By Dr. George Goodheart
Summary: In this 1960 article, the “father of Applied Kinesiology,” Dr. George Goodheart, discusses chiropractic manipulations and nutritional support for treating pain in the shoulder area. One of the most common causes of such pain, he explains, is the precipitation of calcium out of the blood and into the tissues in and around the shoulder joint—a condition resulting usually from an overly alkaline state within the body. (For more on pH and health, see Dr. Goodheart’s excellent primer, “The Acid-Alkaline Balance and Patient Management.”) Other times, Dr. Goodheart says, discomfort in the shoulder is actually referred pain originating from dysfunction in the digestive organs, making nutritional support of the stomach, gallbladder, and liver critical to resolving the issue. Articles like these reveal the holistic understanding of the body’s function—and appreciation of the value of nutritional therapy—that have long distinguished chiropractic care within the healing arts. From the journal Michigan State Chiropractic Society, 1960. Reprinted by the Lee Foundation for Nutritional Research.
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Arm and Shoulder Pain
Shoulder pain may arise (1) in the supraspinatus, in the infraspinatus, and in the subdeltoid bursae (2) in the muscles and tendons about the shoulder (3) in the acromioclavicular joint (4) by reflex from tissues at the base of the neck and upper thorax, including the cervical nerve roots (5) by reflex upwards from the nerve sheaths in the arm and the elbow.
Pain arising in the structures that form and control the shoulder joint may be felt at a distance only. Pains that in fact often arise at the shoulder joint may be felt most intensely at the lower deltoid area or in the arm just above the elbow. Occasionally the symptoms are ascribed to the forearm or even the wrists. The pains may entirely omit the shoulder region and often radiate to the hand. Identical pains may arise from different lesions; the same lesions may at different times give rise to pain at different sites. No matter what the position of the trouble, if it’s severe, the patient often complains of a deep burning ache running down the arm and forearm. The patient has little idea of its source.
To deal with the difficulties with the shoulder joint is indeed a difficult task, but on a percentage basis, the most frequently met condition in the average patient is a bursitis of either the subdeltoid or the infraspinatus tendon. Witness the often-found calcification in the tendon, and compare its appearance to that of another found condition, calculi in the renal pelvis or possibly in the bladder. The same conditions occur and develop that allow calcification.
In a general way, it has been our observation that calcium will precipitate out of the bloodstream and out of the tissues while in its colloidal state and precipitate into a calcareous deposit only when the reaction of the tissues becomes of a greater alkalinity and can be tolerated by the patient’s acid-base equilibrium.
Frequently, the patient will complain of “bursitis,” and just as frequently we may find the condition to be neuritis or some other common condition. But in true bursitis, we must find a calcareous deposit. Occasionally, the calcium is in a state of precipitation where it is visible and [yet] simple X-rays generally do not suffice because frequently the deposit is situated in such a way that it will not become immediately visible if one takes the simple AP [anterorposterior] view of the shoulder.
It has been our practice when the patient complains of symptoms referable to the shoulder to perform a fluoroscopic examination of the patient’s motion pattern about the shoulder and instruct the patient, with his or her arm hanging loosely at the side, to put the arm into extreme supination very slowly and then into extreme pronation very slowly while we observe the shoulder joint carefully for any signs of a calcareous deposit. Frequently, there will be a calcareous deposit behind the greater tuberosity of the humerus, and unless there is some change in the position of the humerus, one is apt to miss the calcareous deposit that lies quite often just beneath the floor of the bursa or possibly at its posterior area.
Frequently, we see calcareous deposits in the supraspinatus tendon, close to the greater tuberosity, and sometimes in the subscapular and infraspinatus tendon. The cause of the deposit is undoubtedly related to blood supply rather than any change in toxemia or infection, and primarily we feel that changes in the acid-alkaline balance directly relate to the precipitation of the calcium deposit [by reason of] the most frequently found calcium deposit—in the kidney or in the ureter—forming when the urine maintains at a highly alkaline level.
