The shoulder/s are the joints where the upper-arm bones known as the humerus, the shoulder blades or scapula, and the collarbone/clavicle come together. The upper-arm bone fits into the scapula socket and is held in place by muscles and tendons. This is the rotator cuff. It covers and protects the upper-arm and allows for raising and movement of the arm. Pain in the shoulder can have a variety of causes.
Injuries can occur in a slip and fall or automobile accident. A task like painting the house could cause a repetitive/overuse injury. The�soft tissues in the shoulder, muscles, tendons, and ligaments�can get injured from excessive strain, falls, and improper motion. Shoulder pain can come from certain conditions like arthritis. And it can present from problems or issues in other parts of the body. This is known as referred pain.
The shoulder takes on more than we realize. It is made up of an intricate network of ligaments and muscles, with the rotator cuff taking most of the load when moving. It is the most flexible joint in the human body, and one of the most unstable. It is�unstable because of its unique construction. Other joints like the ankle or elbow are limited in their range of motion. Shoulder injuries�are common, as the shoulder sustains more injuries than almost any other part of the body.
Here are some questions to help figure out if there is a shoulder injury:
Does the arm move normally?
Is there extreme stiffness?
Is there pain and what type – throbbing, stinging, shooting
Does it feel like it could pop out of the socket?
Is it strong enough for normal activities?
Certain shoulder injuries can be treated at home for a few days with rest and ice. The shoulder can be bandaged with Kinesio tape to hold it in place if necessary. But serious injuries require professional medical help. Symptoms/signs that a medical professional is needed:
The shoulder joint looks deformed
The shoulder cannot be used at all
The pain is extreme and intense
The shoulder is swelling rapidly
The arm and/or hand is weak and/or numb
When the shoulder gets pulled back hard or rotated too far, the top of the arm can get popped out of the socket. This can cause pain, weakness, swelling, numbness, and bruising.
This is an injury affecting the joint where the collarbone and shoulder blade come together. It is the acromioclavicular or AC joint. An accident, fall, or traumatic impact can tear the ligaments holding it together. If the collarbone gets shifted out of place, a bump on top of the shoulder will appear.
After a fall or a hard hit, the bones can break or become cracked. The most common breaks are to the collarbone and the arm bone that is the closest to the shoulder. Pain presents along with bruising can occur. If the collarbone is broken, the shoulder may sag and there will be no ability to lift the arm.
The cartilage or rubbery padding that runs around the rim of the shoulder joint can suffer injury and/or get torn. Repetitive motions and overuse can lead to a tear. It can also be injured in a fall, or anytime it absorbs the brunt of the force. Pain can be felt when reaching over the head, or the shoulder feels/seems to be weak. Sensations like catching, locking, or grinding may also be felt.
Rotator cuff tear
The rotator cuff belongs to a group of muscles and tendons that hold the arm in place and allow for lifting the arm up and overhead. It can suffer damage through overuse or in an accident. The rotator cuff begins to show wear and tear with age. It can hurt at night and when trying to lift objects. Individuals have also reported a crackling sound when moving.
This is a condition that limits how much the joint moves. Bands of tissue or adhesions build up in the joint and keep the shoulder from moving freely. This is where the freeze happens. It comes from the pain, causing the individual to not use it, this allows the adhesions to build.
This is when the tendons of the rotator cuff become pinched within the bones of the shoulder. It can cause swelling and pain. It is often set off when lifting the arms over the head repetitively.
This is when the fluid-filled sacs or bursa that cushion the joints get swollen and irritated. Usually, the onset occurs from repetitive motions. However, it can also be caused by a fall or other injury. The pain occurs most when moving the shoulder.
Also known as degenerative joint disease. It is the most common form of arthritis. It can affect any joint, including the shoulders. The cartilage between the bones breaks down and allowing them to rub against each other causing pain and stiffness.
This is a disease that causes the immune system to attack the protective lining in the joints. It causes pain and stiffness in the shoulders.
There could be nothing wrong, yet pain or discomfort presents. This could be a sign of a condition involving the lungs, gallbladder, liver, nerves, etc.
Shoulder pain could be brought on from the tightness in the chest and trouble breathing. Get emergency medical help immediately.
The tendons that make up the rotator cuff become inflamed. It can happen progressively over time or quickly from an accident, fall, or a direct hit to the shoulder.
These are small, smooth pieces of bone that begin to rub up against the rotator cuff keeping the shoulder from proper movement. They can lead to tendonitis or a tear.
