Shoulder injuries are no laughing matter. They can seriously inhibit daily activities and lead to a lot of pain besides. Chiropractic care for shoulders is the best way to avoid pain and keep yourself healthy and strong.

Chiropractic for Shoulders

While many people think that chiropractors only treat the spine, the truth of the matter is that chiropractors have a keen understanding of both the skeletal and nervous systems and can provide relief to other areas of the body. 

The shoulder is the body’s largest joint and is very complicated. This allows it to provide such a wide range of motion. Shoulder injuries are common because the joint is so intricate and is put to such frequent use. They often follow sports or other athletic activity, vehicular accidents, and even sitting at a desk.

Shoulder pain can seriously disrupt your daily quality of life, and you do not simply have to grin and bear it. Chiropractic care can correct shoulder injuries naturally without the need for surgery

What Shoulder Injuries Do Chiropractors Treat?

Shoulder injuries manifest in many different ways, but these are some of the most common:

• Frozen shoulder—Technically termed adhesive capsulitis, frozen shoulder results in thickened and tightened connective tissue near the shoulder joint. Frozen shoulder commonly occurs after shoulder injuries and limits the joint’s range of motion. 
• Arthritis—Arthritis is a common condition in adults, with a recent conservative estimate indicating 54 million cases in the United States. The symptoms are inflammation and joint pain. Some strains of arthritis, i.e. rheumatoid arthritis, are the result of autoimmune disorders, while others like osteoarthritis follow common wear and tear.
• Tendonitis—Tendonitis of the shoulder leads to irritation and inflammation in the rotator cuff tendons or biceps. Tendonitis most commonly affects those whose work includes repetitive motions, not excluding practicing athletes. Tendon injuries are notoriously painful and slow to heal.
• Bursitis—The bursa is a fluid-filled sac which is designed to protect the tendons. Inflammation or irritation of the bursa is referred to as bursitis. It can result in pain and serious restriction of the shoulder joint and can even be a precursor for frozen shoulder.
• Pinched nerve—Pressure on the nerves in the neck or shoulder (perhaps as the result of another condition) can lead to pain, numbness, and tingling in the upper extremities.
• Rotator cuff injuries—The rotator cuff is a group of muscles and tendons that surround the shoulder joint, attaching the humerus to the shoulder blade and facilitating the lift and rotation of the arm. Injuries to the rotator cuff include everything from mild irritation to sprains to serious tears. The injury can come on gradually with regular wear and tear or result from a trauma like the collision of a vehicle or another athlete.
• Dislocation—Dislocated joints can follow heavy impacts. When the dislocation is in the shoulder, the humerus pops out of the glenoid cavity. The subsequent pain is sharp, and if the nerves are pinched in the impact, numbness may follow. An AC joint subluxation describes a partial dislocation of the shoulder. Once a bone becomes dislocated, the risk of future dislocation is significantly higher. 

How Does a Chiropractor Fix Shoulder Pain?

Once a chiropractor has determined the source of shoulder pain, then it is time to get to work. A chiropractor understands that shoulder injuries often stem from other physiological issues, even in other locations like the spine. Damage to the neck or even rib cage can lead to pain or discomfort around or in the shoulder. A chiropractor treats the body like the interconnected system that it is, offering holistic relief. 

A chiropractor focuses on overall wellness, not just relieving pain. If pain in the shoulder is caused by misalignment to the spine or neck, perhaps the result of a car accident, your chiropractor can adjust the alignment, restoring proper nerve, skeletal, and muscular function for overall relief. 

This holistic approach is well-understood to be effective. A study conducted in 2012 indicated that chiropractic treatment for frozen shoulder yielded 82% complete recovery. Our Dr. Grant can restore up to a 10 degree improvement in range of motion with just one visit.

Consulting a chiropractor for shoulder injuries has the added benefit of professional and individual strategies for strengthening the joint for the future. A chiropractor will never rattle off a list of pain medications and send you out the door. When you work with a chiropractor regularly, you can strengthen your shoulders and spine, reducing your risk of injury in the future. 

How to Avoid Shoulder Pain

While it is impossible to plan for every shoulder pain contingency, you can minimize your risk of further damage by strengthening your shoulders and improving their flexibility. Neck release stretches can keep your shoulder muscles and ligaments loose while regulated lifting exercises can strengthen them. Work with your chiropractor to find the best exercises and stretches for you.

Last month, we discussed the details of traumatic brain injuries and sports-related concussion (SRC). The topic is one of great import among physicians, and a regular conference is held in Berlin to examine the most current research and come to conclusions. The Berlin Consensus has given “11 R’s of SRC Management,” and here we explore each of them in greater depth.

