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"Your body is controlled by the innate intelligence of your nervous system, created by God and helped naturally by chiropractic care."
--Rick Allen, D.C.

August/September 1999 Newsletter

This Issue:

Conservative Treatment of Shoulder Injuries

The shoulder is a very complex joint. Its design allows tremendous range of motion, such that we may perform such activities as dancing, swimming and baseball. Unfortunately, it is a relatively unstable joint and is often subject to injury.

Shoulder overview drawing

Functional Anatomy

The primary joint of the shoulder is the glenohumeral joint, composed of a ball and a shallow socket. Adjacent to this is the acromioclavicular (AC) joint, composed of the outer end of the acromion, which is the most upper outer portion of the scapula or shoulder blade, and the clavicle or collarbone (Figure 1).
Rotator cuff overview drawing

Holding the joint together are various muscles, ligaments and the joint capsule. A group of four muscles called the rotator cuff runs from the scapula to the upper arm: the supraspinatus, infraspinatus, teres minor, and subscapularis (Figure 2). Three large muscles that attach to the chest create much of the shoulder's powerful motion: the pectoralis, latissimus dorsi, and teres major. The tendons of biceps muscle also attach the arm to the shoulder. Several sac-like bursae cushion the shoulder joint.

Common Problems

Because rotator cuff muscles and their related tendons pass underneath the acromion, they may become pinched and irritated, especially when the arm is raised (Figures 3 and 4), causing rotator cuff tendinitis and related problems and the extremely disabling "frozen shoulder". The biceps tendon, because of its intimate involvement with the rotator cuff muscles, can also be irritated and, at times, can rupture. The subacromial bursa, which lies between the rotator cuff and the acromion, often becomes inflamed when the rotator cuff tendons are involved. A common problem of the upper back that may cause pain that radiates through the shoulder and down the arm is a subluxation of the upper ribs. Associated trigger points in the muscles adjacent to the spine and shoulder girdle make the problem worse. The pain, muscle spasm and guarding may be so severe that you cannot raise your arm over your head.

normal rotator cuff drawing pinched rotator cuff drawing

Non-Surgical Treatment

Conservative, non-surgical treatment for such problems has three phases: reducing inflammation, mobilization, and rehabilitative strengthening of the shoulder. In painfully acute cases, I suggest first reducing inflammation with a combination of rest, anti-inflammatory herbs, and ice massage for a few days. Because of their well-documented negative side effects, I recommend patients avoid anti-inflammatory drugs, such as ibuprofen, or steroid injections unless absolutely necessary. Once the acute inflammation is under control, I start mobilizing the shoulder gently through various ranges of motion to prevent stiffness, but not moved so much as to aggravate the inflamed and slightly torn tendons. I will often use special active release techniques to eliminate the fibrous adhesions that form under the shoulder blade in the subscapularis muscle. Oftentimes, I will work in concert with an acupuncturist to further release the muscles and connective tissue of the shoulder girdle. Since spinal problems often accompany shoulder injuries, I will massage and adjust the spine as well. As the patient's range of motion is increased, I will start rehabilitative exercises to strengthen the injured tendons and muscles. All along, I encourage patients to continue alternative exercise that maintains their overall strength and aerobic capacity, but avoids aggravating the shoulder injury. Prevention Prevention is obviously the best strategy. Good stretching exercises for the arms and shoulders are recommended prior to participating in athletics. Proper technique also helps prevent injury--check with your coach. If you start to develop significant shoulder pain, refrain from activity that causes the problem at least for a few days and try to do only stretching and strengthening exercises.

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Conservative Treatment Of Shoulder Pain

Guest column by Paul Puziss, M.D.; Orthopedic Surgeon, Shoulder Clinic of Portland

aul Puziss, MD, Portrait

There are many causes of shoulder pain, some traumatic, some due to aging, and others to disease processes. Traumatic injuries such as severe sprains, rotator cuff tears and dislocations may require surgery, but many shoulder conditions can be quite adequately treated with conservative measures, as Dr. Allen discusses.

Conditions that may well respond to non-surgical approaches include rotator cuff tendinitis, bursitis, calcium deposits, mild arthritis, weakness and postural problems. These problems are frequently treated with physiotherapy, including massage and adjustments, alternating ice and heat, ultrasound, cortisone phonophoresis, and a significant strengthening program. Anti-inflammatory medication can be taken either over-the-counter or by prescription. Bursitis and calcium deposits can often be removed simply using injections of cortisone and local anesthetics. Sometimes the use of DMSO with or without cortisone gel over the acromioclavicular joint on the top of the shoulder can be quite helpful. Cortisone injections can be also placed in the AC joint. Most often these types of conservative treatment are successful.

