Getting into the swing of things, and other ways you can injure your shoulder
Posted by Liz Sims, PT, DPT - Redpoint Physical Therapy, Plymouth, Massachusetts
It’s called “multi-tasking”. As I write this blog, I am using a tennis ball to release a knot in my shoulder blade. What does this have to do with anything, you ask? Wait for it…
The above video was an excellent segue into this week’s topic of “Other ways to injure your shoulder.” You see, I’m finally starting to get into a rhythm at the clinic… I now vaguely know what’s expected of me. I have a long task list each day (which I *never* get to the bottom of). I see patients, do twice as much computer work, and spend my “free time” on the phone with major insurance companies. I stay focused (ish… definitely focused-ish). I keep an eye on the clock, and I leave at the end of the day, because otherwise I’d never leave. Then I go home and do my “other job” which involved taking care of myself, a baby, 2 cats, and a house with my darling husband, who also works ridiculous hours.
It’s not uncommon. Many of us spend too many hours sitting at a computer or doing things for their house or family. And I'm not complaining. But this hard work and dedication takes its toll…
What does this have to do with my shoulder, you ask?
Everything! For starters, there are many studies documenting the effects of repetitive or static activity at the computer (like this one, this one, and this one, for example). EMG studies have shown increased activation of the upper trapezius muscles (stay tuned for another blog describing my hatred of the shrug exercise!) and under activation of the lower trapezius.
On top of that, most people sit with incorrect posture (ha! I’m doing that right now!), leading to lengthened middle trapezius and rhomboids, shortened pectoralis minors, weak cervical flexors, and tight muscles in the back of the head - also known as “Upper-crossed syndrome” (pictured here).
The shoulder is a complex joint (and I'm a nerd), so if you’re interested in the details on anatomy and function, keep reading. If you’re merely interested in my suggestions for improving or preventing symptoms, skip to the end for some tips :)
Got shoulder pain? You’re not alone! Shoulder pain is a common complaint among the general population. Because of the natural anatomy of the joint, it is prone to various injuries when activities are performed with inefficient body mechanics. Per the Bureau of Labor Statistics, shoulder pain was the 2nd most common musculoskeletal disorder causing missed days at work. While shoulder injury statistics are difficult to track, close to half of shoulder pain injuries are due to rotator cuff (RC) pathology, and close to half of all RC injuries will worsen within 5 years, often requiring surgical intervention.
The anatomy of the shoulder joint consists of a ball-and-socket joint (humerus and glenoid bones) held together by several ligaments and the rotator cuff, which consists of 4 muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. In addition, it is supported by the scapula (shoulder blade), whose stability comes from several muscles in the mid-back region: trapezius (upper, middle, and lower portions), latissimus dorsi, and rhomboids, to name a few. The front side of the joint is supported by pectoralis major and minor. The design of this joint allows for maximum movement in multiple directions, but it also sets the shoulder up for various injuries.
In a well aligned shoulder joint, the supraspinatus muscle is responsible for helping the deltoid muscle to abduct the shoulder- lift your arm out to the side (think of reaching for your jacket in the passenger seat) – as well as depress the head of the humerus during this action. The subscapularis helps to internally rotate (think of reaching behind your back) and the infraspinatus and teres minor help to externally rotate (think of brushing your hair back). When the rotator cuff is working well, these daily tasks and many others cause no pain or difficulty.
The point is that posture can directly alter the natural mechanics of the shoulder joint. A typical posture as a result of regular living (driving, computer use, etc) can lead to rounded shoulder and a flexed spine, which changes the position of your shoulder joint and reduces the functionality of the rotator cuff. Use of your shoulder in these circumstances can lead to injury through a couple of routes. The most common rotator cuff injury is supraspinatus tendonitis (an inflammation to the tendon attaching this muscle to bone); with the altered posture described above, the space where this muscle sits has become physically smaller, leading to impingement as well as overuse injury (because it’s not working in its optimal position). Another common injury in this instance is biceps tendonitis; this happens both due to its proximity to the suprasinatus muscle as well as its tendency to be overworked when the rotator cuff is not working properly.
What YOU can do:
Treatment and preventative care through physical therapy is helpful in avoiding surgery. Learning to realign your posture, stabilize your shoulder blades, and regain normal movement throughout the shoulder complex will not only decrease the stress place on the joint, but it will also improve your strength. In addition, it is essential to stretch the pectoralis minor muscle in order to maintain healthy ROM and function in the shoulder. Here is one study supporting the relationship between pec minor length and function.
Do it on your own at home:
Because many people spend time commuting or sitting at a computer during their day, most people can benefit from a few stretches for good shoulder maintenance. Here are a few to get you started:
1. Pec minor corner or door way stretch: Find a corner or a doorway. Place arms as pictured below (A), making sure shoulders are pinched down and back. If that feels good, try stretch (B) and (C).
2. Cross arm stretch: This stretch has been found to be very effective at improving rotator cuff function. Cross one arm over chest, then use your other arm to hug it close.
3. Neck stretch: Place one hand behind your back and lean your head to the opposite side. For a stronger stretch, place your free hand on top of your head and provide gentle pressure.
4. Chin tucks: Lying on your back (easiest) or sitting/standing, keep your head still and gently tuck your chin toward your neck. This strengthens deep muscles in your neck (your neck's "core" muscles), and also stretches the back of your neck.
5. Foam roll stretch: Lie on your back with a foam roller (or a large beach towel rolled up) along your spine. Make sure head and hips are supported on the roll. Stretch your arms out to the side and relax. *If painful, lower your arms toward your hips *You can also try “snow angels”
Also, good work station ergonomics will help to prevent upper-crossed syndrome, neck pain, and shoulder pain:
And, if none of the above helps, try this:
If you can guess where this picture was taken, you'll score some cool Redpoint gear. Also, any tips or comments on the topic are always appreciated :)