When you've become afraid to move your shoulder at all

What follows combines several people's visits into one reconstructed account. It is not any one person's story, and anything that could identify someone has been removed.

How do people describe it when they come in?

The pain is one thing, but they've stopped using the shoulder altogether for fear it will hurt. Even in the treatment room, when we ask them to raise their arm, they hesitate first.

Some have been to several places that didn't help as much as they hoped, and now find it hard to trust treatment at all. In those cases, we listen to that story first, before doing anything.

Why do we look at the fear too?

If you don't use it, it stiffens more; the stiffer it gets, the more it hurts; and then you use it even less. This loop has an especially big effect in the shoulder.

So we don't make you grit your teeth through big movements. We tell you in advance how far we'll go today, and adjust the intensity each time based on how you respond.

Not using the words "just bear with it" matters more than you'd think in treatment at this stage.

What do we look at?

We check whether there's a motion you repeat in one direction. Using the body in only one direction for a long time throws off left-right balance, and continuing like that pushes the shoulder toward stiffening.

We also check whether your shoulders are hiked up, whether the muscles around your neck are overly tense, and whether your pelvis is pushed forward. When the trunk is unstable, the arm has to work that much harder.

How do we treat it?

We break it into stages. First, we use our hands to sort out how your whole body is positioned; next, you relearn how to move; and working directly on the stiff spot is layered on top of that.

For hands-on work, we use a method that moves the joint a little at a time, in stages. We also work on the muscles around the neck, the back and even the buttocks, to share out the load that had been piling onto the shoulder.

For the stiff spot, we use pharmacopuncture, and if needed, a method that gently stretches the joint capsule. Here too, we adjust the intensity each time based on your response.

How did people do?

What usually changes first is the feeling that "this is worth a try." Then the range of raising the arm follows.

The shoulder often loosens in this order: raising the arm forward, then out to the side, then rotating it outward. Rotating outward tends to come back last, so we tell you that in advance.

What are the limits of this approach?

How long it takes varies greatly depending on how stiff it is and what stage it's in. We don't tell you how far you'll get in how long.

If movement actually decreases or night pain gets worse, we take another look. In that case, we may recommend other tests.

If you have the same symptoms

1. There's a loop: not using it makes it stiffer, and stiffer makes it hurt more.
2. We don't make you grit your teeth — we adjust the intensity each time based on your response.
3. We check whether there's a motion you repeat in only one direction.
4. It tends to loosen in this order: forward · out to the side · rotating outward.
5. We don't tell you how far you'll get in how long.

We start by measuring how far your arm can be raised. Our first goal is for you to be able to turn over in bed at night.

If shoulder pain keeps you from turning over at night, come and see us. That night pain is the first thing we work on. Recovery begins once you can sleep.

Because there are many possible causes, progress differs from person to person, even with the same care.