Instep Dance Magazine Articles
Reprints of monthly column as first appearing in Instep Dance Magazine.
Shoulder Injuries - Part 3 - Successful Case Studies
By Rick Allen, DC
"Better health leads to better dancing."
Here are two case studies that show the successful conservative treatment of common injuries of the shoulder. As I mentioned in the prior two articles, these injuries are most commonly caused by chronic overuse, but may also include additional acute trauma. Injuries that require surgical treatment are beyond the scope of these articles.
Review of Common Problems
As was pointed out last month, because rotator cuff muscles and their related tendons pass underneath the acromion, they may become pinched and irritated by that bone, causing rotator cuff tendinitis and related problems and even "frozen shoulder" with associated adhesions under the shoulder blade.
Another common problem of the upper back that may cause pain that radiates through the shoulder and down the arm is a subluxation of the upper ribs. Associated trigger points in the muscles adjacent to the spine and shoulder girdle make the problem worse. The pain, muscle spasm and guarding may be so severe that you cannot raise your arm over your head. That sure makes it hard to dance!
Successful Conservative Treatment of Sharon Wridge's
Sharon Wridge came to me with an aching left shoulder of three months duration. She was unable to raise her left arm over her head because of the severe pain. She had seen her medical doctor who had injected two shots of cortisone in her left shoulder, told her to take ibuprofen, and sent her to three months of physical therapy. Because the physical therapist did not correct the underlying problem first, the recommended exercises actually made Sharon's problem worse.
The underlying problem was four-fold: irritation of the rotator cuff tendons, adhesions under the shoulder blade, and subluxation of the upper ribs and associated trigger points in the muscles of the shoulder girdle.
Seeing Sharon's problem at a dance, I suggested I could help here with the combination of conservative treatments I outlined last month. Especially after the failure of the medical treatment and considering the long-term side effects of the drugs, Sharon was pleased to try a natural alternative.
I started by mobilizing Sharon's shoulder with special active release techniques to eliminate the fibrous adhesions that form under the shoulder blade in the subscapularis muscle. I worked deep into the trigger points of the muscles that form the shoulder girdle. I adjusted the rib that was out of place, giving her great relief. Of course, I massaged and adjusted the spine as well.
As Sharon's range of motion is increased, I started progressive rehabilitative exercises to strengthen the injured tendons and muscles. These include special proprioceptive neuromuscular facilitative (PNF) exercises designed to strengthen and stabilize the shoulder girdle. In hindsight, Sharon told me that she would have improved faster if she had done more of the recommended exercises. Nevertheless, she has recovered almost completely in about six months. She told me she is "much, much better." She can lift her arms over her head without pain. I've personally tested her ability on the dance floor - It's superb and pain free!
Successful Treatment of Competitive Swimmer
Karen Hakanson's Shoulder and Back Masters Swim Coach John Hartman referred Karen to me at the end of April for treatment of her left shoulder and back. Karen said her left shoulder "hurt all the time" since March and an area around the middle of her back "was unbearable to touch" since January 1999. Her overuse injuries were typical of individuals who overdevelop the anterior pectoral muscles, in her case by swimming predominantly freestyle, while failing to develop the counterbalancing posterior muscles of the back. This causes incorrect motion of the shoulder, leading to inflammation and injury.
I treated Karen with a combination of massage and interferential electric stimulation to loosen her muscles, chiropractic adjustment to correct subluxations of her spine, and ultrasound and ice to reduce the swelling at the insertion of the rotator cuff of her left shoulder. Because of the deep irritation of the rotator cuff, I enlisted the help of acupuncturist Marnie Freeman. Overall, I counseled her to eat right, drink lots of water and give her shoulder a rest. Her coach helped by developing alternative water and land-based exercises to keep her in shape without further irritating her shoulder.
Karen summarized the results after three months: "I feel great. My back pain has gone from a constant pain to almost nothing. I can bend over to pick things up without even thinking about my back." Karen is still in the rehabilitative phase of care and needs to further strengthen her muscles to achieve proper balance. Nevertheless, she has been able to resume competitive swimming, winning gold and bronze medals in the Oregon State Games last month.
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