SHOULDER PAIN
What you should know about back pain
The shoulder is a very mobile joint. It helps put our hand, in all sorts of useful
places. We can reach in front and overhead and even behind us. While the
shoulder is thought of as a ball and socket joint, movement of the shoulder blade
or scapula on the chest wall and even side bending in the trunk add to total
movement of the shoulder.
If we compare the shoulder to another ball and socket joint, the hip, we will see
that the hip is a large, stable joint that we can put all our weight through but it
doesn’t move as much as the shoulder. The shape or geometry of the hip
provides much of its stability. The ball sits in the socket. The shoulder gets its
stability in a different way as the ball is large and round and sits on the socket
which is smaller and flat. There is also a piece of gristle or cartilage that
sits between the ball and socket which is called the labrum.
The shoulder has a group of muscles that arise from the scapula and provide
stability to the ball and socket joint. The rotator cuff muscles are deep in the
shoulder and attach to the ball or humeral head. They act in coordination with
the larger muscles of the shoulder such as your pecs and deltoids.
Now that you understand some of the functional anatomy basics of the shoulder,
the two main problems of the shoulder may be easier to understand.
Firstly, the ball and socket joint of the shoulder or gleno-humeral joint can
dislocate or sublux when excessive force is placed on to the joint particularly if
the joint is in an unstable or vulnerable position. Falling on an outstretched hand
can achieve this as the fall applies a force to the shoulder while the hand is
overhead.
Other common problems involve the rotator cuff muscles. Impingement refers to
jamming the ball of the ball and socket joint up against the bones or soft tissues
above it. This can occur because of poor movement patterns or repetitive
activities such as throwing. Patients will often have pain on lifting their arm
overhead and there will be underlying damage and inflammation to the rotator
cuff. Some people have bony prominences that can predispose to this or make
recovery more difficult. The rotator cuff may also tear during a forceful exertion.
These patients have sudden onset of pain and in the early stages may have great
difficulty in moving the shoulder.
From birth your shoulder gains stability through
compressive and distractive forces (pushing and
pulling). This fundamental stability often
needs to be retaught to you after a period of shoulder
pain to ensure that your brain and muscles are
sending the right messages to each other.
References
Grey Cook – Movement
SHOULDER PAIN
The one-two-three of shoulder rehabilitation
1.
Reset – Make a change in movement or pain
Your physiotherapist will look to provide a change in pain your shoulder movement to allow a
window of opportunity to lock in correct movement patterns. This reset may be focused on the
spine, ribcage, scapula, shoulder joint or the surrounding muscles depending on the driver of
your symptoms. An example best illustrates this point, our work environments require all of us
to perform forward based movement whether sitting or bending and lifting, this results in
restriction of the mid back and by default the shoulder blade will move forward on the ribcage.
This does let the shoulder go through it normal range of movement and as a result excessive
pressure is placed on the shoulder. Therefore in order to improve the shoulder pain, the mid
back and ribcage must be first addressed. This reset may come in many forms including but not
limited to stretching, mobilization, dry needling and/or soft tissue release.
2.
Reinforce – Support the change in movement or pain
In order to reinforce your new movement or reduced pain it is important to address any negative
lifestyle factors that may limit your recovery. For example, 10 hours of working with your arms
in an overhead position cannot be reversed by a few minutes of physio exercises per day, so
rotating your duties, or changing your body position during work and sleep may be important to
prevent you aggravating your pain. There will be some changes that are essential. Strapping the
shoulder joint or mid back may also provide an opportunity to reinforce the changes.
3.
Reload – Lock in the change in movement or pain
Reloading the tissues involves your physio giving you specific exercises to train your mind and
body to ‘lock in’ this new pain free movement and function between your spine, ribcage, shoulder
joint and surrounding muscles. This will be progressive, initially starting gentle and moving
toward more dynamic and functional exercises. This will ultimately end with you returning to full
pain free work duties and/or other activities.
Functional Movement Screening
At your last session of physiotherapy you will be discharged having completed a ‘movement
screen’. This will establish the baselines for your body mobility and stability and function
identifying potential injury risk factors. You will also be given strategies to correct or reduce this
injury risk throughout the body.
The one - two - three of sitting workstation posture
Addressing your workstation posture is a very easy way of reducing neck and shoulder pain
1.
2.
3.
References
Grey Cook – Movement
Don’t sit for prolonged periods of time. Get up and move around.
Often the best ways to facilitate this is to use a pedometer. There are various pedometer Apps
available for free which you can put on your smart phone. If you get to mid -afternoon and you’ve
only done a small number of steps, then you will find a way to get up and get going. We’re
normally very good at the things we measure. You should be doing 5 - 10,000 steps per day.
Lift your chair so that
Elbows are above the desk and your hips are above knees
When using your mouse your elbow should still be able to touch your side
If you are shorter in stature, then you will need a footstool to support your feet.
Lift your screen so that the top of the screen is level with your eyes.
Often we need to add a ream of paper under the monitor to get the screen high enough.