Shoulder Problems

By Dr. Donald Liebell

Shoulder pain is one of the most unnecessarily confusing problems in all of musculoskeletal care. People are told they “must have a rotator cuff problem” long before anyone performs an MRI—or even explains what the rotator cuff actually is. They are sent to physical therapy, given anti-inflammatory drugs, or injected with steroids, often without a definitive diagnosis. Some are convinced they need surgery when the real problem has never even been identified.

At the Liebell Clinic, our approach is grounded in responsibility: before anyone treats your shoulder, we want to know what is truly wrong with it. That means proper medical evaluation, and when appropriate, MRI—not guesswork, not assumptions, and certainly not self-diagnosis based on what somebody heard at the gym.

Our clinic is a family-run practice in the deepest sense: everything we use to treat you is something we have used for ourselves, our parents, our children, our extended family, and our closest friends. I practice with three members of my family—my wife Sheila, my sons Dr. Breiten Liebell and Evan Liebell—and we provide only the methods we trust with our own health. This includes the mechanical, neurological, and tissue-repair strategies we know from experience to be effective.

Before I explain our approach, let me address the term that has confused, and occasionally amused, patients for decades: “the rotator cuff.”

Somewhere along the line, “rotator cuff” became the designer-label injury of the shoulder world. Saying you have a “rotator cuff problem” sounds far more impressive than saying, “My shoulder hurts when I reach the cereal box.” It has an athletic flair to it, as if owning a rotator cuff problem places you in the same category as professional baseball pitchers.

Most people who use the phrase have absolutely no idea what it means. None. You could hand them a shoulder diagram, and they might still point to the wrong body part. Let’s remove the nonsense.

The rotator cuff is not:
• A cuff, like on a dress shirt
• A cuff, like on a jacket
• A cup-and-saucer mechanism
• A single structure that “slips out” or “breaks off”
• The entire shoulder joint
• Or anything resembling a singular anatomical “thing”

It is simply this—four muscles and their tendons that help stabilize the shoulder and move the arm. Those muscles are:

• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis

That’s it. No glamour. No sports-medicine mystique. No special membership card.

The term “rotator cuff” has been used in anatomy for well over a century. It gained pop-culture fame much later, largely thanks to baseball injuries and sports media dramatization. Once newspapers began announcing, "Pitcher out for the season with a rotator cuff tear!", the term became a household phrase. Before long, every person with shoulder pain decided they had joined the ranks of professional athletes.

It sounds more dignified than “I strained a tendon.”
It sounds more serious than “I slept on it wrong.”
It certainly sounds more dramatic than “My shoulder mechanics are terrible.”

Here is the reality: shoulder pain is rarely just a “rotator cuff problem.” It is a mechanical problem, a movement problem, a joint problem, a tendon problem, or a neurological problem—and all of these require proper diagnosis before treatment.

By the time patients arrive at the Liebell Clinic, they have usually been through the standard medical pathway:

Primary care
• Shoulder X-ray taken (which cannot visualize tendons or ligaments)
• Diagnosed with “rotator cuff inflammation,” arthritis, or generic “shoulder pain”
• Prescribed anti-inflammatory drugs or pain medication
• Referred to physical therapy

Orthopedics
• More X-rays
• Cortisone injections
• “Try more physical therapy”
• MRI delayed until all conservative care “fails”
• Surgery discussed before anyone evaluates total-body mechanics

Physical therapy
Physical therapy can be tremendously valuable—when applied with proper diagnosis. However, many patients are told to perform rotator cuff strengthening exercises without any imaging. They unknowingly stretch or strengthen irritable tendons, or work around mechanical restrictions that no exercise can address. This leads to a familiar story:

• “I did months of PT.”
• “I had multiple injections.”
• “I took medications.”
• “I tried everything.”

Yet their shoulder still hurts because nobody actually investigated the real problem.

Our philosophy is how ALL  treatment is supposed to be: find out what is wrong before treating it. At the Liebell Clinic, shoulder care begins with responsibility and clarity. We guide patients to proper medical evaluation, and when appropriate, MRI. MRI reveals what X-rays simply cannot:

• Tendon tears
• Tendon degeneration
• Labral tears
• Biceps tendon problems
• Bursitis
• Capsular inflammation
• Subacromial impingement
• Early arthritis
• Bone edema
• Mechanical blockages
• Referred pain from the spine or rib cage

Once the problem is accurately identified, Dr. Breiten Liebell applies a comprehensive, total-body care system that reflects decades of structural and neurological understanding. 

