Shoulder physio is the hardest of all because this joint is the most difficult of all joints to treat well. That said, the two main categories of shoulder problems are ones of mobility. Recurrent shoulder dislocation is obviously a problem of over mobility, whereas ‘frozen shoulder’ is at the lowest limits of under-mobility, so to speak. The main difference between the two is that recurrent dislocation usually results from trauma, whereas frozen shoulder is a slow decline to a painfully immobile shoulder, caused by a steady loss of functional control.
Unlike the hip joint, which sacrifices mobility for stability, the shoulder is almost a 'flail' joint and relies to a large extent on muscles clothing the it to bind everything in place. The legs are for locomotion but the arms have a completely different function: to help provide dexterity to the hands. As much as the hands need to get about, the shoulders have to put them there. This is a tall order for a structure as long and spindly as an arm, with all the muscular controllers up one end – at the shoulder. It’s amazing really it does as well as it does. And you will see I discuss this at length in my book Body in Action.
I also explain why, when shoulders start becoming problematic – when it’s increasingly painful to lift the arm, agony to get your coat on, do up a bra strap, or get your hand to the top of your head – it’s important to start with the basics.
This seemingly invisible tier of arm function called scapula control is more important than you could possibly imagine; without it shoulder physio will not work. Indeed it will be futile – and, worse still, you will strain your neck and give yourself a neck problem as well! You will set in motion - as so many desperate but well-meaning patients do - a self-fuelling decline where working the arm makes the neck worse and as the neck gets worse, arm movement becomes more strained and wonky - and down the route of painful debility you go.
You might be interested to read this transcript of a Radio National 'Health Report' which discusses Frozen Shoulder
As matters develop and it becomes increasingly difficult to turn your head, the motor power of all the different muscles of the shoulder gets more and more discordant. It is then easy to wrench your shoulder afresh, when you least expect it, with an unguarded spontaneous movement of the arm. This happens because the muscles are all jazzed up and twitchy in protecting the joint, so they can’t roll with the punches - and this is how a shoulder problem gets worse. Eventually the whole thing clams up and you can’t move the arm at all ~ frozen shoulder.
Shoulder and neck problems go hand in hand and invariably both need attention in any shoulder physio treatment regime. You probably need some careful spinal mobilising treatment to the joints in your neck (see ‘What is Physiotherapy?’), since problems of the C5 and C6 spinal levels in particular can cause a type of 'mistaken pain' in the shoulder where various tendons and bursae are innervated by these nerves.
With effective shoulder therapy you also need to start slowly getting the arm to work 'cleanly' at the ball and socket joint, without the whole shoulder fore-quarter hauling up and hunching too. Keeping the shoulder down as you lift the arm (even with the help of your other hand to hold the shoulder down) may sound facile but does brilliant things – not least stopping the rotator cuff muscles chafing under the bony ledge of your shoulder.
Having said that, a good percentage of sportsmen and the not-so-elderly have full or partial-thickness erosion through their rotator cuff muscles from this very process and never know about it. You might like to read more about 'asymptomatic structural failure of the rotator cuff' in another shoulder page on this website.
Strange as it would seem, you need strong tummy control (core stability) and even good recruitment of your pelvic floor muscles to start fixing a shoulder problem. Think of lifting a full kettle say, especially if you are seated (unlikely, I know but try it, to emphasise the point). You have to jam everything 'on' to do this properly, otherwise the shoulder of the lifting arm hauls up as you use your neck to help you lift. Just thinking about this one action every time you fill the kettle for a cup of coffee will make all the difference in the the subtle ways you use your arm thereafter. Remember, keep the neck long, don't hunch the shoulder and lift the arm 'cleanly' using the shoulder proper in its socket - strongly. Please read Body in Action (click on link at the bottom of the page to find out more) to understand all about the neck-shoulder connection and to appreciate how interwoven their function is. And then move on to how to start the self-treatment process carefully yourself. It’s all there.
Using the arm badly – worse still exercising willy-nilly trying to help things - transfers enormous strain to your neck. This is why exercises to strengthen the scapular muscles must come first. And believe it or not, you will see that the final advanced section of exercises in the ‘Shoulders’ section of Body in Action I suggest ‘handstands’ as the ultimate scapula stabilising exercise!
Please note the exact same UK version is called ‘Keep Your Joints Young’. You can find out more and buy it here:
Read more about Musculo-Skeletal Disorders
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