Common Shoulder Pain Cause Your Doctor Might Not be Telling You.
Shoulder pain and rotator cuff injuries present a common and sometimes debilitating problem for athletes of any age. Scientists estimate that over 20% of older athletes and at least 10% of athletes under 20 years old will experience some shoulder pain, rotator cuff tear or degeneration resulting in time away from their activity, risk of future shoulder injury, and sometimes the need for surgery. Sometimes these injuries are caused by impact with other players or the ground, but often they are non-traumatic or micro-traumatic rotator cuff injuries. Is there a hidden cause of shoulder pain and injury that is often overlooked? Research and my own clinical experience tell me that there is, and it’s much easier to fix than you might expect.
What is the Rotator Cuff?
The rotator cuff is a group of four muscles and tendons that keep the head of the humerus (the upper arm bone) securely attached to the shoulder socket and are often the cause of shoulder pain. These muscles all originate at the scapula (the shoulder blade). The intricate interplay between the scapula and the rotator cuff muscles is crucial to shoulder function. One key factor in understanding this relationship is scapular upward rotation, a dynamic movement pivotal in maintaining optimal shoulder mechanics.
Often, in my Costa Rica Chiropractic practice, I will see patients complaining of non-traumatic shoulder pain. Sometimes they come in with MRIs showing rotator cuff tears. Typical orthopedic and physical therapy techniques including rest, steroids, and common rotator cuff exercises have failed to provide relief, prompting the patient to consider surgical intervention. But, many times there is another way.
Shoulder Pain has a Hidden Cause.
Most of the time, careful examination of the way the shoulder blade and the arm move shows an altered pattern of movement. This poor movement pattern is sometimes caused by shoulder pain, but might also be the original cause of the problem. Without fixing this movement pattern rotator cuff injuries may not heal and only get worse with time. This is true especially when steroid injections or anti-inflammatory drugs temporarily eliminate the pain.
The altered movement pattern is usually poor scapular upward rotation. That’s when the shoulder blade rotates upward to let the arm move overhead. When doesn’t rotate enough, the tendons of the rotator cuff get pinched by the bones of the shoulder and injury results.
Fix This and Fix Your Shoulder Pain.
Luckily with some specific manual therapy and some targeted shoulder blade exercises, the upward rotation can be fixed very quickly, eliminating the impingement and relieving the shoulder pain. The key is getting to it early. Even waiting to rest, taking drugs, injections and passive therapy like ultrasound or electric stimulation machines may waste valuable time. Addressing the mechanical cause of the impingement as soon as possible is critical.
Anyone with shoulder pain should ask their doctor or therapist if their scapular mechanics is a potential cause of their rotator cuff injury. Qualified doctors and therapist should target muscles and nerves involved in movement of the shoulder blade, the humerus, the clavicle and even the ribs and upper back.
The Key Muscles.
Key muscles are: the Trapezius, Levator Scapulae, Serratus Anterior, Latissimus Dorsi, Rhomboids, Pectoralis Major and Pectoralis Minor. Also, a careful examination of upper spine movement will be helpful. When shoulder pain is coupled with upper back and neck pain, treating those areas is often critical to full resolution.
Treatment should always include exercises to maintain or improve scapular upward rotation. Your healthcare provider should recommend exercises based upon your specific movement imbalance, and not one-size-fits-all exercises.
Understanding the intricate relationship between scapular upward rotation and rotator cuff health is crucial for preventing and addressing non-traumatic injuries. Physical therapists, athletes, and healthcare professionals should focus on exercises and interventions that promote optimal scapular mechanics to mitigate the risk of rotator cuff issues. By emphasizing the importance of scapular upward rotation in shoulder function, we can pave the way for improved injury prevention strategies and enhanced overall shoulder health.