A doctor or chiropractor will begin with a physical exam to check for structural problems to rule out anything involving the spine or neck. Next, is the range of motion exam to see how strong and flexible the shoulder is. This involves moving the arms in different ways, like:
Above the head
Across the body
Rotate 90 or 180 degrees
The doctor could recommend imaging tests to get a closer look:
These can help find bone spurs, arthritis, and other bone-related causes of shoulder pain. The doctor could recommend an arthrogram. This involves using a dye to enhance the details allowing them to render more clearly.
Radio waves and a powerful magnet generate detailed images of the shoulder.
This is a series of X-rays taken from various angles. When placed together, they allow for optimal views to be seen.
This measures electrical activity in the muscles to see if there are any problems with the nerves.
A surgical procedure that utilizes a tiny fiber-optic camera, allowing the doctor to see high-definition images. With certain cases, the doctor could be able to treat the problem during the procedure.
Dislocations, separations, and fractures require medical attention. Getting the shoulder back to the right position followed by a sling to hold it in place while healing and in recovery. For less serious issues, the doctor could recommend rest, heat/ice, and medicine like ibuprofen or aspirin to help with the pain and swelling.
Chiropractic treatment for shoulder injury/s and pain. A Chiropractor can:
Improve range of motion
Restore function to the joint
If the shoulder does not show improvement after the first steps, the doctor could recommend injecting an anti-inflammatory medication straight into the joint for the swelling and pain relief. There are times when cartilage tears, rotator cuff tears, and a frozen shoulder does not improve with rest, physical therapy, or medication. As a last resort, the doctor could recommend surgery. Any problem with the shoulder means that the treatment plan will probably include stretches and exercises to help strengthen the joint and improve the range of motion.
Consider how often the shoulders are used at work and play. Then find ways to protect it:
If working at a desk, make sure the chair has proper back support and promotes proper posture.
Take several short breaks to move around at least once an hour.
If work requires heavy lifting, proper technique is essential.
First face the object being lifted
Keep the back straight
Bend the knees using the legs for power
When reaching for a heavy object overhead, use a step-ladder to get a better position.
Ask the doctor or chiropractor about a strength and conditioning regimen for the muscles around the shoulders, to keep them strong and flexible.
Chiropractic Treatment Shoulder Pain
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The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
A chiropractor is a doctor who specializes in musculoskeletal and nervous system problems. It is the belief of the chiropractic community that problems in these areas can cause adverse health issues, including lowered resistance to disease, illness, and injury.
Chiropractors manipulate the spine to realign spinal joints in their patients. By doing so, patients are expected to experience optimum health without the assistance of drugs or surgery. Instead, chiropractors expect the body will heal itself once the spine and spinal joints are in proper alignment. Additionally, chiropractors consider and address other lifestyle factors which are commonly recognized as significantly affecting health such as diet, rest, exercise, heredity, and environmental factors. They also make other recommendations for changes which are expected to improve the patient�s overall health.
Chiropractors perform many of the same tasks as other general and specialty doctors. Patient health histories are gathered, physical, neurological, and orthopedic examinations are performed, and various laboratory tests, x-rays, and diagnostic imaging tools are used to diagnose and analyze the patient�s condition. Other forms of treatment may be used or recommended by the chiropractor including ultrasound, massage, heat, water, acupuncture, or electric currents. Prescription drugs and surgery are not part of the services provided by chiropractors. Chiropractors may recommend patients to see other doctors or specialists to address health issues or concerns outside of their area of expertise. Some chiropractors choose to specialize in a certain type of practice, such as orthopedics, neurology, sports injuries, internal disorders, diagnostic imaging, or pediatrics.
The Bureau of Labor Statistics predicts a job growth increase of 17% in the chiropractic field over the next seven years. An increasing public interest in alternative healthcare methods is beneficial to the chiropractic field. The public is seeking healthy living options which do not include prescription medicines or surgery; instead, a substantial number of people are searching for solutions which emphasize healthy lifestyles. The non-invasive procedures provided by chiropractors in answer to their patients health issues and concerns appeals to the segment of the public looking for these types of answers.
SELECTING THE RIGHT CHIROPRACTIC COLLEGE
Chiropractor students should select a college which offers a strong science degree or pre-medical program. Some colleges may have an affiliation with chiropractic training schools, which all future chiropractors must successfully complete. Research chiropractic schools to determine which one you are most interested in attending; this will help you to determine if the school is linked to any of the colleges you are considering. Courses in biology, chemistry, and physics will be important to individuals looking to work in a medical field. Electives may be concentrated in health, fitness, and nutrition. Students should, if given the opportunity, study topics and courses related to kinesiology and sports medicine. Courses in psychology and sociology will also help students to gain a more comprehensive understanding of people and society, better preparing them to serve the public. Additionally, business courses ensure that future professionals understand how to successfully manage a business in the complex healthcare field, as medical professionals must understand finances, medical insurance processing, business laws, business practices, business ethics, and medical records maintenance.
