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How you can reach overhead pain free!

shoulder

If you’re getting pain In an area of your body like your shoulder or back when you’re reaching your arms above your head, chances are one of a few things is happening so let’s break down how you can reach overhead pain free.

  • You’ve had a previous shoulder or back injury that you’re recovering from or haven’t done anything about it.
  • You are tilting your ribcage upwards – in other words if you run your hands over the front of your stomach, you can feel the bony prominence of your ribcage poking through under your chest.
  • You are pinching your shoulder blades back.
  • You are cheating and creating movement through other areas such as your lower back.

A lot of things can go into the simple task of lifting your arm above your head. Some of us are lucky and never need to think about it, others not so much.

This task may be something you avoid, you might dread reaching for an object in the higher cupboards, hanging the clothes out or engaging in tasks like throwing and swimming to name a few.

Let’s break down the normal mechanics and what’s involved in healthy shoulder movement.

Starting with the bone anatomy we have a few bones that make up the shoulder joint.

  • Humerus – this is the bone of your upper arm
  • Scapular – this is your shoulder blade where there are multiple attachment points
  • Clavicle – this is your collar bone
  • Ribcage – This is where the scapular sits on and glides around (not technically considered part of the shoulder but none the less important for motion).
  • Sternum – the middle part of your chest where your ribcage attaches too.

These bones form together via ligaments which make up joints such as your

  • Glenohumeral joint (between the scapular and humerus)
  • Scapulothoracic joint (scapular and ribcage)
  • Acromioclavicular joint (a bone on your scapular and clavicle)
  • Sternoclavicular joint (sternum and clavicle)

Now we have a basic understand of some of the key bone structures and joints, let’s delve into the muscles.

First let’s split the body into front and back.

The front we call anterior, the back we call posterior.

On the anterior compartment of the body, we have several key muscles:

  • Pec major and minor (chest muscles)
  • Serratus anterior (ribcage)
  • Deltoids (shoulder)
  • Rotator Cuff (subscapularis)
  • Biceps Brachii (humerus)
  • Traps and scalenes

On the posterior compartment of the body, we have more muscles:

  • Latissimus Dorsi (big back muscles)
  • Serratus Posterior
  • Rotator Cuff (supraspinatus, teres minor and infraspinatus
  • Traps (upper and Lower)
  • Rhomboids
  • Triceps Brachii
  • Levator Scapulae

That’s a lot of muscles and areas to consider isn’t it!

Now there are even more muscles and areas to consider but I don’t want to bog this down too much.

What do we do with this information?

First appreciate that the shoulder can move quite a lot, in fact it’s considered the most moveable joint in our body being able to lift up and down, side to side and even big circle motions.

To be able to accomplish all these tasks areas such as the ribcage, shoulder blade and humerus must work in unison moving independent at varying degrees.

What happens when this doesn’t happen? We get a shoulder that doesn’t move well.

Why this happens can be a host of reasons:

  • Injury & Compensation
  • Lifestyle / Work
  • Use it or lose it – lack of movement often means we get stiff
  • Bias from playing sports
  • Ageing

How can fix and restore normal shoulder movement?

This can be a complex question and ultimately does depend on the individual, getting assessed by a quality practitioner will always be my first answer.

What are some great ways to improve your movement?

Restore what is lacking!

If your arm can lift up (external rotation) but you struggle to drop it back down as shown in the image. Then chances are you are quite rounder through your ribcage or you are already in internal rotation.

How can you tell? Go look in a mirror and take 2 photos – 1 side on to a mirror and 1 in front.

What you will see if you have this disposition is that

From the side:

  • You will have ab tension, and around where a bra strap would be will likely be rounded more.

From the front:

  • Your arms will be rotated in or internally. This might mean the tips of your thumbs are facing each other when having your arms relaxed by your side or their facing your body more than they should.

If you can’t lift your arm up (external rotation) but you can drop it down (internal rotation), again adopt the same approach and take some photos.

