MICHAEL NOONAN

Shoulder pain? Don’t rush to get an MRI

Posted Oct. 10, 2013, at 7 a.m.

The shoulder is the loosest joint in the body. It also has the largest and most complex motions. Because of this, it often pays the price for alignment problems in the upper back and neck, or muscle imbalances in the area. I have seen shoulder problems disappear by treating the spine only, without touching the shoulder itself at all.

Stability for the shoulder is provided largely by muscles, especially a set of four smaller muscles called the rotator cuff. Muscles have two primary functions: They contract to move a bone and then relax. But it is very common to see tension store in a muscle, preventing it from relaxing fully. If a muscle cannot relax completely, then it also cannot properly contract, and this lack of normal muscle function is a primary cause of shoulder pain. It is typical to find a “knot” in one or more of the rotator cuff muscles, and releasing this knot allows the shoulder motion to improve, often immediately.

The rotator cuff muscles are not the big “primary movers” of the shoulder joint; they work by refining and countering the force of much larger muscles such as the pectorals and deltoids. They work like a tugboat, helping guide a large boat into a dock. When they can’t work properly, often due to stored tension in the muscle, the shoulder still moves but it isn’t a smooth, coordinated motion. This unbalanced motion causes the shoulder to become inflamed when it’s used, and as the problem worsens it will stay inflamed constantly.

Shoulder motion is also dependent on normal spinal function. There is still a debate in the chiropractic profession about exactly what happens to a joint when it becomes a problem — does it literally come out of place, or does it lose its normal motion?

While that issue is up for debate, the best way to treat the problem joint is not. Manipulation is a quick, shallow thrust into the joint, designed to restore alignment and motion, well short of causing any injury. It can be done by hand, with tables that move when pushed on, or a special handheld instrument. Its safety record is excellent, far better than any medication, including over-the-counter meds.

One study estimated death rates from anti-inflammatory drug use to be about 1.5 deaths per 10,000 people.

It’s tempting to rely on X-rays and MRIs to evaluate a painful shoulder. But while these tests are great at showing damage to the joint and muscles, this wear and tear is a lot less important than the normal function of the surrounding muscles and joints, which does not show on these tests.

One study looked at MRIs of 96 people who did not have shoulder pain, ranging in ages from 19 to 60. They found 34 percent of those tested had rotator cuff tears, and 15 percent had complete, “full thickness” tears.

Checking and treating the shoulder’s supporting joints and muscles should be the first order of business; only when that fails should the next steps such as MRI be taken. The downside of starting with an MRI is that it makes the doctor start with treating the torn tendons and other signs of damage, when the cause may actually be something far simpler — joints and muscles that don’t work properly.

Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.

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