Spinal problems can be a cause of shoulder pain including such diagnoses as herniated cervical disc, facet syndrome (pain in the small joints), neck strain, arthritis. Spinal adjustments can nicely treat most spinal problems.

Sometimes TMJ pain (jaw joint pain) can be a cause of neck or shoulder pain and may need to be treated by a dentist. Some shoulder problems must be treated surgically.

These include rotator cuff tears, severe arthritis of the shoulder or AC joint, dislocations, loose bodies or other severe problems that fail conservative treatment, such as frozen shoulder.

In summary, except in certain cases of severe problems that demand surgical repair, many problems of the shoulder can be quite successfully treated with conservative care. Surgery must always be the last consideration.

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Remember Matthew Miller?

Matthew Miller, Portrait

In the last newsletter Matthew was shown on the Regainer Table, a special new table I purchased to help patients regain their posture. Matthew has successfully completed the intensive phase of care. Follow-up x-rays of his neck after ten weeks of care show a dramatic improvement of the curve--close to ideal correction. He continues to be headache free. Matthew will continue daily exercises at home and CBP treatments 2x/month at my office to maintain gains he has made. He will be re-evaluated in three more months. At that time he may elect to resume the intensive care for about six weeks. It's my estimate of what's needed to complete the ideal correction of his cervical curve.

(Almost) Perfect Posture

On the left is an x-ray of Matthew when he first came to visit me. In the middle is a recent x-ray, after his intensive 10 weeks of care. On the right is an x-ray of perfect posture, the goal.

x-ray 1, before x-ray 2, after 10 weeks x-ray 3, textbook goal

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Injury Care to Wellness Care: Erin Cason's Shoulder

Erin Cason and bike Bicyclist Erin Cason had a partially frozen shoulder since the Spring of 1998 that restricted her range of motion, created a dull ache in the shoulder joint and upper arm, and occasionally produced sharp pains associated with snapping of the shoulder. When we met in September, 1998 on Cycle Oregon, I told her "I think I can fix that." Despite her skepticism, Erin agreed to let me try. She appreciated the combination of deep massage, electrical stimulation and chiropractic adjustments. I found Active Myofascial Release Techniques particularly effective at freeing the adhesions underneath the shoulder blade. Erin also appreciated the extensive educational resources and suggestions for improved lifestyle. In fact, she told at least 20 other folks about her experience and has become a regular wellness care patient.

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Health Tip

Keep well hydrated...Drink Up!

Especially during the heat of summer, drinking plenty of water is imperative! Loss of body water equaling just 1 to 3% of the body weight will have an adverse effect on athletic performance. You may even get to the point of having weak knees and a foggy brain from heat exhaustion. Worse yet can be heat stroke, when the body's sweating shuts down in an attempt to conserve water and the body temperature rises quickly to a dangerous level. For a list of water-health tips: visit the tips page on my website or call me at 503/257-1324, I'll mail or fax one to you.

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Don't Forget Dr. Rick's Resource Center

All books and videos loaned free of charge. Some titles available for purchase.

Want to eliminate heart disease, osteoporosis, and arthritis?

"Understanding The Science Behind Vegetarian Nutrition" Michael Klaper, M.D., has created this compelling video, reviewed and recommended by one of my patients, Mary Lou Griffith. Good nutrition means good health. I've added the entire nutrition collection of videos and books by the American Natural Hygiene Society.

Have you noticed the soothing music in my treatment room?


"Healing Power of Mozart" It's Mozart, arranged by Don Campbell, author of "The Mozart Effect." Thanks to one of my wellness care patients, Hope Hadley, I learned of Campbell's research documenting that baroque music--in particular Mozart--helps to heal, inspire creativity, and improve intelligence.

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Wellness Care Options:

Choose your care, or we can decide together what is best for you now.
Chiropractic adjustment
Nutritional, exercise suggestions
Up to 45 minutes

Chiropractic adjustment
Brief massage
Brief self-care suggestions
Up to 30 minutes

Chiropractic adjustment
Up to 20 minutes
Dr. Allen lectures about wellness and other health-related topics. To attend a talk, or have him talk to your group, please call 503/257-1324
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