Shoulders take a lot of abuse in our daily lives. We lift and carry heavy objects, reach in awkward ways, hang bags from them, throw things and undoubtedly stress them with the repetitive tasks demanded by our professions. Additionally, the misguided workout positions, routine recreational pursuits and participation in sports unintentionally lead to the most common shoulder injuries.
I usually see people in my office by the time things have gotten so bad that they can no longer participate in their sports, workouts, and many of their regular daily activities.
One injury that involves the shoulder is rotator cuff dysfunction. Whether in the form of tendonitis, weakness, or tears, the muscles that make up the rotator cuff are usually part of the problem.
Four shoulder blade muscles work together to make up the rotator cuff. These muscles are responsible for all of the motions involved with throwing (lifting the elbow out to side, rotating the forearm backward, forward and extending the arm behind back). When these muscles are working properly they do more than just allow us to throw. They help keep the shoulder in the correct position to allow for pain-free reaching in all different directions. When rotator cuff weakness or dysfunction develops, an imbalance of the forces at the shoulder occurs with reaching and the shoulder joint position is altered. Over time, this causes friction on the tendons when we reach in different ways and “tendonitis” or "bursitis" is a common result.
Similarly, since the shoulder is not being held in proper alignment, the tendons may also become ‘pinched’ between the shoulder bones, resulting in impingement syndrome. I see this develop commonly in people who lift weights to strengthen the larger muscles of the front of the body (chest, biceps, deltoids), but neglect the smaller mid-back and shoulder blade muscles. This muscle imbalance at the shoulder is similar to many of the dysfunctions I have written about previously that also develop at other joints (low back, knees/hips/ankles) due to an imbalance of forces where the larger muscles dominate without the control of the smaller stabilizing muscles.
Other common shoulder injuries involve separations, dislocations and generalized laxity of ligaments. In all cases, the ligaments, which are responsible for joint stability, have been injured and are less effective at holding the bones in place. The surrounding shoulder muscles need to compensate for the ligament damage with proper strength and stabilization training to control large shoulder movements in addition to quick, smaller arm motions.
Another common problem involving the shoulder is ‘frozen shoulder’ or adhesive capsulitis. This may occur secondarily to painful dysfunctions like the ones described above, after periods of immobilization (i.e. with fracture healing) or due to an unknown cause. In any case, significant loss of shoulder range of motion develops as the capsule of the shoulder tightens due to disuse over time. A cycle of pain and dysfunction develops, consciously or not, in which pain with shoulder movements causes one to stop performing the painful movements. This lack of movement and disuse allows the capsule to tighten and the surrounding muscles to weaken. Further attempts at use of the shoulder cause more pain so, over time, lack of movement takes over and people end up with a shoulder that is “frozen.”
With traumatic injuries or slowly progressing shoulder pain, it is always beneficial to seek treatment sooner than later. I have seen some people fully recover within days after initiating a rotator cuff strengthening program. This quick recovery will not happen, though, if months or years worth of damage is already done. Symptoms can still be alleviated and even fully abolished, but the rehab will be much longer.
Be kind to those hard working shoulders, be aware of pain with any shoulder movements and be sure to seek treatment should the need arise.
Below are links to a few basic videos of shoulder strengthening exercises that target the posterior muscle groups, rotator cuff and postural muscles:
Scaption Standing http://www.youtube.com/watch?v=TbFo7B6eq7U
Scapular Retraction http://www.youtube.com/watch?v=7byKmZmpGCk
Bilateral External Rotation http://www.youtube.com/watch?v=UV9IfrrlGqc
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