How do you know that your car has an alignment issue? Your front end vibrates at higher speeds, the steering wheel pulls to the side, and you are noticing odd tread wear on your front tires. You bring your car into your mechanic and the advice you get is this; “drive faster, take the corners harder and aim for potholes.” I doubt if any of us has gotten this advice for our vehicle and yet this is the approach taken with most rehabilitation practitioners. They start exercising the shoulder!

Restore the alignment

Most shoulder issues at their core are related to poor mechanics. While the reasons why a shoulder is not moving efficiently vary from person to person there are common clinical patterns that we see and certain muscles and joints that fail to work well. First, determine if you have a shoulder dyskinesia or poor movement pattern of the shoulder complex. Second, restore normal movement patterns after determining the 'why' and what muscles and joints are not working well. Lastly, return to strengthening the shoulder if this is needed.

When the underlying problem that has created the shoulder issue, a loss of glenohumeral mobility, a tight muscle, limited rib rotation creating tension, if this has been addressed then exercise or strengthening can occur. The only exercises that should start earlier are movement or control type exercises to reduce pain and tension.

Strengthening should never be first for a shoulder problem or impingement issue.

A Common Shoulder Clinical Pattern

A common shoulder clinical pattern is posterior shoulder pain and tension with loss of horizontal adduction or bringing your arm across your throat. Infraspinatus (Rotator Cuff) trigger points and pain and weakness are present. Medial scapular border tension and loss of distraction of the shoulder blade occurs, and finally a second rib restriction and pain with upper thoracic spinal stiffness is present. The pain pattern common for this is pain to the back of the shoulder and down the side and back of the arm to the elbow. Patients with this condition will place their hand on the back of their shoulder and trapezius and slide it over the shoulder and down the side and back of the upper arm. This shoulder dyskinesia can cause pain with raising the arm, as well as with lifting weight, and also shoulder blade joint sounds with movement. Sleeping on the affected side is usually difficult and painful. If this problem persists then putting on clothing can be difficult as well.

Symptoms to look for...

• Shoulder joint sounds with movement
• Pain with reaching up or behind the back
• Difficulty putting on a jacket or bra
• Pain with sleeping on your side
• Changes to your activities due to shoulder pain
• Continued shoulder pain with treatment

This is the information that we give to our clients regarding trigger point dry needling.

Tips

Don’t start with exercises – restore the alignment first

Check the upper neck for involvement

Look for scapular ‘winging’ or poor posture

Re-check your shoulder screen for symmetry after treatment

REMEMBER

1. Determine if you have a shoulder dyskinesia
2. Restore normal movement patterns with Manual Medicine
3. Last, strengthen the shoulder