By: Matt Gray, DPT, Physical Therapist at SUMMIT-Claremore
Let’s all start by being honest, shoulder pain is miserable and extremely frustrating, as most of us have had some sort of issue with our shoulders that at some point has limited our participation in something. It may be something small such as an occasional pain that you fought through when hanging Christmas lights, or something even bigger where you avoid any reaching because you know that intense pain with a sleepless night is soon to follow. From what I see in the clinic, there are numerous shoulder injuries that are potentially avoidable had preventative care been performed. Most people realize that with regular maintenance their vehicle will operate at peak function for a longer period of time. This becomes particularly important when the demands are high. I can’t expect my truck to be as reliable when I’m on a long drive in the rain and I haven’t had an oil change in 10,000 miles or replaced my tires when the tread is paper thin. That would be irresponsible and silly. The same concept is evident with shoulder care. When the stress and demand is high, you shouldn’t expect optimal performance of the shoulder if there has not been any maintenance or preparation in a calendar year.
When I analyze a patient’s shoulder during my evaluation, the first thing I look at is the individuals posture and what positions or demands they require during a typical day that may influence this posture. The cervical spine, thoracic spine, and lumbar spine all influence movement at the shoulder joint, and if one or more of these sections does not move well, compensation occurs inevitably which could cause excess and undue stress on a particular joint likely resulting in pain. This pain may be minor or severe, but over time the little things add up and structures likely will succumb to over-stress. This is especially true for individuals who require more function and demand from their shoulders, i.e. throwing athletes (or any athlete for that matter), workers that have job demands that involve lifting, carrying, working overhead or with the arms extended for longer periods of time, or really any person who lives and breathes as we all reach out or up at some point during our day. Improving postural alignment, thoracic spine mobility and cervical spine range of motion will aid in improving shoulder function.
In the clinic, maintaining neutral posture is probably what I cue the most for my patients as they perform movements. My colleague and friend Kyle Stafford, PT, DPT, CSCS wrote a piece on improving posture with 3 simple exercises for postural correction which I will shamelessly use and recommend.
The next tip I would offer someone looking to prevent a shoulder issue, is that you cannot have an optimal shoulder without adequate strength and stability of the scapular (shoulder blade) musculature. Strength is the baseline for every movement and for a joint as mobile as the shoulder, a strong posterior chain (mid back) will allow the joint a safer environment in which to move. This concept can be compared to trying to shoot a cannon from a row boat. Sure you could do it, but you better bring your swim trunks and life jacket because you will be going for a swim. The cannon operates correctly if the environment is stable. The same is true with the shoulder. A strong, stabile posterior chain will be a huge difference maker for your shoulder over time.
The final tip I would offer for preventative shoulder care is very similar to the aforementioned shoulder blade: GET YOUR ROTATOR CUFF STRONG (Oh hello, bold letters indicating significance). Over time as we age, is becomes more and more difficult for our muscles to maintain their strength, as most can attest to. As time progresses, with non use, the tissues will atrophy or become smaller. The rotator cuff (a term used to describe 4 muscles in the shoulder involved in stabilizing the ball in the socket) are not large muscles to begin with, and atrophy occurring is very far from ideal. There is a direct correlation with muscle size/integrity and force output. Simply put, a larger/leaner muscle will be able to produce more force and handle more load. As the load you’re holding increases and your arm gets farther away from your body, the rotator cuff activity is also increased; hopefully you have done your training or else you are asking for some sort of tissue failure. Maybe not today, maybe not tomorrow, but at some point it likely will happen and I would love to see you prolong that time to keep you out of my office. Here are some great exercises to begin with for improving rotator cuff strength and scapular strength. These all can be done with no resistance, resistance bands, light dumbbells, progressing to heavier loads. They should be pain free during the movement, and do NOT exceed end range of motion. Try for 3 sets of 8-12 reps, where the 12th (or last) rep is difficult to complete.
I would recommend these exercises be performed minimum 2x week. I typically perform postural correctives daily, and scapular/cuff strengthening intermittently before and after heavier lifting to prepare my shoulder for pressing, pulling or overhead lifting movements (I try to practice what I preach because as a healthcare provider, I feel like we miss the boat on this too often).
Hopefully now you have some tools at your disposal to prevent you from enduring any serious shoulder problem (Bookmarks this page now for future use). These exercises are a good place to start and build from as you progress. All this said, I totally understand that things happen, injuries occur, i.e. new tires still go flat, but preventative care is something that I personally value in my training and something that I hope all of my patients adopt. Please feel free to email here: firstname.lastname@example.org with any questions or concerns.
Matt Gray, PT, CPT, CSCS
If you have any questions, please do not hesitate to call Matt at SUMMIT-Claremore or any of our other licensed Physical Therapists at our Claremore, Pryor, or Owasso locations.
Claremore Clinic: 918-342-3800
Catoosa Clinic: 918-266-6200
Pryor Clinic: 918-824-4500
Owasso Clinic: 918-376-5077
*A thorough medical and physical therapy evaluation should be considered if you believe there is some issue with your shoulder, as this will allow a more specific plan of care for your needs. The exercises and tips listed are for the general population and not a sure fix as there are numerous other factors in play when it comes to the shoulder, and are meant as preventative care. Come by our clinic or speak with your physician if you feel like physical therapy would be helpful for you as I would love the opportunity to improve your quality of life.
*Images taken from medbridgeeducation.com