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When the shoulder pain is referred

The osteopathic manual treatment to relief the disorder


Our body is a set of psychophysical and functional relations and correlations.

Taking into account this established fact, pains in the shoulder can be caused by a trauma or a physiologic disorder in the joint, but can also be the consequence of irradiations from other structures. In this case we can talk about referred pain.

Here are some examples of possible correlations with disorders in other structures:

1. Neurologic integrity disorder at the cervical ribs C5/C6. Deltoid, biceps, and subscapolaris are concerned muscles, as they are irradiation points of neurological disorders.

2. The shoulder girdle is related to the pelvic girdle and the internal organs; thus, to solve the problem at the shoulder, it can be necessary to treat pelvis and internal organs too.

3. The shoulder disorder is directly connected to the diaphragm disorder. The cause of both can be a compression to the rib C4, which concerns the phrenic nerve, which innervates the diaphragm.

4. Periarthritis in the right shoulder can be related to hepatic disorders. Mobilization or drainage of the liver can be an effective way to mobilize the shoulder.


Step 1

The correct diagnosis

Understanding the main cause of the problem is at the base of an effective and decisive treatment. The osteopath makes some diagnostic test to the patient, then he decides what muscular group and/or articulations are involved according to the limitation in the movements and the type of pain. Very important is also the collection of information on the lifestyle and habits of the patient: pain could be more acute because of daily movements which, in time, worsen the situation (for ex. in the car, turning the trunk and stressing the shoulder to get the bag from the back seat).


Step 2

trattamento acqua

The osteopathic manual treatment

Once the diagnosis has been made, the osteopathic manual treatment concerns both the painful area and the referred parts, in a way not to excessively stress the body. A treatment which concerns only the painful area could be counterproductive. In case of an inflammation with acute pain, the osteopath can at most look for an antalgic position to give the patient some relief and facilitate a resting position of the joint. This can be already considered a therapy. In a chronic phase, this therapy is well combined with thermal mud-bath therapy (especially in case of calcification), massages, rehabilitation in thermal water, especially with the consequences of post-trauma and articular functional rehabilitation. There is no single manoeuvre for each single problem: understanding if the treatment is perceived by the body or if a different approach must be tried, is up to the osteopath’s sensitivity.


Step 3

The response
of the body

The response of the body to the work done by the osteopath arrives after a phase of adaptation by the body to the input, lasting about 21 days.

fase 3

Remedies belonging to the folk knowledge:

Anti-inflammatory remedy: In the situation of inflammation resulting in acute pain, apply compresses of cool water and vinegar.

Anti-pain compresses: In a chronic situation, and non-pulsating pain, with contractures at the ligaments, try lukewarm compresses of water and salt. If the compresses are applied before the osteopathic treatment, the treatment allows the tensed structures to be more easily mobilized.

Be aware of ice compresses: it is a great “anesthetic” but it is also a vasoconstrictor and freezes, and therefore after a temporary relief the pain can increase.

Fabiano Antonello thanks, for the in depth information:

Dott. Fabiano Antonello
Expert in osteopathic manual medicine

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