Shoulder pain is a frequent complaint, affecting a person’s ability to perform routine activities and often interfering with sleep. When discomfort arises from the shoulder joint, individuals commonly seek out non-surgical and non-pharmaceutical options to find relief and restore mobility. The search for effective conservative care often leads to questions about manual therapies and their role in managing joint conditions. Understanding the source of the pain is the first step in addressing the problem, especially when inflammation is suspected.
Understanding Shoulder Bursitis
Shoulder bursitis, most commonly known as subacromial bursitis, involves the inflammation of a tiny, fluid-filled sac called a bursa. Bursae are found throughout the body, acting as cushions to reduce friction between bones, tendons, and muscles. The subacromial bursa specifically sits beneath the acromion—the highest point of the shoulder blade—and the rotator cuff tendons, allowing for smooth movement of the arm.
When this sac becomes irritated, it swells and produces excess fluid, occupying the limited space within the shoulder joint. This irritation often stems from repetitive overhead motions, a sudden increase in activity, or direct trauma to the shoulder. Common symptoms include a dull ache or burning sensation, pain when lifting the arm, and tenderness localized to the outer side of the shoulder. The pain is frequently worse with movements involving a “painful arc” (lifting the arm between waist and shoulder height) and is often felt at night, particularly when lying on the affected side.
Chiropractic Assessment and Differential Diagnosis
When a patient presents with shoulder pain, a Doctor of Chiropractic (DC) takes a detailed patient history to understand the pain’s onset, location, and aggravating factors. This step is important because bursitis symptoms can overlap significantly with other shoulder conditions, such as rotator cuff tendinopathy or shoulder impingement syndrome. Through observation, the DC assesses posture and how the patient holds and moves the affected arm, looking for any guarding or altered movement patterns.
Range of motion testing is performed to identify limitations and reproduce the pain, often revealing the characteristic painful arc associated with bursitis. Specific orthopedic tests are then employed to help isolate the irritated structure. For instance, tests like Neer’s and Hawkins-Kennedy are used to determine if the pain is caused by structures being compressed within the subacromial space. While clinical findings form the primary basis for diagnosis, a DC may recommend advanced imaging, such as an X-ray or MRI, to rule out severe issues like fractures or full-thickness rotator cuff tears.
Specific Treatment Modalities Used by Chiropractors
Chiropractic care for shoulder bursitis focuses on reducing inflammation, restoring proper joint mechanics, and addressing muscle imbalances contributing to the irritation. In the acute phase, treatments are gentle, prioritizing pain reduction and preventing further aggravation of the bursa.
Advanced soft tissue therapies address muscles surrounding the shoulder joint that may have become tight or restricted. Techniques such as Instrument-Assisted Soft Tissue Mobilization (IASTM) or Active Release Technique (ART) are used to target tightness in areas like the supraspinatus or deltoid. These methods work to break down adhesions, enhance tissue flexibility, and improve circulation, which helps accelerate the healing process.
While the inflamed bursa is not directly manipulated, the chiropractor may use gentle mobilization of the glenohumeral joint or the thoracic spine (upper and mid-back). Restoring proper alignment and mobility in these adjacent areas helps ensure the shoulder can move without unnecessary friction or impingement on the bursa. Correcting spinal function can also reduce biomechanical stress contributing to the shoulder problem.
Adjunctive therapies are often incorporated to manage pain and inflammation directly. Therapeutic modalities such as cold laser therapy (low-level laser), therapeutic ultrasound, or electrical stimulation (e-stim) may be applied over the affected area. Cold laser, for example, is used to reduce pain and swelling by stimulating cellular activity.
Long-Term Management and Referral Guidelines
A comprehensive recovery plan for shoulder bursitis extends beyond in-office treatment and relies on the patient’s adherence to home care and rehabilitation. The DC will prescribe specific therapeutic exercises designed to strengthen the rotator cuff and scapular stabilizer muscles, which maintain balanced muscle activity around the joint. Initially, this may involve gentle movements like pendulum swings to maintain mobility without stressing the bursa, progressing to isometric and light resistance strengthening as the acute pain subsides.
Patient education is an important part of long-term management, including advice on ergonomic adjustments and proper posture to prevent recurrence. Modifying activities, especially avoiding repetitive overhead movements or carrying heavy loads, allows the bursa time to heal. The chiropractor will also counsel the patient on sleeping positions, often recommending they avoid sleeping directly on the affected shoulder.
The DC operates within professional guidelines and will refer a patient to another healthcare provider when necessary. If symptoms fail to improve after a reasonable course of conservative care, or if they worsen significantly, a referral to a medical doctor or orthopedic specialist is appropriate. Referral is also necessary if there is suspicion of a large rotator cuff tear, a fracture, or if a corticosteroid injection is deemed necessary to manage severe, persistent inflammation.