As we get
older, years and decades of mechanical stress may lead to deterioration of
joints, ligaments, and tendons. This degenerative process, commonly known as
arthritis, primarily affects weight-bearing joints such as the hips and knees
and those found in the lumbar spine. The shoulder, too, is especially prone to
undergo arthritic changes owing to its extreme mobility. The extensive range of
motion at the shoulder is built-in to the design of this structure, but the
tradeoff is instability. The design of the shoulder sacrifices stability for
mobility.
Degenerative
disorders of the shoulder typically involve the rotator cuff. This broad, flat
structure is composed of the muscle-tendon units of the four rotator cuff
muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor. The
thick covering of the rotator cuff surrounds the head of the arm bone and
supports and strengthens the shoulder joint.
But owing
to the shoulder's inherent instability contrasted with its great mobility, the
soft tissues of the rotator cuff undergo repetitive stress and strain more with
bad posture. Ultimately, degenerative changes may occur, leading to the two
prominent symptoms of pain and restricted range of motion.
An entire
orthopedic sub-specialty focuses on treatment of chronic shoulder pain and
includes long-term use of anti-inflammatory medication, corticosteroid
injections when medications do not provide sufficient relief, and eventually
surgery to repair tears in the various rotator cuff tendons.
"Revision" surgery is commonly performed when the benefits of prior
surgery are exhausted.
The good
news is that in many cases, a more optimal approach is available, one that
utilizes the body's own natural recuperative powers. For many people, chronic
shoulder pain can be reduced and chronic loss of mobility can be improved by
engaging in specific activities and performing specific rehabilitative
exercises to strengthen and correct postural imbalances.
The goals
of rehabilitation are to increase shoulder range of motion and build up
shoulder strength. As these goals are accomplished, the likely result is
reduction of intensity and frequency of occurrence of shoulder pain. Posture is
the #1 objective to correct to relieve stress on the nerves to the shoulder
coming from the neck.
Engaging
in an overall strength training program is an important general approach to managing
chronic shoulder pain. Strength training should be done progressively, starting
with light weights and building up over time. Exercises specific to the
shoulder include seated dumbbell or barbell presses, dumbbell or cable lateral
raises, seated bent-over rows, and internal and external rotation exercises
done with very light dumbbells on a flat bench.
If one has experienced an acute shoulder
injury, early rehabilitation should precede rehabilitative strength training.
Early rehabilitation includes pendulum exercises and finger-walking up a wall
in both forward-facing and side positions.
At
Chiropractic USA we’re experienced in sports and
injury rehabilitation and will be able to help you design an effective
flexibility and strengthening program for improved shoulder function. Call us
today (916) 973-1661
References:
Keener
JD: Revision rotator cuff repair. Clin Sports Med 31(4):713-725, 2012
Lewis
JS: A specific exercise program for patients with subacromial impingement
syndrome can improve function and reduce the need for surgery. J Physiother
58(2):127, 2012
Andersen
LL, et al: Effectiveness of small daily amounts of progressive resistance
training for frequent neck/shoulder pain: randomised controlled trial. Pain
152(2):440-446, 2011
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