He evaluates not only the shoulder, but also the scapula, thoracic spine, rib mechanics, cervical spine, and the kinetic chain that determines shoulder stability. His methods include:

Manual joint mobilization
Gentle, precise mobilization of the shoulder, scapula, and surrounding joints helps restore natural gliding motion and reduces mechanical stress.

Handheld mobilization instruments
Dr. Breiten uses low-force instruments to deliver extremely specific, controlled impulses to restricted joints and soft tissues. These help activate mechanoreceptors and restore function without forceful manipulation.

Auricular therapy
Using the neurological map of the outer ear, Dr. Breiten applies auricular therapy to influence pain regulation, muscular tension, and neurological communication. This is especially helpful for chronic tension, inflammation, and shoulder-related nerve patterns.

He uses a handheld microcurrent TENS stimulator as part of his comprehensive treatment system. This device delivers precise, low-frequency electrical impulses through a small probe, allowing highly targeted stimulation of irritated nerves, tense muscles, and sensitive soft tissues without discomfort or force. It is especially useful for calming overactive pain pathways, improving local circulation, and supporting neuromuscular balance in difficult-to-reach areas such as the shoulder girdle, forearm, hip stabilizers, knee support structures, and the smaller muscles of the hand and wrist. The handheld TENS instrument works in harmony with Dr. Breiten’s manual joint mobilization, handheld instrument techniques, and cold laser therapy, enhancing the overall

Laser therapy plays an important role in shoulder care at the Liebell Clinic. 

Shoulder problems often involve irritated tendons, inflamed bursae, strained soft tissues, and irritated nerve pathways—all of which respond exceptionally well to low-level laser light.

I'm proud to be have been among the first doctors in Virginia (around 2004) to provide laser therapy. I'm even prouder to have my son, Evan Liebell as our full-time laser therapist.  

Laser therapy is not heat therapy, not an invasive treatment, and not an aggressive force-based technique. It is certainly NOT another "red light" therapy; it is the gold standard. Laser therapy uses specific wavelengths of red and near-infrared light to support cellular energy production, reduce inflammation, calm nerve irritation, and promote tissue repair.

Research in the fields of orthopedics and physical medicine supports its use. A randomized controlled trial published in Photomedicine and Laser Surgery demonstrated significant reductions in pain and disability among patients with rotator cuff tendinopathy treated with low-level laser therapy compared to placebo. Other studies have shown measurable improvements in joint mobility, reduced inflammation, and improved functional outcomes for patients with tendon injuries, bursitis, and soft tissue strain.

Evan Liebell provides cold laser therapy as an integrated part of the family-based care we provide. It is among the same methods and technologies we use for ourselves and our own family. Laser works in concert with Dr. Breiten Liebell’s manual chiropractic treatment, handheld instrument techniques, auricular therapy, and total-body mechanical evaluation.

Laser therapy is particularly helpful in shoulder care because of the delicate nature of the rotator cuff tendons and the high degree of mechanical stress placed on the joint during everyday life. Rotator cuff irritation, biceps tendon involvement, capsular inflammation, and impingement-related discomfort often respond quickly to laser-assisted tissue repair. It is also helpful for patients who cannot tolerate manual pressure on inflamed structures.

One of the unique aspects of laser therapy is the diagnostic insight it provides. When patients report immediate improvement in shoulder comfort following laser application—not only to the shoulder itself, but sometimes to the neck or upper thoracic spine—it often confirms the presence of a neurological or biomechanical component that was influencing the shoulder. This is especially valuable for shoulder problems driven by cervical involvement, postural collapse, or nerve irritation that mimics rotator cuff pain.

Laser therapy is safe, painless, and non-invasive, making it an ideal complement to the structural and neurological care we provide.

Shoulder mechanics are inseparable from the thoracic spine (middle back), cervical spine (neck), rib cage, pelvis, and posture. When one area is dysfunctional, the shoulder often compensates. 

Dr. Breiten Liebell evaluates and corrects structural problems throughout the body—not just where the pain is located. We support orthopedic surgery when it is legitimately necessary. There are situations in which no amount of manual treatment, exercise, or conservative care can repair a structurally damaged tendon or major tear. We regularly refer patients to orthopedic surgeons—but only after we obtain the MRI that clearly indicates the true condition of the shoulder.

Our approach is to always provide the highest level of responsible, evidence-guided care using the same methods we trust for our own family. We help patients discover what is actually wrong, obtain proper diagnosis, and receive treatment based on proven mechanics, neurological understanding, and tissue healing science.

Shoulder health is not about trendy terminology or dramatic labels. It is about identifying the real problem and addressing it with precision, responsibility, and complete care.

If you would like to schedule an evaluation or receive guidance on obtaining the proper imaging before beginning shoulder treatment, the Liebell Clinic will be pleased to assist you.