Shoulder pain is one of the most complicated and researched topics in musculoskeletal health but it is fortunate for you that you have landed on this page as we can guide you through things you need to do. The shoulder consists of the:
- The shoulder joint is the ball and socket joint between the arm (the Ball) and the socket (shoulder blade) which is very shallow to allow lots of movement
- AC joint (between the collar bone and shoulder blade) which acts as strut to support the shoudler
- the rotator cuff (4 muscles from the shoulder blade that wrap around the arm bone) to actively hold the ball in the socket
- A series of ligaments, labrum (lip of the socket) and joint capsule to control the ball in the socket in extreme positions of movement
- Big muscles (pec, lats, deltoids) which move the arm quickly and powerfully
Why is the shoulder such a problem?? Well quite simply it is an inherently unstable joint relying on extra movement to put our hand in so many various positions. It has to do this with strength and power in mind but also great precision and control.
Factors contributing to shoulder pain include:
- Excessive use of the arm above shoulder height
- Previous injury – usually landing on it or on your arm
- Excessive or incorrect weightlifting, throwing or swimming
- Posture – the neck (cervical spine) and upper back (thoracic spine) mobility as well as the shoulder blade (scapula) all work to put the shoulder in the right position. Dysfunction in these – either cause or effect – can influence the way the shoulder works.
The key for the shoulder is understanding the pathology. Common issues in the shoulder include:
- Rotator cuff tendinopathy in which the rotator cuff tendons cannot handle the demands required or they can get pinched inside the joint (usually by poor control of the ball or socket) or occasionally outside the joint (by external anatomical structures such as the Acromion).
- AC joint can be a cause of shoulder pain as the two ends of the collarbone and shoulder blades can get compressed and undergo degeneration and eventually lead to arthritis.
- Chronic Instability in which the shoulder may feel loose or keep “popping” out. This can be due to a previous dislocation/subluxation or it may be multidirectional instability which means it can pop out for no specific reason at all.
- Shoulder joint degeneration which includes chronic damage to the cartilage surfaces of the bones within the joint or to the labrum which surrounds the socket
Treating the shoulder includes appropriate treatment for the conditions identified above and then making sure we deal with the cause or effect appropriately. There is no one size fits all approach to shoulder rehab. We need to identify the contributors to your shoulder problem and manage them. This includes:
- Rotator cuff strengthening and control
- Range of movement exercises
- Scapula and posture strengthening and control
- Neck and trunk strengthening
- Advanced stability exercises
- Overall strength and power program to meet your goals
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