Shoulder

Spring will soon be here and surely you will want to make the most of it! A healthy pain free shoulder joint complex is vital for nearly every activity you do. Shoulder pain and disability is extremely common, with as many as one in five people experiencing shoulder problems. Shoulder disorders are also very chronic with 50% having symptoms lasting a year and a half or longer. It is not surprising to find that shoulder-joint problems are the second most common work-related injury, second only to the low back.

The shoulder is also one of our most fascinating joint complexes. Your hand, forearm, arm, shoulder joint, shoulder blade-your entire shoulder girdle complex-has only one bone-to-bone joint attachment to your body. This small sternoclavicular joint, attaching your collarbone to your sternum is the only bony attachment for your whole upper extremity. Except for this small fingertip-sized bone-to-bone joint, your entire upper extremity is attached to your body only by muscles and their tendons.

This makes the shoulder joint unique among all the major joints of the body; it primarily relies on muscles and tendons rather than bones and ligaments for its support, stability, and integrity. As unstable as this all sounds, it makes complete sense once we realize the amount of freedom of movement that this anatomical arrangement allows. Of course, having this great flexibility does sacrifice stability, making the shoulder-joint complex prone to injuries.

This primarily happens when your shoulder is made vulnerable by underlying muscular imbalances in either the rotator cuff muscles that move your arm or the four muscles that stabilize and rotate your shoulder blade. These muscular imbalances are caused by the all too common myofascial trigger point, which can lead to a shortening and weakening of the involved muscles. Furthermore, because of the complexity of the shoulder girdle, trigger points more readily form here.

Most believe there shoulder problems begin when the pain first appears, but muscular imbalance and shoulder joint instability usually has been developing over months or even years before any pain develops. One study on 75 pain-free schoolchildren found that 57% of the boys and 40% of the girls had exam findings indicating instability already present in their shoulder joints. This research study, as well as others, indicates that instability in your shoulder can exist for years before the pain or problem appears. It is vital for complete rehabilitation to realize that even if the pain has only been there for weeks, the underlying myofascial problem and joint dysfunction has been there for many months or even years.

Most likely you have heard of the rotator cuff muscles and the all too common rotator cuff surgery, in fact surgery of the shoulder is now the second most common joint surgery performed. These four rotator cuff muscles get into trouble because they perform a majority of the work moving your arm through space and maintaining the integrity of your actual shoulder joint. However, what is generally not appreciated, even by most clinicians, is that for these four rotator cuff muscles to work properly, four shoulder blade muscles must perform a complex and surprisingly contradictory task. These four muscles must fully stabilize your shoulder blade while at the same time allowing it to freely and correctly rotate on your rib cage as your arm moves.

Together your four rotator cuff muscles with your four shoulder blade stabilizers keep your shoulder joint properly aligned in an extremely wide range of positions. Myofascial trigger points in any of your eight shoulder girdle muscles will disrupt their ability to keep your shoulder joint complex properly aligned. This can lead to many problems. Imagine a sophisticated, complex gear system just slightly out of proper alignment; eventually this will begin to create wear and tear in the gears. Your shoulder girdle complex is like this when myofascial trigger points begin to affect the length and strength of any one of your eight shoulder girdle muscles. The muscular imbalance and subsequent joint dysfunction will eventually lead to parts of your shoulder joint complex wearing out. Generally, the first to go are the rotator cuff tendons, which can lead to surgery and years of pain and dysfunction.

Here's how it generally unfolds, when trigger points weaken and/or shorten any of these muscles, the head of your humerus or upper arm bone can ride high in your shoulder joint. This will lead to a pinching and grinding of the tendons and bursa of your rotator cuff attached to the head of your humerus against the bony root of the shoulder joint called the acromion. Another reason this impingement syndrome takes place is when trigger points in the muscles that move your shoulder blade restrict its rotation. When this happens, the acromion of your shoulder blade does not rotate out of the way of the elevating humerus. This again causes the tendons and bursa to become impinged between the humerus and the bony roof of your shoulder.

This very simplistic explanation of beginning muscular dysfunction in your shoulder complex is the primary way that nearly all shoulder problems develop. In fact, according to Kalb, 95% of all shoulder pain cases can be attributed to the tendons of the rotator cuff muscles becoming pinched between the two bones of the humerus and acromion. If the muscular imbalances caused by myofascial trigger points in the rotator cuff or scapular muscles are not removed, this impingement syndrome will constantly wear away at the tendons and bursa of your shoulder joint, which ultimately leads to degenerative tendonitis.

Because of this impingement syndrome caused by myofascial dysfunction, a great deal of unnecessary arthroscopic surgery of the shoulder is done in the United States. In practice, I have found that when you remove all of the active and hidden myofascial trigger points throughout the shoulder girdle and restore the length and strength of the muscles, most individuals can avert arthroscopic surgery-especially when the myofascial dysfunction is caught early enough.

This simple problem of muscular imbalance of the shoulder joint not only leads to degenerative tendonitis of the shoulder, but it is also connected to many other debilitating chronic pain problems. Why? Because two of the muscles that stabilize and move your shoulder blade, the upper trapezius and levator scapula, contain the most commonly found myofascial trigger points in the human body. It is these muscles that create the vast majority of suffering from chronic mid-back and neck pain, along with headaches.

The key to all of these common upper body chronic pain disorders is the lowly and ignored shoulder blade, and very little is written about its role and importance in chronic pain disorders. In fact, abnormal function of your shoulder blade through muscular imbalance may right now be playing a major role in your shoulder, arm, mid-back, and/or neck pain with headaches. When any of these eight muscles contain trigger points, your shoulder girdle function is compromised and will begin to dysfunction. This disruption of your normal shoulder girdle function, over time, will lead to chronic pain and stiffness of your shoulder joint, mid-back, upper back, and/or neck.

One study found that 100% of shoulder joint instability, pain, and dysfunction could be traced to abnormal shoulder blade function. Therefore, if you wish to recover from your chronic shoulder, mid-back, or neck pains, get these muscles checked out and treated for hidden trigger points right away! Don't let pain get in the way of having a fantastic spring and summer this year.

Author Dr. Greg Fors

About Dr. Greg Fors

Dr. Greg Fors, D.C. is a Board-certified Neurologist (IBCN), certified in Applied Herbal Sciences (NWHSU) and acupuncture. As the clinic director of the Pain and Brain Healing Center in Blaine Minnesota he specializes in a functional medicine approach to fibromyalgia, fatigue, brain fog, digestive disorders, depression and anxiety. He is a sought after international lecturer for various post-graduate departments and state associations. Dr. Fors is the author of the highly acclaimed book, “Why We Hurt” available through booksellers everywhere.

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