Dr. Vliet’s Health Tip: Midlife Shoulder Pain: Inevitable Aging? or Fixable?

• Estradiol, the primary premenopausal estrogen lost at menopause, helps maintain strong bone, the integrity and strength of cartilage supporting all joints, keeps tendons and ligaments strong but properly flexible and elastic.  Progesterone makes ligaments more elastic and “loose,” as adaptation to help the pelvis expand during pregnancy to accommodate a growing baby – but “loose” overly lax ligaments are not something desired as we get older.  Loose ligaments in menopausal women lead to more joint dislocations and sprains. 
• Hormone fluctuations, imbalances, and declines in perimenopause, menopause, and later years lead to marked disruptions in connective tissue homeostasis.  As a result of the loss of estradiol, excess progesterone, imbalance in androgens (ovarian and adrenal), joint tissues become more prone to inflammation, stiffness, and pain.
• My own 40 years of treating women’s hormone imbalances, plus recent observational data, shows systemic estradiol therapy to reach physiologic optimal levels can substantially decrease the risk of shoulder and other joint pain in women.
• “Frozen shoulder” (adhesive capsulitis) peaks in women between 40 and 60, which is the time of major ovarian hormonal upheaval, imbalance and decline in women. “Frozen shoulder” diagnoses are many times more common in women than men, and the majority of these cases rise without major trauma.  Declining estradiol plus comorbidities such as diabetes, thyroid disease, hypertension, and autoimmune conditions further increase risk for frozen shoulder in midlife women.
• Rotator cuff tendinopathy and partial tears become more common after 40, and sex‑hormone–related changes to decrease tendon and ligament strength and increase brittleness are factors making women more susceptible to this damage.
• Midlife loss of estradiol and testosterone lead to acceleration of bone loss (osteopenia, osteoporosis) in women, altering bone quality in ways that can contribute painful degenerative changes and even to increased shoulder fractures.
• BOTTOM LINE: What does this mean for you practically?  If you are midlife or older, hormone decline, loss of muscle, bone and ligament strength AND sudden increased exercise intensity can lead to joints like shoulders, hips, and knees being “weak links” more prone to injury and chronic inflammatory pain.

III.            Hormone Status in Men
Decline in total and free testosterone as men age is a factor that increases overall joint vulnerability and another link to higher rates of rotator‑cuff pathology and worse healing. The research below shows that testosterone decline contributes to shoulder pain through several converging pathways: (1) increased systemic and local inflammation, (2) poorer rebuilding of cartilage and tendon, (3) accelerated muscle loss (sarcopenia) around the shoulder girdle, and reduced bone strength.

Mechanisms: How Low T Worsens Joint Pain

• Testosterone receptors are present in articular cartilage, and testosterone has anabolic effects on cartilage matrix synthesis and reduces cartilage breakdown. Low T (hypogonadism is T levels <300 ng/dL) removes this protection, leads to increased release of inflammatory cytokines and increases oxidative stress.
• Low testosterone increases pro‑inflammatory cytokines (such as IL‑6 and TNF‑α), which drive cartilage breakdown, inflammation of the synovial joint lining, and inflammation of joint nerve endings, micro blood vessels, and bony structures. All of these adverse changes lead to intensified shoulder pain typical of osteoarthritis and degenerative rotator cuff tendon damage.
• Testosterone decline contributes to loss of muscle mass and strength. Men commonly lose 3–5% of muscle mass per decade. Low T accelerates muscle loss and loss of tendon/ligament strength, which increases instability of the shoulder and other joints, and increases risk of injury and pain.
• Low T also reduces bone density, raising fracture risk. Micro‑fractures or osteoporotic changes near the shoulder (humeral head, scapula, spine) and knees can present as, and intensify, shoulder/neck girdle, and knee pain.

