Shoulder Pain & Injuries (1/2) On FLOW

Hi, this is Dr. Steve Gangemi. And in this video series, I want to talk about some common injuries that athletes experience through movement-based sports. So the first one we’re going to discuss is the shoulder girdle. The shoulder itself is a very complex joint, actually three joints, made up by three bones: your humerus, which is your arm bone most people know as, your scapula, which is your shoulder blade, and your collarbone, which most people know as their clavicle. So a lot can go wrong in the shoulder area since it’s such a freely movable joint. It’s a ball and socket joint. You can move it in various directions. You’ve got collarbone issues, you’ve got scapula issues, your shoulder blade. It just needs to move your arm in so many directions. You’re using it for climbing, for carrying. Even if you’re just running or walking, you’re using your shoulder to some degree to balance your body, to propel yourself forward, to stabilize a normal gait with the opposite hip actually. This hip is going to correlate with my right shoulder, and my left shoulder with my right hip.

So there’s lots of harmony of your gait that needs to be working just right for your shoulder to function optimally. So when most people think about the shoulder, they tend to think about rotator cuff injuries. Those are very common injuries. And I want to discuss some natural assessment and treatment options you can use to hopefully see what’s going on in your shoulder and hopefully heal it up to some degree. Or if it’s a chronic injury, get you back where maybe other treatments have failed you. So, rotator cuffs are stabilizing muscles, four of them actually, of your shoulder girdle. They’re not really powerful muscles. They’re not meant to do a lot of heavy lifting or anything like that. They’re really just meant to support and guide the joint to its proper motion. So we always hear about people injuring their rotator cuffs, and then going to rehab, and doing band exercises, and trying to isolate the shoulder or the rotator cuff muscles, but they tend not to work very well. With anything, we don’t want to compartmentalize an injury. As humans, we’re dynamic individuals. We’re always using more than one muscle. We’re always using more than one motion. So just to simply isolate a muscle to try and rehab it that way is actually very primitive, and the methods tend to fail often.

So rotator cuff, let’s talk about the four muscles real quick. We have our supraspinatus, which does this to our shoulder, our arm actually, brings it out about 30° before more of the powerful deltoid takes over. And then we have our teres minor, which is one of the muscles in the back here that goes from the scapula to the top of the humerus, and that lets us externally rotate our arm like this. And then another rotator cuff muscle that does a similar motion, but more when your arm is elevated a little bit, and helps to externally rotate the arm this way, like if you’re throwing a quick little back hand, then that’s called your infraspinatus. And then coming to the last one is a very powerful for the rotator cuff, the most powerful one of the four, again, even though they’re not that powerful is your subscapularis, which helps you throw forward. And that muscle is over the front of the shoulder blade.

For the supraspinatus, the first rotator cuff muscle, I want to discuss is…again if you bring your arm out just a little bit, if you’re having pain there in your shoulder, that’s probably your supraspinatus, maybe some of your deltoid muscle. This is the most common of the four rotator cuff muscles that a person will injure. A fall right on your shoulder girdle area is going to, a lot of times, tear a fiber. Or sometimes even a complete tear, if you’re unlucky enough to tear your rotator cuff. Most people, when they say “I tore my rotator cuff,” they’re talking about the supraspinatus. So, again the things I’m showing here, this is an assessment in treating yourself, but don’t be foolish about anything. If it’s not helping, if it’s not healing, don’t try and keep on doing the things that I’m showing you and not go to the hospital or your doctor to make sure that you haven’t fractured something or really done some damage in the area. Okay, so be smart about what you’re doing.

So if you’re feeling pain, and you put your hand right at the top of where your collarbone comes into your shoulder girdle, there’s like a little divot right in there at the top of your shoulder where the two bones come together in a V. And if you put your finger right there on the top, right in front of those, that bony intersection…and again abduct your arm, which means bring it out a little bit to the side…and the shoulder is feeling better, then that would be a good place to work that trigger point. Which I discussed in another video, to work that trigger point to help heal up that muscular fascial injury, the connective tissue injury, that you have in the supraspinatus. Now if this is an acute injury, it might be really sore to be doing that right now. You might want to just use some general compression stabilization in the area. But again, you compress, you don’t constrict. And you try and do active recovery as much as you can, but not over-stabilize the joint so it starts to develop any scar tissue or anything like that.

So your supraspinatus up here is what a lot of people…it’s underneath your traps. So you might have pain deep in the traps, but it’s really your supraspinatus again. Hold it, move the shoulder, feels better, go with it. Work it out a little bit, 10, 15 even 30 seconds in a pretty deep motion. And if it feels better, that’s where you go. Teres minor and infraspinatus, I really don’t want to get into those individually. Again, these are the external rotators here for your teres minor and your external rotator of your infraspinatus this way. But we’re going back to the scapula area, right over your scapula and into your humerus. The infraspinatus is a more meaty muscle back here and the teres minor is right underneath it there. So you want to just put your hand over your scapula and if you feel this motion work…you should actually feel the muscle moving when you do this. If it feels better when you’re stabilizing that area, if you have a tender spot in there and you work it out like I am right now, anywhere that shoulder blade area, the front of the scapula on your backside, and you do that, and it feels better as you work it out, then you’re in the right spot. You should see a significant amount of pain reduction in your shoulder girdle area.

And then the last muscle is in the front of your shoulder blade, which I call the armpit. That’s your subscapularis, again, the most powerful of the four rotator cuffs for stabilization muscles now. This is throwing forward, if you’re throwing, or even catching, climbing, this is really important. Think your subscapularis. It’s really in the front of your shoulder blade there, your scapula, so you’ve really got to get up in there. It’s a tender area anyway, even if you don’t have an injury in there. And if you could see I’m pushing, if I grabbed my shoulder blade like this, I’m pushing up in there. Tender area, but again, if I did this I can feel that muscle move a little bit. Or if I had some resistance to push down here, I can feel it especially right there at the end. I can feel the muscle in there. And if I work it out for, again, up to 30 seconds, rub out that tender spot, shoulder blade feels more freely movable, diminishing pain, I’m on the right track there.
 

Dr. Stephen Gangemi "Sock Doc"

I'm a board-certified chiropractic physician and clinical nutritionist with a passion for true natural health care. I implement dietary & nutritional therapies, exercise & movement practices, and lifestyle changes along with manual therapy techniques to help the body heal and prevent illness and injuries.