Are massage guns effective- debunking the myth
Massage guns are heavily marketed as a substitute for professional therapists, providing benefits such as sports recovery and pain... Read Article
If you suffer from shoulder pain you will likely be given some analgesics to relieve the pain and some exercises to “correct” the problem. However, according to the Journal of Shoulder and Elbow Surgery 79% of people with shoulder pain are still suffering after six months (1). So, do the exercises work, or are they even a good idea?
When we reviewed the clinical trials and other scientific information we found that using exercises like this is unlikely to correct shoulder problems and has even been shown to cause harm. However, “more enlightened” medics and other professionals do use exercises very successfully as part of correction and rehabilitation programs. In this article we will explain why the first approach will not work, then how others use exercises successfully.
The key issue is that for your shoulder to be able to move such a long way the joint has to be complex and relatively unstable. This requires a complex mechanism to keep the joint surfaces aligned properly as you move. When something affects this mechanism the joint will move abnormally, causing it to pinch, wear fast and become damaged. To correct your shoulder you need to correct what’s affecting the control mechanism. If you just exercise the shoulder will continue to move abnormally and be further damaged.
To understand this lets compare your hip and shoulder joints. Looking at your hip joint first it doesn’t have to move so far so it has a ball sitting snugly in a socket with strong bands holding it in place. Looking at your shoulder for comparison it has a large ball sitting in a shallow socket. That lets the joint move much further, but as you can see there’s not that snug fit in the socket stopping it move up and down, or even pull out for that matter. To keep that ball sitting snugly where is should be we have a complex control mechanism involving balance and the muscles around your shoulder. Lets look at how this works.
Your shoulder need to move in all different directions, but I’ll just use one as an example. As your arm lifts up the ball slides down in the socket.
Lets look at what happens if it doesn’t do that properly. We can see it’s pinching at the top. Also, instead of the load being spread out over a big area there’s a lot of pressure in one spot, and the gap at the bottom is much bigger so it’s stretching things and a lot less stable.
This is the key to most shoulder pain and shoulder problems. If everything is working as it should your shoulder joint moves around nicely and is very happy, but if something is not right such as the balance being upset or some of the muscles not working properly you’ll get that abnormal movement in the joint causing pinching, uneven pressure and abnormal stress.
Doctors call this impingement syndrome, and here is an example showing the ball pinching the structures at the top of the joint.
If you leave it for long enough some of those parts becoming damaged or worn. Doctors like to show you things like that on scans and x-rays saying they’ve found the problem. The trouble is yes they might be a problem, but they are secondary damage caused by real problem,
Understanding that, let look at why the analgesics and exercises will never fix the problem.
The abnormal movement in the joint will have some underlying cause(s) such as a postural imbalance or muscles not doing what they need to. If you exercise the shoulder with those issues remaining that joint will still move around abnormally causing damage. If anything it will accelerate the damage, and that’s what scientists have found. They’ve found that exercises can’t fix these problems (2–5), they won’t fix the shoulder pain, and in many cases make the pain worse (6).
I mentioned that there were medics and other professionals who were using exercises differently and being very successful. Their approach is very logical. They identify and fix the issues that cause the joint to work abnormally. The joint is then able to move normally and exercises are used to help rehabilitation.
With that we’ll make the rest of this article the best resource we can to help you understand the issues and get your shoulder looked after properly. We will be covering:
We have already seen that the common medical approach to shoulder pain is illogical, but according to their own medical journals:
Ironically, the major issues we are about to discuss usually do not rate a mention.
There are three main issues that cause shoulder joints to work abnormally. We discuss these in our article Why shoulder pain keeps coming back and what you can do about it , but will summarise them here.
Postures like shown in this diagram alter the angles and balance of shoulder structures placing them under abnormal stress. Several studies have found this to be a major cause of shoulder impingement (7–13), while one found that if this posture was corrected it relieved shoulder pain (13). As said before though, the medical journals doctors read usually do not mention this (14,15).
(Myofascial) trigger points, or “trigger points” for short are those tender lumps in your muscles that massage therapists find. They actually cause shoulder pain three ways.
As before, this information does not appear in the medical journals doctors read (these journals rely on drug company advertising).
Shoulder joints are very complex so there can be a host of other issues affect the control of their movement. These need to be investigated and taken care of by a properly qualified professional such as a Chiropractor, Osteopath, or a Physiotherapist with special post graduate qualifications. We recommend that you have someone like this check you, especially if your shoulder is not improving.
The successful (and logical) way to help these problems is to correct or eliminate any issues that are causing your shoulder to work abnormally, then use exercises to help rehabilitation. There are professionals who do this well, so lets look at some examples.
If you have shoulder pain we recommend that you seek the help of a professional who follows similar practices to those described below.
Trigger points are almost universally present in shoulder pain sufferers (18), and can cause pain 1) directly by referred pain, 2) by preventing the muscles that control movement from working normally, and 3) by altering posture. We have seen that treating trigger points alone is very effective in relieving shoulder pain.
What happens is by treating trigger points you take care of a lot of potential causes of shoulder pain. Unless there are serious issues, if you remove the issues that prevent normal shoulder function your nervous system will be able to use your shoulder normally again. Normal movements and activities can take care of any rehabilitation. For more information about how to take care of these trigger points please see our article Massage and trigger point therapy for shoulder pain .
There have been several studies of shoulder pain where exercises alone have been compared with exercises plus physical therapies such joint manipulation (freeing up restricted joints) and soft tissue therapy (massage and trigger point therapy) (19–22). In each case the results were way better when using the therapies. In these cases professionals have used various physical therapies to help take care of the issues inhibiting normal joint function, then the joints can exercise functioning more normally for rehabilitation.
The National Academy of Sports Medicine (NASM) produces a 400+ page guide called “NASM Essentials of Corrective Exercise Training" (23). It advises that before doing “corrective” exercises several issues including those muscular problems we’ve mention need to be addressed.
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Trigger points are those tender lumps in muscles that therapists find. This article covers what they are, what they do, and how they are... Read Article
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