Example of impaired movement causing pain

Posted on June 2, 2011

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Here’s a video illustrating how impaired movement can cause someone pain. In this particular video it’s shoulder pain. Pay careful attention to the right scapula, the impairment is progressive so be patient and watch the whole thing.

Also, It helps to look back and forth between the right and the left to see the asymmetry. Although in this case, it shouldn’t be hard to recognize the issue:

 

Now that you’ve likely been officially grossed out (sorry Holly :)), let’s talk about this.

If you’re not familiar with that’s going on with that right scapula (shoulder blade), what’s happening when Holly returns from straightening her arms is her right scap is winging rather than retracting.

That is, while normally the scapula retracts and sits nicely against the rib cage, her right one has decided after a little while it’s bored and isn’t going to sit at all.

Why is this happening? (Simple version; for those interested, specific muscles and anatomy information can be found at the end)

So when Holly first started she mentioned to me that she had been in a car accident a while back and ever since has had shoulder and neck pain from the accident. From listening to her talk she basically had accepted this and was resigned to just living with it for the rest of her life. Holly is 30 so that’s a llllllong time to accept that you’re going to be in pain.

The thing is, often times when someone has a traumatic injury happen to them (a car accident in this case), the reason for having chronic pain 6 months, a year, or years later, is not from the original traumatic injury. It’s from the compensations that come along with the original injury.

Using Holly as an example, while she was recovering she would often slouch her right arm down and let it be pulled forward to alleviate the stress on it.

Doing this over and over caused her muscles to get good at maintaining this position. When it comes to the body, you get what you train. And you are always, always training the body at something. You just may not realize it.

Holly essentially trained her right scapula to wing like that in the recovery from her original injury.  What allowed her to be pain free in the acute stages of her injury recovery is what caused her to experience chronic pain in her shoulder. So it’s not that the car accident is why she still has shoulder pain, it’s the fact that the car accident made her more susceptible to acquire compensations that cause shoulder pain.

How do we correct the issue and get rid of the pain?

Hopefully it’s apparent now that chronic pain can have a solution. Solutions in Holly’s case consist of simply squeezing her shoulder blades together and pulling them down when she brings her arms to her body in the above exercise. Rocket science, I know.

Other exercises that can help consist of wall slides, bench pressing with proper scapular positioning (squeezed together and pulled downward) and various forms of rowing exercises where you don’t let the arm(s) get pulled too far forward (remember this is what caused the scap to start winging in the first place, so we want to avoid all movement analogous to what caused the original issue).

Lastly, but most importantly, correcting her shoulder positioning during the other 23 hours of the day is CRUCIAL. Doing things like not letting her arm hang forward during activities such as using a computer mouse or driving with one arm will help a ton.  And just good ole walking/sitting upright with good posture will help as well.

One other thought: This video is also an illustration of how sometimes you simply need someone else to watch you move and help you figure out why you’re experiencing pain. Holly had no idea her shoulder blade was moving the way it was and therefore had no other reason to believe her shoulder pain was from anything but her car accident. Being aware of the cause of your pain is the first step towards getting rid of it.

Why is this happening? (Anatomy version- I’ll try to make this quick and as easy to understand as I can)

For those interested in some of the nitty gritty, there are muscles that pull the shoulder and scapula forward and muscles that pull the shoulder and scapula backward and down.

When someone’s shoulder is winging like this there is an imbalance and a motor control issue between the muscles that pull forward and the muscles that pull backward. That is, the muscles that pull forward are typically stronger and used more readily than the muscles in the back of the shoulder.

Specifically, pec minor tends to wreak havoc on the shoulder due to the fact that it connects to the shoulder blade and seems to always be in a shortened position in people. This is due to the fact that people are always sitting and walking with slouched shoulders.

Pec minor

So this is the primary muscle that causes issues with the shoulder and scap being pulled forward.

In the back of the shoulder, serratus anterior, the middle and lower trapezius are not working properly (motor control) and are often weak as well. The serratus anterior is especially supposed to be pulling the shoulder blade nice and close to the rib cage due to the fact that it inserts into the medial portion of the scapula, which is what is so grossly sticking out in Holly’s video.

Looking at the orientation of the muscle fibers of these muscles, it’s easy to see how they pull on the scapula:

Trapezius

Middle trap

Lower trapezius

Lower trap

Serratus anterior

 

Now the reason this causes pain is because when the scapula wings it’s putting a greater amount of pressure to the front and top of the shoulder (because it is not being pulled down like it should be).

Basically the top and front of the shoulder joint are being lightly punched, over, and over, and over again. Now there is pretty much always going to be a little pressure being put on the shoulder, but it shouldn’t always be in one direction.

It’s like the tires on your car, if you never rotate them the front tires will wear away a lot faster than if they got a break every 5,000 miles by being put in the back.

Just like how you try to extend the lifespan of the tires of your car, making sure the shoulder moves properly (doesn’t wing in this case) helps improve the lifespan of your shoulder.

 

UPDATE: Here is Holly a few weeks later:

 

 

Notice the improvement in keeping the scap nice and tight against the rib cage. There are definitely still some reps where Holly has to really concentrate, but it is much better.

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Posted in: Shoulder Pain