Reframing Shoulder Pain: Deconditioning vs. Degeneration

The morning sun cast a golden glow over the park as Lisa laced up her running shoes. She had always been active—morning jogs, weekend hikes, and yoga classes—but lately, her right shoulder had started to nag at her. At first, it was just a dull ache after workouts, but over time, the pain became more persistent. When she finally saw her doctor, the words “degeneration” and “wear and tear” echoed in her mind like a death sentence for her active lifestyle.

Lisa feared the worst. Was this the beginning of the end for her shoulder? Would she need surgery? Was she just getting old? The MRI results showed mild rotator cuff fraying and osteoarthritic changes, but what if those findings weren’t the real problem? What if her shoulder pain wasn’t a result of degeneration, but something entirely different—something she could actually change?

The Myth of Degeneration: What the Research Really Says

For decades, the medical community has linked joint pain with structural degeneration—terms like “arthritis,” “wear and tear,” and “tendon fraying” have been used to explain why people experience pain. However, emerging research challenges this notion.

A groundbreaking study published in the British Journal of Sports Medicine found that rotator cuff tears and osteoarthritis are incredibly common even in people with no pain. In fact, up to 40% of asymptomatic adults over 50 have rotator cuff tears visible on MRI. So why do some people experience pain while others do not? The answer lies in the concept of functional deconditioning rather than structural damage.

Deconditioning: The Real Culprit Behind Chronic Shoulder Pain

The human body is designed for movement, but when certain muscles become weak or underused, other areas overcompensate, leading to pain. Over time, muscular imbalances, poor movement patterns, and nervous system adaptations can make normal activities feel painful—even when there is no significant structural damage.

When Lisa learned that her pain wasn’t necessarily due to irreversible damage but rather a lack of proper muscle function, she felt a sense of relief. Instead of resigning herself to a “worn-out shoulder,” she realized she could rebuild strength, improve movement, and retrain her brain to reduce pain.

How the Nervous System Influences Pain

Pain isn’t just about tissue damage—it’s about how the brain interprets signals. Central sensitization, a process where the nervous system becomes overly sensitive to pain signals, plays a huge role in chronic shoulder pain. When the brain perceives the shoulder as vulnerable—whether due to injury, lack of use, or fear of movement—it can amplify pain signals even in the absence of major structural damage.

This is why some people with significant degeneration on MRI have no pain, while others with minimal changes experience severe discomfort. It’s not just about what’s happening in the shoulder; it’s about how the brain processes pain.

Shifting the Focus: Strategies to Rebuild Strength and Mobility

Once Lisa understood that her shoulder pain was due more to deconditioning than degeneration, she took action. With guidance from Dr. Noah Volz, a chiropractic expert in Ashland, OR, she began a targeted rehabilitation program designed to restore strength and retrain her nervous system.

Here are the key strategies that helped Lisa—and can help others—reduce shoulder pain and regain function:

1. Graded Exposure to Movement

• Instead of avoiding movements that triggered pain, Lisa gradually reintroduced them in a controlled way.
• Eccentric exercises, where muscles lengthen under tension, helped her shoulder rebuild strength safely.
• Proprioceptive training, such as gentle resistance band work, improved her brain’s awareness of her shoulder’s position.

2. Addressing Muscular Imbalances

• A combination of scapular stabilization exercises and rotator cuff strengthening helped restore proper function.
• Core and upper back strengthening reduced compensatory strain on the shoulder.

3. Neurological Retraining and Pain Modulation

• Manual therapy and chiropractic adjustments optimized nervous system function and reduced muscle guarding.
• Breathing techniques activated the parasympathetic nervous system, reducing pain sensitivity.

4. Load Management and Recovery

• Lisa learned to respect her body’s recovery needs, incorporating active rest, hydration, and anti-inflammatory nutrition.
• Sleep optimization was a priority, as poor sleep has been linked to increased pain perception.

Lisa’s Turning Point: From Pain to Empowerment

After a few months of focusing on function rather than fear, Lisa experienced a major shift. The pain that once dictated her daily choices faded into the background. She was back to hiking and yoga, no longer defined by an MRI report that once seemed like a life sentence.

Her story highlights a powerful truth: shoulder pain is not always a sign of irreversible damage. More often than not, it’s a signal that the body needs better movement, strength, and neurological retraining. With the right approach, it’s possible to break free from the cycle of pain and regain an active, pain-free life.

Final Thoughts: Moving Beyond Degeneration

If you’ve been told that your shoulder pain is due to “degeneration” or “aging,” take a step back. Ask yourself: Is my pain really about damage, or is it about function? By shifting the focus from wear and tear to rebuilding strength and mobility, you can take control of your recovery.

For those looking to address shoulder pain with a movement-based, neuroscience-informed approach, working with a professional like Dr. Noah Volz in Ashland, OR can be the key to long-term relief. Pain isn’t just about what an MRI shows—it’s about how you move, how your brain processes pain, and what you do to support your body’s natural resilience.

The next time someone tells you your shoulder is “just getting old,” remember Lisa’s story. Pain isn’t a sentence—it’s a signal. And with the right strategies, you can change the conversation from degeneration to regeneration.