Shoulder Injuries and ART

Recently, I’ve been approached by several people with varying shoulder injuries wanting to know more about ART and how it could be a benefit to them, so let’s look into the shoulder, its function, and some of the injuries that affect it.

First, let us start with a little anatomy of the arm and shoulder.  The arm itself is the only extremity that doesn’t have an actual bony attachment to the skeletal frame. The upper arm, or humerus, sits in the glenoid fossa of the scapula.  The scapula then articulates with both the humerus and the clavicle. This shoulder complex basically sits on top of the rib cage.  The only attachment to the rib cage at the shoulder is by the muscles and their tendons of the upper body. More specifically, these are the muscles of the shoulder girdle:

• Deltoid (Middle, Anterior, Posterior)
• Trapezius (Middle and Lower)
• Latissimus Dorsi
• Teres Major
• Rhomboid
• Levator Scapula
• Coracobrachialis
• Pectoralis Major/Minor
• Subclavius
• Biceps Brachii (Long and Short Heads)
• Triceps Brachii (Long, Medial, and Lateral Heads)
• Serratus Anterior
• Serratus Posterior Superior
• Rotator Cuff: Supraspinatous, Infraspinatous, Teres Minor, and Subscapularis

The purpose of these muscles is to attach the shoulder complex to the human spine and rib cage, providing strength and stability.  Unfortunately, what often happens is one (or several) of these muscles will be stronger or weaker than the others, resulting in an imbalance. This usually occurs either with the scapula stabilizers or more commonly, with the Rotator Cuff (which is actually the stabilizer of the shoulder joint).

The scapula stabilizers include such muscles as the serratus anterior, the rhomboids, the pectoralis minor, and the trapezius. The latissimus dorsi also stabilizes the scapular alignment, even though it attaches to the humerus rather than the scapula.

Joint Stabilizers (or more commonly referred to as the Rotator Cuff) originate on the scapula and wrap around the head of the humerus acting like a pulley system. They are:

• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis

An imbalance usually begins with a “dysfunction of the rotator cuff” and if allowed to progress; will result in one of the following:  rotator cuff syndrome; supraspinatus tendinitis; impingement syndrome; subdeltoid and subacromial bursitis; calcific shoulder bursitis;  bicipital tendinitis or even frozen shoulder. In these cases, there is often no direct, acute injury. However, as the shoulder is a very mobile joint with little stability in certain positions, the soft tissues of the shoulder region can be injured during athletic and recreational activities, at work, in an auto accident or even in a fall. Every acute sprain and strain injury to the shoulder must be properly treated and fully rehabilitated if you want to avoid future problems. If not, an injury may lead to chronic instability.

Once the muscle has been damaged, the body tries to repair the muscle by laying down scar tissue to repair the damaged muscle.  This build-up of scar tissue or “adhesions” can cause the following:

• Muscles can “catch” between each other – for example, an adhesion between the rotator cuff muscles and the deltoid will prevent the two layers from gliding smoothly over each other. The result is pain as the two tissues pull against each other when raising the shoulder.
• Weaknesses occur in the muscle by preventing the muscles from contracting or shortening properly.
• Repeated injury. Adhesions lead to tight areas within the muscles that cause repeated strain or microscopic tearing every time we stretch, contract or use the muscles.
• Prevent adequate blood flow (cause hypoxia) to the area of the muscle, tendon or ligament that they affect. Inadequate blood flow can lead to repeated inflammation and a constant ache within the injured area.
• Choke nerves that pass through or near the adhesions.
• Create Biomechanical Imbalance (or abnormal biomechanics) within the shoulder, especially if the “stabilizer muscles” of your shoulder are being bound or restricted by adhesion. When the function of the stabilizer muscles is being impaired by adhesion, this leads to an imbalance of the scapula and/or shoulder joint, causing strain and injury to the surrounding muscles, tendons and ligaments.

Some of the most common activities that result in imbalances or dysfunction leading to shoulder pain are:

• Weightlifting
• Tennis, Racquetball
• Martial Arts
• Swimming, Water Polo, Surfing, Rowing
• Throwing, Pitching, Volleyball
• Trauma:  Football, Hockey
• Fall on outstretched arm
• Golf
• Prolonged sitting at desk or keyboard
• Car accidents
• Sleep position: 6-8 hours of constant pressure

If you or someone you know has shoulder pain or a restriction that is affecting your performance or daily activities, you may want to consider an ART treatment.  Since ART is non-invasive, and most people experience relief after the first visit, why not try it first?