Did You Know That Dr. Bradshaw Can Treat Shoulder Pain

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Illustration of Shoulder Joint

If you suffer from pain or stiffness in your shoulder you are not alone.  Far too often shoulder problems prevent individuals from participating in their favorite activities such as using the computer, gardening, or playing golf.  At times shoulder pain can be so bad that it even prevents the simplest of daily activities such as reaching into the cupboard for a dish, and in some cases can even prevent a proper night’s sleep. This can be a very frustrating problem and to make matters worse this type of condition often gets progressively worse over time.  

Now for the good news, a new treatment technique known as Active Release Techniques (ART) is proving to be a very effective method to combat shoulder problems and get shoulder pain sufferers back doing their favorite activities.  But before we talk about how ART works so effectively we first need to understand how the shoulder becomes injured in the first place.

Why Does the Shoulder Become Injured?

The shoulder is different from most other joints in the body because it is designed to provide a great deal of movement.  For example, the architecture of the shoulder joint enables us to reach up overhead, back behind the body, across the chest, and we can even rotate our arm internally and externally.  When you compare the shoulder with other joints - such as the ankle, knee, or elbow which basically move only forward and backward - it can be seen that the shoulder is indeed a joint with a lot of mobility.

The shoulder is capable of allowing this wide range of movements as a result of the way it is formed.  Basically, the shoulder joint consists of the round surface of the upper arm, called the humerus, connected to the flat surface of the shoulder blade, or scapula.  This “round-on-flat” relationship means the arm does not fit tightly onto the shoulder blade, and it is this loose fit that allows for a large amount of motion.  Unfortunately, in providing greater motion, this loose fit fails to provide bony protection and stability for the should joint, which makes it more susceptible to injury.

Due to a lack of joint stability at the shoulder, proper motion requires a complex set of muscles to help control and stabilize shoulder movement.  The primary muscles that provide this control are the Rotator Cuff muscles.  The rotator cuff is a group of four muscles that cross the shoulder joint and hold the arm tightly onto the shoulder blade.  When the arm is moved in any direction these muscles have to contract to hold the round surface of the humerus in place against the flat surface of the shoulder blade.  If these rotator cuff muscles fail to contract properly the upper arm is not held tightly onto the shoulder blade and the shoulder joint becomes unstable.  When this happens it places a tremendous amount of strain on the rotator cuff muscles as well as the ligaments and other tissue of the shoulder joint, leading to shoulder pain and injury.

How Does Shoulder Pain Occur?

Within our daily activities we use our arms and shoulders a great deal.  As a result there is a tremendous amount of strain placed on the Rotator Cuff and the muscles of the shoulder blade.  Every time you lift, push, pull, or carry anything with your arm the shoulder muscles must contract to stabilize the shoulder and protect it from injury.  A small but constant contraction of the shoulder muscles is even required with something as simple as sitting in front of a computer, in order to hold the arm and shoulder in a proper position.

In addition to high levels of muscle activity that is inherent in normal daily activities, many factors also place additional strain and work load on the shoulder muscles.  For example, repetitive use with certain sports or occupations, poor posture, muscle imbalances, or previous injuries that may not have been fully treated or rehabilitated can further strain the muscles of the shoulder girdle.

Over time this strain can develop into what is known as micro-trauma.  Simply stated, micro-trauma is very small scale muscle damage that occurs in the muscles and ligaments in response to the small levels of strain.  Initially this micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles.  Although only small, this damage still needs to be repaired.  The body responds to micro-trauma by laying down small amounts of scar tissue to repair the injured tissue.  Unfortunately over time this scar tissue will build-up and accumulate into what we call adhesions.  As these adhesions form the start to affect the normal health and function of the muscles.  In fact, they will often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.

The most common approach to treating shoulder pain is medication to reduce inflammation, block pain, or relax muscles that may be causing shoulder pain symptoms.  In the case of chronic or recurrent shoulder pain, sometimes doctors will prescribe stronger prescription medications to help fight the pain symptoms.  In some cases, even more invasive measures such as joint blocks are used, whereby an agent is injected into he joint to block the referred pain and other symptoms.

The main reason that medications fail to provide long-term resolution for the shoulder pain is that they fail to address any underlying problems of the muscles, nerves or joints of the shoulder that are causing recurring issues.  Instead, they address the symptoms of the shoulder pain and simply cover up the underlying issues, that if not addressed will continue to cause problems.  As a result many people become reliant on medication to accomplish relief of their shoulder pain. This is a temporary fix that masks the problem, and increases the risk of side-effects and dependency on medications.

Unfortunately, muscle tightness and imbalance, scar tissue adhesions, nerve entrapments, and abnormal joint movement can not be seen on an x-ray or advanced imaging.  These problems in the muscles, joints, nerves and ligaments can however be felt or tested with the hands of a properly skilled and experienced practitioner. A thorough history and clinical examination is usually sufficient to give the clinician enough information to diagnose the problem.

How Can These Shoulder Injuries Be Fixed?

