Shoulders
From the simplest daily activities, such as picking up our children to more strenuous activities such as lifting weights, our shoulders get a lot of use! While there are many structures that help make up the shoulder, a key component is the rotator cuff. The shoulder is one of the most flexable joints in the body and the rotator cuff helps move and guide it through extreme ranges of motion.
The Rotator Cuff
What is the rotator cuff? The rotator cuff is a group of 4 muscles that help make up and move your shoulder. Seen in the picture to the left are 3 of those muscles located on the back of the scapula (shoulder blade). The fourth muscle, the subscapularis (not shown) is located on the front of the shoulder blade and deep in the armpit. These muscles also help support and keep your upper arm bone (humerus) against the shoulder blade (scapula). Where the two bones come together is called the glenohumeral joint (see this months spotlight).
How do these muscles move the shoulder? The supraspinatus muscle helps raise your arm away from your side and over your head. The infraspinatus and teres minor muscles externally rotate or turn your shoulder out when your arm is at your side. The subscapularis muscle internally rotates or turns your shoulder in when your arm is at your side.
How does the rotator cuff become injured? The rotator cuff can be injured a number of ways. Repetitive activities such as years of baseball pitching, tennis, swimming or activities involving the use of your arms over your head such as moving boxes in/out of storage can irritate the rotator cuff. The rotator cuff can also become injured due to direct trauma such as falling on your shoulder or dislocating it. Injuries can present as pain, weakness, or loss of range of motion in the shoulder. Because the rotator cuff helps provide a majority of the support to the shoulder, a great amount of stress is placed on it making it susceptible to injury.
How is the rotator cuff treated? The first step is to regain normal range of motion with little to no pain. This is done with passive stretching as well as manual therapy techniques such as Active Release® and Graston®. Using these techniques, the muscles of the rotator cuff are stretched and loosened, as well as relieving muscles that are overcompensating due to the injured rotator cuff. Once normal pain free range of motion has returned, exercises are incorporated to help strengthen not only the rotator cuff but the whole shoulder.
| Spotlight: Glenohumeral Joint
The glenohumeral joint connects your arm to your shoulder and is responsible for most of the motion through your shoulder. When looking at the joint, notice how the joint itself is very shallow, it is almost as if the humerus is just resting against the glenoid fossa (see below) of the scapula. Because of this, there is not much support but it allows the shoulder to be very flexible and the arm is able to move quite far in a number of different directions. Since the joint is shallow (as opposed to your hip) the structures (muscles, labrum, etc.) in your shoulder must do a lot of work to help keep you arm in place. Due to the glenoid fossa being shallow, the shoulder is one of the easiest joints to injure in your body. 
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Are there other things that can cause shoulder pain? Yes! While injuries to the rotator cuff are very common, there are a number of ways and causes that the shoulder can become injured. Other injuries to the shoulder that commonly occur include shoulder sperations, impingement syndrome, and muscle strains.
Stretch of the month: Chest Stretch
What does it stretch? The pectoralis muscles on the front of your chest.
Why should you do it? Even though many people do not think of this as affecting the shoulder, it most definetly does. When your chest is tight, it can pull your shoulders forward. When this happens, it causes the shoulders to work harder than normal to hold them in proper postion.
How should you stretch it? To stretch your chest, you will need a doorway or a sturdy cabinet. Start by having your elbow slightly above your shoulder. Once in this position, rest your arm against the doorway or cabinet, making sure that your feet are planted firmly on the ground to avoid falling. Once you are stable, gently lean forward, feeling a stretch through your chest. You can also try to slightly rotate away from the side being stretched as well. This stretch can be performed with the arm is a number of different positions as well. You can also have your elbow at shoulder height. Hold each stretch for 20 seconds and repeat as necessary throughout the day. Remember to make sure that your feet a firmly planted and you are not off balance. If you have a history of shoulder dislocations pay attention to your shoulder when stretching your chest. Don’t force the stretch and if you feel as if you shoulder were to give way, back off and stop stretching immediately.
"Helping you reach the finish line pain free!"
If you have an injury, or a previous health condition, check with your doctor before performing any of the information mentioned in this article.
Dr. Bradley R. Schmidt, D.C.-As a three time Ironman Hawaii finisher, as well as, a college cross country runner, Dr. Schmidt has suffered his fair share of injuries. He enjoys sharing his first hand injury experiences from training and racing, incorporating them into the treatment of his patients. Dr. Schmidt also incorporates techniques such as Active Release®, Graston®, Active Isolated Stretching, and Kinesio® Taping. By combining athletic experiences and effective treatment techniques, Dr. Schmidt is able to understand and help athletes and patients reach the finish line pain free!
Questions? E-mail us at drschmidt@excelsporttherapy.com or visit www.excelsporttherapy.com
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All information copyright Dr. Bradley R. Schmidt, D.C.