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- Art of Wellness Acupuncture & Traditional Chinese Medicine (TCM)11704 Wilshire Blvd, Suite 295, Los Angeles, CA, 90025
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By Qineng Tan, L.Ac., Ph.D.
Shoulder pain is one of the most common types of musculoskeletal pain amongst adults, affecting about one in four people in their lifetime. Almost 20% of disability cases related to chronic pain are due to disorders of the shoulder, such as frozen shoulder (also known as adhesive capsulitis), torn rotator cuff, and tendonitis in shoulder. Neck and shoulder pain can be caused by injury, overuse, arthritis, or degeneration of tissues over time.
Shoulder pain is usually treated first with medications to reduce pain and swelling, and suggested activity modifications. Often people are referred to physical therapy (PT) or sports medicine specialists, so that a specific regimen of exercise can strengthen and stabilize the joints. In more severe cases, surgery may be required to repair torn tendons or cartilage. Acupuncture and other TCM modalities can be used to complement these conventional treatments, helping to reduce inflammation, alleviate pain, speed healing and improve range of motion.
In this article we will discuss some of the causes of shoulder pain, how it is usually treated with conventional methods, and how acupuncture and TCM can help reduce and prevent recurrence of shoulder pain.
Anatomy of the Shoulder
The shoulder is generally thought of as a “ball and socket” joint, but in fact, this part of the body has such a high level of utility and mobility because it is made up of several bones and a complex system of muscles, tendons, and bursae–little fluid-filled sacs that provide cushioning between the bones.
There are really three joints that make up the shoulder: the acromioclavicular joint (AC joint), where the collarbones (clavicle) and shoulder blades (scapula) meet, the glenohumeral joint, where the ball-shaped head of the long arm bone (humerus) fits into a shallow socket (glenoid), and the sternoclavicular joint, where the clavicle meets the sternum. These bones are held together by the “rotator cuff,” a collection of four major muscles and tendons.
The unique construction of the shoulder allows for a wide range of motion, including flexion and extension, adduction and abduction, and both medial (internal) and lateral (external) rotation of the socket joint. The scapula joint allows for protraction and retraction, elevation and depression. All of this amazing mobility comes at a price, however. It is up to the muscles and tendons to provide stability, and when these soft tissues are injured or weakened, the shoulder can become unstable and/or lose part of that mobility.
The 10 Most Common Causes of Shoulder Pain
The most common cause of shoulder pain is a problem with the rotator cuff. When the tendons are torn, or even just inflamed, it can be difficult and painful to lift the arm. This can be caused by repetitive motions executed during manual labor (especially overhead motions, as with painting or construction) or sports-related injuries (especially common with baseball and tennis). In some cases, the tendons of the rotator cuff tear, either due to a sudden injury (acute torn rotator cuff), or degeneration of tissue that occurs over a long period of time (chronic shoulder pain). Other causes of shoulder pain can be related to the bursae, or a disorder of the way the tendons and bones fit and move together.
Common causes of shoulder pain include:
- Torn rotator cuff – A tear or tears in the muscles and/or tendons of the shoulder joints generally causes a dull pain that worsens when you sleep on it. It can cause difficulty performing simple actions such as combing your hair, and all of the actions of the arm may be weakened. A tear can be caused by a sudden injury, but is more commonly due to repetitive motions related to physical engagement in work or sports over a long period of time. Rotator cuff problems should not be ignored. Some tears are best treated with surgery before they become larger. Without adequate treatment and changes in movement behaviors, torn rotator cuff tendons can lead to serious degeneration of the tissues and permanent loss of mobility.
- Frozen Shoulder – Also known as adhesive capsulitis, which refers to the capsule of tissues that surrounds the shoulder joints. When these tissues tighten and become more rigid, it creates a stiffness and severe pain in the shoulder and arm, making it increasingly hard to move without shoulder pain lifting arm. This condition is more common in women, and is seen more often in people between the ages of 40 and 60. PT can be effective for improving flexibility.
- Tendonitis – this refers to inflammation of the tendons that attach the muscles to the bones of the shoulder joints. When the tendons become inflamed, the area feels tender and achy, and normal activities can be difficult.Tendonitis in shoulder can often resolve itself with rest and reduction of the inflammation.
