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#064: Understanding and Preventing Your Shoulder Pain

This webinar replay gives you the essential information to understand how your shoulder pain occurs and some easy solutions and desk exercises to help prevent shoulder conditions that plague the desk jockey.

Disclaimer: This is a transcript and grammar will not be ideal, but the info is valuable!

Intro: We all have to earn a living, but sometimes we don’t think of the effects sitting for an extended period of time has on our physical well-being. Welcome to the modern desk jockey, providing you with healthy solutions for the desk worker, our conversations with industry professionals and topic based podcasts are guaranteed to keep you active, for a healthy, more effective workweek. Now here’s your host Dr. Kevin Christie.

Dr. Kevin : Hey desk jockeys, welcome to another episode of the modern desk jockey, today I’m actually going to be stripping the audio from a webinar I did for a corporation on shoulder pain, and so I will actually put the webinar slides in the show notes and more extensive exercises in there too to work on shoulder issues, it’ll really be helpful for you, I found this to be a nice 20-minute webinar that we did and it was really, we got a lot of good feedback from it so I wanted it to be a podcast episode, and so I’m obviously addressing some slides as I talk so if you’re driving you won’t have that, but I think it’ll be still very valuable for you and then again you’ll be able to access these slides and the video of me doing this webinar on the show notes. So take a listen, this is a webinar. We do a lot of webinars for companies as part of our digital Ergonomics initiatives, so this is just one of many that we offer for corporations and this one’s on the shoulder so without further ado, this is the shoulder pain webinar.

Dr. Kevin : Welcome to today’s webinar, where we are going to discuss understanding shoulder pain, you’ve been listening to a lot of these PowerPoints and webinars we’ve been giving on different topics, and the shoulder is a very common issue that we see with the desk workers and so we really felt having a complete webinar on this topic would help you out, in understanding and preventing some shoulder pains, so we’re going to dive into a lot of the details of that and make it easy to understand and easy to implement the proper changes that you will require to do. First off common shoulder conditions we have listed here, we have thoracic outlet syndrome, which really is if you’re dealing with a lot of numbness and tingling down the arms and pain down the arm, the thoracic outlet is an area where you’re going to have some nerves and such and blood vessels run through and it can get encroached through different things like poor posture, adhesion’s in the muscular restriction, kind of realm you could definitely have some bony growth formation or arthritic changes that can irritate it and it’s, there’s some certain tests that the doctor would do to see if you’re dealing with thoracic outlet syndrome and it can definitely happen with the desk worker. Impingement syndrome, this is definitely something that’s very common, it’s usually representative of pain on the kind of top outside part of the shoulder and a lot of times when you go overhead into movements, you have the pain response and essentially what’s happening is the supraspinatus tendon of the rotator cuff which we will describe in more depth in some future slides, it can get pinched in a sense, it’s the best easiest way I can describe it and it’s impinged upon, that’s why it’s called the impingement syndrome, it’s not necessarily a tearing or a rupture of the tendon or anything like that, it’s just an impingement of that supraspinatus tendon and causing inflammation and pain and what happens is when you raise that arm overhead, the head of the humerus, the arm bone will kind of ride up a little bit too much and then just impinge on to that tendon very common.

