My Shoulder STILL Hurts!

Jessica Bento, Physical Therapist (Creator DVRT Restoration Certification, DVRT Rx Shoulder, Knees, Pelvic Control, & Gait Courses)

This past weekend I had the great pleasure to present at the Perform Better Providence conference. While I had presented at Los Angeles, Chicago, & Orlando programs, this was my first time at Providence which usually brings in a lot of the northeast. Admittedly, I was a bit nervous, over 800 fitness professionals, strength coaches, and physical therapists were in attendance and I knew what I was going to share with them was going to be something SO new! That is the answers to why the shoulder of their clients, patients, and even themselves still hurts!

One of the biggest mistakes not only in helping the shoulder, but almost any issue we experience in our body is thinking that the issue is JUST in that part of the body. Often times, the discomfort/pain we feel is simply a symptom of an overall larger dysfunction.

We often struggle to see that the shoulder is part of a series of chains in the body that all influence what occurs at the shoulder. Why don’t more people talk about this? I don’t know to be honest, as a new physical therapist graduate I can tell you that I did not look at all these variables. The science is there, but unfortunately, for one reason or another we have just missed it in plain sight!

SOOOO much of the research shows that the core and lower body play a HUGE role in what happens in the shoulder. Such as….

“Weakness or limited trunk and hip mobility can alter the normal activation pattern required in overhead throwing athletes, producing distal joint dysfunction. The core musculature acts as a connecting link between the upper and the lower extremity limbs in overhead athletic endeavors.” (1)

“The core musculature acts as a connecting link between the upper and the lower extremity limbs in overhead athletic endeavors.” (2)

“The shoulder complex does not function in isolation. Synchronized sequential rotation from the lower extremity (LE) through the trunk needs to occur in order for the shoulder joint to act efficiently in overhead sports. The shoulder is a part of the kinetic chain and the body is considered as a linked system of articulated segments. Each segment (LE, trunk, pelvis and UE) in the kinetic chain has a specific role in ensuring that the upper extremity (UE) performs efficiently in athletic endeavors. This coordinated sequencing of the segments is known as the kinetic chain. Sequential activation of the LE, pelvis and trunk muscles is required to facilitate the transfer of appropriate forces from these body segments to the UE.16 Such forces result in a harmonized movement at the UE needed in throwing activities in various sports. Momentum generated by the larger segments in the kinetic chain is transferred to the adjacent distal segments. This mechanism results in summation of individual speeds and forces at each segment. Putnam demonstrated that the forces acting at a joint are influenced by the motions at the adjacent segments in the chain. The ultimate speed and forces achieved by the distal segment are the product of all the individual segments in the kinetic link.12 Thus the timely flow of the energy from the lower to the upper part of the body is vital for effective sporting motions to occur at the shoulder joint.” (1)

When we keep focusing on just the shoulder then we see either slower progress or even can make the issue worse. Often people simply pick an exercise that gets a big EMG reading (how much muscle is used) of a specific muscle of the shoulder. However, as renowned physical therapist, Gary Gray asks, “is the muscle singing or screaming”. Very often that muscle is screaming!

That’s why these types of exercises are so much more effective for addressing not just the shoulder, but the underlying issues in the body that would cause problems in the shoulder to develop. In upcoming posts we will dive into other issues related to the shoulder because the TRUTH is that chronic pain of nay sort is always multi-faceted. Try implementing drills like those below to start the process of training the shoulder smarter!

Don’t miss saving 25% off Jessica Bento’s DVRT Rx courses and along with our Myofascial Integrated Movement programs HERE with code “save25” 

 

View this post on Instagram

 

A post shared by Ｊｅｓｓｉｃａ Ｂｅｎｔｏ (@jessbento_physiotherapist)

References:

1. Kaur N, Bhanot K, Brody LT, Bridges J, Berry DC, Ode JJ. Effects of lower extremity and trunk muscles recruitment on serratus anterior muscle activation in healthy male adults. Int J Sports Phys Ther. 2014 Dec;9(7):924-37. PMID: 25540708; PMCID: PMC4275197.
2. Hirashima M, Kadota H, Sakurai S, Kudo K, Ohtsuki T. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. J Sports Sci. 2002 Apr;20(4):301-10. doi: 10.1080/026404102753576071. PMID: 12003275.