Tag Archive for: shoulder pain

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Are Cortisone Shots the Best Option for Chronic Shoulder Pain?

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Nagging shoulder pain can be extremely annoying.

But when it starts to interfere with things you love to do – you can’t help but wonder – is it time to get a cortisone shot? 

When you’ve got dull, nagging shoulder pain that just won’t go away, cortisone shots suddenly seem very attractive. They’re quick, easy, and seemingly harmless – right? Not so fast. Just because cortisone shots for shoulders are routine, popular, and often effective at getting rid of pain – it doesn’t mean they are the best or right thing to do.

What is a cortisone shot and how does it work?

Cortisone shots are typically administered to reduce localized inflammation inside a joint or tendon. In shoulders, it’s very common to use this procedure to reduce pain from arthritis, bursitis, rotator cuff tendonitis, and even frozen shoulders. When inflammation is confirmed to be the root source of your shoulder problem, and it’s not going away with medication, on its own, or with physical therapy – a cortisone shot may be the right course of action. But what if inflammation is not the root source of your problem? What if inflammation is actually a secondary symptom? This is where most of the confusion lies in the medical community. While it might not seem like a big deal (pain is pain, right?) – you put yourself at risk for irreversible damage to your joints and tendons if you keep getting cortisone shots when you don’t actually need them. 

So how do you know if a cortisone shot is best for your shoulder pain?

Step one is making sure you’ve correctly identified the root source of your shoulder pain. Is it a chemical source – where the inflammatory process to heal something injured within your shoulder has gone haywire? Or is it a mechanical source – meaning the source of your pain is due to poor movement habits and imbalances in your body.  The difference matters – and will determine whether or not a cortisone shot is, indeed, the best option for your chronic shoulder pain.  Let’s look at the differences between the two sources of pain to help you figure out when a cortisone shot is best for your shoulder pain – versus when you should hold off.

“Chemical pain”

Chemical pain is normal (until it isn’t) – and it’s the result of your body’s natural inflammatory response to injury. When your body is trying to heal from an acute injury or tissue damage, a complex chemical reaction occurs between your blood and other cells that involves the releasing of chemicals to “flush out” the injured area and start the healing process. A good example of this is when you fall and sprain something. The sprain causes tissue damage – so your body creates inflammation to heal it. Normally this process has a start and an end. As your pain subsides, so does this chemical process called inflammation. But sometimes this inflammatory process can get out of control for various reasons. And the accumulation of toxic chemicals sticks around (they don’t ever flush out or go away). The result is constant irritation to your nerve endings and surrounding tissues. You’ll experience constant, dull pain (even at rest) that will appear extremely sensitive to any and all movements. There will be no reliability as to what makes your shoulder feel better – or worse. As you’ll read below – the presentation of shoulder pain due to an underlying chemical cause behaves quite differently from shoulder pain due to a mechanical cause. When it’s chemical – a cortisone shot is often necessary – and the best option for your shoulder pain 

“Mechanical pain”

Mechanical pain is responsible for 80% of all shoulder pain. The hallmark sign of mechanical pain is that your pain will come and go based on certain activities, movements, or positions. It’s not constant and throbbing like with chemical pain. You’ll find, for example, that your shoulder pain eases with exercise, movement, and certain positions – while other times it seems to have a mind of its own and will hurt constantly. But typically, you’ll have some sense about things you can do to ease and/or aggravate your shoulder pain. And this is what makes mechanical pain so confusing  – because when you’ve aggravated it – your shoulder will feel inflamed. But the presentation is different from that I’ve just described above, namely, your pain comes and goes. This type of inflammation is a symptom – and not the root cause of your shoulder pain. A cortisone shot may work temporarily to abolish this type of shoulder pain, but it’s going to keep coming back until you address the root mechanical reason that is causing the shoulder inflammation. What you risk here is getting repeated cortisone shots in your shoulder because you think they are working – when they are only serving as bandaids. 

The verdict?

For chemical pain, a cortisone shot is likely the best option for getting rid of your shoulder pain. But for mechanical pain – it’s not. For shoulder pain that is mechanical, you fix it naturally, with specialized and corrective movement strategies. The tricky part here is distinguishing between primary inflammation that’s gone haywire versus secondary inflammation that is responding to activities, overdoing it, or simply the way you move. Don’t try to figure it out yourself – let a mechanical pain expert do that for you.

Are you local to Portsmouth, NH?

Consider speaking to one of my specialists for FREE by clicking HERE.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or reserve a seat in her upcoming free Masterclass for headaches, neck & shoulder pain – email [email protected] or call 603-380-7902

pain

Your Pains Location May Not be it’s Source

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Pain is both a confusing and scary topic.

There’s lots of advice out there on what to do when you experience pain and it’s hard to know who to listen to. Should you rest – exercise – apply heat – apply ice – see a doctor – get an MRI – or just wait it out to see if it goes away on its own? Any or all of this advice could be right – but it’s irrelevant until you accurately determine where your pain is coming from.

For example, if you have pain in your knee, and it’s coming from your back, the best knee treatment in the world isn’t going to fix it. Inaccurate diagnosis of pain is one of the most common reasons why so many people suffer longer than they need to, and it’s one of the biggest contributors to unnecessary procedures and surgery. You must accurately determine the source of your pain for treatment to be effective. And the location of your pain, alone, is not a reliable way to figure that out.

Let me explain.