We’re going to discuss the mouse trap, which is something that we’ve, I think we coined I never heard it before, a couple years ago and we see that a lot at the desk worker so we’ll describe that. A lot of people have shoulder stiffness, adhesive capsulitis can occur which is called in the layman’s term frozen shoulder, that doesn’t happen a ton but it can happen where you have significant range of motion and pain in the shoulder joint and really it’s called adhesive capsulitis because the capsule of the shoulder, like where the ligaments and everything ends up having a lot of adhesions and scar tissue in there and it really binds that shoulder joint you really can’t move it too well, so it’s very common. And you can have real bursitis, the bursa sacks in different parts of the body, there’s one in the shoulder you can have bursitis of the shoulder, a lot of times doctors use that as a blanket diagnosis which is not ideal all the time, but you can deal with that and then some of the postural syndromes we’ll cover today will give you an understanding of how sometimes shoulder issues do occur. Okay moving on the anatomy of what I call the shoulder complex and it’s going to deal with four joints, three of them are real true joints, the other ones kind of a pseudo joint in a sense and the first one is the acromioclavicular joint or the AC joint, I think a lot of you have heard of the AC joint, especially if you’ve played athletics at all, that is going to be in the front part of the shoulder, you’re going to have the sternoclavicular or the SC joint, that’s where the sternum and the clavicle which is the collarbone meet and that’s more in the center like below your neck there, so you know where the sternum is mid chest, so you have a joint all the way there, you have the glenohumeral joint, which is the actual shoulder joint that ball and socket joint that you think of so commonly, and then you have what we call the scapula thoracic or the, it’s really where the scapula or the shoulder blade meets with the thoracic spine and you have movement in there, and that whole shoulder complex really makes up what we’re talking about with the shoulder, which is why a lot of times it can be concurrent with some neck pain or even mid-back pain, because there’s connections to those areas and a lot of the muscles that we describe in that region will go all the way from the base of the skull down to the shoulder, so it’s very common or if you end up with the shoulder problem, you end up hiking up, shrugging that shoulder to do movements too much and you end up with all kinds of neck pain as well.

So that’s the anatomy of the shoulder and moving on, I always discuss your shoulder has three lines of defense when it really comes to stability, you want to have proper range of motion within the joint of the shoulder, but you really need to have stability as well, you need to have that good kind of combination of the two and all too often people have lack of stability in the shoulder and it causes a lot of their injuries, and that first line of defense for you is scapular stability or shoulder blade stability, so you really want to have that scapular stability, it’s the foundation of really setting up overall stability of the shoulder joint, and the second is rotator cuff stability, and that’s going to be more of your dynamic stability, so when you move that arm and you’re throwing or hitting or swinging, the rotator cuff which we’ll describe in more detail is going to provide the stability of the shoulder joint during those movements, and in the third line of defense is basically your ligaments, the labrum and capsule of the shoulder, I think a lot of people again that watch athletics they hear about the labrum tears of some of these athletes and with the labrum, there’s no blood supply to that so if it tears the only way to really get it to heal and function ideally would be surgical intervention, not that everybody needs to have surgical intervention if they tear the labrum but to have full use or function of that labrum and the shoulder stability you would need that.

And one of the key concepts of understanding this, what happens is if you lack stability in one of these lines of defenses, then your other two are going to really suffer, so if you have improper scapular stability which a lot of people have, you’re going to ask that rotator cuff to do a lot more work to stabilize and then you end up with rotator cuff dysfunction and myofascial restrictions in that which can lead to pain, can lead to lack of stability which can lead to damage to the labrum which is really bad, can cause that impingement syndrome that we talked about, tearing of the rotator cuff, a lot of people know that you can tear the rotator cuff that’s common knowledge and so a lot of times when you have weakness in one line of defense, it’s going to really stress the others and it’s going to get overworked, so we want to try to avoid that and so a lot of times when we’re doing shoulder injury prevention, we’re really trying to optimize scapular stability, rotator cuff stability and that really spares a lot of times the ligaments labrum and capsule inherently, so keep that in mind, those are the three lines of defense that you have in the scapula, you really want to make sure that it moves well, I could probably do a whole podcast episode/webinar/live workshop on the scapular stability but just understand how important that is, I will have access at the end of this to some exercises that will work on that and that’ll be very helpful.

On this second slide here is the rotator cuff, and if you can see this, you’ve got four muscles that make up this, what we call the sits muscles, so the sits muscles are the rotator cuff that provide the dynamic stability, you have two in the back, the teres minor and the infraspinatus muscle and you have one of the top, the supraspinatus is the one I told you where the tendon comes down and a lot of times is the culprit with any type of impingement or tearing of the rotator cuff tendon that you hear about, so it’s very common. And then you have one on the front called the subscapularis which actually sits on the front of the scapula, which doesn’t tear all too often or anything but is one of the leading causes of shoulder pain when it’s dysfunctional that we see and we do a lot of different myofascial release on that, so I will guide you on how the best way to make sure that our rotator cuffs are doing well and sometimes it’s not about just doing rotator cuff exercises, again it goes back to a lot of times in the scapular stability and even a little bit further down the chain which we will discuss on some upcoming slides.

