everyone lives with this pain forever! And you don’t have to either.
When you take the correct approach, you can definitely overcome your pain. And you may just overcome it faster than you ever imagined.
Now, you may have heard a list of things that can cause shoulder pain from your friends, your doctor, or even on “doctor” Google. But when it comes down to it, having poor movement patterns is the cause of most shoulder problems (and most muscle and joint related problems, for that matter). This is why we take a movement-based approach to helping our patients overcome their complaints.
3. Why Does How You Move Matter?
Unfortunately, most physical medicine providers (physical therapists and chiropractors) only assess and treat the site of pain (your shoulder) instead of actually finding the true causes of the pain. If they’re lucky, the site of pain is the true cause, but this is rarely the case. This is because most muscluloskeletal pain is related to a movement problem. And a movement problem requires a movement-based solution.
So instead of guessing what the problem is and solely treating the site of pain like most providers do, it’s important to take a step back and look at the greater picture: how you move.
For example, maybe your thoracic spine is stiff and doesn’t move well, leading to your improper shoulder movement. Whatever the case, it’s important to look at the entire body and how it moves because everything in our body is connected and affects its neighboring parts.
Enter the Joint-By-Joint Model.
The Joint-By-Joint Model was created by Gray Cook and Mike Boyle and is a very straightforward way of looking at how movement affects the entire body.
Keep in mind, this model is a very generalized approach, but it does a fantastic job of providing a visual of how the human body functions as a whole.
Take a look at the image above. As you can see, there are areas of the body that should move more (have more mobility), and areas of the body that should move less (have more stability). You may also note that each joint alternates in a sequence of mobility:stability.
Now that you have a great visual of how our body should function, and the role of each of our joints, let’s look back to our example we provided above where shoulder pain may be a result of overcompensating for its neighboring parts.
As you can see in the model, the shoulder joint should be mobile and the thoracic spine should be relatively mobile as well. But if the thoracic spine becomes stiff and less mobile, then something has to make up for it’s lack of movement. Often times, it’s the shoulder that takes on too much stress and load, leading to shoulder complaints. There are other scenarios that may play out as well. For example, many times the shoulder blade (which should be stable), loses its ability to stabilize. And when the shoulder blade loses its ability to properly stabilize, the shoulder joint is often put in vulnerable positions that can lead to pain and injury.
As you can imagine, the human body is amazing at compensating and adapting. But unfortunately when parts of our body start taking on too much stress and are overworked and overloaded, things like pain and injury may occur. Even if pain isn’t present currently, your optimal human functioning is still hindered by these movement compensations.
Hopefully you’re starting to understand why movement matters and why you shouldn’t just treat the site of pain!
4. Breaking The Pain Cycle.
The key to overcoming your shoulder pain starts with breaking the pain cycle early and often.
What does that mean? Let’s explain.
Pain is simply a warning sign from the brain telling your body that something is wrong. Think of pain as an alarm. This alarm warns your body of danger (or potential danger) and is asking for a fix.
But when you don’t fix what’s wrong and continually perform movements that cause your pain, this alarm starts going off more frequently. And eventually if you start ignoring the alarm, it stays on all of the time.
So how do you break the pain cycle?
Initially, you have to avoid movements that are causing your pain. When you start experiencing less pain, you interrupt the pain cycle and your body’s alarm returns to normal. It’s that simple once you identify the movements that are contributing to your pain.
5. Find Out What Movements Cause Your Pain.
Finding out which movements cause your shoulder pain is a huge step for formulating a game plan to overcome your pain and breaking the pain cycle. Remember, this is the first step in breaking the pain cycle and it can’t be skipped. The earlier you start identifying painful movements that aggravate your shoulder, and the more consistent you are at avoiding them, the better.
Finding out which movements aggravate your shoulder is a very important step in our history taking process and within our initial examination. While it can definitely be done on your own, having professional help speeds up the process significantly.
While you’re identifying movements that are painful, it’s also important to note which movements aren’t painful. Pain-free movements provide us with fantastic information as well and allow you to keep moving throughout the recovery process in a pain-free manner. They also allow you to continue training in the gym throughout the process in a pain-free manner!
6. Find Out What Movements Are Pain-Free.
Finding out what movements don’t aggravate your symptoms and cause pain is crucial. These movements are what will keep you active throughout your rehab and recovery process.
