Overhead Lifting, Reaching, and Throwing Part I - Shoulder and Rotator Cuff Injury

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. Try standing with your back and back of your head against a wall to see if you have the health and flexibility just to stand straight. Breathe. Smile. Relax. It's all for health.

When you lift arms upward, make sure you are not leaning the upper body backward. The next post will cover that in Part II, which includes a movie of positioning the spine and hip for overhead reaching.

• For more on the forward head and how to fix it, click Breasts Causing Upper Back Pain is a Myth and the associated links.

• To see more on back and shoulder during reaching, click Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain.

• For a post on overhead lifting, click Safer Overhead Military Press.

• For more, plus photos, showing this problem, Overhead Lifting, Reaching, and Throwing - More Part I.
  

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Labels: fix pain, impingement, injury, repetitive strain, rotator cuff, shoulder

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