So, your shoulder hurts. It’s been hurting for quite some time now, and instead of just being a normal ache and pain, it’s starting to get in the way of your life. Maybe it’s causing a hitch in your golf swing and you aren’t hitting the ball as well.
Or maybe you aren’t into sports but it’s to the point where even lifting up your arm for a morning cup of coffee is starting to bother you.
Or are you a fitness enthusiast who’s shoulder pain is a real pain as it is getting in the way of your workouts?
Whatever it is, my goal here in this blog is to talk about our experiences with people with shoulder pain and how you can navigate the complicated and confusing world of healthcare in order to get the best results with the least amount of burden to your precious time and resources. It can be a complicated maze, but strap in and we will simplify it for you!
When your shoulder initially started hurting, did it happen because you fell on it, ran hard into a doorway, or did it come on gradually, almost as if one morning you just woke up and starting noticing it? If you had a traumatic accident to that shoulder, then getting checked out medically (Primary Care MD, Ortho Urgent Care or Orthopedic MD) is a good first step, especially if your shoulder is not improving in the first few days after the accident. You will want to make sure there is not a fracture.
However, most folks will have had something happen gradually over time, without a specific mechanism of injury, and getting imaging first is actually more than likely a waste of time and money…to the tune of at least $2000 flushed down the toilet!
Before going any further, if you don’t think it is a fracture, go to a Physical Therapist for your shoulder pain and it will more than likely save you $2000 not to mention the weeks of pain before you recovered.
OK, continuing on, almost everyone has heard the general advice of taking some ibuprofen or putting ice (or is it heat?) on the painful area. Listen to our podcast on the debate of heat vs ice. For some people that might work, but generally speaking, these type of “fixes” aren’t really fixes at all. They will simply mask the symptoms you’re experiencing until you go right back to those same activities that caused issues in the first place. The problem with this approach, even if it fixes your pain, is that the tissue is still going to be more like beef jerky at the end of the day compared to filet mignon. If you don’t address making the tissue healthy again, your likelihood of reinjury is HIGH!
All you did was put a bandaid on it, you didn’t actually make your shoulder any better. It is still in bad shape, it just doesn’t acutely hurt right now.
Ok, so heat (or is it ice?) didn’t work well for you, and this pain is becoming even more nagging and starting to bother you on a daily basis, not just during certain activities. Now, it’s hard to carry your groceries around, or getting a seat belt on causes your arm to hurt the rest of the day. It’s probably time to get this checked out, right?
This is where healthcare the way it’s designed in the USA can get confusing. Who is the right medical provider to go see first? There are so many different options, but the most important part is knowing who will get you feeling the best the fastest and for the best price; this is where the system fails so many people.
You might go to your primary care physician, which, in the case of an accident or incident that set off this drastic pain, can be a good first step to rule out fracture. From there, you might get a referral to an orthopedic surgeon, which will now create more cost burden to you, as well as long wait times and other hoops to jump through.
I want to pause for a moment to mention that unless you are planning on having surgery, the orthopedic surgeon is the LAST person you want to see! They trained for many years to become experts at one thing – cutting. If you don’t want to be cut, either go to a Physical Therapist or a non-operative Orthopedic Doctor.
You might get referred for an X-ray or an MRI, which, again, in the case of a traumatic accident, are good to use in order to rule out broken bones or irreparable tears. However, this is another cost (often between $2000-$4000), another appointment you need to make, and more time spent in waiting rooms, waiting for your results to be read, and more time in pain. From there, you might get recommended for a surgical procedure (really talk about costs!) or you might get a referral to a Physical Therapist.
During your wait for all this to happen (over about the course of a month), maybe you sought out a massage therapist or chiropractor (more costs, and more time) and got some relief, or maybe your pain got worse. Especially in the case of non-traumatic accidents, it’s easy to see the giant cost and time burden this process creates, with little to no relief along the way.
Here’s one of the biggest kicks in this whole process – we expect that expensive MRI and/or X-ray to give us all the answers. A ton of recent research disputes that fact though. Chances are, if you’re over the age of 40, your MRI will come back as “positive” for tears, bone spurs, lesions, and all sorts of other scary-sounding things in areas ou don’t have pain!
These studies take an interesting twist on things as they put people through MRI’s and find these “issues” and yet those people are NOT IN ANY PAIN! In fact, one study found that 23% of patients over the age of 50 who had no shoulder pain had significant tears in their rotator cuff (Tempelhof et al, 1999)!
Another interesting study found that in a group with full-thickness rotator cuff tears, twice as many people had no pain than did have pain (Minagawa et al, 2013). A final aspect of these studies is that age has a huge impact on whether these tears show up in your MRI – in a final study, 54% of a pain-free group over the age of 60 had full-thickness rotator cuff tears (Sher et al, 1995). Again, this group had no pain or functional limitations!
Let’s go back to your first decision and change things up to see if we get a different outcome. Let’s start with who to go see first.
For the vast majority of shoulder pain, there is a heavily muscular component to it. There are so many muscles that are important to healthy, pain-free movement of your shoulder, and sometimes they get tight, irritated, or don’t work as well as they used to because of the activities you do and/or don’t do on a daily basis.
When was the last time you carried something heavy over your head? When was the last time you were able to do a push-up, or 10? These are all functions our shoulders are designed to accomplish, and things don’t go well if we lose the ability to perform our shoulder’s designed tasks. Physical therapists are the experts in human movement, and are trained in ways to decipher the cause of pain, decreased strength, and decreased motion in your muscles and joints without expensive imaging.
Physical Therapists’ are also thoroughly trained to recognize when another medical provider may need to enter the mix. Go back to the case of a nasty fall onto your shoulder – it might be broken, in which case an X-ray to rule out a fracture would be the best thing to do! However, if there was no traumatic incident, there is an incredibly low likelihood that the bones are damaged, in which case an X-ray or MRI will not tell us any useful information and is simply an expense of your time and money.
The trick here is finding out which Physical Therapists provider may be the best for you. You might ask your friends or family (just like you might have done to choose a surgeon or physician to consult with), you might do a quick Google search, or you might ask your primary care what their recommendation might be. An important part of this process is finding a provider who understands the demands of your hobbies or activities, and who specializes in orthopedic issues.
At Par4Success, not only are we experts at treating injuries brought about by rotary sports, such as golf or tennis, but also with any active individual with a muscle and/or joint issue. Our one-on-one model of care guarantees that you get the best results, including a proper referral should we not be the best medical provider for you to see.
To cap it all off, ,we 100% Guarantee your results! If you do not get any better, while we can’t give you your time back, we can give you your money back. We haven’t had to do that in over 7 years since starting, but we stand by our promise to you!
Tempelhof, Siegbert, Stefan Rupp, and Romain Seil. “Age-related prevalence of rotator cuff tears in asymptomatic shoulders.” Journal of Shoulder and Elbow Surgery 8.4 (1999): 296-299.
Minagawa, Hiroshi, et al. “Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village.” Journal of orthopaedics 10.1 (2013): 8-12.
Sher, Jerry S., et al. “Abnormal findings on magnetic resonance images of asymptomatic shoulders.” JBJS 77.1 (1995): 10-15.