Wednesday, November 5, 2014

Wisdom Wednesday: The Shoulder

Pain and limited motion in the shoulder is a very common musculoskeletal complaint. Its frequency is second only to low back pain. The onset is usually insidious but there is usually some history of a past injury. Most of us tear the rotator cuff of the shoulder at some point in our youth and most of us have forgotten the injury. As we age, this old injury often comes back to haunt us.

The rotator cuff is a group of muscles that support the shoulder and create movement. They are, in order of importance, the supraspinatous, infraspinatous, serratus anticus, teres minor, and subscapularis.

The shoulder is an unusual joint in that there are no ligaments to hold the humeral head to the glenoid fossa of the shoulder. So it is the rotator cuff muscles that hold the arm into the socket. To facilitate this process, the supraspinatous contracts constantly, even in your sleep. It is the only skeletal muscle in the body that does so. If the supraspinatous is weak, the arm actually dislocates from the shoulder. This commonly occurs during sleep and is often the cause of chronic shoulder pain. Strengthening the supraspinatous is the key to resolving most shoulder problems.

Constant contraction of the supraspinatous requires ongoing input from the nervous system, so weakness of the supraspinatous can be an indicator of brain imbalance. The supraspinatous is used in Applied Kinesiology (AK) to evaluate the limbic portion of the brain, specifically its relationship with the endocrine system.

In similar fashion, the teres minor is related to the thyroid gland. So weakness of the teres minor may indicate thyroid imbalance. Monitoring teres minor weakness is also used in AK to evaluate the endocrine system.

The shoulder is also a common site for referred pain. In cardiac insufficiency, pain is often referred from the heart to the left shoulder and down the left arm. Gallbladder inflammation will refer pain to the right shoulder in a similar fashion. When evaluating shoulder pain these referred pain pathways must always be considered, even when there is a strong history of injury.

Otherwise, shoulder evaluation is fairly straight forward. I begin by finding a weak muscle elsewhere in the body. Then I stimulate autogenic facilitation (AF) to rule out any injury reflexes and ascertain accurate muscle testing.

Next I measure range of motion in the shoulder, looking for restriction and pain. Bursitis of the shoulder generally restricts motion without pain and has that insidious onset. The healthy shoulder has more range of motion than any other joint in the body. That is what makes it so vulnerable to injury. The particular motion that is restricted often indicates the nature of the injury. For example, limited internal rotation is usually an injury to the infraspinatous.

Finally, I test each of the rotator cuff muscles by isolating them and challenging their strength individually. In real life they generally work as a team. Once any muscle weaknesses are indentified, the goal is to find a treatment that restores the strength to each affected muscle before the office visit is complete.

Commonly, the shoulder is slightly dislocated and manipulation restores any muscle weakness. However, sometimes stimulation of the origin and insertion of a weak muscle is required. If the fascia is too tight (the covering of each muscle), a B12 deficiency may be the problem and supplementation is required.

If muscle weakness recurs repeatedly, endocrine imbalance must be considered. Of course the patient history often leads you to suspect an endocrine issue early on.

If you have a shoulder problem, please have someone who is well trained in Applied Kinesiology evaluate your shoulder.

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