Shoulder pain can often be extremely debilitating, causing us to lose sleep, have difficulties lifting/carrying items and even getting dressed/undressed. Often people wait it out, thinking it will get better and eventually go away, only to find that it often gets worse. Many times, I see people and they tell me that they suspect its arthritis or a rotator cuff issue because they played sports when they were younger. Sometimes they have already been to another PT and completed 6 weeks of therapy and things did not seem to get better after strengthening their rotator cuff muscles. Of course, I perform a complete evaluation and test their rotator cuff strength and shoulder mobility to find that their rotator cuff is as strong as an ox. The next step, is looking at their shoulder blade or scapular mobility and function. To their surprise, it is typically not functioning appropriately and completely out of sync with what movements are supposed to be occurring.
A simple test I have them do is to raise their arms straight above their heads and then slowly lower them down. What you will see is a completely bizarre pattern of winging without any control. Besides being a pretty cool party trick to show your buds on the weekend, nobody wants that! Because most people come to me after several months of this dysfunction, it often causes the shoulder to begin functioning abnormally to compensate for the dysfunction of the shoulder blade, leading to the shoulder pain. Once we fix the dysfunction through exercises that focus on motor control *not strengthening* this takes the stress off of the shoulder joint.
So, what leads to this dysfunction? A lot of overhead lifting and weakness in a muscle called the Serratus Anterior can lead to the crazy shoulder blade dysfunction. After beginning patients on exercises, it can take up to 2-3 months to fix completely. However, if people can catch it early (right when they begin to have shoulder pain), I’ve seen it return to normal within 2-3 weeks. The point of this story is to not wait for the pain to just go away and to look outside the box. Just because there is pain in one place, does not mean that this area is where the problem is located. Always realize that pain is sometimes just a symptom of a problem elsewhere.
-Amanda Worley PT, DPT, CMTPT