- Bursitis – this occurs when the small, fluid-filled sacs called bursae become inflamed, again, either due to injury, repetitive movements, or other conditions that cause inflammation, such as rheumatoid arthritis. This can cause even small movements, like pushing open a door, to hurt. Usually patients are cautioned to rest, and perhaps even wear a brace to restrict movement until the inflammation is resolved.
- Arthritis – when cartilage and the synovial lining that lubricates the joints begin to wear away over time, the bones of the joints begin to rub against each other. This generally happens in older people, and they begin to feel deep aching that sometimes gets worse when the weather changes. Along with rest, PT, and anti-inflammatories, patients are often treated with corticosteroid shots to temporarily reduce pain and inflammation.
- Shoulder Impingement – Some of the muscle and tendon tissue of the shoulder is sandwiched between the bones. When the movement of the shoulder causes parts of the soft tissue to be pinched by the bones, causing pain, it is called subacromial impingement. This can be caused by swelling of those tissues due to overuse, or because of a tear in a tendon or the labrum, or because of arthritis causing a change to the shape of the bone. In some cases the congenital shape of the acromion or coracoid bones can make someone more susceptible to impingement. The development of a bone spur could also cause this problem. In these cases, surgery to remove bone and create more space in the joint may be indicated.
- Dislocation – This occurs when the upper arm bone (humerus) pops out of the cup of the socket bone (glenoid). This can happen when the arm is suddenly pulled or twisted sharply, or when a person falls on their outstretched arm. The shoulder is the joint most commonly dislocated, and this injury happens more often in young people. It causes severe pain, swelling, bruising, and loss of mobility. Once the displaced arm bone is reset in the socket, mobility returns, but it can take a long time to regain strength. A person may be prone to dislocating the shoulder again without physical therapy, and in some cases, reconstructive surgery is required.
- Separation – This is an injury that causes AC joint pain, in which the ligaments that connect the collarbone to the shoulder blade are torn. This most commonly happens because of a fall right onto the shoulder. This often causes a bump or bulge on the top of the shoulder, where the clavicle is sticking up at an odd angle while the scapula drops down. A mild sprain causing clavicle pain may be healed with rest and restriction of movement with a sling. More severe cases may require surgery. Either way, physical rehabilitation is indicated to help restore mobility and strength.
- Broken collarbone – The collarbone/clavicle, which connects the arm to the ribcage, is a fairly exposed and delicate bone. It commonly breaks due to a fall. This injury causes collarbone pain and makes it hard to move the arm, causes the shoulder to sag, and creates a lot of bruising and swelling. If the break is clean, the shoulder can be immobilized with a sling until it heals. If the broken ends of the bone have shifted apart, though, surgery may be necessary to realign them. PT rehabilitation will then help through a long healing process.
- Labral tear – the labrum is a rounded rim made of cartilage that helps hold the top of the arm firmly in the shoulder girdle. Sometimes the labrum is stretched or torn due to injury or overuse, causing the joint to become loose and unstable. This can feel like a gentle shoulder pop or locking sensation when you move, or it can produce a severe pain when you try to lift the arm. A labral tear can cause loss of strength and range of movement. This condition is usually diagnosed by a specific imaging technique called an MR arthrogram. A labral tear may be helped by lifestyle changes to prevent aggravation, anti-inflammatory medications, cortisone, shots, and physical therapy. In some cases, a severe or complicated case may require surgery to repair the tear or tighten the joint capsule.
Other types of sore shoulder include: a pinched shoulder nerve in the neck area that can cause radiating neck and shoulder pain, or a muscle pull in the upper back or top of the arm, as in trapezius pain, rhomboid pain, or deltoid pain.
As you can see, resolving shoulder pain relies heavily on the reduction of inflammation. It may be that inflammation with a separate root cause (such as heart disease or an autoimmune disorder) created a problem with the soft tissues of the shoulder joints in the first place, or it may be that an injury to the shoulder is the primary source of the inflammation. Either way, reducing the inflammation is the key to relieving shoulder pain and restoring mobility to the joints.
