Acupuncture for Shoulder Pain
In this article, I want to talk about how acupuncture and associated Oriental Medicine modalities can help with shoulder pain. In the first part, I will share my journey with shoulders and acupuncture, as this is the body part that got me interested in acupuncture to start with! In the second part, I will discuss the most common conditions I have seen in the clinic and what some modern research is finding about acupuncture as a treatment for common shoulder conditions.
The shoulder pain I most commonly treat in the clinic comes in mostly three forms: soft tissue tears (rotator cuff and bicep tendon injuries), arthritis, and frozen shoulders (adhesive capsulitis). I also see quite a few people while they are waiting for shoulder joint replacement, or post-op to regain full function. My treatments and patient homework all vary slightly based on the causes of the pain.
Shoulder pain was how I got introduced to how, in some situations, acupuncture can work like a miracle. I was recovering with a combination of a rotator cuff and bicep tendon surgery. During my time in the requisite sling, I started developing a frozen shoulder, and I had a horrid angry pain around the site where they reattached my torn biceps. The area was extremely painful and stiff months after surgery, even after PT, fascial therapy, and chiropractic care. Each night I flopped around trying to get comfortable enough to sleep.
My orthopedic surgeon started testing me for autoimmune diseases to see if my body was attacking the joint or the hardware they put in my arm. Nothing (thank goodness!). He sent me for hot-cold pool hydrotherapy, which helped, but only as long as I was in the pools. Finally, he suggested I try acupuncture since nothing else was working. Apprehensively, I went, not expecting much. I tried a community acupuncture treatment and the practitioner had my sore shoulder looking like a hedgehog’s back full of spines within minutes. I felt relaxed, even sleepy, which I attributed to the very dark treatment area and groovy music. After a while, she removed the needles, and my arm had a warm pleasant vibrating feeling.
I started driving home and all of a sudden, as I gripped the steering wheel, I screamed out because ALL the pain that had been stuck in my shoulder for MONTHS suddenly shifted out of the shoulder and into the web of my hand between my thumb and forefinger. I couldn’t hold the wheel. The pain was intense! I got home and called the acupuncturist who told me to briskly rub the area; I did and within a minute, ALL the pain disappeared- from my shoulder, hand-all of it! That pain I had never came back.
That was the first night I was able to fall asleep without my shoulder waking me up every time I moved. From that point on, I continued with normal recovery and was back to bodywork on horses (my career before acupuncture) within a month. Within a couple of months, I was back to scuba diving, doing yoga, and all the farm chores that require strong shoulders.
Fast forward seven years. I had an unexpected fall on my outstretched arm and felt the familiar ache and weird hanging arm posture of a serious shoulder injury. By this time, I was in the last year of my acupuncture training. MRIs showed I had torn the same rotator cuff again, this time in a different location. I was told surgery was usually needed. The next day the governor of Hawaii “announced that our state would shut down due to the new SARS-COV2 pandemic and all non-emergency surgeries were canceled indefinitely. They gave me a cortisone shot to help with the inflammation, but beyond that, I leaned on my skills and used a sling for six weeks along with acupuncture. I had to baby that arm for about three months, but I never did have a surgical repair on it. Within a few months, I was back to diving.
Today, I am a Master’s swimmer and swim at four coached practices a week, along with diving. Currently, I am logging about 15-20 miles of swimming a month. I am stronger than ever in my shoulder. Now, due to multiple injuries, I have developed some arthritis in my shoulder. If I eat poorly-especially high sugar- for a few days, it will get achy. If this happens, I clean up my diet, use my needles on myself, and get back to functioning. Other than that, I can be super active and use a good diet, monthly acupuncture, and turmeric glycerite daily to keep me completely pain-free. In all disclosure, since the first surgery, I have never been able to sleep on that side again for very long, but it’s a small price to pay for a very full and active life.
Acupuncture and Shoulders: Common Applications and Research
In the first part, I described how I was introduced to the powerful effects of acupuncture through my shoulder injuries, and how today I swim four times weekly with a competitive Master’s swim club, scuba dive weekly, and play with horses- in general, live a good full life! In this article, I would like to discuss how acupuncture and related modalities can address various shoulder pathologies.
Soft Tissue Injuries
These are among the most common injuries I see in my clinic and most often include rotator cuff and bicep tendon injuries. These are broad categories for a large number of soft tissue structures. Often, the injury is from repetitive overuse versus a discreet incident that the patient recalls, where there was a trauma and they heard the dreaded “pop” of a torn tendon. In these cases, depending on the severity, surgery may be necessary. I often see people who are waiting for surgery or are trying everything to be sure they need surgery.
