Shoulder Pain

Shoulder pain, rotator cuff syndrome, tendonitis, tendonosis and frozen shoulder is probably the most common issues I see in my practice. The shoulder is actually two structures. The glenohumeral joint which requires mobility and the scapulothoracic joint which requires stability. This is the base that allows the shoulder to move through it's complete range of motion. Problems arise when we loose mobility in the shoulder and stability in the scapula.

The single biggest cause of these issues is the repetitive injury cycle.

Even traumatic injury can have a root cause in repetitive injury. You basically have an environment that is susceptible to injury because of the cumulative effect of damage caused by doing the same thing over and over. (Think Carpal Tunnel Syndrome from typing on a computer all the time). Carpal Tunnel is a build up of scar tissue that gets so bad it entraps the nerves running into your hands. From just the simple act of typing......Your computer is out to get you! This phenomenon can occur any where in the body. This ultimately is why sitting is so bad and yes sitting also screws up your shoulders. When you consistently contract a muscle you are reducing blood flow to that area. Blood carries oxygen. We now know that when oxygen pressure is reduced below 55 mm Hg the inflammation cascade is initiated. Inflammation is what occurs any time the body is injured. The end result is scar tissue. Scar tissue in turn can restrict normal motion of muscles sliding across one another and entrap nerves that run through those muscles. Sciatica is another example of this problem.

Shoulder pain, tendonitis, tendinosis (which is the long term result of tendonitis), bursitis and rotator cuff issues are all a result of this scar tissue. Even some cases of a condition called thoracic outlet syndrome are caused by this condition.

The Solution

First, we must address the scar tissue. The protocol professional and olympic athletes use is ART Active Release Technique and Graston Tech. In addition a high tech tool that vibrates at 170 cycles per second called a Rapid Release Instrument allow the practitioner to clear scar tissue adhesions from the soft tissue systems of the body. i.e. Muscles, myofascia, connective tissue, and nerves. A specialty protocol in the ART Active Release Technique system specifically addresses entrapped nerves. Additionally I incorporate Type 3 B or Cold Laser into treatment if needed to address inflammation and accelerate tissue healing. This restores normal movement of soft tissue and frees up entrapped nerves. This protocol is very unique in it's approach in effectively managing shoulder pain, rotator cuff injury, shoulder tendonitis, tendonosis, bursitis and even frozen shoulder.

Second, specific exercises need to be tailored to the phase of injury the patient presents with. There are 4 stages of healing a person goes through.

1). Inflammatory stage: 24 - 48 hours.

2). Granulation stage: 3 - 5 days

3).. Fibroblastic stage: 5 -8 days in high metabolic areas and 3 - 5 weeks for low metabolic areas. (Low metabolic areas are things like tendons and ligaments).

4). Maturation stage: May take 1 year.

If the right type of re-hab does not occur in the right phase of injury cycle, the injury site forms a very unorganized type of scar tissue. Other more complex neurological issues also arise which make you much more likely to reinjure the area and develop chronic pain!

Nutritional approaches also play a major role in not only managing shoulder pain issues but in avoiding it in the first place.

Hydration is critical. My personal belief is that most injuries occur, acute and repetitive in nature because of being dehydrated. Cells are much more resistant to all stress mechanical and chemical if properly hydrated. One interesting aspect of hydration is the ability for the cells to actually take in the H2O. Just because you drink or eat it does not mean your absorbing it at the cellular level. Sometimes key mineral salts are deficient that allow the cells to absorb key nutrients and water. Magnesium is one of those key salts. Studies show up to 80% of us are deficient in Magnesium. Concurrently studies indicate about the same number are walking around chronically dehydrated. Magnesium is best absorbed in the Magnesium hydroxide bicarbonate form. 500 times more so than a oral tablet form.

Caution: Because of the popularity of this issue a recipe for making this your self in floating out on the web. Don't do it. The recipe requires the use of Milk of Magnesia. This product has high levels of Aluminum in it.......Not good! You can find the bicarbonate form on the web or I carry it and it's very cheap. It's actually part of my after care instructions for all new patients. It also helps promote restful sleep......You heal while you sleep!

Inflammation Drives Pain!

Reread and follow my nutrition guide for a inflammation free life.

A key nutrient for reducing chronic inflammation is pharmaceutical grade fish oil. Sometimes finding the right dose can eliminate shoulder pain alone. Maintenance level for fish oil is 3 grams per day so if your trying to put out a fire we sometimes need to triple that dose.

I can't over emphasis this one.......Cut out completely sugar and processed carbs. Sugar and white flour feed inflammation like throwing gas on a bon fire. Eliminate all vegetable oils as these also increase inflammation.

Eat grass fed meat. (Same omega 3 levels as wild caught salmon), and lower levels of omega 6 which is ¬ęPro-inflammatory¬ę

Bromelain, an enzyme and a product from Standard Process called Boswellia are amazing for joint health. (Any joint).


If a patient is not a surgical candidate, meaning a grade 3 tear, my success utilizing these protocols is over 90%!!! That's unheard of in the medical field but typical among ART practitioners. Bottom line. If you or some one you know is dealing with shoulder pain, rotator cuff syndrome, shoulder tendonitis or tendonosis, bursitis or frozen shoulder there is help.