Data on osteoarthritis and joint pain

• Low testosterone levels in men AND women were independently associated with increased osteoarthritis (OA) risk in a 2025 NHANES‑based analysis. OA risk rose sharply when T levels fell below a threshold around 51 ng/dL.   These data are consistent with a protective effect on joint structures in men and women when testosterone levels are above this threshold.  Note: These levels in men are severely low but often found in men on androgen deprivation therapy, called ADT or “hormone therapy,” for prostate cancer.
• Low T levels cause increased systemic inflammation and oxidative stress, which are key drivers of osteoarthritis damage and chronic joint pain.  Androgen decline in men and women is one of many factors contributing to joint degeneration and pain symptoms.
• BOTTOM LINE: for all the years I have been helping men with low T (hypogonadism) restore optimal, physiologic and stable testosterone levels, the problems reported prior to Rx therapy—diffuse joint and muscle pain—improves markedly with testosterone Rx medication.

This is one of many reasons I think men need testosterone levels checked as part of annual check-ups. Low T is a risk factor for many major medical and metabolic health risks, including musculoskeletal conditions, but also heart disease, diabetes, sleep disorders, depression and later dementia.

IV.           Declining Strength and Muscle Mass

Studies highlight that maintaining strength and conditioning, especially in physically demanding workers over 50, may be key modifiable factors in reducing painful shoulders as men age. When tendons hurt, rest is not always the answer. With acute pain and injury – yes backing off activity and strain on the joint – is part of the healing process, but it should not become the main strategy. Gentle and gradual return to activity and life should be the goal and maintaining pain-free. Rest will give you temporary relief, but if you return regular activities without fixing underlying issues, including range of motion and strength, the same problems often return.

Maintaining muscle mass and strength through a full range of motion can be achieved through regular strength training and proper nutrition.  This is key to preventing and recovering from shoulder pain as we get older. I discussed this concept in detail in previous health tips and have included links in the resources at the end.

Nutritional Supplements to Reduce Joint Aches and Pains

There are many supplements that can help with specific aspects of shoulder and other joint pain syndromes. I have broken them down into four categories to help you navigate what may be most beneficial for your situation.

1. Supplements to reduce pain and inflammation – Most data are in knee/hand osteoarthritis (OA), but mechanisms also generalize to shoulder OA and degenerative rotator‑cuff–related pain.

• Omega‑3 fatty acids (EPA/DHA, fish oil; green‑lipped mussel oil) as in our TruOmega™ Pure and TruSynovial™ Support (with New Zealand green-lipped mussel extract).  These powerful anti-inflammatory nutrients decrease production of pro‑inflammatory eicosanoids; randomized clinical trials (RCTs) show improvements in arthritic pain, stiffness, and function; green‑lipped mussel extract appears particularly helpful for arthritis and menopausal joint pain.
• MSM (methylsulfonylmethane) – Some RCTs show reduced OA pain and improved function; also used in multi‑ingredient joint formulas.
• Collagen peptides (type II or hydrolyzed collagen) – Trials show improved joint pain and function in OA and menopause‑related joint pain at doses up to ~10 g/day. Dr. Vliet NOTE: I only recommend wild-caught whitefish marine collagen peptide products, not bovine peptides derived from slaughtered cattle parts.
• Curcumin (turmeric extracts) – Multiple RCTs and meta‑analyses show standardized, highly bioavailable curcumin formulations can reduce OA pain and improve function, sometimes approaching NSAID‑level effect, especially at 500–2,000 mg/day with piperine (black pepper) or specialized formulations. Dr. Vliet CAUTION: Curcumin has strong phytoestrogen properties that competitively inhibits estradiol receptors and minimize effectiveness of Rx hormone therapy.  Studies also show that concentrated curcumin supplements can interfere with Rx thyroid medication. For men, the phytoestrogens in curcumin supplements can lower testosterone levels or inhibit effectiveness of Rx testoterone. This caution applies to concentrated curcumin supplements, not the small amounts used in seasoning food.
• Boswellia serrata (AKBA / 5‑Loxin / Aflapin) – Anti‑inflammatory resin; reviews and a 2025 meta‑analysis identify Boswellia extracts (especially Aflapin) among the most effective botanical supplements for reducing OA pain and stiffness.
• Ginger extract – Anti‑inflammatory; included by menopause and arthritis resources as a supportive option for stiffness and pain, though data are less robust than curcumin or Boswellia.

