The shoulder dilemma: So versatile, yet so prone to injury
Friday, August 04, 2017
The shoulder is the body's most mobile joint area. It allows humans to do amazing things like move their arms gracefully in complex patterns, pull their bodies up a steep rock face or power a ball at blazing speeds. It also lets people do ordinary things like shrug, take food out of the freezer and make a bed.
What makes the shoulder so wonderful also makes it more prone to injury than any other joint in the body. Due to its mobile nature, it's also quite unstable.
Interestingly enough, our everyday tasks don't really make the shoulders work to their full potential. How often do we roll the shoulders, stretch a hand behind us to scratch between the shoulder blades or reach really high for something out of reach?
On the other hand, the common activities (or lack of activity) that we engage in daily are detrimental to shoulder health — time spent on computers, cellphones, driving, watching TV, etc.
The catch is that many people don't notice a problem until they suddenly do something active, say jump into a beach volleyball game on vacation, dance at a wedding or help one of their kids with their batting practice. Suddenly, ouch!
Typically, the activity gets the blame for whatever injury or pain felt in the shoulder. Yet the true culprit would be that person's habitual lack of activity.
On the flip side, we find active sports and fitness enthusiasts as well as athletes of all ages who experience shoulder injuries for different reasons. The issue here is often repetitive movement, which in itself isn't bad. However, even the slightest error in alignment or muscular imbalance is magnified by the pure number of repetitions.
What shoulders need to function well under fire is mobility, strength, stability and balance. By balance, I mean each person must assess what he or she needs in terms of activity level — perhaps getting more rest, modifying movements or adopting a regular workout program that includes shoulder exercises. It also signifies working on whichever aspect you lack — mobility, strength or stability — then breaking it down further to target specific muscles in the shoulder girdle that are weak or overly tense.
Although the shoulder has more mobility than other joints, upper back tension can limit the range of motion around the shoulder blade designed to move as a unit with the arm. Our shoulder consists of two joints:
- the obvious ball and socket (glenohumeral) joint that connects the upper arm to the torso
- a less mobile gliding joint that connects the clavicle to the ribs
Swinging a golf club or bat using just the glenohumeral joint without engaging the shoulder blade places undue strain on that joint and can lead to problems in the surrounding muscles and ligaments known as the rotator cuff.
A related problem that impacts mobility is contracted pectoralis muscles that pull the shoulders forward, overstretching and weakening muscles in the upper back.
For mobility to increase, tension in both the area between the shoulder blades and chest need to decrease. Engaging in a regular program that combines massage, conscious breathing, stretching and gentle movement to increase range of motion will get you the quickest results.
You can effectively massage the upper back by lying on a small firm rubber ball and moving on it slowly to apply pressure all around each shoulder blade. Gently stretch and lengthen tight muscles the chest by relaxing in a prone position on a tightly-rolled blanket placed horizontally directly below the shoulder blades. Taking slow deep inhalations followed by exhalations that last as long as or even longer than the inhale will increase the effectiveness of these practices.
Physiotherapist Mark Wong shares several excellent stretches and exercises on his site, to which I must add my personal favorite: the arm position from eagle pose. As importantly, pay attention to and make slight improvements to your posture throughout the day, which will help you nip the main inhibitor of shoulder mobility in the bud.
Strength and stability
Identifying and strengthening weaker muscles in the shoulder girdle will add stability to this area and reduce the probability of injury. As I mentioned above, often the pectoralis is overly developed whereas the deeper muscles of the back, although tense and sore, are weak.
"The strength of your shoulder depends on the coordinated working of several groups of muscles, including the muscles of the rotator cuff, the deltoid and pectoralis major, as well as the muscles that power the shoulder blade," according to an article from the University of Washington department of orthopedics and sports medicine, which provides useful videos of several simple strengthening exercises.
Another excellent source of exercises that include work with elastic bands and dumbbells is the American Academy of Orthpaedic Surgeons. While their recommendations focus on rehabilitation, they're also ideal in preventing an injury.
Alternative methods to build strength include natural movement workouts and hatha yoga that rely on the body's own weight and mechanics.
Regardless of what you or your clients choose as their preferred strengthening method, remember the importance of balancing it out with thorough stretching prior and after as well as the mobilization techniques included in this article.
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