Case Study: Peri-Menopausal Woman With Left Shoulder Pain

Meet Sarah: A Dedicated Administrator Facing Shoulder Pain

Sarah, a 49-year-old administrator for a local charity, spends her days juggling paperwork, coordinating fundraising efforts, and managing volunteers. Her job keeps her at a desk for long hours, but it also requires occasional lifting and reaching, making shoulder mobility essential for her daily routine.

Over the past few months, Sarah started experiencing persistent left shoulder pain with no clear cause. She hadn’t suffered any injuries or accidents, but the discomfort was gradually interfering with her ability to work, sleep, and even enjoy simple activities like cooking or exercising.

Medical Background:

• Perimenopausal: Experiencing irregular cycles, hot flashes, and night sweats
• Mild osteoarthritis in the knees but no prior history of joint injuries in the shoulder
• No history of trauma or major illnesses
• Non-smoker, moderate alcohol consumption

Sarah’s case presented a challenge—there was no obvious injury, yet her shoulder pain was increasing. Given her age and hormonal changes, we needed to assess whether perimenopause could be playing a role in her musculoskeletal discomfort.

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Presenting Complaint: Persistent Shoulder Pain Affecting Daily Life

For the past six months, Sarah has been dealing with a dull, aching pain in her left shoulder, occasionally sharp when reaching overhead or lifting heavy objects. The discomfort has started to limit her range of motion, making everyday activities—like grabbing items from a high shelf or carrying event materials—more difficult.

Adding to her frustration, sleep has become a challenge. Lying on her left side increases the pain, leading to restless nights and daytime fatigue.

As an administrator, Sarah’s role involves organizing events, coordinating volunteers, and handling logistical tasks—many of which require repetitive shoulder movements and occasional lifting. Over time, these demands have worsened her symptoms, making it clear that she needed a solution that would not only relieve pain but also restore function.

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Work-Related Considerations: How Job Demands Impact Shoulder Pain

Sarah’s role as a charity administrator requires a unique combination of desk work and physical labor. While much of her day is spent managing emails, coordinating volunteers, and handling administrative tasks, she also sets up events, moves supplies, and lifts donation boxes—all of which put added strain on her already painful shoulder.

Beyond the physical workload, stress plays a significant role in her discomfort. Tight deadlines, event planning pressures, and the emotional weight of her work contribute to ongoing tension, which may be amplifying her musculoskeletal pain.

Additionally, perimenopause has introduced new challenges. Fluctuating hormones, hot flashes, and mood swings have made it harder for Sarah to get quality sleep and recover from daily stressors—potentially increasing her sensitivity to pain and inflammation.

This combination of physical strain, high-stress work, and hormonal shifts has made her shoulder pain progressively worse, signaling the need for a comprehensive, holistic treatment approach.

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Initial Assessment: Identifying the Root Cause of Shoulder Pain

During Sarah’s initial chiropractic evaluation, several key factors were identified that contributed to her persistent left shoulder pain:

POSTURAL FINDINGS

• Mild forward head posture: likely from long hours at a desk, contributing to muscle imbalances.
• Rounded shoulders: increased tension in the upper back and shoulder muscles, exacerbated by stress and poor ergonomic positioning.

MUSCLE TENSION & PALPATION FINDINGS
Upon palpation (hands-on assessment), Sarah exhibited:
Tenderness and tightness in key shoulder muscles:

• Upper trapezius: commonly tight due to stress and poor posture.
• Infraspinatus & subscapularis: two key rotator cuff muscles that control shoulder movement.
• Lower back & hip tightness: suggesting a compensatory movement pattern affecting her posture and shoulder mechanics.

RANGE OF MOTION (ROM) RESTRICTIONS

Active Movement (when she moves her shoulder on her own):

• Reduced ability to lift her arm (abduction & flexion) on the left side.

Passive Movement (when the doctor moves her shoulder):

• Mild discomfort during external rotation & overhead movement: indicating tight, restricted soft tissues rather than structural damage.

SPECIAL TESTING FOR ROTATOR CUFF HEALTH

• No signs of rotator cuff tears based on orthopedic testing, ruling out more severe structural damage.

