Shoulder Pain and Your Physical Autonomy.

……and don’t call it the rotary cuff.

My stated goal with every patient is to give them a measure of physical autonomy. That is to say, after we have parted ways I want my patients to be able to “treat” themselves if their pain returns. Yes, some aches and pains are better left to a clinician, but the majority of pain, chronic and acute, can initially be addressed at home. Furthermore, I would like my prospective patients to realize that they have the physical autonomy to, at the very least, reduce their musculoskeletal pain and increase their function with some simple exercises.

The shoulder is an area where I see patients often ignore their pain and engage in ultimately unhelpful compensatory movements and postures until they just can’t stand it anymore. To be sure, nothing quite ruins your day, or night’s sleep like the pain that this joint can elicit. Shoulder ailments, even at low levels of pain and dysfunction will make you acutely aware of just how dependent you are on this hyper-mobile joint. Adding insult to injury, shoulder pain will quickly migrate up to the neck and/or down to the upper back making movement and concentration difficult and laborious. However, shoulder pain and dysfunction can be mitigated if you address it specifically and daily.

The shoulder joint is the most mobile, major joint in our body. This joint is composed of the upper arm(humerus), the shoulder blade(scapula), the collar bone(clavicle), and the ribcage. As such, the muscles that impact the shoulder are the muscles shared between these bones. Generally speaking, when you feel shoulder pain, the structures (muscles and tendons) that stabilize the relationship between your upper arm and shoulder blade are the muscles that are shouting at you. This is your rotator cuff (RTC). Don’t panic, relatively few RTC injuries require surgery. However, the RTC is rarely the root cause of your pain. Even a RTC tear is a symptom of an underlying chronic movement dysfunction somewhere in greater shoulder complex, acute pickle ball injuries not withstanding. So the question is, where to start with this problematic joint.

Given the complexity of the joint, shoulder pain can rarely be attributed to a single muscle or tendon. However, the Rotator Cuff (RTC) is at the center of all shoulder movement and is always involved when the shoulder is in pain and/or injured. Yes, there are other structures that can be irritated, torn, or bruised, but because of its central role in movement of the shoulder joint, the RTC is the most appropriate place to start when considering how to rehabilitate the shoulder. The RTC is comprised of 4 muscles that attach the upper arm (humerus) and the shoulder blade (scapula). While most muscles have a foundation of fixed bone from which to operate, the RTC manages the relationship between your upper arm and shoulder blade while both are moving at the same time. To be more specific, the RTC manages the rotation of the upper arm on the shoulder blade, and vice versa.

Any time you move your arm, the 4 muscles of the RTC must contract in different combinations and intensities to manage the rotational movement of the upper arm and shoulder blade at the same time. So the starting point in managing injury to this joint is to rotate it in a stable position, stimulating the RTC to fire in different combinations, without raising the arm overhead.

Shoulder Rotations

Grab some weight that, say 5-15lbs. Lay on your back and stick your arm straight up towards the ceiling. Let the weight push your shoulder down to the floor, keeping your elbow locked. Now begin rotating the weight clock-wise(external rotation) and counter clockwise(internal rotation). This movement will cause your elbow to rotate as well. In fact, the rotation of your elbow is indicative of the motion of the shoulder joint, so cue this range of motion rather than that of your wrist. If motion in either direction causes shoulder pain, rotate just to the point of pain. Try doing this 2-3 sets of 1 minute, twice daily.

Shoulder Rotation Progression

Prone Arm Raises

Now that we have stimulated the RTC, we need to address address the muscles that stabilize the shoulder blade (scapula). Lay face down on a bed or table with your arm hanging off towards the floor and palm facing towards you. Gently pull your shoulder down and back away from your ear as you lift you hand up to the side, away from your body. As you are lifting your arm up, externally rotate your hand such that your thumb is pointing up towards the ceiling. Pause your arm at the top, then slowly lower your hand back to the starting position. If that movement was pain free, try the same motion, but angle the movement more towards your head. If the original movement was painful, try the same motion, but angle the movement more towards your body. Try doing this 2-3 sets of 1 minute, twice daily.

Bonus - Prone Arm Rotations

One of the silver linings of rehabbing the shoulder is that you get to tone your arms at the same time. Two additional muscles that need to be stimulated are the biceps and triceps. The longer portions of both of these muscle insert into the shoulder joint and play important stabilization roles.

Arm Day! Biceps and Triceps

For biceps stimulation, again grab 5-15 lbs. Stand with feet about hip width apart, with your arm at your side and palm facing you. Now bend your elbow, slowly rotating your palm at the same time until it is facing up and the elbow is completely flexed. Now, gently lower the weight to the starting position.

For triceps stimulation, use the same amount of weight. Lay on your back and stick your arm straight up towards the ceiling, palm facing in. Let the weight push your shoulder down to the floor, keeping your elbow locked. Bend the elbow and without moving the upper arm, lowering the weight towards your shoulder until the elbow is completely bent. Then slower return to the starting position. Try doing both of these exercises 2-3 sets of 1 minute, twice daily.

Another Bonus - Shoulder Soft Tissue Mobilization

The most important component to rehabbing the shoulder is time and patience. Don’t increase the weight or the volume of exercise immediately even if you are pain free. Additionally, if you cannot do any of the above exercises without pain or if your activities of daily living cause pain, numbness or tingling in your arm or hand, you need to get a clinician involved.