Could Diagnostic Labels - “Shoulder Impingement” “Rotator Cuff Tear” “Rotator Cuff Tendinitis”-potentially be more harmful than helpful for the long haul for patients?
In this blog post, it will be addressed how diagnostic labels for shoulder pain can affect pain. I hope it prompts some thought and reflection.
Words Matter. Especially words healthcare professionals say to our patients in pain.
First, let’s start off with some basic information about the shoulder.
The shoulder has a lot of movement available to it. If you don’t believe me move your shoulder around then move your elbow around. There is a difference. Why is there such a large difference? Well, the shoulder is referred to as a ball and socket joint. This means there is a rotational component.
Now when a joint has more range of motion it is typically for functional purposes. For our shoulders, we are able to throw, reach overhead, reach across our body, reach away from our body, carry, push and pull. However, the more range of motion available at a joint the more control and stability is needed at that joint as well as above and below it for optimal function.
Let’s take a closer look at the anatomy piece thought before continuing on to the dysfunction and pain topic.
A detailed definition of the shoulder anatomy from the Washington university of orthopedics: “The shoulder is made up of two joints, the acromioclavicular joint and the glenohumeral joint. The acromioclavicular joint is where the acromion, part of the shoulder blade (scapula) and the collar bone (clavicle) meet. The glenohumeral joint is where the ball (humeral head) and the socket (the glenoid) meet. The rotator cuff connects the humerus to the scapula and is made up of the tendons of four muscles, the supraspinatus, infraspinatus, teres minor and the subscapularis. Tendons attach muscle to bone. Muscles in turn move bones by pulling on the tendons. The muscles of the rotator cuff keep the humerus tightly in the socket. The socket, or the glenoid, is shallow and flat. It is rimmed with soft tissue called the labrum that makes a deeper socket that molds to fit the humeral head. The joint capsule surrounds the shoulder joint. It is a fluid filled sac that lubricates the joint. It is made up of ligaments. Ligaments are soft tissue that holds bone to bone. Shoulder injuries can occur to any part of the shoulder.”
If we are to solely focus on the biological factors such as musculoskeletal imbalances or changes- Arthritis, rotator cuff tendinitis, rotator cuff tears, shoulder bursitis, and shoulder impingement would be the main reasons many clients come to us. If you are one of the ones who have been following our blog posts right along- you already know that biological factors are just a small piece of the puzzle when it comes to pain.
If you’re new- you are probably like- What does she mean biological factors? I mean components of pain that are ONLY health related- genetics, age, tissues, mechanical, and anatomical dysfunction. There is more that plays into pain- we just don’t spend any time talking about it. There are two other factors being psychological and social factors.
So giving the pain a diagnosis may in some cases be more harmful as it makes the client only focus on that and not consider anything else. The more you focus on something, the more attention you bring to it.
In healthcare, we forget about how thoughts and beliefs heavily influence body chemistry. So, if we believe something to be “torn” or “inflamed” or “broken” then we focus on only that when we have the pain and assume it is getting worse or that it is further damaged.
Especially when we give people specific diagnoses, such as a rotator cuff, when there was no mechanism of injury! Regardless, we give people a diagnosis and then we send them on their way with that bit of information either home or to the next specialists they will see in 2-4 months from now. We don’t take the time to explain anything further.This contributes to the psychological component of pain. Negative thoughts and beliefs that come with pain can make people feel worse. Negative expectations have been shown to amplify pain, resulting in increased signaling from the spinal cord to the brain’s panic center.
Just because you were given the diagnosis shoulder impingement, rotator cuff tear, or rotator cuff tendinitis, shoulder bursitis, whatever it may be doesn’t mean it is a death sentence.
Here are some statistics with clients with shoulder involvement.
Among people who have had successful surgery, experience no pain and regain all movement, 1 in 5 still have a muscle tear
In people over age 30 who have a shoulder muscle tear, only 1 in 3 actually experience pain or limited activity
Tissue issues can and do result in pain. And yes, treatments may help tissues. But the overall message is that pain is far more complex than just tissues, especially ongoing pain. Treating pain needs a large-scale broad approach.
Research has shown that aerobic exercise, which gets your heart pumping a little faster and pumps blood and oxygen through your body, helps calm nerves down. Now, this doesn’t mean you need to pick up running or weight lifting! Without getting too complicated or scientific, the average person with pain will need to perform just about 10 mins of aerobic exercise to get their heart rate to 100-110bpm to receive benefits. This can be achieved through a brisk walk.
When it comes to exercise and pain, we often see two mistakes. Clients will start doing too much and believe more is better. More=More. Better= Better. We educate our clients about graded exposure which is basically just to start easy and slowly build up while listening to the pain alarm. We tell our clients we like to stay in the “yellow zone” (if you can think of it like a flashing yellow light, you don’t stop you proceed with caution!)
As for the shoulder there is a lot of evidence that supports PT can help with the aforementioned diagnoses. There is actually research that states there is no significant difference with people who had surgery for rotator cuff tears vs. people who just did PT.
Please keep in mind- everyone’s timeline is a little different. Especially if the pain is recurring and/or chronic. It starts to change your nervous system and your pain alarm. At Clash PT we are able to have all of our sessions one on one and provide hands-on treatment with a lot of education. For the most part- our clients notice improvements in their pain after 2-3 sessions. With our approach it allows time for conversation and discussion about pain- which can put a lot of client’s minds at ease.
Hopefully this blog provoked some reflection and discussion.
Please feel free to email any questions @ email@example.com
Why do I Hurt- Adriaan Louw
Pain Management Workbook- Rachel Zoffness