Patient Case Study – Shoulder pain
Dee is a 32-year-old gym owner and instructor who came to me with left shoulder pain. She had injured her shoulder seven months earlier while lifting, but after discussion, she realized that her left shoulder had always been weaker than the right. She was no longer able to perform overhead lifting, which was limiting her ability to teach classes at her gym. Obviously, as a gym owner and fitness instructor, strength and endurance is very important to her.
Physical examination revealed that, while Dee tested very strong in her shoulder, her motions were not coordinated. When raising her arm overhead, she had an uneven “ratcheting” motion of her shoulder blade. Her left shoulder was rounded forward, which can lead to impingement – the ball of the shoulder joint getting pinched in the socket. She also had active myofascial trigger points* in two of her rotator cuff muscles, which can lead to pain and inefficient movement.
The first two visits consisted of manual techniques to improve the mobility of her scapula, trigger point dry needling of two muscles, and Redcord® for scapular depression (pulling shoulders down) and shoulder flexion (overhead).
After the first visit, the ratcheting had improved significantly. After two visits, Dee was able to perform overhead lifts with 25 pounds, which is pretty light for her, but she hadn’t been able to perform overhead lifts since December. On the third visit, we assessed lumbar stability with the Neurac® method, and Dee tested strong; however her right hip was much weaker than the left. At that visit, we treated the right hip, and before she left that day, the left shoulder ratcheting had disappeared.
Dee is now working on gradual, pain-free strengthening of the left shoulder, and is pain-free with teaching after five treatment sessions.
*Myofascial trigger points are tight nodules or contractures in a muscle that lead to pain right at that area as well as refer pain elsewhere. Learn more about the research on myofascial trigger points.