By C. Ashley Border, PT, DPT
Ever wonder what in the world the “shoulder” actually is?
The main joint of the shoulder is called the glenohumeral joint. This articulation consists of the head of the humerus (arm bone) resting in the small glenoid fossa of the scapula (shoulder blade), some would describe this joint as a golf ball on a tee. If you imagine how unstable a golf ball is on a tee, you can appreciate how hard the supporting anatomical structures must work to keep the “ball from falling off the tee.” The structures holding the joint together that offer passive stability consist of the labrum and a series of ligaments that encapsulate the joint. These structures tend to have very little blood supply. The rotator cuff, a series of four small muscles with ample blood supply, comes next. These muscles actively work to give stability to the “golf ball on a tee”. Resting between the joint capsule and rotator cuff are bursae, which are fluid filled sacs responsible for reducing friction between the muscle tendons and the surrounding bones. The most superficial layer of the shoulder consists of the big muscles that help us lift heavy objects, like deltoid, trapezius, long head of the biceps brachii tendon, and pectoral muscles.
How do shoulder problems start, you ask? Well just point to any word in the above paragraph and pretend there is an injury or weakness. You can see that the very mobile joint of the shoulder requires many pieces of anatomy for stability. If one or more of the anatomical structures supporting the shoulder is compromised, it makes lifting the arm over head or carrying a bag of groceries quite difficult, and often times painful.
Here is a brief list of common ways to damage a joint structure:
- Wear and tear from poor lifting mechanics and poor posture
- Overuse without proper conditioning, like bench-pressing or golfing
- Overhead activities, like throwing a ball or painting walls
- Tackling sports
- Falling and breaking the fall with arms
- Holding a dog that pulls on a leash
The symptoms from shoulder injury can range from general tightness, achiness, sharp pain with specific movements, and inability to lift the weight of your arm comfortably or at all. These symptoms may limit your ability to reach an overhead shelf or wash your hair, reach behind your back to tuck in your shirt, or even lift something simple like a grocery bag or throw a ball at practice.
Here in the clinic we often hear, “I thought my pain would just go away.” The reality is that most of the aforementioned structures have little blood supply or are too chronically inflamed to heal themselves properly. If you keep pushing through these symptoms you may make the injury worse or even larger. So, the obvious choice is to come in to a physical therapy clinic and have your shoulder evaluated and treated!
A physical therapy treatment would include:
- Fixing your muscle imbalance
- Improving muscle endurance
- Loosening the tight muscles and surrounding structures
- Retraining the neuromuscular component of body control
- Teaching you how to perform repetitive movements correctly, like swinging a golf club or throwing a ball
- Analyzing and correcting lifting and movement patterns
- Using manual hands-on treatment to improve joint mobility and alignment, and decrease pain caused by damaged structures
