Bedford Chiropractors Analyze Shoulder Pain

00:06-03:39Neck Alignment and Shoulder Pain
03:42-09:14Shoulder Anatomy Xray
09:20-15:29The Rotator Cuff Explained
15:30-19:44Neck Pain VS Shoulder Pain
19:45-22:55Frozen Shoulder Explained
22:56-25:56Thoracic Outlet Syndrome Explained

Bedford Chiropractors Discuss Neck Alignment and Shoulder Pain

Dr. Ben Boudreau: [00:00:06] We’re talking about the shoulder right now; the alignment of the cervical vertebrae is crucially important in your ability to figure out if your pain is coming from the shoulder itself and the structure in there or if the pain is coming from the neck. And clearly, if your cervical spine in the lower doses isn’t at that optimal for you to degree curve it straight. And which is what we’re seeing in this X-ray image here.

Place increased stress on the vertebral bodies and it’ll narrow the spaces from which the nerves exit, and so it’s crucially important to maintain that alignment and do the proper things so you can decrease that stress on the nerves and figure out if the pain is coming from my neck or if the pain is coming from my shoulder. Yeah. So, for those of you who now realize, after listening to all these Humpday Conversations, how important the neck is.

Dr. Clayton Roach: [00:01:02] And the curve in the neck is, just give us a few thumbs up. We just want to hope that you’ve understood at this point the importance of structure and especially the curve in the neck. And just to point things out here in terms of the spacing you’ll see here, the neck, which is supposed to be the other way, is actually curving. The other way and is starting to compress these this is what we’re talking about, the importance of the neck because in these areas here live very vital structures known as nerves that supply everything that’s in that area that we’re going to talk about tonight with the shoulder as well.

Dr. Ben Boudreau: [00:01:44] Yeah. So, if you think about the referral patterns, when we do get the straightening of the neck, people will often present with shoulder pain either in the back or pain into the front, and they’ll say, oh, I feel this pain down to my collarbone as well. And so, these are referral patterns and this is when the nerves begin to get compressed. They’ll actually send pain into a distribution pattern. And so, as you can see, there are these numbers besides the colour-coded areas, C2, C3, C3, C4. These are the areas that are involved. And so C3, C4, meaning the nerves in between vertebrate C3 and C4.

Dr. Clayton Roach: [00:02:27]  C2 is right here. So C3. So the nerve that would be commonality here between C2 and C3 would then supply this area right here.

Dr. Ben Boudreau: [00:02:40] And so for those of you who are with us for our headache talk, you know just how important it is to free up that space because when you don’t, you’ll get that pattern of pain into the top of the head, which can sometimes go right into the back of the eyes. So we want to make people aware that if that curve is correct and those nerves aren’t breathing, that the nerves will send pain down into those areas. For us as chiropractors, it’s crucially important that we can determine if the distribution of pain is characteristic of that narrowing or that impingement of that nerve or if it’s truthfully coming from the structure in the shoulder.

So we always want to be able to figure out, OK, how can we differentiate this? And this is one of the ways that we do that now. So really, a headache is not really a headache. It’s a neck. Right, because the nerves originate from the neck and they supply the areas of the head that were giving that pain.

Dr. Clayton Roach: [00:03:40] So here we go, Doctor.

Bedford Chiropractors Discuss Shoulder Anatomy Xray

Dr. Ben Boudreau: [00:03:42] Do you want to run through the X-rays, maybe explain to our friends? Yes. So what we have here in terms of anatomy, so is called the humerus.

Dr. Clayton Roach: [00:03:52] And here you see the ball and the socket. OK, the socket is called the glenoid and it’s basically part of the scapula, the shoulder blade. You can see a little bit better here in kind of point out here. The borders of the scapula, the shoulder blade, it goes all the way down here, comes back up over here. And here you have. The fossa, the glenoid where this actually articulates with OK, so you can see it over here as well, here you have a bomb called the chromium, which is basically right at the top of the shoulder blade. This one comes around. So when you tap yourself on top of the shoulder, that’s the chromium right there.

So this here is called. Chromium. So the chromium and the humorous. Are in close contact with one another. OK, and there is a space there that’s vital in order for you to be able to raise your hand by your side next to your ear. All right. Here you see the clavicle or in layman’s terms, the collarbone. And because this is called the clavicle, this here is called the AC joint. Because it’s made up of the Chromeo clavicle space, a Chromeo clavicle joint, the AC joint.

