A joint issue is rarely only a joint issue and nothing else. The body is a complex interaction of muscles, ligaments, tendons and joints. I try to take all this into consideration as I treat my patients. At the same time, I realize that as a chiropractor I am using the joints as my primary vehicle to address all the attractions of the musculoskeletal system. Quite often this is enough. Sometimes it is not. To this end I will recommend certain specific exercises and stretches to address, in particular, the muscle part of the musculoskeletal system.
Of all the areas I address, which is to say of all the joints of the body, I believe the shoulder tends to be one that is to the least extent a purely joint issue. If you think about it, the shoulder is a fairly unstable joint. The arm is hanging from the shallow concavity that makes up a part of the shoulder joint. It is basically held in place by ligaments, muscles and tendons. Not surprisingly, what goes on in those connective tissues is going have a big impact on the alignment of the joint. To be sure, adjusting the joint itself to mobilize scar tissue and create better alignment is an integral part of addressing the shoulder. Often this brings very quick relief for patients complaining of shoulder pain.
But the slouching that occurs in our society (think computers, cell phones, desks and cars) results in forward head posture that tends to push the shoulder joint forward and results in poor tracking of that joint. Over time this can cause pain in the rotator cuff tendons. To address this I will give my patients some specific stretches to address the tight muscles that have become chronically shortened.
Another issue that is very often overlooked is a chronic weakness of the rhomboid muscles. These are the muscles that span between the spine and shoulder blades. Their action is to stabilize and bring the shoulder blades together and downward. This helps bring the shoulders backward into better alignment. When these muscles are weak the body will compensate by recruiting other muscles such as the trapezius muscles and others that tend to run between the shoulder and neck area. Since these muscles are not designed to take the stresses of stabilizing the shoulder throughout the day, they tend to get tired and painful and eventually develop trigger points. While a massage will feel great and provide relief, the muscles have to get back to work as soon as one gets off the massage table and the knots come back.
Fortunately, strengthening the rhomboid muscles is fairly straightforward. I will usually give a patient some simple exercises they can do each day to specifically address the weakness of the rhomboid muscles. This will take stress off the rest of the other muscles and over time can help rehabilitate the entire shoulder area.