I’ve met people who’ve suffered from unrelenting tennis elbow for years – despite treatment protocol after treatment protocol – only to find out it was coming from their neck. I’ve met people who’ve undergone major knee surgery and it failed – only to find out later they never actually had a knee problem. Isolated extremity pain (knees, elbows, shoulders) is one of the most mis-diagnosed problems in the musculoskeletal world. In a study published in the Journal of Manipulative Therapy, they found that over 40% of people suffering from isolated extremity pain had a spinal source responsible for their symptoms, even when there wasn’t any spine pain. In other words, the pain they were feeling in their knee, elbow, or shoulder was actually coming from their back or neck (respectively).

Confused? I don’t blame you.

But more importantly, how do you reliably figure out the source of your pain when it’s not always where you’re feeling it?

As already mentioned, the most common place for this to happen is with extremities. If you’ve got shoulder, elbow, or knee pain, and you don’t recall having a specific injury to it, you must consider that it could be coming from your spine. There’s a 40% chance that it is. Where this gets really confusing is that typically, when you’ve got isolated knee or shoulder pain that won’t go away, your doctor will order an MRI. And if you’re over 40 years old, the MRI will almost always show “something”. It could be a torn rotator cuff, torn meniscus, arthritis, or wear and tear. But what most people don’t realize is that these findings are quite normal and happen naturally as you age.

Just because they show up in your MRI – doesn’t mean they are responsible for your pain. Despite the science proving this over and over – doctors continue to order these tests and rely on them to make important decisions about treatment. It’s how people end up undergoing unnecessary procedures or surgery – they let images and an inaccurate diagnosis lead the way.

Whenever I meet someone with isolated extremity pain, especially if it came on suddenly and out of nowhere, I always consider that it could be coming from their spine.

How can you figure this out?

Well, it’s challenging to figure it out on your own. But if you work with a movement specialist who understands this concept – you’ll be able to figure this out accurately. The basic premise is that if you can move your spine in specific directions – repeatedly – and influence the symptoms you feel in your extremity – then there is a very good chance your problem is coming from your spine. Or at the very least, your spine is involved. And whenever your spine is responsible solely or partially for pain elsewhere – and it’s ignored – your problem will persist and likely get worse over time if it’s not addressed.

Moral of this story… If you’ve had pain in one of your extremities for a while now, and it’s not going away, it’s possible you’ve missed the source, and that where your pain is may not be where your problem is. And if you’re considering some kind of surgery or procedure, you definitely want to rule out that the problem could be elsewhere.

Specialized movement exams are one of the most reliable ways to figure this out – studies have proven it. If you’ve had unexplained pain in your elbow, knee or shoulder that isn’t going away, look for someone who understands this and can give you a proper movement exam to accurately identify the source of your pain.

Looking for help and local to Portsmouth, NH? Click here to speak with a specialist.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, or get one of her free guides to knee and back pain, visit www.cjphysicaltherapy.com or email [email protected].

Shoulder Impingement Syndrome

Shoulder Impingement Syndrome – Treat the cause not symptoms

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Have you ever had pain in your shoulders when you try to raise your arms overhead, pull off a sweatshirt, grab a gallon of milk from the fridge?  Or place grocery bags on the counter?  You were likely dealing with shoulder impingement syndrome – also known as rotator cuff impingement.

They call it impingement syndrome because your rotator cuff tendons literally get “impinged” between the round head of your shoulder joint and a hook-shaped bone in the front of your shoulder joint (called the acromion) that is part of your shoulder blade.

This can occur for a number of reasons…

You could have a deformity that causes this, an injury could lead to this, arthritis could contribute to this, or poor posture can cause it.

Any of these scenarios can cause crowding in the space where your rotator cuff tendon passes in front of your shoulder. If this happens often enough – it’s going to get irritated every time you raise your arm past 90 degrees.

When this first begins to happen, it will typically cause acute inflammation. You may be diagnosed with rotator cuff tendonitis. But eventually, the more constant pain and irritation of tendonitis subsides and you only feel pain when you go to raise your arm or reach in certain directions.

This is more commonly known as shoulder impingement.

With the exception of a deformity, almost all cases of shoulder impingement can (and should) be resolved naturally.

The tempting and easy fix is to get a cortisone shot to calm the inflammation.

But what you need to understand is that impingement syndrome – in most cases – is actually the symptom of a more overarching problem. And injecting the tendon with cortisone will often cause more harm than good.

The cortisone will temporarily mask your problem. It will eventually cause damage to your tendon if you keep getting injections. Remember, impingement is caused by crowding of the space where your tendon passes through. You can temporarily take the inflammation away and it will feel better. But, unless you address the reason for the crowded space, your problem will keep coming back.

So how do you naturally get rid of shoulder impingement for the long term?

First, you must address the reason for the crowded space in your shoulder joint where your tendon passes through. Most often – it’s due to poor postural habits and immobility around your shoulder joint – specifically your neck and upper back.

For example, if your upper back is stiff, curved, and lacks adequate mobility – it’s going to impact how your shoulder blades move and are positioned.

With a stiff and curved upper back, your shoulder blades will respond by moving out and up. This scenario makes that hook-like bone (the acromion) sit more forward and down than it should. When this happens, there isn’t enough room for your tendon when you lift your arm above shoulder height. The bony surfaces above and below your tendon create friction and this eventually turns into pain and inflammation. This can happen slowly over time. Or, more quickly if you’ve got something like arthritis where that space might have naturally already narrowed.

Another common scenario is after a shoulder injury. Your neck and upper back may have learned to compensate for a time while you were healing from your injury. The result is some unwanted postural deformities that can lead to impingement of your rotator cuff tendon.