So the next slide shows you the ligaments and labrum and you can see a little tearing there, again there’s no blood supply to that it’s a very common injury and surgery can be indicated but it’s not necessary, if you sit at a desk for a living and you don’t play any overhead sport, so you just lift weights you can manage it you can do good rehab exercises, you could work on getting really good scapular stability, you can work on getting really good rotator cuff dynamic stability, good thoracic mobility, avoid some really compromising positions overhead and you’ll be fine, I see it all the time we get plenty of people with torn labrum without surgery. Now if you’re going to be a professional pitcher or quarterback, you want to play a lot of golf or tennis, there’s other things, like for me as a chiropractor doing adjustments like if I knock on wood and tore my labrum, there’s a pretty good chance I’ll need to have surgery because I do need optimal function of my shoulders to do my job, so there are indications for surgery if you do tear that labrum but again it’s not cut and dry, and you do want to have consultations with a specialist to make those determinations if you’re dealing with this. So that line of defense, that third one is the ligaments and labrum and it’s something you want to definitely keep into consideration if you injure that labrum. All right moving on to the alternating mobility instability pattern, I’m going to be doing a podcast on this separately and it starts all the way from the foot and works all the way to the neck and all the way down to the wrist, but essentially every joint in your body alternates for the need of mobility and then stability, so the hip needs hip joint mobility and then you need lumbar stability, and then moving up you need thoracic spine or mid-back mobility and that’s where I want to start for the sake of the shoulder, because if you’re lacking proper thoracic mobility, it’s not going to allow your scapular movement to be ideal which will inhibit the stability that it can provide for the shoulder, so remember the shoulder has the three lines of defense and that first one is the scapular stability, but if you have improper thoracic spine mobility it’s going to be very hard to have the proper stability of the scapula, and then what ends up happening is you move outward you need proper shoulder joint mobility, if you have improper scapular stability, it’s going to be hard to have proper shoulder joint mobility and so it’s amazing how the joints in the body alternate for that need, so a lot of times when we assess someone we got to make sure that we restore the mobility in their mid-back, and a lot of people with poor posture do not have good mobility in the mid-back and it sets up their shoulder and neck into a really bad compromising position and causes a lot of the injuries.

So when we’re giving exercises for the shoulder, injury prevention, thoracic mobility which we’ll put in this, you’ll see some slides with that, are key as well as obviously the shoulder exercises, so I wanted to touch base on this alternating pattern of mobility and stability because it’s very important. Okay moving on to the next slide and again you’ll have access to this webinar as well, the upper cross syndrome, we’ve covered this on some previous webinars but it’s really important to touch base again on this, so what it is if you have a tight chest, the chest muscles and then you have tight back of the neck muscles, weak mid-back muscles and weak muscles in the front and neck that’s the upper cross syndrome, so you got to look at it across like if my chest is tight and the back of the neck and back are tight, that’s a cross, tight and tight and then weak neck flexors on the front and weak mid-back that’s weak and weak diagonally crossing and that’s what we find with the person with a slouched poor posture and they have that forward head syndrome, the forward head syndrome is a big cause of this issue and causes a lot of different types of neck pain and shoulder pain and really is a problem and it ends up, when you sit at a desk for a prolonged periods of time your chest gets tighter and tighter, you get more rounded really into that slouched position and your mid-back muscles get really weak and it really makes it difficult to have again scapular stability which is that first line of defense, so we really want to make sure that we address this upper cross syndrome with proper postural exercises which I will cover with you moving forward.

Okay, so on that slouched posture and what it does to the shoulder, poor posture will limit your shoulder range of motion and you can end up carrying this posture into certain activities and sports and it really causes a lot of the shoulder conditions that we’re dealing with, so I want to actually have you do this test and I’ll do it with you, I call it the slump overhead test, get your chair, I just want you to sit at your chair and slump into poor posture and then from there, I want you to just take your right arm in that poor posture and raise it up in front of you as high as you can overhead and kind of mark in your head where that is, then bring your arm back down, now sit into really good posture sternum up, don’t retract your shoulder blades or anything, but just nice good posture and then raise that same arm up overhead as far as you can and you’ll see that you have increased range of motion in good posture, because when you’re in that slouched rounded position, you’re really closing off a lot of the shoulder joint range of motion and that’s a big problem that we see that causes a lot of the different shoulder issues that we have, so this is a little test for you to realize how important good posture is, we talked about sternum up, so definitely make sure that when you’re doing activities or when you’re sitting, you’re moving sternum up that’s going to set you in a good posture, that’s going to open up that shoulder joint, and you’re going to have good proper shoulder range of motion and you’re going to spare that shoulder joint from any type of overuse injuries.