Dr. Clayton Roach: [00:05:32] So this is a very, very normal-looking X-ray. And over time, what can happen, this space can start to be narrowed and what will happen because the joint is narrow. When you go to raise your arm next to your head, you start to get a little bit of grinding. And what happens at the end of the acromion here? You’ll see you’ll start to build a bone spur. All right, and what you can do is prevent this problem from happening, or you can wait long enough and you see a surgeon and says, you know what, we’re just going to cut this sucker off here. And what they do to do is call in the Chromeoplast and now they just take that whole bone out.

So, yes, you’re going to have some space, but they also have to tear through the muscles to get there and you get scar tissue and get all kinds of problems that can happen. And, of course, you know, all the things with surgery and infections and all that stuff so far, better to prevent and try to cure this by eliminating some bone there.

Dr. Ben Boudreau: [00:06:37] Yeah. And I just wanted to talk again about this lack of mobility, right. Being in pain, it causes you to be in a more absurd position. I’m just going to turn to the side here. And so if we are in pain or if we’re sick, our spines aren’t going to be straight up and healthy. Our spines are the full representation of how it is that we’re feeling. And so we’re feeling in pain. We’re going to start rolling our shoulders and we’re not going to want to move them. What this rolling of the shoulder does is it closes that space between that humerus here and the acromion and between the humerus and the acromion is the muscle that can lift your arm up.

So if you’re not if you’re in a real position, you can’t lift your arm is high. And what that does, what that space begins to do, that muscle over time is it begins to crush the muscle known as the supraspinatus, and it can lead to a condition called subacromial underneath your Chromeo Impingement syndrome. Yeah. So you see all kinds of impingement syndromes throughout the body can happen in the hip, but it can definitely happen, like Ben said in the shoulder and specifically the muscle here, the tendon is from the muscle called the supraspinatus.

Dr. Ben Boudreau: [00:07:56] So if that tendon gets inflamed, you can call it supraspinatus, tendonitis. So there’s tendonitis that can happen. There’s bursitis that can happen in the shoulder. And definitely the impingement syndromes. We can always talk about the coracoid, which is another portion of the scapula there, the big round piece. Yeah. And you actually have a portion of your upper bicep that inserts on the economy as well. And so it’s a structure that we don’t ignore either.

When we start looking at the shoulder blade, the normal spacing sort of some space should be between nine and 10 millimetres. And so anything less than six is deemed an Impingement syndrome and could lead to a rotator cuff tear or a supraspinatus tear. Yeah. So if you have a lack of movement of your scapula, it can lead to these tears, which is what we aim to regain when we do our treatments. And I just want to say, attaching to this coracoid so cor-a-void

Dr. Clayton Roach: [00:09:05] Is also your pec minor. Right. So what happens when you’re sitting at a desk all day long and your shoulders around in your neck muscle starts to tighten up. It has no choice but to take this whole scapula, the shoulder blade and bring it forward.

Bedford Chiropractors Explain The Rotator Cuff

Dr. Ben Boudreau: [00:09:20] Then once it becomes chronic, you begin to develop what’s called muscle trigger points. And essentially, when the muscles get really tight, they elevate. So the muscles begin to get super sore and stiff. Then that’s what you believe is a shoulder problem. It actually becomes a neck problem, then becomes a biomechanical problem, which then becomes a muscle soreness problem. And so you think that you have this problem that’s right here in your shoulder? Yeah. The pain may be there right now, but we don’t chase pain. We go right to the source of the pain and shrink from there. The proper word is the rotator cuff. OK, so cuff means it envelopes the shoulder and there are actually four muscles in the rotator cuff.

Dr. Clayton Roach: [00:10:19] The first one, there’s one right here which is called a supraspinatus. There is Terry’s minor. There is the infraspinatus. And there is this subscapular sub meaning under the scapula shoulder blade underneath the scapula. So there are four of them. So those muscles, along with the others, control the movement that you have in your shoulder, whether it be flexion, abduction, adduction, internal-external rotation, all these movements force these muscles to glide independently and allow for that movement to happen. Any abnormal structure around the neck, forward head posture, right, and forward shoulder roll that affects the structure or lengthens muscle or creates any chronic pattern, eventually you will start to see a decreased range of motion and less motion comes degeneration.

With degeneration comes inflammation. With inflammation comes pain. And when pain is there, many people will do a lot of things to try to limit pain because the lack of pain people think is healthy. But that’s not always the case because you can stick a cortisone shot in there and make the pain go away. Your shoulder is not any healthier even though you don’t have pain. So just wanted to mention those four muscles. So go ahead, Ben.