When it comes to shoulder pain, always make sure to examine your neck and upper back FIRST.

If there are poor postural habits there, your shoulder will undoubtedly be impacted.

If you really want to get rid of your shoulder impingement – and back to lifting, reaching, and carrying things without any worry – it’s essential that you identify and address the root cause, not just the symptoms (inflammation of the tendon).

Next time you go to the doctor complaining of shoulder pain – and you hear the words “impingement syndrome” or “rotator cuff tendonitis” – don’t assume you need rest, ice, a cortisone shot, or surgery to resolve it.

None of these solutions will give you the long-term solution you’re looking for.

The very last thing you want to do is choose passive treatment interventions or procedures. These either mask the pain or prolong the problem because they only address symptoms.

You want to do everything possible to preserve the integrity of your tendon. The best way to do that is by optimizing the mobility and strength around your shoulder joint first. Do this before resorting to more aggressive measures like cortisone or surgery.

Are you currently suffering from shoulder pain (or anything else) that is keeping you from doing things you love?

Are you contemplating surgery or a cortisone shot because you have been told it’s your best and only option?

Let me know and let us help!

We’re happy to provide a second opinion for you.

We will examine your shoulder and see how it responds to certain movement tests. Then we’ll be able to tell you – and show you – if your problem can be resolved naturally with movement instead of a procedure like a cortisone shot or surgery.

Our patients find that if they end up needing a procedure (which is rare) – they do so with peace of mind. This is because they’ve exhausted a natural, movement-based solution with us FIRST.

If you want to talk to us and see if what we do is right for you – CLICK HERE to request a Discovery Call with my client success team.

They’ll let you know if we can help and get you on our schedule as quickly as possible!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of one of her guide to neck and shoulder pain CLICK HERE or to get in touch, email her at [email protected].

Shoulder Pain

Persistent Shoulder Pain could mean Misdiagnosis

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Persistent Shoulder Pain could mean Misdiagnosis

We’ve been hearing a lot of complaints lately about shoulder pain. Your shoulder joint is one of the most complex and mobile joints in your body. It’s made up and supported by an intricate structure of bones, tendons, ligaments, muscles and connective tissue. They all work in unison to keep it functional.

You’ve got the head of your shoulder joint (looks like a round ball) inserting into a socket within your shoulder blade (your “wing”). This makes up your shoulder joint and is supported by a joint capsule, ligaments, and your rotator cuff muscles.

Surrounding and supporting your shoulder blade and shoulder joint is your cervical and thoracic spine. (neck and upper back). This has both large and small muscles helping to support your ability to push, pull, reach, and raise your arms overhead.

Intertwined within all of that is a delicate web of nerves and blood vessels… No wonder shoulder pain can be a challenge to treat – never mind diagnose.

If you see your doctor about shoulder pain, they will typically want to take a closer look via X-rays and/or MRI’s. X-rays will show you all the bony parts of your joint – to see if anything is broken and check for arthritis. MRI’s will see if anything is torn or worn away, such as rotator cuff or labral tears.

Relying on imaging to diagnose your shoulder pain can be tough. Or any joint pain for that matter.  It’s entirely possible to have arthritis, a torn rotator cuff, or torn labrum – and still have a perfectly functioning shoulder. The problem is we only get things looked at when we are in pain. So, there is no way to know for sure if you’ve had these “abnormalities” already, and if they are the true reason for your shoulder pain.

For example, it’s estimated that between 20-50% of people over aged 50 have “asymptomatic rotator tears”. Meaning – they walk around with a torn rotator cuff and have zero pain in their shoulder. Just because an X-ray or MRI says so – doesn’t mean it is so. And it’s a big reason why so many folks suffer unnecessarily with persistent shoulder pain.

If I meet someone with shoulder pain that hasn’t gone away – the first thing I question is whether or not we have the correct diagnosis. With shoulders, misdiagnosis is all too common given the complex nature of the joint and surrounding structures.

Here are some clues to help you figure out if your persistent shoulder pain has been misdiagnosed:

 

Where is your pain?

When pain is coming from the shoulder, the pain will typically be felt directly in three places. In front of your shoulder, on top of your shoulder, or in a more involved shoulder problem (like a rotator cuff injury) down the side of your upper arm. But it will never go below your elbow. If the pain goes past your elbow and into your forearm or hand – radiates above your shoulder into your neck (the upper trap area) – or deep inside your shoulder blade or middle back – odds are pretty good you’re dealing with a neck problem – and not just a shoulder problem.

If you don’t address your neck, your shoulder pain will continue to persist. I can’t tell you how many people I’ve seen get unnecessary rotator cuff surgery because of this misdiagnosis.

Have you lost mobility in your shoulder?

Lack of mobility is a common symptom associated with a rotator cuff injury or the dreaded “frozen shoulder.” These are, indeed, shoulder problems. So if your pain is persisting, you probably have the correct diagnosis, just the wrong treatment approach.

However, one overlooked area when it comes to shoulder stiffness is your middle back (thoracic spine). If your thoracic spine has mobility restrictions – or even weakness that leads to stiffness (our joints stiffen up to compensate for weakness/instability) – it will impact your shoulder joint. Stiffness in your thoracic spine can inhibit your shoulder mobility. Over time, this lack of mobility will irritate structures within your shoulder joint, causing pain.

If you’ve got persistent shoulder pain and feel like you’ve tried everything, get your middle back checked out. This could be your misdiagnosis.

Do your symptoms involve numbness, tingling or burning?

