My shoulder pain isn’t getting better … That’s because it might no be coming from your shoulder!!

As with so much in life, clinical routine has its seasonal features: the overindulgence accident at Christmas; the gardener’s back in March after a winter of inactivity – most of these problems have an obvious cause an effect but there is one problem that strikes every autumn … and nobody is quite sure why.

Ask a chiropractor how they know when autumn has arrived and they will tell you it’s the sudden influx of patients with ‘shoulder’ pain – instead of half-a-dozen per week, suddenly it’s more than half a dozen every single day. 

Theories as to why range from the ‘cold wintery draught on warm skin’ to the effects of rapidly changing day length on serotonin levels, though no theory has yet been proved (it’s not a well-researched subject). What is, however, seems quite clear from clinical experience is that most of these seasonal symptoms are not shoulder pain at all!

If the pain is across the top of your shoulder or between the shoulder blade and the spine, then the chances are it’s coming from your ribs. Patients often look slightly sceptical on being informed that their ‘shoulder’ pain is coming from their costal joints (the joints between the ribs and the vertebrae) – “surely my ribs are in my chest?” they say.  In fact, the top rib actually joins with the base of the neck and acts as an anchor for some of the big muscles that run up the side and back of the neck (which can often feel as if they’ve been ‘pulled’ or ‘cricked’ if the underlying rib is injured).  You can easily feel your top (first) rib, it’s the bony lump you can feel at the base of your neck just behind your collar bone … that’s how high they go.

By comparison, most pain that arises from the joints and muscle of the shoulder is typically felt at the top of the arm. either whether the rotator muscle pass under the collar bone and attach to the arms or coming directly from the joint between the collar bone and shoulder blade or from the cartilage, ligaments and synovium of the ball and socket joint.

The other things patients often complain of is that – unlike ‘true’ shoulder injuries – they’ve no idea how they’ve done it: it just “came on gradually”, or, more commonly, they “woke up with it”.  That’s because the inflammation in the small joints between the ribs and the spine builds up slowly over several hours, so its not the injury (often from lifting at arm’s length) that hurts, it’s the body’s reaction hours later.

So, if you’ve got a intense ache across the top of your shoulder or feel there's a knife in your back just inside the shoulder blade, then you’re probably suffering from costovertebral syndrome, colloquially known as a ‘popped rib’ … and you may well be suffering: it can be one of the most painful of conditions;  fortunately, it is also one of the easiest and quickest for chiropractors to treat, with recovery often in days. 

There's also something you can do to help yourself if you’re suffering from seasonal shoulder symptoms, use an ice pack (or wrap some frozen peas in a tea towel) and apply for ten minutes or so every hour (that will reduce the inflammation), then pick up the phone and ask one of our chiropractic experts for confirmation that it’s your ribs and not your shoulder that are the source of the trouble.

Plantar Fasciitis may be a common cause of foot pan … but it’s not the ‘sole’ cause.

Plantar Fasciitis may be a common cause of foot pan … but it’s not the ‘sole’ cause.

When it comes to feet there is a medical truism: we all take them completely for granted – until they start to go wrong!

Complaints about foot and ankle pain are a daily presentation to any chiropractic clinic; particularly so at Yeovil Chiropractic Clinic, where we normally have a podiatrist (foot specialist) working alongside us (get well soon, Robin!). 

Although the complaint itself may appear simple, the underlying causes can often be complex – did you know that a quarter of all the bones in your body are in your foot?To make matters worse, foot problems aren’t just caused by feet.  They can also be the result of knee, hip and low back dysfunction and it’s important that any treatment takes this holistic approach.

 Of the dozens of possible diagnoses, which can include congenital variants, neuromas, stress fractures, arthropathies, sprains, strains, bursitis, tendinopthies and fat pad pathologies we, in this country, appear to have a fixation with one condition – plantar fasciitis (pronounced ‘fash-ee-eye-tis’).

Of course plenty of people do present with plantar fasciitis – it’s a common condition in middle and old age.  It’s caused by inflammation in the soft tissues that make up the arch of the foot – so if your pain isn’t in that area, it isn’t plantar fasciitis.  The onset is usually quite sudden and associated with an obvious cause (change in footwear, walking barefoot, trekking across cobbled streets) and treatment should comprise two elements: symptom relief and determining the reason for the dysfunction and not just the cause of the onset – are the bones of the foot aligned properly? Are the muscles working properly? Is there damage to the ligaments? Are the legs functioning in a balanced and symmetrical manner? Are the nerves that control the feet working as they ought?

The symptoms are usually easy to control: medical treatment usually involves drugs to control the inflammation and advice about footwear (Crocks are our top tip) but if you want the treatment to be as effective as possible and minimise the chances of it coming back you need to ask the basic question: ‘why have I got this problem?’

…and if you feet aren’t giving you any grief, perhaps you should ask yourself ‘what can I do to keep it that way?’ – like many musculoskeletal conditions, the signs are normally there for the expert eye to detect before things actually start hurting: so are you taking your feet for granted?

Arthritis – Should I learn to live with it?

 Arthritis is another of those words that mean different things to different people. To most, it means your joints have got a bit of wear and tear in them; to a specialist such as a rheumatologist or chiropractor, arthritis refers to a very specific group of much rarer inflammatory diseases of which rheumatoid arthritis and anklylosing spondylitis are probably the best known. Wear and tear – often referred to as ‘osteoarthritis’ – is a completely different disease process, which is why specialists prefer the term ‘degenerative joint disease’, or DJD for short.

So do you have DJD?  If you’re over 50, then the answer is almost certainly “yes” – most commonly, it affects the joints that we use the most (thumbs, toes, backs and necks) or the ones that bear the most weight (hips and knees), particularly if you’re carrying extra poundage!  So if you’ve got some swelling or stiffness in those joints, can you do anything about it?

My Shoulder is Frozen!

Have you ever had a shoulder joint that’s painful and restricted?  The chances are you probably thought it was a ‘frozen shoulder’ – and the chances are you were probably wrong!

As with some of the previous terms we’ve discussed, such as sciatica and migraines, the problem lies in part with the difference between what you might mean by ‘frozen shoulder’ (it hurts and I can’t move it properly) and what a musculoskeletal specialist means by ‘frozen shoulder’ (very specifically, adhesive capsulitis) … and differentiating between the two is very important as they can have very different treatments and outcomes.

The shoulder is the most complicated joint in the body – in fact, it’s not one joint at all, it’s three joints plus the articulation between the shoulder blade and the top seven ribs.  If it’s going to work properly, there are over 100 joints, muscles, ligaments and bursae that have to we working normally and integrate smoothly.  Fortunately, of all the things that can go wrong, frozen shoulder (or adhesive capsulitis as we should call it from now on) is one of the less common.