Shoulder problems and solutions
This article was inspired by my own stupidity. I promised that I was going to write an article about the shoulder, but first a confession. Most if not all of the shoulder problems I am going to write about I have personally suffered at one time or another based on what I can only call an addiction.
Since a young age I have been addicted to lifting heavy weights. My friends that know me will always mention that I have been doing this since I was a teenager, and now at 46, roughly thirty years after my first real introduction to lifting I can hardly stand to go a week without doing this. In all meanings of the word I am an addict. I don’t do drugs, smoke and I seldom drink but I am addicted to lifting heavy weights, perhaps to my own detriment, but I can’t see this changing in the foreseeable future so, this article is for me as much as it is for you.
For the last several years I have been pursuing a personal best in the bench press. This past summer it finally looked like I was going to hit my goal.
At the end of summer I decided it would be cool learn try jiu jitsu. So I jumped into training jiu jitsu , and although I was not injured during training my shoulder began to hurt quite a bit. So much so that my strength toppled significantly and I was thrown of course once again of hitting my goal. As I dissect the basis of my injury it becomes clear that my shoulders were in good enough shape for lifting since that is a relatively fixed plane of motion, but not stable enough for a dynamic and random activity such as jiu jitsu. I had adapted to strength training, but not something that demanded more flexibility and stability at odd angles.
So, with that in mind, you will see this article written from the perspective of an addict and a person who still does dumb things despite being a clinician for over 20 years and a certified expert in treating shoulder injuries.
The shoulder is a miraculous piece of work, it has almost unlimited range of motion. It is unlike most joints in the body in that it is rather loosely bound to its attachment site and stabilized almost exclusively by muscles. Because of these two factors, large range of motion, and the lack of major osseous and ligament support the shoulder also tends to be the most unstable major joint in the body and prone to injury.
The humerus is your upper arm bone with a ball on the top of it, with numerous little notches for points of muscle attachment. The glenoid fossa is really a concave surface on the outside edge of the scapula (wing bone). The roof of the shoulder is the acromion, (little bump), and the clavicle (collar bone) and they make up a joint appropriately named the acromioclavicular joint. This joint is often where shoulders are separated due to trauma.
Stability of the shoulder is mostly granted with precise control of four relatively small muscles called the rotator cuff. These muscles are Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. They all act at various angles to keep the humerus in what is called the glenoid fossa. (more on this later) Although this might be humerus, its not really funny.. (see what I did there). These 4 muscles are commonly looked at in all shoulder injuries with the predominant muscle being injured being the supraspinatus. Other muscles either directly or indirectly attached to the shoulder are the lats, biceps, triceps, teres major, pectorals, deltoids, traps, serratus anterior, rhomboids and the subclavius. I hope by now that you are getting a picture as to why shoulder problems are often difficult to treat.
There is also connective tissues called the labrum, which means lip, and a capsule that contains the joint. Some or all of these structures can be the cause of shoulder pain and dysfunction.
When people refer to a shoulder injury they usually put their hand somewhere and say I hurt there when I do this motion. This is and can be diagnostic to find where the injury is, but is often not diagnostic to find where the actual problem is that caused the injury.
This problem is pervasive in sports; people hurt in one place and assume that because pain is there, that must also be the source of all their problems. This is a dangerous presumption to make and often wrong. (see the article I posted about foam rolling and the NFL player)
A good shoulder exam will have all the ranges of motion evaluated, side motion, front motion, back motion as well as internal and external rotation as well as scapular movement. The rotator cuff muscles are then evaluated independently to detect strength as well as injury or tears. Certain tests called orthopedic tests are done to illicit pain (yes we are trying to cause you pain) to pinpoint the structures involved or to diagnose something clinical such as impingement. There are dozens, perhaps a hundred of these tests, most people use a handful to do the lion’s share of the evaluation. A really good shoulder exam will test joint glide, muscle and tendon movement through structures as well as a functional evaluation to see what happens when you use your shoulder. Of course I prefer the really good exam.
Any serious athlete, weight lifter or weekend warrior has had a bout of shoulder pain in their lifetime. Shoulder pain is epidemic in weightlifters because of the high load and volume of work placed on the shoulder as well as underlying stability issues due to injuries or failure to adequately train the stabilizer muscles. The gym is littered with guys such as myself rubbing and gripping their shoulders between sets of various exercises, it’s almost a cliché at this point.
For the non athlete, a simple fall on to an outstretched hand can cause serious shoulder injury, so in the big picture shoulder injuries are common.
I would say that in sports the shoulder ranks up there with knee and ankle injuries as one of the most common and most frustrating injuries because it can affect athletes in so many types of sports.
The second part of this article will focus on the actual injuries, what to do, how to prevent injuries and where the hidden problems are that are the underlying cause other muscles to fail or tear in the shoulder.
Stay Tuned for Part 2 which will be on our Facebook page, please go ahead and like our page if you haven’t done so to get this and other articles.
Yours in health,
Anthony Talorico DC