Students must attend chiropractic college in order to enter the profession. Upon completion of the program, students will have earned a doctorate in chiropractic medicine. The Council on Chiropractic Education, or CCE, is the nationally recognized accrediting agency by the United States Secretary of Education which regulates the quality of the curriculum offered at chiropractic colleges. Currently there are 15 CCE accredited chiropractic institutions in the United States. These include, as listed on the CCE website:
Students attend chiropractic college for four years. During this time, students are taught the scientific and academic skills and knowledge required to become experts in the field of chiropractic medicine. The final year is spent in practice, performing the functions of a chiropractic doctor under the supervision of an experienced professional. The curriculum includes intensive study of neuromusculoskeletal conditions, nutritional and holistic health, specialized and focused curriculum in areas of acupuncture and oriental medicine, applied nutrition, and various other disciplines. Students will complete extensive course hours in diagnosis, biochemistry, anatomy, chiropractic technique, and philosophy and ancillary therapeutic procedures.
TAKING THE NATIONAL BOARD EXAM
The National Board Exam for chiropractors is administered by the NBCE. The test is given twice each year. The exam consists of three parts. Part one is 110 multiple choice questions relating to general anatomy, spinal anatomy, physiology, chemistry, pathology, microbiology, and public health. The second part also consists of 110 multiple choice questions, but in the areas of general diagnosis, neuromusculoskeletal diagnosis, diagnostic imaging, and principles of chiropractic, chiropractic practice, and associated clinical sciences. Part three of the test consists of another 110 multiple choice questions and 10 case vignettes covering the areas of diagnosis or clinical impression, clinical laboratory and special studies examination, chiropractic techniques, case management, physical examination, case history, and roentgenologic examination. Each part of the test is timed. Additional specialized testing is offered for applicants who choose to pursue an area of specialization.
LICENSING FOR CHIROPRACTORS
After successful completion of an accredited chiropractic program, graduates will need to obtain a license to practice in their resident state or the state in which they intend to practice. State licensure regulations may vary from state to state. It is important to research your state�s regulations prior to completion of the doctor of chiropractic program to ensure all conditions are met. The Federation of Chiropractic Licensing Boards is a nonprofit organization which provides a link to the licensure information in all states. Locate information for each state through this directory.
The information provided includes licensing fees, renewal requirements, national board testing requirements, security and criminal check requirements, additional certification requirements, continuing education, and malpractice insurance requirements. A link to each state licensing board is also provided.
CONTINUING EDUCATION FOR CHIROPRACTORS
The chiropractic field is experiencing an increase in advancements in technology and knowledge through research and academic exploration. Changing regulations are also an area in which chiropractic doctors will need to remain current. Each state maintains their own continuing education requirements upon which licensing will be contingent. Twenty-four credit hours of continuing education every two years is a common requirement. All programs must be board approved and conducted by approved colleges or chiropractic associations or organizations. Check with your state licensing board to determine if the program has been approved prior to enrollment.
PRACTICING AS A CHIROPRACTOR
After obtaining a doctorate and passing the licensing examination, a new chiropractor has many options ahead of them. Most chiropractors will end up working solo or in a group practice, with about one in three being self-employed. A small group will work in hospitals or physicians� offices. The median pay for Chiropractors in 2016 was $67,520, with the lowest 10 percent earning less than $32,380, and the highest earning more than $141,030. Chiropractors can further increase their salary by building up a strong client base and developing their own practice. Many times, chiropractors will work in the evening or on weekends to accommodate their patients.
DAY TO DAY PRACTICE
Chiropractors will spend a lot of time on their feet as they examine and treat patients. Some of the most important qualities that a chiropractor can have include decision-making, detail-oriented, dexterity, empathy, and interpersonal skills. If the chiropractor is operating his or her own practice, the ability to manage a staff of employees like secretaries and nurses is vital to the success of the practice. An understanding of the current healthcare system is also important, as that will determine what kind of payments a chiropractor may be able to receive, unless they work in a cash-only system. More information can be found in the Occupational Outlook Handbook provided by the BLS.