Acupuncture is a highly effective modality for reducing inflammation, without the sometimes severe side effects that can arise from other conventional treatments like steroid injections. Cortisone shots can reduce pain and swelling temporarily, but repeated shots can cause damage to the area, and in some cases, infections at the site. Cortisone can also raise blood sugar levels, increasing the risk for diabetes.
Scientific evidence suggests that acupuncture treatments reduce inflammation by stimulating the pituitary gland to release more cortisol naturally. It is also hypothesized that acupuncture affects the release of neuropeptides from the peripheral nerve endings, which is a key part of the body’s inflammatory response.
In TCM vocabulary, we consider inflammation to be due to a stagnation of Qi and blood, not only in the area immediately affected, but also in related organ systems. In the case of the shoulder, the corresponding organ system is often that of the large and small intestines. To relieve shoulder pain and restore freedom of movement, it is also necessary to “re-train” the shoulder muscles to move together smoothly. Physiotherapy can be very helpful for this, but there are also TCM practices that can be integrated to help achieve better mobility. One study compared patients with frozen shoulder who were performing exercises to improve the condition with patients who exercised and received regular acupuncture treatments. The patients treated with acupuncture scored significantly higher in improved mobility and reduced pain, and the positive effects lasted for months after treatment ended.
Tuina and Gua Sha, specific forms of therapeutic massage administered by doctors of TCM, can also be used as part of comprehensive treatment for relieving stiffness in the shoulder.
Chinese herbs have been used for thousands of years to help reduce inflammation in the body.More recent scientific studies have demonstrated the direct anti-inflammatory and analgesic effects of Chinese herbal formulations. Specifically, herbs have been shown to inhibit the swelling caused by cytokine production that is typical of chronic joint diseases.
Top 3 Tips for Relief and Prevention of Shoulder Pain
The best way to relieve and prevent shoulder pain from recurring is to manage inflammation. Regular acupuncture treatments are beneficial, but there are also some excellent self-care techniques you can use to relieve pain and improve function.
- Acupressure point for shoulder pain: LI10 (large intestine meridian). Find this point on the front side of the forearm, about three inches below the elbow. Apply gentle pressure while breathing deeply to relieve stiffness and pain in the shoulder, neck, and elbow.
- Practice stretching and strengthening exercises for the shoulder joints. Start slowly, with gentle movements to improve range of motion, then move up to using some light weights to help strengthen the muscles.
- Pendulum – Lean forward with one arm hanging loosely. Use the other arm to brace against a chair for support. Gently swing the hanging arm from side to side, forward and back, and in a circular motion. Slowly return to a standing position. Repeat on the other side.
- Wall angels – Stand with your back to a wall, with the arms at your sides, whole arm and back of the hand pressed to the wall. Slowly raise your arms, keeping them pressed to the wall, and lower them in a “snow angel” motion.
- Follow an anti-inflammatory food program – avoid foods that cause inflammation, including fried foods, refined carbohydrates (flour, sugar, etc.), red meat, and processed fats like margarine and shortening. Consume lots of leafy greens and cruciferous vegetables, fresh fruits, especially berries and cherries, emphasize fish as a primary protein source, and use high quality olive oil. Your acupuncture provider will be able to give you more specific directions for how to eat best to improve your condition.
Acupuncture Near Me for Shoulder Pain
Art of Wellness Acupuncture & TCM in Santa Monica, California, was recently chosen as one of the top 20 acupuncture clinics in Los Angeles. Our doctors have over 30 years of experience both in China and here in the United States. Dr. Tan is a specialist, with training in both TCM and conventional medicine, in orthopedic, musculoskeletal, neurological, and chronic pain disorders of all kinds. We work in an integrated fashion with your other medical practitioners to help you achieve the best results. If you or someone you know is suffering from shoulder pain, call us at 310-451-5522 to schedule a consultation.
*This article is for education from the perspective of Traditional Chinese Medicine only. The education provided by this article is not approved by FDA to diagnose, prevent, treat and cure human diseases. It should not stop you from consulting with your physician for your medical conditions. Traditional Chinese Medicine is based on Qi, which is an invisible force that usually cannot be observed by modern science. Because science focuses on testing ideas about the natural world with evidence obtained through observation, these aspects of acupuncture can’t be studied by science. Therefore acupuncture and Chinese herbs are often not supported by double-blind, randomized trials, and they are considered alternative medicine therapies in the United States.