Now, for the purposes of explanation, it is assumed that the reader recognizes that not all kidney stones are formed of basically an alkaline-urine calcareous deposit. But in the main this is the pattern, and we feel that a similar situation occurs in the shoulder—in the shoulder bursae—and treatment designed to acidify the tissues frequently is of great value in first reducing the period of disability the patient has and second in completely clearing the calcium deposit in the bursa—without any vigorous regime or unnecessary or unusual dietary or physical therapy methods, even though these may be efficacious.
The following technique has been found useful and practical in the management of an acute bursitis. The patient is seen, the diagnosis having been made as to the presence of a calcific bursitis. He is given immobilization by an adhesive strapping on the shoulder in such a way that the arms are lifted up to take the strain off the bursa depending on the location of the bursa, which can be established by fluoroscopy or by simple observation. The direction of the pressure pull of the tape is determined by the relief or by the observation of where the bursa is located. Any existing lesions are removed. Frequently, associated with this bursitis we find a sacroiliac condition on the same side, causing a great deal of muscle pull.
Frequently, there is a subluxation of the acromioclavicular joint, but because of the extreme pain that these patients complain of, any work about the shoulder is generally deferred until such time as the patient can tolerate manipulation of the shoulder.
He is given directions to take one [Cataplex] A and [Cataplex] C tablet [daily]; one [Cataplex] E tablet hourly; and one tablet of acid calcium [Cal-Amo] four times daily. This acid calcium allows first a diffusion of the calcareous deposit by presenting the tissues with a normally acceptable form of acid calcium.
It is our view that, in the light of the so frequently observed calcium deficiency of the modern urban dweller, the paradoxical calcareous deposit in the shoulder in the presence of a calcium deficiency requires explanation.
Frequently, the patient is calcium deficient on a dietary intake or on a metabolic pattern. This calcium deficiency quite frequently causes a pull of the bony reserves of calcium in order to maintain the blood calcium-phosphorus ratio, and although this effort of the body to provide a calcium-phosphorus ratio acceptable to the blood does suffice, the bony calcium that is derived from the bone is usually not acceptable by the tissue when it is needed, and frequently this calcium is then deposited as a waste product in some hardworking joint or bursa in a vain effort of the body to overprotect some critical area of muscle-bone friction. This explains the position of the deposit in the bursa, and it would also explain the frequent presence of olecranon bursitis or bursitis of other areas that we find quite often.
After the patient has been given the A and the C, the E, and the acid-calcium product, with directions to take the A and C and the E, one hourly, and directions to take the acid calcium until he begins to yawn: if yawning supervenes and he is taking 3 a day, then cut it to 2; if he is taking 2 a day, cut it to 1. Yawning generally represents the effort of the body to shift into an acid pattern. This allows dissolving of the calcium deposit, and as the calcium deposit reduces or diffuses into the tissue, there is much, much less pain. This generally takes between 24 to 48 hours. The patient is instructed to expect a relief within 24 to 48 hours, and X-ray evidence invariably will show a dissolution of the calcium deposit within a week if he maintains this schedule. X-rays before and after are an excellent media to prove your point on the modus operandi of first the calcium deposit and second the ability of your therapy to relieve it.
We must frequently find the second cervical, the third cervical, and the fifth cervical subluxated to the inferior on the right in these bursitis cases. This seems to occur regardless of the side of the bursitis, and adjusting within the patient’s tolerance to receive it yields good results. It has been our observation, once the adjustment has been accomplished, to withhold any further adjusting until such time as it can be definitely proven that there is a disturbance in the position of the previously mentioned segments.
Muscles and Tendons About the Shoulder
The most frequently met condition in pain referred to the shoulder is a slipped bicipital tendon. This slipped bicipital tendon generally is complained of by the patient in his inability to place his hand in his hip pocket. Frequently, he has difficulty raising his arm past the horizontal until he’s reached a certain point. Then the raising of the arm past the horizontal becomes a little more easily accomplished. Slipped bicipital tendon frequently follows trauma.
