Why Acute Shoulder Pain Isn’t Always a Shoulder Problem
Can an acute injury, like a sudden shoulder subluxation, still have visceral or neural influences worth treating? In this episode, I unpack why even the most straightforward orthopedic cases often have deeper layers that shape pain, recovery, and movement quality.
I share a case of a collegiate softball athlete whose chronic subluxations suddenly flared after a rough bout of COVID and why her lack of progress with rehab made perfect sense once I assessed her through a whole-organism lens view. You’ll hear how lung restrictions, altered thoracic mobility, and neural tension were driving poor scapular mechanics that her strengthening program could never overcome. A few targeted treatments changed her symptoms instantly and shifted her entire rehab trajectory.
In this episode, you’ll learn:
• Why acute pain presentations often include visceral and CNS influences, even when trauma is obvious
• How post-infection thoracic mobility changes can alter scapular mechanics and create instability patterns
• How to differentiate true tissue instability from altered neural output
• Practical ways to influence supraclavicular, phrenic, and brachial plexus input when local loading isn’t tolerated
This episode will help you sharpen your lens for the cases that look simple on the surface but demand deeper, more connected reasoning underneath.
Resources & Links Mentioned In This Episode:
Episode 16: Why The Shoulder Comes Last
Episode 69: Why Your Shoulder Treatments Might Not Be Enough
Change your approach to treating shoulder pain and dysfunction with my course - Never Treat The Shoulder First
Learn the LTAP® In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
=================================================
Watch the podcast on YouTube and subscribe!
Join the MovementREV email list to stay up to date on the Unreal Results Podcast and MovementREV education.
Be social and follow me:
Instagram | Facebook | Twitter | YouTube
-
Anna Hartman: Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs in the nervous system on movement, pain and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello. Hello. Welcome back to another episode of the Unreal Results Podcast. It's been a minute. Sheesh... I have been sick. And shout out to Doc Joe O, my editor for, um. Helping me out over the last few weeks, um, putting YouTube content out still, even though I haven't recorded any new episodes of the podcast.
We've been holding strong on, um, weekly videos over there, so super grateful for that. I obviously was not intending to take some more weeks off, but, um. I just, well, one, I had a busy week going into the last in-person course of the year in San Antonio. And then, um, so I don't think I recorded one that week.
Um, and then I overextended myself and by the end of that weekend was exhausted. I, after that course, I was in the hotel room with Daniela, my teaching assistant, and I was just I was like, we need to order food in because I cannot move from this bed. I was so tired, so exhausted, more than I normally am at the end of a course.
And so I was like, oh, this is not good. And um, the next day I was okay. Um, we were still in San Antonio. We did a little touristy day, went to the Alamo and uh, but then coming home just. It was another late night on the plane. And then, uh, I woke up that next Tuesday with a sore throat and I was like, no.
And then that just progressed each day. Um, and, uh, bye for Thursday night. I, I was like, okay, I'm sick. And then, um, it just got worse and worse. It just, it, it was weird 'cause it would feel better and then it wouldn't. And my only symptoms really the whole time, besides that first day of the sore throat was a cough.
And then I had some congestion in my nasal area and then, but mostly it was just chest congest congestion and a cough. And I was just coughing and coughing, coughing. And finally I was feeling better by Thanksgiving, but still had a cough. But I decided to go home for Thanksgiving anyways, uh, to make my sister happy and, uh, that.
They just crushed me. And then the next day I was like, okay, I'm dying. I need to go to urgent care. So I went to urgent care 'cause my whole body just hurt from coughing. Like my diaphragm was so sore. My back started was starting to hurt. I just was like, I can't keep coughing like this and the cough, and arguably it was getting worse.
So I went to the urgent care and she listened to my lungs and was like, uh, yeah, you need everything. She's like, you need a rescue inhaler. You need antibiotics. You need a prednisone. And I was like, really? She's like, yeah. So I mean, she's not wrong. It was close to like 12 days already and it was getting worse, not better.
