Why is Shoulder Pain Common?
Shoulder pain is so common because the
shoulder is an amazing joint. Probably one of my favorites in the whole
body. Thats pretty big, considering how many joints I deal with every
in the shoulder is amazing too. Not because I like my
patients to have problems, but because there are just so many things
that can cause it.
- Improper mechanics
- Tight muscles
- Weak muscles
- Loose ligaments
and my favorite...
- Sleeping on it wrong
Shoulder pain is nothing to laugh about. You know
how much it hurts.
And, as good as an athletic trainer as I am, I have shoulder pain too,
on occasion. And it hurts.
The shoulder is an amazing joint...it amazes me
everyday. Let me explain why...
The Gods Must Be
Take a look at the shoulder. The way it is put together seems
crazy...yet it is so "right". It is, by definition, a ball and socket
joint. But if I was a "ball and socket" manufacturer, I would be out of
business if I produced this kind of ball and socket.
The surface area of the "socket" is tiny. I like to think of it more
like a saucer. Flat, not very deep, and small. Now, this saucer would
be fine if the "ball" was about the same size. But it isn't. The
humeral head is huge compared to the glenoid. So, take that saucer, and
now place a basketball on it. See where I am going?
The shoulder is inherently unstable. Which makes me
wonder what on earth they were thinking when they started making the
human shoulder.No wonder so many people have shoulder pain. You have a
poorly constructed "ball and socket" joint that is constantly injured.
But, as with a lot of great things, what seems to be wrong is exactly
what is right. Because the shoulder is made the way it is, it allows
for unbelieveable range of motion. No other joint in the body can move
like the shoulder. Try to move your knee in 3 different directions...or
your fingers. Try throwing a 90 mph fast ball with only two limited
directions of motion. So, maybe the lack of a true "socket", and a
giant ball to boot isn't that bad afterall.
Muscles - The Unsung Heros
about rotator cuff muscles, and how they are often hurt in pitchers and
athletes. And this is true because they place so much stress on the
rotator cuff.But lets not focus on the rotator cuff as the bad guy.
They work very hard when they are healthy. Did you know that simply
reaching overhead requires a lot of very very sophisticated function of
the rotator cuff? In fact, just sitting there, without moving your arm
at all requires the rotator cuff to work.
The rotator cuff, or better yet, the four muscles that make up the
rotator cuff, is where the magic lies in the shoulder. I am not going
to bore you with all of the physiology and kinesiology, but basically,
they act like a steering wheel for the shoulder. Because each of them
attach on the humerus in different positions, they can all cause
different motions in the shoulder. And this is vitally important when
you think about shoulder stability. Afterall, something has to help
keep that basketball on the saucer, as it turns all around and upside
The rotator cuff isn't responsible for creating the big sweeping
motions that we see pitchers and athletes perform. No, their one job is
to guide the humeral head, and to keep it centered in the socket. It
really is that simple. If the humeral head stays centered, all is well.
If not, you get shoulder pain.
The Shoulder Pain Cycle
My patients ask me "why does my
shoulder hurt". Sometimes I wish I could tell them "Because you waited
3 years to come in and see me for treatment."
of the time, I explain the very complex nature of the shoulder, how it
functions, and where their problems are. What are
the most common things I see in my patients?
really, it is usually one or two things among all of them. They have
rotator cuff muscles that are not working correctly, or as a team, and
they have either ligament laxity, or unbalanced capsule tightness, and
weak upper back muscles. All of this is usually caused by the shoulder
The pain cycle in the shoulder starts with some
type of injury. This can be something major, like a dislocation, or
something minor like lifting something just a little too heavy. Once
that initial injury occurs, two things happen. You get shoulder pain,
and you get your bodies response to pain...muscle spasm.
a muscle spasms, it does it because the body tells it to "protect the
joint at all costs". With this new job, it can't do its old job
effectively. And it hurts. Think about the last time you had a charley
horse, and you will know what I am talking about.
So now you have a shoulder that is painful, and muscles that don't want
to work. Remember what the one job of the rotator cuff is? To guide the
humeral head and keep it centered in the socket. Throw that job out the
The cuff has just gone on vacation, too
worried about being in spasm to care about where the humeral head goes.
And beleive me, if you give the humeral head an inch, it will take a
mile. It will migrate up into the acromion...and impinge on the rotator
cuff. It will move forward and put pressure on the biceps tendon. It
might go south and pull on the deltoid or the rotator cuff. But no
matter where it goes, it causes more pain, and more spasm...
And the cycle continues.
Stopping the Madness
Rest is usually the best way to stop the shoulder pain cycle. Sometimes
this is in the form of a sling, other times it means not playing ball
for a week or two.
Unfortunately, once the cycle
starts, it is hard to jump start normal function again. Remember those
rotator cuff muscles that went on vacation from their usual job of
guiding the humeral head? They don't like to get back on the job. And
usually, when they do, they are way behind.
muscles, like the trapezius will help out, but that isn't the
trapezius's main job. So it doesn't do it well. And the cycle will
The only way to fix shoulder pain is to get every muscle back to doing
the job it was meant to be doing. Unfortunately this takes some time.
In order to get to the root of the problem, you will have to see
someone who can figure out what is going on. And that means your
physician or athletic trainer. We are pretty handy at kicking those
rotator cuff muscles in the pants and getting them back to work.
But Wait, There's More!
Shoulder function is a very complex thing. As is shoulder pain. So many
things can contribute to shoulder pain, and it just gets worse with
Did you know that how your upper spine moves
(or more commonly, doesn't move) can contribute to shoulder pain? Did
you know that how strong your hips are can too? I bet your ankle sprain
from 10 years ago could have something to do with your shoulder
problems? Now you think I am just pulling your leg...or arm.
The human body amazes me everyday. It is all connected. So, make sure
that when you do decide to see your physician or athletic trainer, that
they don't forget all of the muscles, bones, and joints around he
shoulder. Make sure that they get those muscles back to their jobs. It
will help your shoulder pain...and it will keep you off the sidelines.
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