KEY TAKEAWAYS
Sarah’s shoulder pain appears to be postural and muscular in nature rather than caused by a structural injury. Her work habits, stress levels, and perimenopausal changes are likely amplifying the muscle tension and joint restrictions leading to discomfort.

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Diagnosis: Understanding the Root Causes of Shoulder Pain

After a comprehensive assessment, Sarah’s shoulder pain was diagnosed as a combination of muscular dysfunction, postural imbalances, and lifestyle stressors rather than a structural injury.

PRIMARY DIAGNOSIS

Left Shoulder Pain – caused by:

• Myofascial dysfunction (muscle tightness & trigger points) in the upper trapezius, infraspinatus, and subscapularis muscles.
• Mild rotator cuff tendinopathy: inflammation of the tendons due to repetitive use and muscle imbalances.

SECONDARY CONSIDERATIONS

Postural Imbalances & Workplace Strain

• Forward head posture and rounded shoulders increase strain on the shoulder joint and muscles.
• Prolonged desk work, repetitive lifting, and lack of movement variety contribute to muscle fatigue.

Perimenopausal Changes & Stress

• Hormonal fluctuations can lead to increased joint stiffness, inflammation, and pain sensitivity.
• Work-related stress from heavy lifting, event setup, and administrative tasks exacerbate muscle tension.

WHY THIS MATTERS:
Sarah’s case highlights how shoulder pain isn't just about the shoulder—it’s often a combination of posture, muscle function, stress, and lifestyle factors. By addressing all of these contributors, we can create a holistic treatment plan that not only relieves pain but also prevents future flare-ups.

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Customized 12-Week Treatment Plan for Shoulder Pain Relief

Sarah’s personalized treatment plan was designed to not only alleviate pain but also improve mobility, strengthen muscles, and integrate lifestyle modifications that fit her busy role as a charity administrator.

PHASE 1 (WEEKS 1-4):  PAIN RELIEF & MOBILITY RESTORATION

Visit Frequency: 2x per week
Goals: Reduce pain, restore movement, release muscle tension

Chiropractic Adjustments & Joint Mobilization

• Spinal Adjustments: Focused on the lumbar, thoracic, and cervical spine to correct posture and improve movement patterns.
• Shoulder Mobilization: Gentle adjustments to the glenohumeral joint for improved range of motion and flexibility.

Manual Therapy & Soft Tissue Work

• Trigger Point Release: Targeted work on upper trapezius, infraspinatus, and subscapularis muscles to reduce muscle tightness.
• Decompression Chair Therapy: Reduces spinal pressure to improve posture and decrease shoulder stress.

At-Home Exercise Plan

• Stretching: Focus on neck, shoulders, and upper back to release tension.
• Rotator Cuff & Scapular Stabilizer Strengthening: Builds endurance for long-term shoulder health.

Stress Management Techniques

• Deep breathing & mindfulness practices to reduce tension-driven pain.

PHASE 2 (WEEKS 5-8): STRENGTHENING & POSTURAL CORRECTION

Visit Frequency: 2x per week
Goals: Strengthening, posture correction, pain management

Chiropractic & Manual Therapy

• Continued spinal and shoulder joint adjustments as needed.
• Active Release Techniques (ART) to break down adhesions and improve flexibility.

Progressive Rehabilitation Exercises

• Resistance Band Strengthening: Improves rotator cuff stability to prevent re-injury.
• Postural Exercises:
  Chin tucks & scapular retraction to improve alignment.
  Ergonomic recommendations (desk setup, chair height, movement breaks).

PHASE 3 (WEEKS 9-12): LONG-TERM STRENGTH & INJURY PREVENTION

Visit Frequency: 2x per week
Goals: Strength maintenance, long-term self-management

Chiropractic & Soft Tissue Work

• Spinal & joint adjustments as needed for maintenance.
• Decompression Therapy & Manual Therapy to prevent tension buildup.

Advanced Home & Workplace Strategies

• Continued Strengthening Exercises (resistance bands, core work).
• Injury Prevention Tips: Balancing work responsibilities with physical wellness.
• Encouraging movement-based activities (walking, swimming) for stress relief.

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Summary: A Whole-Body Approach to Shoulder Recovery

By integrating chiropractic care, manual therapy, targeted exercises, and lifestyle modifications, Sarah’s treatment plan supports long-term pain relief and improved function.

