Shoulder Pain

Are We Sure It’s the Shoulder? 

A lot of different emotions come along with pain: confusion, hurt, anger, disappointment, anxiety, hopelessness. Although these emotions can be a part of the recovery process, they also make it hard to discern what’s going on. 

The good news is your pain can be outsmarted if you slow down and listen to what your body and mind are telling you. Listening to your body is a process that’s improved through trial and error. Together, we can learn to listen for the individual signals that YOUR body is communicating. 

To slow down, follow four keys to recovery: rule out the neck, identify painful movements, identify pain-free movements, and make sense of it all. 

1. Are you sure it’s the shoulder? Ruling out the neck.

Dr. Jesse grew up in Southern Illinois, and nothing drives him crazier than spending energy on a “wild good chase.” 

In shoulder recovery, a wild goose chase is when a client’s shoulder problem actually stems from the neck. 

We can make the shoulder the strongest it has ever been but if the problem revolves around the neck, we likely won’t turn the corner. 

The neck is comprised of the spinal cord and its branches that come from the cord. Without getting too nerdy, the brachial plexus is a group of nerves that branch out of the neck and travel down the arm. If these can get irritated, they can make it appear that pain occurs at the shoulder and not the neck. 

At Modern Movement Clinic, we make sure to rule out the true cause by doing testing at the neck. 

If your pain was not the result of a singular incident, or if you know that you have not been excessively overloading your shoulders lately, this should perk your ears up to look deeper into the root cause of your pain. Some other examples include: 

• Your shoulder pain comes with neck pain, or vice versa
• You had neck pain around the time you should pain started
• The pain in your shoulder radiates down your arm
• You experience pain on the inside part of your shoulder blade
• You have pins & needles, numbness or tingling, or burning type pains in the shoulder.

Sound familiar? Keep reading. 

2. What hurts my shoulder? Identifying painful movement.

Your clinician needs to know what movements are painful so that they can help chart the route to your recovery. 

The first step any good clinician or therapist will take you through is a movement assessment. Sometimes you know that “when I do this, it hurts.” Other times, there are many motions that elicit pain. 

The movement assessment helps us identify where we feel pain, and when. 

The more information we have, the faster we can put together the story of what movements might be limited or modified for the time being to allow the body to calm down and flush out the irritation in the area. 

The movement assessment consists of the client replicating different scenarios that involve movement in different ways. Joints such as the shoulder and hip are the most mobile in our bodies. Therefore, there are many movements in planes like the sagittal, frontal, transverse with movements to test such as flexion/extension, abduction/adduction, horizontal abduction/adduction, and scaption. For example, movements such as throwing a ball or raising your arm in front of you, to the side, and behind you all represent different planes of motion and actions. 

When we test these movements, we can pinpoint which motions are causing problems for your shoulder. 

Differentiating painful movements are what gives us a larger picture of the overall situation. 

Taking a holistic view of your specific circumstances is what typically separates traditional clinicians or therapists from modern practitioners. For modern practitioners, we know anatomy rarely ever dictates pain. There is often acute trauma (such as broken bones, lacerations, etc.) or a mechanical overuse/underuse that underlies pain. 

Understanding painful movements is an important step to learning about how we will chart your path to recovery together. 

3. What feels okay with my shoulder pain? Identifying pain-free movements

Focusing on what movements feel okay with your shoulder is JUST as important as identifying what feels painful. 

We use clues from your movement assessment to get an idea of what movements do not cause a threat right now. Know that as time moves on, your movement portfolio will get bigger and you’ll be able to do more activities with far less pain. 

With the information of what motions feel okay, we’ll make a plan to get you back moving. 

Starting with movements that feel okay, you’ll slowly regain your ability to do your everyday tasks. We’ll add special modifications customized to you to increase your activities even more. With the ability to move more, you’ll rebuild your confidence, step-by-step. 

Confidence is key! 

4. Making sense of everything  

Now that we have a clearer picture of the source of your pain, what movements are limited, and what movements feel okay, it’s time to put the puzzle pieces together.   

Through extensive continuing education and current research (something else your practitioner should be keen on), pain has been found to be much more like an alarm system for your body, NOT A DAMAGE INDICATOR. 

Think of your pain as a smoke alarm. 

A smoke alarm is incredibly helpful for alerting you to a potential fire, but if you’ve ever cooked in an apartment, you know the alarm can also be touchy. When we repeatedly force our body into movements that feel painful, the alarm bells may be ringing all the time. This is not only annoying, but also confusing. Therefore, we want to modify or avoid irritating movements right now. 

For now, limit motions that hurt and do more of what feels good. 

No, it’s not rocket science, but it will make a huge impact on your recovery. When we talk about movement that feels “good,” this doesn’t mean that the excerises make you feel like you’re on a tropical vacation. But, if the motion feels doable then do more of it.  

