Treatment Table Podcast

Mini Consult | "I've Been Told My Shoulder Is Degenerating..." Here's What That Really Means

• Mathew Ah Chow • Season 1 • Episode 22

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0:00 | 14:13

You've been told you have "shoulder degeneration"... now what?

Those words can feel like a life sentence.

Many people leave a scan believing their shoulder is wearing out, exercise will make it worse, and surgery is inevitable.

But that's often not the full story.

In this Mini Consult, Doctor of Physiotherapist Mathew Ah Chow explains what shoulder degeneration actually means, why MRI findings don't always explain pain, and how the right exercise programme can dramatically improve strength, movement and confidence, even when your scan shows arthritis or wear and tear.

You'll learn:

• What "degeneration" actually means
 • Why scans often create unnecessary fear
 • Why movement is medicine for shoulder pain
 • The simple shoulder analogy that changes everything
 • How one client avoided shoulder replacement surgery
 • The exercises that matter most

If you've ever been told your shoulder is "bone on bone", "wearing out", or "degenerating", this episode is for you.

Remember: your scan tells a story but it doesn't tell your future.

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SPEAKER_01

Welcome to the treatment table podcast. This is your mini console where I take one question on one topic and break it down to an easy takeaway. I'm your host, Dr. Physiotherapy, Matthew Archau. Let's go.

SPEAKER_00

Hey Renel, do you want to read us our question for this week? Yeah, sure. This week it comes from Dai. And she says, I've been told I have degeneration in my shoulders. Is there something I can do about it?

SPEAKER_01

Okay, guys, I'm going to give you a little bit of a rant. So just hold on and I will answer this question. But first of all, it really bugs me when clients come in and they hand me a piece of paper and they say, I have degeneration. I've seen the doctor. There's nothing I can do. Can you help me? Now, what we know, and this is also from research and my experience, is that the words degeneration, wear and tear, bone on bone, it creates such a horrible sense of fear and a horrible sense of impact on people's health and what they believe is really happening in their body. So their confidence of what is what they can do, and their confidence of what their ability is and how much they can progress and rehab and improve their day-to-day quality of life is already on the back burner. So they're already starting from a really, really low point. And it's not always the GP's fault or the scan's fault. It's just not interpreted very well. So this is what generally happens you'll start getting some shoulder pain, you'll go see the doctor, the doctor will then send you off for some scans. Now, these scans are not always necessary, but sometimes they are necessary. It's generally when we, as physios, as primary contacts, won't go straight to a scan. But generally within the GP, because they're limited with time, they don't have time to go through a full 45-minute assessment of your shoulder to identify what some of the other causes may be. They're going to send you for a scan and you're going to go get that scan, you're going to come back into the GP, they're going to sit down and they're going to read off the report that says you have degeneration.

SPEAKER_00

Okay, so this might be a dumb question, but what is degeneration?

SPEAKER_01

So it's like the equivalent of you going to the hairdresser and the hairdresser coming back to you and saying you have gray hair. And you're like, awesome. What does that mean? Exactly. Right? So it's it's the changes that we have in the joint that are part of our normal aging. So, yes, ideally a joint has a perfectly smooth surface, and the cartilage around it is perfectly smooth. But we know through aging and the normal process that surface isn't as smooth as it used to be.

SPEAKER_00

So you can't prevent it, it's just a natural part of aging. That's right.

SPEAKER_01

That's right. And it's it's part of something that happens to all of us, and we have different levels of that wear and tear or arthritis or degeneration, and it's a normal part of aging. But what then happens is you get that scan, then you go home and you Google degeneration or wear and tear and arthritis, and of course, you're gonna get the worst case scenario. And unfortunately, what happens after that is you stop using your shoulders, and then you become fearful of the movement, and you then protect it, which means the muscles get weak, and then you become more sensitive to the pain.

SPEAKER_00

So it becomes like a self-fulfilling prophecy.

SPEAKER_01

Definitely, yeah, and that's what I mean. Like, it's so hard when a client comes in and they said, I've been told, I've got degenerations, nothing I can do, you know, I need surgery, I'm here as a last resort. And I'm like, oh man, I have to start all from the very beginning and start to rechange their beliefs around their shoulders and their neck and what that pain means, because they've ingrained this habit of this movement is bad, exercise is bad, I'm gonna further create more wear and tear. I can't use my shoulders.

SPEAKER_00

Okay, so if you've got a whole bunch of listeners who may have never heard of any of this before, what would you say to them? Like, so if you're if you get to start with a blank slate, they don't have any of these pre-existing beliefs, how would you start teaching them about aging and like how to look after their bodies and potentially dealing with something like this?

SPEAKER_01

What's really important is that as we get older, that we have the muscles to support the joint. What I see as a really n-bad case is that the wear and tear or the arthritis and the changes that are happening progressively get worse and worse. And that creates more pain, it then limits your mobility. You stop using the muscles the way they should, you start compensating, and then becomes this whole cyclic effect. What we want to do early on is a lot what we've covered already in previous podcasts is keep moving. Your mobility is really important. Strength training, build up those muscles to keep those joints as strong and as stable as possible.

SPEAKER_00

Just always comes back to movement.

SPEAKER_01

It does, it really does. And keeping that movement consistent, sometimes, yes, things are gonna ache. Yes, sometimes things are sore. Yes, joints are gonna pull up a little bit sore, but it doesn't mean that's the end. It doesn't mean that you now have arthritis, you know, sometimes our joints crack or creak. Uh, we call it crepitus, but that noise that you feel doesn't mean that's bone on bone. It just, as long as it's not painful, keep going.

SPEAKER_00

Okay, so for Dye, what should she do?

