Joe is a swimmer. Even as a senior citizen, he has stayed in pretty good shape by exercising in the pool. He was on the swim team in a major university back in the day, and he still loves to compete.
He is right-handed, so his power stroke in freestyle swimming requires his right arm plowing through the water. He has always had some soreness after a significant work out, but his recent shoulder pain was unusual and persistent. Any movement exacerbated the pain, and he said it was on top of the shoulder where the collarbone attaches to the shoulder blade.
He went to an orthopedic surgeon who wanted to do surgery quickly. Joe was hesitant to jump into surgery, as anyone should be, because surgery should always be the last resort after everything else has failed unless it is a true lifesaving procedure. He wanted to explore other options.
When he came to the clinic, I could see the distress in his face. This was more than just a sore shoulder. It threatened his ability to do what he enjoyed most to keep himself fit. This is a threshold in life that we do not cross lightly.
His range of motion in the right arm was significantly affected when he tried to raise the arm in a forward, lateral, or backward direction. The pain was well localized in the area he described. It was slightly swollen and red over the area as well.
What Joe is describing is really quite common among people who exercise frequently with the upper body. Sometimes it is relatively simple to control.
The joints in the shoulder are complex. The arm, or humerus, articulates with the shoulder blade in a very small, narrow groove. It is really held together with muscles, tendons, and ligaments. The collarbone, or clavicle, attaches to the sternum on one end and to a piece of the shoulder blade on the other end and acts as a strut to stabilize the whole shoulder joint, much like a strut in the front end of your car. The clavicle attaches to a piece of the shoulder blade called the acromion process to make the acromioclavicular joint, known to physicians and athletes as the AC joint. Joe's problem was that his AC joint was inflamed, causing significant pain upon movement in the shoulder.
Our examination revealed that the shoulder was misaligned. This became obvious when the motion of the right shoulder was compared with motion on the left. This is not a surprise and a swimmer, whose entire body weight is propelled on the strength of the muscles that attach to these structures.
Research literature tells us that x-ray is not usually informative in a case like this where there is no trauma or expectation of fractures. Many times I will proceed to treat a shoulder conservatively, returning to the question of imaging by x-ray or MRI if we do not get the results we want with conservative care.
In Joe's case, I used chiropractic techniques to adjust the scapula, the humerus, and the clavicle, including the right AC joint. Range of motion returned to near normal compared to the left side following the adjustment and realignment of these bony structures. Soreness remained at the AC joint, and this was treated with infrared laser for about 20 – 30 minutes.
Joe was pain free following treatment. He canceled the follow-up surgical appointment and return to his work out, swimming to his heart's content. He continues to do well, working out and having fun.
Joe's story is typical of many of the athletes we treat. There are many things we can learn from his situation. First, pain warns us that something is not right. It is not just a consequence of aging and should not be accepted that way. Second, pain is not an indicator for surgery. Conservative care is always your first option, especially for seniors.
So, if you are a senior, don't stop exercising. If you are hurting somewhere, find a source and treat it directly. In the words of the late Paul Harvey, "He who rests, rots!"