Dr. Ben Boudreau: [00:11:48] And so that’s a great point there with the supraspinatus infraspinatus, Terry’s minor subscapularis rotator cuff muscles. And so it’s always best to treat the joint, which is what we do. So we start from the joints, allow the muscles to move to their full capacity. The muscles begin to relax because we’re removing any sort of average impacts the nervous system might be having on those structures. And so a lot of times people will still leave and they’ll still have these little leftover feelings of pain. And so we sort of just clean those up by doing a few trigger points.

Sometimes Dr. Roach and I will do some trigger points. That’s just to make the muscle calm down a little bit to really get the full impact of that adjustment. Yeah. Yes, so what we want is sometimes people show specific patterns of where the pain is.

Dr. Clayton Roach: [00:12:42] You can jump off the trigger point and work the muscle, but if the joint doesn’t have proper motion, that is always going to return.

Dr. Ben Boudreau: [00:12:50] And it was about to say and a lot of people, the shoulders, when you first touch the shoulder, when you first put your hands on the shoulder, the shoulder is is very difficult to move to begin with. And so it’s always best to start with something light. And so we like to go great for the joints in the mid-back, target the neck as well, and free up that, to begin with. See how the responses and then go from there because trigger point therapy from the beginning, if you were just doing that, can be a very painful process for a shoulder that hasn’t moved or it hasn’t been moving for a long time.

I had a patient not too long ago who saw a therapist for a shoulder problem and this just started digging into the shoulder and actually made it worse because upon checking that patient, there’s almost no range of motion in the shoulder. So, of course, the muscle is all going to be bound up because it’s protecting that joint. Right. So it’s like trying to get a bulldog that’s guarding a property to try to tame it down. It’s guarding it and muscle. That’s what they do. So if the range is not good in the joints on healthy, that muscle is going to definitely be tight and they’ll use words like, oh, it’s a rope and you’re all right. Well yes, of course, because that’s what the muscle is supposed to do.

Dr. Ben Boudreau: [00:14:07] Yeah. And so those muscles, these rotator cuff muscles are all stabilizers for that joint. And so the best thing to do is to just get in there, try and get a little bit of movement through the shoulder, through that back and through that neck and start moving it, moving it around. But the muscles generally are super tight. So try to avoid all that trigger point, the beginning. That being said, you know, to be able to diagnose something like a shoulder versus a neck is truly an art. And so you’ll often find me in practice generally. And Dr. Roach as well. We will do tests on the shoulder to help determine, OK, now is this truly a rotator cuff issue?

We have these special tests that we like to use or is this come from the neck? And often because we’re seeing a lot of shoulder cases because of our because of some of the things that we have going on right now, a lot of people are coming in. We get the shoulder X-ray and get the neck X-ray. It’s late I’ve been seeing a lot of neck issues and there is nothing wrong with the shoulder joint. So let’s ask a question, guys, and you’ve been with us for a while now. If a person has numbness, tingling into the fingers.

Bedford Chiropractors Compare Neck Pain VS Shoulder Pain

Dr. Clayton Roach: [00:15:30] Is the problem likely neck or is it likely shoulder? All right, just think about that. I want to give the answer. The problem? One of them likely cannot be the shoulder because there are no muscles in the shoulder to go down to the hand and whether the nerves come from they come from the neck. Right. So show me a thumbs up or a heart. Those of you who had that question correct, that it was the neck because that is really the only thing that can create symptoms in the hands because there are no nerves that originate in the shoulder. Right. So show me the love or the thumbs up that you got it right. So sometimes just by having more knowledge, you can start to ask the right questions.

Right. And that’s our whole goal with this, because oftentimes what’ll happen is you have micro-traumas sitting at a desk and your neck starts to be a problem. And now you start to have a shoulder problem because of your mechanics and now there’s numbness and tingling. So a lot of times people say, oh, my shoulder is going down to my hand. Well, it’s not the shoulder, it’s the neck. So some practitioners will go after where the pain is. And if your shoulder is more in pain in the neck, they’ll be treating the shoulder. But the problem is always, you know, you’ve got to trace it back in terms of where it started. So the neck is definitely in that case, the problem.

