Understanding Shoulder Pain
Treating Shoulder Pain with Active Release Techniques
Far too often shoulder problems 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. 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 in treating many common shoulder problems. In this article we will briefly review the causes of shoulder pain, then discuss what ART treatment is and why it is so effective in treating shoulder pain.
The Normal Shoulder
The shoulder is different than other joints in the body, as it consists of the round surface of the upper arm connected to the flat surface of the shoulder blade. This “round-on-flat”relationship means that unlike the hip, 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. Like the name implies these muscles will rotate the arm, but more importantly, they act to hold the round surface of the upper arm tight and firm against the flat cavity of the shoulder blade. If any of these rotator cuff muscles become tight or weak the upper arm cannot be held tightly onto the shoulder blade. This causes the shoulder motion to become ‘sloppy’ which stretches and stresses the joint.
How Does Shoulder Pain Occur?
All shoulder pain occurs through one simple principle – the stress placed on the shoulder exceeds the capacity limits of the joint. This seems logical to most people when thinking about traumatic injuries such as muscle tears or broken bones, but what most people don’t realize is that the damaging and excessive loads do not have to happen all at once. In many cases pain and tissue damage are not the result of stress from a single event, but instead occur as the shoulder is exposed to small amounts of repetitive stress over weeks, months, or even years. (This is actually what happens in almost every shoulder condition). With this injury mechanism, 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.
Here’s how this works…..
Through a variety of causes such as excessive or repetitive use with certain sports or occupations, or with poor posture with sitting (sitting with poor posture can actually reduces blood flow to the shoulder muscles which leads to to tightness, irritation, and eventually pain) it is not uncommon for small scale damage to develop within the shoulder muscles. This damage is referred to as micro-trauma. (At first this micro-damage is not painful, but can become painful over time, as we will discuss below). Although only small, this micro-trauma still needs to be repaired, which the body does by laying down new connective tissue in and around the damaged area. This new tissue (often referred to as scar tissue, or soft tissue adhesions) acts to glue the damaged tissue back together.
Muscle damage and tightness associated with Shoulder Pain is associated with scar-tissue adhesions. To treat these adhesions stretching is not enough. Hands-on treatment such as Active Release Techniques therapy is needed to work out the muscle adhesions and restore normal strength and flexibility to the muscles.
While this scar tissue is a normal and necessary part of healing problems can develop when the shoulder muscles are subjected to micro-trauma over the course of weeks or months (i.e. we continue to play the same sports, do the same jobs, or sit all day). This ongoing micro-trauma will lead to the accumulation of scar-tissue in and around the shoulder. As this occurs it will start to make the shoulder tight, stiff, and inflamed, and the shoulder movement will become ‘sloppy’.
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
In an attempt to relieve Shoulder Pain a variety of treatment methods are traditionally used. Some of the more common approaches include muscle relaxants, anti-inflammatory medications, rest, heat, ice, ultrasound, massage, acupuncture, and stretching and strengthening exercises. 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 that develops within the rotator cuff and surrounding muscles.
Passive approaches such as muscle relaxants, anti-inflammatory medications, rest, ice, acupuncture, and ultrasound, all focus on symptomatic relief and do nothing to address the cause of the problem. Stretches and exercises are often helpful, however they themselves do not treat the underlying scar-tissue (remember these adhesions are the underlying problem with the shoulder). In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from shoulder pain.
Exercises to stretch or strengthen the rotator cuff muscles may be helpful in some cases, but without first addressing the scar-tissue adhesion exercises will be limited and slow to provide relief for shoulder pain.
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. With respect to shoulder pain the goal is to 1) break-up restrictive scar tissue adhesions in the rotator cuff and surrounding shoulder muscles, and 2) restore normal movement to the shoulder joint.
If you are unfamiliar with ART you can think of it as a type of active massage. The practitioner will first shorten the muscle, or nerve, and then apply a very specific pressure 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 muscles 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.
How Long Will It Take To Feel Better?
One of the best things about ART is how fast it can get results. Each treatment takes about 15 minutes, and although each case is unique and there are several factors that will determine the length of time it will require to fully resolve each condition, we usually find a significant improvement with shoulder pain can be gained in just 4-5 treatments – even in cases of long-standing shoulder pain that has not responded to other treatment approaches.
Get Relief With Active Release Techniques.
To book an appointment to receive ART treatment for your shoulder problem simply call our office, or book an initial appointment online. For more information on ART, or for inquiries regarding specific injuries or conditions you can call us, or simply fill out our contact form.