The shoulder is the most flexible joint in the body. It’s so flexible that, unlike other joints, it has very few ligaments holding it together. Instead, it has a group of muscles, the Rotator Cuff, that act like adjustable ligaments to stabilize the joint in any position. The Rotator Cuff stabilizes the joint whether you are reaching overhead or doing pushups. This exceptional flexibility comes at a cost, however. The shoulders broad range of motion and lack of limiting ligaments makes it an inherently unstable joint that is prone to injury and pain. Common injuries in the shoulder are impingement, rotator cuff tears and labrum tears. Evidence suggests that shoulder injuries are more common than previously suspected. One study in the New England Journal of Medicine estimated that a large percentage of people over the age of 60 have rotator cuff tears. One reason these injuries may go undetected is due to people associating pain, stiffness and weakness with age or they may not be aware that there are solutions available.
What’s the trade off?
What do we get in return for this injury prone and potentially troublesome joint. In biomechanical terms, the shoulder is the platform for hand function. As human beings, we use our hands for everything: writing, lifting, carrying, communicating, climbing, weight bearing. And the joint that allows all this to happen is the shoulder. The shoulder moves the hand to wherever it needs to go and stabilizes it in that position so it can do whatever it is that you need it to do. This is basically everything, let’s face it. Imagine if you couldn’t move your hands around. How would you get anything done?
The shoulder supports hand function, so what supports shoulder function? You guessed it, the spine. Similar to the way the shoulder positions the hand so it can perform its many functions, the spine positions the shoulder so it can perform its tasks. What happens when the spine is not as strong or as flexible as it should be? What tends to happen is that the shoulder is forced to compensate. This transfers force from the spine to the shoulder and, over time, this additional stress causes injury.
Many people show up at the doctor’s office, or the Physical Therapy office, complaining of shoulder pain, stiffness and/or weakness. This pain can usually be helped with some medication, a shot, some strengthening or pain-relieving modalities. But what if the pain is due to a problem in the spine, or even the hips? If we don’t address the underlying problems and relieve the stress on the shoulder, all these symptoms are going to return, and damage is going to continue and eventually we may end up having surgery. You might even end up having surgery on the other arm too.
One of the things we do in Physical Therapy is examine function, that is, the way the whole body works together. We also factor in daily habits like work, driving and exercise. In many cases, and particularly in the case of the shoulder, we find that the underlying cause or a contributing factor in the patient’s condition originates in another part of the body. This is very important because if you only address the area that’s hurting, you have not truly solved the problem and unsolved problems return eventually. Treating the whole person always yields superior, longer lasting results.
When is a good time to start?
If you have read this blog and you have questions or if you are having pain in the shoulder now, either with activities or maybe at night, give us a call and ask for a Discovery Visit. There is no charge for this visit and you get to sit down with one of our movement experts to see if Physical Therapy is a good option for you. Now you may need to go see a different specialist and if that is the case, we will refer you the person who is best suited to help you with your problem. If Physical Therapy is a good option, we can start you right away and get you on the road to long lasting pain relief and return you to the activities you enjoy.