Now, these don’t have to be shoulder specific movements. In fact, we encourage you to play around with movements that don’t involve the shoulder!
Think back to the Joint-By-Joint Approach we talked about above. Instead of continually stretching your shoulder because it temporarily feels better, how about you start working on your thoracic spine mobility and/or shoulder blade stability?
If you’re not sure what exercises and movements to try, that’s what we’re here for! We take the guess-work out of the entire rehab process, which often results in time and money saved.
7. Create Your Game Plan.
Now that you have an understanding of why movement matters and what movements to avoid in your rehab process, it’s important to make a plan.
And it’s even more important to stick to the plan you’ve created! Rehab is a process, so don’t expect your shoulder pain to resolve in a week’s time.
There are a ton of different ways you can treat your shoulder pain, including massage therapy, acupuncture, and other techniques, but unfortunately these are just temporary relief techniques. There’s nothing wrong with them, and they’re fantastic tools, but they’re not fixing your movement problems.
The best and most researched way of overcoming shoulder pain is through exercise and staying physically active. This is where the true “magic” happens and makes long-term changes in your movement and musculoskeletal health.
It’s important to realize that your game plan and rehab process may have ups and downs (good days and bad days). This is a totally normal part of healing and overcoming your shoulder pain, but it’s important to take note of what may have aggravated your shoulder symptoms. It could have been something you did the day prior or something you did the day of. Either way, it’s important to continually reassess how you’re feeling and make changes as necessary.
Your game plan should include specific exercises that are prescribed from your physical therapist or chiropractor to provide pain-relief, improve your mobility, improve your stability, or a combination of all the above. These exercises are very important to perform, but it’s equally important to make modifications to your daily lifestyle as needed (like avoiding certain movements the cause pain as we talked about earlier).
Let’s address some common questions we hear about shoulder pain treatment:
“Should I be stretching my shoulder?”
This is a tricky one! Because some types of shoulder pain respond well to stretching and mobility work. And other types of shoulder pain are actually made worse by stretching. It all depends on what your individual limitations and causes of your pain are.
So why could stretching your shoulder not be the best solution? Well, believe it or not, your shoulder muscles are likely tight for a reason. But just because they’re tight, doesn’t mean that they need stretched. In fact, these muscles could be tight because they’re guarding your shoulder joint and providing it with a sense of stability and safeness. If you stretch these tight muscles, you take that stability away and may cause your symptoms to flare-up again!
If you feel that stretching your shoulder only provides you with temporarily relief for 10-15 minutes, then this may be the case for you. So instead of continually stretching your shoulder, you may benefit from trying some sort of strengthening/stability exercise for both your shoulder joint and the shoulder blade. Additionally, you may benefit from some sort of thoracic spine mobility exercise.
Instead of stretching your lower back, we recommend looking back at the Joint-By-Joint Model above and providing your lower back with some sort of pain-free and gentle movement to provide it with more stability. Additionally, you may work on mobilizing your thoracic spine and hip joints to improve their mobility.
“Should I get a massage?”
Absolutely! Massages feel amazing. Who doesn’t love a gentle, relaxing massage? Getting a massage is a great idea to help you relax. But like we mentioned before, it’s not a long-term fix because it’s not getting to the root causes of your problem: your movement.
If you find yourself continually going to your massage therapist for low back pain relief, it’s time to dig deeper to find out the true causes of your problem. And we’re here to help you do just that!
“Should I ice my shoulder?”
In general, our recommendation is to actually utilize heat instead. We’re not sure about you, but usually cold tends to tighten up muscles even more. And if your muscles are already tight and stiff, this may just contribute to the tightness and stiffness.
On the other hand, heat tends to relax your muscles and make you feel more loose. But if that’s not the case for you, then utilize what works! Everyone is slightly different, but heat tends to be our go-to recommendation for shoulder pain. But just remember, utilizing heat is not the long-term solution!
If you continue to find yourself utilizing heat (or ice) for your shoulder pain, then something isn’t working. If this is you, we highly recommend you dig deeper into finding out the root causes of your pain. Remember, we’re here to help you with this!
“What about PRP and/or stem cell injections?”