Multiples Sclerosis is autoimmune disease, Traditional Chinese Medicine & Acupuncture are very helpful to improve these condition.
Dr.Tan’s Case and Testimony
Mr. M- a healthy 50-year old Caucasian gentleman—first visited my office Art of Wellness Acupuncture a few years ago. As an attorney, he had been working very hard to support his two daughters, who were both in college. About four months ago, the onset of serve lower back pain along with tingling in his left leg changed his life completely. He saw several doctors, had a number of x-rays and an MRI which revealed a moderate bulging disk on L4-L5. He tried different pain pills, NSAIDs, and underwent three months of physical therapy, none of which had helped. Recently, he had been experiencing numbness and weakness in his left leg, and was suffering from depression due to his inability to carry on with daily work and regular activities. When he talked to me, I noticed that he constantly rubbed his eyes. I asked if he felt any abnormalities in his vision. He answered yes, and that he had periodic occurrences of blurred vision. When I suggested that he showed me how he walks, I noticed his poor balance. He tended to fall on his left side because his left leg did not seem to follow his motion. Then I checked his knee and ankle reflex and found that they were excessively active. I was almost certain that the condition that made him suffer so much in the last few months was not a simple bulging disk or sciatica; it was a disorder of the central nervous system-Multiple Sclerosis. Immediately, referred him to a neurologist and suggested that he have a brain and cervical MRI. Two weeks later, he came back to my office with a confirmed diagnosis of Multiple Sclerosis.
Mr. M. is just one of 200 patients who are diagnosed with MS every week in the United States. There are about 400,000 people in the U.S. and 2.5 million patients who are suffering from this disease in the world.
Cause of MS
MS is an autoimmune disease in which infections or environmental changes can confuse the body’s defense system. Sometimes a foreign antigen mimics a group of the body’s own proteins. When the immune system response by mounting an attack against these foreign invaders, it inadvertently destroys the foreign antigen along with any similar antigens, including the body’s own tissues.
A recent study shows that a virus called adenovirus type 2 looks remarkably similar to the composition of the protective covering around the spinal cord and parts of the brain—the myelin sheath cells. The attacks of the immune system of this virus along with the mistaken attack on the myelin sheath is believed to be the ultimate cause of multiple sclerosis。
Common symptoms of MS
- numbness or tingling, usually in the leg or arm
- muscle weakness
- pain (moderate to severe)
- Slurred speech
- Blurry, double vision or blindness
- bladder malfunction
- bowel dysfunction
- sexual dysfunction
- cognitive abnormalities
Most commonly, MS first manifests itself in a series of attacks followed by complete or partial remission as symptoms mysteriously lessen. These symptoms, however, will return later after a period of stability. This is called relapsing-remitting (RR) MS.
Treatment of MS
Unfortunately, there is no cure for MS yet. In Western Medicine, the treatment focuses mainly on decreasing the rate and severity of relapse. Beta interferons, anti-cancer drugs (to weaken the immune system), and steroids are commonly used for the treatment of MS. These medicines can reduce the number of MS lesions, delay the progression of the disease, and provide symptomatic relief for the patient.
In TCM, a condition called “Wei Syndrome” with symptoms similar to MS, was documented 2000 years ago in a classic Traditional Chinese Medicine book called Emperor Classic Medicine. Acupuncture and Traditional Chinese Medicine has been involved in the treatment ever since. MS patients who have tried acupuncture report improvement in pain, spasticity, numbness and tingling, fatigue, depression, anxiety, and bowl, bladder function.
Maintaining a healthy lifestyle is very important for the MS patient. This includes:
- Getting enough time to sleep and rest. Go to bed early
- Exercise regularly. Tai Chi and Yoga are very good to help patient relax, balance and with muscle strength
- Balanced diet, a lot of vegetables and enough protein from white meat
- Stress management
- Daily meditation and positive thinking
- Staying connected with friends and joining a support group
- How to reduce and prevent inflammation
Patient Story- Gilly
I was diagnosed with Relapsing Remitting MS in 1991 and I had no idea what a crazy, unpredictable journey I was about to embark on.