Dr. Ben Boudreau: [00:16:56] And it’s unbelievable to think about. Not unbelievable, I should say. It’s unbelievable. It’s believable. But, you know, when people like we have people come in and they say, you know, I’m having people I’ve never been able to adjust my shoulders a lot of pain or, you know, I’ve just had massage done, but it hasn’t really helped too much except a little bit. But the pain comes back a little bit after a while. And it’s unbelievable to see the results in people when you start releasing the neck and then people can begin to move that shoulder a little bit more and then you can start to get further down the chain. It all starts from the source, from the center of your body, the core. And once you release those segments, things start to get easier.

I had a patient come in this morning and for her initial appointment, I got her X-ray back. I was looking at it and she was like, I’ve got this pain right here and my shoulder isn’t great. And I look at her X-ray and she’s got these changes, degenerative changes all in the neck. And clearly, there was a reversal of that lordosis. Right. And so going back to slide. Right. And looking into the shoulder, there’s nothing there. So when you explain that to a patient, they say, well, how can this be? That’s when you have to work back and just say, you know, you’ve been stuck like this for a long time. The neck is not healthy right now.

The spine hasn’t been moved. It needs to be moved. And your muscles are compensating for something that’s happening here. And so that conversation is always difficult for especially new patients chiropractic to understand because they’re so used to people chasing their pain and where the pain is. No, where it started.

Dr. Clayton Roach: [00:18:39] And anybody can press on where the pain is and make it feel better for 15 minutes. That’s what can be done right. But to affect the cause takes a little bit of expertise. One of the things I want to mention, one golden nugget and then and I check many times people will say, you know, I’ve seen so many people for my neck problem, my neck is never good, OK? So, you know, I’m sitting there saying, well, do they all not know what they’re doing? Am I going to assume that they all did it wrong?

And I’m going to go after the neck again and try to redefine insanity because everybody is going after the neck. So my thinking is, what have they miss? It’s not that they don’t know what they’re doing. They’re probably great at treating the neck. But if the neck hasn’t gotten better, there’s got to be something else. That something else might be one of the joints that we haven’t mentioned tonight, which is your SC joint. OK, the SC joint is the only joint that attaches your arm to your spine. It’s the only one. OK, so what ends up happening is if this SC joint is not correct in its alignment.

Bedford Chiropractors Explain A Frozen Shoulder

Dr. Clayton Roach: [00:19:45] This whole shoulder neck complex will never stabilize. Show me the love, show me a thumbs up, because most of you probably did not know that. So if you have an unstable neck, you’ve gone too through a car accident, suffered trauma, have ongoing headaches, neck discomfort, even pain going down the arm, it could be your SC joint. So what we do is we tested through muscle tests and you will see right away that one is not as strong as the other. It could be the one that’s lower.

It could be the one that’s higher. That’s the problem. Whichever side that muscle test is weak, it’ll be that side. So if that side does lower, it means you have an inferior clavicle. If the side that’s weak is the one with the high side, it means you have a superior clavicle. Lack of movement here will create neck issues. So if your neck is not resolving, that is probably one of the culprits. Frozen shoulder. One more thing right on top of frozen shoulder, which is also called adhesive capsulitis. OK, so probably all of you have heard the word frozen shoulder. Adhesive capsulitis is a term,

Dr. Ben Boudreau: [00:20:58] Yeah, and so adhesive capsulitis frozen shoulder and its complete lack of mobility in the shoulder that oftentimes will come on seemingly at a random point. I just woke up one day and it was like this. And so it’s a very gruelling and painful condition that oftentimes takes quite a bit of time to eventually begin to thaw out. That’s what we. That’s what we turn the medical term for, for frozen shoulder. When it starts to get better, we say it’s in a thawing phase. Right. So it’s beginning to dissipate in the nerves are starting to finally calm down. They say that people who are at increased risk for a frozen shoulder, are diabetics.

And so if you diabetics in women. And so it’s you know, if you know that you’re predisposed for a condition like this, it’s probably best to start having the shoulder looked at and always keep that range of motion because it’s a condition that’s very tough to deal with. Yeah. Now that’s if it’s true, frozen shoulder. Some people think they have a frozen and they can’t move their arm. And it’s actually a little nerve that goes to the trapezius muscle that doesn’t allow you to be able to elevate your arm, which in that case, sometimes one neck adjustment gives you your full range of motion back. We have many testimonials like that, which is very, very cool. These people come in.

