- by Grant Twentyman (Musculoskeletal Physiotherapist)

There are many possible causes of shoulder pain. These range from acute injuries such as a muscle or tendon strain from lifting a heavy bag of groceries, to chronic injuries including postural or overuse conditions.

To give you a greater understanding of how dynamic and interesting the human shoulder is, here’s a simple anatomy lesson. The upper arm bone – and arguably the most hilarious bone in the human body – the Humerus, is ball-shaped at the top. This ball fits into the ‘socket’ of the shoulder joint. The roof of the shoulder socket is a bony structure called the Acromion.

At the outer-front of the shoulder there’s a small but very important space beneath the Acromion, and above the ball of the Humerus – called the Subacromial Space. This space is passage for some important structures – primarily the Supraspinatus tendon and the Subacromial Bursa.

How is this jargon relevant to me? You may ask…

If the subacromial space is decreased, this causes painful pinching of the sensitive supraspinatus tendon and/or subacromial bursa as you raise your arm. This is called Impingement Syndrome. These pinched structures become inflamed, swollen, and therefore get pinched even harder.

How does the subacromial space get decreased?

A large proportion of people today spend a lot of time at a computer. This may be due to the nature of their job, studies, or excessive Facebook status updates, “Grant Twentyman is about to go to the toilet”. If you adopt the typical computer-pose (shoulders slumped forward, chin protruding towards the screen), this decreases the subacromial space. Done day after day, this can cause tightening of front structures and/or weakening of the back structures, narrowing your subacromial space.

Another scenario is the testosterone-fuelled male at the gym, maxing out on the bench press every day to build massive pecs and shoulders. If he neglects ‘pulling’ exercises like seated cable row or pull-ups, he can get a muscle imbalance (and also appear quite ape-like), decreasing the subacromial space.

Other causes include a ‘hooked’ shaped acromion, or bone spurs caused by arthritis.

Impingement syndrome is characterized by shoulder pain and weakness while raising the arm, and often aches while lying in bed at night.

Physiotherapy and Pilates are excellent ways to resolve impingement syndrome. As a Physiotherapist, I can manually loosen your tight anterior structures and prescribe a few key exercises to strengthen posterior structures, opening up that subacromial space. I may also suggest either over-the-counter anti-inflammatories like Voltaren, or fish-oil as a great natural alternative, to ease pain and bring the inflamed tendon and bursa back to a healthy size.

To really fast-track your shoulder back into balance, Pilates is a fantastic way to activate and strengthen your shoulder retracting muscles, get your shoulderblade back, and open up your subacromial space. A skilled Pilates instructor can ensure you perfectly activate the most important muscles, and correct your problematic posture.

If you have an ache in your shoulder, whether it’s from long days at the office desk, excessive throwing at cricket training, or updating your Facebook status every time you eat a sandwich, get professional help from a LIVe Physiotherapist and Pilates practitioner as soon as possible. This gives you the best chance to sort out the problem while it’s easily fixed, and reduces the risk of the tendon becoming chronic, degenerative and all-round nasty. Having said that, if you’re already at that stage – we can help you with that, too.

 

Key Words: Shoulder Pain, Shoulder Injury, Shoulder Physiotherapist, Shoulder Physiotherapy, Physiotherapist Applecross, Physiotherapist Fremantle, Shoulder Ache