Shoulder Pain

Anatomy of the shoulder

The shoulder is designed to allow large movements in all directions (ball and socket joint), this is great functionally as we can manipulate objects with our hands in lots of various positions. Unfortunately there is a strong correlation between large range of motion and instability, as such it is important to understand what mechanisms provide stability to the shoulder.

There are a number of structures used to stabilise the shoulder:

• Glenoid Labrum: Deepens the surface area the humeral head sits in.
• Shoulder capsule: Holds the shoulder in place
• Ligaments: restricts end of range movements
• Scapular: A direct barrier to prevent movement
• Muscles: create and prevent movement at the shoulder.

Shoulder pain from trauma

Following a collision or fall it is very common to sustain a shoulder injury. Any of the above structures can be damaged depending on the direction of force. Depending on how your injury presents will determine whether a scan in necessary and surgical intervention is needed. As the shoulder has a large range of movement available the brain will restrict movement to structures that are damaged to prevent pain and aid healing. However other structures will move excessively and create abnormal movement patterns. After the original structure has healed secondary problems will result if correct movement patterns aren't restored to normal.

Shoulder pain referred from the neck

The most common type of shoulder pain is commonly received from the neck region. Nerves exiting the neck (Cervical Spine) provide sensory and motor innovation to the shoulder, the muscles attached from the neck to the shoulder can also tighten causing secondary issues,  therefore any dysfunction in the neck will effect the shoulder in one way or another. Neck mobility or stability issues need to addressed to fix 95% of shoulder issues.

Poor shoulder biomechanics

Optimal shoulder mechanics involve smooth rhythmic control between the arm (Humerus) and shoulder blade (Scapulae). Muscles around the shoulder and neck contract and relax in correct sequence to ensure the Humerus doesn't impinge on the Scapulae. Any imbalance will result in compensatory or abnormal movements that will eventually lead to pain. This condition is very common in gym goers, especially those who focus on bench press and other related chest exercises.

Postural related pain

For those who find themselves sitting at a desk all day and have a slouched (flexed) posture will most likely find they have postural related pain. If you are finding that you are unable to stand up straight (lacking thoracic extension) you will find this places huge stress on the shoulders. This is exacerbated   when attempting to do anything at or above shoulder height. Office workers that attend boxing classes are a classic example of this.

Miscellaneous

• Frozen shoulder (Adhesive capsulitis): synovial folds stick together limiting movement in all directions, (insidious onset).
• Polymyalgia Rheumatica: inflammatory condition effecting multiple joints
• Osteoarthritis: degenerative bone condition
• Thoracic Outlet Syndrome: Condition where the nerves travelling between the collar bone and first rib get compressed.

Postural back pain

Postural Back Pain

The most important concept to understand about postural back pain is that a sustained position for a lengthy period of time is not ideal, even if you are maintaining the best posture. The body is designed to move and relies on movement for correct function. Moving the body results in:

• Muscle contractions: Returning blood to the heart and organs for filtration, cleansing the muscles of chemical substrate build up and aids in recovery.
• Joint positional change: Alters the distribution of load, which in turn will reduce the force at a particular part of the joint, therefore reducing chance of injury.
• Psychological factors: Stimulating the brain and improving productivity.

Should you find that a sustained position needs to be maintained, optimal biomechanics that shares force equally through most joints need to be adopted.

Below are two different postures that can be applied:

Sitting posture

Place both feet firmly on ground, shoulder width apart with equal weight distribution. Ensure your bottom  is firmly against back rest and you have a neutral spine (lower back slightly off back rest, back of shoulders against back rest). Tuck your chin in (giving the impression of a double chin) ensuring your ear lobes are in line with your shoulders which should be relaxed and slightly squeezed back, elbows should be by your side and the keyboard is slightly below elbow level with the top of  the computer at eye level and keeping your chair in close to the desk.

Standing posture

Placing equal weight through both feet, with your knees slightly bent, ensure that you squeeze your shoulders back slightly, pushing your chest out and tucking your chin in (giving the impression of a double chin). For a person of slender builds, you should tuck your tail bone under slightly, and for those that find themselves to be overweight it is recommended that you stick your bottom out slightly due to the different weight distribution around the centre of mass of your body.

Injury will occur when excessive force exits the body at a certain point. The above postures limit excessive force exiting the body at a certain point. By moving the body consistently you will be changing the amount of force at a particular joint at any given time. However repetitive movements can be detrimental as they can lead to the same joints and muscle been loaded in the same way. This can lead to an overuse injury as not enough recovery is given to working muscles.

Prevention is better than cure

In order to prevent postural pain, the following tips outlined above will assist in preventing injury before it actually happens. If you find static postures or repetitive movements needs to be maintained in any work situation come and see us for a consultation at Bondi Platinum Physio or discuss your issues with a medically trained professional to ergonomically assess your work place.

Remember, equal weight and load distribution with adequate recovery will help prevent most injuries.

Have a lovely day at work!!