What Is Behind Your Shoulder Pain

In 2003, 13.7 million Americans saw physicians for shoulder problems. So chances are, even if you don’t have a shoulder problem, you know someone who does.[1]

Most common shoulder conditions are sore rotator cuffs (tendonitis or bursitis) and frozen shoulders (caused by adhesions that restrict motion). Both are soft tissue issues-problems in the muscle and fascia (the connective tissue holding the muscles together).

When I had my clinic in Scottsdale, AZ, I got a lot of referrals from a hand surgeon. This particular surgeon got the patients that no other doctor could help. He was not a big fan of shoulder surgery, though; he believed that most of these problems could be solved through treating the soft tissue. And he was right. In every case I saw, the patient’s pain was caused by an improperly-positioned arm. When their arm was de-rotated, their pain disappeared.

When you stand in front of a mirror, which way does your elbow point? When you bend your arm, the lower arm should raise up in front of your stomach. Just as your knees are meant to point forward, your elbows are meant to point out to the side. If your elbow points behind you, your arm is mis-aligned.

The Problem

The shoulder joint is amazing. Between the actual joint, which is the most mobile and freest-moving in the body, and the shoulder girdle (shoulder blade and collarbone), all that holds it together is soft tissue. This huge range of motion allows you to tuck your shirt in, throw a baseball, and climb a tree. But it also makes the shoulder joint vulnerable to injury.

Over years of using the arm in ways it wasn’t designed for, or from previous injuries, scar tissue builds up. Each little strain is a micro-trauma that produces a little more scar tissue. The scar tissue helps stabilize and protect the joint, but it also pulls the arm and shoulder out of alignment, producing more strain. Often this pattern shortens the back of the joint and weakens the front, setting the joint up for a rotator cuff injury. Or the entire joint might tighten up, producing a frozen shoulder.

The Solution

Without putting the arm into proper alignment, the arm and shoulder will always be vulnerable to injury no matter what treatment you use. To fix the current problem and prevent future injuries, the entire arm and shoulder need to be structurally re-organized.

This sounds more complicated than it usually is. First, the soft tissue restrictions need to be released from the neck to the mid-back and out to the shoulder joint. (The infraspinatus, a muscle in the back of the shoulder blade, is usually twisting the arm.) Often, restriction in the arm needs releasing–but it needs to be done with an eye to re-establishing proper alignment, not just relaxing all the muscles.

Once all the soft tissue regains its resiliency and everything’s back in position, the shoulder pain leaves. Of course, you’ll need to learn how to use your arm correctly, so as not recreate the strain: whenever possible, bend your arm with the elbow out to the side. For example, don’t do bicep curls with your elbow pointing back; do them with your elbow on your knee, pointing out to the side.

I’ve treated baseball pitchers who were looking at giving up their career because of shoulder injuries. In every case – and often after only one session – they were pitching faster and more accurately than ever as a result of Rolfing. The body has an amazing ability to heal itself when the strain is removed and its natural order is returned.

If you’re wondering about tennis elbow and carpal tunnel injuries, the answer is yes, the rotation that causes chronic shoulder problems causes those, too. More on these later.

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[1] National Center for Health Statistics, National Ambulatory Medical Care Survey, 2003