Rethinking Shoulder Pain Treatment

Our approach to working with shoulder pain or injuries is very unique in that we really don't work around shoulder injuries when properly indicated. The majority of the time, we don't force someone to rest for several days while inflammation quiets down. Yes, it can be necessary in rare circumstances. However, rest and traditional methods of ice and anti-inflammatory meds are often over utilized when properly prescribed movement (i.e. exercise) is probably the better bet for improved recovery. At Gallagher Performance, we have a nasty habit of getting our athletes, clients and patients to work through pain and injuries by strategically incorporating exercise with specialized approaches tailored to find "the hardest thing they do well". We want to find what they can be successful with while not posing any undue risk. And the best part? The system works.

When it comes to the shoulder, pain and injury is most commonly associated with poor shoulder function and faulty mechanics. And when I say most commonly, it's not a stretch to say over 50% of shoulder injuries are due to these underlying problems. If muscles are unable to fire properly to provide ideal amounts of support (stability) and motion (mobility), then injury will occur regardless of how strong or flexible one is.

I have written extensively on the subject of the "hidden cause of injury" since the root cause of the overwhelming major of musculoskeletal injury is dysfunctional movement. Most doctors and trainers do not have the training or eye to look for dysfunctional movement and no amount of rest, ice, and Advil will ever provide the solution. No amount of passive modalities, taping, cupping, mobility drills, or stretching will correct dysfunctional movement. When it comes to shoulders, the solution to reducing shoulder pain and preventing injury is all about restoring proper rhythm and mechanics of the shoulder joint. This includes all it's associated articulations – the glenohumeral and scapulothoracic. Basically we have to improve how both the "ball and socket" joint or "shoulder joint" (as most of us know it) and "shoulder blade" function together.

When it comes to improving the function of the shoulder, we'll take an athlete or patient and have them perform variations of rows, pulls, presses, and ground-based movements with adequate loads to reinforce ideal body mechanics and correct dysfunctional movement or stability patterns. This is done through a combination of exercises, tempos, external stimuli, and progressions to essentially re-educate the nervous system. This is why it's called neuromuscular re-education. We must teach the nervous system to do things better and break bad habits. Yes bad habits can be very challenging to break. Most people would rather pop a pill or rest until their pain disappears rather than break bad habits because breaking bad habits sounds like hard work. Popping pills and rest are great because they are easy and effective. But those who deal with chronic recurrences may want to think about a different strategy once their patience wears thin.

For example, some lifters have such poor thoracic spine posture and scapular dyskinesis that they may need 6 months+ of rehab and corrective work. But they have no interest in that. They have no interest in stepping back a little and refocusing their training for long-term development. They prefer to band-aid symptoms while they push their training and perpetuate the pain cycle.

The funny thing is breaking bad habits isn't as hard as most people think. If you work with the right person you'd be surprised what proper coaching, cueing, and exercise can do in a relatively short period of time. The reality is most people are highly resistant to breaking bad habits because of either ego or the unwillingness to take a step backward. Typically after a number of training or therapy sessions, the individual is able to perform any and all movements without pain and with improved shoulder mechanics. For those dealing with shoulder pain, improving their mechanics through sensory-motor training enables their nervous system to be re-educated. This re-education process is the most effective form of therapy and healing available. It cannot be understated that a critical component of this process is proper coaching and cueing. This is the responsibility of the coach or therapist. As much as proper coaching and cueing can be beneficial, improper coaching and cueing can prove to be very damaging. It is my opinion that many injuries occur because the athlete or patient had previously received very poor coaching or instruction.

This is exactly why performing exercise with proper technique is proving to be the single most effective form of therapy as it promotes almost immediate healing.If someone is having pain during a movement, they are doing something wrong. Correct them into the proper movement and watch their pain disappear. The key is re-educating the nervous system so movement becomes both therapeutic and performance-enhancing to one's body rather than promoting pain and destroying joints. This is truth when it comes to the shoulder joint as well as any joint within the human body.