This structured yet flexible approach ensures she can continue her work without limitations while preventing future shoulder pain.

Outcome Measures: Tracking Sarah’s Progress & Recovery

Sarah's 12-week treatment plan led to significant improvements in her shoulder pain, mobility, and overall well-being. Here’s how we measured her progress:

Pain Reduction

VAS Pain Score (Visual Analog Scale)

• Before Treatment: 7/10 (moderate to severe pain)
• After 12 Weeks: 2/10 (minimal discomfort)

Takeaway: Chiropractic adjustments, manual therapy, and targeted exercises successfully reduced pain intensity, allowing Sarah to move more comfortably throughout the day.

Increased Shoulder Mobility

Range of Motion (ROM) Improvement
Shoulder Abduction (raising arm sideways)

• Before Treatment: 120° (restricted)
• After Treatment: 170° (almost full mobility)

Shoulder Flexion (lifting arm forward)

• Before Treatment: 135°
  
• After Treatment: 170°

Takeaway: Through joint mobilization, soft tissue release, and corrective exercises, Sarah regained near full range of motion, making everyday movements easier and pain-free.

Patient-Reported Functional Improvements

• Daily Activities: Sarah noted less shoulder discomfort when reaching overhead, carrying objects, or lifting supplies at work.
• Stress & Sleep Quality: She experienced fewer nighttime disruptions and improved relaxation, likely due to both chiropractic care and stress reduction techniques.

Takeaway: The mind-body connection plays a huge role in musculoskeletal health. Addressing both physical pain and stress factors contributed to Sarah’s overall well-being.

Work Performance & Satisfaction

How Did This Impact Her Job?

• Easier Event Setups & Volunteer Coordination: No longer dreading lifting or long hours on her feet.
• More Energy & Less Pain at Work: Could complete administrative tasks without discomfort or the need for frequent breaks.

Takeaway: By improving her physical resilience, Sarah regained confidence in managing the demands of her charity work without pain holding her back.

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Final Thoughts

Sarah’s comprehensive chiropractic care plan allowed her to:

• Reduce pain significantly
• Restore full shoulder function
• Improve sleep, stress, and overall well-being
• Perform daily work activities with ease

Her success story highlights the power of chiropractic care, manual therapy, and lifestyle changes in addressing chronic pain—without resorting to invasive treatments.

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Conclusion: A Holistic Approach to Lasting Relief

Sarah’s 12-week chiropractic care plan proved to be a game-changer, addressing not only her shoulder pain but also the underlying lifestyle and stress factors contributing to her discomfort.

By integrating:

• Chiropractic adjustments to restore joint function
• Manual therapy & soft tissue release for pain relief
• Targeted exercises to strengthen and stabilize the shoulder
• Ergonomic & posture corrections to prevent reinjury
• Stress management techniques to support overall wellness

Sarah not only regained mobility and reduced pain but also improved her daily function, energy levels, and work performance.

Ongoing Considerations for Long-Term Success

Periodic Chiropractic Check-Ins

• With her demanding workload, occasional maintenance visits will help prevent recurrence of pain and ensure continued mobility.

Workplace Posture & Ergonomics

• Implementing small daily adjustments—like better desk setup, movement breaks, and mindful posture—will protect her shoulder from future strain.

Active Lifestyle & Stress Management

• Consistency is key! Continuing her exercise routine and stress reduction techniques will support long-term musculoskeletal health.

Final Takeaway

Sarah’s case highlights how chiropractic care is more than just pain relief—it’s a comprehensive approach that considers the whole person, their lifestyle, and long-term well-being.

By combining hands-on treatment with proactive strategies, Sarah didn’t just get temporary relief—she gained the tools to maintain her health for years to come.

Dr. Harrell’s Final Insight

"Sarah’s journey is a perfect example of how chiropractic care goes beyond quick fixes—it’s about long-term solutions. Pain doesn’t happen in isolation, and neither should treatment. By addressing her shoulder pain holistically—through movement, posture correction, stress management, and chiropractic care—we helped her not only feel better but function better. My biggest takeaway? When we treat the root cause, not just the symptoms, we give patients the power to take charge of their health and get back to living fully."