Over the past several weeks I have been trying to help one of our members, Kim, with her shoulder pain issues. She is a fit and active 50 something, that rivals many 30 year olds I have seen. However, she has had a cranky shoulder for some time now. Without checking my notes, I’d say she has been complaining about shoulder pain for almost a year now. Like many, she felt that if she stayed active and didn’t push it, the pain would go away and she’d be back to normal.
Well, that hasn’t happened and now the simplest of daily things like reaching for the milk in the back of the fringe can cause debilitating pain. Normally I would not work with a person in pain until they have seen their Doctor, Physio or Chiro. Pain during normal movement is the cue for us to refer out to get some sort of diagnosis or professional opinion. However, there are many times when a person just doesn’t take our advice.
I hate seeing people in pain; particularly shoulder pain because it’s so common. It actually frustrates me when I can’t help. As a result I’ll reach out to my network of professionals to see if there is anything I can do that won’t get me in hot water and make their situation worse. The situation with Kim was no different. I had gone through a modified version of our Functional Movement Assessment with her (I just worked on her upper half) and based on her history, presentation, movement quality and results from common impingement tests I could isolate the mechanical break down that was more than likely a large contributor to her shoulder pain problem. It’s referred to as Scapular Dyskinesis.
Kim’s shoulder blade does not move the way it should in order to make room for the head of her arm bone to rotate while she lifts her arm up and over her head or to the side. The shoulder blade (scapula) forms the socket part of the ball and socket shoulder joint. At the top of that socket is a bony process called the acromion. There are some soft tissues that run through that space between the head of the arm bone and the acromion; namely a bursa and the tendon of the supraspinatus muscle (one of the rotator cuff muscles) If the muscles that move the shoulder blade don’t do their job either at the right time or at all, the shoulder blade won’t rotate up and tip backwards to make room for the arm bone as it goes up and consequently, those soft tissues will get pinched. This is referred to as subacromial impingement which is the most common type of shoulder impingement. The image below illustrates the scenario.
I had just read a study that yielded impressive results from doing a modified version of a yoga based pose they called triangular forearm support. You can read the study abstract here: https://journals.lww.com/topicsingeriatricrehabilitation/Abstract/2011/04000/Yoga_Based_Maneuver_Effectively_Treats_Rotator.10.aspx. This intervention allows me to help without manually (me actually adjusting or manipulating) treating Kim, as that is beyond my scope. It’s basically an isometric hold done with specific cuing. If anything I thought it would activate one of the muscles responsible for articulating the shoulder blade which would create more space for her arm to move. At best it would improve pain free range of motion and at worst, nothing would change.
Well, if I didn’t see it with my own eyes, I would not have believed how successful just two minutes and one exercise could be. Kim’s range increased by at least 25 degrees and that extra 25 degrees was pain free! Yes she experienced the pinch at her new end range but I’m excited to see how far we’ll get in a few weeks of supplemental work. I’ll keep you posted with her results. Checkout the video below and if you or anyone you know could benefit, come see me for an evaluation.