One of the most common things I see in the clinic and hear about in the gym is people struggling with shoulder pain. Generally, it starts as a slight niggle that you only feel sometimes, which then starts to become more frequent and more intense, until it’s too painful to train through or do daily activities normally.  At this point you decide, you had better get it looked at. You get told you’ve possibly strained or torn something, have bursitis or another diagnosis that means you must stop using your shoulder for at least a few weeks. Sound familiar?brachial plexus

With a high percentage of these cases the pain is felt in the shoulder, however, the real issue actually lies in the neck (cervical spine). It can involve one or more of the nerves that begin in the neck and travel through what is known as the ‘Brachial Plexus’. The Brachial Plexus is a network of nerves forming from the nerve roots of C5-T1 that branch into many different nerves to innovate the structures of the shoulder and arm. Unless there is a direct trauma e.g. a fall, an acute muscle injury under load or through movement/stretching that you know for sure is what started the pain, it is unlikely that your pain is from a strain or a torn muscle, especially if the pain has progressively become worse over time. So how do you know the pain you’re feeling is nerve pain? Nerve pain can present in many forms, from the commonly known ‘pins and needles’ and ‘tingling’, through to sharp shooting pain, stabbing pain, pain only with movement, a dull constant ache or pain that you can’t quite locate but its ‘just in that general area’.

There is some good research coming out on shoulder pain showing commonly diagnosed conditions such as bursitis and impingement syndrome, are no longer thought to be the mechanisms causing shoulder pain. With the use of MRI and other imaging, it has been found that a high number of asymptomatic people – that is people who have no shoulder pain or other symptoms – were found to have pathological abnormalities such as bursitis or tears etc. This tells us that even with these pathological conditions present, it is possible to be pain-free. So why is it then that some people do get pain while others don’t, even when they have the same condition? One theory that is currently gaining more momentum is taking it back to the cervical spine (neck) and the nerve root. It is hard to argue when a gentle mobilization of the cervical spine and some nerve manipulation take a client’s shoulder pain away almost immediately! Of course, it is not always this easy and every person and body is different but, it’s definitely something to be aware of, especially if it is you with the shoulder pain.

Don’t be in a hurry to get cortisone injections or surgery. These are decisions that should not be taken lightly and contrary to common belief, are regularly unsuccessful in stopping pain. Exhaust ALL conservative treatment options and rehabilitation first before heading down the invasive treatment path. Whether you are thinking about getting a cortisone shot or having surgery, you will need to go through the rehabilitation afterwards. If you are prepared to commit to that, why not commit to trying the rehab first, without the invasive option. There have been plenty of studies done showing clients who participated in conservative treatment and rehabilitation had superior results to those who had invasive treatment (surgery), so why not try it first – you can always go back and look at surgery later if it doesn’t work, but you can’t undo surgery.

Keep moving, stay positive and remember………

‘A pain-free body is a functional body’