Shoulder Pain:

There are several ways to injure and cause shoulder pain. It may be from repeated movements, continuous wear and tear, postural dysfunction or trauma. To fully understand how a shoulder gets injured, one must understand the complexities of this joint. It is by far the most complex and mobile structure in the body. It is made up of the glenoid fossa, which is a small indentation on the scapula, with one side of the joint being a round structure called the head of the humerus; these are held in place by ligaments, capsules, cartilage, tendons, and muscles.

The shoulder is the most complicated joint in the body. It has a biomechanical relationship to the truck and neck, and it requires a thorough understanding of all the muscular and fascial anatomies. Understanding the complex movement of the shoulders is important in order to restore functional strength, mobility and reduce pain.

The shoulder mostly receives its stability from the fascia. Therefore it is paramount that the relationship between the glenoid fossa and the head of the humerus remain consistent and in good anatomical alignment, otherwise sheering forces will cause damage to the structures in the joint. This anatomical alignment is dependent upon the stability of the muscles and the relationships of the clavicle to the sternum. The main problem that we encounter is that the position of the scapula becomes distorted and is allowed to rotate upward towards the ear and drift forward due to tightness of the pectoralis musculature. Once the distortion has occurred, the biomechanical relationship of the glenoid and humerus is destroyed and strains to the rotator cuff become common. This phenomenon is called impingement syndrome and becomes a common diagnosis for shoulder pain.

Shoulder pain can also be developed due to overuse syndrome, a strain or a lifting injury. Once the mechanism of injury is established and understood, a treatment plan can be established. In many cases there is a direct relationship between the cervical spine and the position of the shoulder girdle in relation to the truck.

In order to relieve shoulder pain, we try to realign the scapula in relation to the cervical spine, the trunk and the arm. We initially do this based on the understanding of the facial and muscular binding. Our approach is a treatment plan specifically designed to alleviate these muscular and fascia issues in order to bring the scapula back into its anatomically appropriate position. Reducing the muscular tension and fascia binding in the rest of the arm has specific effects on the correct anatomical position of the scapula. Once this has been accomplished we begin an active program of appropriate stretching, flexibility and strengthening exercises. The exercises are designed to de-rotate the scapula and depress the scapula so that the muscular system can be retrained to hold the glenohumeral joint in the proper position and avoid further issues of injury. The same philosophy and approach is applied to all post operation rehabilitations and/or severe traumas.

To prevent further and future issues it is necessary that the exercise program, stretching program and postural re-training are effective at alleviating the fascia binding. The proper exercise re-training allows for a stable scapula with pain-free glenohumeral joint movement. This is all accomplished by our unique and thorough approach through our understanding of biomechanics as it relates to the shoulder girdle, trunk and cervical spine, as well as the fascial structures.

Some of the structures that are not commonly addressed are the dynamics of the sternocleidomastoid muscle, the pectoralis major, both sternal and clavicular sections, the pec minor as it attaches to the coracoid process. Both the scalene muscles and the pec minor can affect on the brachial plexus, which can cause a neurologic symptoms in addition to the shoulder pain and dysfunction. The dynamics of a severe forward head posture what we call the sternal syndrome; has equal effects on the position of the upper quadrant and alignment of the scapula and the cervical spine. As one can see this becomes a complicated affair and requires thorough treatment programs that can restore the alignment and resolve the shoulder dysfunction and pain.

Other observations of shoulder pain are spasms and fatigue of the deltoid itself. Tightness of the scalene can radiate pain into the insertion of the deltoid. These minor spasms must be tolerated to allow proper humeral head position

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Dallmeyer Physical Therapy Treats Shoulder Pain of All Types