CHIROPRACTIC SPECIALTIES AND CERTIFICATIONS
Another way for chiropractors to increase their annual earnings or skills would be to specialize in one or more areas. Specializations can help a chiropractor better diagnose and treat chronic illnesses, sports injuries, and/or complex occupational injuries. The American Chiropractic Association and American Board of Chiropractic Specialties (ABCS) lists 14 specialties and provides guidance to maintain standards of chiropractic certification. These include, as listed on the American Chiropractic Association website:
Has special knowledge of both the normal function and diseases of the bones, joints, capsules, discs, muscles, ligaments, and tendons, as well as their complete neurological components, referred organ systems and contiguous tissues, and is able to diagnose and treat the conditions related to them.
Chiropractic Occupational Health (DACBOH) Specialist
A DC trained in health care diagnosis and treatment choices for workplace neuromusculoskeletal injuries who is able to provide a broad range of work-related injury and illness prevention services for employee populations.
Women often seek out chiropractic care during their pregnancies. One of the main reasons for this is that if they are having musculoskeletal pain, their Obstetrician or Midwife generally has very limited options for conventional medical treatment. They are less likely to prescribe medication, which presents an amazing opportunity for us as chiropractors. What initially began as a strange combination of a sports certification and a prenatal/pediatric certification has created a successful and in-demand niche for us. For the most part, I cannot imagine treating prenatal patients without having the sports background. First, most women at some point in their lives have been or currently are an athlete. And second, one of the most common complaints women have during pregnancy is myofascial pain, and who better to treat that than a sports chiropractor? Here are 5 common and easy-to-treat complaints during pregnancy:
One: Pubic Bone Pain
This pain is very common during the second and third trimesters of pregnancy. Women will often describe it as exquisitely tender, worse with rolling over in bed at night, walking or climbing stairs. Conventional medical opinion is that the ligaments during pregnancy are much more relaxed (due to the hormone, relaxin) causing separation of the pubic symphysis and thus inflammation and pain. Sports chiropractors are uniquely qualified to assess this joint, and the common causes of pain can include:
1. Adductor hypertonicity easily addressed with myofascial release or techniques such as Graston, which can be done over leggings or on skin.
2. SI Joint fixation or Pubic Symphysis fixation. While I am generally a diversified adjuster, an activator adjustment to the superior or more-tender pubic rami will go a long way in terms of providing relief. I strongly discourage any audible manipulation of the pubic symphysis.
3.�Kinesiology taping�of a �RockTape Baby Belt� or modified version of this can provide significant relief and is much more comfortable than a pelvic support belt.
4. Using an ice pack for 15 minutes prior to going to bed at night will decrease pain and inflammation while sleeping.
Two: Rib Pain
Rib pain, especially in the lower and floating ribs, is common as the weight of the abdomen is pulling on the oblique abdominal muscles and their attachments at the ribs. Adjusting the ribs at the thoracic spine and incorporating myofascial release or Graston Technique will work quickly (often in just 1 treatment). Finish up with a few strips of kinesiology tape and your patient will feel significantly better.
Three: Upper Abdominal Numbness
Upper abdominal numbness is a common symptom during the later stage of pregnancy. It often presents as numbness but can also be painful and worse with sitting. One of the easiest ways to provide relief is with one simple strip of kinesiology tape over the top of the abdomen directly under the rib cage.
Four: Swelling in the arms and legs
Swelling in the arms and legs is very common and can lead to numbness, tingling or pain. Before beginning treatment, be sure to assess if the swelling in the feet is significant and test for pitting edema which can be a warning sign of preeclampsia. This can be corroborated with a high blood pressure reading and is very dangerous. Two very effective sports techniques for use with lower extremity swelling include 1.�NormaTec PULSE Recovery System�which is not contraindicated in pregnancy. Patients can do a few 20-30 minutes sessions per week to promote circulation and decrease swelling. 2. Kinesiology taping for edema on the ankles.
Five: Lower Back Pain
Lower back pain in pregnancy is very common. Evaluating a pregnant patient prone is very easy if you have pregnancy cushion that sits on top of your table. If you do not, you can evaluate the lower back in the seated or side lying position. Lower back pain can generally be addressed with diversified adjustments (without any rotation as to not stress the abdomen). In addition, the Webster Technique for pregnancy is a valuable tool for assessing and treating lower back pain during all stages of pregnancy. There are also valuable kinesiology tape applications for lower back pain,�RockTape features a pregnancy taping pdf online. In addition, there are no contraindications to using the Graston Technique to address myofascial pain in the lower back.�
Most of the taping techniques discussed above can be done by patients themselves after a one-time demonstration. Have an assistant or patient�s family member take a video of the application for reference at home. Many sports chiropractic techniques can be used very effectively on prenatal patients.
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