These are signs of nerve compression or irritation. If that’s happening – it’s likely coming from your neck or upper portion of your middle back (cervicothoracic junction). It could be due to a bulging disc or a restricted/faulty movement pattern that is irritating nerve roots (or discs) in your spine. An isolated shoulder problem typically does not involve nerve root compression or irritation. Sometimes certain trigger points in your rotator cuff muscles can refer pain. But this usually feels quite different from what I’m referring to.

Do you consistently feel pain, numbness, tingling or burning in your shoulder blade, middle back, or down your arm? Especially if it seems to move around during the day? Then it’s likely not a shoulder problem. In the medical world we call this presentation “cervical radiculopathy”. If you continue to experience persistent shoulder pain and you’ve got any of the symptoms I just mentioned, this is probably your misdiagnosis.

Confused? I don’t blame you.

The moral of this story is that if you’ve got persistent shoulder pain and given treatment your best shot, then you’ve likely been misdiagnosed. Shoulder pain loves to disguise itself as a spine problem (neck and/or middle back) even when you don’t feel pain in your spine.

Whatever you do, don’t resort to any surgery or major procedures until you’ve thoroughly explored these areas with a mechanical pain expert who knows where to look.

If you are local to Portsmouth, NH…

Consider reaching out to one of my specialists by requesting a free discovery visit HERE. They will ask you all about what’s been going on – and see if we would be the best fit to help you.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch, email her at [email protected].

golf injuries

Five Common Golf Injuries and How to Avoid Them

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Golf is a beloved passion enjoyed by millions around the world, and the season has officially begun here in New England. Let’s talk about golf injuries. Most golfers won’t let anything get in the way of tee time – but when you’re dealing with back, knee, elbow, or shoulder pain – playing 18-holes is just not as fun.

An injury of any kind during golf season not only impacts your performance – but it keeps you from enjoying the game to the fullest.

Your buddies are walking the course while you have to drive the cart… Instead of focusing on your swing, you’re thinking about your pain and whether or not you should push through it…

The good news is that with the right knowledge and preparation, you can avoid some of the most common injuries impacting golfers.

Here are five of the most common golf injuries and what you can do to avoid them:

1. Back Pain

Back pain is the most common injury to plague golfers. Repetitive bending and twisting is a well-known source of back problems – and that’s literally all you’re doing when you play golf. While practicing proper swing mechanics can help, it might not be enough.

If you lack adequate mobility in your spine, for example, the best swing in the world won’t compete. It’s important that you take time to optimize and maintain good spinal mobility during golf season.

Stretching backwards regularly, and avoiding excessive sitting during the day, are two things alone that could make a huge difference in your back mobility – and pain – and help you to get through golf season injury-free.

2. Elbow Tendonitis (Golfer’s Elbow)

Golfer’s elbow occurs when the tendons on the inside of your elbow become inflamed from the repetitive swinging motion of the golf club. Once again, good swing mechanics can go a long way in preventing this from happening. But it’s also important to consider what’s happening above and below your elbow joint.

If you’ve got a weak rotator cuff, or weak and stiff wrists for example, your elbows will experience added and unwanted strain when trying to do something like swing a golf club. It’s important that you perform regular conditioning of these areas (both mobility and strength) during golf season to keep your elbows from suffering the consequences.

3. Knee pain

Between walking 18 holes, and the repetitive twisting that happens at your knee when you swing a golf club, there’s the potential for lots of stress (and injury) through your knee joints.

If you lack adequate mobility or stability in and around your knees, you could develop pain as the season goes on. The power in your golf swing should come from your hips and core, not from your knees (or back). If they aren’t very strong, your knees could take the brunt and eventually suffer.

Much like the elbow, the most common source of knee pain comes from the joints above and below, and not necessarily from the knee itself. To keep your knees mobile and healthy, and prevent them from getting overstressed during golf season, it’s important that you take measures to optimize the strength in your core and hips, as well as the stability in your feet and ankles.

4. Rotator cuff (shoulder) Injuries

Another common injury for golfers is strain, tendinitis, or impingement of the rotator cuff. Your shoulder is the most mobile joint in your body, and the rotator cuff’s job is to provide strength and stability to your shoulder joint. If it’s weak, or compromised in any way, you could eventually see problems during golf season.

There’s quite a bit of stability required from your shoulder joint to withstand the acceleration and deceleration forces that come with a golf swing. The repetitive swinging of a golf club could take a rotator cuff on its last leg and push it over the edge.

As mentioned several times already, work on your golf swing. But given you don’t want your shoulder girdle or rotator cuff bearing all the strain, you have to make sure your core is strong, as well as your mid back muscles and upper thighs and hips.

This group of “powerhouse” muscles will give you a stable foundation so the more distal areas of your body (knees, elbows, and even shoulders) don’t get injured from having to work so hard.

5. Wrist and Hand injuries

Wrist and hand injuries – such as sprains, strains, and even fractures – are also quite common in golf due to the gripping and twisting of the club.

Using proper grip technique when holding your club is paramount, but you’ll also want to make sure the club you’re using isn’t too heavy or long. And as mentioned previously, make certain you’ve got a strong and stable shoulder girdle, because much like the elbow, your wrists can compensate for weakness above the chain.

But one overlooked area when it comes to wrist and hand problems is your neck.

Did you know that 47% of upper extremity pain (including wrists and hands) can come from a source in your neck?

An underlying neck problem could be the cause of your weak hands and wrists, if this is the case, working on grip strength will not make a difference. You must first resolve what’s going on in your neck.