So clearly it was infection and, uh, yeah, my wheezing just was tough. Um, the wheezing was weird. It has been weird. It's been more of a whe on the exhale than, um, an inhale though when she listened to my lungs, there was wheezing on both inhale and exhale. So the wheezing on the exhale was a very like mucusy infectious inflammation type of sound of like rales almost. So anyways, um, started an antibiotic on that Friday after Thanksgiving and just by the next morning, oh my gosh, I felt so much better. But still since then, I still am like having trouble breathing and um, I'm like a hundred milligrams of prednisone in and almost done with my Z-Pak for antibiotics.
So, um, yeah. Anyways, feeling better, but still not a hundred percent. But here we are recording a podcast anyways and just, um. I wanna get back on track. Uh, I have a week to, um, finalize all of the preparation for the Revitalized Mentorship that's starting. I'm super excited. I changed the mentorship this year to include business coaching and I also changed the mentorship from four months to 12 months, so I'm super stoked for that.
I have a great group of clinicians that are joining me, um, I think 10 or 11 brand new to the mentorship and then some mentorship alumni, um, rejoining for the integration and business coaching piece. And I'm just really excited, um, about it. And then, um, also, you know, um. Offering the educational curriculum as a self-paced option again this round, um, to those people who have, um, already gone through the LTAP level one.
The LTAP level one is a prerequisite now for the mentorship. So working on that this week, traveling up to my football player in Seattle for a day and then. Just have a lot of calls with mentorship people, so super stoked to be doing that. Excuse my, um, cold sounds still, um, on this episode, but you know.
Life. So what do I wanna talk about today? I wanted to talk, I was already intending to share these three cases with you all because, um, they're just cool cases and I like sharing, um, cases when I have them. Uh, but then on, um, one of my posts, um, I was talking one of my social media posts. I was talking about how shoulder pain and dysfunction always has a visceral or essential nervous system, um, component to it.
Um. Which is like the whole premise for my course called Never Treat the Shoulder first. Um, you know, I'll have Joe link those episodes that I've done on the podcast about that too. But, you know, someone made a snarky comment about it and was like, oh, I broke my clavicle so I have shoulder pain, but yeah, sure it's my liver.
And I'm like, mm. Okay. Okay. Um, first of all, don't be so dense and sometimes social media, and this is like there is two sides of social media. There is the creator side, and then there's the consumer side, and the consumer doesn't understand the, um, constraints that the creator has, right? Like this day and age.
You've got seven seconds to hook somebody and teach them something and entertain them. Seven seconds. So it's like the hooks end up being very black and white and absolute. And we all know that that is not how real life is. Alright. And so it, that is a little frustrating when, when, um, consumers chirp content like that, as if like, you know, it's the whole argument of like the hook of like the one exercise to fix your knee pain.
Use your brain. There is not one exercise to fix your knee pain. And um, it's one of those like, if it's too good to be true, it's not true sort of thing. Like at some point as a consumer, you just have to like, use your brain and realize it's a marketing tactic. And also you wouldn't have paid attention if I didn't have that hook on it.
So it's a little of a catch 22 in that aspect, but, um, so it's like I get it. Like, I totally get it. It's nuanced, but also it's like the, it, it is just how it works. And, but I did wanna unpack what his comment was because my reply to him was, yeah, I get that. Acute injuries like, yeah, of course broke your clavicle. Your clavicle hurts. Your shoulder hurts. Like, pretty straightforward, however. When you can consider the viscera and the nervous system and their influence on the upper extremity, or the influence in anywhere in the body, how it influences sensation, how it influences core control, dynamic alignment, it opens up a lot more treatment opportunities for you, which in the case of a traumatic injury, like a clavicle fracture, which you might not actually be able to do manual therapy or exercise.
Treatment to the area of injury to decrease pain. It is nice to know all the other treatment options that could avail be available to treat that area. Right? So it's like when I think of a clavicle fracture, I think of a few things. Number one, that's the supraclavicular nerves and the relationship of the supraclavicular nerves to the brachial plexus and the cervical plexus, and then therefore the visceral organs in the central nervous system.
