Shoulder pain: Is it really my shoulder that hurts?

Here's the scenario: You are having right shoulder pain located at the top of the shoulder going down the shoulder/deltoid area into your biceps area.  You haven't had really bad neck pain since this shoulder started hurting and you haven't seriously injured your neck before either.  But you do rub your neck quite a bit throughout the day. You have a hard time lifting your arm up with weights either in front of you or to the side, reaching in front of you, sometime even holding a glass or cup of coffee.  It's been coming on little by little and has gotten to the point where it's really affecting your normal day.

So which is it?  is it your shoulder or something else???

In a this type of scenario, you want to get your shoulder looked at first and do some basic strengthening for the shoulder.  This includes scapular stabilization exercises, scapular retraction exercises, stretching all your tight muscles (pecs and lats and teres), then some isolated strengthening for the rotator cuff both in static and dynamic positions.  

But after about 2-4 weeks, it's gotten a lot better, but still hasn't fully resolved.  What else could it be?!?!?

Well, when you go to an orthopedic doctor who specializes in the shoulder, more often than not, they are focused on the shoulder and the problem at the shoulder.  They may even get imaging at the shoulder as well to verify their findings.

But more often than not, there is also a component relating to the neck that might be the culprit.  This is due to a cervical radiculopathy, which in lay mens terms is a mild impingement at the neck that makes the shoulder weak and also be painful.

Treatment for this is pretty easy once you've identified it as this.  A physical therapist or a trained professional can perform gentle joint mobilizations to the neck, more specifically to the two vertebrae which are locked/impinged to loosen them up.  Also you will want to retrain your neck muscles to find midline again without any deviations.  Once you are aware that your neck is stronger, then you will want to slowly incorporate functional movements with keeping your neck muscles engaged and in midline while slowly incorporating shoulder strengthening so that you're whole system begins working together again.

Now your shoulder problem/pain should decrease.  But remember, strengthening quickly does no one any good.  Strength can take about 6-8 weeks to make a substantial change.  And most of all, remember that your neck muscles are endurance muscles, so the exercises should be repeated at least 2-3 times a week just to keep them in check!  =)

Braces: helping or hurting you?

I commonly get asked about whether or not to wear braces.  So here's my thinking behind it all and when to wear it and when not to wear it.

Braces are intended to lend support to structures that are weak or be used to aid in recovery.  So there are two situations in which you want to wear a brace as I just mentioned.  When someone has a recent injury, i.e. throws out their back, sprains their ankle, sprains their knee, has a car accident, a brace can help keep things more stable and help prevent the injured area from getting any worse. In this case, the brace is there to help increase stability to the injured area, decreasing the movement, and ultimately decreasing the amount of pain.

The second situation is when there is no stability any more because the ligaments are too loose to support it, or when the ligaments have actually completely torn, causing excessive degrees of motion to the joint.  In this case, the motion in the joint cannot be restrained by the ligaments any more and in normal activity, may result in a new acute injury, if not braced.  The brace is used to replace the ligaments, or passive structures of a joint.

Now the do's and don'ts according to my logic.......

As I mentioned in the first situation, after severe pain  or recent injury, braces can help reduce pain and help in returning to daily activities.  BUT, if a brace is worn too long, it can begin inhibiting involuntary muscle contraction from deeper stabilizing muscles which are meant to help support the area, resulting in greater weakness.  So for example, after having back surgery, a brace may be recommended so that there is greater support to allow for normal activities of daily living.  But after pain and inflammation have gone done and are tolerable, there should be effort made to reconnect to the stabilizer muscles to engage them in bracing your back.  In all honesty, who wants to have to wear a brace the rest of their life unless they really had to?!?!??

The second situation, where a ligament, let's say an ankle sprain, has repeatedly been sprained for a soccer player over several years and now there are just about no ligaments left.  An ankle brace may be appropriate to help the soccer player feel more stable during running as to prevent any additional injuries to their ankle.  In this case, exercise is still important to make the musculature as dynamic and reactive as possible, but it will probably not be enough, so a brace would be important to add an additional layer of support/stability.

I hope this helps clear up any confusion as to when and when not to wear a brace.

Again, this is just advice, and the best thing would be to ask your local physical therapist for specific instructions.  Take care and don't "brace" yourself too much!! =)

Dr. J Wong

Posture: Part 1 - Sitting is more than "just sitting"

Posture:  How many times in your life have you been told, “stand up straight” or  “sit up taller” or “straighten out your back”?  Have you also been told to have an ergonomic adjustment to your workstation, but still find yourself getting the same aches and pains?

I would like to introduce you all to what I call “Active Sitting”. 

The difference between passive sitting and active sitting is that with passive sitting, you are letting your entire body stack on top of one another without any musculature support and possibly slowly stretching ligaments and making the wrong muscles work to hold you as well as letting your other foundational muscles become weaker.  Passive sitting is often considered to be slouch sitting.

Active sitting uses more of your postural stabilizer muscles to hold you up, releasing a lot of the tension and compression through your spine, especially your low back.  Compression of your low back in sitting can cause disc problems (herniations), nerve compression, bone spurs, and possibly some other pathologies. 

So the next logical question is, “How do you actively sit???”

Well, the easiest answer is “turn on your muscles while you sit!!” But there is a biomechanical method (or a way to move your body) to turn your muscles on without having to actually contract them.  I’m a firm believer that if you change the forces in your body, then the correct muscles will work automatically and resolution will happen.

First sit in a comfortable position (in any chair) with your hips equal to or slightly higher than your knees.  Then sit up tall, and possibly over extending through the back at first.  Next extend your head and neck, but bring it back so that your ears are just about in alignment with your shoulders (chin tuck motion) and keep your eyes level at all times. At this point, you may feel a slight stretch in the back of your neck at the suboccipital area (a point that often is tight and may bring on headaches).  Slightly squeeze your shoulder blades together so that you feel the muscles working between your shoulder blades (not your upper trap).  Then, keeping your chest up and head tall, then roll backwards through your pelvis, as to tuck your tail bone under you.  At this point, you should feel your lower abdominals work and should feel a sense of relief through your back.  (It is ok to shift your whole body backwards  to maintain a straight line through your spine.)

You are now “actively sitting”.  The initial goal is to do this as often as you can so you can correct your body’s form so it can begin to recognize what it should do.  My preference is to try to get into the position 10-15 times in an hour (for those who sit a lot for their jobs or in their day), but not to worry about holding or maintaining for any duration in the beginning.  After about 2 weeks of getting the body to recognize it’s position, then we can worry about the endurance of the muscles.

Congratulations on learning to “Actively Sit”.  Spread and share what your learn and start helping your body feel better while sitting!!

Stay tuned to more information about posture and exercises to help make it easeier.

Dr. J Wong