Hopefully these tips help you to understand why golf injuries happen and most importantly, how to prevent them.

If you try these tips and are unsuccessful, then it might be time to talk to an expert who can help you work through these aches and pains so you can be back on the course in no time.

Are you dealing with pain now and local to Portsmouth, NH?

Consider talking to one of my specialists for free. Tell us everything that’s been going on with you, and determine for yourself if we’re the best people to help you. CLICK HERE to speak with a specialist.

syringe

Shoulder Still Hurting After Your Covid-19 Booster?

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Shoulder pain is quite normal after any vaccine.

But prolonged shoulder pain isn’t.

Shoulder injuries related to vaccine administration (otherwise known as “SIRVA”) is a rare, but possible occurrence when you get a vaccine or booster shot. Shoulder injections should enter the deltoid muscle. But SIRVA occurs when a healthcare professional administers the vaccine too high, or too deep into your shoulder.

When not properly administered, your next booster shot could graze your bone or nerve, or even puncture your bursa (a fluid-filled sac that protects your shoulder tendons).

Pain from SIRVA can be really difficult to distinguish from the normal pain that occurs after a shot in your arm. But it’s critical you know what to look for. Because if left untreated, SIRVA can cause prolonged problems in your shoulder over time.

I’ve seen folks end up with entirely preventable rotator cuff tears, bursitis, and tendonitis – all because someone didn’t take their complaints of shoulder pain after getting a Covid shot in their arm seriously enough.

Normal shoulder pain after a Covid vaccine or booster shot:

Mild skin sensitivity and localized shoulder pain is quite normal after a Covid vaccine or booster shot. Some people experience what is now known as “Covid arm” – a mild rash and skin sensitivity that can occur anywhere from a few days to even a week after receiving your shot. You’ll experience skin sensitivity and/or swelling that might look similar to cellulitis.

While annoying, Covid arm is not considered dangerous or threatening.

The symptoms will typically go away after a week or two and in the meantime, talk to your doctor or pharmacist about over the counter or prescription remedies that can address the symptoms of itchiness or swelling.

Localized shoulder pain at the site of your vaccine or booster shot is also normal. The pain you feel is from the mild trauma caused by the needle being inserted into the soft tissue (muscle) of your arm. It often feels like a bruise, and you may experience a little bit of swelling. It will typically go away after 2-3 days. Even though your arm can be quite sore, the important distinction here is that you’ll still have full, normal function of your arm. In other words, despite the soreness, you can still move your arm freely up and down if you had to without restriction.

Your arm soreness will go away with time, but gently massaging the area of pain, and even some easy movement or exercise can help the soreness go away faster.

Abnormal shoulder pain after a Covid vaccine or booster shot:

The symptoms of SIRVA are different, and typically more severe than what I’ve just described above. If not addressed, some of these symptoms could lead to long lasting shoulder problems or compensatory problems elsewhere.

As I’ve already alluded to, one of the main distinctions between “normal” shoulder pain after a vaccination shot and SIRVA is how well your arm functions. If the needle was accidentally inserted into your joint capsule, for example, you will notice limited mobility and possibly limited strength. If unaddressed, symptoms like this can manifest into more serious shoulder problems down the line such as adhesive capsulitis or frozen shoulder.

If the needle was inserted too high or too deeply, and beyond your muscular layer, it could have injured your bursa. This could cause it to become inflamed, turning into shoulder bursitis. Your mobility may or may not be impacted when this happens, but you’ll notice prolonged shoulder pain that doesn’t subside after 2-3 days like it should. Bursitis is actually a really simple injury to treat. But with SIRVA, it’s often dismissed as normal pain after the shot.

When ignored – shoulder bursitis can lead to compensatory movements due to pain – and cause problems later on in places like your neck, shoulder blade or even elbow.

One last common problem we see as a result of SIRVA is rotator cuff tendonitis. Much like bursitis, you may have normal motion in your shoulder, but what you’ll notice with this is again, the pain will persist longer than it should. But unlike bursitis, you’ll also have pain and weakness when you exert force through that tendon – particularly with overhead movements or lifting something with an outstretched arm.

This is also not a complicated injury to rehabilitate, but if not addressed, could turn into a more serious problem such as a rotator cuff tear or chronic tendonosis – conditions that are more difficult to treat.

To recap – your shoulder will hurt after getting a vaccine.

It’s normal. And you may even experience Covid arm. But these symptoms should go away and not remain.

And you should still have normal function of your shoulder, despite the pain.

If you have shoulder pain that persists, and especially if you’re noticing limited mobility, it’s something worth getting checked out. The last thing you want is for these symptoms to go on longer than needed, or turn into compensatory, more complicated problems.

The good news is that even with SIRVA, your shoulder pain can be successfully treated naturally, and without medications or procedures. Don’t let a healthcare professional brush off your concerns and blame your prolonged shoulder pain on your booster shot.

Talk to a musculoskeletal expert who understands this sort of thing and get some help!

CLICK HERE to request a Free Discovery Call with our Client Success Team.

They’ll let you know if we can help – and if you’re a good fit for our services – get you scheduled as soon as possible.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of one of her guide to neck and shoulder pain CLICK HERE or to get in touch, email her at [email protected].

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

Will a Cortisone Shot Help Your Nagging Shoulder Pain?

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Nagging pain in your shoulder can be extremely annoying. But when it starts to interfere with things you love to do – you can’t help but wonder – Will a Cortisone Shot Help Your Nagging Shoulder Pain?

