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Shoulder pains and postural reeducation

Re-educate the body and be aware of it: the word to the physiotherapist

The pain in the shoulder can be caused by trauma or accidents, osteo-articular degeneration, or in most cases, by the repetition of the same, not necessarily heavy, activity. A bad posture can generate contractures in the short term, and produce potentially serious inflammatory states in the long term.

Therefore white-collar workers, students and those addicted to their computer are among the categories of people showing a higher risk of pain and inflammation of the shoulders. All those people who spend days and evenings sitting at their desks tying on their keyboards (with strong tendons and muscular stress) aassume different bad postures which cause tensions, contractures, inflammations, and the worsening of articulation over time.


Shoulder joint

Shoulder joints are the most mobile in our body: they can complete a 360 degree rotation, if they are in good health. The appearance of trouble and pains often causes the person to limit shoulder and arm movements, which consequently leads to the progressive immobilization and loss of movement capacity. Such immobilizations are known as: hypotonia of the related muscles, contractures at neck, shoulders and back which are due to work overload needed to compensate the movement deficiency.


The shoulder is similar to a crossroads of bones, muscles and tendons. It is constituted by the shoulder girdle complex, four communicating articulations connected by muscular fascia which regulate the mobility between the trunk and the upper limbs. This type of structure allows for greater mobility, but on the other side stability is more difficult to maintain, as these four joints (glenohumeral, sternoclavicular, acromioclavicular, scapulothoracic) must work together to maintain a healthy balance.

In fact, a lot of the shoulder related pathologies are concerned with the capsule, which has the function of maintaining stability, and the rotary cuff which is in charge of mobility. These types of pathologies often happen at a younger age (from 35 on) whereas degenerative processes such as osteoarthritis usually start to show after 60 years of age. Traumatic events such as fractures and damages strike all ages of people, often because of heavy sport and work activities.


Wrong habits lead to a chronic disorder

We have seen how the shoulder is composed of muscular complexes which steady each other. If you overload a muscle with a wrong, repeated behaviour, other muscles have to compensate for the imbalances and are then themselves stressed. This stress, when extended in time, worsens and can cause the contracture of a single muscle or of the entire area. When we ignore the pain, which is the alarm signal sent by our body, we contribute to the degeneration of the situation: inflammation with acute pain, progressive limitation of movement up to the “freezing” of the articulation.


Prevention first

Prevention is the magical word to avoid the above described unpleasant situation of progressive states of pain with functional limitations; this can be done with a correct postural hygiene. Teaching it in school would be appropriate, and body perception should be learnt as well. Prevention means also doing periodical check-ups starting from the age of 30, to ensure a better quality of life in the years to come. If you really can’t avoid the pain, don’t ignore it and don’t kill it with anti-inflammatory drugs, but cure it starting from the cause. The physiotherapist cannot and must not replace an orthopaedic specialist or a physiatrist who have to, first of all, rule out the possibility of serious pathologies such as cysts or degenerations, breaking or fraying of tendons. Once the diagnosis has been established, you will be in the hands of the rehabilitation specialists.

Some postural advice:

When you are sitting, try not to stretch out on the chair with the pelvis on the edge, because you overload the lumbar area of the back and contract the shoulders to sustain your body.

Keyboard and screen should be right in front of you to avoid torsions of the trunk and neck.

If you often use the telephone, better to use headphones rather than to sustain the receiver or the cell phone for long time; absolutely avoid holding the phone between neck and shoulder, or you will certainly end up with a contracture!

When you are driving avoid the “lorry driver position”, with your elbow on the door at the height of the car window. Place both your hands on the steering wheel, in the 10 past 10 position.


Life is harder for those who are left-handed: as they live in a world planned for right-handed people, they learn “right-handed” behaviours and put them into practice with the left hand; thus they are more subject to wrong postures and incorrect functional attitudes.


Kinesiotherapy and patient’s active part

The recovery from a state of pain can’t be done by the physiotherapist alone. Undergoing sessions of kinesitherapy helps you to be aware of your body and the area concerned by the problem; it means learning to listen to the pain and being able to describe it, exercise at home following the directions of the physiotherapist to move the shoulder or, in general, the painful part, and focus on the correct posture in order to allow the body to modify its postural behaviours. Don’t forget the body has a memory, and it must be re-educated with patience and perseverance.

Voncini thanks, for the in depth information:

Giacomo Voncini
Masseur and physiotherapist

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