Shoulder Joints & Function

Image credit((Source: “Woman resting sore shoulders after rowing canoe on lake,” Photo by Kalen Emsley on Unsplash »))

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If you’re suffering from poor shoulder function or an injury to shoulder joints, Hands On Healing in Montgomery, Alabama offers treatments designed to promote healing and prevent their reoccurrence.

Shoulder Mobility

Unlike more stable joints in your body such as the hips or ankles, our shoulder joints are designed to be much more functional and mobile.

The benefits of high mobility and range of motion allow us to accomplish more delicate movement tasks.

Shoulders maintain a high level of mobility due to two different joints:

1. Glenohumeral (GH) joint (the ball and socket)
2. Scapulothoracic joint (the shoulder blade)

This dual joint design provides a nominal amount of strength while still ensuring we have the high level of dexterity and mobility that our bodies need.

However, two joints attempting to create the same essential functions lead to complexity, and with complexity come complications.

Shoulder Dysfunction

There is indeed no shortage of dysfunctions and conditions that can affect someone’s shoulders including:

• Rotator cuff injuries
• Dislocations
• Arthritic conditions
• Impingement syndromes
• and more

The multitude of movements that the shoulder is capable of (between 12-15 when including both joints) can lead to circumstances in which specific functions are compromised or imbalanced.

What Makes the Shoulder Susceptible to Injury?

In most cases of dysfunction that involve the shoulders, the most common problem that we as therapists encounter is tissue restriction that affects the scapula (shoulder blade).

The scapula forms the “seat” that creates the ball-and-socket joint of the glenohumeral joint itself. Since the glenohumeral joint is made to be highly mobile, misalignment of the joint will quickly lead to tissue damage and dysfunction.

One of the biggest reasons that imbalance forms in the scapulothoracic joint are that it is not a “joint” by definition, as it lacks a direct attachment to the axial skeleton.

Scapular alignment is held in place by only fascial-muscular development, leaving the shoulder girdle highly susceptible to almost any other bodily imbalance.

In approaching any shoulder dysfunction, we as therapists will seek to create balance and function in the scapula first, which could start with treating your legs.

Healthy shoulder function is by no means mysterious, but it will be a heavily weighted task if the whole of your body is not improved along the way.

Types of Shoulder Injury

Many types of injuries can affect one’s shoulders.

Rotator cuff injuries and shoulder impingement conditions are often the most common shoulder problems that many people will deal with in their lifetimes.

Both forms of injuries stem from the fact that the shoulder is an intricate design that requires that the two primary joints, the scapulothoracic, and glenohumeral joints, work together in an organized fashion to ensure the prevention of injury.

Circumstances that give rise to these types of shoulder injuries are related to the function of the glenohumeral joint (the ball and socket).

Since the GH-joint is meant to have a high level of mobility as opposed to stability, this joint is reliant on proper placement and structure.

Placing the GH-joint in a structurally imbalanced position while attempting to engage it in movement (especially load-bearing movement) will cause the kinetic energy to transfer into the wrong myofascial structures, like tendons and ligaments, instead of being adequately supported by stronger and more capable shoulder muscle groups.

Shoulder Misalignment

When the shoulder is improperly aligned, these muscles will “grind” or “rub” against bony structures and become injured.

Inflammation occurs as the tissue attempts to heal and restructure itself, leaving you with the sensation of pain and movement dysfunctions.

Figure 2 (click to enlarge) shows how tears will form in smaller muscular structures that are meant to control more delicate movements, not heavy lifting.

Shoulder Overuse

Rotator cuff injuries (and to some degree impingement conditions) in the manual therapy field are part of a list of problems that stem from overuse, much like shin splints.

There is a bit of a trend with conditions that form when an area of the body is poorly aligned and then used in excess, forcing the body to recruit and use muscles that are poorly designed to handle more significant, more powerful tasks.

When first dealing with overuse injuries, your therapist is going to consider a few factors for encouraging improvement, the first being the duration of the damage.

If the shoulder is just beginning to hurt, the injury is too irritated for bodywork and manual therapy to have much effect. Using ice and conservative treatment will help start the healing process.

Another concern will be your body’s underlying structure. As we have pointed out before, ideal function of a specific area of the body requires that the whole system works in tandem.

Fascia & the Shoulder

One of the primary bodywork concepts that we emphasize at Hands On Healing is the connective tissue system.

We as therapists simplify this system referring to it as fascia – which is precisely meant to organize the human frame from head to toe.

Seeing fascia as anything other than a full-body tissue downplays the significance of the role fascia has in organizing and stabilizing the structure of the human body.

The idea of a “full-body” tissue can be a bit much to discuss in short detail, so when talking about points of fascial adhesion and restrictions, it’s much easier to explain the effects that they have on our structure by showing how fascia relates to our body’s movement.

The Arm Lines

Since we’re focused on the shoulder, it’s time to introduce you to The Arm Lines.

There are four lines in total, two lines for the anterior arm and two lines for the posterior. One of the two lines for the front is superficial (on top), and one is buried (beneath), and the same goes for the two lines of the back, one superficial and one deep.

These lines serve to coordinate the movement and alignment of the upper limbs, keeping the shoulders, elbows, wrists, and hands all following the same basic functional patterns.

So here’s the kicker: just as the other Anatomy Trains lines can create dysfunctional patterns, leading to symptoms far separated on the body from the area that causes the conditions, so too can the arm lines.

It’s this view of the arm lines that allows us as therapists to explain how conditions such as tennis or golfer’s elbow, or carpal tunnel syndrome, are in fact caused by restrictive patterns of the shoulder, chest, or upper spine.

Treating Shoulder Injuries

When first facing or dealing with conditions that have developed in the arms or into the wrist and hands, the very first discussion point we will have with clients is the importance of ensuring healthy shoulder balance and proper function.

Since the shoulder joint has a vast range of motion (ROM) and can easily rotate around the ball and socket, patterns that spiral and torque the arm are common.

They are the critical components to understanding the how something as simple hunched shoulders will lead to arthritis in the hands.

In a previous article, we introduced the concept of connected fascial lines that relate to movement, called Anatomy Trains.

You may recall The Deep Front Line that connects the adductor muscle groups of the inner thigh to the deep pelvis and spine. Every part of our body is organized and connected by these fascial lines.

Shoulder injuries are just like any other problem that plagues an individual’s life. They most certainly can be healed, and more important, prevented from coming back.

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