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Shoulders are complicated! There are several key “teammates” in the game of maintaining a healthy shoulder. This team includes: the shoulder blade, the upper back, the rotator cuff, and the neck. If one of these “teammates” isn’t doing its job effectively, the shoulder is more likely to become painful or injured. Here’s the “line-up” and a few reasons why each teammate is so important The Shoulder Blade (scapula)
The shoulder blade must rotate up and out when the arm is lifted overhead. Shoulder blade movement is produced by 17 muscles which attach to the shoulder blade. If one or more of these muscles are weak or otherwise not performing well, the shoulder blade may not be able to adequately lift to take some of the pressure off the tendons which go from the shoulder blade to the upper arm bone (humerus). This can cause pain or increased wear and tear over time.
The Upper Back (thoracic spine)
The upper back must be flexible in order to lift your arm over your head with ease. If your upper back is stiff (very common with slumped posture or in people who work at desks all day), you may be increasing the wear and tear on the tendons that attach from your upper arm to your shoulder blade when you lift your arm overhead.
The Rotator Cuff
The rotator cuff is a group of 4 muscles which attach from your shoulder blade to the upper arm. These muscles allow you to rotate your arm inward and outward and also stabilize your arm bone in the ball and socket joint. Without strength and endurance in these muscles, you can get increased wear and tear in your shoulder. Fun fact time! A huge percentage of people with NO shoulder pain have rotator cuff tears! This means that you may be able to overcome rotator cuff tears with strengthening and stability exercises! If you have been diagnosed with a rotator cuff tear, but have never tried physical therapy, you should!
The Neck (cervical spine)
The nerves that course through your arm all the way down from your fingers exit the spinal cord through the cervical spine (or your neck!) If these nerves are compressed by your spine or by other structures along the way down your arm, you can get pain or weakness in your shoulder or arm. Also, some of the muscles that attach to your shoulder blades also attach to your neck. If you have stiffness or other pathology in your neck, it can affect your shoulder!
I told you, it’s complicated! Don’t worry, there are people who can help! So how do you know what’s wrong? Get it checked out by a physical therapist or other healthcare professional who will do a comprehensive exam of each of these areas. A great option is a physical therapist. In most states, you can go straight to a physical therapist without a physician’s referral. At my practice, Dr. Holly Physical Therapy (Bakersfield, California) clients can come straight to my practice to get each of these areas checked. It is important that the entire area, including the spine and surrounding nerves are checked to be sure that your shoulder pain is actually coming from your shoulder and not your neck or other structure. The good news: all of the problems mentioned above can typically be helped with physical therapy! Sure, there are tears and problems that are large enough to require surgery, but I always recommend trying physical therapy first (because who wants to get their shoulders cut open for no reason? Am I right?!). Since the shoulder is so complicated, it is crucial to find the real cause of your shoulder pain before moving forward with treatment. In my practice, I test, re-test, rule in, and rule out all of the above structures plus more with my clients who have shoulder pain. If you want to quickly get rid of your shoulder pain, be sure that none of these areas go unchecked!
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