Dr. Clayton Roach: [00:22:18] They are doing this, they can’t lift their arm up, I had a guy, I think I told you there, they’ve been right three years, three years, physio, massage, one adjustment when he brings his arm back. So we actually caught it on video, which is really cool. And he was like, like, what is this? This is voodoo. I was like no this is the spine and looking at the cause of the problem. So that’s what is a good stretch for the SC joint. There’s really no stretch for a joint because it’s a joint. Right. So you’ve got to work the muscles that are around that joint and there are multiples that will allow proper movement, but it needs to be restored first. The movement needs to be given and then you maintain that area.

Bedford Chiropractors Discuss Thoracic Outlet Syndrome

Dr. Ben Boudreau: [00:22:56] Yeah. And so if I could say, you know, there are muscles that insert on that joint itself, you know, mainly you were talking about the clavicle. Right. And so the clavicle is the bone that’s going to be moving a lot more than your sternum, really. So you can just stretch your legs out, bringing that arm back into an extension to try and get that anterior movement of it as well. You can bring your neck to the side and up because a lot of your scaling will insert there as well. Yeah, and the scaling these muscles here on the side

Dr. Clayton Roach: [00:23:30] Actually can create numbness and tingling in the hand because when they get tight, they compress against the nerves and the vessels that supply the hand. And that can become a condition called thoracic outlet syndrome. So those muscles insert right in the clavicle. So people that have forward head posture like this. These scalenes are always on fire, you just push it a little bit and you’re like, we actually do that exam on people, so you just push a little bit and they’re like, yeah, it’s just because you’re pushing hard. I’m like, no, it’s because your head is forward and these muscles are always tight. So with the slight of my own pressure just creates a little what we call a doorbell’s sign and sends a zing down the arm. So definitely needs to be stretched.

Dr. Ben Boudreau: [00:24:09] The doorbell sign is one of them you know, it’s a quintessential test because it’s one of our key determinants in figuring out, OK, is this pain into the extremity, into the arm coming from the neck or not. And so TOS, one of the more common conditions that we do see in the clinic, especially C6 radiculopathy. With the pain in the three fingers here, we also see this pinky one as well. So determining if it’s coming from the neck, always doing the doorbell test, figuring out how tight these scales are. And just so you know, thoracic outlet syndrome TOS puts pressure on the vasculature as well.

So sometimes you’ll see cold temperature changes in the fingers because it does affect the vasculature as well. And anything putting pressure there can be a long rib. It could be pressure on the muscle. There’s a lot of things that can create that, including lung cancer.

Dr. Clayton Roach: [00:25:10] That can come into that space and create numbness and tingling into the hand. So, again, that’s our job, to be able to see those red flags, not yours to worry about, but for us to be able to detect that. All right. I think this was good.

Dr. Ben Boudreau: [00:25:26] Yeah, definitely helpful for a lot of people. I’m sure the neck is an interesting thing. The shoulder is complicated just by that virtue of having all those muscles inserting on there. So whenever you come in with a shoulder case, we’ve seen a lot of them lately. And we want to make sure that we’re giving the best care possible and that we’re reaching the fullest potential that your spine can get. That’s ultimately what’s going to help you get better. The fastest.

Dr. Clayton Roach: [00:25:57] Absolutely. Yes, so thank you guys so much for being live with us. We actually have quite a few people live tonight, which is great. You know, just we’ll just take a little pause here and just get you guys to take action right now and just share this episode if you please. Thank you.

Dr. Ben Boudreau: [00:26:15] Then why don’t you go ahead and include the Calendly link in case some of you share this episode and somebody wants to come in or whatever, and they have access to us through our calendar. And again, please share this episode. It will affect the lives sometimes of people that you don’t even know you’re affecting. But it’s all good karma.

Dr. Clayton Roach: [00:26:35] Love you guys, and we will talk to you next week, Humpday conversation number 19 tonight is closed. Closing thoughts.

Dr. Ben Boudreau: [00:26:45] Appreciate you guys continue to support and we look forward to talking to you guys again next week for your questions and thank you so much. Cool. Take care, guys, and see you next week.

Dr. Clayton Roach: [00:26:56] Bye-bye. What’s up? Listen, if you like this episode, you’ll probably like the other ones. Chances are pretty good. So here’s what you need to do. You need to like us and follow us on Facebook. Following means, you get notified when these two guys are alive. Next, family, friends, you need to share these episodes because you never know. You might help them because they need this information as well. And guys, if you ever miss an episode, make sure you subscribe to us on YouTube. That way, you can watch the episode over and over and over again. Guys, we love you and appreciate you. Take care.