Summer shoulder care

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With summer in full swing, the tennis courts are full and the cricket pitch is being well used. With so many people picking up a racquet or throwing around a cricket ball, we are seeing a lot of new shoulder injuries at Advance Wellness Centre.  Many of these injuries can be prevented or reduced in severity if you follow a few of the principles below.

First a quick anatomy lesson.  Most people know that the shoulder is a ball and socket joint, but don’t realise just how shallow the socket is.  When I was at school in Ohio we had a shoulder specialist who worked with the local major league baseball team and he compared the stability of the shoulder with that of a bowling ball sitting on a golf tee.  In other words, not very stable at all.

The shoulder is primarily held in place by a variety of muscles and ligaments, rather than bony structures. The smaller and deeper group of shoulder muscles are called the ‘rotator cuff’ muscles. They are a group of four muscles which act as stabilisers to hold the upper arm to the shoulder blade. In order for the shoulder joint to work correctly, all of these smaller muscles are required to work in unison with each other, as well as the larger muscles of the shoulder girdle.

At the moment the most common injury we are seeing is impingement or pinching of the deep rotator cuff muscles.

Here is a brief description of impingement:

Impingement – Pressure on one or many of the rotator cuff tendons, which can lead to tendonitis (inflammation of the tendon), tears and bursitis (inflammation of the bursae. Signs can include increased pain with use, increase in pain and stiffness morning or night, tender, red, hot to touch or ‘crunchy’ feeling/sound when moving the shoulder.

In our sitting-dominated society we are constantly in a head and shoulders forward posture which tightens the structures at the front of our shoulders and chest and stretches the structures behind our shoulder joint, such as the scapula stabilising muscles.  This imbalance can lead to muscle shortening, impingements and bursitis in the shoulder region.  As soon as this happens your racquet game or throwing game will be severely restricted.

So how can you tell if your shoulder is too tight? Below is a simple ‘test for tightness’.

Simple test for tightness

Based on the Functional Movement System (FMS)

The shoulder mobility reaching pattern
This looks at the movement relating to the scapular/thoracic region, thoracic spine and rib cage. The pattern looks at both shoulders range of motion. When doing the movement the neck and surrounding muscles should remain relaxed and there will be a bit of natural extension in your thoracic region. It is easier if someone else can assist with the measuring.

Procedure:
Firstly, measure your hand length from wrist crease to the tip of your longest finger. Stand with feet together and make a fist with each hand, thumbs inside the fingers.

All in one motion and at the same time reach one fist behind the neck and the other behind the back. During the test the hand should move in one smooth motion and remain fisted.

Now measure the distance between the two closest points of the hands. This test can be performed three times bilaterally.

If the fists are within one hand length (score 3) then that is good, if within one-and-a half hand lengths (score 2), not so good and greater than one-and-a-half hands (score 1) this is poor.

At the end of the mobility a ‘clearing test’ of the shoulder needs to be done to ensure no impingement is present as it can sometimes be undetected by the shoulder mobility test.

Once again, this test can be performed with each arm. If pain is felt it should be noted and a score of zero given for the entire shoulder reach test.

The procedure is as follows. Place the palm of right hand on left shoulder and lift your right elbow as high as possible, while keeping your palm on your shoulder.

So you have now scored your shoulder mobility. What can be done if there is some pain or lack of movement?

A couple of options to start with are foam roller exercises and strengthening scapula stabilising muscles.

Foam roller
Benefits of using a foam roller include; reduced tension around neck, back and shoulders (can mean less headaches), improvement in posture by getting the spine into a ‘neutral’ position, increased circulation around the body, after exercise can reduce lactic acid and muscle soreness and if regularly used can reduce injuries and increase flexibility. They are aimed at stretching and massaging tight structures around the shoulder joint complex to increase functional range of movement.

shoulderexercise2Back – (Thoracic spine neutral relaxation).
Lay on roller lengthwise down spine. Press your lower back into the roller and relax. Press the back of the neck (not the head) into the roller and relax. Rest elbows on ground for balance. Relax shoulders. Let back muscles relax over the roller for 5 to 10 minutes.

Chest stretch – In this position to increase the stretch through your chest you can hold your arms out 90 degrees to your body. Hands and fingers should be comfortable. Hold this position for 30-40 seconds to prevent hands and fingers from going numb.

Shoulder release – Another movement, in this position for additional shoulder range can be, raising both hands back over your head, slowly and pain free towards the ground.

Strengthening scapula stabilisers
Once again, these exercises can be done by most people, if not then please give us a call.

The emphasis is on ‘quality’ not ‘quantity’. It can take some getting used to switching these muscles on and off as they are not easily visible and are generally stretched and weak with the increased forward posture lifestyle of today.

You will need a Swiss ball, some 1 kg hand weights and possibly some guidance at first until you get ‘the feel’ for the exercise.

shoulderexercise1‘W-hold’ (see pictures)
Have feet against the wall, lie face down with chest area on Swiss ball, keep spine and neck in straight position. Look at the floor and let arms hang down.
Gently, retract (draw shoulder blades together) then keeping arms straight pull backwards up to level of body, at a 30-50 degree angle, pull together shoulder blades. In a controlled movement extend hand out so elbows are straight. Hold for 30 to 60 seconds.

T-Hold (see pictures)
Same position as ‘W-Hold’ but with arms extended 90 degrees at shoulder height. Repeat as above.

So three simple stretching exercises on the foam roller and two simple strength exercises which will do a lot of good for your racquet game and throwing game.

If you are still struggling with any of these or want a full assessment of your movement mechanics please feel free to give us a call at Advance Wellness Centre.

www.advancephysio.co.nz

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