As a physiotherapist I love a good discussion about joints, bones and muscles and in my opinion, there is no joint more interesting (and more frustrating) than the shoulder. It’s only when you injure your shoulder that you realize how crucial this joint is for completing even the most simple daily tasks. Washing and combing your hair, tucking in your shirt, reaching up into the kitchen cupboards and even opening and closing doors would be some of the most simple yet painful tasks reported by my patients. Whether this is familiar to you or not, the most important step in managing or preventing injuries is by understanding how your shoulders work.
There are two basic concepts that I think will help us to understand why the shoulders are vulnerable to injury. Firstly, in every joint in the body there is a tradeoff between stability and mobility. Look at the incredible amount of movement you have in your shoulders compared to your knees. Your knees can mostly only bend and straighten along one line in order to provide stability while supporting your weight in standing and walking. Your arms, however, have the freedom to move in nearly any direction, which of course is important in our daily activities but unfortunately the tradeoff is a relatively unstable joint.
Secondly, the joint surfaces for the shoulder are much like a golf ball sitting on a golf tee - it requires balance. If you think of it in this way then it’s easy to understand how important the muscles are that surround the shoulder joint. These muscles are collectively known as the rotator cuff and they ensure that the golf ball-like surface is held in the center of the tee while your arm is performing its tasks.
When everything is functioning as it should, the shoulder is a beautiful design that allows for a vast amount of function in the arms. However, when an injury occurs, it’s the loss of this important balance in the shoulders that contributes to a large percentage of people with ongoing shoulder pain and disability. Injuries can be as specific as damage to the joint and surrounding capsule or rotator cuff but even injuries to the neck, back and shoulder blade can contribute to the loss of balance and control in the shoulder.
We all know that a fall onto an outstretched arm or a force that twists the arm in an awkward way can spell bad news for the shoulder. However, it’s the ‘overuse’ type conditions that tend to catch people by surprise. These usually occur as a result of repetitive lifting, throwing or painting activities that involve lifting the arm above shoulder level. We always say “the best cure is prevention” when it comes to an over use injury and its no different with the shoulder. A strong, balanced rotator cuff and a good awareness of proper shoulder blade, neck and back posture will go a long way in helping to recover from and prevent these injuries.
Of course things are often not as simple as they first appear, the shoulder is a complex area that often doesn’t recover the way we would like. However, this is often because the initial injury as been neglected, allowing it to progress and contribute to further disability. It’s all too often that I hear the words, “I thought if I left it, the pain would eventually go away”. If only this was the case but too often it is not. The message is this – show your shoulders some love and they will love you back!
Nick Black is a Registered Physiotherapist at Sun City Physiotherapy Winfield. He can be contacted at the Winfield clinic (250.766.2544) or by email at winfield@suncityphysiotherapy.com.