This is the first part of an in depth look at the shoulder, why we need it and how to fix it. We will look at the painful shoulder, the stiff shoulder and the unstable (hyper-mobile) shoulder. If you struggle with neck pain or upper back pain, don’t underestimate the contribution of shoulder strength/function to that pain.
We will start with some of the basics simply to get you acquainted with one of the most versatile and useful joints in our body.
The shoulder complex actually consists of 4 joints created by 4 bones. This combination of bones and joints is why we can move the shoulder through such large ranges of movement. It is also why it is such a frustrating part of the body to fix.
Humerus (upper arm)
Clavicle (collar bone)
Scapula (shoulder blade)
The glenohumeral joint (basically what most people consider the shoulder and connects the upper arm to shoulder blade), the acromioclavicular joint (connects the shoulder blade to the collar bone), the scapulothoracic joint (the floating shoulder blade bone on the back of the chest cage) and the sternoclavicular joint (collar bone to breastbone).
According to an American orthopaedic surgeon, Dr John M. Kirsch, he lists a 5th joint in the shoulder, the acromiohumeral joint, which is visible with x-rays when the arm is held overhead or when hanging with the arm. You can read about this and his solution for shoulder pain in his book, ‘Shoulder Pain? The Solution & Prevention’.
What makes the shoulder so unique?
Ball and socket type joints, like the hip, are stable on their own. Unlike the hip, the bony structure of the shoulder that allows more movement also makes it unstable. Fortunately, the incredible design of the ligaments, muscles and tendons are here to save the day. Together they form a system of slings and pulleys that hold it all in place.
The rotator cuff complex consists of 4 muscles originating from 4 different sites on the shoulder blade and eventually all weaving together to form one tendinous attachment onto the upper arm. These are the suprapinatus, infraspinatus, teres minor and subscapularis. This complex as well as the long head of biceps forms a large part of the shoulder stability and rotation control.
The lats, biceps, triceps, deltoid, pecs, traps and serratus anterior are the big muscles that control the big shoulder movements.
Watch the following video for a great display of the muscles and where they sit.
The ‘unstable’ bony structure, together with the ‘stability’ provided by the muscles makes the shoulder one of the joints with the most movement. It can also create large forces which result in movements like being able to throw a spear. Some even say this very ability to throw missiles with accuracy is why we evolved ahead of the rest of the animal kingdom. Whether this is true or not, the shape and structure of our shoulders make us more versatile and able to perform more tasks. Therefore, this system needs to be protected. It needs to be kept strong and healthy so we can get the most pain-free and functional use out of our shoulders.
How do we do this?
By strengthening/practicing our shoulder movements as part of our weekly strength training. Besides needing 150-300 minutes of moderate-intensity aerobic activity per week, we should also strengthen muscles of all the major muscle groups 2 or more days per week. This is according to the WHO. Strengthening is the most researched and supported treatment for preventing injuries.
Pull (extend or pull backward, hang)
Push (flexion or pushing forward, push up, press)
Raise (arms sideways, forwards, backwards and rotate)
Lift (lifting an object, generally above the head)
Carry (carrying an object)
What is practiced, improves.
That is the basic premise to understanding bio plasticity (the ability of tissue to change) and tissue capacity (how much load/pressure tissue can handle).
What is overdone, damages.
That is the basic premise to understanding tissue damage (when the tissue’s capacity is exceeded, and it didn’t have enough opportunity to adjust).
Both of these statements are over-simplified for the sake of understanding complex conditions.
There is a fine timeline between improving and damaging. A physical practice requires enough time between practices for tissues to adjust and the change in tissue structure to become the new status quo. Too little time between practices and the tissues don’t fully adjust, which if repeated can result in damage. But not always. There are a whole bunch of other factors that can impact on a tissue’s ability to adjust or not to and whether you exceed its capacity by the practice. To name a few, sleep quality, strength, infection, stress levels, tissue health, lack of use, belief. But this is a discussion all on its own albeit a very important one.
A healthy shoulder
To gain or maintain a healthy and able shoulder, we need to practice the different movements of the shoulder on a regular basis (at least twice per week as mentioned), slowly and gradually adding more load and starting with more controlled simple movements moving towards less controlled, more technical movements of the shoulder complex.
If your goal is simply a healthy strong shoulder that can handle activities of daily living, stick with the controlled movements as your exercise game plan.
If your goal is a specific sport or activity, then you need to gradually work towards the specific movements you want to achieve.
Not sure how to do this? Why don’t you book an assessment with one of our physiotherapists and they can guide you in the process and simultaneously educate you in the other factors that contribute to shoulder (general tissue) health.
This content is for education and information purposes only. It is not intended to replace professional medical advice, diagnosis or treatment. If you have any health concerns or pain, please contact your local healthcare provider directly.