Wednesday, July 19, 2023
In the last few months, I have worked on two very interesting cases of individuals with shoulder pain. One of the cases was a woman in her mid-40s, who slipped and fell on the stairs in her house and banged her shoulder. The other was a woman in her late 50s, that had shoulder pain slowly creep up on her for a few months and then it turn into a frozen shoulder.
In both cases, surgery was recommended as the solution, and in one case, months of physical therapy and cortisone shots were tried with no improvement. In the end, it turns out neither of them needed surgery and gained back full function.
In this article, I will share the approach I’ve used for the last 20 years to rehabilitate shoulder injuries - and yes in many of these cases , they were told "surgery was the only option."
Let me start by saying there is a place for surgery. I am not someone who believes that surgery is never a good option. In some cases, it is a great option.
That being said, in my experience, over 90% of the individuals that I have worked with that were told surgery was the only option were successfully rehabilitated without surgery.
And in the cases where surgical repair was necessary, the surgery still did not address the reason there was damage in the first place.
To truly be empowered to make educated decisions on any condition or circumstance you find yourself in, you must have some understanding and basic knowledge of the circumstance. When it comes to physical injuries, it is important to be informed on about your body so are not completely in the dark when someone is recommending something like surgery to you.
It's like bringing your car to a mechanic without knowing ANYTHING about your car or how it works. The mechanic can tell you that you need a new "flux capacitor" and you will say, "Sure, sounds good!" In the case of your car, you may just be losing a few thousand dollars but when it comes to your body, the stake are much higher.
For these reasons, I do my best to educate each client I work with their body and explain what is happening in their specific case. My goal is to empower each individual with knowledge so they are more capable of caring for their bodies.
So on that note, let's talk about the shoulder complex.
Three regions are important to define and understand when talking about shoulder injuries - specifically rotator cuff injuries and frozen shoulder.
The first region is what is called the glenohumeral joint.
The glenohumeral joint comprises two bones: The humerus and the shoulder blade. These two bones meet up to create the glenohumeral joint. And a joint is simply a region where motion takes place. The glenohumeral joint is specifically called a ball and socket joint or multiaxial joint. This gives this joint a high level of movement capacity. It is also the area where most people have the shoulder pain.
The second important region is the scapulothoracic joint.
This region consists of the scapula (shoulder blade) and the rib cage, which attaches to the mid back or thoracic spine.
The scapulothoracic joint is called a “non-anatomical joint” or "floating joint" because there is no boney attachment between the scapula and the rib cage. It is responsible for translatory motions, which allows the scapula to move in one of eight directions: elevation-depression, protraction-retraction, upward rotation-downward rotation, and scapular tilting up and down.
Third region is the Thoracic Spine..
The thoracic spine comprises 12 vertebral bodies, which comprise 11 joints in total. The thoracic spine is where the ribs connect, creating additional joints that innervate into the thoracic spine for another 24 joints (12 on each side) called the costovertebral joints.
Now that you know that major regions of the shoulder complex, let's talk about the rotator cuff. The rotator cuff is a group of 5 muscles that go from various places on the shoulder blade to the top of the humerus - crossing the glenohumeral joint.
The infraspinatus, teres minor, and teres major all sit on the back of the shoulder blade. The supraspinatus sit on the top of the shoulder blade and the subscapularis sits underneath the shoulder blade, closest to the ribcage. The rotator cuff as a whole is to provide stability throughout the glenohumeral joint and facilitate some of the finer movements of the area like rotation.
When one of the rotator cuff muscles tear (most commonly the supraspinatus), it is a result of the muscle being asked to do too much, resulting in common shoulder pain. Now anytime a muscle is being asked too much, it is usually because another muscles or region, is not doing enough.
This is where accessing the three regions of the shoulder girdle is critical.
Its important to understand that the body was designed to move from the inside out. In general, the joints closer to the body's midline are able to move more. As you go out from the midline towards the end of the extremities, you will encounter joints that don’t have as much gross movement but can do the finer movements. If you would like an example of this, just try signing your name with your belly button as opposed to your hand 😜
When you look at these three regions of the shoulder complex, the glenohumeral joint is the joint that is furthest away from the midline and the thoracic spine is closest to the midline. This also puts the insertion points of the rotator cuff at the furthest distance from the midline.
In the case with the shoulder complex, and many others, the region furthest from the midline is often the area that is compromised - and with rotator cuff injuries, that is the case. This makes the two other regions essential when evaluating and designing a treatment plan for shoulder injuries..
Unfortunately, this is not usually evaluated when you go to traditional health professionals. The standard treatment and approach for these ailments focus mainly on the glenohumeral joint. Exercises like internal and external rotation are prescribed to strengthen the rotator cuff muscles and/or stretching specific muscles that cross that joint, like your pecs and/or lats.
Although these prescriptions can be a part of rehabilitation, I have found them to be less than 10% of an effective program. I didn’t use any of these approaches when rehabilitating the two women that had a rotator cuff tear and frozen shoulder.
What I did find with both of these women was significant restriction in both their scapulothoracic and thoracic regions. I performed some precise bodywork on all of the soft tissues that innervate the scapulothoracic joint and the thoracic spine. Specifically, I intended to restore the eight different motions of the scapula on the rib cage and facilitate thoracic extension. Once I was able to create those motions in isolation, I then integrated them by coaching the movement from the thoracic spine through the scapulothoracic joint and into the glenohumeral joint.
The results in both cases were restoration of full range of motion and no surgery.
So the key things to remember if you are suffering from shoulder pain and/or have been diagnosed with rotator cuff tear or frozen shoulder:.
In summary, if you are suffering from shoulder pain, please understand that there is absolutely a place for orthopedic surgery and you should absolutely not take that option or ANY other options off the table. I can tell you from my experience, it is often jumped to as the solution way to fast and many cases it is not necessary.
If you would like to read an article from the more traditional perspective, the "Mayo Clinic Q&A: Rotator Cuff Injuries & Surgery" by Cynthia Weiss, is a good one - BUT notice she does not mention anything about the regions you read about in this article when it comes to treatment.
Yours in Vitality,
I am a integrated holistic health professional that has empowered thousands of individuals over the last two decades to optimize their physical, mental, emotional, and spiritual well-being, I am obsessed with empowering myself and others to embody the principles of vitality and no longer settle for the current traditional models of "health."
You can work with me virtually or at my office located in Palm Beach Gardens, FL.
* physical rehabilitation
* fitness programming & training
* life coaching
I offer private coaching as well as my weekly small group coaching program
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