When you’ve got dull, nagging shoulder pain that just won’t go away, cortisone shots suddenly seem very attractive. They’re quick, easy, and seemingly harmless – right? Not so fast.

Just because cortisone shots are extremely routine and popular – it doesn’t mean they are the best or right thing to do.

Cortisone shots are typically administered to reduce localized inflammation inside a joint or tendon. In shoulders, it’s very common to use this procedure to reduce pain from arthritis, bursitis, rotator cuff tendonitis, and even frozen shoulders. When inflammation is confirmed to be the root source of your shoulder problem, and it’s not going away with medication, on its own, or with physical therapy – a cortisone shot may be the right course of action.

But what if inflammation is not the root source of your problem? What if inflammation is actually a secondary symptom?

This is where most of the confusion lies in the medical community. While it might not seem like a big deal (pain is pain, right?) – it’s a problem if you keep getting cortisone shots when you don’t actually need them.

Why?

Well overuse of cortisone shots can cause degeneration of your tendons and joint structures. So you only want to get one when you know: 1) it’s going to help and 2) if it’s necessary.

But how do you know? The key is in understanding the source of your pain. With chemical sources of pain, the source is inflammation and a cortisone shot is a good idea. But when it comes to mechanical pain, inflammation may exist but it’s not the source of your shoulder problem. In these cases, cortisone is either not helpful – or worse – it “works” but then masks your problem, sometimes for years.  

Let’s talk about the two sources of Shoulder pain to help you understand.

 

“Chemical Pain”

Chemical pain is the result of your body’s natural inflammatory response to injury. It’s a complex chemical reaction that occurs after tissue damage that involves the releasing of chemicals from your blood and other cells to “flush out” the area and start the healing process.

A good example of this is when you fall and sprain something. The sprain causes temporary tissue damage so your body creates inflammation to heal it. Normally this process only lasts a few days, your pain subsides, and you’re back to normal in no time. But sometimes this inflammatory process lingers longer than it should.

For various reasons the accumulation of toxic chemicals sticks around and the result is constant irritation to the nerves and surrounding tissues. Constant, dull pain, even at rest, that tends to be very sensitive to any and all movement is often a tell-tale sign that you’re dealing with pain that is chemical in nature. In this case, a cortisone injection could be a good course of action for you.

“Mechanical Pain”

Mechanical pain does not need a cortisone shot and it won’t respond well to it. The hallmark sign of mechanical pain is that your pain will come and go based on certain activities, movements, or positions. It’s not constant and throbbing like with chemical pain. Eighty percent of all musculoskeletal problems – including shoulder pain – are mechanical in nature.

Now, the real problem is that whether or not your pain is mechanical, a cortisone shot often does take away your pain. Not only is this confusing – but many people question why they should even be concerned about this. Well – when the pain and inflammation you’re experiencing is secondary – which is often the case with mechanical pain.

 You never actually treat the true source of your shoulder pain when you “cover it up” with a cortisone shot.

For example, you might have an irritated rotator cuff tendon or arthritis that is exacerbated because of poor posture or immobility in your shoulder joint. If you inject cortisone into your tendon or joint, the pain will likely be relieved. But this will only be temporary. It’s only a matter of time before your poor posture and movement habits cause irritation and pain again. This is the vicious cycle I see a lot of folks get themselves into. You risk never fixing the real problem. And irreversible damage to your tendon that might eventually need to be fixed surgically. 

Moral of this story… don’t rush to get a cortisone shot just because you’ve been told you have inflammation.

You must figure out the source of your inflammation first. Cortisone shots are not necessary if your pain is mechanical in nature. And it might actually prolong your problem. If your pain comes and goes, or you have good days and bad days, this is a classic sign that your pain is likely coming from a mechanical source.

Your best course of action is to work with someone who understands and specializes in this. I’ve seen many cases where getting a cortisone shot provides a false sense of hope, and as a consequence, delays quality treatment that you should be getting instead. 

Are you local to Portsmouth, NH?

Request to speak to one of my specialists to see if we would be the right fit to help you get out of pain. CLICK HERE to request a Free Discovery with one of my specialists.

If you can’t wait for the call  – get our free guide to neck and shoulder pain now. 

This totally free guide – written by leading back pain specialist, physical therapist, and movement expert, Dr. Carrie Jose – reveals seven easy ways (plus a bonus section!) that are PROVEN to help you ease neck and shoulder pain quickly – without pain medication, procedures, or surgery.

Click here to download the guide!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To get in touch email her at [email protected] or call 603-605-0402

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The Number One Reason your Shoulder Pain isn’t Going Away

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Statistics show that shoulder pain impacts approximately 15.4% of men and 24.9% of women. The prevalence of shoulder pain also tends to increase and become more severe as we age, especially for folks in their 50’s.

There are many reasons why we get shoulder pain. It’s the most mobile joint in your body, making it more susceptible to injury. But why – for some – does it seem to just linger and not go away?

The number one reason is mis-diagnosis. Here are a few examples of what that looks like.

  • Your MRI says you have a rotator cuff tear – so you get surgery – yet the pain comes back or doesn’t fully resolve like they told you it would.
  • You’re told you have impingement syndrome – so you get arthroscopic decompression surgery – no success.
  • Perhaps you’ve been told you have tendonitis in your shoulder and need a cortisone shot – followed by physical therapy. Nope, that didn’t work either.

When it comes to shoulder pain, it’s critical that you know for certain the pain in your shoulder is actually coming from your shoulder. If not, you’re going to waste your time fixing the wrong problem and are more likely to get an unnecessary procedure or surgery. 