Is very significant and so I can actually influence the clavicle, um, from a cutaneous pain standpoint, um, from a blood flow standpoint, from a healing standpoint, and then from a movement standpoint to the subclavius muscle and the traps, if I better understand the central nervous system, the cervical plexus, the brachial plexus.
The relationship with the phrenic nerve to, um, as a sensory nerve to the thoracic and upper abdominal containers. So it's one of those things that's like, yeah, no, your clavicle fracture was not caused by, um, increased liver load and like an unhappy liver from drinking or something like that. But also we can't discount the role that the liver and the abdominal container can play on shoulder function, shoulder pain, and um, blood flow and just general relationships.
And so it's like, you know, don't be a dick. Also, it's one of those things that sometimes those snarky comments, it's not like people are making them to be a dick on purpose, but it's like they're just so stuck in the old paradigm that they're like, oh, you're an idiot. My best example of my, sometimes what makes me think of this is like when make people make snarky comments about something.
When it's unfamiliar territory to them. It reminds me of when I was in, um, the fourth grade. I think it was the fourth grade. It was either the fourth grade or the third grade. I remember sitting at lunch eating with my friends and someone declared that their mom was the Easter Bunny, and I was like, pfft.
Clearly at that age, I still believed of those magical things like the Easter Bunny and Santa Claus and things like that. So what was I like eight or nine? Um, which, bless, bless that. I still believed in those things. But anyways, um, I, somebody declared their mom was an Easter bunny and my, I, my comment to them, my smart ass comment to them was like, if your mom's the Easter Bunny, then my mom's the tooth fairy.
Come on. Are you freaking kidding me? Don't be so dense. Like don't be so dumb. Your mom's not the Easter Bunny. Just like my mom's not the tooth fairy. And it's like, that seems so silly. To us now, because we live in a world as adults where we know that that is made up, that that is a, a made up thing that we do for kids to like have this magic of a holiday season, whatever seasons it was.
Or like this magic of like dealing with a trauma of losing a tooth. Right? So it's, but when you're in it. It's so true to you that anything out, anything that, um, challenges, it is like, ugh. You get defensive and you're like, and, and sometimes when you get defensive, the smart assness snarky comments come out because it's like, don't be so stupid.
But really it's like this, this is the cognitive dissonance that I speak of, and the, oftentimes I'll talk to class, uh, talk to groups that I'm teaching, and I'm like, Hey, my goal over the teaching is to challenge some deeply held beliefs you have about the body, and you're gonna be offended whether you realize you're offended now, or it comes later, you will be offended.
I will run into that dissonance and that defensiveness that's going to make you instantly wanna do like a snarky comment like that, but my challenge to you is notice those things as they come up and then be open to seeing things differently. Or trying to see things differently, being a scientist about it.
Try it out, see how it works. I get it. You broke your clavicle. It sucks. I mean, I don't even know if this person really did break their clavicle. It was their example, but like in that scenario, yeah, it sucks to break your clavicle and it fucking hurts. But how are you gonna treat that pain? You can treat it with pharmaceuticals.
Sure. You can treat it with ice. Sure. Um, or you could treat it by like doing some breathing into the, um, thoracolumbar junction area or doing a neck, a new stretch on Erbs point to influence the nerve to the subclavius. Right. And the accessory nerve. You could do an accessory nerve guide, you could do a trigeminal nerve guide.
You could do gargling. You could do humming. There's so many ways that you could influence those supraclavicular nerves that it's like actually when we look at the body in this whole organism lens, even acute traumatic injuries can follow these patterns of having some sort of neural or visceral, not necessarily driver, but connection or influence or, um, relationship that we can leverage in order to have better outcomes. So anyways, um, that, that is just, it was just one of those things, those, somebody was like, oh. Like, I posted the comment and my response on Instagram stories, and sometimes I get in my comments, like my friends, um, defending me or like being, like supporting me or being like, don't let that person bother you, blah, blah, blah.
