By Lowell Birch
It is a surprise to many that the shoulder is the most common human injury. The mechanisms of injury are a variety of accidents and activities such as a slip and fall, a car accident or simply carrying a heavy suitcase to the ticket counter.
Whenever we exceed our conditioned maximum at the gym, gardening at home or something as simple as reaching for a tea cup on a high shelf, we may create a strain. If not attended soon, it may become a chronic issue that the body is unable to heal by its own magic.
When a muscle is over-stretched or over-loaded with some activity or a continuous motion without proper rest for recovery, it often reacts to protect itself by contraction. These contractions cause restricted blood flow with resultant build up of by-products of muscle work, such as lactic acid, creating sensitivity and pain. These symptoms result in stiffness, restricted motion and often will disturb the patient’s sleep.
The extreme example of this is the frozen shoulder, termed such because of the patient’s inability to move the shoulder even slightly without crying out in pain. An unfortunate vineyard worker presented in my office a few years ago, holding his right arm close to his body, wincing in pain with even the slightest movement. His history revealed that he and another worker had been stringing the heavy wire that supports the grape vines. They were using a come-along to stretch the wire, the wire had snapped, and the end had whipped around penetrating the worker’s shoulder muscle.
As this occurred at a major winery, he was examined by the insurance doctor who made little of the injury, and prescribed pain killers with an order to return to work. The patient found he was unable to perform his work duties, and not knowing what to do, he went home to recover. His shoulder became progressively worse, and within a few days he was unable to move his arm.
When he was finally referred to my office by a friend, he was depressed and fearful that he would never again be able to use his right arm. His situation was complicated by his anxiety that he would not be able to provide for his young wife and 12 children.
Examination revealed that the wire penetration was not infected, but the underlying shoulder muscle was locked in a tight spasm which had led to an overload of other shoulder muscles, resulting in a frozen shoulder. After 3 1/2 weeks of treatment, during which he was able to qualify for disability benefits, he was able to resume his work at the winery and his shoulder was pain free.
Another patient recently presented in my office for low back and neck issues, and as he neared recovery, asked if I could treat his shoulder problem. He related that he had injured his shoulder about 50 years ago and could not even remember the cause of the injury. He stated that he found it difficult to sleep on the side of the injured shoulder, which awakened him repeatedly during the night. He had learned to live with the problem, and since there was little interference with activities of daily living, he had not sought therapy in the past.
Examination of the shoulder revealed spasmed, dysfunctional rotator cuff muscles, sore and tender to the touch. After suffering fifty years of discomfort, the shoulder was returned to normal range of motion with pressure release therapy, and all nocturnal pain was relieved with the help of an electronic muscle stimulator.
Fifty years must be a record for a muscle to remain in a dysfunctional contraction after an injury! When therapists say a muscle has memory, they are not kidding!