I’ve had shoulders on my mind lately. My mom recently had surgery for the first time – an operation on her shoulder. The recovery process has been difficult to witness, as I have a visceral feeling whenever I experience anyone in pain, but with family it’s 10 times harder. I drove her to PT, and saw her wince and groan during therapy. I’ve chopped vegetables and prepared nourishing meals to help improve her strength. I even washed her beautiful hair once. For better or worse, I’ve inherited her proclivity for caretaking. Honestly, I take joy in it.
It should be mentioned that my mom is otherwise in great shape. Prior to surgery, she was still running three miles at 5 AM. Not long ago, she was a compassionate nurse. Growing up, she was our homemaker; cooking nearly every meal and cleaning up after all of us constantly. (See notes on repetitive movements below, ugh)...
My husband and I recently moved to be closer to my mom and dad, where I’ve relaunched my acupuncture practice. A month later after opening, I realized I was now having intense neck/shoulder pain on one side. Was this because I have more responsibility placed on my shoulders? (financially and emotionally). Personally, I do feel there’s a connection, but we’ll get to that, and how stress can be connected to shoulder issues in Traditional Chinese Medicine (TCM).
Nowadays, I’m pondering questions like why do women generally suffer from shoulder pain more than men? Why is frozen shoulder (adhesive capsultitis) most common in menopausal women? Has the weight of the “invisible (or mental) load” finally started to take its toll? That’s my own personal theory. There isn’t a clear link or any scientific evidence to support this, but it’s true that frozen shoulder occurs more often in women in menopause. In Asian countries, it’s often called the 50-years-old shoulder. It’s theorized that this is due to the post-menopausal decline of estrogen, which helps lubricate joints. In TCM, we call this Yin Deficiency, and it’s a natural part of aging.
Let’s take a closer look at the shoulder from a mechanical (some might say Western) perspective. The shoulder is the most mobile joint in the entire human body. It’s connected to both the front and back of the body, as well as (of course) the arm. This can make it difficult to identify the cause of pain without medical imaging. The following are the most common diagnoses and causes of chronic shoulder pain:
Mostly drawn from this blog by Beacon Orthopaedics and Sports Medicine
Rotator Cuff Tear - Most frequently caused by repetitive overhead motions
Shoulder Impingement - Also most frequently caused by repetitive overhead motions
Labral Tear - Caused by injury, or … you guessed it – repetitive overhead motions
Frozen Shoulder - Unknown, seen most in menopausal women
Shoulder Joint Arthritis (Called Bi-Syndrome in TAM) - Arthritis is most frequent later in life, and more common in women and people who use repetitive overhead shoulder movements
From a TCM perspective, shoulder tension can be associated with Liver Qi stagnation.The liver governs the movement of QI in the body. The free flow of Qi in the body ensures the free flow of blood. More specifically, liver blood nourishes and moistens the sinews that attach to joints and allow for movement. A common TCM saying: If there is free flow, there is no pain; if there is no free flow, there is pain.
So, why does my shoulder hurt? This is a question that has a complicated answer with many factors involved. In my mom’s case, her imaging showed arthritis of the joint (Bi-Syndrome). No doubt this was due to repetitive movements throughout her life, and of course getting older (Yin Deficiency). My shoulder pain is most likely caused by a combination of hypermobility, stress (Liver Qi Stagnation), work-related posture and repetitive movements. So what can we do to prevent or help shoulder pain?
Here are 6 ways to prevent, or improve shoulder pain:
(NOTE: We are focusing on chronic shoulder pain, not shoulder pain due to an injury)
Be mindful of your posture - During periods of high stress, it’s common to unconsciously hold tension in our shoulders. For example, being hunched over a computer screen. Or in my case, over a treatment table.
Be conscious of repetitive movements - Which if done enough, can cause arthritis later in life. Repetitive movements could be work or life-circumstance related. Digging, throwing something over and over, cleaning/chopping/lifting with the same dominant arm. Try switching it up, decreasing your weight load or taking small breaks to rest or stretch. Which brings me to…
Stretch - Yoga has many effective shoulder-opening poses (to balance out those hunched shoulders). Shoulder “flossing” with a yoga strap, thread the needle. Even holding your arms out in a “T” shape and rotating your palms so one is up, and the other is down, and switching a few times, is a great thing to do daily.
Ditch the heavy purse or bag - Don’t fill up your purse and then mindlessly sling it over the same shoulder again and again, ok?. When you have a phone, keys, laptop, books, etc. all on one shoulder, it can be a lot of weight to bear! So don’t fill it up, Mary Poppins. Better yet, carry a backpack! Here’s the one I recently bought for a trip: LINK
Get acupuncture! If you catch frozen shoulder in the early stages (First 1-3 months), you can actually prevent it from getting worse. You can even keep your shoulder mobile – no freeze!! This would be a fantastic time to follow all of these tips, but also to get acupuncture and other body work. Acupuncture can utilize points that are local (where you feel the pain), and distal to the area of pain (and stagnation). Acupuncture also addresses the root of your imbalance – whether it’s Liver Qi Stagnation, Bi-syndrome, Kidney Yin Deficiency or something else.
Sleep on your back. No cozy side-sleeper likes this one, but it can’t be denied that you’re putting strain on your joints when you sleep on your side. Both the joint you’re sleeping on and the joint on top of your body are stretched out of alignment for long periods of time during sleep. A good way to train yourself to sleep on your back is to buffer yourself with pillows on both sides (sorry partners, snuggling will need to happen before you nod off). You can also try using a pillow propped under your knees to prevent you from turning onto your side.