2. Supplements to strengthen muscle and support joints structurally The goal here is better peri‑scapular and rotator‑cuff strength, bone/joint integrity, and neuromuscular support.

• Protein and essential amino acids – Sufficient high‑quality protein intake is fundamental for maintaining shoulder girdle and global muscle mass supporting joints. Experts specializing in joint‑health emphasize diet plus whey or plant protein, and amino acid complexes such as TruAmino Complex™ with essential amino acids to support muscle mass.
• Vitamin D3 with K2 – Supports muscle function and bone health; low vitamin D is linked with muscle weakness and joint pain. RDA recommendations of 600 IU have been found to be far too low and newer professional recommendations find higher levels (2000 – 4000+ IU) to maintain adequate levels of vitamin D in the optimal range of 70-90 for immune as well as muscle and bone health.  Try our TruBioD3 2000 IU and TruOptiD3 5000 IU+K2!
• Calcium plus magnesium supplements, but taken separately to improve absorption of each one! Both are critical for bone mineral density and muscle contraction/relaxation.  Both are especially important for postmenopausal women to prevent osteopenia and osteoporosis that can exacerbate shoulder pathology. I recommend trying our TruMagnesium™ supplement, which is hard to get adequate amounts in our diet.  But for calcium, I recommend you focus on getting calcium from food sources spread throughout the day. Plain full fat Greek yogurt (also a great source of protein, Vit D3), goat’s milk Kefir (plain) and other dairy products are your best source of calcium, but also canned fish with bones, beans, nuts/seeds and leafy greens.
• B‑vitamins (esp. B3, B6, B12) as found in TruB Full Spectrum –  Support mitochondrial cellular energy metabolism and neuromuscular functions that play important roles in muscle performance, endurance, and red blood cell production.

3. Supplements to support joint and muscle mitochondrial function
The nutritional target is to improve mitochondrial function, energy production, and reduced oxidative stress in chondrocytes and muscle.

• Targeted mitochondrial antioxidants:  Our unique L-ergothioneine supplement, TruMitochondrial™ Boost, features the concentrated form of the histidine derivative L-ergothioneine produced via the natural fermentation of mushrooms in a proprietary process to improve potency and purity.  Erothioneine’s antioxidant and cytoprotectant actions combat oxidative stress at the mitochondrial cellular level throughout the entire body to provides multiple health benefits for mitochondrial function.
• Coenzyme Q10 (CoQ10), found in our TruActive CoQ10 (Active Ubiquinol), is a key component of the electron transport chain and is widely used in mitochondrial medical strategies for repair of damage because it serves as an ATP‑supportive nutrient (with extensive research data in primary mitochondrial disorders and muscle function).
• Alpha‑lipoic acid (ALA) – TruAlpha-Lipoic SR is a mitochondrial cofactor and antioxidant. For individuals with mitochondrial disorders, ALA 50–200 mg/day is used for mitochondrial support, pain reduction.
• Acetyl‑L‑carnitine / L‑carnitine – Supports mitochondrial fatty acid transport and energy production and is commonly used in mitochondrial and neuropathic pain protocols, though OA‑specific data are limited.
• NAD+ precursors (nicotinamide riboside, nicotinamide mononucleotide, and niacin) as found in TruNiacin™ SR.  Not directly joint‑specific in the sources above but increasingly used to support mitochondrial function and sirtuin activity, which are implicated in OA cartilage mitochondrial dysfunction.
• Urolithin A – A gut-microbiome derived metabolite (a postbiotic) of ellagic acid found in pomegranates, strawberries, raspberries, and walnuts, that promotes selective recycling of damaged mitochondria. Urolithin A has been shown (in a OA mouse model) to improve mitochondrial health in joint tissue, reduced cartilage degeneration, synovial inflammation, and pain, and improved mobility, suggesting disease‑modifying potential. If you don’t eat a lot of fruit every day, you may want to try our TruFruits&Berries™ for a good source of concentrated ellagic acid and other great polyphenols found in fruits and berries!

