Hi, I'm Margaret Martin at MelioGuide.
And today I want to talk about something really important to me and to many of my clients
who come to see me.
Oftentimes they'll go, "Margaret, that exercise program you gave me was great.
But it is really bothering my shoulder."
And other times, people come to see me specifically because they have pain between the shoulder
blades or it feels like it's coming from under the shoulder blade.
So that's what today's blog is all about.
It's all about shoulder blade pain, avoiding shoulder pain, thinking about possible causes
of shoulder blade pain.
And so let's go through what are some of those common causes that most of us don't even think
about?
So one of the first ones is waking up in the morning.
If you notice that you have shoulder pain when you first wake up in the morning it might
be either how you spent your last few hours before going to bed, your position when you're
lying in bed, the position of your shoulders vis-à-vis your pillows.
The other thing to think about is how you actually sleep.
Is your shoulder tucked underneath you?
Is your arm tucked underneath your head?
All these things can be very compressive on the shoulder joint itself.
So listen to your body.
If you're feeling that pain first thing in the morning, think about sleeping position,
think about, what are you doing in those last few hours of the day.
You're coming to see a therapist and as therapists we can only do so much because we're trying
to undo what you do all day long.
So what is it that you're doing all day long?
What is it in terms of your postural stresses?
How do you spend your day?
Are you spending your day at a computer without the elbow support, without the proper ergonomic
alignment?
Are you being brought into these positions that put your shoulder at a mechanical disadvantage?
So that's something, whether it's a computer, whether it's how you spend hours knitting,
how you spend hours reading, those kind of things are all really significant in so far
as your shoulder and the postural stresses that places on the shoulder joint itself.
Are you just recovering from an injury or an insult to your shoulder where you might've
had a cast on?
You might've been wearing a sling, or even, sometimes when we're having shoulder pain,
we also have arm pain and we start wearing braces on our arms.
Well, all of this starts to change how we move and how we hold ourselves and can set
up tender spots in our muscles or trigger points in our muscles.
And so that's certainly something to be aware of.
The fourth point in regards to consideration for your shoulders is how are you built?
Some of us, we all have different length of arms, different length of legs.
Well, some of us structurally have short upper arms.
And that's a big disadvantage when in the world they're creating chairs and armrests
in cars to accommodate sort of the average person.
And so if you don't fit, like I don't fit into an average height, if your upper arm
doesn't fit into an average length, then those armrests are just a little bit too low for
you all the time.
So you're going to have to accommodate that.
You're going to have to have little pieces of foam that you can strap on to, your work
chair or set your car seat such that...because a lot of the armrests are too far.
I have a lot of my clients just take like a sleeping bag or create a sleeping bag type
effect, bunched up, so they can have a nice armrest as an opportunity to relax their shoulders
on long drives.
And so that's that fourth point, that structural alignment or the misalignment that is created
by the ergonomics in our society.
A fifth point for things that can create pain in the shoulders would be a sedentary lifestyle.
Muscles love to move and especially a joint like the shoulder, it's such a fabulous joint
in that it allows us so many ranges of motion.
We have this external rotation, internal rotation, flexion, extension, adduction, horizontal
adduction, all this wonderful motion.
But as we go through our day-to-day life we get set into a very patterned motion.
So many times I'll ask people, "When was the last time you raised your arms up overhead?"
And they don't remember other than if they've reached up for something or they put something
on that required a lot of reaching.
So making sure that you bring those shoulders into the full range of motion that the anatomy
provides, which is so wonderful, including the motion of the shoulder blades which involve
not just coming forward and back, but going up and down.
There's this wonderful whole avenue of motion that comes from the shoulder girdle as they're
called, or the scapula.
And so making sure that when you do move the arm that the shoulder girdle moves with it,
the scapula moves with it.
A sixth point to think about when trying to assess what is it that's causing your shoulder
pain and to help us as clinicians figure out what's hurting you is what is it that you're
using on or around the muscles of the shoulders?
And when I say this I think about my sisters who are all large-breasted and they have to
wear bras that are just so tight and have such straps that just sink into their upper
trapezius.
So for some people it's bras, for other people they decide to wear backpacks, but their backpacks
might not have that little tie piece that takes some of the weight off of the shoulders
or the waist piece that helps to take the weight off of the shoulders.
And those things that can restrict blood flow to the muscles can be very subtle but cause
eventual pain through the creation of trigger points.
