What moves up and down, side to side, and then around in circles, yet has an asymmetrical axis? You might be shaking your head wondering how that's possible. Okay, here's another hint. It's a body part we all have, and because of its incongruous design, it is also the source of much discomfort, pain and disability. In fact, some folks claim they feel the "weight of the world" on it...
Yep. It's the shoulder(s). And for all of its amazing range of motion, the joint (glenohumeral) movement is a complex orchestration of muscles that simultaneously stabilize and help it glide in place. This multi-tasking motion is a miracle of movement IF no faulty use, overuse, trauma or degenerative changes exist. Well, so much for miracles. Most of us can recall at least one incident of pain in the shoulder that had us wincing with the slightest movement.
If you look at the design of the shoulder, you can better understand what can potentially interfere with its movement, thus causing you pain. First of all, the head of the upper arm (humerus) rests in a shallow space (fossa) of the shoulder girdle (scapula). If the humerus were a golf ball, the tee would be the fossa. Add to these boney neighbors another one that hangs over them (acromion), and you have one close-knit neighborhood. Now, these bones and joints can't do a thing without the nearby muscles and tendons. This is where neighborhood feuds can erupt.
If the shoulder-hood is peaceful and everyone is getting along, this is what occurs. The arm initially elevates through the action of the superficial shoulder muscle (deltoid). The head of your upper arm is moving in its shallow space up against the overhanging acromion and adjacent ligament. In order for your arm to raise any further without being obstructed, four muscles comprising the rotator cuff assist. Together, they must secure the humerous head against the fossa, rotate it, and then begin to depress it downward - while still rotating it - in order for it to pass under that overhanging acromion. It's like a neighborhood square dance!
As in all neighborhoods, though, you have some folks who - well - bring down the hood. Their behavior disrupts the harmonious status of those sharing that close-knit space. The shoulder-hood is no exception. Repetitive overhead movements or forceful pulling motions can create wear and tear on the tendons under the acromion. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) all have tendons, too. These all combine to form a "cuff" over the upper arm. But their attachment to the scapula is by a single tendon "unit." That "unit" is like the neighbor who always hosts the block parties. Small property, big parties, and no one else reciprocates. This neighbor gets worn out, but can't leave the neighborhood, so he fusses a little. Then he fusses a lot. That fuss is the pain you feel and the ensuing restricted movement. Something is awry in the cul-de-sac.
Symptoms of rotator cuff trauma can be sudden and accompanied by acute pain and weakness. Or, more commonly, they may develop gradually following long term wear. The pain can be felt when lifting or rotating the arm and can radiate down the sides of the arm. Over time, the pain may exist at rest or with no activity at all. A doctor's diagnosis and prescribed treatment is the first step.
As a preventative strategy or to strengthen a weakened shoulder, rotator cuff exercises should consistently be a part of your fitness program. It's like all of the neighbors sharing in the party-hosting. It's work, but if everyone does their part, no one feels taken advantage of.
Here are two simple strengthening exercises:
1. Lying on your left side, hold a light dumb bell in your right hand. Your right arm is next to your body and flexed about 90 degrees at the elbow. Rotate the upper arm, raising the dumb bell towards the ceiling to a 45 degree angle with the elbow still flexed. Pace the movement for two seconds up and four seconds down. Repeat 12-15 times on each side.
2. Standing, grasp a light dumb bell in each hand. With straight arms, internally rotate them so that your extended thumbs point towards the floor - as if you are emptying a drink onto the ground. Raise your arms sideways, still pointing the thumbs downward until the dumb bells are just below the shoulder. Repeat 12-15 times.
Exercising the rotator cuff muscles not only helps prevent future injury, but can also help improve posture. Imbalance in the internal rotators of the shoulder can lead to shortening and tightness. This rounded shoulder posture further inhibits the intricate movement of the shoulder joint.
So, be a good neighbor. Do your part in creating a peaceful network of movement in the cozy shoulder-hood. Remember, no one likes a party pooper.
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