The Traditional Approach

Image via Wikipedia

In an attempt to relieve shoulder pain, a variety of treatment methods are used, either on their own or in combinations with other methods.  Some of the more common approaches include anti-inflammatory medications, rest ice, ultrasound (US), muscle stimulation (E-Stim), steroid injections, stretching, exercise, and when all else fails, surgery.  Unfortunately most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.

The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues.  It is these adhesions that are binding the tissues together, restricting normal movements, and interfering with the normal flexibility and contraction of the muscles in the shoulder area.  

Passive approaches such as medications, rest, ice, and steroid injections all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction.  More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however , they themselves do not treat the underlying adhesions.  In face without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief of recovery from the shoulder condition.

Our Approach: ART - A Better Solution

ART stands for Active Release Techniques.  It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves.  ART treatment is highly successful in dealing with shoulder injuries because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues.  By locating and treating the soft-tissue adhesions with ART, it allows the practitioner to, 

break up restrictive adhesions

reinstate normal tissue flexibility and movement

more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain.

You can think of an ART treatment as a type of active massage.  The practitioner will first shorten the muscle, tendon, or ligament, and then apply a very specific pressure with their hands as you actively stretch and lengthen the tissues.  As the tissue lengthens the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment.  When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area.  In this sense, each treatment is also an assessment of the health of the area as we are able to feel specifically where the problem is occurring.  

An addition benefit of ART is it allows us to further assess and correct problems not only at the site of pain itself, but also in other areas of the kinetic chain, which are associated with movement compensations and are often contributing factors to the problem.  This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.

One of the best things about ART is how fast it can get results.  In our experience, many types of shoulder injuries respond very well to ART treatment, especially when combined with the appropriate home stretching and strengthening exercises.  Although each case is unique and there are several factors that will determine the length of time required to fully resolve each condition, we usually find a significant improvement can be gained in just 4-6 treatments. These results are the main reason that many elite athletes and professional sports teams have ART practitioners on staff, and why ART is an integral part of the Ironman triathlon series.

To book an appointment to see if ART will be able to help with your shoulder injury, simply call our office at

910-368-1528.

Did You Know That Dr. Bradshaw Can Treat Plantar Fascitis

If you experience pain in your heel or bottom of your foot with walking, prolonged standing, or when first getting out of bed in the morning, you may be suffering from a foot condition that is commonly diagnosed as Plantar Fasciitis.
Unfortunately, this condition often results in months and sometimes years of discomfort, and too often leads the foot pain sufferer to limit their normal activities.  It commonly interferes with their work, as well as sports and recreational activities.  Traditional treatment methods for this type of foot pain are often slow to provide relief and often do not address the true source of the problem, leading to incomplete relief and a high rate of re-occurrence.
Fortunately, a new treatment technique known as Active Release Techniques (ART) is proving to be a very effective method to resolve Plantar Fasciitis and other common foot conditions.  But before we talk about how ART works so effectively, we first need to understand how Plantar Fasciitis develops in the first place.

Understanding Plantar Fasciitis

WikipediaThe foot is a very complicated area which includes 28 different bones and many different joints.  These bones and joints have to move as the demands on the foot change.  In order to help control the position of the foot and stabilize the joints there is an intricate system of muscles and ligaments associated with the foot and ankle.  Many of these muscles are located on the back of the calf and have long tendons that cross the ankle and foot and can have an effect on the foot and toes.
There is also another group of muscles that are located on the bottom of the foot.  The vast majority of these muscles attach into the bottom of the heel.  Additionally, located just under the skin and over the top of the foot muscles is the "plantar fascia". This is a very tough and dense connective issue that runs from the bottom of the heel all the way to the toes.  The fascia works to support the arch of the foot and helps to stabilize the joints of the foot when bearing weight.

It is important to realize that beneath the plantar fascia the muscles are arranged in layers, and each muscle within each layer has a different job or function.  For example, some of the muscles attach all the way into the toes and act to flex and stabilize the toes, while other muscles attach into the other bones of the mid-foot to control and stabilize the arch of the foot.  For the foot and ankle to work properly, and to prevent pain and injury, not only does there have to be adequate strength and flexibility of the foot and calf muscles, but these different layers of muscles need to be able to glide freely over one another during normal use.

Image via Wikipedia

Lateral X-Ray of a Calcaneum Demonstrating A Spur

Throughout the day we are on our feet a great deal.  As we stand, walk or run, it places a tremendous amount of pressure on the foot.  This creates a tension on the plantar fascia causing the muscles of the foot to contract to help support the arch and stabilize the joints of the foot.  Over time the muscles and the fascia will become strained and fatigued, and can develop small amounts of injury known as micro-trauma.  Simply stated, micro-trauma is very small scale damage that occurs in the muscles, fascia, and ligaments in response to small levels of strain.  Initially this micro-trauma is not painful, but may be perceived as a mild ache or tightness in he muscles or at the heel where these muscles attach.  Even though it is only small, this damage still needs to be repaired.  The body responds to soft-tissue injury (including micro-trauma) by laying down small amounts of scar tissue to repair the injured tissue.  Unfortunately, over time, this scar tissue will build-up and accumulate into what are known as adhesions.  As these adhesions form, they start to affect the normal health and function of the muscles.  In fact, they will often lead to pain, tightness, lack of flexibility, muscle weakness, compromised muscle endurance, restricted join motion and diminished blood flow.

