Updated: Feb 15
“Stop testing your shoulder!” I told my patient, Aaron.
*Aaron is a 35-year-old chap who hurt his shoulder and arm from doing pull-ups. Having had his arm and shoulder symptoms for the past 5 months which he initially thought would just improve. He finally sought help when he was finding the shoulder ache and tightness not improving even with resting from any upper body exercises.
He noticed he is now beginning to feel that even his neck and upper back are aching, especially while working, which is typical deskbound work with hours of sitting. Being quite a resourceful patient, he learnt to massage his back by lying on a massage ball. He would also sometimes jerk and throw his arm in a quick flicking manoeuvre, in an attempt to ease the achiness and tightness in his arm and shoulder.
All of which he did only provided temporary relief, which brought him to see me for physiotherapy.
After speaking with him and examining him. It became obvious that his behaviour in trying to ease his achiness and discomfort was not helping. He had a peculiar tendency to move his arm to check for the presence of the achiness and tightness as they tend to move around from his neck, upper back, to his arm and shoulder.
That is when I told him without reservation, “Stop testing your shoulder!” I wanted him to stop looking for his pain. “How many times a day do you think you do this?” I asked. He replied at least 10 times a day, just to check where he is feeling his tightness and achiness and sometimes out of frustration jerk and throw his arm hoping to get some relief.
“Leave the testing and checking to me when you come for physiotherapy, to assess your progress and your condition,” I told him that his testing of his shoulder is an example of “practice makes permanent” and a case of “getting what you are looking for”. By looking for his tightness and achiness up to 10 times a day, he will reinforce the presence of his symptoms and this repeated behaviour makes the symptoms more permanent. His behaviour is definitely not helping him get better.
It took a little bit of convincing but he took my advice and changed his behaviour. He had to be mindful to not give in to the urge to test his shoulder, jerk and throw his arm in an attempt to get rid of the achiness and tightness in his upper back and shoulder.
Aaron returned one week later, after that initial consultation, reporting that his arm and shoulder feeling a lot better. He is not feeling it as often and when he did feel it, he resisted the urge to test and jerk his arm, continued to focus on his work or daily task at hand, and he noticed the ache and tightness slowly fading away.
What Aaron experienced could only be explained by “bioplasticity”, a process by which our brain, nervous system and body are “plastic” and are able to change when our behaviour changes. A change in unhelpful behaviour, changes how our brain and body are wired and how much we will experience pain. This change happens really quickly, within 3 days, nerves can change how its wired and this can in turn change how much pain is perceived by the individual.
In the past, when Aaron felt some ache and tightness coming, he would experience a level of distress as he “tested” his arm and shoulder. I reminded him that moving and stretching is good for him when he feels tight and achy, which is different from the way he moves to search for his symptoms.
We discussed more helpful strategies to reduce his symptoms. This includes some stretches, strengthening and breathing exercises. There was also less emphasis throughout the next few sessions on getting rid of the tightness and achiness, and more attention and focus on progressively working on muscles to help him return to pull-ups.
This change in attention and focus during sports rehabilitation is so crucial in helping Aaron move away from the goal of “fixing a problem” which is his achiness and tightness, towards the goal of “returning to pull-ups". By working towards the goal of returning to pull-ups, we were then able to, through bioplasticity, use “practice makes permanent” and “getting what you are looking for” in a helpful and positive way.
*Name has been changed for patient confidentiality.