Client with Shoulder Pain: Work through or Refer Out?

Client with Shoulder Pain: Work through or Refer Out?

One of the most common injuries and complaints we see in our sports chiropractic office is shoulder pain. Most commonly, these are grouped into two “buckets”.

Bucket 1 is musculoskeletal / biomechanical / postural pain patterns. 

Oftentimes these end up with a diagnosis of “shoulder impingement” syndrome. There’s a disruption to normal movement patterns, and the result is improper loading mechanics that result in pain. Typically, these respond well to conservative manual therapy and corrective exercise. The underlying cause is often Upper Crossed Syndrome type patterns. This modern posture puts the thoracic spine in a hyperflexed position, causing excess strain on the shoulder, especially in overhead lifts. 

Bucket 2 is structural. 

This typically means an acute disruption to the tissues of the shoulder as seen in sprains (damage to muscle or tendon), strains (damage to ligament) or tears (of various severity) to a structure like the labrum. These often result in greater disability and instability. 

In the video, I cover a few important ways to differentiate between the two and how to know when to work with a client versus refer to a professional. One important thing to note when it comes to rotator cuff issues, is the statistics on surgical outcomes versus rehabilitation. Studies have consistently shown that surgical outcomes for rotator cuff tears offer only 50% resolution of pain after 2 years post-op. Whereas rehabilitative outcomes of similar cases yield up to 75% resolution. 

It’s a good reminder to not jump past conservative care and strength training as an alternative to surgery. 

Stay tuned for Part 2, where we’ll highlight a some of the best corrective exercises for shoulder pain.

In good health,

The Sports Chiropractors of SF Custom Chiropractic
(Dr. J, Dr. Mills, Dr. Jessica, Dr. Li, Dr. Groff, Dr. Remillard and Dr. Pulmano)


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