Corpo Bene'

Normal shoulder function is determined by the stability provided by the passive, active and control subsystems (central nervous system) of the joint complex. Given the complexity of the shoulder, it is not surprising that it is one of the most commonly injured joints. Knowledge and understanding of the anatomy and the intricate relationships of each of the subsystems is essential for successful assessment and treatment.

Shoulder pain is a frequent complaint of active individuals, especially as they start to progress in age. Due to the frequency of occurrence, people tend to self diagnose, because their symptoms are just like their friend’s, etc.etc. Trainers and therapists are frequently placed in the position of having to manage these problems in the early stages, and it is important to be able to identify certain signs and symptoms which will dictate the course of action.

Complex and Often Misunderstood
The shoulder is a very complex joint. It does not share the same bony stability that the knee or elbow has, therefore allowing for a great deal of movement. For the trainer or therapist, it is critical to understand how this joint works before helping people manage any painful issue.

FORE!

The easiest way to picture the complexity of the shoulder is to picture a golf ball sitting on a tee. The tee represents the glenoid component of the glenohumeral joint ( The ball at the top end of the arm bone fits into the small socket – glenoid, of the shoulder blade to form the shoulder joint-glenohumeral joint , and the ball represents the head of the humerus-the upper arm). If there is a shift in any direction of the golf ball on the tee, it will fall off. In order to function properly, the golf ball has to stay centered on the tee.
Next, imagine there is a ring around the tee, deepening it somewhat and offering more stability (of the golf ball). This ring is called the labrum. It is a “non-moving” stabilizer for the glenohumeral joint. Other static stabilizers would include the ligaments and the capsule. These static stabilizers all offer a great freedom of movement being that they are not completely rigid (much like a bushing). Sometimes, these structures are actually looser than normal, which is a condition called excessive joint laxity, which can lead to instability. Therefore, we rely primarily on musculature to provide stability at the shoulder. The critical factor in the shoulder is proper symmetry or balance, just as with the golf ball and the tee. The muscles are what contribute to this balance. If the muscles surrounding the joint have a balance in both strength and flexibility, then the shoulder will be able to function properly. If not, then a wide variety of problems may result, from impingement of the rotator cuff (not “rotator cup”) tendon and bursa, to chronic instability, to labral tears, and so on.

Weight Training Advice
Any weight-training program should adequately address ALL of the muscles and force couples (groups of muscles working together to perform an action, such as a rotator cuff and deltoid) to “keep the golf ball centered on the tee”. This would include a rotator cuff strengthening program, adequate strengthening for the back and scapular stabilizers, exercises such as press ups for the depressors, and shoulder exercises which do not compromise the mechanics of the shoulder. An example would be keeping all presses slightly in front of the head, allowing less compression at the AC joint (where the collar bone meets the shoulder blade). A good warm-up and post workout stretching will also help. With a properly balanced program, problems at the shoulder can easily be avoided.

Evaluation of the Muscle Chain: Identifying the Pain via observation of Movement and Posture

Postural evaluation is a reliable method of creating a precise treatment plan to facilitate efficient recovery from a painful muscular condition. Muscular asymmetries or imbalances are often implicated chronic pain and dysfunction, correcting the imbalance can be a long-term solution for chronic musculoskeletal imbalance.

Evaluating a client’s posture includes knowing what to look for and then knowing what to do about it.

What to Look For
Key physical points that are focused on when going through a postural evaluation:

Feet:

Pronation Distortion (one or both ankles falling in).

· Toe position (clenched or relaxed).

· Weight distribution (outside/inside of the foot or balanced over the ankles).

· Direction of foot position (toe in/out)

Knees :

· Knee position (in/out).

· Valgus / Varus (knock knee or bow leg).

· Are the knees locked, straight or slightly bent?

Torso :

· Hip Position (one high or lower, rotated).

· Mid-line deviation (is the middle of the hip in line with the bottom of the sternum).

· Hip position over the ankles (projection or retracted pelvic posture)

· Low back posture (lordosis or straight back)

Upper back / shoulders:

· Upper torso kyphosis (rounded) / Shoulders Back

· Shoulders leveled (one higher than another)

· Arm position (one arm longer than the other, one ahead of the other)

· Shoulder blade position (is one or both sticking out or rotated)

Neck and head :

· Head shift (side to side, rotated, backward or forward according to the shoulder position)

· Head position according to the body (draw a straight line from the top of the head through the nose, chin, and navel to the mid-point between the feet?

The Rings of Balance
Symmetric or balanced posture is when the (Ring 1) feet are directly under the hips and knees, while the torso, (Ring 3) shoulders and neck are balanced over the (Ring 2) hips with minimal muscular activity to hold this upright position. The knees and feet should point straight ahead (norm would be feet rotated out up to 5˚), and the client’s weight should be symmetrically balanced over the feet. From the side you should be able to draw a straight line through the ear, shoulder, hip and ankle. Any deviance from this balance or symmetry could mean either a current or eventual problem.

The Muscular Culprit
When to evaluation is final and the distortions are identified, the next step is to identify the muscles involved. The trainer or therapist must determine which muscles are abnormally stretched and which are shortened before choosing the most effective techniques to correct the imbalance . Neuromuscular Therapy is one such technique traditionally used to restore balance to the musculoskeletal system.

The Dot-to-Dot
Neuromuscular techniques can restore a client’s ideal alignment. There is one more step that must be taken – figuring out how the problem started. Detective work is often needed to determine where the poor posture originated from. Since the way we carry ourselves is an accumulation of our experiences, emotions, traumas, strengths and weaknesses, a trainer or therapist must typically ask the right probative questions and build a historical picture of the body (a dot-to-dot of the persons biopsychosocial make-up).

Poor posture (muscle weakness or tightness) will pull the body out of balance. In general, being conscious of maintaining proper posture, as well as finding a way to release stress will help many people maintain their realignment. However, lifestyle modifications such as nutrition, fitness and relaxation techniques may be necessary.

Key Books and Authors:

Tom Meyers, Anatomy Trains

Michael Clark, NASM – Corrective Exercise Continuum

Vladamir Janda’s tightness/weakness model