The last 10 months I’ve spent my time working at our partnering company Restore Rehab and Wellness run by a fantastic chiropractor Dr. Sarah Forster. Her knowledge and understanding about the body and injury are beyond any other clinician I’ve worked within the past. I was lucky enough to collaborate and team up and create a rehabilitation service like no other.
As things started to shape up and our system we created was implemented, I began to see a common theme with patients. Many of them were dealing with shoulder pain. This theme made me think about our world today, and I’m going to guess that the leading issue of shoulder pain today is the combination of sitting all day with the addition of our smartphones and looking down for long periods of time.
Majority of us all sit and now layer on top a device that we look at 90% of the time, and we wonder why our shoulders hurt. This situation is most likely a gradual thing, as it takes time for painful patterns to develop that cause us to go see someone. But, it is still an issue many people are dealing with right now.
The Common Issues
Shoulder issues are individual, but there are some common traits that you can place into “buckets” as I call them to categorize them. We have:
Rotator Cuff Injury/Tear
Before I begin, I never tend to use the verbiage of “conditions” to patients as it could be more detrimental to their recovery. When a patient hears that they have a condition called “impingement,” they automatically feel defeated and weak. When I see a patient, I make it clear to them that their “shoulder needs some work” and here’s what we’re going to do to make it stronger. I also remind them that rehab is just like working out. When you show up consistently and have a goal of doing more volume either by more repetitions, another set, or more substantial weight to improve, rehab works the same.
You perform your exercises pain-free, practice them, do them often, your pain will subside and get better.
Frozen Shoulder is something I see a lot with patients. I would say the majority of people out there have some sort of degree of frozen shoulder as you if look up the definition, you’d find something like this:
“Frozen shoulder occurs when it’s capsule thickens and tightens around the shoulder joint, restricting its movement.”
Doesn’t this sound like the majority of people who sit at a desk all day, then come to the gym and realize their shoulders hurt when they press overhead? I believe that you’re entire shoulder doesn’t need to be restricted entirely to be considered “frozen.” Any restriction to normal shoulder function is frozen shoulder in my mind, and we need to change that ASAP.
Frozen shoulder sounds worse than it is, and it can be easily fixed if the client or patient is determined to follow their rehabilitation protocol. The first step is consistent pain-free movement. Many times, a lot of people will use their bad shoulder in everyday activities and forget it’s limitations and perform a motion outside of their range of motion and might get a jolt of pain or straining sensation.
What happens is with this information it’s fed back to the brain and nervous system, and the issue here is, your brain and the nervous system remembers EVERYTHING. Now, when you go back to utilize your bad shoulder again in a similar motion, your nervous system will do everything in its power to protect you and stop you before the pain point like before.
Remember, the nervous system in our body wants to keep us alive so that it will create safety barriers. Now, that there is a feedback loop of protection, every time you use your lousy shoulder through a painful motion the range of motion will decrease, and voila, you got frozen shoulder.
As I said before, the first step is, to begin with, pain-free motion to communicate back with the nervous system that movement is safe and okay. Then, improve the quality of the shoulder joint itself, and practice and hammer it out consistently for a long time. With individuals with frozen shoulder, I always fall back on shoulder CARS.
Shoulder CARS is my go to as it teaches the patient their true pain-free range of motion of their shoulder joint. Coaching them on how to move pain-free, and figuring out where their limitations are is a powerful thing. 99.9% of the time the patient will have pain in their shoulder performing it the way I demonstrate it just like in the video, so I make sure to educate them that it DOESN’T need to look like the way I performed it.
The Shoulder CAR might look half the size demonstrated, or even just half of the rotation depending on the severity of the pain. Remember, never go through pain!
The typical wear and tear of the shoulder joint itself. Arthritis, and to be specific osteoarthritis is a common condition many people and patients have. Mostly, the soft and smooth cushion of cartilage we have in our shoulder joint deteriorates, and we can hear grinding or clunking when performing movement.
As we age the chances of getting osteoarthritis goes up, and the most simple thing to do for preventative care is movement. I always tell patients and clients that movement is medicine, and we need to move our joints consistently. When we move our joints, especially with CARS we are building a foundation by loading the shoulder capsule with a lot of great feedback and information, as well as improving the strength of the surrounding tissues.
Moving our joints on a daily basis with purpose will send plenty of nutrients and synovial fluid to keep the joint happy and healthy. When it comes to arthritis, this concept is key to fighting off painful patterns and movement.
Rotator Cuff Tear
Another situation of wear and tear but to a point where there is a partial tear or full tear. I’d say the majority of people are dealing with a partial tear and tend to have a similar symptom where they can’t sleep on their side of their injured arm.
I think the rotator cuff tear is probably the most annoying, stressful, and most energy-sucking injury for the shoulder to experience. It limits you entirely from everyday life, and you don’t know if your daily activities are causing more harm or are safe to do. Depending on the severity of the tear, that will determine the approach I take with exercise. Remember, I’m working with a chiropractor that will make the call to what’s appropriate for exercise selection.
An excellent place to start is shoulder isometrics. Yes, it may seem lame and not super sexy, but it’s a starting point, and most people don’t have pain while performing the exercise:
My next approach is performing a single-arm kettlebell farmer carry. If you notice in this video, I abduct my arm to about 20 degrees. At this degree of abduction, you get fantastic activation of your rotator cuff. Any time you grip a kettlebell, dumbbell, barbell, etc, as tight as possible, you end up sending a lot of great feedback to the shoulder. You’re communicating with your shoulder that you’re about to pick up something substantial, so let’s position ourselves optimally to ensure no injury.
Overall, I believe that many shoulder issues fall into three “buckets” as I mentioned above. Knowing that most people are dealing with these three, it becomes easier to help patients and clients overcome pain. With these three categories, using the three exercises above are my go-to’s for rehabilitation success.
Key Exercises To Remember
Remember these three:
- Shoulder CARS
- Shoulder Isometrics
- Single Arm Kettlebell Farmer Carry
And here’s two more to throw into the mix I tend to use a lot:
Remember, shoulder pain is an individual approach. Sometimes my “buckets” don’t work at all, and you have to go back to the drawing board, and that’s fine. As long as you’re determined as a coach and patient, you will see success.
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