The biceps has two heads—one with its origin from the top of the coracoid process, the other from the upper lip of the glenoid fossa. It’s the biceps head that has its origin on the upper lip of the glenoid fossa that we are concerned with. The head of the biceps slips from the groove over the humerus (from the bicipital groove of the humerus) and immediately causes an automatic shortening of this biceps tendon, which then interferes with the accidental reduction back in position. This causes subsequent pain, swelling, and much disability.
The therapy is simple. The arm is allowed to hang loosely at the side; the elbow is flexed so the forearm is at right angles to the floor; a steady lateral (rarely medial) pressure is exerted on the slipped bicipital head; and the elbow is pushed straight posterior, hugging the patient’s thorax, until the limit of motion is reached. Continuing the lateral, rarely medial pressure on the bicipital tendon, the elbow is then taken away from the chest, brought out forward, and returned to its previous position. A slipping back of the tendon into the bicipital groove of the humerus should be observed. When this is accomplished, it may require repetition.
Following the reduction of a slipped bicipital tendon, traction taping to hold the slipped bicipital tendon into its position is recommended. Efforts made to elongate the muscle by carrying heavy weights [and] massage of the insertion at the bicipital tuberosity of the radius [are] recommended, as are other forms of physiotherapy, but the main element is to reduce the slipped bicipital tendon. This constitutes the most frequently found condition of the muscle and tendons about the shoulder joint.
One should not forget the fact that the teres major, the subscapularis, and the infraspinatus are all capable of contracting in a cramped fashion and causing a posterior rotation of the humerus, which in turn sets up the compensatory contraction of the pectorals major, causing difficulty in movement of the shoulder. Manipulation—heavy and deep—of the origin and insertion of the teres, the subscapularis, and the infraspinatus produces good results, along with secondary manipulation of the origin and insertions of the pectoralis major.
The coracobrachialis very seldom enters into the shoulder joint conditions since this is not a very powerful muscle. The latissimus dorsi, however, is frequently involved in shoulder joint conditions, and it is also wise to always examine the status of the pelvic girdle and the sacroiliac joint as well as the sacral-lumbar joint and carefully reduce conditions here. The previous article on disc lesions would accord an excellent method of investigating this area.
Disturbances of the acromioclavicular joint, which is basically the butt joint between the coracoid process of the scapula and the distal end of the clavicle, can be classified as lesions that cause a separation of the acromioclavicular joint or an approximation of the acromioclavicular joint. Generally, if the shoulder joint (the acromioclavicular joint) is separated, the patient carries his arm away from his body; if the patient has an approximation of the acromioclavicular joint, he carries his arm near the body.
Manipulation to reduce this is directed to the scapula, and since the scapula floats free on the posterior thorax, a steady pressure designed to either open up or reduce the acromioclavicular joint is many times all that is needed. Pressure applied on the scapula, diagonally inferior on the supraspinatus ridge, along with simultaneous headword pressure at the lower margin of scapula will generally allow an approximation of the previously separated joint to occur if one holds it long enough—approximately 4 to 5 minutes. The opposite is true in the case of an approximation of the acromioclaviclliar joint: if a medio-diagonal pressure is held below the supraspinatus ridge along with a separating pressure on either the coracoid process or the clavicular border, [this] will suffice to cause a normal separation of the acromioclavicular joint.
Taping to insure either approximation or separation of the joint is seldom necessary, but in difficult cases this is occasionally recommended. Severe tearing of the acromioclavicular joint heals slowly, and surgery is frequently recommended in a severe tear.
Reflexes from Tissues About the Base of the Neck, Including the Cervical Nerve Roots
A.A.O. [sic] combination lesions produce much brachial pain, and frequently disturbances in cervical two, cervical three, and cervical five produce referred pain in the arm and shoulder and can easily be reduced by attention to these particular segments. Reflexes from various viscera produce pain in the brachial plexus, and most frequently met are digestive visceral reflexes. The gallbladder and the stomach are the most frequently indicated, and attention to the gallbladder and gastric reflexes and the gallbladder and gastric function in terms of nutritional support will aid in the reduction of any painful process arising from these areas and having a referral point in the shoulder and arm. Your attention is directed to the usual techniques of treating reflex pain, such as thumb-web areas, foot areas, and belly reflexes.
