When we assess patients with pain and injury we really need to look at how things work as a whole.
Taking an Osteopathic approach to the assessment of shoulder pain means we’ll look at the movement and function of the scapular (shoulder blade), the thoracic spine (rib cage) and the shoulder joint itself. We’ll also look more broadly at how the neck, lower back and hips move and work in relation to these areas.
We do this to identify any factors that might disadvantage the shoulder structures (part of the ‘why’ your shoulder hurts in the first place) but more importantly we do this to identify useful strategies for offloading sensitive shoulder structures … (the much more important, ‘how’ to make it hurt less)..
You see, we hear so much over-simplified nonsense about ideal posture, alignment and movement but the reality is we don’t all need to look and move the same to do things well or to be strong, fit and healthy.
There is wild variation in normal anatomy and neurology (for movement control) so wherever we have physical or functional short comings, we’re usually able to compensate and adapt well to overcome pain and limitation… sometimes we just need to know what helpful or useful compensations to encourage your body to make. And how to introduce them in sensible incremental progressions that allow for nervous system and connective tissue adaptation.
That’s where a more functional style of assessment comes in really handy because we can try on different compensatory strategies to see how they help your pain and function and once we find strategies that work for you we simply train them to build capacity and give you longer term gains.
In the video below you’ll see a shoulder examination that allows us to see what sort of trunk control you have when you load the shoulder, what the shoulders ability to control rotation is like and how the neck contributes to tasks as the shoulder nears the limits of it’s functional capacity.
First up in a standing wall press we can get an idea of trunk and scapulo-thoracic control; and by introducing a single arm space hold we can assess the capacity of the shoulder complex to control rotational load. Short comings here commonly contribute to impingement syndromes and rotator cuff tears or tendinopathies.
The follow on weight bearing reach test then allows us to amp things up a bit to see how you cope with both higher loads and a range of functional positions. This really lets us see any weaknesses, restrictions or limitations that contribute to shoulder pain and to see how other areas like the neck, elbow and wrist contribute when the shoulder nears the limits of it’s functional capacity.
Want to know more?
You can learn more about our approach to shoulder pain and improving shoulder function by checking out blogs in the MOH shoulder series;
- Osteopathic treatment for the shoulder
- The rotator cuff and shoulder mobility
- Pilates for shoulder strength & stability
- Building shoulder strength
- Myotherapy and shoulder blade pain
For more information, ideas and exercises check out our Health Tips blog.