Thursday, August 29, 2019

The Shoulder, the Most Mobile and Troublesome Joint in the Body

Brian Watters, DC, MS, CSCS

The purpose of the shoulder is to be the most mobile joint in the entire human skeleton. With mobility, however, there is inherent instability. We need a very moveable joint for our upper extremities since many everyday tasks require us to move this appendage in a multitude of ranges in front, above, and behind us. With this great benefit comes a risk: instability.

When most physicians talk about instability, they are referring to something that can be very dangerous. Example: In the Lumbar spine, instability can result in nerve damage. Instability is a term used very loosely to mean different things. In the shoulder is means that there is no bony structure surrounding the joint to provide stability, it is purely muscular and ligamentous. Herein lies the problem. Anywhere there is a muscle or ligament, there can be excessive force placed on the joint that becomes damaging or there can be weakness or misuse of muscle that can be damaging to the surrounding joint.

To be moveable in everyday life we need flexibility, and the shoulder is no different. When we think about the life of an active person, especially in terms of lifting in the weight room, we need good flexibility for overhead motion in a slew of overhead movements. We can typically address flexibility in the overhead arena very efficiently based on an overhead squat. If the arms drop forward or the Thoracic spine does not extend we need to work on T-Spine extension and/or shoulder flexibility. It could be chest (pec) tightness, back (lat) tightness, posterior shoulder tightness, or an entire list of things. We can foam roll, stretch, mobilize, use PVC pipe, etc. What happens if there is still an issue in flexibility or even pain during a movement that needs a solid shoulder?

Stability is the answer. But not blind stability. We need to address the deficit in the muscles surrounding the shoulder, such as in the rotator cuff, or look at correcting movement of the scapula by stabilizing the muscles involved in scapulohumeral rhythm. This takes a trained eye to spot and diagnose, but many are very obvious. Most pain syndromes, in fact, are caused by inability of the muscle moving the scapula to work in chorus with one another and needs to be addressed.

We always address shoulder flexibility in a joint, but when that doesn’t correct the issue we need to talk about stability. We already coach it by saying things such as “bend the bar” and “activate your lats”. But when the shoulder still has issues, we need a targeted approach to specific muscles in the scapular and rotator cuff areas.

Train Smart.

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