Our Burlington Physiotherapy and Chiropractic clinic treats lots of different conditions and injuries affecting any joint, muscle, tendon or ligament in the body (more or less). Shoulder pain and shoulder injuries are among the most common conditions. For the next few weeks, we’re going to focus our blogs on shoulder pain, its causes, treatment options and exercises. For this week, we’re going to start from scratch and walk you through some of the basic anatomy of the shoulder, relevant to most of our Burlington readers…

To keep it simple, the humerus is the bone in your arm that forms a joint with the scapula (or shoulder blade as many call it). Of note in the picture is the clavicle (commonly known as the collar bone). The clavicle (visible from the front) has a joint with the scapula (on your back). This joint is called the acromioclavicular joint, which is the joint we injure with a separated shoulder.

This picture illustrates the more superficial muscles. The deltoid has three parts; the front, middle and back. From this view, we can see the middle and rear deltoid. In the next picture we can see the front or “anterior” deltoid. Underneath the deltoid are the rotator cuff muscles.

This is a picture of the front of the shoulder. You can see the bicep muscle / tendon tucks underneath the deltoid. Also under the deltoid are the rotator cuff muscles seen in the next picture

The rotator cuff muscles have attachments on the scapula (shoulder blade) and the humerus. Among other things, they are very important muscles for stabilizing the humerus so that it moves in the right “spot” on the scapula. Rotator cuff muscles are often injured. We regularly see diagnostic ultrasound reports that indicate tendinosis, tendinopathy or tear of these muscles, most frequently the supraspinatus.

Obviously, this is a very basic outline of the shoulder. We plan on tackling various concepts related to the shoulder in the coming weeks so this will serve as a starting point and reference point for weeks to come.

Shoulder pain is very common among active individuals.  Although there are many different causes of shoulder pain, many studies have been published in recent years which link scapular (shoulder blade) position and the activity patterns of the muscles around the scapula to many types of shoulder injury. Among the evidence is the consistent finding of delayed lower trapezius activity in dysfunctional shoulders. 

Lower Trapezius Exercises

A 2009 study published in the Journal of Orthopaedic and Sports Physical Therapy used EMG analysis to examine muscular timing in the trapezius muscles during various exercises. The results of the study indicate that the prone extension exercise and the prone horizontal abduction (with external rotation) both promote early firing of the middle and lower trapezius muscles (when compared to the other muscles that move the shoulder).  This is a good thing for those of you who might be confused…in other words, many shoulders have weakness in this area and we now have scientific evidence as to the best way to strengthen these muscles.

Shoulder Exercises – Lower Trapezius

In the prone extension exercise, you simply lie on your stomach (on a bench) with your shoulders flexed to ninety degrees. You then extend your shoulders to achieve the end-position pictured below. (Don’t use a stick as pictured below…it is recommended to use dumbbells).

In the second exercise, you start in the same starting position as the first exercise but you bring your arms out to the side (as pictured below).  Finish the exercise with your thumbs pointing up to the ceiling. 

Treatment for Shoulder Pain

As always, we do our best to bring you the most current and accurate information both in our clinic and on our website.  References are provided below.  If you’re experiencing shoulder pain we suggest that you have your condition examined by one of our doctors; jumping into a strengthening program without being diagnosed is not recommended.  Most cases of shoulder pain not only benefit from strengthening the right areas, but they also require focused treatment at the dysfunctional structures.  Laser therapy is one of our popular treatment methods for shoulder pain and can be applied by either our physiotherapists or our chiropractors.  For more information, call 905.220.7858 or email us at info@burlingtonsportstherapy.com. 

References

Cools AM, Dewitte V, Lanszweert F et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? The American Journal of Sports Medicine 2007; 35(10): 1744-1751.

De Mey K, Cagnie B, Van De Velde A et al. Trapezius muscle timing during selected shoulder rehabilitation exercises. Journal of Orthopaedic and Sports Physical Therapy 2009; 39(10): 743-752.

Hirashima M, Kadota H, Saraurai S et al. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. Journal of Sports Science 2002; 20: 310-310.

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Shoulder pain attributed to swimming is very common and there are many different causes. Listing all of these causes and conditions is beyond the scope of any blog as it is a very complex topic.  Nevertheless, this article will address one of the more common scenario’s; impingement of the shoulder.

Impingement of the Shoulder

Although there are different types of impingement and many different shoulder abnormalities that are related to the condition, we often see a “functional” impingement in our practise. In this condition, various soft tissue structures are compressed during shoulder movement. The repetitive overhead nature of swimming is notoriously linked to impingement of the shoulder. When impingement is present in a swimmers shoulder, it is definitely a situation where a relatively small problem can turn into a large one if not managed properly.

Shoulder Pain and the Rotator Cuff

Since degeneration of the rotator cuff tendons is now considered a relatively normal process of aging, it is safe to assume that many of you who are reading this will already have some changes in these tendons. Subjecting these degenerating tendons to repeated compression (as with impingement and swimming) has been found in the literature to accelerate the degenerative process. Advanced tendon degeneration has also been linked to rotator cuff tearing and untreated rotator cuff tears have the potential to accelerate the progression of arthritis in the shoulder. Given this vicious snowballing effect of shoulder injury, preventative exercises are obviously a great idea!

Exercises for Shoulder Pain

The following exercises can help to prevent or reduce impingement for some individuals as they target some of the common weaknesses that are linked to this condition. As we always recommend, your best course of action (whether you’re in pain or not) is to have your shoulder examined by a suitable healthcare practitioner (like a chiropractor) who can identify any weaknesses or factors that may predispose you to impingement and who can tailor a strengthening program specific to your needs. Call our clinic today! 905.220.7858  info@burlingtonsportstherapy.com

Retraction – Pinch your shoulder blades together. Hold for 10 seconds and relax.

Depression and Retraction – Combine the motion above (pinching your shoulder blades together) while pulling them downward. Hold for 10 seconds and relax.

Low Row – The low row is performed by pulling backward at the shoulder while pinching your shoulder blades back and down.

References

Cools, AM., Cambier D. Witvrouw E. Screening the athlete’s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. British Journal of Sports Medicine 2008; 42: 628-635.

Kannus P., Jozsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. Journal of Bone and Joint Surgery (American) 1991: 73(10): 1507-1525.

Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. American Journal of Sports Medicine 2008; 36(9): 1789-1798.

Nho, S., Yadav H., Shindle M., MacGillivray J. Rotator cuff degeneration. American Journal of Sports Medicine. 2008; 36: 987-993.

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