So – if your shoulder pain isn’t coming from your shoulder – then where is it coming from? 

The most common culprit is your neck or mid-back. In fact, studies have shown that 40% of the time extremity pain (including shoulder pain) comes from a source in your spine – even when you don’t feel any pain in your spine. 

Here are a few key signs and considerations to help you figure out if your shoulder pain has been misdiagnosed:

1. Where is your pain located?

When your pain is coming from your shoulder, the pain will be localized to your shoulder joint. True shoulder pain is felt directly in front of your shoulder, on top of your shoulder, or in a more involved shoulder problem (like a rotator cuff injury) you might feel some achiness down the side of your arm. But it will never go below your elbow. If the pain goes past your elbow and into your forearm or hand, or radiates above your shoulder into your neck (the upper trap area), or if you feel pain deep inside of your shoulder blade into your mid-back – odds are pretty good that you’re dealing with a spine problem and not a shoulder problem. 

2. Do your symptoms involve numbness, tingling or burning?

These are signs of nerve compression or irritation. If that’s happening – it’s likely coming from your neck – and could be due to something like a bulging disc – or a restricted/faulty movement pattern that is irritating nerve roots in your neck. You might feel symptoms in your shoulder, shoulder blade, or even down into your arm. What’s particularly misleading is that it’s entirely possible to feel all these nerve symptoms in your shoulder or arm – and not actually feel anything in your neck. If you’ve got more pain in your arm than you do your shoulder, be sure to get your neck fully checked out. This is a huge area of mis-diagnosis for those suffering with long-standing shoulder pain.

3. How is your posture?

Poor posture can wreak havoc on your shoulder joint – without you even knowing it. If you’ve got a really curved middle back, combined with a “forward head” posture, you’re just setting your shoulder up for failure. Chronic, poor posture will crowd the tendons and structures in your shoulder joint over time. Every time you raise your arm overhead, or try to lift something with an outstretched arm – there will be implications if you’ve got poor posture.

The tricky part about this scenario is that you really will have pain in your shoulder. You’ll have wear and tear of your rotator cuff, and you’re more likely to have degeneration in your shoulder joint that might cause it to feel weak. The confusion here is that the shoulder “problems” are actually symptoms. The real cause is your posture and it’s either been missed or not addressed. The good news is that if you address your posture, most of these “wear and tear” shoulder problems will go away naturally, and you can avoid unnecessary procedures and surgery. This problem flies so under the radar that it’s overlooked all the time.

If you’ve got a true shoulder problem and it’s been diagnosed correctly – it should go away with proper treatment.

If that’s not happening, it’s worth considering that the true source of your shoulder pain has been missed. Start by getting a thorough check of your spine.

Don’t know where to start?

You can request a free Discovery Call with someone from my client success team. They’ll let you know if we can help – tell you if you’re a good fit for what we do – and get you on your way to living pain free. CLICK HERE to request a free Discovery Call.

Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

Why your Cortisone Injection Failed You

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Why your Cortisone Injection Failed You

When you have joint pain that won’t go away, especially after trying lots of physical therapy, your doctor might recommend you get a cortisone shot.

Cortisone shots are often prescribed for things like back pain, bursitis, bulging discs, cartilage tears, osteoarthritis, tendonitis, and many other conditions that are perceived to be inflammatory in nature. While every single one of these conditions can cause things to be inflamed, it doesn’t mean that inflammation is your underlying problem. If something else is causing any of these structures to get irritated and inflamed, then your cortisone injection won’t work. At the very best it will provide you temporary relief, but the problem will ultimately come back in about 6-12 months time.

Cortisone shots also come with many potential problems and side effects. So you really want to be sure that it’s necessary before you get one.

The list includes problems such as: cartilage damage, death of nearby bone, joint infection, nerve damage, temporary facial flushing, temporary flare of pain and inflammation in the joint, temporary increase in blood sugar, tendon weakening or rupture, thinning of nearby bone (osteoporosis), thinning of skin and soft tissue around the injection site, and whitening or lightening of the skin around the injection site. And none of these side effects account for human error with the procedure. If your doctor is “off” with his/her injection – you could end up with unnecessary tissue trauma and pain because your shot wasn’t injected correctly.

So when it comes to cortisone shots, you really want to make sure that 1) the root source of your problem is inflammation and 2) you actually need one.

The reason why so many cortisone injections “fail” is because quite often – they weren’t needed in the first place. Even though the actual pain you are experiencing might be due to inflammation, the underlying cause leading to the inflammation could be something else entirely. Cortisone shots are used to address inflammation. But 80% of the time the musculoskeletal pain you’re experiencing is due to a mechanical or movement problem. So while the symptoms you’re experiencing could be due to inflammation, the root cause of your issue could be due to something else. In this case, the cortisone shot will not help – or worse – provide you with temporary relief that leads you to think it did.

Let me explain with a bit of scientific research.

Studies show that 70-80% of people over the age of 50 have a bulging disc on their MRI. 60% have a meniscus tear in their knee. These findings are considered normal as you age. The research also says that not all of these people experience pain. So you can have two people with the exact same MRI findings and one person will be perfectly fine while the other can barely walk. This is how we know that “the finding” (a bulging disc or meniscus tear for example) isn’t necessarily the problem.

The source of the problem is what is causing that bulge or tear to get annoyed.

About 80% of the time it’s going to be something like a faulty movement pattern or “mechanical issue,” such as poor mobility or stability, leading to some compensatory movement strategies in your body. When you don’t move well, structures like normally occurring disc bulges and meniscus tears can get irritated.

