by Allyson Friday, PT, DPT, OCS
As a PT, an athlete, a sloucher, and a former shoulder patient, I know a thing or two about shoulder injuries. And If I could tell you the most important thing about the shoulder, I
would. But I can’t, because there are many important things. The shoulder is often referred to as the “shoulder complex”, and it’s just that, complex. The design of the shoulder allows for a lot of motion, yet little stability.
Which leads me to the first important thing – strengthening. Every injured shoulder needs strengthening. In fact, it’s safe to say that every shoulder needs strengthening, injured or not. Proper strengthening is injury prevention. But you already know that –there are still 4 more essential components to shoulder rehab that you need to know.
2. Motor control. I could list a dozen excellent exercises for the shoulder, and I’m sure you could find a dozen more online. However, if you do them improperly, you are likely reinforcing a poor movement pattern. Motor control means activating the right muscles at the right time for each movement. For instance, if I ask you to lift your arm above your head, and you hike your shoulder to your ear, you are overusing your upper trapezius muscle.
For those who have been doing strengthening exercises faithfully and still hike your shoulder, the problem may be motor control. This is where the trained eye of your PT can help you fire the appropriate muscles at the right time. The upper trapezius is supposed to work when you lift your arm, but it’s not supposed to dominate the movement.
3. Joint mobility. While I can generalize that strengthening is important for everyone, the need for joint mobilization is very patient specific. Some shoulders suffer from too much mobility, while others are too stiff. We often think of the shoulder as a single joint, but it’s actually a complex of four joints affected also by the upper back and elbow. We always consider the surrounding joints when treating the injured joint, because limitations in surrounding joints often cause increased stress at the joint in question.
4. Posture. Sit up straight! You don’t want to hear this, do you? And yes, I myself just had to make a postural correction as I typed. Poor posture has a direct effect on the shoulder. It causes you to round your shoulders, which tilts the shoulder blade forward and creates impingement. Often we find ourselves hunched over the computer with a rounded spine, shoulders to ears, and then wonder why our shoulder isn’t getting better! The point here is that 30 minutes of PT exercises and a few PT visits a week are not enough to create change. Real change requires an awareness of postural habits in the rest of your life. And sitting up straight doesn’t mean throwing your shoulders back and arching your low back. Good posture starts from the core with a gentle engagement of the lower abdominals, while relaxing the upper trapezius and setting the shoulder blades on the back. Good posture shouldn’t feel like a strain.
5. Specificity. The fun part about treating the shoulder is the specificity required. This is where the list of important things is infinite. Every person has a different combination of history, weakness, degree of injury, tolerance to treatment, anatomical variation, as well as different goals and motivation. While the principles of the joint remain the same, individual variability surrounding the structure makes every case interesting. So the treatment that worked for your friend’s shoulder may not work for yours.
From my experience with shoulder injuries, the key to resolving problems is to do your shoulder exercises properly, support your shoulder with good muscle activation and proper mechanics, seek early treatment when you have pain, and sit up straight! The shoulder is a complex and delicate joint, necessary for both drinking your beverage of choice, and swimming many miles; clearly, having a healthy shoulder is vital! Each injury is different, but consideration of these five key elements of shoulder health will get you well on your way to a full recovery.