What you might see will vary this time:

From the side:

  • You may see the ribcage elevated or popped up at the front
  • Shoulder blades will likely be squeezed together

From the front:

  • The tips of the thumbs will be more forward, the sternum will be lifted up
  • Think of a proud chest

Each of these positions are extremely common. Both can get away with lifting their shoulder above head, they will just likely compensate in the process.

Person number 1 with the rounder back caused through excessive ab tension.

This person needs to extend slightly, let their abs relax instead of being contracted all the time. Use your head to look upwards.

Try rotating your palms or thumbs outwards more to give you shoulder external rotation. This person will also benefit from practising breathing in and expanding their ribcage.

Person number 2 with the straight or extended back will likely have more lower back tension.

This person should focus on the exhale – breathing out, as well as aiming to place more weight on their heels (will likely need this walking as well) as this will enable them to move their hips backwards, and re-centre their gravity.

For healthy movement we must be able to move in and out of these positions. Static postures don’t really give us much of an indication, rather the ability to move dynamically.

That is, can you access both internal and external rotation of your shoulder? Can you flex and straighten your spine?

If you are stuck in one of these predispositions then you may struggle to get into the other.

For these people that is the key, restore what is lacking.

Minimise Compensation

Set yourself up in a favourable environment and you’ll reduce the likelihood that you need to cheat with tasks like lifting your arm up over head. Initially you may lay on your back and elevate your legs, this will give you a neutral playground for your body to work.

Eventually you want to progress into more complex movements while keeping the compensations down, then before you know it, you’ll be able to reassess the movement you are after e.g. lifting your arm above your head.

My top three exercises to accomplish better shoulder motion are:

Supine Pullovers
Arm Bars
Landmine Shoulder Press

 

 

 

 

How have you found these exercise tips?

Feel free to reach out for a chat about how we can get you moving right again!

Reach us at moverightep@gmail.com

Pain: What is it, how does it work and how do we help you overcome it!

Pain: What is it, how does it work and how do we help you overcome it!

pain

Pain is something that can debilitate anyone throughout their life. Today let’s break down some of the key fundamentals of what pain is, how pain works and most importantly what you can do about pain!

First, I want you to picture stubbing your toe on the edge of your lounge.

Ouch! If a past experience came into your head, you may have a memory of jolting back, stopping every task, thought, emotion you had before, becoming completely aware of the sensation you just experienced in your poor toe.

Now the next question is, did you still feel pain from that memory? Maybe not the toe scenario specifically. Maybe you had an injury to your knee from sport or you broke a bone when you were little. Do you still feel some pain, tenderness, ill thought, protectiveness even around the injury?

If you answered yes, you aren’t alone. Many people actually suffer from pain long after an injury has passed.

How can this be though?

Well, there are a few key points I want you to understand straight off the bat.

  1. Pain is an in-built protective device
  2. Tissue damage and pain often do not relate
  3. The longer we have pain, the better our body (nervous system) becomes at producing pain.
  4. Pain is a by product of how much pain your brain ‘thinks’ you are in, not how much you are actually in.

Now each person is unique in how they will perceive, exhibit and think about their pain.

The first step for individuals or practitioners working with individuals is to figure out one’s pain beliefs.

Our belief, thoughts and feelings can be a huge implication for how we recover!

Did this surprise you?

This is now a widely and well documented area which gave birth to the biopsychosocial model. Basically, this is a model that views you in three main components and how they interact with one another.

Biological – such as breaking your arm and experiencing pain

Psychological – that is how you think and feel about your above broken arm, are you worried, anxious, depressed?

Social – that is how your relationships are affected by your injury. Are you unable to participate in group activities / sports like cricket now because you broke your arm – maybe you will feel isolated or have an imbalanced lifestyle.

If these factors aren’t viewed in a holistic manner – a broad approach that views how the injury, disease or pain itself is impacting you on multiple fronts, I hate to say it but the treatment you receive won’t be very effective.

In my experience this is largely an active process on your part. To truly heal from debilitating pain, you must take ownership of yourself, engage with the education being provided with you and implement the techniques, strategies over a period of time so you build resilience, mental fortitude and self-efficacy.