I woke up one morning, tried to get out of bed but my legs were like jello, I had no balance and had double vision.
I was given a spinal tap and MRI and lesions were detected on my brain & cervical spine.
When first diagnosed, my neurologist put me on one of the few FDA approved medicines for MS which don’t cure the disease, but delay the progression. For that I inject myself daily and have done so for 17 years
For the first 7 years after being diagnosed, I experienced relapses (flare up of symptoms) on average twice a year. The treatment for relapses was a 5 day course of steroids administered through IV, followed by 12 days of oral steroids.
The relapses affected my motor skills the most, especially walking but after a treatment of steroids, I was almost as good as new.
My friends suggested I try acupuncture. I was recommended to Dr Tan because he had studied MS in China. *
Dr Tan has been monumental in my life. He has given me treatments for a multitude of injuries I’ve suffered over the years due to frequent falls and is an expert in pain relief. He treats me for stress relief which contributes my general wellbeing. Dr Tan is very knowledgeable about Western medicine and MS treatments so I always ask his opinion.
I’ve been diagnosed with MS for 21 years and feel fortunate that Dr Tan has been treating me for a large part of that time. Although I partake in Western medicine, I know that Western medicine only treats the symptoms but Eastern medicine treats the cause of the symptoms.
My MS has progressed to the stage that I now use a wheelchair full time.
I go to acupuncture for preventative care. My immune system needs extra help especially during cold & flu season.
I am very aware that MS is a ‘designer’ disease, and no two people have the exact same symptoms. I would encourage anyone with MS to avoid stress, keep up a healthy immune system and try to stay positive and happy, because your emotional state affects your physical being.
How to Reduce and Prevent Inflammation
We usually think of inflammation as something that affects our muscles and joints, causing them to swell and ache. We observe these manifestations when people are injured causing knee pain or elbow pain from injuries like an ankle sprain. This suffering from pain and tenderness is actually our body’s normal protective response to restrict our body from further activity to cause more injury. For those acute inflammation incidences, we need to temporally put pressure near the heart end and apply ice to the injured area to discontinue bleeding and swelling. With time, we expect our body to reduce the inflammation and resume as normal. However, there are some conditions when the body is in a constant low grade heat or chronic inflammation, like rheumatoid arthritis, psoriasis, or celiac disease this is even observed with kidney stone, gall bladder stones, and high cholesterol.
Cancer is another disease linked with chronic inflammation/toxins. Over time, chronic inflammation can cause DNA damage and lead to some forms of cancer, according to the National Cancer Institute. More recently, science has made it clear that inflammation is also part of what causes poor blood flow through the arteries, causing problems in the body’s circulator system and the heart. Obesity and unhealthy eating habits can increases inflammation in the body. Autoimmune disorders like Lupus, Multiple Sclerosis can cause chronic inflammation in healthy and unhealthy people. But really, the root cause of inflammation is a dysfunction of the metabolism, or digestive process. It is the body’s normal defensive response to excess internal heat.
In Traditional Chinese Medicine, there are two energy measurements: Yin and Yang; which is present in everything. Yin represents cold, water, dark….and Yang represents hot, fire, light…..both energies need to be balanced in order to keep everything in shape. In our body, our organs need fire/heat to keep our body temperate normal and operate every part of the body well. However, if the fire is too strong, that will cause fever or infection or inflammation. In Chinese, fire is 火 (pronounced huo), inflammation is 炎(pronounced yan). As you can see, 炎 has two 火, means too much fire or excess heat.
Excess heat can be caused by stress, too heavy of a diet, and eating the wrong kinds of foods, and extreme environmental heat.
How to reduce and prevent inflammation?
Stress management is an important part of our daily task especially at the end of the day, we are able to unwind ourselves, release tension, and allow energy to flow. When there is ongoing or long term stagnation that is unaddressed, excess heat/toxins will be generated. Having acupuncture treatment regularly always helps people de-stress, calm the mind and body and achieve anti-anxiety. Once the whole body’s Qi/blood is flowing freely, the stagnation opens up, heat is reduced, and the inflammation will disappear. On top of acupuncture treatment, cupping is very helpful to clear excess heat and detoxify the body.
