We’ve all been there. We get shoulder pain and don’t know what to do about it. Maybe we try some stretches or put cold packs on it, but eventually, the pain goes away and we forget about it. But what if the shoulder pain keeps coming back? What if you’re an athlete and your shoulder is preventing you from performing at your best?
Or what if you’re just an ordinary person who wants to be able to reach up and brush their hair without feeling stabbing pains? There might be a different approach to healing shoulder pain that you haven’t tried yet. In this blog post, we will discuss some of the options available for treating shoulder pain and how a different approach might be the answer for you. Thanks for reading!
Shoulders are a very common problem.
I had shoulder issues when I was a teenager. I remember I was big into karate and volleyball. It took a few really bad hits unprepared, and I dislocated my shoulder, Eventually, we found out that I had a rotator cuff tear.
Now back then, the only solution was to have surgery. To this day, it still defines a 10 out of 10 pain on the scale because, for one, it was a tough surgery. And two, after the surgery was even a harder or longer period of recovery from the rehab.
It took six months to a year before I got back to where I was feeling normal and myself again.
Now, if I saw a similar patient today, I would take a different approach. I would try to help them get better or to a point where they can be functional and do what they need to do much sooner than surgery would otherwise do.
Imagine spending six months just having to deal with the physical therapy and not being able to move. That sounds terrible.
The regenerative method
If you think about it, when you have surgery, the doctors are cutting through all these structures in your body. Your body has to figure out which scars to break down and which scars will be helpful for the future. The only way for your body to do that is by doing exercises that stress the structures that are supposed to be loose and pliable while strengthening the ones that are supposed to be strong. If you can do all of that after surgery, imagine how much quicker you could accomplish the same without having surgery.
That’s what we do with some of our regenerative strategies. We can identify the cause of a tear by looking at it and then figuring out what we need to do to fix it. Sometimes we suck out or vacuum out some of the scarrings. Then we inject a product that will help your body stitch itself back together instead of relying on a surgeon’s deft hands.
Figuring out the tear
You might be wondering how we go about knowing if somebody might have a rotator cuff tear and further identifying the percentage of the tear.
We have seen a lot of shoulders that have tears in the rotator cuff muscles. Even if the shoulders are working fine, we can see the tears under ultrasound. This is because your body has been able to build up compensation for the tear.
There was a study I read once that found a link between age and rotator cuff tear. The study found that the older you are, the more likely you are to have a rotator cuff tear. But it’s not always a bad thing. sometimes your body can adapt to the tear and it won’t cause any problems.
Does this mean that when we’ve had all these patients scanned when they come to Wellward, they have to have a couple of thousand dollars for an MRI so that they can see what’s going on inside?
When we say scan, we’re using ultrasound to scan that shoulder. The advantage of that is that we’re able to look at structures in motion.
Dynamic examination vs MRI scanning
When you get an MRI, you’re in a stagnant position. They come over, put a nice pillow under your head, and position your shoulder in a nice comfy way. And then they put you in the scanner where you’re going to be in there for 45 minutes. So if it’s an uncomfortable position, you’re not going to be able to tolerate that for 45 minutes.
When we use ultrasound to look at someone’s rotator cuff, we can see where the pain is coming from. We can also see how bad the tears in the rotator cuff are. To do this, we move the ultrasound machine around and take pictures from different angles. This way, we can see things that sometimes even MRIs miss. It is hard to get a good picture of the rotator cuff, but it is worth it because it can help us figure out what is causing the pain.
I think a lot of people aren’t thinking about that when it comes to the imaging of their shoulder, that we need to have the tissue somewhat stressed to get a full understanding of the shoulder. This means if they’re in a comfortable position that doesn’t hurt, then that might show that there’s nothing wrong, almost in an MRI.
That is typically the case. If something is going on for a long period, the inflammation in that area can be a marker of a problem, but sometimes all of that settles down. You’re not able to see as much as you can under a dynamic examination.
Somehow it will make sense when someone may need an MRI scan, they would probably wait a good couple of months before getting one, This is because they would hope the pain would get better on its own. And it sounds like a lot of the major inflammation that would be a sign that there’s a major problem would be gone by then.
With two months, you’re probably still safe at seeing that acute injury. But if you’re talking about something that’s been going on for months or years, and we’re talking about a little bit harder of a problem to diagnose, and that’s why a lot of people will get the MRI, they’ll find some kind of a problem, like a rotator cuff tear.
