A new review of drug free approaches to shoulder treatment leaves out an important reason for shoulder pain.

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Shoulder pain is one of the most common reasons to visit a doctor, affecting your daily activities and even your sleep. There are numerous approaches to treating the shoulder, as evaluated in a recent systematic review (1) of non drug and non surgical treatment of shoulder conditions.   The current evidence is not showing that most of these approaches, whether they be shoulder exercise protocols, chiropractic manipulation, or  other methods are work consistently or convincingly enough. Of the 69 studies, most providers showed minor to moderate evidence of effectiveness and cold laser showed moderate effectiveness for relief.  Long term results for rotator cuff problems treated non surgically with exercises, and other non invasive treatments when compared to surgical options was not as effective.  Cold laser offered relief for shoulder conditions such as shoulder impingement syndrome, rotator cuff-associated disorders , adhesive capsulitis and nonspecific shoulder pain. One of the flaws with all of these studies is that none of these look at the effect of the core and lower body on shoulder function.  For example, it is becoming better understood that poor lower body stability and pelvic range of motion will effect shoulder motion.  Basically, the body moves as a contiguous structure and shoulder motion is part of this.   Gait problems that are inherited can cause lifetime compensations affecting the hip flexors which include the psoas which will restrict shoulder motion, resulting in pain, impingement and tendonosis.  The typical frozen shoulder we see in our offices usually involves hip capsule tightness as well, as a compensation for gait. If all of these shoulder complaints were the same, and were just problems in the shoulder girdle, why isn't the research data more consistently showing improvement?  Looking at the shoulder based on the symptom and then evaluating a treatment to the area of complaint is part of the reductionist paradigm that is problem focused while viewing a body that is holistic in its function, Doctors assume that our diagnosis for impingement, rotator cuff tear, adhesive capsulitis and other shoulder problems is an appropriate behavior for clinicians, leading to treatments that are ineffective or yield minor improvement with conservative care. Clinicians and their patients need to look at shoulder movement and the pain associated with poor movement patterns while considering the body as a whole, or in other words, take a holistic view of how the shoulder works and what it is affected by.   It is not good enough to just do exercises or to place therapies that make the shoulder less sore on the shoulder, only to return worse later on as either a torn rotator cuff, a lower back problem and even a neck problem. If we look at the movement problem of the shoulder, and consider that the ribs, the fascia, the nerves, and even the lower back can restrict the shoulder and the body through neuroplasticity can learn poor movement patterns reinforcing a return to shoulder pain, your doctor should approach your shoulder problem keeping an open mind.   Your doctor must consider your unique body style as well, since many of us are shaped differently and our bodies work differently as well. Perhaps, this is why treat-test-treat protocols with active evaluation is a better tool to evaluate the shoulder.   Checking the shoulder may show lower body involvement and lower body involvement may show shoulder involvement, leading to a more effective treatment and a better resolution of the pain and any future problems the mechanism behind the pain may create. The question is, who is the best provider to evaluate your painful condition.  The answer is the one who is open minded, holistic, performs manipulation to restore motion in the ribs, scapula and even address the lower back on the same visit to efficiently treat and then test their result, to see if it had the intended improvement in function.  The old way of using a protocol to the area of complains fulfills low expectations that patient have as they age and that many studies satisfy such as this one. For your healthcare dollar, especially with non surgical options which are preferable, learn to expect more.
  1. J Manipulative Physiol Ther. 2017 Jun;40(5):293-319. doi: 10.1016/j.jmpt.2017.04.001. Epub 2017 May 26. Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions. Hawk C1, Minkalis AL2, Khorsan R3, Daniels CJ4, Homack D5, Gliedt JA6, Hartman JA2, Bhalerao S7. View the full publication here.