The shoulder is the most flexible joint in the body. It's so flexible that, unlike other joints, it has very few ligaments holding it together. Instead it has a group of muscles called the Rotator Cuff that act like adjustable ligaments to stabilize the joint in any position, whether you are reaching overhead or doing pushups . This exceptional flexibility comes at a cost however and the shoulders huge range of motion and lack of limiting ligaments makes it an inherently unstable joint that is prone to injury and pain.
Common injuries in the shoulder or impingement, rotator cuff tears and labrum tears. Evidence suggests that shoulder injuries are more common than previously suspected. One study estimated that 70% of people over 60 have rotator cuff tears. One reason these injuries may go undetected is because people associate pain, stiffness and weakness with age or they may not be aware that there are solutions available.
So what's the trade off? What do we get in return for this injury prone and potentially troublesome joint? Well in biomechanical terms, the shoulder is the platform for hand function. As Human Beings, we use our hands for everything: Writing, lifting, carrying, communicating, climbing, weight bearing. And the joint that allows all this to happen is the shoulder. The shoulder moves the hand to wherever it needs to go and stabilizes it in that position so it can do whatever it is that you want it to do. Which is basically everything, let's face it. Imagine if you couldn’t move your hands around. How would you get anything done?
So the shoulder supports hand function, so what supports shoulder function? You guessed it, the spine. Similar to the way the shoulder positions the hand so it can perform its many functions, the spine positions the shoulder so it can perform its tasks. So what happens when the spine is not as strong or as flexible as it should be? Well what tends to happen is that the shoulder is forced to compensate. This transfers force from the spine to the shoulder and over time, this additional stress causes injury.
Many people show up at the doctors office, or the PT office complaining of shoulder pain, stiffness, weakness. This pain can usually be helped with some medication, a shot, some strengthening or pain relieving modalities. But what if the pain is due to a problem in the spine, or even the hips? If we don’t address the underlying problems and relieve the stress on the shoulder, all these symptoms are going to return, and damage is going to continue and eventually we may end up having surgery. You might even end up having surgery on the other arm too.
So one of the things we do in PT is to examine function, that is, the way the whole body works together. We also factor in daily habits like work, driving and exercise. In many cases and particularly in the case of the shoulder, we find that the underlying cause, or a contributing factor in the patient's condition originates in another part of the body. This is very important because if you only address the area that’s hurting, you have not truly solved the problem and unsolved problems return eventually. Treating the whole person always yields superior, longer lasting results.
In the case of shoulders we almost always find there is a problem with flexibility in the spine that has to be addressed in addition to the pain complaint in the shoulder joint itself. Fortunately it's very simple to incorporate spinal flexibility exercises into the plan of care so both areas can improve at the same time.
After seeing the PT and having your problem both diagnosed and treated the next thing to address is a maintenance program to prevent the original problems coming back. Any program involving the shoulder should provide exercises or activities that maintain or improve flexibility in the shoulder and the spine. One of the things I like to recommend to my patients for this purpose is yoga. Taking a class once or twice a week is not only a good way to stay flexible but it's also a great work out and an opportunity to get to know health conscious people like yourself in the community.
5 Ways to Relieve Shoulder Pain Without Medication or Shots.
Heat or Ice: Hot and cold are useful for easing pain in sore shoulders. There are a lot of opinions over which is best . The goal of any program to improve shoulder health is to get the joint moving again. Heat or ice begin this process by decreasing your pain enough to where you can tolerate stretching or exercise. So I say use the one that gives you the most pain relief. As a general rule however, heat is good for shoulder pain caused by chronic conditions such as arthritis or fibromyalgia while ice is better for pain caused by acute conditions like sports injuries.
Wall Walks. Stand facing the wall. Keeping your shoulder relaxed, walk your fingers up to the highest point you can reach on the wall. Pause there for 5 seconds and walk your fingers back down. Repeat this 5-10 times in a session. Do 1 or 2 sessions a day. Put a piece of masking tape or a sticker at the highest point you can reach on the wall, try to get a little bit higher each day.
Pendulums: Lean on the edge of a table or a wall with your good arm, hang your painful arm down with your hand pointing at the floor and relax it. Rock your body back and forth so you relaxed arm swings like a pendulum. Your arm should be relaxed, not helping with the movement. Gently swing your arm forwards and backwards, side to side and small circles clockwise and counterclockwise. Do this for 20 repetitions in each direction then rest. Doing this exercise relaxes the muscles surrounding the joint and also improves fluid circulation within the joint giving you valuable pain relief.
Doorway Stretch: Stand in a doorway, put both arms in the high five position either side of the door frame, step gently into the doorway until you feel a stretch on the front of your shoulders. Stretch like this for about 30 seconds, try to relax your shoulders. Repeat this 3 or 4 times. If you can’t reach the doorframe on either side, stand in the corner of the room and use the walls to support your arms.
Noodle stretches: Do these two stretches daily to improve your shoulder pain: Find a pool noodle or get one at the store. With scissors or a knife, cut about 18 inches of noodle to use as a mini foam roll. Put the noodles on the floor or a yoga mat , in a vertical position. Now lie on your back , on top of the noodle so it aligns with your spine between your shoulder blades, put both arms in the “high five” position, relax for 3 minutes. When 3 minutes is up, switch the noodle to a horizontal position, across your back around the bottom of your shoulder blades. High five position for 3 more minutes.
Shoulders are complicated so it's important to have an expert in your corner. If you need help, reach out to my team at firstname.lastname@example.org and let's talk.
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