I recently received the Oregon Health & Science University spring magazine in the mail and when flipping through it saw in the Question & Answer section this question:
Let's examine what is said here and what part is true and what part is not true and how you can figure out the best course of action to become pain free.
The "causes" of shoulder pain according to this are (1) trauma such as broken bones or shoulder dislocation, or (2) overuse or degeneration.
1. Trauma such as broken bones or shoulder dislocation. This trauma could be from getting hit by a car or falling down the stairs. But this trauma could also be from tripping on a curb or falling off your bike and dislocating your shoulder, which in this case we must ask why would this relatively small impact cause such severe damage to you when most people survive this trauma injury free?
The answer comes down to what position was your shoulder in when you fell on it? Was it square and balanced supported by strong muscles? Or was it rounded forward and down with little muscular support? In the first case you would probably dust yourself off, get back on your bike, and forget it ever happened. In the second case you might be in agony as you wave down the first car you see to take you to the ER to pop your shoulder back into socket and repair the torn rotator cuff muscles.
1. Trauma such as broken bones or shoulder dislocation. This trauma could be from getting hit by a car or falling down the stairs. But this trauma could also be from tripping on a curb or falling off your bike and dislocating your shoulder, which in this case we must ask why would this relatively small impact cause such severe damage to you when most people survive this trauma injury free?
The answer comes down to what position was your shoulder in when you fell on it? Was it square and balanced supported by strong muscles? Or was it rounded forward and down with little muscular support? In the first case you would probably dust yourself off, get back on your bike, and forget it ever happened. In the second case you might be in agony as you wave down the first car you see to take you to the ER to pop your shoulder back into socket and repair the torn rotator cuff muscles.
If you take two cars, one in perfect shape and the other with a bent frame, and crash test them at 35 miles per hour, which car will sustain more damage? The car with the bent frame of course. The same principle applies to your body. Having poor postural alignment will increase your chance of injury and the severity of injury.
2. Overuse or degeneration. Overuse and degeneration are both thought of as the effect of repeated movements over time. We blame overuse and degeneration on the (a) activity (too much running, throwing, swimming, etc) and (b) age (being 50, 60, 70, etc), but there are some major logical problems with both these arguments.
a) We think too much running causes knee arthritis, or too much swimming causes rotator cuff tendonitis. If this was true every runner would eventually get knee arthritis and they don't, and every runner who gets knee arthritis would get it in both knees and they don't. If swimming causes rotator cuff tendonitis every swimmer would eventually get tendonitis and they don't, and every swimmer who gets tendonitis would get it in both shoulders and they don't. There must be something else going on.
b) If aging causes degeneration, then every person who is say 60 years old would have degeneration in their shoulder and that just isn't true. There are 30 year olds with shoulder degeneration and 90 year olds without shoulder degeneration. There must be something else going on.
a) We think too much running causes knee arthritis, or too much swimming causes rotator cuff tendonitis. If this was true every runner would eventually get knee arthritis and they don't, and every runner who gets knee arthritis would get it in both knees and they don't. If swimming causes rotator cuff tendonitis every swimmer would eventually get tendonitis and they don't, and every swimmer who gets tendonitis would get it in both shoulders and they don't. There must be something else going on.
b) If aging causes degeneration, then every person who is say 60 years old would have degeneration in their shoulder and that just isn't true. There are 30 year olds with shoulder degeneration and 90 year olds without shoulder degeneration. There must be something else going on.
The something else that is going on is postural misalignment. Postural misalignment or bad posture puts joints, muscles, tendons, ligaments, and cartilage in a poor mechanical position which causes rubbing, scraping, twisting, pulling, and squeezing of tissues and leads to tissue breakdown. Tissue breakdown (called "overuse" and "degeneration") can take the form of frayed tendons or ligaments, cartilage damage, deterioration of vertebral discs, stress fractures in bones, and the formation of bone spurs and the "-itis's" (arthritis, bursitis, tendonitis) that are a response to friction.
The "treatments" for shoulder pain described in the answer from the OHSU doctor are:
- rest
- over-the-counter anti-inflammatory medicines
- physical therapy
- cortisone injections
- surgery
Rest does not fix the underlying cause of the injury and pain, but only allows the symptom to fade away. When activity is resumed the pain will often return.
Over-the-counter anti-inflammatory medicines are treating the symptom of inflammation, but again doing nothing about the cause of the inflammation.
Physical therapy is often focused on the area of symptom and at reducing symptoms, but usually does not look at the underlying cause of the pain and correct it.
Cortisone injections might relieve inflammation and pain, but again do nothing to address the cause of the inflammation and pain.
Surgery treats the symptom of say a rotator cuff tear, but does not fix the cause of the rotator cuff tear.
As you can easily understand, these "treatments" for shoulder pain might temporarily relief shoulder pain, but do nothing about the underlying cause of the pain. Treatments focused on the symptom will almost always guarantee that the same or a related symptom will reappear and that further tissue damage is occurring.
Over-the-counter anti-inflammatory medicines are treating the symptom of inflammation, but again doing nothing about the cause of the inflammation.
Physical therapy is often focused on the area of symptom and at reducing symptoms, but usually does not look at the underlying cause of the pain and correct it.
Cortisone injections might relieve inflammation and pain, but again do nothing to address the cause of the inflammation and pain.
Surgery treats the symptom of say a rotator cuff tear, but does not fix the cause of the rotator cuff tear.
As you can easily understand, these "treatments" for shoulder pain might temporarily relief shoulder pain, but do nothing about the underlying cause of the pain. Treatments focused on the symptom will almost always guarantee that the same or a related symptom will reappear and that further tissue damage is occurring.
In order to cure shoulder pain we must find the underlying cause of the pain and associated tissue breakdown. Pain and tissue breakdown is not caused by old age, overuse, or bad luck. The cause of pain and tissue breakdown is misaligned posture. Postural misalignment can come in many forms: loss of the normal spinal curves, rounded shoulders, tipped pelvis, rotated torso, winged scapula, abducted feet, collapsed knees, or flat feet. Some postural misalignment are obvious like forward head posture and some are more subtle like internal femur rotation or an anterior-posterior pelvic disparity.
To cure shoulder pain it is important to have a posture evaluation by a qualified Postural Alignment Specialist who will be able to explain what posture misalignments you have, how they are causing the pain and tissue breakdown, and what you need to do it correct them and become pain free. If you live in the Portland Oregon area and would like to come into my clinic to have a free 30-minute posture evaluation contact me today. If you live anywhere else in the United States or the world, contact me to set up a free posture evaluation via Skype or email.
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