Next is the mousetrap, we just started noticing a lot of people coming into our office with right-sided neck and shoulder pain and the reason why we called it the mousetrap is that, upper trapezius muscle which goes from the base of the skull down to the shoulder blade and the mid-back that we discussed, they are getting this just nasty trigger point right on that right side more than the left, it can definitely happen in both without a doubt, but what we are finding was more on the right side I’m like why is this happening, and the more we realized and we did a lot of ergonomics assessments was that, when you’re using that mouse a lot and especially if your ergonomics is not set up properly maybe your desk height is wrong or your chair height or you’re reaching for the mouse too much, you end up shrugging that shoulder a little bit causing a lot of overuse of that right upper trapezius muscle using the mouse, so hence avoid the mouse trap. We just noticed a lot of this in treating a lot of upper trapezius right-sided neck shoulder pain with becoming common problems, so you really want to make sure your ergonomics is proper and obviously you have plenty of resources for that on past webinars and such. The other thing you can do believe it or not is you can move that mouse over to the left side, it doesn’t have to always be on the right, you can alternate, I wouldn’t put it on the left always just alternate, maybe it’s Mondays you do it on the right, Tuesdays on the left or half-day on the right and then the second half of the day on the left and you just alternate from there and try to get a little bit more of the equality of right and left and give your right side a little bit of a rest there.

But key aspect number one is, really proper ergonomics to make sure that you’re obviously not putting excessive strain on that shoulder, we see a lot the keyboard is well with neck and shoulder issues if that keyboard is too far out in front of you, then you’re going to be reaching for that keyboard to type and it’s going to put a lot of forward drawn rounded posture on you and it’s going to cause a lot of shoulder issues that we discuss. So make sure that, you should be able to, when you’re sitting and using the back rest of your chair and you’re using the keyboard you should have 90-degree angle, so good posture sternum up, elbows bent at 90 and you should be reaching you got to bring that chair up closer to your desk, a lot of people are too far away from it, but you should be able to just sit there and use the keyboard and not have a problem and be all in that 90 degrees with the shoulder and the elbow, and that will take a lot of stress off the shoulder and obviously we discussed the mouse, make sure it’s not too far out in front of you, make sure it’s not too far out to the right, make sure that your desk height is not such to where the desk height is too high, if the chair is too low then you’re going to shrug up a little bit, so it’s definitely one of the things you need to address. So really understand the keyboard and the mouse can be a cause of your shoulder pain at the desk. Alright, so now we’re moving on to some of the exercise, the first one I have here is the can opener which is for mid-back mobility, remember restoring mid back thoracic spine mobility is the key of getting the scapular mechanics correct and really having good scapular stability, so this is a really good exercise for you to do, the next one is a good chest shoulder stretch so recall we had that upper cross syndrome which was really tight chest and anterior shoulders and doing this will really open you up, I’ve got two examples here for you of the chest stretch, one using a gym ball and the other one using a wall or a doorway and very good stretch for you to do.

The next one is called the reach, roll and lift and this is going to really help with your scapular stability and work all those little scapular stabilizing muscles that are around the scapula and the mid-back, very important to utilize this to gain proper stability in that scapula/shoulder blade same thing different words. Alright and then I will put more exercises related to this webinar for you, I want you to start working on those for right now and obviously some of the upper cross syndrome as well, and we will have plenty of resources for you regarding this short little webinar for you, have a great week and we will see you next week.

Outro: Now that you have a better idea of how to improve your physical health while at work, let’s take it a few steps further by subscribing to our show and visiting our website you can find immediate tips, preventative measures and the resources we mentioned earlier to continue to improve your well-being while at work. Tune in next time for more healthy solutions for the desk worker, here on the modern desk jockey.