I wanted to write about my experience with shoulder pain and both presents between the shoulder blade but more commonly presents at the top of the shoulder from the neck to the tip of the shoulder, sharp pain at the front of the shoulder that can travel down the arm. There can also be presentations of headaches, nausea, dizziness and numbness or tingling in the hands. I find that with all these symptoms, there is on general common presentation.
What I generally notice is:
1) There is a moderate mid back extra curvature that is slight but causes the upper back to be slanted forward slightly. This will cause the shoulder blade to move away from the spine.
2)The shoulder blade has moved away from the spine in the back. This is will cause weakness in the Rhomboid and Middle/Lower Trapezius muscles, which are located between the shoulder blade and spine. A rotator cuff muscle called Infraspinatus that rotates the shoulder outwards is also weak allowing the shoulder blade to be in a more inward rotated position. This is an important thing as any time you bring your arms up, there needs to be an external rotation of the shoulder or it will pinch structures that are important to good biomechanics. The pinching is what can cause the local pain in the front of the shoulder and can cause achy referrals down the arm.
3)When the shouder begins to pinch and not move properly, the muscle between your shoulder and neck can be overworked and cause local pain and headaches in the temple region. This muscle is the Upper Trapezius.
4) At the same time that there are these muscle in the back that are becoming stretched and weakened, there are muscles that can become shortened and stuck so that are unable to lengthen. These muscles hold the shoulder in a forward position. These muscles include the Pectoralis Minor and Major muscles, a portion of the Bicep muscle in the arm, Serratus Anterior (that pulls the shoulder blade around the side of the rib cage) and a Rotator Cuff muscle that attaches to the front of the shoulder called Subscapularis.
5) Another important thing that can happen is that the head of the arm bone (that fits in the joint) moves a little forward in relation to the joint surface. The shoulder joint is fairly shallow and stabilization of the arm in the joint relies very much on local ligaments and muscles and the joint capsule (that surrounds the joint).
So as we dominantly do things in front of us all day, the mid back can cause us to be a little more stooped forward, causing the shoulders to move more forward pulls the shoulder blade away from the spine. This all causes pinching in the shoulder during movement and weakness of important stabilizing muscles and overworks other muscles.
So the simple solution is to bring the shoulders and shoulder blade back but in most cases, the muscles and tissues at the front of the shoulder is so tight and adhered that it is impossible for the person to bring their shoulders back.
It is my job to make the spine more mobile, make sure the shoulder blade is mobile, and make it easier for the person to hold their shoulders in the position that they should be in. But creating mobility is only half the job. Exercises are given to help the person to keep tissues stretched, keep awareness of the good shoulder position and to learn to move the arm around keeping the good shoulder blade position so that shoulder biomechanics are at it’s optimum without pinching sharp pain, muscle strain, headaches, backaches or pain/tingling down the arm.