And I'm like, also, it doesn't bother me. Um, I find it comical and I like, I, I am a type of person where it's like, I like to be challenged. Especially intellectually and I will fire back. Like if you wanna try to pretend like you know more than me or you're smarter than me, or like, which is like, who fucking cares?
Anyways, you can be smarter than me and know more than me. Great. I would love to learn from you then. But it's also one of those things that sometimes people come at me, um, like, like. I don't know what I'm talking about, and so I'm like, oh, no, no, no. Hold my beer. Let me show you. I actually know what I'm talking about.
And also, let me give you more nuance because Yeah, a seven second hook, being like all shoulder pain is from the visceral and central nervous system is just that. It's a hook. It's, it's an opportunity to catch your attention, to challenge a deeply high belief, to get you to read my post and engage with my post, which success. That is what happened. So anyways, let me share these cases with you. Um, first case is actually a shoulder thing. Um, one of my, um, collegiate athletes came to see me on break. She plays softball. Um, she has a history, I guess I didn't know this, she had a history of subluxations of her left shoulder.
Um, she's right-handed, so it's not her throwing shoulder, but it's bothers her when she's hitting. So, um, it's something that bothered her in the past but hadn't really bothered her. She's never had surgery. I don't think she's even had any like MRIs, but the doctor's confirmed that she had, um, some glenohumeral joint instability and some episodes of subluxation.
She manages it well with exercise and um, self-care type stuff. So, um, she was away at college returning to sport after a lower extremity injury. And, um, then she. Just started having these episodes of subluxation again. And so they like held her out from hitting, they gave her a brace. The doctor and the athletic trainers at the university have been, you know, helping her doing exercises, you know, creating a treatment plan for her.
And the doctor basically was like, you know, if you fail the exercises and you continue to have these symptoms, then we need to think about like maybe doing surgery. And she was like, absolutely not. So she comes to see me. And, um. I assess, I use the LTAP to assess her and see where the body is directing me and um, you know, tie it always back to the orthopedics.
So the LTAP directed me actually to her like lung area, um, right lung. Bronchus, uh, mediastinum type area. Um, she had some thoracic, uh, restrictions in that area too, I think around T two and T five, which are the borders of the visceral somatic reflexes to the lung. So that kind of sometimes makes sense. She had, from an orthopedic standpoint, she had some, um, adverse neural tension on that left side.
Um, specifically at her elbow. Um, she had limited, um. Her mobility was actually pretty good and not too. Pain provocation ish, but I didn't like force it 'cause it was like there's, I don't wanna sensitize this by like doing all these mobility tests. I trust that it's unstable. But I did a manual muscle tester because those are kind of where her pain was.
She had, um, pain and weakness, um, and pain. Yeah, pain and weakness with shoulder flexion, palms up with external rotation and like a scarecrow position. And then she also had pain with shoulder abduction. And a little bit with shoulder flexion. She was significantly lacking, um, scapular upward rotation. She was lacking about two and a half inches from the inferior angle of the scapular to the mid axillary line, which would be full upward rotation.
And, um, that was the most significant. I also looked at her gait, um, just since previously we had been rehabbing an ankle injury and her gait, she was not arm swinging on the left side at all. And um, her SI joint was not moving on one side as two. So. Anyway, so that was all of her orthopedic things. She had some like altered motor control around her calf raising as well.
So we did treatment to the area of the lungs, um, the T two T five muscle energy techniques, some cupping. Did a bronchus stretch on her, just fairly general um treatment in that area. We, we utilize some humming and then we reassess her. And, um, she had significant improvements. She, um, had. Full strength and no pain with shoulder flexion, palm up, full strength, no pain with shoulder external rotation and, um, improved upper rotation in abduction and, um, shoulder flexion.
