Your shoulder is brilliantly designed to allow your arm to reach, grab, throw, push, pull, etc., etc., etc., but I’m sure if you have experienced shoulder pain in your lifetime you might argue that there are some flaws in the blueprints. I have seen shoulder pain bring some of the toughest guys to their knees and frozen shoulders put women’s lives on hold for 1-2 years. I personally, have dislocated my shoulder multiple times and eventually had surgery on it in 2001. My shoulders and I are not friends, but I have learned how to keep my enemies close and under control.
Knowing what I know about biomechanics and anatomy, I would still have to support the idea that the shoulder is extraordinarily designed, but I would make the case that it should come with a detailed instruction manual of how to actually use it properly. Your shoulder is a complex ball-in-socket joint that’s function is intimately tied to the posture and alignment of your ribcage and thoracic spine. ‘Normal’ movement in your shoulder requires the ball to spin in the socket, the shoulder blade to slide over your ribcage and your torso to remain in a relatively stable position; a problem in any or all of these factors will lead to dysfunction and eventually pain in your shoulder.
It is not hard to determine what structure in your shoulder may be damaged and hurting, but it can be harder to understand why you damaged anything in the first place. Sometimes why is easy. You may have tried tackling a two hundred pound Kiwi rugby player determined to run through you and your shoulder lost the battle like mine did, but most of the time ‘why’ is more complex than you would like. Shoulder pain usually involves a combination of factors that over time lead to the insidious onset of pain.
I treat a lot of the top Seniors level (35+) tennis players in British Columbia, many of whom compete in the national and world championships every year. These are not professional athletes, but very active adults with full time jobs that work hard and play harder. The combination of work + age + sport inevitably results in aches, pains and unfortunately injuries.
The top five things that tend to bring tennis players into the physio for servicing are:
1. Tennis Elbow
2. Rotator Cuff Impingement
3. Knee Pain
4. Torn Calf/Achilles
5. Low Back Pain
Below I will briefly touch on some of the principles you should follow in dealing with these injuries as they relate to tennis, age and work.
Lateral elbow pain does not necessarily follow the “if it hurts, ice it” rule. Nine times out of ten the root cause of lateral elbow pain stems from your neck and the back of your shoulder. It is usually an irritation of your C6 nerve root in your neck and the radial nerve in your arm…that being said, if your elbow is hot, red and swollen, go ahead and ice it, but don’t expect just ice and rest to fix the problem. Hands down the best way to fix tennis elbow is to go for IMS acupuncture to calm down the nerve irritation. Once the arm feels better have a physio teach you how to move more efficiently so your swing doesn’t create too much strain on your neck and shoulder. You may also need a tennis pro to adjust your technique and/or your racquet.
Suggested articles: Elbow Pain: why it can last so long & how to fix it properly Why Elbows Hurt
Rotator Cuff Impingement
Most shoulder pains are some form of an impingement (which implies a pinching of one or more of the tendons of your rotator cuff).
IMS stands for intramuscular stimulation and is an anatomy specific form of acupuncture performed by specially trained physiotherapists and some doctors. It has its roots in traditional Chinese acupuncture, but is fundamentally different in many ways. IMS uses Western medicine’s understanding of the neurophysiology of pain and Dr Chan Gunn’s assessment techniques of identifying underlying nerve irritations to treat chronic pain issues. The technique does use acupuncture needles, but not in the way someone practicing traditional acupuncture would. Traditional acupuncture focuses on pre-mapped out points in the body that relate to different organs and meridians of energy running through the body. Fine acupuncture needles are then inserted into a number of these points and the person rests with them in for 10-20 minutes. It can be very useful for the right condition, but it is not as specific or as purposeful as IMS.
To understand why IMS is performed the way it is you should have a basic understanding of how your body experiences pain. If you haven’t already, please read the article titled Why Things Hurt: Explain Pain.
When a physiotherapist performs IMS he will first assess your basic posture and movement patterns to look for some common signs of underlying nerve irritation. The most common one is to palpate for tender bands or knots in particular muscle groups. He will look for restriction of movement in major joints such as your hips and shoulders and note the appearance of the skin and muscle tissue on either side of your spine. When there is an underlying nerve irritation in an area, the skin can start to look like the rind of an orange peel, feel thickened and respond differently to light touch. A person may develop goose bumps easily and/or have areas of coolness or hair loss. The therapist will take all these things into account when determining where to treat you. Read More
Chest up, shoulders back and down is the best posture
Most people think of posture as simply the need to keep your chest up and your shoulders back and down. Sounds like a simple feat right?! Then why will most people admit that they think they have bad posture? The answer to that is because good posture is not a simple thing, it is actually a learned, coordinated skill that encompasses the whole body. We are what we repeatedly do and our posture is a reflection of our childhood, our sports, our jobs, our emotions and our attitudes.
There is a continuum of flexibility and mobility among the population. Some people are naturally very loose jointed and hypermobile while others are compressed and stiff as a board. Where you end up on the spectrum seems to be partly genetic and partly personality. The people that fall in the middle or the average/normal people tend to have the least pain and injury problems. The further a person strays in either direction from the average the more and more posture, movement and pain problems they tend to develop. There is not one perfect posture for everybody, but there is a norm that we should all be trying to achieve no matter which side of normal we are on.
“Stiff as a board” “Normal” “Loosey-goosey”
Our bodies are brilliantly built to deal with gravity as a constant downward force, unfortunately most people don’t know how to use their bodies properly or efficiently and end up with muscle imbalances, pain and dysfunction. Posture should be looked at as a life skill not a genetic trait we can blame on our parents. A very basic understanding of anatomy and biomechanics can save people a lot of grief throughout life. Read More
If you experience an acute accident or injury, like spraining your ankle, it is easy to understand why your ankle may hurt. You likely tore some of the ligaments and or muscles around the joint and experienced subsequent swelling, bruising and inflammation. Over a four to six week period your body typically fills in the torn tissue with scar tissue and then slowly remodels it back to its original state. Sometimes though the pain persists beyond six weeks even though all the swelling and bruising have long disappeared. Other times pain appears for no apparent reason in the complete absence of an injury and you can’t understand why or what you did wrong.
Nerves are the electrical wiring of your body. They supply the energy for all your muscles and organs to do their jobs. Your brain and spinal cord are like the electrical fuse box of your body and your spine and skull are their protective coverings. Peripheral nerves extend out from your spine at every level on both the left and right sides. The nerves that extend from your neck are responsible for most of the muscles in your shoulders, arms and hands, while the nerves that come from your low back enervate all of the muscles in your hips, legs and feet. The nerves in the middle are responsible for your trunk and a lot of your organs.
Muscles are comprised of a whole bunch of stringy tissue that can stretch and contract. The muscle should have a certain amount of resting tone in it, i.e. at rest it is slightly contracted, not flaccid or extremely tense; this is dictated by the input of the nerve. Read More