What’s causing your shoulder pain?
This is always a difficult question, due to numerous problems that could happen and the fact that the shoulder is made up of several boney, muscular, and ligamentous structures. Let's start off with a little anatomy review.
The shoulder is made up of three large muscles collectively called the deltoids, 4 rotator cuff muscles, and several other muscles.
The deltoids individually are the anterior deltoid, medial deltoid, and posterior deltoid. These muscles help the arm with flexion (moving forward), abduction (taking the arm away from the body), and extension (bringing the arm back behind the body).
Four muscles together make up the rotator cuff. This is commonly, incorrectly, called the rotator cup or rotary cup. The rotator cuff is made up of the supraspinatus, infraspinatus, teres minor, and subscapularis. Together they stabilize the shoulder, hold the head of the humerus into the glenoid cavity, and maintain the shoulder joint.
Other muscles related to the shoulder are:
Triceps brachii, which is the large muscle in the back of the upper arm that helps straighten your arm.
Pectoralis major, which is a large fan-shaped muscle that stretches from the armpit to the collarbone and down across the chest. Although it seems like a chest muscle, it also is a very important shoulder muscle which helps with bringing the arm towards the body and inwardly rotating your arm.
Pectoralis minor which is the smaller pec muscle that fans from the upper ribs to the shoulder. The pec minor can draw the shoulder down, or the shoulder blade (scapula) upwards.
Teres major runs under the shoulder and helps rotate the shoulder upward.
Biceps brachii, known as the bicep muscle, is a thick muscle that rests on top of the humerus and rotates the forearm and also flexes the elbow.
Latissimus dorsi, usually just calls the lats, is a flat rectangular muscle of the back that helps rotate the arm and move the arm away and closer to the body.
So why are you having shoulder pain? This is a loaded question as you can see the overwhelming amount of muscles that could be part of the problem.
Some problems include:
Shoulder pain coming from the deltoids. This could be a strain or caused from trigger points in the muscle belly. Trigger points are when the muscle binds up in one spot making a knot. Think of it like a wrinkle in a fabric.
Bursitis, which is inflammation of the bursa (a fluid-filled space) and tendons, which connect your shoulder muscles to your upper arm bone.
A rotator cuff tear which could be in any of the four rotator cuff muscles listed above. A rotator cuff tear occurs when the tendons of the rotator cuff separate from the bone. Tendons are the ends of the muscles which attach the muscle to the bone. As such, when a muscle pulls too much they can tear this anchor (tendon).
Frozen shoulder, also called adhesive capsulitis. Frozen shoulder is a common condition that leads to stiffness of the joint and sometimes constant pain, or just discomfort when reaching behind your back or head. A true frozen shoulder limits motion so much that even when stretching the joint is very hard or impossible to move.
Bicep tendonitis which usually causes pain that develops gradually at the front of the shoulder that moves down over the biceps muscle. The pain is often worse with repetitive lifting, carrying heavy bags, or overhead activities.
Other causes could be Bicep Tendon Rupture, SLAP Tears (Superior Labrum Anterior Posterior tear), Shoulder Osteoarthritis, AC Arthritis (arthritis of the place where the clavicle meets the acronium, which is the hard, pointy spot on the top of the shoulder), Shoulder Instability, and Shoulder Dislocation.
What this laundry list of possible problems mean is that it’s incredibly hard to diagnose exactly what is going wrong. So, what do you do?
First, did the pain come on gradually or suddenly? If pain came on gradually, especially if performing a task that cause repetitive movements, then that narrows it down. Most commonly, this leads to tendonitis or trigger points in a muscle. Ice will help relieve tendonitis, as it decreases inflammation. Helpful hint: any medical word ending with itis means inflammation. If it’s an overworked or tight muscle, then heat will be helpful. Why? Because when a muscle gets tight, it narrows blood vessels. Heat opens these back up and allows the muscle to get fully nourished again.