4. Supplements helpful in menopause‑related joint/shoulder pain

These are not substitutes for the more potent anti-inflammatory and anti-oxidant bone and joint repair/regeneration properties of Rx estradiol therapy, but these nutrients can help modulate inflammation, bone/muscle health, and vasomotor symptoms that worsen pain. The list includes magnesium, calcium, vitamin D3, and Omega-3s already covered above. Our TruMagnesium™ which comes in a chelated form that is well-absorbed, less likely to cause diarrhea and helps anti‑inflammatory and protective roles to reduce cartilage breakdown, Magnesium also plays a major role in sleep and muscle relaxation.

Self-Help Treatments For Joint Aches and Pains

So many people think that shoulder, knee and hip pain means you have to see an orthopedic surgeon and either get “steroid shots” or have surgery for joint replacement.  LONG before you may have to consider surgery, there are MANY conservative, self-help options you can try first.  And you may find these do the trick and you don’t need more invasive and risky options.  It’s worth trying these approaches.  As always, if pain gets worse, or mobility more impaired, it is wise to see a Physicial Medicine and Rehabilitation (PM&R, or physiatrist) specialist physician, or a surgical specialist.

I have found that for most age‑related joint pain, a structured exercise‑based program plus simple analgesia is more effective long term than injections or surgery, which should be reserved for severe and select cases based on individual evaluation. Any surgery, but especially shoulder surgery, can be tricky in older people with multiple medical problems, and generally involve long and challenging recovery and continuing physical therapy for 3-6 months.

Here is how I generally guide my patients with shoulder and other joint pain syndromes. I have used most of these modalities myself and they really do work!

I.      Targeted exercise and physical therapy are most often the first‑line evaluation and treatment for rotator cuff–related pain, many degenerative arthritic shoulder disorders and other localized joint pain.  Well-designed physical therapy focuses on scapular control, rotator cuff and periscapular strengthening, capsular stretching, and proprioceptive training, and can provide meaningful pain relief and functional gains for most older patients with rotator cuff problems. A consistent home-exercise program is essential for improvement – don’t just throw the exercise handouts in a drawer and forget about them once you get home!

For my patients, and our readers, you may want to consider a Virtual Consult with Ken Lamm PT, a physical therapist and pain specialist in Tucson who founded the Tucson Pain Network 35 years ago.  I have referred patients from all over the country to him for in-person or virtual consults for many, many years.  He is superb at identifying myofascial and biomechanical factors that restrict movement and cause localized should neck, knee, hip pain. You would be surprised how many people I send him for shoulder pain that is NOT due to arthritis or “rotator cuff tear” but due to body posture and myofascial restriction.  He teaches people to relieve such pain with simple exercises at home.  One consult well worth it to have an assessment and initial recommendations – then if helpful, you can schedule more sessions. I see him regularly. Email to request a consult – Klamm@comcast.net. Fees are reasonable and paid by credit card. You can tell him I sent you, no physician Rx needed.

II.    Topical pain relievers widely used for localized arthritis pain areas

1.    NSAID: Voltaren (brand name)/diclofenac (generic name) over the counter gel that can be used AM and PM daily for extended periods of time.  I use it regularly for knee, hip, and hands (thumb joints that hurt).  After rubbing on area, you don’t have to wait until the “gel” dries – the diclofenac is absorbed under the skin quickly, you can put on clothes and go ahead with activities.  There are minimal risks of GI bleeding or increased BP with topical use of NSAID gels compared to oral meds.

2. Licart Patches (Diclofenac):  Another option for those who don’t like the gel (above) or who want 24 hour relief.  Licart Patches can be applied once a day to a local area like knee, shoulder, feet, etc. Licart Patches are Rx from your doctor – but end up costing less than the Salon Pas patches that are OTC, and LESS effective.  May be covered by some health insurance plans.  SalonPas patches 4% Lidocaine patch for short-term pain relief. Lidocaine is a topical anaesthetic but does not have anti-inflammatory benefits like Voltaren gel or Licart Patch

