by Eric Winder, DC 

Shoulder pain can range from annoying to debilitating which can lead to a serious cramp in one’s lifestyle. In my fascia-focused practice, I treat a wide variety of shoulder conditions in people of all ages and fitness levels. The shoulder is complex with a multitude of muscles, tendons, ligaments and other tissues which require careful assessment and treatment. Although most shoulder pain issues are not caused by just one point of injury, there is one area I treat more than any other—with tremendous success. 

The most important place I treat for many types of shoulder pain is the outer biceps tendon in the upper arm. This is often true even when there is another diagnosis such as a rotator cuff tear or bursitis. Of course, the biceps tendon itself can also be inflamed which causes direct tendonitis pain. No matter the type of shoulder pain, however, I find that fascia restriction around the outer biceps tendon is a major culprit, so releasing that restriction is a crucial part of successful treatment. 

A patient, whom I will refer to as Bill, came to our office not long ago for lower back pain, but also asked for help with a recent persistent shoulder issue. Raising his arm overhead was difficult, and he could feel sharp twinges of pain just by reaching forward and lifting a coffee mug. He also experienced a frequent ache in his upper arm that would wake him occasionally at night. A rotator cuff tear had been diagnosed by MRI, and he was considering an operation if the pain did not subside.  

After a thorough examination, I explained to Bill that much of his shoulder problem resulted from muscular imbalance due to restrictions in fascia (fibrous connective tissue).  Specifically, he had restrictions in the pectoral muscles of his chest, the supraspinatus muscle on top of his shoulder blade and the outer biceps tendon. Therefore, I was able to inform him that, despite this rotator cuff injury, treatment of the restricted connective tissue should relieve much of his shoulder pain. 

I treat many people with torn rotator cuffs, arthritic shoulders or other changes that seem untreatable except with surgery. The reason I can help in these cases is not because releasing fascia restriction miraculously repairs a torn cuff or makes arthritis disappear. Rather, the tears and arthritis usually happen because the joint already has muscular imbalance and instability caused by restrictions in fascia. Treating these restrictions allows restoration of joint stability and muscular balance. This means the joint can move properly with optimum muscular control which, in turn, protects it from pain. 

There are several possible causes of strains and injury to the outer biceps tendon. Most medical references point to activities that raise the arm overhead such as swimming or tennis, and this is indeed common. In my experience, an even more common cause is heavy or high-repetition curls that raise a weight as the arms are exercised.   

In fact, I know a gym owner who no longer allows his personal trainers to teach biceps curls for weightlifting for this reason. The exercise is too stressful on the outer biceps tendon, and can cause tissue degeneration, even if it’s not painful. Therefore, I always recommend my patients to switch to other exercises to work out their biceps. This includes rowing-type motions and pull-ups (with palms facing away), as well as other alternatives. 

For those who do curls with weights on a regular basis (either at the gym or perhaps a Silver Sneakers class), it’s important to know that just because there is no pain at the time does not mean it won’t cause damage.  In Bill’s case, he had done heavy biceps curls on a regular basis for many years. He hadn’t worked out in recent months, but the degenerative change in the biceps tendon finally affected him, causing the painful shoulder.   

Fortunately, when we released the various restrictions around his shoulder, his range of motion returned, and he was nearly pain-free. The most notable improvement occurred on a visit when we released the fascia tension within and around the outer biceps tendon. This improvement occurred despite the underlying rotator cuff tear.  Bill stopped waking up with arm pain, and with a careful strengthening protocol, he could take surgery off his agenda. 

As previously mentioned, shoulders are complex and finely tuned, but are also easy to take for granted when they function well. If a shoulder is painful, the cause is often not permanent tissue injury, but instead “kinks” in the fascia network of the shoulder musculature.  The outer tendon of the biceps often plays a key role in causing shoulder pain. Fortunately, the tendon is amenable to fascia therapy, and afterward, can be protected by avoiding potentially harmful exercises like biceps curls. 

With the COVID-19 crisis, our evening programs have moved online. You are invited to attend a Zoom webinar on May 27, 6:30 p.m. You will learn in-depth about fascia, why it is important, and how to solve fascia problems with gentle manual therapy. Dr. Eric Winder will discuss case examples, provide a treatment demonstration and hold a Q&A session following the presentation. Visit GentleBay.com to register for the Webinar.  Dr. Eric Winder has 23 years in practice and focuses on relieving pain and restoring alignment and motion through fascia release therapies without forceful manipulation.