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The Shoulder Joint Complex

The shoulder is a complicated joint complex that is many times trained improperly and often resulting in serious injuries.  To understand the importance of your shoulder joint, you must first understand the biomechanics of the shoulder joint complex.   Many exercise enthusiasts see the shoulder joint complex as the pectoralis muscles (chest muscles), deltoids (shoulder muscles) and trapezius, however, the more important muscles are the stabilizing muscles of the shoulder joint that lie beneath the larger, more often exercised muscles.

The important thing to remember about the shoulder joint is that it is not a true joint”.  A true joint is comprised of two articulating surfaces of a bone that are surrounded by a synovial capsule (for lubrication and movement).  The only articulating joint for your entire arm is where the breast bone (sternum) meets the collar bone (clavicle).  The rest of the shoulder complex is a series of muscles, ligaments and tendons that have to work in synchronicity every time the shoulder moves.  This means that shoulder stabilization is pivotal to allow for proper biomechanics, but more importantly, stability is necessary to prevent injuries.

The shoulder complex can be broken down into several basic movements.  Those movements are abduction (movement away from the torso), adduction (movement towards the trunk or across the torso), internal rotation and external rotation.  These movements are accomplished by the supraspinatus, infraspinatus, subscapularis and teres muscles.  The pectoralis, latissimus, and trapezius are gross movement muscles and would not be able to perform there perspective duties without the control of the stabilizer muscles.

Exercising the stability muscles of the shoulder complex is an absolute necessity if you are to maintain a healthy shoulder complex.  Some of the most basic ways to stabilize a shoulder complex is simple exercises in external and internal rotation with light weight and the arm at 90 degrees as well as the arm at the side.  TYI’s are another great exercise for shoulder stability.  These should be performed at the beginning of every workout that will involve shoulder movement.

Without shoulder stability, your odds of suffering a shoulder injury increase significantly.  Continued weakness or instability can quickly lead to increasing problems with stability or impingement of the soft tissue (AKA muscles) resulting in pain. When a shoulder in injured, the pain patterns felt can be confusing and elusive.  You may feel pain only when the shoulder moves, or all of the time.  The pain may be temporary and disappear in a short amount of time, or, it may continue and require special diagnosis and treatment.  The important thing to remember is that pain is a sign that there is damage.  When there is damage, you should have it examined by a health professional.

Because of the complexity of the joint, there are many pain provokers.  Some of the most common injuries that result from instability include bicipital tendonitis, supraspinatus sprain/strain, the gleno-humeral labrum (joint capsule), the acromio-clavicular joint, the coraco-clavicular joint, trigger points in the teres major, teres minor, supraspinatus, infraspinatus, the anterior, medial and posterior head of the deltoid, pec major and minor, subclaviculus, and trapezius…..and those are just the more common ones.  Shoulder injuries can be very complicated and proper examination and rehabilitation is pivotal in preventing more serious problems later in life.

Muscles have interesting pain patterns.  Dr. Janet Travel, John F Kennedy’s personal physician conducted landmark research in the field of muscular pain patterns discovering that many times, muscles will refer pain in other parts of the body away from the injured muscle.  This is called a muscular pain referral pattern.  Understanding some of these pain patterns will help you identify what muscles are weak and problematic as well as need stability.  The more common referral patterns seen in exercise enthusiasts and athletes are:

  • Bicipital tendonitis – presents as a sharp pain in the anterior shoulder region.
  • Trigger point referrals from the stability muscles present with anterior shoulder pain, pain radiating down the arm, pain in the forearm, as well as hand numbness and tingling.  The pain that travels down the outer part of the arm to the wrist can even mimic a cervical disc injury.
  • Bursitis in another common shoulder injury that will result in pain at the outer part of the deltoids and be provoked with any movement greater than 15 degrees.
  • Supraspinatus Strain/Sprain can cause pain and tightness at the top of the shoulder region and is involved in over 50% of all shoulder injuries.
  • Infraspinatus can refer pain down the front of the biceps to the wrist.

Once a muscle is injured, it is strained and usually turns spastic or hypertonic.  When this happens, the constant tension will cause micro-tears in the muscle.  Once this happens, your body will lay down fibrotic tissue in an attempt to protect and stabilize the muscle.  When this happens, altered biomechanics result in the entire shoulder complex which leads to other injuries in adjacent muscles since the entire shoulder must work in synchronicity causing further damage and injury.  At this point of the injury, an intense regiment of myofascial release and specific soft tissue manipulation can help break down the fascial adhesions and start to restore proper motion of the girdle.  Once the muscles are moving properly, the shortened muscles start to lengthen , and the weakened muscles undergo a course of strength, conditioning and rehabilitation.  The longer the injury is present, the longer it takes to repair normal function.

The take home message of their article is to stress the complexity and synchronicity of the shoulder complex and the importance of stability.  I treat shoulder injuries on a daily basis and the two most common causes of shoulder injuries is muscle imbalance and weakness, and exercising with two much weight with an imbalanced shoulder.  Hopefully, this article will make you more aware of this importance and not only get you to start stabilizing you shoulders, but more importantly, seek proper treatment if it is.

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