Shoulder Mechanics

Whether throwing a ball, paddling a canoe, lifting boxes, sleeping, working at a desk, texting, any sporting activity or pushing a lawn mower, we rely heavily on our shoulders to perform all these activities. Normally, the shoulder has a wide range of motion, making it the most mobile joint in the body. Because of this flexibility, however, it is not very stable and is easily injured. The shoulder is made up of two main bones: the end of upper arm bone (humerus) and the shoulder blade (scapula). The end of the humerus is round, and it fits into a socket in the scapula. The scapula extends around the shoulder joint to form the roof of the shoulder, and this joins with the collar bone (clavicle). Surrounding the shoulder is a bag of muscles and ligaments. Ligaments connect the bones of the shoulders, and tendons connect the bones to surrounding muscle. Four muscles begin at the scapula and go around the shoulder, where their tendons fuse to form the rotator cuff. When the shoulder moves, the end of the humerus moves in the socket. Very little of the surface of the bones touch each other. Ligaments and muscles keep the humerus from slipping out of the socket and keep the clavicle attached to the scapula.

To keep shoulders healthy and pain-free, it’s important to know how to spot and avoid common injuries.

Signs that you should seek treatment include:

1. Shoulder pain that persists beyond a 2-3 days
2. Recurring shoulder pain, even if it has a history of settling on its own
3. Inability to carry objects or use the arm
4. Inability to raise the arm
5. Injury that causes deformity of the joint
6. Shoulder pain that occurs at night or while resting
7. Swelling or significant bruising around the joint or arm
8. Signs of an infection, including fever, redness, warmth or swelling

Dr. Rodwin can assess your shoulder problem and will recommend treatments specific to your issues based on her diagnosis which may include: chiropractic adjustments, massage therapy, Active Release Treatment, acupuncture, stretches, etc. It is very important to seek out treatment early on before the problem becomes a chronic issue.

Heron Wolck Acupuncture 3 edited

Heron Wolck Acupuncture ed

Pictured above is one of Back to Health’s patients: Heron Wolck. Heron has treatment for his shoulder, low back and hip. He has been doing very well, and is happy to be back to all the activities he wants to do. He can now lift with no pain! His treatment includes combined chiropractic, acupuncture and ART on his shoulder. Hard to believe that he could barely move his right shoulder when he came in, now he has full mobility! 

“Finding someone like Dr. Rodwin is a bit different for everyone. I chose to put my faith in Dr. Rodwin based on a personal reference that was made, that showed she cared about people. When a doctor takes a genuine personal interest in a patient, that’s what I like. After all, we expect our “caregivers” to “give a care” about us and make us feel better. We develop relationships with our care givers over time, and I’ve found a type of trust in Dr. Rodwin that I really enjoy and I am relieved to have found. I have complete confidence in how my discomforts are treated and managed. Dr. Rodwin, Barbara, has been friendly, reassuring, professional, and my issues have been addressed very effectively! It’s only good sense to look after our aches and pains as a form of maintenance, but the truth is that I also enjoy and look forward to my appointments. The staff Dr. Rodwin has assembled, all seem to work together so harmoniously, and everyone just seems so positive, it’s a little like visiting a very happy family. I’ve always been treated so very well, and I only have good things to say about the people I have met here. I consider time spent with them, to be good for me! Regards, Heron.”

You can find out more about how our clinic has helped others on our ‘patient stories’ page

Common Injuries:

Bursitis: The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff. Bursitis is an inflammation of a fluid-filled sac, or bursa that lies between a tendon and skin or between tendon and bone. Normally a bursa protects the joint and helps make movement more fluid.Bursitis

Shoulder Instability: Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition

Shoulder Dislocation: A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.

Frozen Shoulder: Also called ‘adhesive capsulitis,’ this is a common condition that leads to stiffness of the joint. This condition can take a long time to heal and if you ever get this it is painful. Dr. Rodwin has treated this many times and has seen this condition improve quickly with certain treatment modalities. “I cannot believe how quickly my shoulder improved with the treatments, advice, exercises that I was given. My friend did this at the same time as me, did not see Dr. Rodwin and her condition is still not back to normal 2 years later!”  – Carole (patient)

Rotator Cuff Tear: A Rotator cuff tear occurs when the tendons of the rotator cuff become irritated due to shoulder misalignments and the muscles or tendons will develop knots or adhesions. This then causes improper motion of the shoulder due to the shortening of these tissues. Sometimes with leaving this too long the tissue can ‘break’.Rotator Cuff Tear

Shoulder Separation: Also called an AC separation, these injuries are the result of a disruption of the Acromio-clavicular joint. This is a very different injury from a dislocation!

Arthritis: Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery. Arthritis is a gradual narrowing of the joints and loss of protective cartilage in the joints about the shoulder.

shoulder, shoulder blade, scapula, shoulder pain, shoulder arthritis, shoulder x-ray

Motions Explained

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Normal movement of the shoulder requires fluent action at four different joints and these often are out of alignment with shoulder problems:

• Scapulo-thoracic Joint: Movement of the scapula (shoulder blade), gliding on the rib cage and with the thoracic spine (mid-back). Normal motion is: for every 2/3 of Gleno-humeral elevation (shoulder), there is 1/3 of scapulo-thoracic (mid-back with shoulder blade) elevation. Movements occurring here include elevation/depression {up/down}, retraction/protraction {squeezing shoulder blades together or Active Release Technique} and internal/external rotation {rotating shoulder socket in and out}.

