MANAGEMENT OF SHOULDER INJURIES – PART 2
In last month’s article, we talked about common shoulder injuries and what structures are often affected. We will follow up with some reasons shoulder injuries are so common and how we can best manage these stubborn issues.
Early intervention is important with shoulder injuries to prevent compensatory movement patterns. As the shoulder complex involves coordinated movement from the collarbone, scapula, humerus and the thoracic spine – it is important to address these factors early. As the shoulder joint is really the most flexible joint in the upper body, it really is the one that takes the brunt of compensatory movements. Often our neck, upper back and chest muscles are the initial culprits of stiffness, to which the flexible shoulder joint compensates for.
There are several barriers to the recovery of shoulder injuries that can contribute to the degeneration of the surrounding soft tissue structures. Repetitive and prolonged overhead activity can pinch both the supraspinatus and biceps tendons. This repeated compression can cause micro-tears in the tendons and restrict the blood supply to these structures. Further swelling and thickening can occur over time. The supraspinatus, in particular, has an inherently poor blood supply.
This makes this structure even more susceptible to damage with repetitive use and overhead activities. A lack of activity, or deconditioning, can also be harmful. When there is pain with movement and one opts to rest and avoid aggravating positions – poor posture, muscle atrophy and weakness can occur that may further disrupt the mechanics at the shoulder joint. Frequent sleeping on the same side can also compress the joint and certain soft tissue structures over prolonged periods of time.
Poor posture is deleterious for most areas of the body! The shoulder and neck complex are commonly affected. Rounded shoulders, slouched posture, and the chin poked forward are commonly seen. This posture causes the neck to be compressed, especially at the C5/6 vertebrae. At this level of the neck, the nerve roots exiting at C5/6 innervate (provide nutrition, sensation and strength) to the muscles of the shoulder. When these nerves are compressed, there is a lack of nutrition to these muscles and soft tissue structures. Eventually, they may exhibit signs of achiness, weakness, pins and needles, or pain.
If our posture is fairly rounded in the upper back or we spend many hours at the computer or driving, the upper back and scapular muscles tend to lengthen and weaken, thus not contributing to the stability and proper movement pattern at the shoulder. The shoulder joint can “drift” forwards and stress the anterior shoulder muscles (biceps, anterior deltoids, pectorals), which may cause tendonitis and impingement.
There are a variety of treatment options for acute and chronic injuries. Icing an acute injury for the first 48-72 hours can help reduce inflammation and pain. Avoiding overhead activity and limiting movement to pain free ranges initially
can reduce the impingement (pinching) of certain structures. Gentle range of motion exercises, using pulleys, a cane
or assistance from the other arm, can encourage circulation and reduce stiffness. Maintaining proper posture can reduce muscle imbalances and reduce stress on affected structures. Stand tall, relax the shoulders away from your ears and slightly tuck the chin. Gradually progressing to strengthening exercises that incorporate the neck, upper back, chest and shoulders will help to create balance, awareness and coordination of this complex joint. You may seek treatment for a pesky shoulder strain and find your therapist addressing your neck, breathing patterns, rib cage, upper back and overall posture. Hopefully these articles have helped to explain why all those areas are important and are likely the culprits as to why your shoulder is bothering you.
Rehabilitation of the shoulder can be a complex process. The longer an injury is allowed to continue without being treated, the more the body compensates, making recovery a longer process. As with all injuries, the sooner you seek treatment following an injury, the quicker the recovery and your return to the activities you enjoy.
Jennifer Gordon (BSc.PT, AFCI)
Bragg Creek Physiotherapy
www.braggcreekphysio.com