If pain came on suddenly, especially after a movement, lifting, or injury, you’re at a higher risk of having a sprain, strain, or even a complete tear.
This is all very overwhelming, I know. So, what should you do? If pain persists then your best option is seeking medical care. The internet is not your friend, as it offers far too much information, causing even more confusion than all the information above.
So, some simple rules:
Pain comes on suddenly = use ice and rest.
Pain comes on slowly, especially after work = use heat and rest.
Pain after a traumatic event, like a slip, fall, or car accident = see your doctor.
To help prevent or reduce pain from all of the above, you can do this: Stabilizing Shoulder Exercises.
Why? When the shoulder is stable and the muscles are strong, your risk of injury or all the problems above go down significantly. Also, many injuries only get better after performing Stabilizing Shoulder Exercises.
So, what are these? Here’s a list of some of the best:
Shoulder circles- Hold arms out at sides like you’re a bird and make small arm circles until the shoulders are tired.
Prone flexion- lay on stomach with arm hanging over edge of bed. Raise arm up to ear like you’re Superman flying.
Prone abduction- lay on stomach with arm hanging over edge of bed. Raise arm up to the side like you’re a bird or an airplane.
Prone extension- lay on stomach with arm hanging over edge of bed. Bring arm backwards towards your hip.
Prone rows- lay on stomach with arm hanging over edge of bed. Keep elbow bent and pull arm up at the side like you’re pulling on a lawnmower cord or rowing.
Wall push ups- with feet away from the wall, and hands up on wall at shoulder’s width apart, lower face towards wall and then push back out.
Many people get obsessed with the ‘show muscles’, which are the muscles that becoming bulky and good looking; but they forget all the other shoulder muscles. What happens when one muscle becomes too strong and one too weak? Well, think of strapping a fridge to a trailer, only you didn’t tighten one side enough, and the other side you tightened as far as it could possibly go. What will happen? Most likely while bouncing down the road, the straps won’t keep the fridge stable and it will tip. The same can be said of the shoulder.
So, what’s causing your shoulder pain? Or should we ask: what started that led to the shoulder pain? Imbalance.
What’s causing my headache?
Cassandra DenHartog PTA, LMT
That’s an age-old question which has many answers.
First of all, what are headaches? Usually, we associate this term with pain in the head, but did you know there are many kinds? Whether you’re having pain in the front, back, or all over can make a difference.
Where is your pain located?
Forehead and around eyes- Usually is a sign of eye strain. This is common with people doing a lot of computer work or in constant brightness changes. Solution? First make sure you are not expressing stress and worry with your facial muscles. Massage, using upward strokes around forehead and eye brows, can help. You can get muscle knots around your eyebrows, which can result in pain around the eyes and forehead. If massage doesn’t help, try having an eye exam. You may not be focusing correctly. Glasses, or a correction in your glasses prescription, could help with this.
Back of the head at base of skull- Headaches located here are usually due to stress and tension. The upper trapezoid muscles, the muscles at the tops of your shoulders, come up and attach in the back of the head. When these muscles are overworked, they constantly pull on the back of the head irritating the tendons. It’s like tendonitis of the skull. This causes pain that starts at the back of the head near the base of the skull that can wrap all the way around. Solution? When you feel this headache type start coming on, use ice on the back of the head. This decreases inflammation and helps prevent the pain from spreading. If this does not help or the headache is already too bad, try shoulder massage. Start at the tops of the shoulders and massage up to the back of the head. Remember to give extra love to the base of the skull. Self-stretches can also help prevent these type of headaches. The best stretches: pulling your nose to your armpit, and pulling your ear to your shoulder.
Side of the head- These headaches are typically caused by the temporalis muscles; the muscles of the temples. They can also be caused by eye strain, or emotions causing excess use of facial muscles. Solution? Take your pointer finger and begin to rub on your temples. If you are feeling soreness or tenderness in this area, this is most likely part of the problem.
