Osteopath Dr Phil's Tips

Shoulders

We see lots of patients with quite simple neck and shoulder strains and seizures. Although these may be very painful and restricting they can respond well and quickly to good hands on therapy. But there are a whole group of painful shoulder problems that can last for months or even years. These are a much more challenging task for us to get right.

Evolution

There are several obvious faults here. As our bodies evolved from sea to land creatures, from four legs to two and to highly complex hand users the blood circulation has failed to keep up. To reach tissues that need a good supply the current arrangement is ridiculously useless. A dozen unnecessary twists and turns attempt to supply the joint lining, the rotator and biceps tendons, and all of the crucial support ligaments. This is a triumph of unintelligent design: the knee is similarly awful.

Ageing

Our bodies repair and grow very well until we are around 24. After then the basic form and structure become fixed, and can lose efficiency very quickly. I would guess that healing time and rehabilitation for sports injuries doubles every couple of years; and many patterns of damage become permanent. It’s tragic when some fine competitors seem to age 30 years in a decade! As tissue support deteriorates these old “war wounds”: come back to haunt us in later life and are often difficult to sort out.

Complexity

The shoulder girdle is actually slung from the base of the skull and anchored to the rim of the pelvis. It’s only point of firm contact with the torso is at the top of the sternum. Everything else about the shoulder floats around in three dimensions under muscular control. This makes us examine a huge range of movements for ease, reluctance, block, pain and inflammation.

Over-bracing

The body’s first response to any injury is to brace all the muscles moving the parts. This can stop further strain, and keep close alignment during repair, but this is only good in the short term.When muscles are over-braced for too long they lose bulk and become fibrous, inflamed and painful. These may later be numb and useless.

Inflammation

The body’s inflammatory response is part of natural attempts to heal any injury or infection. This is highly complex, involving the immune systems and local prostaglandin cascades. Again this is great in the short term, but creates huge trouble if sustained for too long.

Ergonomics

Over-bracing can often happen without injury. Imagine a guitar or piano player. If they tried using their hands without flexing their shoulders and trunk they might cramp up within minutes. The music would be thin, lifeless and boringly slow anyway. Now look at how we sit at the computer. Static over-bracing of the neck, back and shoulder muscles can gradually build up heaps of trouble: along with excessive RSI that stresses the forearms. If we don’t wriggle while we work we are asking for trouble.

Treatment

Good body therapy starts with an understanding of the type of shoulder problem and the typical time frame. We can then aim to shorten this: generally by as much as two thirds. Initially we work carefully away from the worst area: releasing restrictions to aid blood supply, gradually easing the float of the shoulder blade, and allowing only very small movement into the most inflamed tissues that must be rested. Once the area is pain free at rest, the treatment becomes more local. With gentle slow pumping and traction the inflammation clears more quickly and what small movement there is can be reconnected gradually to general coordination. Until this second phase is well under way exercise is a huge mistake, and prolongs the trouble. Only in a third phase do we encourage the bit-by-bit regaining of full movement, strength and use.