RECOVER: May 29, 2015

Reach for the sky....it's not always as simple as it seems

Spoiler Summary: It takes a finely tuned system to get your hands over your head....maybe that's why it's referred to as the shoulder "complex"....thankfully, it doesn't have to be as complicated for everyone..

For the last few weeks I've been writing about some of the various body areas that tend to get a little cranky over time.  I started from the center (spine) and now, move outward to the shoulder complex.  The shoulder complex includes 3 joints, 1 articulation, 15 different muscles and many ligaments.  It also houses a major nerve bundle and the blood vessels that supply the arm and hand.  So even though it's not actually called a complex because it's so complicated....it probably could be.

Shoulder pain is an incredibly common thing, with estimates as high as 67% of people being impacted per year.  Although there are many different injuries and diseases that can be included, many start as a movement disorder -- the shoulder just isn't moving like a shoulder should.  The bad news is: depending on the number of risks we are exposed to, it's fairly likely that most of us will have an episode of shoulder pain.  The good news is: if you know what to look for, the early warning signs of movement-faults are not that difficult to spot and correct.

Probably the most telling sign of a shoulder evaluation is how smoothly a person can bring their hands over their head from the side, as if to "flap their wings" into an overhead position.  In a balanced shoulder, the hand moves freely upward and the arm and shoulder blade are coordinated and smooth.  In a shoulder where the movement is impaired, there is usually a "catch" or a "hitch" in the motion, often when the arm is out to the side, parallel to the ground (90 degrees or thereabouts).  It might come a bit before and it might last a bit after in the range, but generally in that area, the motion is not as smooth and the person might compensate to achieve the overhead position or to avoid discomfort.

After looking at this motion, we often ask the person to put their hand behind their head followed by placing the back of the hand in the lower back.  These motions allow us to look specifically at "rotation", which is often restricted and causes problems.  If this is clear and moving freely, we might ask that they move the hand from these positions to test the strength of certain muscles or the stability of the joints.  As we note impairments, we might ask them to change their posture or change the angle a bit here or there so that we can tease out which is the offending muscle or structure.

If all goes well to this point, we might ask the person to perform any number of "special tests" where we are testing very specific combined motions or looking for very specific signs and symptoms.  And finally, we might palpate ("poke around") to look for tender areas which might signify areas that are irritated or inflamed.

One of the most common culprits that leads to shoulder pain is "forward & rounded" shoulder position -- when the shoulder blades round forward and the arms rotate inward slightly -- especially common in people who put in long hours doing tasks that require a forward position (from operating a tool in the road to a keyboard at the desk).  This change in position places the muscles and tendons at a different angle of pull and causes faulty mechanics, often resulting in pain.  If we notice forward/rounded shoulders but the person is otherwise able to "move well" (or when they re-establish normal movement and get to that point), we will often have them perform an exercise progression that is designed to ensure a long term fix - example video-short here.  If, on the other hand they have adopted that posture as a compensation, we will often given them exercises designed to obtain better mechanics first.

When all 15 muscles are pulling with the right force and firing at precisely the right moments, when the joints and the articulation are stable (but not compressed) and when the nerves and vessels are gliding without getting "snagged" or stuck, pain subsides because the shoulder is once again moving.....like a shoulder should.

It's a complex.....but if you know what you're looking at, it doesn't have to be complicated.  Here's to moving well - reach out if you need help.

Have a great weekend,

Mike E.