Overhead Lifting, Reaching, and Throwing Part I - Shoulder and Rotator Cuff Injury
Monday, August 04, 2008
Jolie Bookspan, M.Ed, PhD, FAWM
The photo at right shows one main contributor to shoulder and rotator cuff pain, and one for lower back pain. Can you see them? Can you see why the person in red is not getting as much stretch in the shoulder as they think?
I see patients for shoulder pain all the time. Their chart says, "normal range of motion at the shoulder," or the chart reads with a number of angle degrees corresponding to directly overhead reach. I ask the person, "Reach up for me please." They lean their upper body backward, increase the inward curve of the lower back, and their hand points directly overhead. Often they do this while tilting their neck and head forward, which puts the shoulder at a position of compression when the arm is raised. I show them how to straighten the upper body upright, reduce the lower back over-arch, and return to neutral spine. I ask them to reach up again. They can't. They shoulder is too tight to reach directly overhead. They were never stretching their shoulder when they thought they were. They were getting the motion from their lower back, not shoulder. They were only leaning backward, adding compressive load to their lower spine joints, called facets. This will be covered next in Part II.
In the photo, note that the head is forward, a major contributor to rotator cuff injury during overhead arm motion. Lifting your arm with the neck and head tilted forward mashes the upper arm bone against the shoulder bones. This compresses the soft tissue between them, including the rotator cuff and nerves that go down the arm. Each small pinch can eventually saw at the area until a rotator cuff tear begins.
Rotator cuff injury is common, even in people who do no overhead athletics, like pitching, martial arts, or kayaking. Reaching upward is common around the house and for exercise. Starting in the morning, you wash or comb hair (or polish a bald head). You pull clothing on and off overhead. You reach in cabinets, wave goodbye, shield your eyes from the sun, open car trunks and hatches, put things up on racks, shop for groceries and put them away in cabinets, lift children, clean curtains and tub walls, put work in overhead shelves - many reaches, all day, every day. At the gym there are overhead lifts, stretches, and arm motions.
Compressing the nerves that pass through the area and go down the arm sets is called impingement. Impingement is not a disease. Someone with a diagnosis of impingement does not have a real diagnosis. Impingement is not a cause of pain, it is a result. If you stop the mechanical cause, then you can stop the resulting impingement. No drugs or surgery or repeated therapies are needed:
- Notice your neck and head position when lifting overhead and don't let your head and neck sag or jut or tilt forward. To see if you have the health and flexibility just to stand straight, try seeing of you can stand comfortably with your back and back of your head against a wall. If not, try some posts on upper body flexibility, such as Fixing Upper Back and Neck Pain. Don't force. Breathe. Smile. Relax. It's all for health.
- When you lift arms upward, check if you lean your upper body backward (photo above) or tilt your pelvis out of upright neutral position. To see how to prevent the resulting overarched lower spine, and restore neutral spine, click Kettlebells Without Spine Injury, and to see short movies, see Fast Fitness - Fixing Yoga Warrior and Lunge Exercise to Neutral Spine and Friday Fast Fitness - Neutral Spine in 5 Seconds.
- More on the forward head and how to fix it - Breasts Causing Upper Back Pain is a Myth and associated links.
- More on back and shoulder during reaching - Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain.
- Overhead weight lifting - Safer Overhead Military Press.
- More photos and situations for safer daily and exercise overhead movement, click Overhead Lifting, Reaching, and Throwing - More Part I.
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Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail" (under trumpet) upper right.
For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify through DrBookspan.com/Academy. See Dr. Bookspan's Books.
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Photo by Rose Davies
Labels: fix pain, impingement, injury, repetitive strain, rotator cuff, shoulder
4 Comments:
At Tuesday, August 05, 2008 8:03:00 PM,
Anonymous said…
thanks for posting this,,,,,,,
you have helped me correct my Back and Hip Problems with my running
(40-years next April)
since I have NOW torn a shoulder muscle this article could Not have come at a better Time.....
........anxiously awaiting the next installment.
ted
At Friday, August 08, 2008 4:19:00 PM,
Anton said…
At 49 years of age, and after a couple of decades at a desk, I decided to quite smoking and get back into shape. That was about a year-and-a-half ago, and all is well. I do moderate resistance and aerobic training at our local gym, and enjoy it very much. It keeps me away from the cigs, and gives me a more positive outlook on health, eating, and life generally. But, I've developed (coincidentally or otherwise) 2 relatively minor (not acute) but nagging problems: 1) what my orthopedist calls patella-femoral syndrome, and 2) a nagging aching lower back.
Well, I discoverd Dr. Bookspan on the Internet while searching for ways to reduce knee pain, and I then bought one of her books (Fix Your Own Pain Without Drugs or Surgery} and both my knees and back have improved somewhat (after about 4 weeks of following the book's advice).
I don't know how I got my knee problem (could be from using the treadmill at the gym, so I now use the stationary bike and/or recumbent bike). I think I triggered my lower back by poor technique during standing shoulder presses (i.e. hyperlordotic strain from poor technique). In any case, Dr. Bookspan has opened a whole new world I barely knew existed: correct body mechanics, and how they can effect not only exercise, but everyday movement of our bodies.
Thanks so much Dr. Bookspan!
Now, if I could only entirely get rid of my lower-back muscular pain :)
Sincerely,
Anton
At Tuesday, September 23, 2008 5:18:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Ted, good work. We have enjoyed reading your several success stories on Fitness Fixer, including Back Pain From Running.
Anton, thank you for intelligent work fixing your knees and letting us know. Now that you noticed that you stand and lift weight with too much inward spine curve (hyperlordosis), just move your spine to neutral to see if that takes away the source of the problem. Use the links in the post above to get started. Also check if you routinely do another common back pain source - rounding in a slouch when sitting and bending to get things. It's easy to stop the pain when you move in healthy ways instead.
At Saturday, December 20, 2008 6:14:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Anton, This site's blogger software wasn't posting comments or replies for a while. Thank you for your patience. Good work stopping some causes of your injuries by changing injurious joint angles. Glad you're feeling and looking better. Here are some links:
For knee pain, check if you let arches sag inward, which is a common contributor to the "patellofemoral" problem your doctor mentioned - click Fast Fitness - Fix Flat Feet, Pronation, and Fallen Arches.
Fitness Fixer and my books cover lower back thoroughly. Check if you spend time bent forward when standing, sitting, bending - Are You Making Your Exercise Unhealthy?, Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch and Common Exercises Teach Bad Bending. Exercises like crunches and conventional hamstrings stretches that bend forward to touch toes are common sources of the same forward bending that is already overdone at your desk. They are commonly repeated as "fixes" for back pain, but that is myth. For lower-back muscular when standing, check if you overarch - Spotting Back Pain During Running and Walking - What Do Abs Have To Do With It?.
Looking forward to your next success story.
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