While both PRP and stem cell injections can be beneficial, they’re not very beneficial on they’re own. We like to explain to our patients that PRP and stem cell injections provide your tissues with the ingredients they need to heal, but not the instructions. What do we mean? Well, tissue healing and remodeling happens through a process called mechanotransduction. Simply put, this is the process of your cells responding and adapting to mechanical force, such as the force provided by specific rehab exercises.
Essentially, the specific rehab exercises are the “instructions” that start the mechanotransduction process.
So providing your tissues with the ingredients to speed up the healing process through PRP and/or stem cell injections is pointless if you don’t change your movement habits and provide your tissues with instructions/stimuli to change and remodel (rehab exercises).
With all this being said, we won’t leave you without a generalized game plan.
So what should you do?
First, you need to remove the movements/activities that are causing your pain. Secondly, you need exercises that are prescribed for your individual movement limitations to help you improve your mobility and stability limitations. Thirdly, you need advice on which movements and activities to modify or regress so you can stay active and moving throughout your rehab process. Finally, you need a rehab professional like ourselves to help guide you along the way, provide you with pain-relieving manual therapies, continually modify your exercises, and set you on your way for living independently.
8. What To Expect From Us.
We’re here for you along your entire rehab journey.
From the moment you walk through our office door for your initial assessment, you’ll be with us one-on-one for at least an hour. This hour will allow us to thoroughly gather a solid medical history, create personalized goals, and assess your lower back pain through a detailed movement and physical assessment.
Following the history and physical assessment, we’ll educate you on the causes of your shoulder pain and formulate a game plan to get you back to living an active, pain-free lifestyle.
We’ll also provide you with an estimated number of visits (and a time frame) for you to completely resolve your shoulder pain. This will include the number of visits you need per week, which is typically never more than 1-2 times per week.
Your treatment and care will be individualized to your personal goals, wants, and needs. Often, this looks like a mixture of hands-on manual therapies, stretching, joint mobilizations and adjustments, and of course, corrective exercises.
Following your initial visit with us, you can expect 30 minute or 60 minute one-on-one follow-ups with us. Spending this amount of time with us in an intimate, one-on-one setting is how we get the results and outcomes you’re looking for.
If you aren’t sure if we’re a great fit for you, then reach out to us!
We offer all our potential patients the option to have a free phone consultation with us to make sure we’re a great fit to work together.
9. What We Expect From You.
If you’re reading this, we hope you’re already our ideal patient, especially if you’ve made it this far through the guide.
We expect all of our patients to be invested in their health. If you’re experiencing shoulder pain, you need to prioritize your health above all things. We can only do so much as your healthcare and rehab provider to help you overcome your shoulder pain.
To get the most out of your rehab (and actually achieve your goals), you have to be invested fully in the rehab process as well. We must work as a team and you must hold your own with your at-home homework and lifestyle modifications. After all, there are 168 hours in a week and you will only be spending 1-2 hours with us each week.
That’s only 0.6-1.2% of your weekly time spent with us!
As you can see, you have to put in the work. You can’t expect us to “magically” fix you. You must be invested in the process. And if you’ve had your shoulder pain for months or years, you must not expect it to magically disappear after 1-3 visits. It’s just not plausible for a long-term strategy.
10. Will I Need Diagnostic Imaging?
Believe it or not, diagnostic imaging is overutilized in the physical medicine field. All too often people are running straight to their medical doctor for an MRI for their shoulder pain. Unfortunately, all they’re doing is wasting their time and money.
Instead, your best bet is to see a physical therapist or chiropractor first. They’ll be the one to decide whether or not you’d benefit from having imaging performed based upon the results of your physical examination and history.
In most cases, you won’t need any diagnostic imaging. But if things aren’t adding up in your physical exam, then we may send you out for further imaging and testing.
Here’s when we think it’s a good time to have diagnostic imaging performed:
- If there are any red flags found in the physical exam.
- If a solid trial of conservative care has been performed without much success and we feel we need more information.
- If things just don’t add up in your first visit.
11. Finding A Good Doctor/Therapist.
You should look for a few things when trying to find the right healthcare provider for you. Especially a rehab provider to help you overcome your shoulder pain.
These are the qualities we possess ourselves and feel that all healthcare providers should possess as well.
- They should spend plenty of time with you to find a solution.
- They focus on your concerns, priorities, and goals.
- They actually perform physical tests.
- They allow you to be independent.
- They find ways to keep you active and moving.
- They continually progress and modify your rehab game plan as you improve.
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