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Shoulder Injuries - "Wear, Tear, and Repair" Syndrome

Posted by Simeon Niel Asher on



Shoulder injuries are often more painful at night. This can lead to a damaging "wear, tear, and repair" syndrome.

During the daytime, the weight of the arm itself cuts off some of the blood supply to the shoulder muscles. This is generally not problematic. However, when shoulder muscles are injured or damaged this has several important implications.

Muscle Damage

First, any muscle damage is not repaired during the daytime. This is because muscle damage needs a healthy blood supply to bring reparative cells and products to the damaged tissue and to remove toxins and worn cells from the damage site.

Secondly, this means that repair can only occur at night. When we lay down to sleep, there is no pull of gravity on the shoulder and the blood supply can flow freely. Most shoulder problems are worse at night because of the increased blood flow to tissues. These become readily swollen; the swelling pushes on other tissues and stimulates pain from small nerve endings. The swelling also attracts reparative cells which trigger inflammation.

In the case of frozen shoulder syndrome this night pain is doubled; partly because of the increased blood supply (in an attempt to repair) and partly because of the nature of inflammation.


Inflammation is sticky. It draws water to the damaged area, and hence causes swelling. This swelling is worse at night as the arm is not being moved. Once the arm and shoulder are moved, the inflammatory swelling is dissipated, making the pain diminish. This is why, generally, the shoulder feels better during the daytime when the arm is being gently moved, and much worse at night.

With the more severe shoulder injuries, the damage cannot be repaired in one night, and the next day the arm is used again with a certain amount of damage remaining within the shoulder muscles. If this process goes on for several weeks, a curious situation occurs.

Critical Zones

What seems to happen is that certain areas inside the damaged muscles (known as the critical zones) accumulate calcium molecules (chalk). This chalk is viewed as an irritant to the already damaged tissues and its presence triggers further bouts of inflammation which in turn leads to further cycles of pain. The chalk accumulates and if there is enough, it can weaken the damaged muscle so much that it tears further. This process can become a vicious circle.

Early Intervention

Too many people allow their symptoms to develop rapidly before seeking treatment. Early intervention should always be advised for shoulder injuries that persist, especially where the client feels they are entering a cycle of "wear, tear and repair" as described above.

There are many types of shoulder injury, some far more nasty than others. Most can be treated more effectively with intervention in the early stage.

About the author

Simeon Asher was voted one of London's top 10 osteopath's by the London Evening Standard Newspaper. Simeon is a practicing osteopath who has been studying, researching, and teaching trigger point therapy for the last two decades. Simeon is the author of a number of best selling books and courses on trigger point therapy and is a regular guest lecturer in the UK, Europe, Scandinavia, and South America. In 2015 Simeon was invited by the Israeli health service to help start a program for teaching trigger point therapy to family doctors.



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This trigger point blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.




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