Ever seen one of those 30-foot, telescoping poles with a saw blade bolted to the end? I've got one of those. As a good little home owner, I take pruning and yard work pretty seriously. Just this weekend, I was 10 feet off the ground on a ladder, holding this modern technological marvel high above my head, in hopes that my backyard would get just a sliver more of golden sunshine this Summer.
There were six small branches shooting out of the stump of an older, larger branch that I had cut off five years prior. These new ones I took out in less than 5 minutes, and miraculously it occurred to me: my shoulders don't hurt! My name is Dr. Allan Buccola. I am a physical therapist and owner of Impetus Physical Therapy in Greensboro, NC. My more recent posts have been pretty content heavy, so I wanted today's post to explore everyday life, and how physical therapy practice complete changes it---especially when your shoulder stops working.
Whenever I do work around the yard that is remotely dangerous, my wife likes to gather the kids and the camera and take pictures. I'm not sure if this is for insurance reasons or to rally empathy from mommy group friends, but it's always interesting to have an audience. I used to do a lot more work like this before PT school, when I had 16 hours on the weekend to devote to landscaping. I recall how miserable it was trying to saw branches with this giant pole. My shoulders would fatigue within the minute and I'd have to take a rest.
I just thought it was normal. Using both of my arms for manual overhead tasks was reserved for a subset of tasks that only occurred occasionally anyway. Changing light bulbs, installing ceiling fans, trimming trees. These all made my shoulders tired and sore super fast. I thought nothing of it. Even hanging up a new shower curtain required three bouts with a couple of rest breaks. I can even think back to days of high school marching band wherein we would march around for hours in the August sun with arms in the air as if holding a trumpet, in miserable, unrelenting pain. How was I supposed to know that I had weak shoulders?
Physical therapists ask pretty specific questions about daily functional tasks once we know what body part is malfunctioning. When it comes to the shoulder, we ask about very shoulder-specific activities, things like washing your hair, scratching your back, reaching into high cabinets, and the back of the top shelf in the refrigerator. We ask about putting on a seat belt and donning a bra or a coat..but usually not holding a 30-foot telescoping pole directly overhead.
The list of activities that require full mobility of the shoulder is pretty extensive. Any reader here can probably think of 5-10 tasks off the top of their head, just from their daily routine. The other major component of almost any shoulder dysfunction is interrupted sleep. Waking throughout the night in excruciating pain with immediate need to change position is common. People live like this for a long time, I think because they don't know they have options.
big muscles v functional strength
I can distinctly recall the 'shoulder machine' at the YMCA where I came of age. This machine, for deltoids specifically, was the least glorifying of them all in my experience. I never got stronger, and it almost always gave me neck pain and headaches. Did I ask a trainer for help? Nope. That's just not what 14 year-old boys-who-know-everything-already are good at.
Ten years pass by, living in Greensboro and doing overhead shoulder presses with dumbbells at the local gym. Things are clicking (literally), and hurt pretty badly, but not enough to cease or consult anyone. Par for the course, so I thought at the time. I think most people are like this, which I can almost guarantee, because by the time I'm seeing them in physical therapy, things are far worse.
Typically, they've already had 2 cortisone shots, or three, or four---which is a really bad idea (FYI), or they've already had that rotator cuff surgery that puts them into a sling for 3 weeks. My heart goes out to these people, and not just because the shoulder is one of the most painful joints in which to experience a loss of mobility, but because it all could have been avoided if they'd gotten to PT sooner. This is a huge uphill battle for PTs, simply trying to get to these patients before they need surgery.
posture affects shoulder function
There is no shortage of research that relates most shoulder dysfunction to longstanding maladaptive postural changes in the thoracic spine and altered positioning of the shoulder blade. If the arm is a tree, the shoulder blade is the root system, stabilizing and shifting position to accommodate the mobility of an intrinsically unstable joint...that works really well most of the time. The human shoulder blade is so much more mobile and functional than that of other primates, that it is one of the predominant reasons that we can throw spears and rocks at 90 mph (or baseballs) and other primates cannot.
When this intricate system is out of whack, repetitive motions began to compound repetitive stresses that eventually break down the hardware. If you go to the wrong practitioner with shoulder pain, you'll probably leave the office with a prescription, maybe even some fancy black and white pictures. That script will do nothing to address the circumstances which led to the dysfunction in the first place.
Physical therapy can identify and fix all of these things. We are trained to identify altered spine posturing and mobility. We are experts at paying attention to your shoulder blade when you're scratching your head, adjusting your glasses, or even filling out paperwork in the waiting room. We can address the system as a whole, even before someone has shoulder pain in the first place. We can help patients avoid years of expensive injections, prescription drugs, and surgeries. This is injury prevention at its core. If you're having shoulder pain, don't ignore it. Get rid of it. Come see me, or any other PT who can help make things better before they get worse.
This weekend was just one of those moments where I realized yet another way that PT school has improved my life. When you study the shoulder in school, you identify pretty early on, everything about your own shoulder that is dysfunctional. When I was 14 years old pumping iron at the local YMCA, I was concerned with how much I could bench press, how much I could curl---the American adolescent obsession with muscular imbalance as I call it.
Later in PT school, I changed it up. I understood how the system had broken down, why my arms fatigued so fast, and how to change it. I improved my posture and thoracic my spine mobility. I worked on the shoulder blade musculature, because strong trees need strong roots. These days, I'm constantly catching myself doing things well that used to be painful or difficult. That's the beauty of injury prevention and that's the beauty of physical therapy!
Never stop moving!