Hi, this is Dr. Steve Gangemi. And in this second part of the shoulder girdle injury, treatment, and prevention video I want to talk about the more powerful, stronger muscles of the shoulder girdle that many people injure, or they’re weakened, so they end up with a rotator cuff issue. But we need to treat and assess the actual more powerful muscles that support the shoulder girdle. Lets do it.
Okay, so aside from the rotator cuffs, again, that are a very common injured muscles since they’re trying to stabilize. But the rotator cuffs tend to fail because they’re working harder than what they should, because the more powerful muscles of the shoulder girdle area are not working properly. So in other words, if you’re lacking a big, thick, strong, powerful muscle that’s not working as well, as efficiently as it should, because there’s some muscular imbalance. And now the rotator cuff is having to work harder than it would like to, and you end up injuring it again, unless you actually fell and tore a muscle.
So a few of the really important muscles…they’re all important. But a few of the ones that a lot of people are using, especially when they’re climbing, are your serratus muscles. These are the muscles that sit over your ribs. They look like finger muscles. You can really see them in body builders and really, basically someone whose really ripped, lean. You can see them sit over your ribs. And they’re going to basically…a lot of people think about them. Especially in anatomy books they talk about pushing, and I can feel mine as I push out like this and really put pressure on my serratus muscles. But they also really stabilize your scapula. If I’m pushing down like this, and if I had resistance against this hand here, and I’m pushing down, I’m going to really feel my serratus muscles move.
So obviously these are big-time important if you’re climbing, if you’re pushing, even if its just a push up type motion. And, what else? Any striking, any combative issues, you’re going to be using your serratus muscles along with a lot of your rotator cuffs. And crawling exercises, and climbing. That’s where you’re really going to use a lot of serratus. So you can look for those trigger points up in there. The connective tissue, the fascia, which is that thick, web-like matrix of connective tissue that integrates all your muscles basically is going to, with your serratus especially, is going to link up very closely with your subscapularis, which is that rotator cuff muscle. So any stuff in here, you’re having trouble moving and pushing down, pressing, think subscapularis, think serratus.
Going over to the back side, a really powerful muscle that we have is our rhomboid, that helps to press our arm in and really stabilize our scapula this way. That muscle is basically here in between our spine and our shoulder blade. So these muscles are really helping to really stabilize your scapula, give you the proper range of motion and mobility of your scapula that a lot of people lack. So they end up losing the ability to do a certain sport, or a certain type of motion, and they end up injuring it. So you want those scapulas to be moving very freely. Again, your shoulder blades, if you’re looking at someone from the back, and if you notice, maybe…or if you have someone else look at you, you might notice that one’s moving very freely and the other one not so great. Then you have some instability in that area. And you can look for trigger points in that rhomboid, again, in between the spine and the scapula or the serratus.
Or coming around to the side your powerful deltoid muscle, which a lot people consider, or they think about when they say their shoulder. They usually mean the deltoid, which is this this type of motion right here. Elevating, abducting, bringing your arm out to the side, all the way down, right to the side of my arm here and that part of my actual shoulder. Don’t forget about your pecs from the front. Just like your serratus for pressing, you’ve got your pecs, they make up a big portion of your shoulder girdle. We kind of just think of them as just front muscles, as your chest muscles, but they really have a lot to do with the motion of your shoulder girdle and the support of your shoulder girdle. So I’ve seen a lot of people have a shoulder blade, or a shoulder blade instability issue. And they say, “Hey, I’ve injured my shoulder,” but its not. It’s actually a pec injury. You have three pectoralis muscles way in the front here, and you can go and poke around there. If you’re a woman look out for the breast tissue, but just stay way up here off the breast tissue and get into the muscle, and you can just hold that area. Again, feel if its tender anywhere in there, and move your arm around. If your shoulder blade feels better, then go with that.
The last muscle I want to mention, because its actually really important and a lot of people don’t think about it, because it has to with your biceps. Biceps, bi means two, so for bicep muscles we have two muscles. And everybody tends to think of their short head of their bicep because we think about curling and lifting, or even a pull up type motion. But actually the long head of your bicep is really what is important here, not that the short head isn’t, but in terms of elevating your shoulder and the connection between your elbow and your shoulder. So your bicep tendon starts right up in the top part of your humerus, the top part of your upper arm bone, and goes through a very, depending on you it can go through a very shallow or a very deep groove, the bicipital groove. And some people, if yours is more shallow, you will never really know unless you have surgery on the area.
You can have that bicipital tendon slip out a lot because of instability in the shoulder, as a result of any of the other muscles that are going on in the shoulder that we just talked about: your serratus, your subscapularis, or any of the rotator cuff muscles. So if you have problems elevating the shoulder like this, you’ve got to think outside the box on this like we do with a lot of injuries, and not just focus and compartmentalize the area, and think about “Oh, the pain is just right here. I need to only look right there.” But in this case, look even way down just below the groove of your elbow, where your upper and lower arm come together. That’s where the long head of the bicep inserts. So you can look for a trigger point in there, and feel if its tender in there, and rub it out. Or even if you just held it for a second or two and elevated your arm. And if you notice that your shoulder feels better…again, you don’t have to have any pain in your elbow. But if your shoulder feels better with elevation, then you know you have a problem with the long head of your bicep. And you’ll see some pretty great improvements with that.
So you’ve got to think outside the box again. Think about maybe how your elbow is functioning, and your scapula especially, and all the muscles surrounding your shoulder blade. We didn’t discuss them all right now but its a good place to get started. So you can hopefully heal up a chronic shoulder injury, a bad shoulder that you may have, or weakness if you’re climbing a lot, and you notice one side is stronger than the other. You can look at these things, give yourself a little self assessment and self treatment with no harm done. But again if something’s not getting better, if its an acute injury, make sure you have that checked out by your healthcare professional so you know you didn’t tear something or break something and you’re trying to treat a fracture. That wouldn’t be a good thing. Good luck.
Hello Doc. I really hope you can help me, or at least help me find an answer to my shoulder pain. The pain began when I was around 26yo and now I’m turning 46 in January and this doesn’t get any better.
The pain is between my left scapula and the spine and it runs longitudunally from the top of my shoulder all the way down to the distal end of my scapula. I was also misdiagnosed with fibromyalgia, I also had some Physical Therapy done at some point, infiltrations of Xylocaine and something else I forgot the name (the purpose was to numb and lubricate so it was some sort of oil), I even did Hiyamah (or cupping) on several occasions.
Nothing works, pain still there, some days more than others, but it never goes away completely. This is probably not much to go on, but I’ll take whatever you can offer.
Dr. Stephen Gangemi "Sock Doc" says
Hi – other than this and the other SD Shoulder Video the best advice I can give you is to find a holistic doc or therapist in your area for evaluation/treatment. I’m happy to set up a Skype with you too if you’re unable to come to my office in NC.