Today’s post was inspired by one of my most difficult patients… my father! While at work my father felt a strain in his right shoulder while lifting a heavy piece of equipment and after letting the pain nag him and hinder his movement for over a week, he FINALLY asked for my help.
The shoulder is probably one of the most complex joints in the entire human body… so let’s talk about some of its components and then we can have a better understanding of how to fix them.
The shoulder complex is comprised of the 3 joints; the sternoclavicular joint which connects the clavicle (collarbone) to the sternum (breastbone), the acromioclavicular joint which connects the acromion process of the scapula (shoulder blade) to the clavicle, and the glenohumeral joint which connects the glenoid fossa of the scapula to the head of the humerus (upper arm.)
The glenohumeral joint is the ball and socket joint that most people think of when discussing the shoulder. Because the glenoid fossa (socket of the joint) is smaller than the humeral head (ball of the joint) the shoulder has a very high degree of mobility, but less stability than other ball and socket joints, such as the hip. Luckily the shoulder is also comprised of numerous muscles and ligaments to help stabilize the humeral head, preventing it from dislocating from the socket.
One of the most important muscle groups in the shoulder is the rotator cuff, which consists of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. Theses muscles work as a unit to ensure proper movement of the scapula, which then allows the head of humerus to remain in the socket.
Because the rotator cuff muscles are necessary for so many of the activities we perform on a daily basis, the tendency for overuse injuries to this part of the shoulder is very common. Therefore, it is vital that we keep these muscles strong enough to withstand the repetitive motions we put them through every day. These are some simple stretches and exercises you can perform to maintain your rotator cuff:
*Remember to always begin with non-weight bearing exercises and slowly progress in resistance, especially when first starting an exercise program or recovering from an injury!
- I-Y-T-W-O Exercise: Begin standing or lying on your stomach, stretch both arms straight overhead to form an I, then slowly widen your arms into a Y shape, then straight out to your side to form a T. If you can perform these 3 movements without pain then you can progress to bending your elbows in towards your ribs to form a W, and then lower your hands to your lower back with your palms facing out to form an O. Do 3 sets, holding each position for 3-5 seconds.
- Stick Stretch: Begin lying on your back holding a small dowel or stick with both arms perpendicular to your body. Slowly extend your arms overhead keeping both arms straight, hold the stretch for 3-5 seconds, and then return to the starting position. Perform 3 sets of 5 reps.
- The Empty Can Exercise: This exercise specifically targets the supraspinatus muscles, which is the most commonly injured muscle in the rotator cuff. Begin standing and extend the arm of the affected shoulder at a slight diagonal, with your thumb pointing towards the floor, as if you are dumping out a can of soda. When this movement can be performed repeatedly without pain, then you can add a free weight or resistance band to improve muscle strength. Perform 3 sets of 10 reps.
- Wall Pushup: This exercise is performed exactly as it sounds. Begin by standing arms-length away from the wall and perform 3 sets of 10 pushups. To increase resistance, step further away from the wall to increase the amount of body weight being placed on the arms and shoulders. Progress to performing pushups on an incline bench, and then eventually the floor.
- Planks: My favorite exercise of all, planks are ideal for improving shoulder stabilization. However, planks should ONLY be performed when there is absolutely NO pain when performing any of the previous exercises. If you begin to experience pain in the plank position, return to the wall pushup until your shoulders are strong enough to support your entire body weight.
Another common shoulder injury is an AC joint tear, often referred to as a separated shoulder. The acriomoclavicular joint is connected by the acromioclavicular ligament, which can tear due to a fall or impact injury, which is common in many contact sports. The severity of the injury is graded 1-3.
A Grade I injury involves a slight tear in the AC ligament, but the joint is still in tack. This type of injury is the most common and resolves on its own with a short period of limited activity.
A Grade II injury means there is a complete tear in the AC ligament, creating a dislocation between the clavicle and acromion process of the scapula.
A Grade III is a true separated shoulder. With this type of injury, not only is there a complete tear in the AC ligament, but there is a complete tear in the coracoclavicular ligament and joint capsule as well. A true separated shoulder requires surgical intervention to repair the torn ligaments.
The first priority when recovering from surgery is to regain range of motion. This is often a slow and tedious process, but a necessary one in order to restore proper function to the shoulder. Range of motion exercises should include:
- Pendulum Swings: Lean forward and rest your uninjured arm on a stable surface (table, counter, or bench.) Let your arm hang under the weight of gravity and slowly shift your body weight side to side to gently swing your arm. Repeat this movement shifting your body weight front to back. Complete the exercise by gently rotating your arm in small circles, gradually getting bigger and bigger.
- Wall Climbs: Standing facing the wall, slowly walk your fingers up the wall and then back down. Perform 10 reps and then stand perpendicular to the wall and repeat 10 reps with your arm to your side.
- Internal/External Rotation: These can be performed sitting, standing, or lying down. When recovering from an AC tear I would recommend performing this exercise lying down without any resistance, and slowly progress to sitting using a light free weight, then standing with increased weight. To begin, lye on your back with your elbows bent to 90 degrees so that your fingers are pointing to the ceiling. Slowly let your hands fall back towards your head so that the back of your hands are on the floor, return to the starting position, then let your hands fall towards your hips so that your palms are on the floor. Perform 5-7 reps, holding each position for 10-15 seconds.
Once full range of motion is restored without pain, the patient can return to normal activity.
Keep in mind that the shoulder is a hyper-mobile joint that requires the proper balance of mobility and stability to function properly and reduce the rate in injury.
Everything is connected, and a problem in one joint can often lead to problems in adjacent joints if left untreated. Listen to your body… if something feels wrong, then it probably is!