Unfortunately, shoulder pain is quite common. As the shoulder joint is very complex, it is no surprise that there can be various reasons for this. Basically, the shoulder joint is a ball and socket design, with the socket being very shallow to allow for complex and extensive range of movement. The ball part of the mechanism (humerus or upper arm) is held into place with ligaments and a set of muscles coming off the shoulder blade and going into the head or top of the humerus. These muscles are collectively called the rotator cuff muscle spasms. Any disruption to the correct function of these muscles can lead to pain and lack of range of movement.
The most common muscles to be effected is the supraspinatus. The joint position is also determined by the larger muscles surrounding the joint and in particular inserting into the top of the humerus. These include the latissimus dorsi (back) and pectoralis muscles (chest). The pectoralis major muscles often become chronically shortened with people who have spent a lot of their time stooped over a desk, e.g. with their shoulders forward. Also as the internal rotators of the shoulder (muscles that rotate the shoulder inwards) are stronger than the external (muscles that rotate the shoulder outwards), it is not unusual to see the shoulder fixed in an inward or internal rotation position. What this means is that it is important to ensure correct posture at all times and train the external shoulder rotators. It is also important to remember that shoulder pain and/or injuries can come from the neck, upper back and sometimes lower back and pelvis areas. Therefore, it becomes even more important to focus on correct posture.
Correct posture while sitting can be obtained through several different methods. What is important to observe is that pulling your shoulders back and pushing your chest out causes a reduction in the distance between the shoulder blades and thus a type of pinching action which results in an increased tension in the upper back and can accentuate or create upper back pain. The alternative to this method is achieved through less effort and has fewer side effects. The best way to obtain correct posture is to think of a string attaching to the top of your head and someone pulling it up toward the ceiling. This creates an elongation of the spine. It is also important to ensure that, at a workstation, the monitor is close (and big) enough and if driving, avoiding bucket seats. Avoid sitting for long periods.
Exercising the rotator cuff can be started off with a simple exercise. This is to be on your side with your uppermost elbow wedged into your side and held at a right angle, taking hold of a weight (can be something as simple as a tin of beans) and lowering it to the ground and then lifting it up. If you are going to the gym and lifting weights regularly, it is vital to balance chest muscle with back muscles workouts.
Unfortunately, even with addressing the aforementioned factors, it is possible you could develop and/or exacerbate shoulder pain. Under these circumstances it is important to seek professional help, such as a chiropractor, osteopath or a physiotherapist who will give you the appropriate form of treatment and advice on posture and exercises. Massage of the effected tight muscles combined with manipulation of the restricted joints can help.
There are times, however, when this conservative form of therapy is not sufficient. Under these circumstances the medical profession can provide more interventionist therapies such as steroid injections. Ideally, this should be undertaken while a diagnostic ultrasound is scanning the area. It is also important to have a diagnostic scan of the shoulder before having a steroid injection to determine if there is any damage to the capsule or tendons of the shoulder. It appears that results tend to be better when the medical professional administering the injection has undertaken this procedure frequently.
Steroid injections seem to be very effective in true frozen shoulder (also called adhesive capsulitis). A simple test to determine the extent of frozen shoulder is to try to put the hand behind your back and reach for the shoulder blades. If this is severely restricted, it could signify a frozen shoulder that needs more interventionist treatment. It should be emphasised that early assessment of a shoulder injury is crucial.
Another therapy that seems promising is shockwave therapy for tendonitis. This appears to be most effective when combined with an exercise programme designed by a medical professional. In extreme cases, it may be necessary to undertake surgery. This is rare and early treatment by a chiropractor, physiotherapist or osteopath is usually sufficient.
Mark Butterworth – Headingley Chiropractic Clinic