Do You Have Shoulder Pain?
- Shoulder pain occurs in up to 21% of the general population with 40% persisting for greater than one year
- Shoulder impingement accounts for 40-65% of injuries
- Shoulder injuries make up annual costs estimated at $39 million
- Altered shoulder mechanics can be the primary cause of degenerative changes
The shoulder joint requires a balance of stability and mobility.
Stability is primarily derived from the surrounding muscles, while mobility results from the capsule and ligaments.
The shoulder is actually composed of 4 joints:
The joints below (Lumbo-pelvic-hip) and above (elbow and wrist) can also affect movement and potentially pain and injury at the shoulder region (see prior posts on the Kinetic Chain).
Many people think of the shoulder muscles as the Rotator Cuff, which consists of the SITS muscles:
- Teres minor
The rotator cuff is the primary steering mechanism for the glenohumeral joint.
These muscles essentially stabilize the head of the humerus in the glenohumeral joint, along with the deltoids, during movement.
Other important muscles that are often overlooked or underemphasized in shoulder problems include:
- Pectoralis group- typically overactive
- Latissimus Dorsi- typically overactive
- Rhomboids- typically underactive
- Trapezius (Upper- typically overactive , middle and lower- typically underactive)
- Levator scapulae- typically overactive
- Serratus anterior- typically underactive
With all these muscles and joints, how does one know what is causing their shoulder pain?
An integrative assessment is the most reliable way to identify the source of your shoulder pain.
Sample shoulder assessment:
Static posture- Upper crossed syndrome (characterized by rounded shoulders and forward head carriage). This position alters the joint mechanics around the shoulder girdle.
Overhead squat- Common observations include arms falling forward and low back arching.
Wall movement tests (abduction, rotation and flexion)- Common observations include arms falling forward, low back arching and hands moving away from the wall
Pushing, pulling and pressing- Common observations include shoulders elevating, forward head and scapular winging
The above distorted movement patterns are characterized by a combination of over and under active muscles (see other important muscles that are often overlooked or underemphasized in shoulder problems above).
The static and dynamic assessments can show how the muscle and joint dysfunction is affecting movement.
Range of motion and muscle testing identify which muscles are involved
Once these muscles are identified, the answer to your shoulder problem lies in:
- Inhibiting and lengthening the overactive/tight muscles
- Activating the weak muscles
- Mobilizing the involved joints
- Performing the appropriate corrective exercises to reinforce the treatment and reeducate optimal movements
Do you have shoulder pain?