The people who fail to overcome their pain are often stuck in a cycle of seeing another health care provider who treats their symptoms such as a sore knee. These practitioners will often say the cause is one singular issue such as a muscle not working rather than a multi-factoral concoction of reasons that have lead to the appearance of pain.

Instead, a quality practitioner should improve pain in a person by:

  • Treat the person not the symptom
  • Build resilience
  • Encourage continual movement (with modifications if need be)
  • Promote health awareness
  • Improve their movement capabilities
  • Provide pain education about fear avoidance, resilience and self-efficacy
  • Build rapport and trust with the person in front of them.

 

Ok let’s break this up with some fun facts:

  • The entire brain (cells) is replaced every few weeks
  • If no problems whatsoever exist in your body e.g., nerves, immune system, musculoskeletal system, you may still feel pain if your brain thinks you’re in danger
  • Giraffes and Humans have the same number of neck vertebrae (bones)

Still with me?

A few key points keep popping up throughout this blog

  • Pain is protective
  • Tissue damage and pain do not have to match
  • Pain can be heightened by how our brain is feeling in a given environment

Time to break it down!

Pain is protective:

How can this be? It hurts! Well pain is a signal albeit a relatively strong, in your face, look at me signal. It is ultimately here to protect us.

Pain prevents worse things from happening. Try and touch a hot stove, what does your body do? Jolt back from a sharp burst of pain. While this hurts acutely or for a short period of time, it avoids a long term or more serious injury such as 3rd degree burns from happening.

 

Tissue damage and pain do not have to match

This is one for the often-long term or chronic pain people. The average healing time for most tissue to heal is 3 months

Muscle – 2-4 weeks

Tendon – 4-6 weeks

Bone – 6-8 weeks

Ligaments – 12-52 weeks (complete strength)

So why is it that our pain can last years, decades even?

Tissue damage does not necessarily = pain.

Think back to our biopsychosocial model – if you are someone with pain that has lasted over 3 months, you are deemed someone with chronic pain.

Using the above model let’s create an example:

You had a disc bulge injury from picking up an object from the floor. Disc bulges typically heal themselves within 12 months of the injury, pain usually subsides within 3 months by itself. Now say you do still have pain and it’s now been 2 years since your injury, what gives?

Well even though from the biological side of things you are all good, there may be lingering, untreated areas of the psychological and social aspects.

Psychologically you may have told yourself that picking up that object caused your back to hurt so you now avoid picking up objects a certain way, or maybe you still pick them up but you brace yourself like your about to lift up a car.

This person is exhibiting fear avoidance and catastrophizing behaviour. These two terms mean you are thinking worst case scenario, scared that by lifting this object because of your past experience, you will again hurt your back.

Enter the social side, maybe you don’t go bowling with your friends anymore because you don’t want to pick up a bowling ball, or maybe you have limited other social activities because of the fear of hurting your back again. This will now lead to feelings of isolation and being separate.

How does this lead to pain? Well remember the key point that pain can be heightened by your brain?

If you are feeling unsafe, alone and helpless in an environment your brain can become hypersensitive to normal sensations. This can lead to feelings of pain – sharp or dull aches even though there isn’t actually any physical damage there.

This isn’t to say your pain isn’t real. Your mind is powerful, you think it, it’s real!

As I mentioned earlier, to improve upon this you must break out of this vicious cycle of despair and helplessness.

You aren’t alone in your treatment, however you are the one who has to actually engage with the treatment for it too work.

  • Look into gradually exposing yourself into different movement patterns again e.g. learning to pick things up from modified distances until you become comfortable.
  • Continue learning about pain – what it is, how it’s produced.
  • Check out this great Ted Talk that gives a snapshot of pain science – TEDxAdelaide – Lorimer Moseley – Why Things Hurt – YouTube
  • Get moving – start gentle e.g. walking and build your confidence!
  • Appreciate how adaptive we are as humans. Our brains are plastic meaning we can alter – learn and unlearn negative thoughts and feelings.
  • Be patient and kind to yourself – This isn’t easy, it will take time and a lot of hard work. But with the right support network you can become free of pain!