Recognize

The first step of SRC management is to recognize the problem. Unfortunately, there is no perfect diagnostic test for immediate diagnosis of concussion in sporting environments. Most sports related concussions do not present frank neurological signs, and it can be difficult to recognize concussion immediately after an inciting event. 

To recognize SRC, we must first clarify that it is often defined as the representation of immediate and transient symptoms of traumatic brain injury (TBI). Unfortunately, this definition can only take physicians so far. While on-hand physicians should consider the symptoms, they should recognize that sometimes they do not manifest immediately. One response to be cautious of is the bilateral fencer response, in which the athlete’s arms are held rigidly in the air after impact. This posture is an indication of traumatic brain injury and usually only lasts a few seconds.

More serious abnormal involuntary physical responses include Decorticate (Flexor Posture) and Decerebrate (Extensor Response). The former manifests as rigidly straight legs, clenched fists, and arms bent to hold the hands at the chest, and the latter sees the upper extremities and head extended and the back arched. The flexor posture following TBI has only a 37% survival rate, and the extensor response’s survival rate is a mere 10%.

Remove

An athlete who is suspected to have concussion must be removed from play and from the field, court, or track in order to benefit from further SRC management strategies. He or she should undergo medical assessment and monitoring for deterioration without delay. Preliminary first aid should be administered, and SCAT5—a standardized tool for evaluating concussions—performed.

SCAT5 is used as a screening evaluation in the diagnosis of sports-related concussion. It does have a limited role in tracking recovery, so it should not be used by itself to make or exclude the diagnosis of concussion.

Only trained professionals should move the athlete or remove the helmet or other equipment. The evaluation should be performed by a physician or other healthcare professional. After the injury, the player should not be left alone. Monitoring should be constant. If concussion is diagnosed, the athlete should not be allowed to return to play until the concussion has abated.

Re-Evaluate

In the ER or a doctor’s office, further evaluation should be performed. This should take into account medical history, the improvement or deterioration from the time of injury, a neuropsychological assessment, and a neurological examination, including cognitive fxn, mental status, vestibular function, sleep/wake disturbance, ocular function, gait and balance.

Rest

Rest is the most commonly prescribed intervention for SRC management, despite the lack of evidence that such a prescription is helpful. However, to avoid the risk of exacerbating the damage, patients should refrain from activity for at least 48 hours. Rest can ease discomfort during the recovery period by mitigating symptoms and minimizing the demands on the brain.

Rehabilitation

The rehabilitation stage of SRC management is often paired with rest, especially in the initial Berlin Consensus. Athletes should be aware that treatments vary by patient, but careful monitoring is a necessity. 

Refer 

A definition of persistent symptoms is required to describe the failure of normal recovery after an injury to the brain. These “persistent symptoms” encompass a wide array of non-specific post-traumatic symptoms that may be linked to other factors, and they fall beyond the “normal recovery time” for such injuries (>10-14 Days for adults and > 4 weeks for children).

Recovery

Though information exists online that cites a concussion recovery period of 10 days, know that that number is far too low. Most concussed athletes recover—clinically speaking—within the first month of injury. The exact window is highly dependent on the SRC management strategies employed during recovery. Athletes should work with their physicians to track recovery, taking advantage of diagnostic tools such as functional magnetic resonance imaging (fMRI), fluid biomarkers, and transcranial magnetic stimulation.

Return to Sport

The process for concussed athletes to return to sport should be graduated, following a stepwise rehabilitation strategy. Athletes should work with their physicians to follow a timetable that works with their symptoms and recovery speed. The first step recommended is to keep all activity to levels that does not exacerbate symptoms. After a reasonable time, athletes may return to light aerobic exercise and then sport-specific exercise. The fourth stage is non-contact training drills, and the fifth is full-contact practice. Once these stages have been completed incrementally, an athlete is likely to be cleared to return to sport.

Reconsider 

The high incidence of sports-related concussions does not have to be a foregone conclusion. We can adjust the way we play, and schools especially can implement an SRC policy. All athletes, regardless of level of participation, should be addressed with the SRC management strategies outlined in the Berlin Consensus. 

Residual Effects and Sequelae

Further research is required to fully understand the long-term effects of SRC. Though it has been suggested that repeated concussion or subconcussive impacts cause chronic traumatic encephalopathy (CTE), the true relationship between the two remains uncertain.

Risk Reduction

Prevention is the best medicine, the list of SRC management strategies would be incomplete without suggestions for SRC prevention. This includes effective protective equipment, such as helmets (especially common for skiing, snowboarding, and American football) and mouthguards (though the evidence for their effectiveness in preventing SRC is mixed). Preventions can also be behavioral, such as limiting the use of body checking or contact in general during practice.

Prevention begins with understanding the problem, so improving our education about concussions and SRC management plays a critical role in limiting the issue. Further research, especially about the effectiveness of SRC prevention interventions, is a must.

