How A Patient With Chronic Shoulder Pain Was Helped In 1 Visit

By Dr. Jessica Warnecke PT, DPT, OCS

​I recently had a patient come to me for shoulder pain she’d been experiencing intermittently over the past 6 years. We discussed her symptoms and concerns a bit on the phone and she explained that her pain starts out of nowhere, and then ends by itself- sometimes 2 days later sometimes 2 weeks later. She had struggled to get any answers because once her symptoms started, she was either in too much pain to move or she couldn’t get in to see her physician in time before the pain resolved. She was getting to the point of frustration and unsure if anything could even be done. 

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She had started to rely on medicine and shoulder stretches when the pain started to help give her short term relief. She wasn’t sure she could pinpoint anything in particular as the cause of her pain, but stated that sometimes her sleeping positions seemed to aggravate it, and she had just recently changed jobs from moving all day to sedentary on her laptop. This woman was very active and recently had to adjust her workouts and stop doing certain activities altogether out of fear that she could potentially cause a shoulder pain flare up.

At the time of our phone conversation she wasn’t currently feeling any pain but I discussed the concept of referred pain and said that her symptoms sounded like they could actually be coming from her neck. I also informed her that a lot can be done preventatively in this case to avoid future episodes. She agreed to come meet with me, I fully evaluated her upper body, and all the special tests came back positive for a neck pain referral pattern into her shoulder. No issues noted at all in any shoulder test performed.
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So what is referred pain? The short answer is that it’s pain felt in a part of the body other than its actual source. It’s hard to pinpoint an actual prevalence number because these pains go misdiagnosed or undiagnosed SO often. However, in my years of experience as a PT, I can say that referred pain from the neck or back (cervical and lumbar spine) is part of if not the entire cause of pain in at least half of the shoulder and hip pain patients I treat.

What does this mean? Well, if referred pain is present, but only the symptoms are treated and not the actual source, then the issue won’t be fully resolved. I don’t know as much about cars as I do the human body, but I do know that if my car won’t take me from home to the grocery store because it’s out of gas and low on oil, me adding oil to the car won’t fix the fact that gas is out and the car needs it to move. If I only looked at this woman’s shoulder, treated the muscle she was feeling pain in, and then sent her on her way, nothing would be done to help improve the function of her neck, which was the main source leading to the muscle pain in her shoulder. Thus, her issue would not be resolved and she would still be left stranded next time an episode flared up.

Being aware of referred pain and understanding how to properly diagnose it is very valuable in today’s society. Too often medication is given out to mask the pain symptoms. Also unfortunate, nowadays visits with your physician are short (averaging 17 min) and you as the patient only get an average of 5 minutes speaking time. This makes our jobs as physical therapists even more crucial in order to help with proper diagnosis of musculoskeletal pain issues. I am lucky enough that I have the luxury of time that I could talk to this person on the phone for 15+ minutes about her issues. Then, I was also able to spend an hour strictly devoted to her, doing a thorough evaluation, and treating what needed to be treated. I gave her a set of corrective and preventative exercises to improve her neck function, educated her on how to be aware if her referred pain came creeping back up, and told her to call or email me if she had any other questions. Last I heard from her, she was pain free and working towards training for a two-day bike race through the Texas Hill County.

I hope that this quick education on referred pain can give a new light to you or anyone you know that has been dealing with some sort of unusual intermittent or chronic pain and hasn’t yet found something successful to help. Don’t lose hope! Being able to talk and explain your story to an attentive PT can be the start to your healing process.
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