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The shoulder complex is just that… complex! It is a series of incredibly mobile regions stacked on top of each other in such a way that if there is a significant issue in any one of these regions, the whole thing doesn’t work well. What I want to do with this blog post is give you QUICK and EASY assessments you can do on your shoulder to discover what it can do and what it should be able to do!
 This quick and easy assessment gives us an idea of how well your shoulder can go overhead (flexion) and how well it can go behind you (extension). If you’re having difficulty with either of these movements, make note of which is the most challenging and let's move on to the next test.
  Lying down with a towel under your elbow, see how much range you have going backward and forward with your wrist. In total, you should have about 160 to 170 degrees of total motion with the shoulder staying pinned on the table (see how the second image has the patient pinning their shoulder to the table so it doesn’t come up). Typically we see the back of the wrist touching the table when going back and the front side of the wrist nearly getting to the table, for a normal range of motion. If you’re having difficulty with either of these, take note and let's move on to the last assessment.
    Being able to use your shoulder overhead is challenging without the correct musculature in place and ready for action. The “Reach, Roll, Lift” assessment really tests your shoulder’s ability to have good range of motion, as well as good muscle activation to pull your hand off the ground. First, crouch down, then slide your palm across the ground overhead; roll your thumb upward to the sky while keeping your outside of the hand on the ground; finally, pull your thumb and arm to the sky, keeping your arm straight. If this is not possible, make note, and let's move on. After you’ve done these three assessments, you may have found you are lacking certain fundamental movements of your shoulder that are required for healthy functioning of your upper body. At Athletes’ Potential, we specialize in working with correcting these issues regularly and getting our patients back to the activities they love, fast, and without the need for injections or surgery. If you discovered that you are unable to perform any of these three assessments, feel free to reach out to us and schedule a treatment today! Thanks for reading,
Dr. Marcus Rein, PT, DPT, CF-L2
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 A hot pan - don’t touch it! A wet slippery slope - probably should avoid it. A cactus - definitely avoid it. The experience of pain has taught us these simple rules, and we should be thankful! Burning our hand, slipping on rocks, and getting poked by a cactus’ spines are all three damaging things that we do our best to avoid to ensure our own health. These examples are the easiest way to understand pain, in that it is an alarm system that is designed to protect us from damage by giving us a quick response from which we can learn. Let’s go one level deeper. What happens if you go on a big hike and wake up the next day with your legs in pain? It’s a deep soreness that you haven’t felt before and it’s really bothering your hips and knees. Is this cause for concern? Is this damage? What kind of pain is this? What if you are simply sitting down in the gym after a workout and turn to pick up your water bottle and your back spasms, causing intense discomfort? Is this cause for concern? Is this damage? What kind of pain is this? How about just waking up with shoulder pain for no reason, but it lasts for 10 years? It won’t respond to medication or injections, and resting it just makes it worse. Is this cause for concern? Is this damage? Why the heck is this pain still around? As you can see, the alarm system pain provides is activated in all of these scenarios. This alarm system provides a symphony of sensation that plays its tune and it's up to you (and maybe the assistance of a professional) to decode the symphony. Let me share with you the things I look for in a patient’s presentation to help decode their sensations: 1. Numbness, tingling, or burning? If you are having numbness, tingling, or burning that does not resolve quickly or returns regularly, you likely need an assessment from a professional to determine its root cause. PTs are very skilled in caring for this type of pain! However, if this sensation is with progressive weakness or progressive loss of sensation, you should contact your primary care provider for assessment quickly. If it is rapidly progressive, you should go to the hospital. 2. Pain that's slowly getting better but still around? As long as the pain is getting better overall, healing is occurring. If it's slow, it's still progress, so don’t discount it! If you are frustrated in the pain’s slow speed of improvement, it might be time to come in to see us as we are also very skilled at finding ways to more rapidly accelerate your healing. 3. Pain that is not getting better for over a month? If you’ve been having pain that has not been improving for over a month, it is definitely time to see a professional. PTs are fantastic at diving into the mechanical issues that are causing your pain and improving the painful region’s overall capacity to provide you a higher healing potential. As a final note… there are SO many factors that can affect pain! Here’s a short list of proven secondary factors that have a direct effect on the subjective interpretation of the pain alarm system: Modifiable Factors Proven to Affect Pain*:
Non-modifiable Factors Proven to Affect Pain
As you can see, this complex experience doesn’t just include the local injury but so many other factors! If you would like to read more about the pain experience and its study, I highly recommend "Explain Pain." It is a short read that is well researched and provides a great contextualization of the entirety of the pain experience. So, if you are having pain and want to better understand it, start with contextualizing it as an alarm system that you must learn to interpret. If you’d like to understand your pain further, “Explain Pain” is a great option. And, finally, when you’re ready to have your pain improve, come see us at Athletes’ Potential! Thanks for reading, Dr. Marcus Rein, PT, DPT, CF-L2 * van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology - where do lifestyle factors fit in?. Br J Pain. 2013;7(4):209-217. doi:10.1177/2049463713493264 |
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