My Shoulder Hurts and I Don’t Know Why

My Shoulder Hurts and I Don’t Know Why

Both chronic and acute shoulder injuries stem from one main concept, the fact that at the shoulder joint we sacrifice stability for mobility. In comparison to the ball and socket joint of the hip (which is our prime example having extra stability in the place of reduced mobility), think of the shoulder as more of a “ball-on-a-tee.” Our humerus acts as the “ball” and the glenoid fossa of the scapula (or shoulder blade) acts as the “tee.” While it may grant us the ability to style our hair, it leaves us susceptible to injury, nature’s way of saying you can’t have your cake and eat it too.

Shoulder Injury

Down the acute path, many injuries result from an inability of our surrounding musculature to accept the force of an external load such as wall, or the ground. We slip and fall, and instinctively use our arm to brace ourselves against an immovable ground (as the alternative of landing directly on our butt or face isn’t appealing to most). Sometimes we play sports that present unexpected collisions; sometimes we straddle an 1800 pound bull and hope that the arm we strapped to it will be hold for 8 seconds. In all cases, the force is transmitted up our arm towards the shoulder joint where our surrounding musculature will either succeed in dissipating those forces, or be overmatched and rely on our passive support structures (ligaments, capsules, bone) to accept the force. In these cases, prevention is a difficult, and recovery is more about managing pain and finding ways to maintain strength, promote tissue recovery, and reduce the amount of compensation we will instinctively do as we allow the damaged tissue to heal. Injuries that typically fall into this place would be glenohumeral dislocations (“popped your shoulder out”), AC sprains (“separated shoulders”), and rotator cuff strains.

Chronically, however, many injuries we encounter in this stream are preventable, and have long term solutions. If we are required to throw baseballs as hard as we can repeatedly, or reach up to hold and hammer nails on a day to day basis, pain and discomfort can occur as a result of irritation, compression, and distraction forces created by our own biomechanics.   Think back to our “ball-on-a-tee” concept, good quality shoulder movement and strength will be the result of good congruency between the ball and the tee not only at rest, but throughout our entire range of motion.   If our ball starts to sit too far forward on our tee (from hunching over a desk or repeated movements), we begin to demand more stability out of structures on that side as they struggle to keep the ball in place. In these cases we start to see injuries such as biceps tendinopathies and labral lesions. Sometimes we develop the movement pattern of trying to move our arm without securing it against scapula. Our rotator cuff, which is a collection of muscles responsible for securing that ball on the tee, now has to work harder to keep up and eventually fatigues and starts to become damaged. The challenge for recovery in chronic injury lies in determining what structures are causing the irritation, and why.

Keep an eye out for future blog posts as I dive into all things shoulder related.

Jeff Peach CAT (C), CSCS, Absolute Baseball Academy and Junior Dinos Baseball Coach

brandonthome@gmail.com

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