Osteopathy and the Shoulder: Between Biomechanics and Myths

Shoulder pain (subacromial impingement, rotator cuff issues, capsulitis) affects up to 30% of adults. While osteopathy is a valuable ally in restoring mobility, it is also a field prone to many "holistic" theories that lack evidence. For effective treatment, it is essential to separate useful manual therapy from pseudo-scientific claims.

Understanding the Shoulder: The Scapulo-Thoracic Complex

The shoulder is the most mobile joint in the body, but also the most unstable. It depends on a perfect balance between bones, tendons (the rotator cuff), and upper back posture.

• The Subacromial Space: This is where the rotator cuff tendons pass. A lack of mobility in the shoulder blade (scapula) or the collarbone (clavicle) can "pinch" these tendons.

• The Cervico-Thoracic Link: The nerves controlling the shoulder muscles originate from the cervical spine (C5-C7). Neck stiffness can therefore weaken the shoulder.

The Myths of Osteopathy

Certain traditional explanations are not based on solid biological foundations and can delay appropriate care.

A. The Visceral Osteopathy Myth (Liver and Stomach)

• The Belief: Right shoulder pain is said to be caused by a "congested liver," and left shoulder pain by the stomach, via the phrenic nerve.

• The Critical Reality: While referred pain exists (a real liver medical issue can radiate to the shoulder), there is no scientific evidence that manual manipulation of the liver can cure rotator cuff tendonitis. A painful shoulder is a problem of mechanical load and tendons, not a digestive issue.

B. The Clavicle "Realignment" Myth

• The Belief: Your collarbone or shoulder is "out of place," and the osteopath must "put it back."

• The Reality: Except for traumatic dislocation (a hospital emergency), bones do not move out of place. The osteopath restores articular gliding. The "crack" (HVLA) does not reset anything; it is a neurological reflex that relaxes the muscles surrounding the joint.

C. The Diaphragm and "Cellular Respiration" Myth

• The Myth: Treating the diaphragm is claimed to "release" the shoulder through deep tissue chains.

• The Reality: While proper breathing aids general relaxation, the idea that the diaphragm is the mechanical "key" to frozen shoulder (adhesive capsulitis) is speculation without clinical foundation. Capsulitis is an inflammatory and fibrous reaction of the joint capsule itself.

Scientific Reality: What Really Works

Osteopathy is effective when it focuses on neuromechanics and movement control.

• Scapular Mobilization: Restoring the scapulo-thoracic rhythm is essential. If the shoulder blade does not move correctly, the humerus strikes the acromion.

• Trigger Point Therapy: Releasing muscles such as the subscapularis or infraspinatus helps center the head of the humerus in its socket.

• Cervical Desensitization: Treating neck stiffness reduces the irritability of the nerves that innervate the shoulder.

Toward Comprehensive Care

Osteopathy "opens the door" to healing by removing painful blockages, but it is not enough on its own. For a healthy shoulder:

1. Active Rehabilitation: Strengthening exercises are indispensable for repairing and remodeling tendons.

2. Accurate Diagnosis: An ultrasound or MRI is often necessary to check the condition of the tendons before manipulation.

3. Therapeutic Honesty: A good osteopath treats your back, neck, and shoulder, but will not promise to heal your tendons by massaging your stomach.

Alain Guierre