Reflexes Upward from Nerve Sheaths in the Arm and in the Elbow
The most commonly met condition that causes referred pain to the shoulder and to the upper arm is a separation of the radioulnar joint. This is generally caused by a fall or some trauma that is experienced with the wrist held in extreme extension and weight being born on the extended joint.
The separation of the radioulnar joint produces what is called carpal tunnel syndrome; nerve pressure is exerted because of the traction exerted on the carpal ligaments producing pressure by traction. The reduction of the separation between the radius and the ulna at the wrist joint is the therapy of choice to reduce the referred pain. Frequently, the pain is referred to the elbow or to the biceps area. Reduction and maintenance of the reduction by proper adhesive strapping or the wearing of a leather wrist band is productive of good results.
Changes in the elbow joint are also productive of pain referable to the arm and the shoulder, and the elbow joint generally requires a pronation extension to realign the humerus to the radius and ulna. This is a relatively simple maneuver in which the arm is flexed, carried into moderate pronation, and then, with pressure exerted on the acromio process, the arm is brought into full extension and mild pronation. Generally a palpable click is heard with the great reduction.
Occasionally, in children more often than adults, the radius can enter into a pronation or supination pattern. There is generally an occurrence of heavy traction, with pronation or supination being exerted at the same time [and] with the radius head slipping out at the time supination or pronation is produced. Flexion with the thumb on the head of the radius and then mild extension, along with pronation or supination depending on the pattern involved, frequently causes a reduction of the moderate subluxation of the head of the radius with a subsequent reduction in pain. As was previously mentioned, this occurs much more often in children than in adults, but it does occur [in adults], and it is frequently a cause of referred pain to the arm, the shoulder, and the wrist.
It is hoped that this brief survey of conditions in and about the shoulder joint may prove useful and practical—the main points primarily being proper diagnosis, proper therapy, [and] proper nutrition. In the case of bursitis, the use of A and C, E, and an acid-calcium product is essential for the dissolution of the calcareous deposit and the reduction of the muscle and tendon disturbances.
We have frequently found that vitamin E complex and Manganese B12 combinations are of great value in chronic dislocations, as is also the case in acromioclavicular joint separations and in reflex disturbances in the shoulder joint. In terms of nutrition, attention to both gallbladder and stomach function is practical and useful, along with the use of appropriate A, F [i.e., AF Betafood] and possibly Betaine [Hydrochloride] products for the liver and gallbladder as well as other lipotropics and attention to either reduction or increasing of the hydrochloric acid level, depending on results of simple tests for gastric function.
In neuritis associated with fatigue, B complex is indicated; in alkalosis association, acid calcium and phosphorus compounds are needed. Shock doses of E complex occasionally are required in syndromes following excessive use of synthetic fats.[Note from original publisher:] This article is published as a service by the Research and Nutrition Committee of the Michigan State Chiropractic Society. This section is devoted to the problems of chiropractic nutrition. It is conducted by Dr. A.J. Dysert, Chairman of the Committee on Nutrition of the MSCS.
By Dr. George J. Goodheart Jr. Reprinted from Nutritional Section, Michigan State Chiropractic Society journal, July 1960, by the Lee Foundation for Nutritional Research. Edited by Dr. A.J. Dysert, Cedar Springs, Michigan.[Information added by Lee Foundation for Nutritional Research:]
“A” and “C” mean vitamin A and C complexes: CY1711-13.
“E tablet” means vitamin E complex: CYl715.
“Acid calcium” means Cal-Amo tablets.
“Manganese B12” means Manganese-Phytate B12.
“B complex” means vitamin B complex: CY1712.
“A and F” means vitamin A and F with Betafood: CY1711-16-27.
“Betaine” means Betaine Hydrochloride.