Kevin, a 36 year-old male presented to our office with a complaint of right shoulder pain. The pain had been present for approximately 4 months and had begun to significantly affect his normal daily activities. He felt the pain when he reached to lift something out of the refrigerator or back seat of his car, and even felt pain when getting dressed in the morning. However, the thing that was most significant to him was how the pain hindered his workouts. He was unable to perform many of the exercises he enjoyed, was very frustrated, and becoming depressed about the situation. He had tried rest, NSAID’s, and his doctor had given him a steroid injection, all with little or no perceived benefit.
Upon inspection, we noted that his shoulders were rolled forward (protracted) and that he had a forward head posture. His musculature was well developed and symmetric. However, his muscle lengths were out of balance. He had a shortening and tightening of his chest muscles (pectorals), back muscles (latisimus), upper shoulder muscles (upper trapezius), and occipital muscles bilaterally. We also located a trigger point in the muscle under his right scapula, which was very tender to palpation. Shoulder and spine ranges of motion were somewhat limited due to spinal restrictions and the associated tight musculature. Shoulder x-rays were unremarkable, but neck x-rays revealed a complete loss of the normal curve of his neck.
When discussing treatment options with him, we learned that he was interested in correcting the condition and preventing its return. In order to accomplish that, we needed to address each of the contributing factors. Ultrasound and transverse friction massage was performed directly to the inflamed tendon. The patient was given instructions to perform ice massage to the area at home, stretches to address the imbalance of the associated tight muscle groups, and strengthening exercises for his rotator cuff. Manual trigger point therapy was performed directly to the right sub-scapular muscle. Chiropractic adjustments were also performed to the restricted spinal joints.
After 4 weeks, Kevin noted a significant improvement in pain and function. He rated his improvement at 50%. After 8 weeks, his symptoms were gone and he returned to his normal activities.