Moving more in a supported way will get you back on track in no time. 

Movement assessments are so important because this information can’t be gleaned from an X-ray or just touch. Movement tells us which direction to go in. You’ll also read below why X-rays or MRIs doesn’t always need to be something we need initially. 

Instead, take the first steps by assessing your movement with a professional. 

What Are Red Flags When It Comes To Shoulder Pain? Signs To See Medical Specialists That Aren’t Physical Therapists or Chiropractors 

Shoulder pain isn’t ALWAYS caused by a mechanical event.  

It can stem from an underlying cause. However, this scenario is very unlikely. As in, only 1% of cases. The other 99% of cases fall under the non-emergency category and are very treatable with shoulder rehab. This is when you would see a movement therapist like at Modern Movement Clinic. 

However, for the 1% of those with an atypical case, we want to make sure you don’t ignore the signs to get the help you need. 

If you are experiencing any of the symptoms below, you should seek out further medical advice, such as the Emergency Room, a medical specialist, or your General Practitioner depending on the situation. 

History of Cancer 

History of Vascular Disease 

Unexplained Weight Loss 

Consistent and Ongoing Infection or Fever 

Prolonged Use of Steroids or Any Drugs That Inhibit the Immune System 

Significant Trauma (Accident or Trauma Recently) 

Prone to Fractures (Osteoporosis or Osteopenia) 

Loss of Bladder or Bowel 

Numbness and Tingling In the Groin Area (Saddle-Like Paresthesia) 

Numbness and Tingling In Your Arms (Especially If Upper And Lower Body) 

Major And Noticeably Motor Weakness In Lower Extremities (Hard Picking Up Legs or Drop Foot) 

Limited Spinal Range of Motion (All/Majority Directions Supremely Limited) 

Neurologic Findings Persist Beyond One Month 

Severe Tenderness 

Visual & Auditory Disturbances 

Severe or Unexplained Headaches 

Trouble With Balance & Coordination 

Chest Pain, Unusual Swelling, or Shortness of Breath

How can I take immediate steps NOW for my shoulder pain? 

Do I Need An MRI For My Shoulder Pain?

Turning to imaging, through X-ray or MRI’s, is often our first instinct. 

The inclination to go straight to imaging is common, but more often than not you don’t need to spend the time and money. In fact, getting an image scan first can often INHIBIT your progress as the report offers little explanation to understand what’s important. Reports with too much information and too little explanation can lead us down the WebMd rabbit hole and to further confusion. 

Valid reasons for getting image scanning would be if you’re experiencing any red flags mentioned above or if we do not see any improvements in your treatment. In this case, you will likely take an X-ray before an MRI. 

Okay So What Can I Do About My Shoulder Pain?  

Summed up in two words: keep moving. 

People commonly want to stop and rest when experiencing pain. Although rest is relaxing, new research says rest is less beneficial than if we just kept moving on with life. After all, this is just a speed bump. We’re slowed down but it doesn’t mean we won’t get to where we want to be, a pain-free shoulder area. Massage therapy, dry needling, soft tissue, and adjustments or mobilizations are a nice addition to the therapeutic experience, but the most reliable therapy is activity and exercise. 

To act in your shoulder recovery now, start by moving and making a plan. 

How Can I Form A Long-Term Plan For Conquering Chronic Shoulder Pain? 

We’re glad you asked! 

Having a long-term plan will be your biggest asset in shoulder pain recovery. 

Consider the following questions to make a personalized plan that will work for your lifestyle. 

Setting a Goal

Your goals must align with you personally. We often make goals that don’t relate to who we are or what we care about. Instead, create goals that are realistic and have personal meaning to you.  

For example, instead of the blanket goal of “I want to get rid of my shoulder pain,” think along the lines of “I want to play with my kids comfortably” or “I want to work out with my buddies with confidence.” It’s simple, it’s got meaning, and it’s personalized to you and your needs and wants.  

Where Are You At Now? – Current Fitness

Your activity level should be on par with where you are fitness-wise. That way, the pace of progress you see is a level you feel comfortable with. If you have never been active before, that’s okay! You may just need more consideration to think through what reasonable expectations look like. 

Modern Movement Clinic always keeps your needs and abilities in mind while pushing you towards progress. 

Where Are You At In Life? – Personal Situation

Life gets crazy, doesn’t it? Maybe you’re a new parent. Maybe you have a new job that is a bit more demanding. Maybe you’re taking care of your partner or a loved one. Everyone has their own specific situation that we consider.  

This doesn’t mean that you’re not prioritizing your own health. We just need to find out when that should be and what it looks like.  

Consistency – Can’t Water Your Lawn With a Bucket

The biggest myth in any rehabilitation program? That progress requires 120% effort, all the time.  

On the other hand, you can’t put in 0% effort and expect results. However, consistency is the single most important factor in reaching pain-free progress.    