When someone undergoes a shoulder injury their body adapts and switches the mechanics from 2/3 shoulder motion to 1/3 shoulder motion and from 1/3 mid-back-shoulder blade motion to 2/3 mid-back-shoulder blade motion. Commonly this movement is not fixed completely for patients that have shoulder problems and this is the main reason why their problem does not go away. The thoracic spine (mid back) needs to be treated as well to aid in resolving their shoulder issues.

• Acromio-clavicular Joint: Movement about this joint is very slight- but this synovial joint actually allows small amounts of superior and inferior glide {up and down motion} and rotational motions. When this goes out of alignment there can be discomfort or pain in the front of the shoulder.

• Sterno-clavicular Joint: This refers to the joint of the acromion at the manubrium {breast bone} of the sternum. Movements allowed here include elevation/depression, anterior/posterior {front to back motion} translation and small amounts of rotation. Problems in this area can lead to discomfort/pain in the front or the upper back area.

• Gleno-humeral Joint: Movement of the head of the humerus {shoulder joint} in the glenoid fossa {shoulder blade area}. Problems with this joint can lead to muscle imbalances and tightness in the muscles in the shoulder.

It is VERY important with shoulder problems to evaluate the motion of all these shoulder joints to aid in resolving the shoulder problem.

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Kysa ART Shoulder 1

Kysa ART Shoulder 2

Pictured above, Dr. Barbara Rodwin performs Active Release Technique on a patient to help relieve her shoulder pain.

How Can These Shoulder Injuries Be Fixed?

The Traditional Approach…

In an attempt to relieve shoulder pain, a variety of treatment methods are used, either on their own, or in combination with other methods. Some of the more common approaches include: acupuncture, active release technique, adjustments, icing, anti-inflammatory medications, rest, muscle stimulation, stretching, and exercise. If the adhesions are binding the tissues together, restricting normal movements, and interfering with the normal flexibility and contraction of the muscles in the shoulder area it is really important to have the active release technique!

Passive approaches such as medications, rest, ice, and steroid injections all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as chiropractic, active release, stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from the shoulder condition.

At Back to Health Wellness Centre we recommend the following treatments:

Chiropractic and Active Release Technique (ART):
Chiropractic treatment involves addressing any joint (shoulder/elbow/hip) restrictions with chiropractic adjustments, and using soft tissue techniques such as Active Release Technique and trigger point therapy to loosen the surrounding musculature and increase range of motion. A stretching and strengthening program is prescribed at the appropriate time to help stabilize the joint and prevent re-injury.

Acupuncture:
Acupuncture, in conjunction with other treatments, speeds up the healing process, and decreases inflammation. Acupuncture does this by stimulating the natural release of endorphins, which are the body’s natural pain killers. Dr. Rodwin and Dr. Kath VanZeyl are certified acupuncture practitioners at Back to Health.

Massage Therapy:
The aim of massage therapy is to first assess the source of the joint restriction, which may include trigger points, adhesions, tendonitis or bursitis. Once this is determined, treatment may include decreasing inflammation, reducing muscle spasms, and increasing circulation in order to maintain tissue health and range of motion. Massage also eliminates any scar tissue that restricts the joint’s movement.

Cupping:
Many of our patients have been asking lately, what exactly is Cupping Therapy? Cupping is a technique that involves the application of glass or plastic “cups” to the surface of the skin. A gentle suction is applied to the cups to create a vacuum which draws the skin, small blood vessels, muscle and connective tissue into the cup. At Back to Health Wellness, our Naturopathic Doctor, Dr. Kathy Van Zeyl, uses it typically in a “sliding” technique with oil applied to the skin to allow the cup to “glide” up and down the length of a muscle. This functions to relieve muscle tension by stretching and loosening the muscle and connective tissue, while increasing blood flow and draining the lymphatic vessels to bring nutrients and drain wastes from the area. This technique has been found to be extremely useful in acute or chronic muscle tension, IT band syndrome, shin splints and Achilles tendonitis, plantar fasciitis, and has been used most recently by our very own Dr. Rodwin with great success. Derived from Chinese Medicine, Cupping Therapy is used to “relieve stagnation” and allow for “qi” and blood to flow freely throughout the body’s 12 meridians. If you’d like to learn more or try a treatment, talk to our Naturopath Dr. Kathy Van Zeyl, ND, for more information.

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Click this photo to watch Dr. Kathy Van Zeyl’s video on cupping therapy!

Interferential Current Therapy (IFC) is a treatment to aid the relief of pain and the promotion of soft- tissue healing. It produces electrical currents that pass through the affected area of the body which decrease swelling, reduce pain, and decrease muscle spasms.

Shoulder Test

Questions

1. Side bend your head/neck to the left. Does your right shoulder rise up?
2. Side bend your head/neck to the right. Does your left shoulder rise up?
3. Rotate your head to the left; are you able to rotate completely?
4. Rotate your head to the right; are you able to rotate completely?
5. Bend your head/chin to your chest; can you go all the way?
6. Bend your head backwards, can you go all the way and is there stiffness?
7. Do you get stiffness in your neck or shoulders during the day while sitting?
8. Do you get headaches/migraines?
9. Bring one arm up and the other behind your body, can your hands touch?
10. Go the other way.
11. Bend one elbow in front of you; wrap the other one around – can your hands touch?
12. Go the other way.
13. Are your shoulders even?
14. Roll your shoulders both forwards and backwards; is there tightness or noise?
15. Do your shoulders round forward?
16. Bend the right wrist up, is there stiffness/tension in the arm.
17. Bend the left wrist up, is there stiffness/tension in the arm.
18. Bend the right wrist down, is there stiffness/tension in the arm.
19. Bend the left wrist down, is there stiffness/tension in the arm.
20. Do you round forward at the shoulders?

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