Among the common injuries I see farmers for, shoulder complaints fall into the top tier. The shoulder can cause grief for many reasons, but almost all of those reasons have common roots.
Anatomically the shoulder is a fairly shallow joint, especially when compared to deep ball-and-socket joints like the hip. For a shallow joint it has a lot going on. Multiple connection points for the muscles that surround the shoulder, upper arm and neck are found crossing over and around the shoulder capsule. Along with this a large portion of nerve roots exiting the neck travel down through the shoulder into the arm and chest. It also has, when healthy, a large range of motion. This is a busy joint! No wonder it has a large array of common complaints.
Some of the most common things that people come to me complaining of, off the farm, are impingement syndromes, tendinitis (usually of the biceps or rotator cuff tendons), and frozen shoulder (adhesive capsulitis). Impingement and tendinitis conditions of the shoulder are broad terms that essentially imply either pinching/compressed soft tissue (usually from postural issues) or poor mechanics (movement) causing too much friction on a tissue. Frozen shoulder has more complex roots.
Due to our upright ambulatory nature, we humans spend the bulk of our time using our arms in front of us or overhead. Whether it’s fixing machinery or feeding cows, chances are much of your day is spent using your arms in a 180-degree range in front of your body. If you do lots of work with your arms above 90 degrees, you have a higher risk of tendinitis (friction and irritation of the tendon) in your biceps tendon, which inserts at the front of your shoulder, and the tendons of your rotator cuff (which also insert at the front of the shoulder). Both impingements and tendinitis happen when we have a forwardly rolled upper body position; caused both by repetitive work with our arms in front of us, and perpetuated by the same.
When our posture is rolled forward it implies that the stabilizing muscle groups that fill the upper back are likely not working as well as they could, both part of the problem and caused by our repetitive lifestyles. The shoulder capsule becomes overly busy in the front portion, and this puts even more strain on some of those inactive muscle groups in the back. The front gets tight, and the back half gets stretched and “weak.” In order to begin fixing the painful conditions that can come with this common postural imbalance we need to start by helping those stabilizers in the upper back “wake up” and work a bit more efficiently; thereby offering support to the more vulnerable front half. Before you can do this, you have to get out of pain. This is best done by any combination of manual therapy, anti-inflammatories, ice and rest. Once you’re out of pain you can begin actively correcting the root issue, your movement mechanics.
Some early exercises for shoulder impingements and tendinitis are:
- Wall Rotations — Leaning against a wall, tuck the entire spine from hips to base of the head into the wall (knees can be slightly bent and feet slightly ahead of you). From here bring arms with elbows touching up to 90 degrees, and then rotate forearms towards the wall. Repeat this daily three times for rounds of five to 10.
- 90/90 Rotations — Laying on your side with knees bent up towards your chest (should be at about 90 degrees from hips) stack the arms perpendicular to your body straight out. On an exhale rotate the top arm over towards the opposite direction to where you’re facing, so you end up rotated through your upper body with eyes looking towards the moving hand. Repeat on each side two to three times per day, for rounds of 10 movements.
- Doorway Pec Major Stretch — Find a doorway and place your arm at 90 degrees on the door frame (your arm should look like a backwards L). Step forward with your body until you feel a stretch at the front of your shoulder and chest. Hold here for 10 to 15 big deep breaths. Repeat multiple times per day on each side.
When it comes to something more complex like frozen shoulder, the reason why this condition occurs is still somewhat of a mystery to the medical field. Some common beliefs have to do with infection to the joint capsule, hormonal changes in the body (this condition is most commonly seen in middle-aged women), or a history of trauma re-aggravated by stress (emotional or physical). I’ve seen success in clients utilizing manual therapies and exercises to manage pain and to progress range of motion, as well as acupuncture, craniosacral therapies, and stress management techniques. Each case is unique so therapy must be appropriate for the individual.
It’s important to remember that breaking the cycle of pain first is imperative to rehabbing the problem, just as it’s important to know that passive treatments like anti-inflammatories or other pain medications have an important short-term role and aren’t doing anything to correct the underlying problem. There is a place for both passive and active therapies.