Treating shoulder pain - Myoreflex approaches
Most common cause for shoulder pain
Experiencing shoulder pain is the 3rd most common reason for seeking out a doctor or specialist for help, following knee pain and back pain. But it can also be used as an excellent example of how new approaches, therapies and understanding of underlying causes can help a lot of people who are currently suffering with this problem. One of the most common reason for shoulder pain are rotator cuff injuries.
The rotator cuff consists of 4 muscles. These are the
- Teres minor
Rotator cuff injuries
Reports say, they may affect as much as 85% of cases seen in the clinic. These muscles are very important in stabilizing the shoulder, making small movements to maintain the arms ability to move in a fluent way and without pain. When these muscles are overloaded or injured, they can become chronically problematic and painful. Let us have a look, at how these theories, as to why pain occurs, are currently understood, and what this new theory adds to this understanding, which may help a lot of people with chronic shoulder pain a way to heal from this problem.
The main problem, according to the theory by orthopedic surgeon Charles Neer, is that there is an impingement of the tendon which occurs just below the outer part of the shoulder blade, what is known as the acromion of the scapula.
Normal treatments of shoulder pain
Some of the typical treatments to deal with this are cortisone injections managed by doctors, medication, or in some cases, surgery will be performed to remove the outer part of this bone. But we do see, that these methods don’t always have the desired effect.
The new theories
What could be proposed, is to consider why this current movement pattern is causing an impingement at this area. The impingement and the following tissue damage are a result of a faulty movement pattern. There is a change in how the shoulder moves, which is causing damage to the tissue. Rather than attacking the damaged tissue or medicating the pain signals, which does not affect the underlying causes, and/or removing bones. It could rather be suggested to put attention towards affecting the underlying changes in the movement pattern which caused this problem in the first place. Identifying and restoring the normal pattern, if possible, instead. This is the myoreflex approach which differs from many of the conventional approaches that only focuses on attacking the damaged tissue or pain signals instead of restoring the normal function of the shoulder.
Understanding normal shoulder movement
Let’s have a look at some of the possible causes to these dysfunctional changes.
The first thing which is important to understand is that normal overhead motion with your arm, is not an isolated movement of your shoulder joint. It is a combination of several joints. One of those is the movement of the shoulder blade. 1/3 of your total motion when reaching above your head with your arm, comes from what is known as an upward rotation of your shoulder blade. Only 1/2 of the movement originates from the shoulder joint itself, so 60 degree of motion comes from the shoulder blade, and 90 degrees of motion is from the shoulder joint, and to keep this a bit simple, the final 30 degrees comes from the collar bone as well as other movements which completes the full elevation of the arm.
The painful change of movement
What this means, is that for example, if the upward rotation of the shoulder blade does not work as intended, one of the problems which can then occur, is that there is a reduced subacromial space when lifting the arm to the outside of the body as you reach above your head. This again, leads to a painful shoulder because of compression of the tissue underneath the bone, this tissue can be for example be the subacromial bursa, which is a fluid filled sac to avoid friction to the surrounding tissue, and most commonly the supraspinatus muscle, which is one of the most frequent reasons for shoulder pain, but it can also affect the other rotator cuff muscles as well. The change to this upward rotation of the scapula, is not the only potential cause for this problem, there are other movements which can impede the same structures as well. Understanding for example that when lifting the arm completely above your head also involves a 10–15-degree extension of your thoracic or upper spine, weakness of parts of the trapezius muscle will diminish the scapula’s ability, and thereby the shoulder’s ability, to move easily. This is one of many other important parts which influences the shoulder. As an example, if the muscles in the front of body is then over-exerted and locked into flexion, such as when the stomach muscles are too tight, the movement of extension for the upper spine become hindered, and thus affecting the movement of the shoulder.
Improve the movement patterns affecting the pain
What is my point with all this? It’s that you need to manage these movement patterns, and make sure that the impingement does not occur in the first place. And you will find, a change in the normal movement pattern when these types of problems occur. The attention in treatment, should be to normalize and re-integrate a functional movement pattern for these dysfunctional muscles that are affecting the damaged structures in the shoulder, rather than attacking this damaged tissue itself, which is a result of the mentioned dysfunctional movement pattern. And the underlying cause for the affected dysfunctional movement pattern, does not need to be directly connected to the shoulder joint. It could be connected, for example, via myofascial lines (also known as muscles lines) to for example the shoulder blade, or other joints directly affecting the shoulder, but dysfunction within these indirect patterns can affect how the shoulder is able to move - limiting its movement, and thus creating damage because of a restricted movement pattern, such as an impingement. It is often connected to a previous injury or over-exertion where the muscles have not been able to maintain or re-integrate its normal ability to either move or stabilize the body during that movement, thus affecting the shoulder.
What should be done
In my view, you should assess the problematic movement causing the pain, and the muscles ability to stabilize this movement pattern. You should take care, during your conversation or anamnesis, with the patient to ask of any previous injuries or problems and see if they may affect this movement pattern. And then by treating the dysfunctional movement which causes impingement, you focus on alleviate this tissue, by altering the current movement pattern so that impingement does not occur in the first place.
Exercises and potential solutions
Normally, this type of therapy is done through treatment sessions, but there is also a possibility to do some specific exercises. Which exercises, depends on your individual pattern as to how this problem has developed. And this is not an isolated question for the shoulder, but rather other parts of the body as well, which can cause a compensational activity level affecting the shoulder and these specific movements. But regarding relevant exercises, we do have some usual suspects, which we can on a general basis advice exercise for. Starting with exercises releasing the deep front line of the body, using active stretch exercises, also known as KiD exercises. When this line is shortened, the body is hunched forward, creating a change of the position of the shoulders, and the conditions these muscles must work under. Another frequent help could be to release the spiral line of the body. Which is directly affecting the muscles rotating the shoulder blade. As well as doing exercises for the lateral lines of the body, which help with moving the weight to the outside of the body, which helps with the stability of motion when lifting the arms.
If you would like to know more about these treatment concepts, I advise you to look at the videos regarding myofascial lines, compensated movement patterns, KiD – active stretch exercises and the brains understanding of our position.