An anti-inflammatory diet is essential along with a low calorie diet. The meaning of “calorie” is, after all, a unit measurement of heat or energy. Simply put, ingesting more calories creates more heat in the body. If the calories aren’t being burned through physical activity, then they are stored in the body as excess fat. Fat not only weighs you down, but triggers the immune system, which tries to attack the fat as if it was a foreign substance. Carrying excess fat acts on several levels to create detrimental inflammation within the body, causing more Qi/Fluid blockage and that blockage creates more inflammation.
Second, anti-inflammation diet is cool or cold food. If you are an Art of Wellness member, you know what group of food you should stay on, either cooling food, like majority of vegetable, and fruit or add more warm/hot food kale, mustard green, turkey, walnut, black bean, ginger pecan, lamb to tonify your Yang. Besides of working on appropriate diet, having herbal supplements is very especial assisting reduce inflammation. Cause herbs are from plants, carry stronger energy than our food. Due to the poor taste, we do not consider eat them like other vegetable. It is important to pay attention not only to what you eat, and how much, but also how you eat, and when. Many people’s eating habits lead to poor digestion.
Eat sitting down. The body draws both blood and Qi into its center – the stomach and spleen – in order to digest food. Eating while standing or walking, or trying to concentrate on some other problem, draws much-needed energy to the extremities or the brain, away from the digestive process. And also , should eat in a relaxed environment avoid arguing.
Chew food thoroughly. Failure to chew adequately means that the rest of your digestive system has to work harder to break down your food into usable nutrition.
In general, choose more fresh, raw, and lightly cooked foods, and avoid baked, fried and heavily processed foods. These foods retain the heat energy that was used in their preparation, and that creates more heat inside you.
Increase your use of bay leaf, cilantro, dill and other herbs like rosemary, thyme, and oregano, all of which have anti-internal heat properties. Choose high Omega-fatty-acid fish such as salmon, and good quality fish oils. Eat lots of leafy greens. Avoid coffee, and drink green tea instead. Fermented foods such as pickles, sauerkraut/kimchee, miso and tempeh help to heal and promote good balance in the intestines. Shitake mushrooms are a source of copper, a rare nutrient, important in the prevention of arterial inflammation.
It probably comes as no surprise that we recommend cutting back on unhealthy fats (trans fats, processed cooking oils, and fatty red meat). And avoid sugar as strictly as possible, as sugar consumption leads to insulin resistance and is a major cause of inflammation.
Avoid the nightshade vegetables: peppers, eggplants, potatoes and tomatoes. This includes spices and seasonings made from peppers, such as paprika and red pepper flakes. These foods can irritate the intestines, affecting their permeability and setting off unwanted immune responses. These in turn lead to inflammation, muscle spasms and stiffness.
What to Eat to Beat the Heat/inflammation
In Chinese culture, we drink mung bean soup during the hot days of summer. Cooked mug beans cool down our internal body heat and detoxify the body. We even feed this soup to people who are suffering from heat strike. Mung Beans are very nutrition, offering easily digested proteins, and do not create gas like other beans can. Their natural sweet flavor and bright green color are pleasing, as well.
Try this simple recipe:
- Add one cup of mung beans to six cups of water
- Bring to a boil, simmer for 5-10 minutes
- Sweeten by adding Asian pear or add a pinch of salt and eat as a soup or tea.
- Or simply one table spoon of mung bean with two cups of boiling water, cover with lid, drink this tea when it is in room temperature. Refill two cups of water boiling water again in remained mung bean container, repeat 2-3 time, eat the mung bean at the end.
To ice or not to ice?
In the early hours of the morning, it is always best to drink liquids that are body or room temperature, in order to protect the fire of the digestive system. In the afternoon on a very hot day, it is generally OK to have a cold or iced drink to refresh yourself. However, women who are about to have or who have their menstrual period should never drink ice-cold beverages. The stomach sits right above the uterus, and the action of cooling down the female organs too much can cause cramping. And of course, we would always advise against drinking sugary iced coffee drinks, which can actually cause dehydration.