For men who do have to dress up at work, ties and having ties that are tight around the
scalene muscle and the sternocleidomastoid muscles in the neck can also create trigger
points that can be...the pain from these trigger points can go as far back as the lower shoulder
blades and that space between the spine and the shoulder blade.
So thinking beyond just, "What did I do with my shoulder last week?
I didn't seem to do anything odd."
But it's just those compounding effects of day-to-day life and the forces that happen
to be on the shoulder.
Another one to think about is purses.
I have so many women that come with really heavy purses, and they hardly have anything
in the purse but somehow that purse ends up being four and five pounds and they're always
carrying it over the shoulder, same shoulder.
And even as they do a cross pattern it's still a lot of weight born through the shoulder
and, again, constricting the blood flow to the muscles and altering your postural alignment.
And then the seventh thing, we talked about, and this is the other extreme from sedentary
lifestyle, when you don't, ... So sometimes we don't move enough, and sometimes we move
too much but in the same pattern all the time.
So a habitual exercise pattern of movement, we often, and a lot of my clients, will gravitate
towards the things that they're good at and the things that are easier to do.
And so if you tend to be forward, and I used to, in my past life, have a golf fitness practice.
And so golfers would set up where they've been hanging out all day.
And so they were sitting behind the computers with folded shoulder forward and they'd go
to their posture and at rest in the same alignment because it felt comfortable.
And that's where their body habitually had been hanging out as opposed to opening things
up and realigning so that they get a better swing.
But in terms of the shoulders and the health of the shoulders and shoulder pain, it's so
significant because you're just compounding this forwardness.
So all of this forwardness, you're kind of going, "Okay, Margaret, all these causes,
these are causes, but I have pain.
So how do all these causes lead to pain?"
Well, they lead to pain because certain muscles get short and tight.
Other muscles get long and weak.
And so we have to address not just the short and tight muscles and the long and weak muscles
but how you got there in the first place, or else, if we just address those muscles
and those weaknesses, we're not going to help you get rid of the cause of the pain, the
ultimate deep cause of the pain.
And so if you are starting an exercise program, the last thing I want you to do is give it
up because of shoulder pain, but rather I hope this blog helps you to kind of go, "Okay,
when I do that pushup, or when I do that row, am I doing that row and really bring my shoulder
blades or am I keeping them forward the way they're hanging out all the time all day?
Maybe I need to change how I'm sitting at my desk, during the many hours of the day
so that when I go into the gym I'm not taking that posture in with me."
Go through the muscles and feel the muscles through your shoulders and kind of go, "Do
I have any tender spots?"
And taking tools such as a Theracane, taking just simple tools like a tennis ball, or a
yoga therapy ball, or a little...I love little street hockey balls, and getting those balls
in up against the wall between your shoulder blades and your spine, on the shoulder blade
itself, below the shoulder blade, so that you can start exploring and going, "Oh, wow,
I didn't realize how tender this is."
And the beautiful thing, we usually will only get one shoulder bothering us at a time so
you have your good side as your comparison and go, "I wonder how that muscle feels on
the other side?"
And you go feel, you see how it feels on the other side, and you're like, "Wow, it feels
really good."
Well, that's what you should expect of both sides.
And so you're going to want to work through doing some self-massage.
And I love, love, love this book, "The Trigger Point Therapy Workbook."
I use it all the time as a reference for my clients.
I suggest that clients purchase it so that they can...
They have a great section at the beginning, of the shoulder section for instance, that
has where pain is referred to.
So even as therapists we sometimes go, we forget that the scalene muscles in the neck
can be that source for that nagging pain down here as well as other pain sources or sites.
And so by exploring all the places that can cause the arm pain that can be coming from
your infraspinatus or the deep under the shoulder blade pain that can come from serratus posterior
superior and you have to get at it by moving the arm across, well, all of those little
details are covered in this book with great diagrams and great descriptions on how to
do that.
And so I encourage you to use that as a first tool if you don't have access to a good massage
therapist or a good physiotherapist, and know that if your pain doesn't start to change
dramatically within a week or two weeks of doing some self-care on your shoulders, please
seek the advice of a healthcare professional, of your doctor, because there are many other
causes for shoulder pain that can be referred from your organs, from potential fracture
if you have osteoporosis.
There are more dangerous reasons for having shoulder pain.
So, however, having said that, most of the shoulder pain that I see is simply from people
not being aware of the causes of the shoulder pain, how to look after their shoulders, and
how to keep their muscles healthy, happy.
Hoppy and happy.
So with that, I'm going to sign off for today.
Thank you for tuning in and I wish you many, many years of happy, flexible, mobile shoulders.