1/4 Hour Neuro #20: "How to Reduce Shoulder Pain?"

A Holistic Approach to Shoulder Pain

Hello everyone and welcome to the Neuro Quarter Hour. This week, we address a crucial question regarding the treatment of shoulder pain. Someone expressed their confusion about our approach, which does not focus solely on the shoulder but includes seemingly unrelated exercises, such as eye work or archaic reflexes like the Asymmetrical Tonic Neck Reflex (ATNR) or the Symmetrical Tonic Neck Reflex (STNR).

Treating shoulder pain is often too specific and symptomatic. If you have shoulder pain, you treat the shoulder. While this may provide temporary relief, it is not always the most sustainable solution. Indeed, if we only address the symptoms without understanding the underlying cause of the pain, the problem is likely to reappear. It is essential to trace back to the root of the problem to avoid relapses and achieve lasting rehabilitation.

The Ineffectiveness of Symptomatic Approaches

Muscle-focused treatment of the shoulder involves strengthening the muscles in the area to support the joint. The shoulder feels better, but if exercises are stopped, the muscles lose their tone and pain returns. This demonstrates that a specific approach does not resolve the underlying cause. It is crucial to understand why the pain arose.

In many sports, despite hours of rehabilitation and muscle strengthening, 70 to 75% of individuals still experience shoulder pain. This is proof that consistently doing the same thing without success necessitates a change in approach. As the saying goes, "Insanity is doing the same thing over and over again and expecting different results."

The Importance of Primary Systems and Archaic Reflexes

Why does the shoulder move this way? We need to consider the muscular chains and biofascial chains. The shoulder is part of these chains, and a problem anywhere in the chain can impact the shoulder. Similarly, archaic reflexes play a fundamental role. For example, the Asymmetrical Tonic Neck Reflex (ATNR) influences the relationship between laterality and arm movement during head rotation.

The Symmetrical Tonic Neck Reflex (STNR), on the other hand, establishes the vestibular and visual proprioceptive system. A dysfunction in head flexion or extension can lead to shoulder issues, affecting internal or external rotation. The development of the shoulder joint in children, especially during crawling, is directly linked to the establishment of the STNR. These reflexes, being primary in our development, are the foundation of healthy and functional musculature.

The Link Between Palmar Reflexes and the Shoulder

There are also connections between palmar reflexes and the mouth. A problem in the hand can have repercussions along this pathway that includes the shoulder. This highlights the complex interconnection of our body and the necessity for a holistic approach to resolve pain.

The Role of Reflex Stabilization and the Brainstem

We often focus on voluntary movement, but reflex stabilization, which involves the brainstem, is often overlooked. This stabilization regulates muscle tone as well as agonist-antagonist tone. When moving a joint voluntarily, a different loop is activated compared to that of the reflex force.

Sometimes, by working on a part of the body far from the shoulder, such as the opposite hip, we can achieve a positive effect on shoulder stabilization and muscle tone. Scientific studies have shown these links, explaining why we can improve shoulder function without directly working on it. This is a principle similar to that of osteopathy, where the focus is on finding the cause rather than concentrating on the painful area.

Beyond Mobility: A Broader Perspective on Proprioception

Proprioception is not limited to targeted mobilization or muscle strengthening. It encompasses a much broader system that includes the vestibular system, visual inputs, and many other factors. By focusing solely on mobilization, we are only utilizing a small part of all the available tools to address a problem.

Various proprioceptive strategies exist: compression, the use of heat (thermotherapy of thermoreceptors), or mobilization and amplitude strengthening (mechanoreceptors). To effectively support individuals, it is crucial to revisit the fundamentals of anatomy, biomechanics, and especially neuroanatomy to understand how the brain creates and regulates movement. It is time to open our minds and explore approaches beyond limited methodologies.

When Pain Becomes Chronic: A Change in Approach is Necessary

If you constantly experience shoulder pain and usual treatments are not working, it is a sign to look elsewhere. As the saying goes, "The criminal is rarely the victim." Just because the shoulder is screaming does not mean it is the culprit. Chronic pain indicates an underlying problem that has not been resolved.

In our approach, we assess shoulder mobility, then perform a movement that has no apparent relation to the shoulder to observe its impact. The goal is to demonstrate that it is not always necessary to work directly on the painful area. For example, chronic shoulder tendinitis can be alleviated by working on an archaic reflex related to the neck.

Working in parallel with a physiotherapist for specific strengthening and a neuro approach for archaic reflexes allows for regained mobility and sustainable strengthening of the joint. The idea is to always use and maintain your joint range of motion: use it or lose it. Gain range, work on it, and maintain it for optimal joint health.