Image via Wikipedia

Muscles of leg

As the muscles and fascia of the foot become strained and develop adhesions, they become very tight.  As the tightness increases, the tissues begin to pull away from the heel where they attach, which will eventually lead to pain and irritation at the bottom of the heel.  In many cases with long term muscle tightness, formation of this constant tension can even lead to a bone reaction and formation of a heel spur.  The presence of this heel spur on an X-ray has often led to misdiagnosing the heel spur as causing the pain.  The problem is that this heel spur is very rarely the cause of pain, leading to inappropriate treatment.
In addition to causing pain and tightness these adhesions are also very sticky, affecting the ability of the muscles to stretch, contract, and slide over one another.  Recall that there are several layers of muscles in the foot.  Each of these muscles has a different function, and therefore contracts at different times.  For this process to occur correctly, the muscles need to be able to glide freely on one another.  As adhesions develop, they will cause the individual muscles and different muscle layers to stick to each other, preventing this normal gliding.  When the muscles lose the ability to glide over one another, it will bind the entire area together.  Think of these adhesions like rust and grime that can build-up in an automobile. Normally the parts of the car should be well oiled and move smoothly, but when rust and grime are allowed to build-up the car begins to break down until eventually it does not work properly and repairs are needed.  The same thing happens in the body.  Stretching or contraction of one muscle will cause a pull and tension on all of the other muscles.  This in turn will cause more and more strain on the muscles as well as increase tension at the heel.  Another common development is that the accumulation of scar tissue adhesions can affect the nerves in the region of the ankle and foot.  This occurs because, between the layers of muscles there are nerves that run all the way from the knee, down the lower leg, around the ankle, and into the bottom of the foot.  Just as the muscles tend to be able to glide on each other, nerves also need to be able to glide freely between the layers of muscles.  In many cases the accumulation of scar tissue can cause the nerves to become stuck to the surrounding muscles and fascia.  Instead of the nerve easily gliding between the muscles, it becomes stretched and irritated leading to foot and heel pain.  It is quite common for a nerve entrapment at the foot or ankle to cause foot and heel pain and lead to an incorrect diagnosis of Plantar Fasciitis.  Obviously an incorrect diagnosis will lead to incorrect treatment, which will not be effective in relieving the condition.

How Can Plantar Fasciitis and Other Similar Foot Problems Be Fixed?

The Traditional Approach

In an attempt to treat Plantar Fasciitis, a variety of treatment methods are used, either on their own, or in combination with other methods.  Some of the more common approaches include anti-inflammatory medications, rest, ice, orthotics, night splints, ultrasound (US), muscle stimulation (E-Stim), stretching and exercise.  Unfortunately, most of these traditional techniqus generally require a long period of time before they provide any significant relief, and in many cases, provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.
The main reason these approaches are often ineffectie is they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues.  It is these adhesions that are binding the tissues together, restricting the normal sliding of the tissues, and potentially entrapping the surounding nerves at the foot and ankle.
Passive approaches, including medications, rest, ice, and ultrasound, all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction.  More active approaches, such as stretching and exercises, are often needed for full rehabilitation of the condition and to restore full strenght and function of the muscles.  However, they themselves do not treat the underlying adhesions.  In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from the foot condition.

Our Approach: ART - A Better Solution

ART stands for Active Release Techniques.  It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves.  ART treatment is highly successful in dealing with foot and ankle injuries because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues.  By locating and treating the soft-tissue adhesions with ART, it allows the practioner to,

1. break-up restrictive adhesions
2. reinstate normal tissue flexibility and movement
3. more completely restore flexibility balance, and stability to the injured area and to the entire kinetic chain. 

You can think of an ART treatment as a type of active massage.  The practioner will first shorten the muscle, tendon, or ligament, and then apply a very specific pressure with their hands as you actively stretch and lengthen the tissues.  As the tissue lengthens the practioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment.  When scar tissues adhesions are felt the amount and direction of tension can be modified to treat the problematic area.  In this sense, each treatment is also an assessment of the health of the area as we are able to feel specifically where the problem is occurring.
And additional benefit of ART is it allows us to further assess and correct problems not only at the site of pain itself, but also in other areas of the kinetic chain, which are associated with movement compensations and are often contributing factors to the problem.  This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.

One of the best things about ART is how fast it can get results.  In our experience, the many types of foot injuries respond very well to ART treatment, especially when combined with the appropriate home stretching and strenghtening exercises.  Although each case is unique and there are several factors that will determine the length of time required to fully resolve each condition, we usually find a significant improvement can be gained in just 4-6 treatments.  These results are the main reason that many elite athletes and professional sports teams have ART practioners on staff, and why ART is an integral part of the Ironman triathalon series.

To book an appointment to see if ART will be able to help with your foot or ankle injury, simply call our office at 910-368-1528.