Do you know chiropractic can help with shoulder pain? Shoulder pain affects 42% of office workers in Singapore and only 50% of shoulder pain fully recover within six months. Perhaps you are suffering from a frozen shoulder and have tried physiotherapy or other chiropractic treatments to no avail. The situation is pretty bad. Today we share with you why that might be the case. (No, it’s not your fault.)
Singapore #1 Tennis Player Roy Hobbs seeking chiropractic treatment for shoulder pain. Do you know chiropractors can also help with your shoulder pain?
Shoulder pain is complicated
It may not be obvious to most of us but shoulder pain is pretty complicated. There are different types of shoulder pain resulting from different types of shoulder problems making shoulder pain diagnosis particularly tricky!
According to a paper published by Lewis (2016), clinicians must be able to determine:
- If the pain is coming from another area rather than the shoulder itself, i.e. cervical spine (neck)
- If the pain is the result of a stiff shoulder, i.e. frozen shoulder, dislocation, osteoarthritis
- If the pain is due to excessive movement, i.e. shoulder instability
- If the pain is coming from the soft tissues in the area, i.e. rotator cuff syndrome, supraspinatus tendinopathy
- If the pain is due to a combination of all of the above!
Let’s face it. This is a lot of considerations!
Poor Quality of Care in Singapore
It also doesn’t help that the standard of musculoskeletal care in Singapore is pretty low. Despite the overwhelming evidence supporting exercise as a more efficacious intervention, most therapists in Singapore still offer manual therapy as a core modality to treating musculoskeletal pain. Research has shown that the focused on damage or painful tissue doesn’t make sense because shoulder complaints frequently outlast the time needed for the damaged tissue to achieve full healing (Lewis, 2016). We really cannot emphasis enough that pain doesn’t equal damage. If you have a difficult time getting your head around that, check out our car alarm analogy at Why We Choose Exercise: A Chiropractor’s Approach to Pain.
Remember, best evidence suggests exercise therapy. If you had received exercise-based treatments and are still not getting better, drop us a message. We promise to help you figure out why.
Psychosocial factors are not addressed
The biggest reason why manual therapy-based treatments fail is their failure to consider psychosocial factors. From running injuries to lower back pain and even shoulder pain, research has shown that psychosocial factors have a crucial part to play in the recovery process. How often do other chiropractors and physiotherapists address them? My guess is not very often. This is why people are not getting better!
To make the matter worse, therapists in Singapore are often guilty of negative framing musculoskeletal pain patients. For example:
- Your shoulders are very tight.
- You have to stop sleeping on your side.
- You won’t be able to go back to kickboxing anymore.
- Crossfit is bad for your shoulders.
- You need to come weekly if not next time -insert appropriate fear mongering strategy-.
- This is the worst shoulder I’ve ever seen.
- You will take a very long time to get better.
None of the above are evidence-based advice. In fact, they worsen their patients outcomes! In a study just published last year, positive recovery expectations and self-efficacy is linked to improved treatment outcomes.
Pain Education is severely lacking
What we really should be talking more about is the importance of education. We mentioned it for the first time in Why We Choose Exercise: A Chiropractor’s Approach to Pain. The reason is simple: You can’t give a person long-term pain solution if they don’t accurately understand pain and how it works.
Because pain is complex and multifaceted. It is not just a mere case of “I am injured therefore I am in pain.” Your pain experience is a sum of your bodily sensory inputs, your prior experiences, and the current environment you are in. Therefore, contextual factors and how you interpret pain actually makes a difference to your recovery. Sounds confusing? Check out our earlier posts on pain at:
- Why Your Pain Hurts: A Bayesian Approach to Pain
- All You Need to Know About Pain: Elite Athlete Edition
The role of pain education is to avoid or reverse maladaptive emotions, unhelpful cognitions or behaviours. The only way this can happen is through education. When was the last time a healthcare provider sat you down to talk to you about pain? I am guessing it has never happened before. This is why you are not getting better.
How to find a good chiropractor for your shoulder pain?
We were afraid you’d never ask!
- Always choose an evidence-based practitioner. It doesn’t matter if the person is a chiropractor, physiotherapist, or osteopath. He/she HAS to be evidence-based or you are just wasting your time.
- Exercise is the core component of your treatment. The first-line of treatment for musculoskeletal pain is exercise. Shoulder pain is no exception! If your choice of provider does not offer exercise as the main treatment, you really should be cutting your losses and go elsewhere.
- Education is the core of your treatment. Education should cover all of the following aspects:
- The nature of the injury
- Pain and influencers of pain (what pain is and what pain is not): check out Why Your Pain Hurts and All You Need to Know About Pain
- Risk factors that affect your injury from an evidence-based approach: check out Five Reasons Why Your Shoulder Might Be Hurting
- Fear avoidance
- Pain catastrophising
- Manual therapy is only used as an adjunct. While manual therapy hasn’t been demonstrated to deliver long-term results in cases of musculoskeletal pain, it is not entirely useless. Most international guidelines do provide for the use of manual therapy as an adjunct treatment to be used in conjunction with exercise. We think manual therapy may influence pain experience through the modification of contextual factors. Again, it is not your long-term solution. No, we don’t believe you should resort to manual therapy unless it is indicated for.
- Avoid places that glorify manual therapy and sells it as the solution to your “tight muscles”. In our past blog posts, we have highlighted that IASTM (including Graston) doesn’t work and that chiropractic adjustments are only good for short-term changes. If your choice of therapist tells you manual therapy is the gold, he/she is either lying to you or just plain outdated with current research. You should find a new therapist.
Sure, there is no doubt shoulder pain are difficult to deal with. No, that does not mean you shouldn’t try to get better. We do know from research that under the chiropractor’s guidance, your chances of getting better dramatically improves.
For more readings check out:
- Seven Reasons Why We Are Not Your Regular Chiropractor
- How Much Does It Cost to See a Chiropractor in Singapore Chiropractor Singapore Price