Traumatic brain injuries are serious threats to individuals’ physical and mental wellbeing. They impact athletes and non-athletes alike, and understanding them is the key to their treatment and prevention. In this article, we discuss the ramifications of concussion/mTBI, its pathophysiology, and the basic tools used to diagnose it. The study and treatment of concussion/mTBI is a rapidly evolving field, and physicians and individuals should stay abreast of current research.

The Definition and Classifications of Traumatic Brain Injuries

Traumatic brain injuries (TBI) can follow an impact to the head, such as a blow or jolt, and can cause chemical changes within the brain or damage to brain cells. They vary in severity and are classified accordingly, taking into account how quickly patients can open their eyes, what their vocal responses are like, and how cognizant their motor responses are. The Glasgow Coma Scale (GCS) has historically been a common method for differentiation.

mTBI

mTBI stands for mild traumatic brain injury. “Mild” has less to do with the severity, instead indicating that overt structural brain damage is absent. mTBIs are non-penetrating, functional, and often temporary. They are always not visible on imaging, leading to high incidence of cases which go undiagnosed and untreated. mTBI is the most commonly sustained classification of brain trauma.

A concussion is a functional injury, the mildest form of mTBI. In fact, the two terms are often used synonymously. Which term is used depends chiefly on the kind of literature, sports literature usually defaulting to the term concussion and neurologic literature using “mTBI.” The medical field is in transition, considering “concussion” to be outdated terminology, though the Concussion in Sport Group has recommended that the terms be distinct, with concussion indicating complete recovery and associating mTBI with more persistent symptoms.

MTBI/STBI 

Moderate and severe TBI indicate structural damage that can clearly be seen via imaging. Moderate and severe TBI result in unconsciousness of greater than 30 minutes and amnesia for longer than 24 hours. Their Glascow Coma Scale values fall below 13. Examples include epidural hematoma, subdural hematoma, subarachnoid hemorrhage, intracerebral hemorrhage, and intraventricular hemorrhage.

The Epidemiology of Concussion/mTBI.

Based on available data, there are an estimated 48 million cases of concussion/mTBI in the US each year. 3.8 million of those are sports-related concussions, while 240,000 are the result of motor vehicle accidents. Concussions now represent almost 10% of all injuries for both youth and collegiate players.

The literature—based on reported values—shows that a higher percentage of sports-related concussions are sustained during gameplay than in practice. Men’s rugby is the chief offender, with men’s US football and women’s ice hockey taking second and third place, respectively. The only sport for which the practice rate of concussions appears to be greater than those sustained during gameplay is cheerleading, usually as the result of 2+ level pyramids.

It is estimated that half of all sports-related concussions go unreported, though that figure appears to be shrinking as concussion awareness improves There has been a cultural shift where parents are keeping children out of sports to avoid the risk of concussion. Without other exercise, however, the risk of obesity and other related health concerns increases. 

Research indicates that medical schools do not prioritize recognizing diagnosing concussion/mTBI. Another study performed in 2016 found that knowledge about concussion was comparable between medical students and chiropractic students. There is certainly room for improvement to minimize knowledge gaps. According to the comparison of studies conducted in 2012 and 2018, Canadian medical schools were taking this improvement of the concussion curriculum to heart. 

The Pathophysiology of Concussion/mTBI 

Concussions have been found (relatively recently) to primarily affect the white matter of the brain. This makes up about 60% of the brain and doesn’t finish developing until after middle age. White brain matter is responsible for communication within the brain and with the rest of the body. 

At the impetus of head injury, a series of neurochemical reactions results in an ion imbalance. This causes neuronal dysfunction and increased activation which creates an energy crisis where ATP cannot be made in appropriate volumes. In cases of severe TBI, the damage to brain cell mitochondria can be permanent. Concussion also affects cerebral blood flow.

The symptoms of concussion are varied and affect different parts of the brain:

• Physical—headache, dizziness, amnesia, nausea, fatigue, vomiting, blurred vision, tinnitus, sensitivity to light or sound
• Cognitive—slower reaction times, confusion, “fogginess,” difficulty learning, forgetfulness
• Emotional and Behavioral—sadness, changes in personality, anxiety, increased impulsivity, easily irritated, increased emotionality, nervousness, depression
• Sleep—nonrestive sleep, oversleeping, disturbed sleep cycle, difficulty falling asleep

Severity of symptoms are given by the patient on a 0–6 scale. The effects of concussion/mTBI are cumulative. Two trauma events in close temporal proximity increases the risk of irreversible brain damage, especially when the second event is delivered within a period of vulnerability. This makes diagnosing and treating concussion/mTBI properly even more urgent. Athletes and non-athletes should not “shake off” head injuries, instead receiving the proper care and allowing adequate time to heal. The Google-generated recovery estimate of 7–10 days is misinformation.