It allows us to manipulate objects in an infinite number of directions at various speeds. The shoulder is the most mobile joint in the body and provides many degrees of motion. This freedom of motion allows us to reach high and low, far and near for objects in space.
A large amount of shoulder mobility does not come without a price. An increase in shoulder or (Glenohumeral Joint) mobility leads to a decrease in the stability of the joint. When a joint is unstable, it is more likely to suffer an injury.
This movement can vary from typing at a computer with poor posture to an unstable tennis or golf swing.
Shoulder injuries are not discriminatory to a specific sport or action. They affect both male and females athletes and non-athletes alike.
The following guidelines in this article will help to prevent the possibility of developing a shoulder injury due to overhead sports, poor posture and improper weight training.
Aside from these joints, there are other anatomical structures that play a large role in normal shoulder function. These include
Full shoulder flexion in the sagittal plane in a normal adult is 180°. This movement is not accomplished by the glenohumeral joint alone.
In fact, full arm elevation involves a thoracic extension, the 1st & 2nd ribs must depress and move posterior, the scapula (shoulder blade) must rotate upwards, the clavicle needs to elevate and roll back and finally the glenohumeral joint needs to glide downward and roll upward.
The most common area of injury to the shoulder occurs in what is known as the sub-acromial space.
This space is located just under the acromioclavicular joint. There are many structures passing through this space leading to a very tight passage. Included in this space is rotator cuff tendons, neurovascular bundles and other connective tissues.
Inflammation will take up valuable real estate in the sub-acromial space leading to possible impingement of the tendons, nerves or vasculature.
The job of the four rotator cuff muscles (infraspinatus, supraspinatus, teres minor & subscapularis) is to synergistically contract at the same time to hold the shoulder centrally in the glenoid fossa to maintain a precise axis of rotation.
This movement reduces space in the sub-acromial region which often leads to rotator cuff impingement. The rotator cuff tendons rub against the acromion causing friction, inflammation and eventually will tear if not resolved.
When positioned in a seated position, gravity works against us to pull our head and shoulders forward. This posture leads to a decrease in sub-acromial space and places us at risk for shoulder impingement.
How can this be avoided?
Having a good ergonomic chair that places the hips slightly above the knees will orient the back in a good position. Armrests are important for taking pressure of the shoulder girdle. The neck should be positioned in neutral by tucking the chin back in an attempt to lengthen the neck.
The shoulders should be positioned down and back. Try to imagine bringing the shoulder blades toward the opposite back pocket. A stretch should be felt across the chest and shoulders.
When lifting something overhead, the shoulders must stay down. If the shoulder moves upward towards the ears, you are increasing risk for impingement by closing down the sub-acromial space.
Repetitive movements using improper body mechanics lead to shoulder injury.
If an athletic movement such as the golf swing or tennis serves leads to pain in the shoulder, don’t try to work through the pain. Seek professional advice from a physical therapist or a sports doctor.
You may avoid a serious injury by inquiring when the discomfort first begins. Waiting until you can’t bear the pain usually means the injury is serious and may require surgery.
There are many variations of exercises that can be used to strengthen the rotator cuff muscles and back musculature.
Seated rows and lat pull-downs are great ways to strengthen the muscles around the shoulder blades. Keeping the shoulders down and pinching the blades together is the proper mechanics during this movement.
Shoulder external and internal rotation will keep the infraspinatus, teres minor and subscapularis strong.
Shoulder elevation to the front and side will strengthen the deltoids & supraspinatus. Make sure the shoulders do not hike up toward the ears with this exercise.
Finally, proper stretching to keep the shoulders and pectoral muscles loose is vital to healthy shoulders.
A well-balanced exercise program that promotes flexibility, rotator cuff and back strengthening, and precise body mechanics during exercise will allow persons to excel in their respective activities minimizing the risk for a shoulder injury.
Brad Gilden has been practicing orthopedic & sports physical therapy since graduating from New York Medical College in 2000. He has worked in a variety of settings treating patients with various neurological, orthopedic and sports injuries. In 2004, he completed a clinical doctorate in upper quarter & hand therapy from Drexel University. He joined Elite Health Services as a managing partner and rehabilitation coordinator in 2005. FULL BIO »
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