Moser: Sore shoulders reflect complex mechanism

The shoulder joint is a ball-in-socket joint where the ball is larger than the socket, like a golf-ball sitting on a tee.

Spring is here and with it comes many of the activities people love to do in the Okanagan Valley.

Often, these activities (such as golfing, cycling, stand-up paddle boarding, gardening, baseball, volleyball, swimming, and tennis to name a few) can cause a dysfunctional or sore shoulder.

The shoulder girdle is a complex system. The shoulder joint is a ball-in-socket joint where the ball is larger than the socket, like a golf-ball sitting on a tee.

This allows the shoulder to have lots of flexibility.

Although having movement is good, the muscles surrounding the shoulder girdle must work together as a close-knit team in order to give the shoulder stability.

Commonly, patients complain of sore shoulders during and after performing overhead activities.

This often occurs when there is an imbalance in the muscles that control the shoulder girdle causing impingement.

If you take your fingers and follow your collarbone to the edge of your shoulder, you will feel a bony prominence at the tip of your shoulder called the acromion.

I often tell patients it is as though the acromion forms a bridge, or arch, over the shoulder joint.

With your arm at your side the space is the largest between that bridge and your shoulder joint (the ball).

As you reach your arm outwards, or above your head, this space gets smaller.

When there is inflammation of the shoulder joint, the acromion can pinch on the structures beneath, and it is often reported as a “catching,” “pinching” or “dead-arm” feeling.

This is termed impingement and can occur with a number of different shoulder conditions.

One of the mechanical reasons that can create impingement is when the stabilizing muscles of that shoulder aren’t correctly doing their job, and the mobilizers of the shoulder (i.e. rotator cuff) have to work overtime to compensate.

As the rotator cuff becomes inflamed, its tendons thicken.

In turn, there is less clearance of these structures as they move under the acromion.

This can cause more irritation and more inflammation creating a vicious cycle.

A physiotherapist will help break this cycle by determining the mechanical reasons this is happening.

Once the cause of the problem is understood the first stage in recovery is to get the inflammation and pain controlled.

Different modalities can help with this step, such as ultrasound, electrical modalities, ice/heat, and anti-inflammatory medications.

A physiotherapist will also use manual therapy to stretch out or move tight muscles and joints to get the shoulder in a more optimal position to start strengthening.

The strengthening stage can be very specific.

One needs to learn to activate the stabilizing muscle group (muscles on your back) before the mobilizing muscle group (the rotator cuff).

At this stage it is important that you do not overwork the rotator cuff making the impingement worse.

I often advise patients that when they are finished exercising or their activity, if the pain from the activity does not subside within 30 minutes, that activity was too much.

It is important to note that properly strengthening muscles takes approximately six to eight weeks, longer if not done correctly.

Contact a physiotherapist if you are looking to achieve a quicker recovery.

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