Ms. B, a 39 year old social worker spending a lot of hours at the computer every week, presented with a 2 month history of right shoulder pain and major movement restrictions. The pain started gradually without any specific injury. The ultrasound of the right shoulder showed supraspinatus tendinosis (rotator cuff muscle) and subacromial bursitis indicating inflamed structures in the shoulder which could explain the restricted movements and cause pain.
Ms. B’s main goals: (self rated as 10/10 being pain free and full function)
- To do housekeeping tasks without pain, e.g. cooking, hanging cloths (5/10)
- To open the car door without pain (6/10)
- To recover full shoulder movement (4/10)
We performed a systematic assessment of Ms B’s musculoskeletal system and found the following imbalances:
- Muscle guarding around right side of neck and shoulder
- Muscle tension in both calves
- Major restricted right shoulder movements
- Suboptimal alignment of legs and poor standing posture
- Stiff neck and lower thoracic spine
- Restricted right and left hip flexion
- Restricted hamstring flexibility right > left
Through a clinical reasoning approach, we worked out together that Ms B’s right shoulder internal rotation was a good test to measure changes in her condition. Through a process of treatment directed testing, we found the biggest and quickest change in this test occurred with a left soleus (deep calf muscle) release, which improved Ms B’s shoulder movement considerably, reduced thoracic stiffness and increased both hamstrings flexibility concurrently.
Following this intervention, Ms B mentioned that she had issues with her calves in the last months. She couldn’t walk more than 20 minutes without feeling tension and pain preventing her to continue. We therefore added a goal which was to walk 60 minutes pain free (5/10).
Through more left soleus release, we reached full and pain free movement of the shoulder within two sessions. Gait analysis will be conducted and further work on postural correction and motor control will be achieved to prevent tension building up in the calves again.
This case demonstrates how lower body tension and imbalance can influence symptoms in the upper body, and how a systematic whole body approach is required to solve these types of problems. In Ms B’s case, we wouldn’t have thought the left calf could influence the right shoulder problem and wouldn’t have assessed this area without a systematic whole body approach.
If you would like to learn more about the neuroscience behind the approach we used with Ms B, please click here.