SPEAKER_01

Okay, so Dye, I'll share a story with another client who has very similar. He came to me about two years ago with bilateral, meaning both shoulder degeneration. He's been told by a surgeon that he needs joint replacements in his shoulder. Now, it is, I've seen probably two or three in my career. It is horrific surgery. It is the last end case result that we give to clients for a little bit of relief, but basically, once you have that surgery, you can't lift above head. It's very limited. And the surgeries are improving, the joint plates are improving, but not at the rate, right? What we've done with this client is reduce the amount of aggravating activities. So he was still very fit, still quite young, doing martial arts, working. What we managed to do is modify the things that were aggravating the shoulders. And we were able to bring down the inflammation, the pain, and reduce the irritation within that joint. So that's the first thing I'd say is what we want to do is think about modifying your current activity. So it's not about not moving and protecting, it's just about changing things so you're not aggravated, you're not irritating it.

SPEAKER_00

So, what are some good exercises that people can do?

SPEAKER_01

Yes. So, what I would recommend then is think about the ball in the joint. Now, most ball and socket joints have a very big socket that fits around. Think about your hip joint. What's different about the shoulder is that we have a big ball, think about a golf ball on a T. So the T that holds that ball in place is actually very small. So it's very easy to move around. This is great for mobility. This means we can move, we can reach overhead, we can spin our arms around. But what it makes it difficult for is when we start to get wear and tear, it makes us a little bit more unstable. And that ball really struggles to stay on the T. So what's really important, the exercises are really working on stabilizing the ball on the T so you're not constantly falling or moving or shifting. So we call those rotator cuff exercises or shoulder stabilizing exercises. Now, when you see a physio, they'll start off this really basic and then progress it into different movements. But the principle is the same. You want to keep the ball centered on the T as much as possible, and then we slowly make that harder and harder. And as because the benefit of our shoulder joint, even though it may have degeneration, is that we can improve the movement. We're not going to improve the wear and tear, but we're going to improve the movement, improve the strength. And the same that I've seen with my clients, their function, their day-to-day, all improves to the fact that they don't need that shoulder replacement anymore because they're not suffering from pain. Their wear and tear hasn't changed, but they're stronger and they've got more movement.

SPEAKER_00

Okay, so we know that movement is really a good way to help manage degeneration. Are there specific exercises that people can do? Like is it weightlifting? Is it Pilates? Is it walking? What are the best exercises for people to do?

SPEAKER_01

So, what we want to think about again is that ball centering on the T. What I like to do, first of all, is teach people about where their shoulder is and how to change the position of that T and then how to place the ball back on the T. Now we know from research, and one of the things that I like to do, because rotator cuff techniques, if you look at YouTube, rotator cuff exercises will talk about internal, external rotation, but it's not generally a functional movement. We don't take our elbow with elbow tight and move our hands side to side. Most of our movements today are multi-directional. So I like to do what we call closed chain exercises, and this is where your hands are on the ground. This way you get more feedback from the ground up to your shoulder, and you can literally feel the ball come back into that socket. So think things like push-ups, planks, and this is where sometimes I like Pilates because you're gonna be put into those positions with the right core activation, the right head positioning, and all those cues are gonna help activate those rotator cuff muscles really well. Saying that then you need to then progress into some strength training as well. So pushing, pulling, starting with your elbows in tight, gradually moving to elbows out to the side, and then later on you can move to overhead. What everyone thinks they're doing right is go straight to overhead, and again, that's generally overload. It irritates the shoulder, it makes it feel bad, you stop using it, and then you're back in that horrible cycle. So start really easy, slow. That's why I said close chain versus moving around through kind of open chain or moving it around with weights. Start there and then gradually progress.

SPEAKER_00

And so then if you're younger and you haven't been diagnosed with this, obviously we've said it's not you can't prevent it because it's just a natural part of aging. But is there a way to slow it down or make it less painful as you get older?

SPEAKER_01

Yeah, definitely. What you'll probably notice early on, um, before you get to that wear and tear or degenerations, if we were to regularly scan your shoulders, is that you're probably going to get more overload issues. And so we talked about this in one of our early episodes with the fascia and the connective tissue. And when that is strained or you're pulling on your tendons, that causes different types of issues. So the most important thing is keeping the mobility, keep those ribs moving, the neck moving, and then keep the strength training. So you want to build up those muscles around the shoulder. All of that really helps to keep the ball centered on the T and prevents that kind of you know excessive wear and tear. I don't like using that word, but we just don't want to be putting the joint in under more strain than we're gonna use it for.

SPEAKER_00

Always back to movement, always back to movement.

SPEAKER_01

Most important. A main takeaway for dye is that your scan is not the end of the world, right? Your shoulders may be degenerative, but you can still improve. You can still get stronger, you can still improve your day-to-day, your quality of life. That pain might come and go, but you just vary what's annoying it, and then gradually build it up. Go see your physio, start really slow and progress that. And you will get better. Just like my other client with both shoulders who had who needed replacements. He is now doing everything he still wants. He's still doing martial arts, he's still punching. And that's through slowing down, taking away those activities, building up those muscles, and then easing back into it. So, good news. Don't worry too much about degeneration. Keep moving, get stronger, and you'll keep being able to do the things that you really love doing. So that's a wrap for today's mini consults. We'll see you next week on the treatment table. Please make sure you keep sending through your questions. You can DM us on our Instagram, treatment table podcasts, or send me an email, treatment tablepodcast at gmail.com. Loving the questions, guys. Keep them up. And we are still working on securing. We've got three guests and some also some sponsors coming up for our season two. So very exciting. We are progressing, we're making some big, exciting shows. So keep tuned, and we'll see you next week on the treatment table.