Why Shoulder Pain Keeps Doesn’t Get Better

Jessica Bento, Physical Therapist (Creator DVRT Restoration Certification, DVRT Rx Shoulder, Knees, Pelvic Control, & Gait Courses)

I’ll be honest, being a practicing physical therapist or over 20 years, I get frustrated a lot of times. I want people to feel better TOO and sometimes it can get really disheartening that people DON’T seem to get better. This is especially true when we look at the stats on chronic shoulder pain.

While the conversations are progressing around subjects like chronic low back pain to include other factors from the biopsychosocial model, interestingly, these same ideas get little attention to when we are discussing other chronic pain issues. If we understand the interrelationship of our physical, mental, and social states, then we SHOULD apply these concepts to any chronic pain condition.

This interconnection is being recognized way more in the medical field like at the Harvard Medical School symposium on whole person health. 

We NEED to be more aware of these other factors other than just looking at shoulder itself. There are some stats showing the failure rate of rotator cuff surgeries can be as high as 94%! (1) Research has shown that chronic shoulder pain shares some of the same issues in chronic low back pain as far as catastrohpizing and other emotionally related issues that increase the perception and pain and lower function (2).

This has forced many practitioners, like myself, who often get frustrated that people aren’t getting better from their shoulder pain even when they are rather consistent with exercise. So, when we start realizing there are additional factors to consider, we can actually discover potentially better solutions. For example, a research study found that a 5 minute mind-body intervention (using meditation and other strategies) improved shoulder pain and function significantly (3).

“The pain intensity was significantly reduced, while flexion and abduction were significantly improved, in the experimental group compared to the control group, after the intervention. In addition, the change of flexion negatively correlated with the change of pain intensity in the experimental group, but not in the control group. These results show that a short-term application of mind-body intervention significantly alleviates shoulder pain and improves shoulder movement, suggesting its potential use as a therapy for people with shoulder pain.”

Does this mean EVERYONE is going to get better by using some of these strategies I am going to show you? No, not really, this is often more complex than doing a 5 minute practice, but there are some keys to understand how to build the likelihood of greater success….

-Explain why they are having pain. Research shows when the neuroscience of chronic pain is explained, that information by itself can help reduce pain perception, but along with a comprehensive program, it does even better.

-Look for easy to address lifestyle factors that can be modified, or at least raise some awareness of how lifestyle and stress can impact their levels of pain.

-Share with them that unfortunately, chronic pain doesn’t typically disappear overnight. However, let’s not focus on removing the pain, let’s help build habits that deal with the emotional stress that chronic pain causes. Learning some of these mind-body practices is NOT about changing pain right there and then, but teaching how to build safety signals in the brain that will eventually help with the pain experience. This means we focus on “just doing the practice”. Many people that use meditation, yoga, breathing exercises, Tai Chi, and the like get frustrated when they don’t feel a decrease in pain, but that is because they are trying to solve their chronic shoulder pain with these practices.

Sound confusing? When you try to “fix” your chronic shoulder pain with very specific methods and exercises, you actually reinforce to the brain that something is actually wrong and you are in danger. Believe it or not this can amplify that experience of pain and just continue this cycle that makes us feel like we are not improving.

So, I am NOT saying don’t exercise and don’t strength train (we started this discussion yesterday, you can read about it HERE), but I AM saying we probably need to add in some mind-body interventions into our chronic shoulder pain plan as well. How do we do it? Here are a couple of examples from our Myofascial Integrated Movement (MIM) training system.

If you want to find out more you can check out our programs like our MIM programs, Breath Work Course HERE and our special DVRT Rx Shoulder Combo for 40% off with code “combo” HERE

 

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References:

1. Abtahi AM, Granger EK, Tashjian RZ. Factors affecting healing after arthroscopic rotator cuff repair. World J Orthop. 2015 Mar 18;6(2):211-20. doi: 10.5312/wjo.v6.i2.211. PMID: 25793161; PMCID: PMC4363803.
2. Menendez, M.E.; Baker, D.K.; O Oladeji, L.; Fryberger, C.T.; McGwin, G.; A Ponce, B. Psychological Distress Is Associated with Greater Perceived Disability and Pain in Patients Presenting to a Shoulder Clinic. J. Bone Jt. Surg. 2015, 97, 1999–2003
3. Kang H, An SC, Kim B, Song Y, Yoo J, Koh E, Lee S, Yang HJ. Reduced Pain by Mind-Body Intervention Correlates with Improvement of Shoulder Function in People with Shoulder Pain: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2022 Mar 24;2022:6149052. doi: 10.1155/2022/6149052. PMID: 35368768; PMCID: PMC8970874.