Chances are you have had shoulder pain at one point in time in your life. Just to name a few, shoulder pain can be caused by overuse, trauma, and improper lifting mechanics. Often times we as people try to self-manage our daily aches and pains when instead your pain could easily be addressed by a licensed Physical Therapist. As a matter of fact, I recently had a patient with chronic shoulder pain of 3 years that was completely addressed in less than 5 visits. Let us begin our discussion today with the makeup of the shoulder joint.
Anatomy of The Shoulder
The shoulder is a very complex ball and socket joint of the upper body. By design, the anatomical makeup of the shoulder allows this joint to be very mobile and as a result, can limit its ability to remain stable. If you were to remove all the soft tissue structures from the shoulder and solely look at the bony anatomy you would quickly find the ball (humeral head) looks very much like a golf ball on a tee (glenoid fossa/socket). An important anatomical feature of the shoulder complex is the clavicle which is very much like the strut on your vehicle absorbing and dissipating force. Interestingly, it is the only bony attachment of the shoulder to the axial skeleton. There are 17 different muscles that attach to the shoulder blade (scapula). Of those 17, 4 of them are better known as the rotator cuff muscles. These 4 muscles serve to help stabilize the shoulder (glenohumeral joint) by compressing the ball into the socket. The labrum is a cuff of cartilage that deepens the glenoid fossa and further stabilizes the shoulder.
Arthrokinematics of The Shoulder
Arthrokinematics is a fancy word that really just says arthro (joint) and kine (to move) or how the shoulder joint moves through its available range of motion. There are a lot of moving parts when you reach overhead to grab something as simple as a cup from the cabinet. The first 15 degrees is by activation of the supraspinatus (the most common torn rotator cuff muscle. More on this later). Followed by the deltoid. At this point, your shoulder is around shoulder height. To reach beyond shoulder height, your muscles have to work in synergy to reach overhead. This is known as a force couple. The serratus anterior pulls your shoulder blade forward while your lower trapezius muscle finishes the movement by tipping the shoulder blade upward to achieve a full range of motion. However, this is only half the movement. Control when lowering your arm is also important to avoid pain. Pain can be caused by poor control when reaching up or lowering your arm back down to your side. This is just one example of how complex your shoulder really is.
Is your Shoulder Worn, Born, or Torn?
The simplest way to categorize shoulder pain is under the three categories worn, born or, torn. However, there are some instances where shoulder pain does not fall perfectly into one of these categories. The shoulder joint is an uncommon location for Gout but could be a possibility. As alluded to earlier, poor scapular control (think force couple) can cause impingement pain where the supraspinatus tendon is pinched between the acromion and humerus when reaching above shoulder level. More on this later.
There are several types of arthritis that can cause shoulder pain. Our focus here will be on joint degeneration caused by trauma or normal wear and tear from daily activities. This condition is known as osteoarthritis. However, the shoulder joint is not commonplace for osteoarthritis due to normal use because it is not a load-bearing joint like the hip or knee. Physical therapy can help restore motion in the shoulder, increase strength, and alleviate pain through an individualized treatment program.
Multidirectional stability is a term used to describe when there is general laxity of the glenohumeral joint. In this population, weakness of the rotator cuff muscles and other periscapular musculature can increase the risk of dislocation. Shoulder instability is also common with trauma like a fall causing shoulder dislocation. In either case, physical therapy can help stabilize the joint and reduce the risk of recurrent dislocations and the need for surgical intervention.
Labral tears can also be a contributor to shoulder instability and are also found in the overhead athlete population from overuse. A labral tear may feel like grinding, locking, or catching with movement. Pain could be caused by overuse of the surrounding muscles working to stabilize the joint. Physical therapy can work to improve dynamic stability through training of the periscapular and rotator cuff musculature.
Rotator Cuff Tear
Rotator cuff tears can also be due to a single trauma or repetitive microtraumas from faulty shoulder mechanics (subacromial impingement). In a 2013 study, it was found that up to 73% of people with a full tear in their rotator cuff were able to rehabilitate their shoulder without surgery.
Can My Shoulder Pain Be Addressed By A Physical Therapist?
Great question! The only tried and true way to evaluate your specific issue is to get a thorough assessment performed by a trained professional. Similar to having your blood pressure taken or getting regular blood work done at the doctor’s office, certified health professionals can regularly assess your joints and movement patterns to ensure they are within optimum ranges. That’s where Aviator Sports Performance & Rehabilitation comes in!
Aviator Sports Performance and Rehabilitation is deeply rooted in the scientific study of human movement and the innovative integration of technology into practice, ultimately aiming to help patients, athletes/clients in maintaining healthy, fit lifestyles, reduce injury risk, and achieve higher levels of sports performance. Our highly trained staff (Composed of Doctors of Physical Therapy, Certified Strength & Conditioning Specialists & Biomechanic Specialists) & state-of-the-art movement screening services can help identify any significant abnormal movement patterns or strength limitations present, and work to provide our clients with a fully customized corrective action plan to mitigate injury risk and help improve performance.
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