Shoulder pain is a common complaint that often prompts individuals to seek conservative care. Discomfort frequently interferes with daily activities, leading many to search for non-surgical solutions. This article explores the role of chiropractic care as a conservative approach to musculoskeletal issues, specifically addressing whether a chiropractor can effectively manage shoulder bursitis.
Understanding Shoulder Bursitis
A bursa is a small, fluid-filled sac that cushions and reduces friction between bones, tendons, and muscles around a joint. In the shoulder, the most frequently affected bursa is the subacromial bursa, located between the rotator cuff tendons and the acromion (the highest point of the shoulder blade). Bursitis occurs when this sac becomes inflamed and swollen.
The inflammation is typically caused by repetitive movements, overuse, or direct trauma. Activities involving frequent overhead reaching, such as certain sports or occupational tasks, can irritate the bursa over time. Common symptoms include a dull, aching pain in the shoulder, which may radiate down the arm, and tenderness. Patients often report increased pain when lifting the arm above the head or difficulty sleeping on the affected side.
Chiropractic Evaluation of the Shoulder
A chiropractor begins with a thorough history and physical examination to accurately diagnose the source of shoulder pain. The initial consultation focuses on understanding the pain’s onset, aggravating factors, and previous treatments. This information helps differentiate bursitis from other common shoulder pathologies, such as rotator cuff tendinopathy or referred pain from a cervical spine issue.
The physical examination involves palpation to check for tenderness and swelling around the joint. The practitioner assesses the active and passive range of motion, noting any limitations or painful arcs of movement. Specific orthopedic tests are performed to narrow the diagnosis, such as the Neer’s or Hawkins-Kennedy tests, which evaluate for impingement. Distinguishing bursitis from a rotator cuff injury often involves comparing the patient’s pain response during resisted muscle testing.
Non-Adjustive Treatments for Bursitis
While chiropractors are known for joint manipulation, treatment for acute shoulder bursitis focuses on conservative, non-adjustive techniques to reduce inflammation. Since the bursa is acutely inflamed, high-velocity adjustments to the glenohumeral joint are often avoided initially to prevent further irritation. Care begins with therapeutic modalities aimed at managing pain and swelling.
Cold therapy, such as ice packs, is applied during the acute phase to reduce localized inflammation and pain. As the condition progresses, heat therapy may be introduced to increase blood flow and promote tissue healing. Chiropractors frequently utilize soft tissue therapy techniques to address the muscles surrounding the shoulder.
Soft tissue therapy targets tightness in the rotator cuff, deltoid, and upper back muscles. By easing tension in these supporting structures, pressure and friction on the inflamed subacromial bursa can be significantly reduced. Techniques used include:
- Myofascial release
- Therapeutic massage
- Trigger point therapy
- Instrument-assisted soft tissue mobilization (IASTM) to improve tissue flexibility
Once the initial acute pain subsides, rehabilitation exercises become a focus of the care plan. These exercises are tailored to restore the shoulder’s range of motion and strengthen the muscles that stabilize the joint. Specific attention is paid to strengthening the rotator cuff muscles and the scapular stabilizers, which are crucial for maintaining proper shoulder mechanics and preventing recurrence.
The chiropractor also provides ergonomic and postural advice to prevent positions that aggravate the bursa. This guidance may include modifications to a patient’s work setup or sleeping positions. Addressing underlying biomechanical issues, such as poor posture or muscle weakness, helps correct the root causes of the bursitis.
When to Seek Medical Consultation
While conservative care is highly effective for most cases of shoulder bursitis, certain symptoms should prompt an immediate referral to a medical doctor. These “red flags” indicate a need for specialized medical intervention beyond chiropractic practice. The presence of systemic symptoms, such as fever, chills, or unexplained rapid swelling, suggests the possibility of septic bursitis, a serious infection of the bursa.
Intense localized redness and warmth over the joint that does not improve with conservative care also warrant prompt medical attention. Furthermore, if pain and disability persist for 4 to 6 weeks despite consistent chiropractic treatment, a referral is necessary. A medical consultation may explore options such as diagnostic imaging, corticosteroid injections, or aspiration of the bursa fluid for testing. The chiropractor works collaboratively with the medical team to ensure comprehensive care.