Understanding Shoulder Pain & Rotator Cuff Treatment
Resolving Shoulder Pain with Active Release Therapy
If you suffer from pain or stiffness in your shoulder you are not alone. Far too often shoulder problems such as rotator cuff injuries, prevent individuals from participating in their favorite activities such as using the computer, gardening, or playing golf. At times shoulder pain can be so bad that it even prevents the simplest of daily activities such as reaching into the cupboard, and can even prevent a proper night’s sleep. This can be a frustrating problem, but to make matters even worse, many common shoulder conditions are slow to respond to traditional types of care.
Now for the good news…..
A new treatment technique known as Active Release Techniques® (ART®) is proving to be a very effective method to combat rotator cuff problems and get shoulder pain sufferers back doing their favorite activities. But before we talk about how ART® works so effectively we first need to understand how the shoulder becomes injured in the first place.
How Does Shoulder Pain Occur?
All musculoskeletal injuries, including most shoulder injuries, occur through one simple principle, the load (i.e. the physical stress or strain) placed on an anatomical structure exceeds that structures capacity to tolerate that load. This seems logical to most people when thinking about traumatic injuries such as muscle tears or shoulder dislocations, but what most people don’t realize is that the damaging and excessive loads do not have to happen all at once. Instead, many injuries are categorized as overuse or repetitive strain injuries, meaning pain and tissue damage are not the result of strain or overload from a single event, but instead occur as the musculoskeletal system is exposed to a large number of sub-maximal, repetitive forces over weeks, months, or even years. In this sense, tissue damage occurs slowly over time, eventually accumulating to a critical point in which symptoms are felt. This is why in most shoulder problems it is difficult to trace the pain or injury back to a specific incident or event.
To better understand the occurrence of overuse injuries it is important to realize that even with simple daily activities there is a significant amount of stress placed on the muscles of the shoulder. You see the shoulder is different than other joints in the body because it is designed to provide a great deal of movement, this is accomplished though the unique shape of the shoulder joint. The shoulder joint consists of the round surface of the upper arm, called the humerus, connected to the flat surface of the shoulder blade, or scapula. This “round-on-flat”relationship means the arm does not fit tightly onto the shoulder blade, and it is this loose fit that allows for a large amount of motion. Unfortunately, in providing greater motion, this loose fit fails to provide bony protection and stability for the shoulder joint, which makes it more susceptible to injury.
To protect it from injury, the shoulder relies on a complex set of muscles known as the rotator cuff. This group of four muscles holds the arm tightly onto the shoulder blade. When the arm is moved in any direction these muscles have to contract to hold the round surface of the humerus in place against the flat surface of the shoulder blade. If these rotator cuff muscles become tight or weak the upper arm cannot be held tightly onto the shoulder blade, making the shoulder joint unstable and prone to injury.
There are a variety of situations that can cause muscles to become tight or weak. For example, repetitive use with certain sports or occupations, poor posture, lack of use, lack of stretching, muscle imbalances, or previous injuries can all affect the normal function of the shoulder muscles. Over time this strain can develop into what is know as micro-trauma. Simply stated, micro-trauma is very small scale damage that occurs in the muscles, tendons, and ligaments in response to small levels of strain. Although only small, and at least initially is not painful, this damage still needs to be repaired, which the body does by forming new tissue in and around the injured tissue. This new tissue, often referred to as scar tissue or soft tissue adhesions, is very sticky and acts to ‘glue’ the damaged tissues back together.
Unfortunately, over time this scar tissue can build-up and accumulate in the muscles, tendons, and ligaments of the shoulder, including the rotator cuff muscles. As this happens it places more and more strain on the area as the muscles must now stretch and contract against these adhesions. This in turn places even further strain on the shoulder, which leads to even more micro-trauma. Essentially a repetitive strain injury cycle is set-up causing continued adhesion formation and progressive shoulder dysfunction. At this point pain and tightness at the shoulder will start to become noticeable.
As this repetitive strain injury cycle continues the ability of the rotator cuff and shoulder blade muscles to meet the demands placed on them diminishes. At this point it is not uncommon for the muscles to give way and a more severe and debilitating pain occurs. In fact, many patients come into our office explaining how they have shoulder pain but they did not really have any major type of injury occur. When further questioned these patients almost always describe some mild pain or tightness in their shoulder, neck, or upper back that has been building over time. As you can see from the explanation of the repetitive injury cycle, these types of injuries build-up over time until it eventually develops into larger scale injury.
How Can These Shoulder Injuries Be Fixed?
The Traditional Approach to Shoulder Pain
In an attempt to relieve shoulder/rotator cuff pain, a variety of treatment methods are used, either on their own, or in combination with other methods. Some of the more common approaches include anti-inflammatory medications, rest, ice, ultrasound (US), muscle stimulation (E-Stim), stretching and strengthening exercises, and when all else fails, surgery. Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.
The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues. It is these adhesions that are binding the tissues together, restricting normal movements, and interfering with the normal flexibility and contraction of the muscles in and around the shoulder.
Passive approaches such as medications, rest, ice, and ultrasound, all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery.
Our Approach to Shoulder Pain: ART® – A Better Solution
ART® stands for Active Release Techniques®. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. What makes ART® different from other treatments is that it is designed to identify and address scar tissue adhesions that are interfering with the normal function of the body. By locating and treating the soft-tissue adhesions with ART®, it allows the practitioner to, 1) break-up restrictive adhesions, 2) restore normal tissue translation and movement and 3) more completely restore strength, flexibility, balance, and stability to the shoulder and surrounding area.
You can think of an ART® treatment as a type of active massage. The practitioner will first shorten the muscle, tendon, ligament, or joint capsule, and then apply a very specific tension with their hands as you actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the tissue to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area. There are over 500 specific ART® treatment protocols which allow the practitioner to “feel” which structures have become problematic and require treatment. In this sense, each treatment is also an assessment of the health of the area as we are able to feel where the problem is occurring.
One of the best things about ART® is how fast it can get results. In our experience, the majority of shoulder problems respond very well to ART® treatments, especially when combined with home stretching and strengthening exercises. Although each case is unique and there are several factors that will determine the length of time it will require to fully resolve the condition, we usually find a significant improvement can be gained in 3-4 treatments.
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“My first meeting with Dr. Nick helped to put the pain in context. Finally, an explanation and some real answers.”
– Jeff Smith, Sackville, NS