The Connected Shoulder
The shoulder can be a complex area to treat because of its diverse connections and range of motion. In 2019 all of my shoulder patients (male and female ) had been dealing with symptoms for more than one year by the time they came to see me. They had received treatment elsewhere with no lasting relief. Treating persistent pain/dysfunction requires out of the box thinking. It’s important to understand that with persistent dysfunction, the primary driver of symptoms is not typically located in the same place as the pain or initial injury. The best lens to have is to view the body as one that is fully connected.
Pain with reaching overhead is one of the most common complaints with shoulder patients. I have heard therapists educate on how overhead reaching and lifting can lead to impingement and therefore should be avoided. This isn’t entirely true. Lifting overhead and bearing weight on your arms are two very important practices for stability in the shoulder girdle. The mechanism of how you perform them may need to be tweaked however.
When it comes to reaching overhead you need to take into account how many joints are actually contributing to this motion. Besides the true shoulder joint (glenohumeral joint), the clavicle at both insertions has to rotate. The scapula rotates up and out and the ribs expand. Even the lower cervical spine rotates to provide mobility in the shoulder. The soft tissue connections should also be considered. The shoulder has connections from the head all the way down to the pelvic girdle. Therefore you can directly or indirectly affect shoulder mechanics from multiple body locations.
I had a patient who complained of shoulder pinching when reaching overhead. Part of his rehab plan was to perform a weighted overhead press. In the old days this was a no-no. However, teaching someone to avoid an exercise for fear of pain isn’t the best plan of action. Adding in this exercise for him gave him more confidence and less fear. Plus the added load created better muscle contraction which improved the glide of the humeral head thus reducing his impingement. This isn’t prescriptive. It is an idea of how each persons complaints and movement patterns are unique. The interesting thing is, he originally came to the clinic for neck pain. The neck pain was a byproduct of poor shoulder mechanics and weakness due to an old injury. Sometimes in therapy you have to treat the shoulder to help the neck and sometimes you have to treat the pelvis to help the shoulder.
An often forgotten connection is the reciprocal movement pattern between the shoulder girdle on one side with the pelvic girdle on the other side. This comes into play for many reasons- for example a runner that complains of persistent shoulder pain should have a thorough look at her shoulder plus her running mechanics to see the torso rotation, her breathing, her arm swing, and the pelvis elevation and depression during running cycle. This takes into account not just the shoulder but integrates the whole system. When you give a runner an isolated shoulder stretch and tell them to stop running, you lose them. When you give them a new perspective or paradigm shift on moving during their run and how it connects to their symptoms, you give them a why! It makes all the difference.
The shoulder isn’t just one joint that needs to be stretched. It’s deeply connected to the rest of the body and your story matters. In order to problem solve why your shoulder may hurt when you reach overhead, think about the mechanism of injury and the timing in which the pain occurred.
- History of a fracture
- Car accident
- Upon a stressful period of time
- After a surgery
- During or after sports/exercise
- House cleaning
- During menstrual cycle
- Reaching and lifting
- Pushing and pulling
- Getting dressed
- Nursing or holding your child
Each of these can speak to a unique root cause and lead to the next right step in your recovery. Your physical therapist should consider the entire connected system and empower you to reach your specific goals. My soap box – treat the whole person and take time to listen to the whole story.
One of my shoulder patients stated, “I feel like I know my body so much better thanks to you.” This is what PT is all about!
Due to COVID-19 I am now accepting local patients via my online program. If you need a physical therapist to help you restore the use of your shoulder to get back to the activity you love, please contact me today.