But that won’t be the whole picture of what’s going on because oftentimes what’s happening is similar to a lot of our other joints. They’re held in place by ligaments and they’re moved with tendons and muscles. Now, if your ligaments are failing your muscles and tendons will help you move the joint. However, they’re not built for that kind of stamina. So over time, they can break down and tear. That’s what we see on the imaging. Some precursor problems that are also causing some issues that if ignored treating the rotator cuff alone, wouldn’t be enough.
For people who’ve got things like multi-directional instability of the shoulder or label tears, we may wonder why this isn’t fully taken care of during a surgical process in the main? It’s usually that the rotator cuff is the primary thing. And if there’s some instability in the shoulder, it somehow becomes left towards rehab to hope for the best.
This is often because those are the things that are most visible on imaging and they’re most accessible with surgery. Some of these structures are deeper inside the shoulder joint and it’s harder to reach those areas, therefore, it’s harder to repair.
Now when we’re doing an injection-based therapy as an alternative to surgery, what we’re doing is we’re targeting the structures that are both visible and dynamically unstable. We’re using growth factors or products that will help stimulate awareness that your body has ignored a problem or has somehow become complacent to this issue. It will reinstigate some of that irritation that your body needs to become aware that there is a structure that needs repair.
Coming into Wellward with chronic shoulder pain: what to expect?
We go with the H.E.A.L methodology. This is the framework we used for most of our issues. This starts with hearing the messages that your body conveys with pain. It’s not just about chasing what the imaging or the radiology identifies as the problem. It’s putting it in the full context of that individual and seeing if things make sense. Biomechanically, if you have a rotator cuff tear, it’s often an indication you have other problems on top of that.
Focusing on one issue is not going to fix the whole problem. Instead, it’s likely going to band-aid it. Eventually, you’re going to come back in a few months or years with a recurrence of the same problem. So, that is why we are starting with hearing the message your body conveys with pain and figuring out where the problems lie.
The second is envisioning goals. Oftentimes these things can derail you from the things that you want to achieve. It’s helpful to plan out what timeframe are we going to achieve those benchmarks to get you back to where you want to be.
Alleviating the symptoms comes next. We all know that recovering from an injury is not pain-free, the recovery part itself can be uncomfortable. We want to minimize the discomfort in that period.
And then finally, leveraging repair processes that your body typically has and using them to our advantage to stitch things back together without having to go in there and stitch it manually.
When we’re trying to leverage some healing, how is it that something that’s injected can fix a rotator cuff tear?
A lot of rotator cuff tears heal on their own. This is because your body needs certain growth factors and it needs to be stable. When we give you injections with growth factors or PRP (platelet-rich plasma), we are using medications like prolotherapy or even bone marrow aspirate. This has a high concentration of cells that help repair the tear. What we are doing is helping your body create the stability it needs to heal itself.
Sometimes what happens is that your body will layer down scar tissue in the place of a healthy tendon. And that scar tissue will be strong enough to hold things in place, but not strong enough to hold them in place when you’re under maximum stress, like when you’re moving your arm.
We intend to break down those scars and generate a signal that invites your body to bring in cells that will do the repair process or, or encourage the stem cells in your body that just reside in the periphery, for them to go into active mode and start stitching things back together on their own.
What about the older individual who has just a ton of scar tissue along a torn rotator cuff and who does not want to have that surgery again? What can be done for that?
There’s a lot that can be done even without surgery to just break down scars. If we’re not able to do it with injections, there’s a procedure called the tenotomy, where we use a probe that’s comparable to a vacuum cleaner that sucks out the scar. And then once that scar is out, now we can use our regenerative products or exercises to give your body the incentive it needs to build in that healthy tissue instead of that broken-down scar.
We have seen this work successfully. If this had been known as an available option for healing shoulder pains in the past, we would gave recommended starting with physical therapy and exercise. From there, we can see how much progress you can make. If it’s not advancing at a certain pace, then look at either doing injections to instigate further repair or move into that tenotomy procedure that will suck out the scar tissue and couple it with regenerative therapies that will accelerate that repair process.
Usually about four to six weeks after each procedure, you’ll see a significant improvement. So if we’re doing them back to back, sometimes we’ll couple them within a few weeks apart. This way, within four to six weeks of the second procedure, we should start seeing significant strides forward.
If you’re experiencing shoulder pain, don’t despair. There is a different approach to healing that just might be the answer for you. At Wellward, we specialize in helping people recover from injuries through our regenerative approach. We use dynamic imaging to help figure out the extent of your injury and then employ our unique HEAL methodology to help you heal quickly and completely. We’re excited to help you get back to doing what you love without shoulder pain holding you back. Have questions? We would be happy to schedule a free discovery call with you so that we can discuss how our process could help you heal quickly and completely.
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