You’ve got shoulder pain.
You’ve had scans. You’re told that there’s a rotator cuff injury. You’re told that its not going to heal on it’s own. You’re told that the only way they can fix it, is by surgery.
The rotator cuff tear isn’t going to fix itself. You’re going to have to sew up that tear. If you want to fix the tear. Now read the first paragraph again.
Every sentence in it is true.
But there’s something missing in that paragraph.
Where does it say, that the pain in your shoulder is because of the tear?
Where does it say, that fixing the tear will fix the pain? Where does it say what caused the tear?
If you don’t know what caused the tear, how are you going to prevent it after fixing it with surgery?
Let’s just talk about the cause first.
Joints that start hurting one fine morning didn’t tear that morning. That joint has been deteriorating for a while, but it has been soldiering on, the best it could, until one fine day, it went on strike.
Why did that shoulder deteriorate?
Were you swimming 5km in rough seas daily?
Were you playing 2 hours of elite level badminton?
Or, were you being yourself? Standard issue desk Jockey? Hunched over your computer and later at home, with your smartphone?
Or did you leave work and head straight to the gym to do chest and biceps on Monday? That’s the gym rat type desk Jockey.
Either way, standard issue or standard issue gym rat, your shoulders were fighting a losing battle against
1. Movement deficiency
3. Poor nutrition
4. Poor sleep
Most of the movement in our day to day life is with your upper limbs in the same position as they are in front of a computer. Flexed and internal rotated. Your shoulders never get the chance to extend and externally rotate on a regular basis as part of your routine. That’s the movement deficiency part.
That leads to further rounding of the shoulders and further restriction of full range of movement. Vicious cycle.
Movement feeds the joints. Alternating compression and traction is what feeds the ligaments and cartilage. Without movement daily wear and tear will not get repaired. Damage accumulates and finally results in mechanical failure.
The rounding of the shoulders happens due to habit, but it also happens as a compensation for your forward head posture. This is why, this article is titled so. Shoulder pain is usually, a pain in the neck. Forward head posture compromises blood supply and nerve supply to the upper limbs.
You might have noticed that your shoulders are part of your upper limbs. That craning forward of
the neck will cause pressure on the brachial plexus and the axillary/brachial artery transition
Poor blood supply will result in poor intra articular fluid(fluid inside the joint) because intra articular fluid is an ultrafiltrate of blood, essentially.
Poor nerve supply will result in poor movement and more risk of injury and minor instability that can gradually cause you to accumulate unnecessary damage that wouldn’t have occurred if the nerve supply was intact. Poor nerve supply also means poor repair after the damage has occurred
0. Control pain
1. Correct head and neck posture before attempting aggressive physiotherapy for restoring range of motion in the shoulder
2. Correct shoulder posture after correcting the neck
3. Strengthen and correct coordination of rotator cuff musculature, after correcting shoulder posture
4. Consider surgery only after the above 3 steps have been carried out sincerely and failed.
5. Even if the exercise program “failed” in the sense that it couldn’t prevent surgery, at least, it would make your recovery from Surgery faster
Something about step 0
-usage of NSAIDs for pain control will impair collagen synthesis. Yes painkillers do inhibit the healing process, but try explaining that to a patient who is desperate for relief. If they listen, good for them. If not prescribe them what they want. It’s not worth arguing over.
– exercise can be used to control pain very well in intelligent patients, who are not pain or movement phobic.
-manual therapy using myofascial release can also provide excellent short term pain relief, but it is time and labour intensive for the doctor or physiotherapist.
I normally attempt to transition my patients through 3 levels of rehab movements.
I’ll post a link of level 1 below. It’s in Malayalam, but the exercises should be obvious enough to just follow
For patients who can’t even manage level 1, they can be started on just arm swinging with a light weight (1 to 2kgs for women, 3 to 5 for muscular men) in their hands and palms turned towards.
The amplitude of the swing should be slightly less than what you’d see during a slow walk.
After a few weeks of that, they’re usually ready for level 1.
I’ll post a video of that sometime soon. Don’t ask for a deadline.
Which brings us to the next topic.
How do you fix forward head posture?