So I had planned on stopping the “shoulders saga” after the previous two posts but then thought about this on the way to work today – there are a lot of ways to work on the shoulders that essentially do nothing for you, therapeutically. I confess, in my past I have worked on shoulders for my benefit versus the benefit of my patient – but I was just a young buck, and didn’t know any better! Dear therapists, repeat after me, “I will not punish my patients with painful soft tissue work for my own pleasure”. Now then, what the hell am I talking about?
As you’ve read about before, the shoulder is an intricate and interesting structure with some pretty amazing functions that, when faced with a poor position to work from, will present with some problems. I trust you’ve been doing some pre-hab, to correct your poor positioning and prevent future problems.
No doubt, at some point in your shoulder pain/discomfort/tightness past you’ve asked someone to give you a massage/shoulder rub/thumb-destroying good time. No doubt, it hurt quite a bit, and if you were the victim of experienced hands, you may have had to use your safety word (which may or may not have been “popcorn”). There is a decent chance you walked away and felt “better”, at least for a little bit. Was it “better” in comparison to the excruciating pain you were just recently feeling? Or did your shoulder pain go away only to come back in a day or two? If you “felt a bit better” for a day or two, that’s good news, but the treatment was ultimately no different than popping a couple advil.
“Heresy! Those patients’ muscles were sore and I stripped the hell out of their muscles and then they weren’t sore anymore! What happened to “treating the cause???” – I fixed the problem!”
Did you? Invariably, the rhomboids, levator scapulae, traps, rotator cuff muscles and maybe even the lats are going to be tender on a patient with an active shoulder complaint. Taking this a step further, using trigger point therapy (or really just ischemic compression as there probably isn’t any true pain referral happening here), ART, stripping massage, or any of the other dozens of different soft tissue techniques on sore muscles is going to result in, “yeah that really hurts, but it hurts in a good way, you can press harder if you need to”. Which means the patient believes the therapist is doing the right thing, and so does the therapist. But WHY are the muscles tender and WHY did they develop this shoulder problem? (The answer to this second question is not, “because they bailed awkwardly on a ring dip”)
Poor positioning and movement patterns. This probably just sounds repetitive at this point but unless you work to correct your shoulder positioning, you are going to continue having problems. Spend some time stretching out your “business” as Kelly Starrett would say. Instead of being “bad” at certain movements, make sure you aren’t trying to execute those movements from a weak position and take the steps to improve your position.
Now, before I get attacked for “putting down” soft tissue work, which I’m not doing, let’s go back to how you should be approaching the solution to this problem. You start with some poor scapulae positioning and then you do overhead work, pullups, oly lifting, etc. and experience some pain and your “bad shoulder” starts “acting up”. By all means, see a therapist if you want to experience some serious pain, and naturally improve your pain status (after treatment) with regards to this acute situation. Now that you’re past that, move forward and prevent future problems – ask your therapist what steps you should take (where to stretch, where to strengthen) to prevent future painful episodes. Many times the tender muscles in an acute episode are not the muscles you should be working on to correct shoulder positioning. For examples, the rhomboids are going to be sore in this acute situation, but they are more than likely weak and stretched away from their optimal position. Pressing on them does nothing to improve shoulder positioning and may even make the situation worse. Working on pec minor in an acute situation, isn’t going to do a whole lot to help with the patients pain, but would be the right step to take in improving shoulder positioning.
What’s that saying? An ounce of prevention…?
Dr. Adam Ball