Shoulder pain...which one?

Shoulder pain is one of the most Image-1common musculoskeletal issues that I see in my practice from week to week. Its easily as common as neck, lower back, hip and knee pain. So why is shoulder joint dysfunction so common? Well from the lay view, most people intepret shoulder pain as a rotator cuff issue, usually stemming from increased medial rotation. Common thoughts are that the use of the computer mouse, impact on this postural problem.

Too much bench press, throwing, ipad playing, racket or club, bat sports or anything that contibutes to excessive internal, external rotation, protraction, retraction, elevation or depressing of the shoulder joint and girdle and other actions will contibute to shoulder pain. Impingement syndrome is probably one of the most common shoulder problems.

Often external rotation exercises are utilised to combat these problems, often ineffectively. Determining whether the issue is one of mobility or stability and motor control should dictate which modality of therapy should be used together and the type of movement should be dictated by the dysfunction of each of the four joints of the shoulder.

Paul CHEK used the term slave joint to decribe any articulation below C2 (2nd cervical vertebrae) as a term to describe the vulnerability afforded to any joint that could be affected by heirachical factors such as breathing, atlas ( 1st cervical), vision, jaw and others that could influence lower joints such as the shoulder. Whilst this is a particularly useful model to bear in mind, both local and global dysfunction often effect the shoulder joint in isolation or together, from the head down or the foot up.

More often than not dysfunction in the opposite ankle can increase the facilitation of shoulder muscles. A lack of dorsi flexion or movement of the ankle which raises the whole foot off the ground whilst keeping the heel on the floor, can be a common feature in shoulder dysfunction. treating the shoulder may be the last thing that needs to be acheived in restoring shoulder function and decreasing pain.

Restoring shoulder mechanics need not be lengthy periods of shoulder rehab. Identify the cullprits involved in over working, rewire the ones that don't work enough, and create a stimulus that holds that pattern.

If you have shoulder pain and all people ever do is look at your shoulder, ask them to take a look at your ankle, breathing pattern, neck just in case they need a nudge in the right direction.