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Acupuncture and Shoulder Pain

In this article I will show how acupuncture and soft tissue release (massage) can treat a range of shoulder related problems. Acupuncture is excellent in the management of shoulder pain and can provide well needed pain relief in shoulder and neck pain.The shoulder is susceptible to injuries because it has a full range of movement which leaves it venerable to injuries and  it is easily over stressed or injured through acute or repetitive over activity. Vast mobility is at the expense of stability. The shoulder is a dynamic joint with over 20 muscles stabilising and assisting in movement so the possibility of pain from one of these muscles is highly likely.
The muscles in the shoulder are commonly referred to as rotator cuff muscles and patients will often come to the clinic presenting with a rotator cuff tear or tendinopathy.

Shoulder pain can develop for a number of reasons. Postural positions will destabilize the shoulder, repetitive actions can cause irration and inflammation and aging can be a contributing factor. Other shoulder problems resulting from accidents and injures will generally respond well to acupuncture treatment. Here is a nice little video outling some common injuries.


Shoulder Impingement Syndrome: Explained in a... by sportsinjuryclinic 


Trigger points are often found in the rotator cuff muscles which are  hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibres, these are commonly referred to as knots. Trigger points will often refer pain to other areas of the body often very far from the site of the original trigger point. Trigger points are found using palpation and pressing gently can reproduce referral patterns. For example pressing on a muscle in the shoulder may reproduce a referral pattern at the side of the neck, over the head and into the back of the eye but the source of the pain is in the shoulder. The video below explains in detail how trigger points develop.


Initial Assessment
When assessing a shoulder injury the following are always carried out prior to treatment.
Full history
Assessment of both shoulders
Range of movement assessed both actively ( by patient) and passively (by the practitioner) of shoulder, neck and relevant parts of body
Palpation for trigger points or sites of tenderness
Specific tests to identify precise cause
Remember that referred pain is a symptom; I want to address the cause which is commonly where the pain isn’t.


Some common examples

Failure to reach behind the back which produces pain is typically due to infrapspinatus. Pain may refer down the arm in the patterns below.



Pain on initial abduction (raising the arm away from the body) in the first 20 degrees is typically due to supraspinatus and the pain pattern can be seen above. Supraspinatus trigger points can cause clicking or popping in the shoulder because when tight this muscle keeps the humeral head so tight in the socket that it is prevented from gliding properly.



Subscapularis is a medial rotator of the shoulder and is often overlooked. It is often is spasm pre and post frozen shoulder. Shortening of this muscle will often comprise shoulder movement. Trigger points can develop if the arm is held in one position for too long for example if you have broken your arm and it is kept in a sling. Other injuries such as over exertion in sports that involve throwing or racket sports can cause undue strain in this muscle.

 


Levator scapula

The Levator Scapula contracts to raise the shoulder blade (such as when you shrug your shoulders), and helps to rotate the head to the same side. Trigger points and shortness will cause pain along the side of the neck and the patient will be have restricted movement in their neck. Having the shoulder elevated for long periods will produce these trigger points which is common in poor posture form work related positions.


Trapezius

The trapezius is a large sheet muscle and will always have a trigger point within in the muscle. Trigger points in the trapezius can refer pain into the neck, head and back of eye. This pattern is so common consentient with poor postural problems in today’s modern workplace where many long hours are sat in front of a computer screen. This can a common cause of tension headaches.


Clicking or popping in the shoulder indicates probable trigger points in the rotator cuff muscles and is an indication that the shoulder joint isn’t articulating well leaving you prone to injuries, shoulder instability and tears.
The first simple step is to assess the position of the glenohumeral joint which is the ball and socket joint. Typically in today’s society this will be in an anterior (forward) position leaving it prone to catching or impinging some of the muscles.

If this is the case then treatment will include focusing on repositioning of the glenohumeral head based on the principle if that if the body is in the correct position then it will function correctly. A simple test for the practitioner to carry out is to manually reposition the joint while the patient moves the shoulder. If there is an improvement in pain and range of movement then this confirms the hypothesis.

A holistic approach should never be ignored. Factors such as pelvic rotation will in turn rotate the ribcage leaving the scapula and glenohumeral head in a comprised position.
Treatment
 I treat the conditions listed above using a variety of techniques.
Gentle stretching of the affected muscle group which increase range of motion and decreases pain.
Deactivation of trigger point using acupuncture. This is a very quick method and when used sensitively and in skilled hands provides long lasting results and a reduction in pain and symptoms. The video below shows how a trigger point is found and treated using acupuncture but I have to state she is a bit rough, I am more gentle than she is.


I use deep tissue massage which can help reduce pain and
restore normal movement. Deep tissue massage is generally designed for more focused massage work. Working a specific joint, muscle or muscle group, the practitioner can access deeper layers of the soft tissue. Starting superficially and easing into the depth of the muscle slowly often allows more movement and restoration of normal tissue functioning.

Patients would also be given some stretches and/or strengthening exercises to do at home and advice to prevent to injury from reoccurring.

There are occasions when surgery is necessary to repair a torn tendon or remove calcium deposits but I would always consider a conservative approach first.


And Finally
Why would you consider this approach well the answer is simple. It’s a drug free solution, you can avoid surgery, provides pain relief and uses minimum intervention to restore normal shoulder functioning.

 

 

 

 

 

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