Acupuncture is excellent for stimulating blood flow through the injured region, and will induce the release of natural pain killers right at the site of injury, all of which can bring about healing naturally. Some recent and exciting research showed that biomarkers of inflammation (cytokines) decreased in the joint fluid of the shoulders with rotator cuff injuries following consistent acupuncture treatment (Guan et al, 2020). In shoulder injuries, I often use an electro-stim machine hooked to the needles to induce short- and long-acting endorphin release directly at the site. I also like using infrared laser therapy, moxibustion, and infrared lamp therapy combined with penetrating Chinese herbal solutions on the injury site to relieve pain and increase mobility. I will also typically tape injured patients with supportive kinesiology tape after a session.
I have had two serious shoulder injuries, one treated with surgery + acupuncture, and one with just acupuncture. Because shoulder surgery often has a notoriously challenging and extensive recovery, there are a variety of factors that will be considered if your orthopedist recommends surgery, including age, desired lifestyle activity level, occupation, and overall ability to heal without surgery.
As an acupuncture physician, I also take these same factors into account. I do not advocate for or against surgery in general, as every case is unique and people must make their own decisions. For example, I am grateful I had my 2013 surgery and I am grateful I avoided surgery in 2020.
At best, I have been able to help people who didn’t want surgery return to obtain a high level of normal, pain-free function. In severe cases, I have been able to help people function with less severe pain, improve their range of motion, and often be able to sleep better.
Arthritis
Unlike many soft tissue injuries, arthritis cannot be cured, just slowed down. Arthritis is a bony inflammatory disease and is classified as either rheumatoid or osteoarthritis. Rheumatoid is an autoimmune form that destroys the soft tissues around the joints and deforms the bones, usually bilaterally, and is characterized by lasting morning stiffness (beyond 30min-1 hours of waking), and may have red, swollen, hot joints. Osteoarthritis is not autoimmune but has similar destructive effects on joint tissues and bones, and can be an individual joint, often one that has been subject to physical trauma or overuse. Because shoulders are the most mobile joint in our body, they are highly subject to both injury and overuse and are a common site for arthritic changes in the body.
Acupuncture, moxibustion, and all the other modalities I listed above are also used for shoulder arthritis, and a stringent 2018 metanalysis (a rigorous analysis that mathematically assesses the quality and results of all published research on a topic), found that acupuncture was more effective for pain control against the control measures, and was effective beyond the placebo effect (Vickers et al, 2018). In practice, I also find both plain and electro-acupuncture highly effective for arthritis. The main differences are that people with advanced arthritis will typically need maintenance acupuncture to remain pain-free. Often, this looks like an initial series of 3-5 treatments to get the pain under control, followed by a maintenance schedule ranging from every 2-6 weeks based on each person’s presentation. For maximum therapeutic effect, I strongly suggest discussing diet as a source of inflammation in the body. Evidence-based dietary therapy is one of my great clinical interests, as food should always be considered the “first medicine”.
Adhesive Capsulitis/Frozen Shoulder
This condition, known commonly as “frozen shoulder” is most commonly found in middle-aged and postmenopausal women and can have a sudden onset with no prior trauma. However, it can occur with anyone, particularly after a trauma where there is a period of immobility. Frozen shoulder presents with rather a rapid onset of increasing pain and stiffness when the shoulder joint is mobilized. In severe cases, the shoulder has an extremely limited range of motion and is “frozen” in place. The exact cause is still uncertain. Most frozen shoulders will self-resolve slowly over a period averaging two years- but this is a long time not to have use of your shoulder! Worse, the condition can jump to the other shoulder. I first encountered this condition in a dear friend who was in acupuncture school with me. She had suffered from it in her other shoulder previously and it took over two years to release with just regular PT care. With frequent acupuncture, gua sha, and aggressive fascial treatment, she never lost the use of her arm and was able to resolve the condition in under a year. There is little published high-quality research on the topic of acupuncture and frozen shoulder, but Ben-Arie et al (2020) found that the research that did exist showed that acupuncture was effective for short and mid-term relief of pain and restoration of shoulder function in frozen shoulders. Hopefully, more data will continue to be published as interest in this low-risk modality grows.
Acupuncture for Related Issues
Citations
Ben-Arie, E., Kao, P. Y., Lee, Y. C., Ho, W. C., Chou, L. W., & Liu, H. P. (2020). The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine: eCAM, 2020, 9790470. https://doi.org/10.1155/2020/9790470
Guan, J., Geng, W. Q., Li, Y., Liu, G. Y., Ding, L. B., Liu, Y. J., Xue, W., Wang, H., & Zheng, X. F. (2020). Decreased Synovial Fluid Biomarkers Levels Are Associated with Rehabilitation of Function and Pain in Rotator Cuff Tear Patients Following Electroacupuncture Therapy. Medical science monitor : international medical journal of experimental and clinical research, 26, e923240. https://doi.org/10.12659/MSM.923240
Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., Irnich, D., Witt, C. M., Linde, K., & Acupuncture Trialists' Collaboration (2018). Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The journal of pain, 19(5), 455–474. https://doi.org/10.1016/j.jpain.2017.11.005