Shoulder Pain

The shoulder is a ball and socket joint connecting the upper arm to the torso. On the upper back,
the scapula (shoulder blade) and its four related muscles (taking the acronym “SITS muscles”) form
the rotator cuff that provides the muscle tension neccessary to rotate the upper arm. These muscles
are prone to overuse causing early degeneration. From a physical, western medical perspective
shoulder pain is caused by an injury such as inflammation, strains, impingement and tears to the
muscles and tendons of the shoulder joint and rotator cuff.

In a younger, active person, these injuries are often due to repetitive use: frequent repeating of a
particular movement when playing sports or during manual labor. As we age the body weakens.
The muscles, tendons and ligaments that join the bones and provide movement become less elastic,
strong and flexible. The body becomes less resilient and has a more difficult time repairing itself.
Therefore, seniors are especially prone to injuries of the shoulder and other joints such as the back,
hip or knee, due to weakness of the structures in these joints.

Progressive rubbing contacts of muscles, tendons and ligaments against bones cause inflammation
and swelling called “itis”, as in tendonitis (inflammation of the tendon) or bursitis (inflammation of
the joint capsule, or ‘bursa’). In this case, the body has sent an increased amount blood to the area
with high numbers of white blood cells to attack and destroy the pathogens causing tissue damage.
Increased blood in the area produces the accumulation of heat, a key feature of these various ‘itises’
(inflammations).

Standard, western medicine addresses shoulder and other joint pain in one of three ways: physical
therapy to strengthen and aid the rebuilding process to the damaged structures, drugs to block the
sensation of pain, and surgery to repair severely torn muscles, ligaments or tendons.

Chinese medicine (acupuncture, Chinese herbs and other related modalities) takes a holistic
approach to treating the injured tissue. The body is able to spontaneous heal without outside
intervention. We see this healing process at work with cuts, bruises or simple strains, colds and
flu’s. There are times when the injuries and disease processes become too complicated for the body
to resolve on its own, causing us to seek outside intervention from a healthcare practitioner.
Chinese medicine is able to signal the body and tell it what it needs to do to repair itself.

Acupuncture points have different functions. Analgesic points are effective for stopping pain. Others
circulate blood, sending nutrients to strengthen and repair the damaged tissues. Local points direct
energy and treatment to the affected area. They are combined with points having functions to treat
tendons and ligaments and affect specific areas such as the shoulder, neck or back.

Chinese medicine uses herbs instead of drugs to treat conditions both internally and externally, with
topical applications. Like acupuncture points, the herbs also have specific functions for treating
injuries and disease. Some herbs strengthen the body and build blood, useful for injuries due to
weakness of the tissues. Others affect circulation, moving blood and draining fluids, useful for
treating edema, swelling and bruises. Herbs that clear heat are used to reduce inflammatory
processes. Some herbs can stop spasms and contractions of the muscles. Herbalists may use
internal herbal formulas, or external plasters and liniments. Special ‘hit medicines’ were developed
over a millennium ago for treating injuries sustained while practicing the martial arts.

So how effectively does acupuncture treat shoulder pain? A 2004 study published in Pain magazine
answered this question. 130 patients with shoulder pain (cuff tendonitis, capsulitis, etc.) received
either 8 weekly acupuncture treatments or 8 sham treatments. A blinded and independent assessor
checked progress at seven weeks, three and six month intervals using the scientific standard: visual
analogue scale (VAS). After 7 weeks, VAS score fell by 43% in the acupuncture group compared to
20% in the control (sham acupuncture) group. The improvement was maintained in the three and
six month interval assessments. Similar improvements were shown in the pain and disability, range
of movement, pain medication consumption, quality of life and Lattinen Index scores.1

Let me illustrate the effectiveness of Chinese medicine in treating shoulder pain with a case study. I
was approached by the mother of a young woman who had been experiencing shoulder pain for five
months, beginning when she entered college (I’ll call her Mary). The pain began after a stress
related, emotional episode caused Mary to lose consciousness. She awoke to the first onset of pain
that began in the rhomboid muscles of the upper back, by the shoulder blade (scapular area) and
radiated down the outside of her left arm, causing a prickly, pins and needles type of sensation
(paresthesia) from the elbow to the pinky finger. Mary was an active female, and a member of her
college lacrosse team. Owing to the stress of college life, Mary was frequently tense and irritable,
erupting with angry outbursts.

Four months previous, Mary was seen by a doctor who ran a number of scans and diagnostic tests,
none of which showed a structural problem or nerve damage that would explain why Mary was
experiencing pain and paresthesia. The doctor prescribed medications and physical therapy. After
four months of weekly physical therapy sessions with no improvement, the doctor ordered an MRI to
find the cause of the pain. The MRI scan came back normal. The doctor theorized that due to
frequent stress and tension Mary was tightening her muscles causing the nerve impingement. When
we are under stress, we tend to tighten the muscles of the upper back. The mid-back and rotator
cuff muscles had become weakened by repetitive use from years of playing lacrosse. Excessive
tightening the muscles due to stress became the proverbial straw that broke Mary’s back, producing
the nerve impingement. The doctor offered treatment options of acupuncture, trigger point
injections or electric shock treatment. Mary’s mother wondered if acupuncture would help.

I suggested weekly acupuncture treatments, and prescribed a topical herbal liniment to address the
pain. After two days of using the liniment, Mary’s noticed improvement in symptoms. After two
acupuncture treatments, Mary reported that she was less irritable and that her shoulder was much
improved. She had no elbow pain and rarely noticed the paresthesia sensation in her lower arm and
pinky finger. After four acupuncture treatments, Mary no longer had any pain in her left arm or
shoulder. At both the four and eight month follow-ups Mary reported that the pain had resolved and
there was no recurrence of symptoms.