Still wasn't all the way to mid axillary line, but was. Equal to the other side. And then her gait, she had full arm swinging and improved calf raise and improved SI joint mobility. I did one more round of the LTAP and took me to the essential nervous system and um, did a quick treatment there and then reassessed everything.
And she looked at me and was like, what? My shoulder feels completely normal. That was crazy. And I'm like, yeah, that's cool. Okay, now I was like, now at the end of the day, I didn't change the fact that your shoulder is unstable by treating your lungs the interesting thing, what preceded this? Instability episode for her was, she had COVID pretty bad when she first got to school.
That COVID was about three or four weeks before her shoulder started bothering her with hitting. So I have no doubt that that was kind of like the trigger for it. Um, but it's one of those things, it's like, well, I'm not, it's treating your lung. It was very, Roddy needed for sure. Um, probably due to, you know, whatever's going on from her infection, um, from being sick.
But it's not like that changes the, her instability in a sense, right? Like true. Instability of the joint, if she truly has instability of the joint is like that's not gonna change it. What it changed was the dynamic alignment between the scapula and the glenohumeral joint improved function of the scapula thoracic joint so that she wasn't driving all of her overhead movement and all of her arm movement through the glenohumeral joint, through that hyper mobile segment.
Um. And it also made it where her, her body was now improving the output, right? The, the function of those muscles, the strength, motor control of those muscles. So now the exercises that she was going to be doing or had been doing, she's gonna get more out of 'em because now they're turning on automatically.
Because before they were too involved in protecting her lungs, protecting her rib cage mobility, um, to. Worry about full upward rotation and shoulder control. Right. So it's like, it's, it's not that I cured her instability. She's always going to have that unless she gets it surgically fixed, right? But we changed the driver of why her, all of a sudden she lost this stability and dynamic alignment and good cork, like good motor control of upward rotation and shoulder scapular, thoracic rhythm and things like that.
And so I just told her that. I was like, Hey, this means you're always going to have a tendency for some shoulder instability and shoulder pain, and we have to remember that. Um. Sometimes there's deeper drivers like this. So you got COVID, your body was protecting the more important organs and then it, the output was such that given your instability, it was driving more pain.
Right. And so it's just like, it's, it's just is a it different way to look at things and, um. This doesn't even mean that every day we have to treat her lungs. It just means like, yep, okay, now you can continue your rehab. I'm not saying you don't have to do your rehab, but I'm like, continue your rehab and it's gonna be a lot easier from here on out.
You're gonna feel like you make more gains versus for the last month and a half, she's been rehabbing and doing all these exercises, trying to strengthen these muscles and not really making any gains, and I go and treat your lungs and all of a sudden improve her strength from a three out of five to a five out of five.
So, and this is where the little bit of a mind fuck comes in because like we're, we've operated in this biomechanical model that makes us think that it takes a long time to improve strength, which it does, but not when there's a neural component that is inhibiting it. For a reason. Right. Did we gain high, like hypertrophied muscles, like gain muscle strength in that aspect? No.
We improved motor control and we improve motor control. We improve motor like strength output and um, right. So it's, so it, it is just understanding this whole organism concept a little bit broader and knowing when to. Like when it doesn't make sense. So like that, that it go, goes back to that too. For six weeks she's been doing exercises and not really making gains.
That doesn't make sense. Something else was at play when things don't progress the way you think they should. In traditional rehab, there's something else going on. So. Anyways, I'm gonna keep this episode short. I'm gonna save my next two cases for the next podcast episode. Um, those are actually both meniscus tears and, um, I wanna share about those treatments.
So, um, again. With the whole point, similar point to this episode is that yes, we can have acute traumatic injuries, legit pathological problems with the tissues, but still treat it from this whole organism lens, still treat it, understanding that there can be influences and connections that will either support healing and recovery.
Or limit healing and recovery that we can identify and address to optimize a return to full function. So I look forward to sharing those. And, uh, thanks for being here. Sorry again for the, uh, weeks off, but, uh, thanks for understanding.