Many times I will see a client when they are on the road back after an injury. A common injury that I have a lot of success with is with the shoulder. The shoulder is a complicated complex that involves many muscles and includes movement of the shoulder blade in respect to the ribs underneath, mobility of the collar bone with it’s two joints on each end, upper vertebrae of the Thoracic spine and of course, the joint, which we all connect with as being the shoulder (where the arm attaches to the shoulder blade). The only part of the whole shoulder that really connect with the rest of the spine is where the collar bone attaches to the breast bone. Other than than, the shoulder relies on muscles, ligament and other connective tissue. It is a very mobile joint.
The main concern with the shoulder complex is that during the injury time, the person will probably not move the shoulder joint through it’s full motion and to protect it, will pull the shoulder forward and inward. It may often be limited to 25 – 50% of it’s movement. There is a law called Adaptive Shortening. This relays that if tissues are in a shortened position for long enough, in this case Chronic Protective Spasms from the injury, then the tissues will stay in that shortened position. This includes the capsules that surround the joint, ligaments, muscles and tendons. Tissues can also compress the nerves in the area possibly affecting nerve conduction. This is where my training in Fascial Release really comes into play. It is my job to release all the connective tissue or Fascia that is restricting normal range of motion of all joints involved. The most common presentations that show post shoulder injury are when the shoulder blade is stuck by it’s surrounding tissues not allowing it’s normal motion during shoulder movement and tissue that pull the Glenohumeral Joint forward and inward dramatically affecting that joints movement.
Once the shoulder becomes mobile, exercises are given to help to help to return it back to function. Again, this is a very mobile joint with lots of joints involved so the exercises are done slowly and gradually. Pool exercises and mobility while laying on the floor are good to start with reduced gravity. Having the shoulder back in neutral position is key so having the client be aware during the day of keeping the shoulder is a better position will determine how quickly the client is able to get back to normal function. Unfortunately, pain and injury will reduce movement dramatically. Sometimes this is necessary but if the person can move the area gently, it encourages circulation to the area, which is beneficial to the muscles and nerves in the area. Part of the assessment is to see what the person is able to do.
Below is a picture in general with respect to the shoulder complex. You can see how the arm attaches to the shoulder blade. The Acromion of the shoulder blade attaches to the Collar Bone that attaches to the Breast Bone or Sternum and is all controlled by ligaments, muscles, tendons and joint capsules.