Thursday, July 19, 2012

Shoulder Pain During A Workout

A few days ago I was working out at Equinox here in the Back Bay with a friend of mine who's a trainer and we got to talking about his shoulder.  He said "when I work my chest or shoulders I get pain in the front of my shoulder, so I just avoid doing shoulder work."  And since this is something that I see a lot of in the office I thought we could discuss it here in this post.  After a few weeks of treatment to his shoulder he was back doing military press after avoiding it for months.  But shoulder pain can be complex, so lets run through a few of the common causes.

First we have to look at the major muscles of the shoulder area itself.  The main ones, that you can find on yourself, are the trapezius and the deltoid.  Basically the trapezius is the large muscle going from the shoulder up to the neck, and the deltoid is the actual shoulder muscle itself.  These are the primary movers of the shoulder.  When performing military press, lateral raises, or shoulder shrugs these are the muscles doing the most work.  These will cause pain when they are either too tight, too weak, or torn.  But even though these are the main movers of the shoulder they are rarely the cause of shoulder pain.

Another cause is an actual torn tendon, muscle or cartilage in the shoulder, which can happen but most often occurs after a trauma like being tackled, or launching a football when you haven't thrown one for years.  There could also be arthritis in the shoulder joint itself which can cause significant pain.  Irritation to a nerve in your neck can also cause pain into the shoulder.  But these are all more rare and more severe than what most people experience in the front of the shoulder.

One of the main reasons that shoulder pain comes about a problem with the rotator cuff, which is composed of four muscles; Supraspinatus muscle, Infraspinatus muscle, Teres Minor muscle, and the Subscapularis muscle.  Try to picture your scapula, or your wing bone on your back, this is where your rotator cuff is located.  These muscles all turn into tendons, the way any muscle does, and these tendons travel through the shoulder area and attach near the outside and front of the shoulder.

This attachment is why most people who have rotator cuff problems will feel the pain in the front of their shoulder.  When a rotator cuff muscle becomes too tight, too weak, enflamed, or torn the body feels the pain in the front, and not normally in the back.  The primary goal of the 4 rotator cuff muscles is to keep the scapula close to the rib cage, and to provide stability to the shoulder.  Most people think of a baseball pitching injury when they hear rotator cuff, but these muscles can become dysfunctional just by sitting too often.  The more we sit, the tighter the rotator cuff becomes, and the more it will pull on the front of the shoulder.

So what can we do about this anterior shoulder pain?  First you should try to loosen up that area.  Get a tennis ball and lie on the ground with the tennis ball touching the muscles near you shoulder blade.  If you're doing this correctly you'll start to feel pain in the front of your shoulder, where the tendons attach.  Now just lay there for a few minutes until the pain subsides.  Repeat this a few times a day for a few weeks and see how the shoulder pain decreases.  If that doesn't help you'll have to see your chiropractor, physical therapist, or massage therapist to get these muscles evaluated for you.  If you find someone who knows what they're doing they'll be able to figure out what muscles are tight, which are weak, and which may be actually injured.  Then a plan of strength and stretching can be created to help ease the pain.

Doctors Note:  If you suffer from pain in the front of your shoulder it may be an easy fix.  More often than not the problem is in the rotator cuff.  Try lying on a tennis ball directly on the muscles of your rotator cuff for 5 minutes each day to see if this decreases the pain.  If it doesn't then have someone evaluate the shoulder.   And avoid the urge to just lift weights through the pain... you'll probably just end up tearing something... which can put you out for months.

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Tuesday, July 10, 2012

Hip Pain While Running in Boston

As the summer flies by here in Boston we're seeing more and more people come into our Copley Square Chiropractic office with a common running injury which can only be described as hip pain.  The hip is a hard area to define for most of us because it combines many different parts of our anatomy.  Most of us think of the outside part of our hip or butt area when we think of the hip, but others think of the internal structure, where our leg connects with our pelvis.  It all depends upon who you talk to.  The main point of this post is how to deal with pain felt more externally, on the outside of the hip area, or the "jamming" internal feeling that is primarily caused by a tight and tender Tensor Fasciae Latae muscle.

Picture Source:

Your TFL runs essentially from the top of your hip bone (iliac crest) to the outside of your femur.  It's not very long, only a few inches in most people, but is essential for proper walking and running.  Along with your gluteus medius muscle it helps to stabilize the leg and hip area during one legged movements, such as the push off phase of running, or standing on one leg.  It's an area that tightens with sitting, but to this point we don't have a great stretch to ease the tightness.  Eventually the TFL "turns into" your iliotibial tract (or IT Band) which connects to the outside of the knee, as seen in the picture above, and may cause knee pain.

Common symptoms of TFL issues are low back pain, outer hip pain, pain going from sitting to standing, outer knee pain, a "jamming" feeling inside the hip joint, and pain during or after running.  Tightness in the TFL often leaves the athlete feeling as if the hips are "twisted" or that they need someone just to pull their leg away from their hip.  It's an annoying problem that can last for months and in some cases years.

Luckily for runners of all ages there is a way to treat this problem.  The first step is to work on the TFL muscle yourself.  This can only be done with self trigger point work, which means you get some sort of a ball (tennis ball, golf ball, softball) and lie directly on your TFL.  It will look as if you're on your side, with the ball jamming into your TFL.  It's always recommended that you find exactly where the TFL is located before performing this movement, because if you end up lying on your hip bone or femur you're going to be in more pain than when you started.  Once you find the TFL you can lie on the ball for 2-5 minutes.  This should decrease some of the pain, and after a week should take the pain away completely.

If you're an avid runner or athlete who has tried this approach and aren't getting the results you're looking for it probably means you need some outside help.  Here in the office we see many people, and not necessarily runners, who just can't seem to get relief on their own, so they need our  help.  What we do is deep muscle work on the TFL itself and also we can adjust the femur so that it's not so tight in the hip joint.  This takes away the "jamming" feeling and enables the TFL to relax.

Doctors Note:  Hip or outer glut pain is often caused by a tight TFL.  TFL tightness is caused by sitting or squatting too much.  Stretching hardly ever helps... and this is NOT something that just goes away on its own.  Try self trigger point therapy for a few days to see if you get relief.  If not, call either your chiropractor, physical therapist, or massage therapist (whoever knows how to do deep tissue work) to have them work the muscles on a deeper level.

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