The Shoulder Is The Body’s Most Mobile Joint
The shoulder joint is one of the largest and most complex joints in the body and the shoulder allows the greatest range of motion of all of the joints in the body. Due largely to the mobility capabilities the shoulder joint possesses it is a joint with a relatively high risk of injury and accompanying degenerative problems. Meaning physiotherapists are frequently consulted regarding shoulder complaints and the need for targeted shoulder pain exercises. As a joint the shoulder is of “ball and socket” design and is formed with the head of the humerus (ball) sitting into the shallow glenoid (socket) of the scapula. The specifics of the shoulder joint allow for considerable movement but with this it means that the shoulder relies heavily on the soft tissues like the joint capsule, ligaments, the glenoid labrum as well as the musculotendinous structures to help provide necessary joint stability. The shoulder joint must operate with a careful balance between providing both stability and mobility. Therefore the design must allow for a large range of movement, yet be stable and strong enough to support the body’s weight, lift heavy objects as well as assist in manipulating and throwing objects from a wide variety of postures. Doing all this and avoiding injury is no small feat.
Common Structures Capable Of Causing Shoulder Pain
There are several important structures in the shoulder that can cause shoulder pain and frequently benefit from the prescription of shoulder pain exercises including:
- The subacromial bursa, also referred to as the subdeltoid bursa. This is a small sac of fluid lying beneath the acromium, the bursa plays a roll in cushioning and protecting the underlying tendons of the rotator cuff and is a potentially pain sensitive structure of the shoulder. The bursa is often aggravated through performing repetitive activities at and above shoulder/head height.
- The rotator cuff is a collection of muscles (and tendons) that create movement, provide stability, and assist in shoulder joint position control. Again, the rotator cuff are potential pain sensitive shoulder structures and can suffer inflammation, degeneration and tears from repetitive overloading, compression or specific trauma.
- The glenoid labrum or simply the “labrum” is a cuff of fibrocartilage. The labrum forms a cup like support for the head of the humerus (the “ball” part of the ball and socket joint) to fit into. The labrum is attached around the margin of the socket ultimately helping deepen the socket by approximately 50% this deepening of the socket assists by adding additional stability to the shoulder joint. As with the forementioned structures the labrum is another pain sensitive source and can be injured through traumatic events such as shoulder dislocations, as well as trauma the glenoid labrum is also prone to degenerative changes and overload common with athletes playing throwing sports and regular heavy weight lifting.
As mentioned there are several pain sensitive structures in the shoulder including but not limited to the subdeltoid bursa, rotator cuff and glenoid labrum. Some of the other common sources of pain in the shoulder that physiotherapists regularly treat include the AC joint, the biceps longhead tendon and the joint capsule.
Balancing Mobility And Stability
Minor injury to any of the above structures are usually successfully managed conservatively via physiotherapy and shoulder pain exercises. Vulnerability of these tissues to injury is high due to the fine balance the shoulder has between allowing mobility yet at the same time providing stability. If this balance is even just a little bit off then injury may occur. If the shoulder is “too mobile” and does not have appropriate strength to support this mobility, or any sort of imbalance between strength and mobility exits then injury risk increases.
The shoulder joint has been described as likening it to that of a golf ball sitting on top of a golf tee, this comparison emphasizes the fact that the socket unlike in the hip joint does not encase the ball of the shoulder. Where the ball (humeral head) is resting on top of the far smaller “tee” (the glenoid) and it is this image of a large ball sitting on a smaller tee highlights the importance of structures like the glenoid labrum, the joint capsule and the rotator cuff in the overall shoulder function. When referring to the shoulder joint the rotator cuff is a group of four muscles and tendons coming off the shoulder blade and attaching to the upper arm. The rotator cuff as a group of musculotendinous structures help keep the “ball” in place within the shallow socket. Contraction and co-contraction of the rotator cuff work to ensure that the arm remains positioned biomechanically centered within the joint with all movements and loading activities of the shoulder.
Injury Specific Shoulder Pain Exercises Are Vital
As mentioned it is due to the small joint contact zone between the ball and socket that the shoulder joint is quite unstable, this is exactly why shoulder muscles like the rotator cuff are so vital to having a normal functioning shoulder. Several shoulder pain conditions exist due to these muscles simply not being strong enough, imbalanced, or uncoordinated in their firing and control of movement. These “dysfunctions” can often be “normalized” following assessment and prescription of injury-specific shoulder pain exercises. Frustratingly for many patients there are no short cuts, if weakness or muscle imbalances play a role in someone’s shoulder pain then the general rule is if these are not remedied, then symptoms will persist or even worsen over time.
Shoulder Disorders Are Frequently Dictated By Age And Activity
Shoulder disorders are a common complaint, some reports have numbers at around 3 out of 10 adults being affected by a shoulder disorder at any one time. Common shoulder disorders can be age and activity dependent. Conditions like frozen shoulders (adhesive capsulitis) and rotator cuff disorders are more common in middle age to older populations, yet more traumatic conditions like a shoulder dislocation or acute AC joint disorders tend to affect the younger more active and less risk adverse populations.
As previously highlighted shoulder pain is a problem with several potential causes. The exact prescription of shoulder pain exercises depends on the origin of the pain it is not a one size fits all. Ascertaining this comes best through accurate assessment and although in many situations generic shoulder pain exercises may be both safe and appropriate, in some situations these exercises may in fact aggravate the disorder. Therefore seeing a Sydney physio for assessment and prescription of appropriate shoulder pain exercises is the safest and most effective approach when looking to manage a shoulder condition. If you have any questions about shoulder pain exercises or your shoulder pain then call us at Sydney Physio Clinic and we can help point you in the right direction.
Disclaimer: This information is provided as an educational service and is not intended to serve as a substitute for personalized medical advice. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned in this post. Anyone seeking specific advice, or assistance regarding “shoulder pain exercises” should consult his, or her physiotherapist, orthopaedic surgeon, general practitioner, sports medicine specialist, or otherwise appropriately skilled medical practitioner.