Shoulder Pain - Workman's shoulder?
When I first started my practice in Oakington I presumed my patients would have mainly bad backs - and lower bad backs at that! I was surprised when it occurred that the vast majority of my patients would, in fact, have shoulder pain!
I have many patients who are self employed workmen such as plumbers, kitchen fitters and electricians who have shoulder pain.
It's not that their backs do not hurt - it is more that they can live with a back ache but shoulder pain is affecting their work!
So why would a self employed tradesman suffer with shoulder pain? Let me explain...
Many workmen are self employed and do a lot of manual work. Think of a decorator or an electrician - they spend many hours reaching up or around an object in order to do their work.
Manual work, such as maintenance, involves a lot of use of the pectoral muscles. The pectoral major muscle is attached to your collar bone (the clavicle) to your sternum (your chest bone) and to the upper arm.
Many of my patients are also self employed. What difference would that make? I hear you ask!
When we are stressed, we use our muscles if inspiration much more. Our accessory muscles of inspiration (sternocleidomastoid, scalenes) are also connected to the clavicle but located the neck. The affect of these muscles effectively tightening, and pulling the clavicle upwards, along with to pectoral muscles that are tight due to the physical aspect of the manual work, pulling the clavicle downward, prevents the clavicle moving up and down with the arm. This puts more pressure onto the other end of the clavicle, the arm end.
At the end of the clavicle lies the acromioclavicular (AC) joint that connects the clavicle to the scapula. The arm literally dangles off of the shoulder blade (scapula) and the scapula is connected to the rib cage by muscles alone - the is no physical joint!
The AC joint allows the arm to raise above the head. It functions as a pivot point, acting like a strut to help with movement of the scapula resulting in a greater degree of arm rotation.
If the clavicle is unable to move in a normal range then the AC joint does not have its normal range of motion. It gives rise to pain in the shoulder and is often accompanied by subacromial impingement which is basically inflammation of the bursa (little sac) that separates the rotator cuff muscles from the tip of the shoulder blade. This creates pain upon moving the arm upwards (abduction).
The more the shoulder hurts, the more concerned the person will be as there are no days off sick for someone who is self employed. The neck muscles get tighter, the AC joint is put under more stress, it hurts more, there is less movement available in the shoulder, it really is a vicious cycle.
This is where osteopathy can help. By reducing tension in the chest muscles and the neck muscles, thereby restoring movement in the shoulder joint and taking the pressure off of the AC joint through osteopathic techniques and giving advice to reduce the inflammation in the bursa (to ice the shoulder regualy and take supplements such as turmeric and fish oil), shoulder pain can easily be rectified.