Do you get pain on top of the shoulder joint whenever you lift something? Maybe you’ve been told that your bursa is inflamed and is being squished by the bones in your shoulder? If that’s what happens every time you lift your shoulder, will you make it worse with every movement?
Well, I have some good news for you. Science is always evolving and we’re always learning more! More studies are showing now that ‘impingement’ doesn’t necessarily occur as the painful sensation you feel. We have multiple bursa in our joints – they are fluid-filled sacs that protect our tendons and tissues from friction against our bones. ‘Impingement’, where the bursa is somewhat compressed, has been found to occur in patients with AND without pain!1BURSA THICKENING is a normal adaptation response to load, in the same way our hands develop calluses, and does NOT directly relate to pain.2
Your Rotator Cuff shows similar results where Supraspinatus tears are COMMON! And have been found in several PAINFREE patients.1 In saying this… I am NOT saying the pain is in your head. Your pain in the shoulder is real, but there are so many factors to bring a pain EXPERIENCE. It’s no longer just about the tissue damage.
Look at this diagram below of your Rotator cuff and the tendon. It’s different to other tendons, as you can see it is more like a BLANKET. It’s wide and contains several supportive fibres. Not only that, you have at least nine muscles that move the shoulder alone and more that assist with stabilisation! The pain that you are feeling (with or without a muscle tear) is more to do with your current tissue capacity to perform the task and control loading. Whether that is based off stiffness in the shoulder, weakness in certain muscle groups or maybe instability of the joint itself.
Okay, if impingement doesn’t necessarily occur, then how do you treat this?
Let’s compare these methods
- Massage/needling/other passive therapies: This may provide relief as muscles can become tense as you subconsciously ‘guard’ the painful shoulder. This does NOT fix the problem that causes pain
- Corticosteroid injections: Again, these MAY reduce inflammation within the joint but it does NOT fix the problem that causes pain. It is temporary and pain can return, with additional injections becoming less effective.
- Surgery: for advanced tears, this may be recommended by a surgeon. However, surgical repair may help it LOOK structurally normal… it doesn’t relate to what you feel and how it will move and function. Surgery alone is not a reliable solution.
- Active therapy: Movement assessment and exercise prescription can identify the underlying deficits so you can rebuild strength and capacity.
The first two methods have a place in therapy, if they give you enough relief to move and cope throughout the day. BUT the active therapy is what addresses the underlying cause and builds longevity of health for your body. Not only that, it means you have active control over your joint health without having to rely on someone else’s manipulation. Remember… PAIN DOES NOT ALWAYS MEAN DAMAGE.
I want to encourage this way of thinking for most people dealing with chronic pain. Let’s pull away from the graphic visual words (pinching, tearing, grinding etc.) and instead start to recognise that your joint/muscle/tissue is most likely painful because it does not have the CAPACITY to perform these tasks.
Author Caitlyn Huth – Exercise Physiologist/Coach
REFERENCES
- Gandikota Girish, Lucas G. Lobo, et al. Ultrasound of the Shoulder: Asymptomatic Findings in Men. 2011, American Journal of Roentgenology197:4, W713-W719
- Daghir, A.A., Sookur, P.A., Shah, S. et al. Dynamic ultrasound of the subacromial–subdeltoid bursa in patients with shoulder impingement: a comparison with normal volunteers. 2012 Skeletal Radiol, 41: 1047.