Pain coming from the jaw up into the head- This usually comes from the masseter muscles or muscles around the jaw. This can be a common trait for people with TMJ problems, or people who chew a lot of gum, or have a tendency to clench their jaw. Solution? Massaging the masseter muscle can be very beneficial. You do this by opening your jaw wide and following your teeth back until you feel the muscular structure of the masseter muscle where your jaws comes together. Relax your jaw and, with mouth closed, massage this muscle up and down. This muscle should feel very tight but soften when massaged. Also, try avoiding aggravating activities such as gum chewing.
Pain all over the head- If there was no specific spot where the headache started, it could have more of a chemical and a muscular cause. First thing to check is if you’re hydrated. Remember the average human needs at least a half-gallon of water a day to stay adequately hydrated. Also, consider if you’re are going through a hormone change. Hormones can be behind frequent headaches with no other apparent cause. If this is suspected, you should consult your doctor. Hormone imbalances are hard to self-correct, but not impossible. If a doctor isn’t for you, look at eating a lean diet. Remove anything that causes an inflammatory reaction; this means cutting back on gluten, decreasing or totally removing red meats from your diet, and eliminating all sugars. Decreasing inflammation in your body can help with hormonal balances.
Pain in ears and into head- This most often feels like an earache. Often it is due to plugged Eustachian tubes, or what people call plugged ears. Often this is hard to get rid of. Solution? Start by taking several hot steamy showers. Sometimes this is enough to relieve this pressure. If not, you may want to consult a doctor. If you are experiencing dizziness, a feeling of the room spinning with movement, or a feeling of being drunk, you could be experiencing vertigo. This I something you should consult your doctor about, as this usually can quickly be relieved.
Pain in head and neck with head down- This occurs when you are looking down or at a computer screen a lot. In this age, it’s what people call “texter’s neck,” which is caused by the increased strain of holding the head at a forward position for a prolonged time. This can be relieved by adjusting how you look at screens, books, etc. and raising things up to eye level so the head is square atop the shoulders.
It’s come again. The holidays. With it came food, sweets, food, and more sweets. If you’re like most authors during the holidays you indulged. Now it’s a new year and time again to renew all those exercise and weight loss promises. But don’t forget to take down the decorations. Get that January blog ready to go. Oh, and don’t forget about starting on all your projects to hit due dates in time. .
A little overwhelming? Being an author, I find myself in this trap a lot. As an author you are never “caught up”, or “ahead of the game”. This leads to a lot of stress. Exercise tends to get pushed to the back burner, so we can fight the inevitable feeling of always being behind.
Well that can change. Here is an easy program for any author to help get back in shape and keep hitting deadlines.
Get your computer on a bar top, high table, or anywhere that you can stand and work. Yes, stand. Get upright. Use muscles. Studies have shown activity helps boost memory and brain function.
Squats- at you high rise desk perform mini squats down far enough that you can still type, but wouldn’t be able to if you go any farther.
Wall Sits- When you hit writer's block go find a wall. Place your back to the wall and then slide down until your hips and knees are at a 90-degree angle. Hold for 30 seconds while taking deep breaths.
Single Leg Stance- While writing, stand on one leg. Try not using your hands for balance and keep typing. Hold until you get tired and then switch legs.
Knee Squeezes- Place a pillow between your knees. While standing and working squeeze knees together as hard as possible on pillow and then relax. Repeat until the insides of your thighs feel fatigued.
Heel Raises- While standing and working on computer go up on your toes and then back down. Repeat until fatigued.
Chair Dip- With your back to a chair, put your hands on the seat of the chair. Slowly lower yourself down and then back up. Repeat until your triceps feel tired.
Wall Push Ups- Get up and put your hands on any wall. Bend your elbows and try to lower your nose to the wall and then straighten your arms.
Keep at it. Every time go until you feel fatigued. After a while you’ll notice you can do these exercises for longer and longer periods of time. You should feel more energized while writing. Utilize your times of writer’s block for you and your health.
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