Osteopathy & Massage at Remedy Health
Shoulders are complicated joints, but they can get better…..
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Most people have had shoulder pain at some point, and been told they have a ‘rotator cuff’ problem, but what does that mean? Why is shoulder pain so common, what is the rotator cuff and what can’t you do to help yourself? Hopefully we’ll be able to answer some of your questions in this blog.
As people are getting back outside in the nice weather, playing golf, tennis and swimming shoulder issues will often reappear, so hopefully we can help you understand your shoulder better and give you some simple tips to keep them in good condition in this newsletter.
Why is shoulder pain so common?
Shoulders are complicated joints, they rely purely on muscles and ligaments to keep them moving freely and pain free, which is where shoulder posture is critical (and why we bang on about it so much!).
Modern life is tough on shoulders, sitting at a desk, working on a computer, driving a car, using a mobile phone, everything in life means our shoulders are being pulled forward, which is bad news for shoulder, upper back and neck posture, and increases the chances of suffering from pain. In addition a lot of people tense their shoulders in response to stress, and problems in the neck and upper back will also cause issues in the shoulder. You can’t really treat shoulder pain without working on the neck and upper back too!
If you’ve had shoulder pain, it’s quite likely that someone has mentioned a ‘rotator cuff problem’ to you, so we thought we’d tell what the rotator cuff is and why it’s so important.
What is the rotator cuff?
The Rotator cuff are a set of muscles that act as the guy ropes of the shoulder. All of the muscles start on the shoulder blade (scapula), and then anchor on the front of the upper arm. Their job is to guide the top of the humerus (upper arm bone) as the arm moves to stop things from getting pinched in the joint and ensure that the bigger muscles (like your deltoids, lats, traps) can produce force and power. They also help to guide arm movements so we can get our hand exactly where we want it in space to pick things up, and do fine movements like writing of sewing.
The four rotator cuff muscles are:
- Supraspinatus Initiates abduction (lifting the arm away from the side).
- Infraspinatus External (lateral) rotation of the arm
- Teres Minor External (lateral) rotation and adduction (moving the arm towards the midline).
- Subscapularis Internal (medial) rotation of the arm.
But in order to keep the rotator cuff healthy and the shoulder pain free we need to maintain good shoulder posture and muscle balance around the shoulder. As with other areas of the body this isn’t easy as the muscles at the front of the shoulder are much stronger than the ones at the back of the shoulder, and as soon as our shoulder moves from its optimal position the rotator cuff has to work extra hard, this leads to the clicks and clunks many of you will have felt when moving your arms around. As already mentioned having good shoulder posture in the modern world is hard, and hence shoulder pain is very common.
Below we’re going to describe some of the injuries we commonly see in shoulders.
Common Shoulder Problems
Rotator Cuff Tear
These can range from partial to full tears in one or more of the rotator cuff tendons (mentioned above). They can happen suddenly due to a fall or lifting a heavy object, or gradually over time due to wear and tear. Tears often result in significant pain, weakness, and difficulty lifting or rotating the arm.
Shoulder impingement
This occurs when the tendons of the rotator cuff get compressed as they pass through a narrow space beneath the acromion (the bony projection at the top of your shoulder blade). This can lead to inflammation and pain, especially with overhead activities. Bone spurs in this area can sometimes contribute to impingement and lead to tears.
Arthritis
This is a degenerative joint condition where the cartilage that cushions the ends of the bones in the shoulder joint breaks down over time. Causing pain, stiffness, and a limited range of motion are common. You might also hear a grinding or clicking sound (crepitus) when moving your shoulder. Age, previous shoulder injuries, and family history can increase the risk of developing shoulder osteoarthritis.
Frozen Shoulder (Adhesive Capsulitis)
A lot people get told they have frozen shoulder, but this condition isn’t as common as you think! It involves a thickening and tightening of the capsule
surrounding the shoulder joint. This restricts movement and causes significant pain.
Frozen shoulder typically progresses through three stages:
- Freezing Stage: Gradual onset of pain that worsens over time, with increasing stiffness.
- Frozen Stage: Pain may start to subside, but stiffness remains significant, limiting the range of motion.
- Thawing Stage: Gradual return of movement in the shoulder. This whole process can take anywhere from 6 months to 2 years.The exact cause isn’t always clear, but it’s more common in people with diabetes, thyroid disorders, and after a period of immobilisation (e.g., after a fracture).
The exact cause isn’t always clear, but it’s more common in people with diabetes, thyroid disorders, and after a period of immobilisation (e.g., after a fracture).
Bursitis
Is inflammation of the bursae, which are small, fluid-filled sacs that cushion the bones, tendons, and muscles around the shoulder joint. This can be caused by repetitive movements, direct trauma, or underlying conditions like arthritis can lead to bursitis. Pain that may worsen with movement or direct pressure on the affected area.
Referred Pain
Sometimes, pain felt in the shoulder actually originates from another area of the body, such as the neck or upper back. Nerve compression in the neck (cervical radiculopathy) can cause pain that radiates down into the shoulder and arm. Problems with internal organs can occasionally refer pain to the shoulder as well, although this is less common, such as the gallbladder causing pain in the right shoulder, and the serious one of a heart attack causing left arm, shoulder or jaw pain.
Instability
This occurs when the head of the humerus (upper arm bone) slips out of the glenoid fossa (the socket in the shoulder blade). This can be a partial dislocation (subluxation) or a complete dislocation. It is often caused by a traumatic injury, such as a fall or sports injury. Some individuals may have a predisposition to instability due to ligament laxity. It can present as pain, a feeling of the shoulder “giving way,” and visible deformity after a complete dislocation.
Shoulder problems can be difficult to diagnose, surgery isn’t often necessary, and most problems can be resolved with manual therapy, stretching, rehabilitation exercises and improving back, neck and shoulder posture.
Exercises to help your shoulders
As we’ve told you, shoulders suffer a lot in the modern world, and some simple stretches can really make a big difference to your posture and overall muscle balance. We thought we’d share a couple of our favourites to help your shoulders out and give them some welcome relief.
Pectoral stretch
How to do this stretch: Place your arms at 90 degrees, with your palms & forearms flat on the wall, and face towards a corner. Push/lean your body into the corner keeping your hands in the same position. You will feel a stretch across your upper arms, front shoulders and chest. Whilst holding the stretch take a deep breath in, and as you breathe out try to drop a little deeper into the stretch. Hold for 20-30 seconds and repeat two or three times. You can also do this stretch in a doorframe, but make sure that you keep your forearms and elbows flat against the frame.
Upper trapezius stretch
To do this stretch: In order to stretch the left side, place your right arm behind you, grab your wrist with your left hand. Pull it gently towards your left foot. Take your head and tilt your left ear towards the left shoulder, you can also turn the head down slightly and look towards the floor. This stretch is versatile and you can even do it with your hands in front of you. Hold the stretch for 15 seconds and repeat two or three times on each side.
For both of these stretches, you should be able to feel the stretch, but it shouldn’t be painful!
If you are suffering from shoulder pain, make an appointment to see us, we can diagnose why you have pain and help you get back on track. Remember the pain might not be coming from your shoulder!
ABOUT THE AUTHOR
ELIZABETH DUFFIN (B.Ost, Bsc hons, msc )
Elizabeth graduated from the British School of Osteopathy (now the University College of Osteopathy) in 2005 and has over 19 years of experience practising in Sussex and Surrey. She treats patients of all ages and uses a hands-on, individualised approach combining manual treatment, movement testing and exercise prescription to support recovery and long-term wellbeing.
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