If you suffer from pain or stiffness in your shoulder you are not alone. Far too often shoulder problems prevent individuals from participating in their favorite activities such as using the computer, gardening, or playing golf. At times shoulder pain can be so bad that it even prevents the simplest of daily activities such as reaching into the cupboard for a dish, and in some cases can even prevent a proper night’s sleep. This can be a very frustrating problem and to make matters worse this type of condition often gets progressively worse over time.
The shoulder is different from most other joints in the body because it is designed to provide a great deal of movement. For example, the architecture of the shoulder joint enables us to reach up overhead, back behind the body, across the chest, and we can even rotate our arm internally and externally. When you compare the shoulder with other joints – such as the ankle, knee, or elbow, which basically move only forward and backward – it can be see that the shoulder is indeed a joint with a lot of mobility. The shoulder is capable of allowing this wider range of movements as a result of the way it is formed. Basically, the shoulder joint consists of the round surface of the upper arm, called the humerus, connected to the flat surface of the shoulder blade, or scapula. This “round-on-flat” relationship means the arm does not fit tightly onto the shoulder blade, and it is this loose fit that allows for a large amount of motion. Unfortunately, in providing greater motion, this loose fit fails to provide bony protection and stability for the shoulder joint, which makes it more susceptible to injury.
Due to a lack of joint stability at the shoulder, proper motion requires a complex set of muscles to help control and stabilize shoulder movement. The primary muscles that provides us control are the Rotator Cuff muscles. The rotator cuff is a group of four muscles that cross the shoulder joint and hold the arm tightly on the shoulder blade. When the arm is moved in any direction these muscle have to contract to hold the round surface of the humerus in place against the flat surface of the shoulder blade. If these rotator cuff muscles fail to contract properly the upper arm is not held tightly on to the shoulder blade and the shoulder joint becomes unstable. When this happen, it places a tremendous amount of strain on the rotator cuff muscles as well as the ligaments and other tissue of the shoulder joint, leading to shoulder pain and injury.
Within our daily activities we use our arms and shoulders a great deal. As a result, there is a tremendous amount of strain placed on the rotator cuff and the muscles of the shoulder blade. Every time you lift, push, pull, or carry anything with your arm, the shoulder muscles must contract to stabilize the shoulder and protect it from injury. A small but constant contraction of the shoulder muscles is even required with something as simple as sitting in front of a computer in order to hold the arm and shoulder in a proper position.
In addition to high levels of muscle activity that is inherent in normal daily activities, many factors also place additional strain and work load on the shoulder muscles. For example, repetitive use with certain sports or occupations, poor posture, muscle imbalances, or previous injuries that may not have been fully treated or rehabilitated can further strain the muscle of the shoulder girdle.
Over time this strain can develop into what is known as micro-trauma. Simply stated, micro-trauma is very small scale muscle damage that occurs in the muscles and ligaments in response to small levels of strain. Initially, micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles. Although only small, this damage still needs to be repaired. The body responds to micro-trauma by laying down small amounts of scar tissue to repair the injured tissue. Unfortunately, over time scar tissue will build-up and accumulate into what we call adhesions. As these adhesions start to form they start to affect the normal health and function of the muscles. In fact, they will often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.
The most common approach to treating shoulder pain is medication to reduce inflammation, block pain, or relax muscles that may be causing shoulder pain symptoms. In the case of chronic or recurrent pain, sometimes doctors will prescribe stronger prescription medications to help fight the symptoms. In some cases, even more invasive measures such as joint blocks are used, whereby an agent is injected into the joint to block the referred pain and other symptoms.
The main reason that medications fail to provide long-term resolution for shoulder pain is that they fail to address any underlying problems of the muscles, nerves or joints of the shoulder that are causing recurrent issues. Instead, they address the symptoms of the pain and simply cover up the underlying issues, that if not addressed will continue to cause problems. As a result many people become reliant on medication to accomplish relief of their shoulder pain. This is a temporary fix that masks the problem, and increases risk of side-effects and dependency on the medication.
Unfortunately, muscle tightness and imbalance, scar tissue adhesions, nerve entrapments, and abnormal joint movement cannot be seen on an x-ray or advanced imaging. These problems in the muscle, joints, nerves and ligaments can however, be felt or tested with the hands of a properly skilled and experienced practitioner. A thorough history and clinical examination is usually sufficient to give the clinician enough information to diagnose the problem.
In an attempt to relieve shoulder pain, a variety of treatment methods are used, either on their own, or in combination with other methods. Some of the more common approaches include anti-inflammatory medications, rest, ice, ultrasound (US), muscle stimulations (E-Stim), steroid injections, stretching, exercise, and when all else fails, surgery. Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.
The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues. It is these adhesions that are binding the tissues together, restricting normal movements, and interfering with the normal flexibility and contraction of the muscles in the shoulder area.
Passive approaches such as medications, rest, ice, and steroid injections, all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from the shoulder condition.
A.R.T. stands for Active Release Techniques. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. A.R.T. treatment is highly successful in dealing with shoulder injuries because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues. By locating and treating the soft-tissue adhesions with A.R.T. it allows the practitioner to, 1) break-up restrictive adhesions, 2) reinstate normal tissue flexibility and movement, and 3) more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain.
You can think of an A.R.T. treatment as a type of active massage. The practitioner will first shorten the muscle, tendon, or ligament, and then apply a very specific pressure with their hands as you actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area. In this sense, each treatment is also an assessment of the health of the area as we are able to feel specifically where the problem is occurring.
An additional benefit of A.R.T. is that it allows us to further assess and correct problems not only at the site of pain itself, but also in other areas of the kinetic chain, which are associated with movement compensations and are often contributing factors to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.
One of the best things about A.R.T. is how fast it can get results. In our experience, the majority of shoulder injuries respond very well to A.R.T. treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and there are several factors that will determine the length of time required to fully resolve each condition, we usually find a significant improvement can be gained in just 4-6 treatments. These results are the main reason that many elite athletes and professional sports teams have A.R.T. practitioners on staff, and why A.R.T. is an integral part of the Ironman triathlon series.