Lighter and less aggressive exercises more frequently are much better than heavy and aggressive exercises a couple of times a week.  Good consistent input yields good consistent output. 

Remember the pain alarm? Remember how doing good movement makes the alarm calm down? Imagine doing it consistently during the days and weeks. (Cue mind-blowing gifs) 

Like the heading says, and like people of Denver and the mountain west know, you can’t expect a green lawn by slinging water out of a bucket into the backyard. Consistency is key. 

Control – What We All Want Out of This

When we experience shoulder pain, or any pain, we can feel like we’ve lost control.  

Feeling like you’ve lost control in your life makes you feel like your efforts don’t matter. Apathy towards your pain is the OPPOSITE of what we want. Instead, buckle in. You’re in the driver’s seat here and you get to control the acceleration and ETA most of the time. 

Being aware of your recovery and progress gives you a higher success rate. Seeing progress encourages you to continue forward and maintain consistency. 

Outcomes – Don’t Expect Easy Street

Any good plan has pitfalls. Some pitfalls we anticipate and others we may not see coming at all. We often expect because we follow the program that a positive response will result 100 times out of 100. Have you ever studied for something and STILL did bad? Just me? Okay.  

No, I’m not saying you must be physically active 24/7 for the rest of your life. But a mindset of setting goals of moving, self-efficacy, and consistency does make the work more sustainable. You may even start to notice other positive benefits in your life as a result. 

Sometimes people believe that rehab from an injury should be a progressive upward slope. Injuries and pain are tough. Everybody responds differently and at different rates. We all come from different backgrounds and experiences with pain and injury which can manifest in recovery. However, by having a plan in place, we do create more control in the face of the uncontrollable.  

What I do need to do now? 

If you’ve gone this far, don’t quit now! (That’s a joke and motivation at the same time!) But it obviously means you care. I care too. The first thing is making sure you stay active. Whether you are an athlete or not, you don’t need to be sidelined. With shoulder pain, we can do alternative exercises that can have the area work in different ways.  

You would get this from an assessment at Modern Movement Clinic and any other good movement therapist who practices with an evidence-based approach in the greater Denver area. You may be a runner, skier, hiker, or just a weekend warrior but that doesn’t mean you need to put your activity to a halt. Movement is medicine. 

Other Miscellaneous Questions 

Active vs. Passive Therapy – Did I Say We Had to Move?

I like massages, vibration guns, heat, mobilizations, adjustments, and dry needling just as much as the next person. 

We call this type of treatment passive care. 

When you perform different therapeutic techniques to yourself, we call this active care. A lot of research actually shows you recover faster when this is part of the plan. The adage “If you give a man a fish, you feed him for a day. If you teach a man to fish, you feed him for a lifetime” takes full shape here. 

At the Modern Movement Clinic, you have options. 

Sometimes we need to manage the acute pain while also knowing that movement is medicine. Why not have both? Exercise and movement yield the best long-term results and you guessed it, give you control. 

Should I Be Stretching My Shoulder Pain Away? – What If I Said No?

Stretching for recovery is one of those ideas that has persisted for decades. 

However, as more research comes to light, we have found that stretching out the shoulder can potentially inhibit progress. 

It all comes down to “why do we feel like we need to stretch?” Most of the time, clients feel a need to stretch “because it feels tight.” But what if your tightness is a reaction from the body as opposed to a symptom? 

Remember our conversation about the body’s alarm system? 

The nervous system is kicking in here and sending you different messages. In this case, the nervous system makes the area “tight” to protect the area since it feels under threat. Often times, when we stretch this actually makes the nervous system tighten up MORE.  

At the Modern Movement Clinic, we commonly suggest simple movements that are pain-free or very minimal in pain that help let the nervous system know that we don’t have to have a “helicopter parent” overseeing everything. 

What About Massage Or Cool Gadgets? – I’m Hip, Too!

In short, absolutely! 

My answer to these things is “if it feels good and you don’t notice any repercussions…go for it!” Sometimes relaxing by getting something like this is the step you need to move out of the pain phase.  

Foam rollers, vibration guns, cupping, performance tape…it’s all fine and we say use it if you see benefits. Many have their theory of what it is doing but they are all just modifying the sensation of pain and that is it. Although these should not be viewed as a long-term solution to the problem and don’t address the problem in how it likely manifested, they have benefits that many people see every day.

To Ice Or to Heat, That Is the Question!

We get the question, “Should I use ice or heat for my shoulder pain?” all the time, and for good reason. The RICE (rest, ice, compression, elevation) principle has been around for years and it’s just easy, right? 

At Modern Movement Clinic, we know that the evidence has shown that ice doesn’t help in the way what we previously thought. In fact, the creator of the RICE method has publicly addressed his theory to say as much. We suggest using what feels best to you.   

