Shoulder pain can be one of the most difficult problems to fix in the body. Unless a tear or bone spur shows up on an MRI or X-ray, many health care practitioners become stumped with regards to resolving chronic or nagging shoulder and elbow pain. One reason for this is the shoulder's unique anatomy and mechanics, which are unlike any other joint in the body.
Shoulder and elbow problems usually come in the form of rotator cuff tendonitis, bursitis, impingement problems, tennis elbow, or golfer's elbow -- you name it. I refer to these as structural diagnoses because they describe a specific painful tissue that has been injured. Typically, these diagnoses are followed up with advice to stretch, rest, or ice the involved tissue. While this may calm the irritation, an identical problem will resurface down the road or take the guise of an injury in an adjacent area. While these diagnoses pinpoint the tissues that are most affected, they don't indicate the conditions that lead to the problems in the first place. I liken this to seeing an X-ray of a broken left thumb and appropriately casting it to heal without realizing that the right hand is continually hitting it with a hammer. Until we can make the right hand stop, the left thumb will continue to be reinjured, if it ever really heals at all. Yes, the broken bone is painful, but the right hand continues to deliver more pain and injury, preventing true healing from occurring. I believe something similar is happening that causes these recurring structural issues in the body.
I interpret the presence of these structural diagnoses as evidence of functional problems. Functional problems are those in which muscles or joints don't move optimally and thereby create stress to the surrounding tissues. In my experience, functional problems lead to structural diagnoses and pain. This may occur due to poor movement patterns, weakness, limited range of motion, old injuries, or all of these factors. I believe the repeated stress from functional problems leads to physical changes in the body such as bursitis, arthritis, rotator cuff tendonitis, or epicondylitis -- in other words, structural diagnoses. Structural diagnoses, once again, don't describe the roots of the pain but instead symptoms the root problems create.