 

 

Each of these things can be done by a quality practitioner, if you feel you need help with overcoming pain, wanting to move more and be free to do the things you love again. Move Right EP can help you.

Reach out today at moverightep@gmail.com

Work with your Injuries instead of against them!

injuries

 

Work with your Injuries instead of against them!

Have you ever been injured? I know I have! Injuries are something that can happen to us at any time or any place. No injury is truly preventable, even with all the right training in the world, accidents happen, people fall and play contact sports, people have vehicle crashes and so on.

 

A common first thought especially when it comes to training is to stop everything, to postpone your training and rest. Did you know this might actually be one of the worst things you can do when injured?

Injuries depending on the time can lead to numerous negative health effects.

From a movement perspective.

  • We may start to change our movement, take an ankle injury for example. You may start to change how you walk or run or jump to prevent that ankle from taking pain – remember you body is highly adaptable. However, in my experience this generally only lasts for so long before we get another ache or pain further along the line. Leading to pain in your hip or knee for example. This is a prime example of compensation; your body utilizes other areas to accomplish a job.

Think of an employee doing one job (the one they are paid to do) and then a few staff leave so they take on more responsibility, now they are spread thin trying to accomplish multiple tasks. Eventually they burn out, lose enjoyment and potentially quit. Our body can’t quit but it can complain with aches and pain!

 

From a strength perspective

  • Our strength and size, generally within six weeks we lose a significant amount of strength from inactivity, our nervous system becomes less efficient at generating force.
  • We become less efficient with movement patterns in areas of form and technique thanks to the principal of reversibility.

 

From a wellbeing perspective

  • Injuries may leave you skipping events, functions and social activities with your friends.
  • Your mental health may change due to the feeling of not being able to engage in activities you used to.


From a work / relationship perspective

  • You may shift your priorities to a business mindset, neglecting your health. The problem again with this is like compensation, we can only do this for so long before we get negative outcomes from neglecting our health! Your mental capacity, productivity, mood will change as a result leading to a business that may be affected in more ways than one!
  • Your relationships may suffer, with them now taking on a greater role of caring for you depending on the injury, there is often an economic cost from missing work or not being able to drive and so on.

General ways you can stay active with injuries can be found HERE.

 

The general notion I want you to take away from this is that Injuries Suck.

Again, I will say, why not work with your injuries, rather than against them?

This can be a game changer for you, the factors and scenarios I ran through above and more!

The first way we can begin working with our injuries is through our mindset.

 

Mindset:

  • First, we must accept what has happened. Some of us can be in denial and still try everything we did when uninjured, it doesn’t work like that. Accept that your body needs time to heal.
  • Take control of your emotions, thoughts and feelings. This will go a long way to stop you reacting to the situation in a negative way. To do this practice ‘staying in the moment’, this means be present! Don’t let your mind escape you into every possibility of what could or might happen. Anxiety and depression are often linked with being too far in the future, or too far in the past leading to an array of thoughts about ourselves. Staying present through grounding techniques may assist you!
  • To ground yourself – Look at 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 good thing about yourself.

This is sensory grounding, a technique that plays on your senses to encourage you to be present!

Physical:

  • Move! Injuries don’t mean you have to stop moving. Instead, it’s about finding the activities you can perform safely that won’t lead to further harm of the injured area, depending on the injury you might actually need to move for it.
  • Take a low back injury, rather than lay down in bed, get up and go for a gentle walk letting your arms and legs swing effortlessly.
  • Hurt your arm? You can still train upper body! Training your uninjured side can actually help your nervous system on both sides leading to maintaining or reducing the negative physiological effects of not training the injured side! Win, win!
  • Train within the ranges that you can, maybe you get sore by moving your elbow or knee? We can still perform plenty of exercises, such as isometrics. That is where your muscle length does not change shape. Think of doing a slight lunge and then holding that position with out dropping down further or standing up. This is an isometric. Or holding a part of the push up position with slightly bent arms.

Working with your injuries, is empowering! It will help you take control of your mood, your body and leave you more resilient to overcome obstacles in your path.

I look forward to hearing your success, share it with me @ moverightep@gmail.com

 

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