3. DMSO (Dimethylsulfoxide) Liquid (or Gel) also OTC:  This can be used topically for localized joint pain. I use it for arthritis in my thumbs and find that it has similar anti-inflammatory pain-relief effectiveness to Voltaren gel.  I found a reliable resource: www.DMSOStore.com, which sells pharmaceutical grade, highly purified, low-odor DMSO.  Veterinary products of DMSO have been used for DECADES for musculoskeletal injuries, pain and promoting healing for dogs and horses especially.  But these products are higher in the garlic odor and not as purified as the above option. I tried a veterinary product but could not tolerate the intense and pervasive odor.  I have a whole seminar on DMSO – what it is, what it is used for, etc. archived under Faith Over Fear tab on our website www.TruthforHealth.org and here

4.  Epsom Salts (magnesium salts) in warm water.  Helps relieve muscle and joint aches as the magnesium and warmth penetrate the skin and improve blood flow and muscle relaxation.  Take a whole body soak in a Tub or use Epsom salts warm compresses for local area.  Pain relief and muscle relaxation short term. Use in addition to above options.

III. Oral Over-the-Counter Pain Relievers

Even though these are OTC, they all have potential serious side effects used daily at higher doses, so you must use them with CAUTION. ORAL NSAID forms and Tylenol that can lead to increased BP, fluid retention, liver and kidney dysfunction at high doses every day.

1. I don’t recommend Tylenol/acetaminophen for arthritis pain!
Main reasons: It is not a very effective pain reliever, it has NO anti-inflammatory actions (needed for arthritis pain especially!), it blocks glutathione production, which means mitochondrial cellular energy production is impaired, and this leads to poor cellular oxygenation, oxidative stress, and MORE inflammation and pain! But the BIGGEST REASON: there are serious potential adverse effects on liver and kidney function if dose not monitored closely.  Tylenol (and other acetaminophen products) are the second leading cause of liver failure in the US! Sadly, such effective marketing of Tylenol as safe has covered up its serious risks and lack of much effectiveness for the inflammatory type of pain in arthritis.

IMPORTANT: Read my Health Tip article on acetaminophen at www.TruthforHealth.org website (here) for more details on the risks and many adverse effects! They are serious, especially as people get older. I NEVER recommend Tylenol or acetaminophen products for my patients for regular daily use.

2.  ORAL NSAIDS: OTC Aspirin,  Advil (ibuprofen), Aleve (naproxen) – I find that all are pretty much equal in effectiveness as a general rule, but for me personally, Aleve worked better than the others and didn’t cause the tendency for bruising that daily ASPIRIN can cause as we get older.  Therapeutic doses of the OTC strengths are Advil-two pills THREE times a day, Aleve two pills two times a day, Aspirin 325 mg (enteric coated is safer) 2-3 times a day and watch for increase in bruising, and reduce dose if that happens.  Prescription doses of ibuprofen and naproxen are higher but need to be monitored by a health professional prescriber since they can lead to high BP, fluid retention, and adverse kidney effects over longer time at higher therapeutic doses.

IV.  Rx medicine: Hydroxychloroquine or HCQ (Rx in USA, may be OTC in Mexico).
This is FDA-approved for Rheumatoid Arthritis. RA patients take it at fairly high dose it for years without major side effects.  HCQ is ALSO effective for Osteoarthritis although the company did not seek FDA-approval for this diagnosis. Usual dose: 200 mg twice a day for OA pain relief, up to total of 400-800 mg daily for RA.  I have a whole seminar on HCQ benefits in reducing inflammatory pain (such as arthritis), anti-viral effects, and benefits in diabetes and cancers.   Seminar archived on our website www.TruthforHealth.org and (here).

There are other oral Rx meds that are used for systemic chronic pain management, but these are not as effective and not as appropriate for localized inflammatory arthritis pain management as the ones I discussed above. This should be a good start for your self-help strategies!