For example, let’s say you have a bulging disc in your back. If you sit for most of the day, travel a lot for work, or have a job that involves a lot of repetitive lifting, these types of activities are known to really aggravate a bulging disc. If all you do is inject cortisone to calm down the irritation, you won’t be fixing the real problem… which in this case is your daily movement habits. After about 6 months of returning to all these activities again, the pain WILL come back.

The good news is that there are ways to solve this type of problem (and others) naturally, and without a cortisone injection. But the important thing for you to realize here is that if you did get a cortisone shot recently and it appears to have “failed,” the last thing you want to do is get another one or resort to an even more invasive procedure. It’s possible you didn’t need it in the first place, so you want to make sure that is uncovered first.

So, if you’ve recently had a cortisone shot and it didn’t work, it could very well be that you never actually needed it… or that the wrong problem (inflammation) was being addressed instead of the underlying cause.

If you are considering something like a cortisone shot, it’s always a good idea to get a second opinion to make certain you really need it and that it’s the best course of action for your problem. And if you’ve already had one and it didn’t work, don’t worry, odds are good that there is still a solution out there for you… and it doesn’t have to involve more procedures.

It could be as simple as learning how to move better!

Sign up for a FREE Discovery Session today to speak with my client success team to see if we can help you avoid quick fixes like cortisone shots and get long lasting results. 

Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.

golf injuries

Common Golf Injuries and How to Avoid Them

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Most golfers I know won’t let anything stop them from being out on the course – especially here in New England where the golf season is not very long.

But let’s face it, when something hurts, playing 9-holes is just not as fun.

Jack Nicklaus had it right when he said, “Professional golfers condition to play golf; amateur golfers play golf to condition.” That explains why 62 percent of amateurs will sustain a significant golf injury, typically because they’re out of shape, have poor swing mechanics, or don’t adequately warm up.

Here are three common golf injuries and things you can do to avoid them.

Elbow Tendonitis

Tendonitis is characterized as the painful inflammation of a tendon. It’s caused by repetitive movements that overload the tendon, eventually causing it to feel strained and overworked. When it occurs on the inside of your elbow, which is something that happens a lot with golfers, it’s called “golfer’s elbow.” The treatment is ice and rest initially (which means you don’t get to play golf for a while) followed by progressive and proper loading of the tendon to get it back to a healthy state. This whole process, if done properly, takes time… and it can certainly ruin your golf season if it’s not caught early.

What causes elbow tendonitis? We know that technically, it’s inflammation of tendons in your elbow. But what leads to that in the first place? Often weakness in your mid-back and shoulders along with mobility restrictions in your wrists. Your elbow is significantly influenced by what happens above and below it. If your mid-back and shoulder area are weak, the rest of your arm won’t feel supported and your elbow can get overworked. If your wrist is tight and immobile, your elbow will be forced to move more than it should, especially through a golf swing. This will cause extra stress on your tendons and eventually result in tendonitis. The best way to prevent this from happening is to make sure you’ve got adequate mobility in your wrists, and good strength in your mid back and shoulders.

Back Pain

One of the most common ways to hurt your back is with repetitive flexion (bending) and rotation (twisting). Well, what does a round of golf consist of over and over? Repetitive bending and twisting! Every time you swing that golf club, you’re putting your spine through one of its most stressful positions. And if it’s not prepared — it’s going to get injured.

One of the best ways to prepare your spine for a long and healthy golf season is to avoid a lot of sitting and keep it mobile. Sitting for prolonged periods makes your back more susceptible to injury in general, but especially if you’re going to be doing a lot of bending and twisting. Interrupting your sitting frequently during the day is a very easy way to minimize its harmful effects. 

If you lack adequate mobility in your spine, it will feel strained every time you try and swing your club. When you overstress a joint that is stiff, the muscles around it tend to tighten up and spasm in response. It’s important that you take time to optimize and maintain your best spinal mobility for golf season. This will significantly help to decrease the stress that occurs in your spine when you swing in one direction repetitively, and ultimately help you prevent a back injury.

Knee pain

Between walking 18 holes, and the repetitive twisting that happens at your knee when you swing a golf club, there’s the potential for lots of stress (and injury) through your knee joints. If you lack adequate mobility or stability in and around your knees, you’re going to have problems. Much like the elbow, the most common source of knee pain I see in my golfers comes from the joints above and below, and not from the knee itself. To keep your knees mobile and healthy and prevent them from getting overstressed during golf season, it’s important that you take measures to optimize the strength in your core and hips, as well as stability in your feel and ankles. 

The power in your golf swing should come from your hips and core, not from your knees (or back). If they aren’t very strong, your knees will want to try and help, and they are not designed for this. Your knees need to be loose and free during a golf swing. If not, the muscles and ligaments around your knee joint will take on unwanted stress. 

Another cause of unwanted stress to your knee joint is lack of support from your feet and ankles.

Your knees need a stable foundation if they want to bend and twist without stress. If stability below is lacking, your knees will tighten up in an effort to compensate. Moral of the story: make sure you’ve got mobile knees, a strong core and hips, plus stable feet and ankles, so that knee pain doesn’t derail your golf season.

Hopefully these tips help you understand why golf injuries happen and most importantly, how to prevent them. If you’re feeling stuck and looking for individualized expert help – request a FREE Discovery Session. We look forward to speaking with you!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth, NH.  To get a free copy of her guide to taking care of back pain – click here.