Conditions · Shoulder
Shoulder pain,
properly examined.
Shoulders are the most mobile joint you have, and that mobility is bought with complexity — four joints, a ring of tendons, and a blade that has to glide freely across your ribs for any of it to work. When a shoulder stops behaving, the useful question is not "where does it hurt" but "which part of that system has stopped doing its job".
That distinction is what an extremity assessment exists to make, and it is the part most often skipped.
01 · The differential
Four common sources, one symptom.
Most shoulder pain presenting in clinic traces back to one of a handful of places, and they need different handling. Telling them apart is the whole job of the first appointment.
The rotator cuff
The four muscles that hold the ball centred in the socket. Painful arcs of movement, trouble reaching overhead or behind your back, and weakness that shows up on testing rather than in ordinary use.
The soft tissue around the joint
Tendons and the structures that let them glide. Often the culprit when a specific movement or position reliably provokes it, or when the pain came on after a change in what you were doing.
How the shoulder blade moves
The blade has to rotate and tilt as your arm rises. When it doesn't, the joint runs out of room and everything above it takes the load — a mechanical problem that is easy to miss if nobody watches you move.
The neck
A shoulder that hurts is not always a shoulder problem. Pain referred from the neck can present as shoulder or upper arm pain with a shoulder that examines cleanly — which is why the neck gets examined too, every time.
02 · The credential
Why an extremity certification matters here.
Chiropractic training is spine-heavy by default. The Certified Chiropractic Extremity Practitioner qualification is postgraduate training specifically in the joints away from the spine — shoulders, elbows, wrists, hips, knees, ankles — and the assessment and adjusting techniques those joints need.
In practice it means your shoulder gets examined as a shoulder, not as an afterthought to your spine. It also means the neck is examined properly in the same appointment, because the two are part of one problem more often than either is treated that way.
03 · The appointment
What actually happens.
A new patient appointment is 45 minutes. It starts with the history — when it began, what you were doing, what makes it worse, what you have stopped being able to do — because the pattern usually narrows the field before anyone touches anything.
Then the examination: how the shoulder moves and how far, orthopaedic testing of the cuff and surrounding soft tissue, how the blade behaves as your arm rises, neurological testing where it is warranted, and an examination of the neck and upper back. Then I explain what I have found and what I think it means, and we agree what to do about it.
04 · The treatment
What treatment involves.
It depends entirely on what the examination found — there is no standard shoulder protocol here. Depending on the case it can include specific adjustment of the shoulder, upper back or neck, soft-tissue work, dry needling, kinesiology taping, and loaded rehabilitation exercise to rebuild what the assessment showed was missing.
You will know what I am doing and why before I do it, and we reassess as we go rather than working through a fixed plan.
05 · The limits
When it isn't one for me.
Some shoulders need imaging before anyone treats them, and some need a different clinician entirely. Where that is the case I will say so and refer — for imaging, for a surgical opinion, or on to a colleague where the case needs a tool I don't carry.
Go to A&E, not to a chiropractor
A shoulder that has visibly dislocated, an obvious deformity after a fall or accident, or an arm that has gone weak, numb or cold suddenly. These need emergency assessment today.
Signs that need imaging first
Significant trauma, a sudden loss of strength suggesting a substantial tear, or night pain that is unrelated to position. I refer for imaging rather than working around the uncertainty.
Patients who came in with this
Saw Dr Spice for a shoulder issue and he was great! Professional, attentive, and knew exactly what to do. My shoulder’s feeling so much better — highly recommend!
Some words to describe Richard... Genius; Hero; Magician; Problem solver; Thorough; Committed... Richard originally treated a shoulder injury from Swimming/Netball. I’d not been able to swim for 8years... within two months - I was swimming a mile again... He’s now working his magic on my plantar fasciitis, as I’ve not been able to run for 2months - progress is VERY good after 3 tough sessions.
Where to see me
Two London clinics, same practitioner at both. A new patient appointment is 45 minutes and includes your first treatment where that’s appropriate.