Additional Self‑Help Strategies for Joint Pain

• Activity modification, heat or ice, and short rest from provocative overhead or heavy‑load tasks are standard early steps for age‑related shoulder arthritis and tendinopathy.
• Myofascial release, Massage (Shiatsu, deep tissue, lymphatic and other types), cranial-sacral therapy, and physical therapy can all help with secondary muscle tension/spasm and pain, in addition to specific modalities I discussed above for inflammatory and degenerative joint pain.
• Maintaining general strength, flexibility and aerobic movement conditioning also is helpful to improve mobility and decrease pain for older adults, particularly the many ways you can exercises of all kinds in WATER!
• Photobiomodulation (low-level red or infrared light therapy) can help chronic shoulder pain by reducing inflammation, improving local circulation, and stimulating cellular repair in tendons, joint capsule, and surrounding soft tissues, which in turn decreases pain and improves function. We have presented two seminars on LIGHT AS MEDICINE, so check our Faith Over Fear archives at www.TruthforHealth.org

NOTE: It is beyond the scope of my “Self-Help Strategies” Health Tip this week to get into a discussion of steroid injections, platelet-rich plasma (PRP) injections, Acupuncture, TENS, and other more complex approaches, including surgery, that all involve working with specialist medical professionals.

IN SUMMARY:  Integrated Approach to Self-Help Pain Management

• Identify with blood tests the nutritional deficiencies that contribute to joint pain, and correct these deficiencies to support muscle mass, mitochondrial function, reduce inflammation and aid healing.
• Seek to have lab tests to identify hormone factors contributing to joint pain and degenerative changes: decline in estradiol for women and testosterone for men.
• Protect sleep as much as possible, since sleep problems are common in older adults and worsen pain sensitivity and recovery.
• Address metabolic contributors such as prediabetes, diabetes, weight gain, and low physical activity, which are linked with higher shoulder pain and frozen shoulder risk.
• KEEP MOVING PHYSICALLY! Stay active with low-impact movement such as walking, swimming, yoga, or mobility work to maintain joint motion and whole-body conditioning, and include strength-training to maintain muscle mass to support your joints.
• Pay attention to posture and avoid long periods of desk work or being hunched over using mobile devices. All of these positions increase neck and shoulder muscle tension and aggravated shoulder joint pain.
• Keep your shoulders moving with gentle, regular range-of-motion, work such as shoulder rolls, rather than prolonged guarding or complete rest. Get up from the computer or TV watching, move and stretch at least once an hour!
• Use heat for stiffness and cold for sharper inflammatory pain as needed.
• Seek medical evaluation if pain is lasting more than a few weeks, if the above strategies have not helped, or if you are experiencing more impairment of movement or function, such as shoulder motion decreasing, sleep disrupted, or there is nerve pain/numbness/tingling, or weakness.

As you put all the pieces together that I have described today, I encourage you to consider our other natural medicines with our top quality, cGMP-compliant professional formulas: TruMitochondrial™ Boost,  TruNAC™, Tru BioD3, Tru B™ Complex Full Spectrum, TruZinc™, TruC with BioFlavonoids  (Natural sourced Vitamin C with complete Bioflavonoids), and TruProBiotic™ Daily to replenish critical bifidobacteria depleted by COVID shots, viral illnesses, and antibiotic therapy.

All Truth for Health Foundation Products Meet or Exceed cGMP Quality Standards, the highest quality standard for supplements sold in the USA. For more information, references from studies are listed in the Product Data Sheets for each product, available on our website.  Check us out at www.TruthforHealth.org Click on tab for Store.  OR www.shopTruthforHealth.com

CAUTION: As always, we urge you to avoid supplements without checking knowledgeable sources to evaluate your medical situation, proper lab tests to verify what is needed, and to make sure to avoid adverse interactions with prescription medicines and other supplements you take.  Under medical practice regulations, we are unable to answer individual medical questions or make specific individual supplement recommendations for people who are not established patients of Dr. Vliet’s independent medical practice (www.ViveLifeCenter.com).

To Your good health and improving resilience!
Elizabeth Lee Vliet, MD

More Resources:
Dr. Vliet’s Health Tip: “From Stiff to Strong: Regenerate Your Joints with Green-lipped Mussels, Red Light, & Hormones”
Dr. Vliet’s HEALTH TIP – TruAmino™ Complex
TruMitochondrial™ Boost –Dr. Vliet’s earlier Health Tip