For example, in Dr. Jesse’s personal experience with pains he’s had (yes, he’s human), he enjoys heat more so than cold because he PERSONALLY feels like it relaxes his body more. 

If it helps, use it. If you don’t see a benefit, you don’t need to continue to do it. If it makes matters worse, look elsewhere.  

In the end, use what works as there are no rules to this, just guidelines. 

What to Expect From Your First Visit (And Practitioner) 

Whether you work with Modern Movement Clinic in-person, online (oh yeah, we can do that, too), or with another therapist, make sure the first part of your recovery comes from working with a licensed healthcare professional. 

Not your gym buddy, Jim, not your parents, and not your athletic sibling that you still resent but won’t admit it … unless any of them are licensed healthcare professionals who have trained and passed examinations to do so. 

Many other professionals in the health and wellness industry are great additions to helping some areas of your shoulder pain, but they are not trained to make clinical assessments and diagnoses as this is out of their scope of practice. 

Let’s see what else your examination and experience look like with a practitioner from Modern Movement Clinic. 

Don’t Wear Your Sunday’s Best (Unless It’s Athleisure) 

If you’re coming to Modern Movement Clinic, whether an online consultation or a live visit in our Denver-based clinic, you’re going to move.  

 We get that sometimes you might be coming from work or going to work, but to get the answers you seek, we need to see how you move. Bring a change of clothes if you’re coming from another activity. Dress in comfortable clothing that allows for freedom of movement. 

Are You A “Fashionably Late” Person? Read This Then

We’ve all been there, right? Traffic hits, weather turns, kids are screaming bloody murder, and inevitably time speeds up. It happens!  

However, we recommend that you leave 10 minutes earlier than what the navigation says on your phone if it is your first visit. This ensures you find our location without being rushed when we sit down to chat.  

This can take away from the emotional component of your pain and limit our ability to get the entire picture of what is causing your pain.  

The first visit lasts around 90 minutes unless indicated by the practitioner. Corresponding visits will be based on the time you and the practitioner agree upon.  

We’re Pretty Modern – Doing Things Digitally

We want to remove as many complications as possible for you. 

We have an online booking option that allows you to take control of your recovery from the comfort of your home. Your payment is taken care of online through our scheduling app, your exercises are all digital, and each session’s recap is emailed to us after you finish. 

After all, it is the 21st century and your rehab and performance should reflect your needs today.  

We’re Here For You. Not Our Egos.

Finding the right healthcare provider can be hard as it sets the tone for your recovery process. Some things to look for are listed below: 

• Does Physical Testing – clinical and physical examination is paramount as it relates to what your goals are. It takes time and analysis to do this. You shouldn’t be rushed in and out of the space. We don’t use special gadgets and gizmos to do the analysis unless it is needed and even then, they shouldn’t be regarded as cure-alls but as an adjunct. All that glitters is not gold quite often.
• Focuses On You – at Modern Movement Clinic in the Denver, Colorado area, you’re not a number. You’re not even a deductible. If you come here, you are a priority. What matters to you in your recovery? That’s our priority, too! Did we just become best friends?! Now let’s get you better so we can go do karate in the garage.
• Lets You Have Independence- we like you moving and being your best self. We realize some people have an easier time with that than others do and that’s okay! We aren’t pushy at Modern Movement Clinic. You have options. Sometimes options can be confusing, so we always make time to talk with you about your options so you’re well informed about what option fits best for you.
• Grows With Your Goals – things can change in a recovery plan, and you want someone who can change with you. When you improve, you don’t want to be doing the same things right? BOOOORRRRIIIINNNGGG. At Modern Movement Clinic, we are constantly tweaking, progressing, and altering movements to fit your needs and goals.  

What Kind of Questions Should Be Asked During the Exam For Your Shoulder Pain?

During a history, we are creating the story that surrounds your challenges, getting more background information, and asking you things you may have not considered yet. Together, these help you inform your own goals. 

Here are some types of questions that should be asked in your history: 

• Where is your pain located?
• When did this start?
• Is this something that is constantly present, or comes and goes?
• What does the pain feel like?
• Does this change with activity? 
• What does your pain scale look like?
• Are there any medications or interventions you do now that make it better? What about things that make it worse?
• Do you have any numbness, tingling, or weakness of the area or other areas corresponding with your shoulder?
• What’s been your experience with this pain thus far? Have you already seen anyone for this?
• How is this shoulder pain inhibiting your day?
• What is this pain taking away from you right now?
• If you had no pain at all right now, what would you be doing differently?
• Do you have any short and long-term goals after reading those last two questions”  

Whether it is getting back to playing the piano, hitting a PR in the Denver Marathon, or simply catching your littlest one running around the house, our goals for recovery should reflect where we are. We all need to have these types of questions discussed to set the best and most successful plan. You’ll find that at Modern Movement Clinic.