Donkey Shoulders

Shoulders can be a bit tricky, to say the least. They're like donkeys, responding better to a smart coaxing than a kick in the ribs. The more you try to force them, the more they inflame and stubbornly resist. And don't try to sleep on one - a sore shoulder or a donkey.
I've learned to be pretty conservative with exercise and hands-on mobilization directed at the shoulder, at least for the initial visit or two. Shoulders will refuse to do their part very well until you've addressed the lay of the land around them, namely the scapula, thoracic spine, and soft tissue restrictions of nearby muscles and fascia. 

Understanding finnicky donkey shoulders (as well as many other orthopedic problems) requires a good grasp on the concept of a symptom threshold. Symptom threshold is why it's challenging (or dishonest) to say precisely why any one body part is not happy.

Many people have tears in the cartilage ring that deepens the shoulder socket (the labrum), rotator cuff tears, or other structural defects of the scapula. Many times inflammation of the involved tissue is visible when viewed under a microscope. But not all of those people have problems. Many of them function fairly well because they haven't reached the threshold of pain...


There's usually a number of factors that contribute to crossing that threshold. I've read and learned through experience that while most people manage to get by, their body is just a step or two removed from threshold.

A fall, a heavy strain, or last weekends painting project may have seriously stirred up a shoulder pain, but there are often factors that have been years in the making. Those "years in the making" issues often keep the involved tissue from healing correctly after trauma.

Shoulder... mistakes.

 A typical example of the symptomatic threshold might look something like this:

-Most people sit for a significant amount of time with their thoracic spine slumpy, their shoulder blades protracted and arms rolled in front of them (poor static posture - factor 1).

This exercise is good for physical therapists.
Do it if you want to go to rehab.
-Then don't exercise much, or they go and exercise, performing far too many pressing movements (poor exercise program selection - factor 2).

-The exercise and other movements takes place in that same kyphotic, protracted position (improper movement patterns layered on poor posture - factor 3).

-They have weak rotator cuff and upper back muscles (factor 4).

-Maybe they have a type 3 acromion. This is a slight structural issue of the shoulder blade that allows less space for the upper arm bone and shoulder tendons (factor 5).

-On top of those issues that were present all along, the person suddenly gets a "factor 6." Maybe that's a weekend golf tournament or tree pruning competition. Or maybe there's trauma, like a fall from a horse or bike.

The point is that there's some kind of heavy strain, trauma, or repetitive overuse that's simply the straw that broke the camel's back. The shoulder that had been sitting on the brink of a problem crosses the threshold, and ouch.

When it's been a few weeks and the shoulder has not recovered from factor six, you really do need to address the other factors.

Simply resting and taking some medicine will often get the shoulder back below threshold. But all it takes to get back to square one is an awkward reach, throw, or lift. The more modifiable factors that you can address with rehab and other modalities, the better chance you have of keeping that shoulder functioning how you want it to. 

That's about the best we can do. 
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