Shoulder disfunction

Shoulder

 

One of the most common things I see in the industry being as an S&C coach and a sport therapist is shoulder dysfunction. In this article I am going to talk about shoulder position, keeping it basic.

Posture

Today's lifestyle is one that challenges our posture more and more, from long hours being seated in front of a computer or laptop to bad exercise programs. All of these bad habits help create bad positions for our shoulders; the chest becomes short and tight and the shoulders get pulled forward into an internally rotated position which makes the back musculature to become lengthened and in a weakened position, putting a lot off stress on these muscles and therefore on the shoulders that are now sitting in a forward and very unstable position. Over time this rounded shoulder forward head posture gets exasperated as we continue to carry on with our lives and our bad habits, we add a few gym sessions on top of all of this and it's not long before there is pain or an injury.

Injury

Most people I see that have pain or injury in the shoulder blame a small group of muscles called the rotator cuffs, but in most cases these small muscles are the victims and the bigger muscles that attach to the shoulders are the real perpetrators. This is extremely important to remember as a lot of clients I see as a therapist have been treated time and time again, and on investigation I find that a lot of the treatment is on the “victims” and rarely the “perpetrators” have been treated. The shoulder is a very complex joint and there are a lot of potential causes of pains and dysfunctions.

The basics

When I look at the shoulders of clients who have pain or dysfunction by simply knowing the mechanics and anatomy of the joint and the surrounding area this tells me a lot about the problem and issue on hand. Now, I am not saying I know exactly what the problem is without further investigation, however over the years it becomes easier and easier to spot the potential “perpetrators”.

As discussed in the posture section if we can see that the shoulders are slightly rounded, internally rotated and there is a slight forward head posture then this tells us a lot.  It means we can go after the muscles that are pulling the “victims” into a weak uncomfortable position, generally what we find is that the pecs are short and tight and that the upper back has become weak and switched off as it's in a compromised position. I have listed some points where I see some mistakes in the training and treatment of clients within the wellness industry.

  • Training programs are not balanced, they are sometimes random and there is a lack of thought about how the body should work and how it's designed to work
  • Therapists are treating the “victims”, and not getting the to the root of the problem. A role model of mine recently said "always ask WHY?" And as a therapist I try to always ask why “Is this dysfunction/pain happening. 
  • Therapist are treating clients and doing some great work but unfortunately they are sometime missing the bigger picture, why would I take a client and treat them on a massage table, help to deactivate over active muscles in the chest to help pull the shoulders back and just send them on there way. Treating the “victims” here will give some relief short term and the client might leave feeling better, however they will go back to the same environment that is causing the problem e.g. their work desk or their bad exercise prescription where the problem will continue and over time will become even more painful or dysfunctional. This is the perfect time to help strengthen the under active muscles that will now activate better as I have switched of the perpetrators.
  • Education in my eyes is why we are there as coaches and therapists, we are not there to simply count reps and rub peoples backs for an hour (unless that's what they wanted in the first place). I feel it's important that we try our best to educate our clients to help themselves, so they learn why they are working various muscle groups in the gym or why they are foam rolling their hamstrings. I believe that it’s important for trainers, therapist and coaches to understand how their clients feel. If the client doesn’t understand why they are causing them selves pain with a yoga tune up ball or a foam roller then they are less likely to do this.

So basically, what we need to do is work out the best way to get those shoulders back into a anatomically correct position using all the skills we have as a wellness professional, such as massage, self myofascial release, ergonomics, training and most importantly knowledge and education.

 

Lee Irvine