Keeping Your Shoulders Healthy

Witaya Mathiyakom1, PT, PhD Jill McNitt-Gray2, PhD Gerontology Center 2Biomechanics Research Laboratory Department of Kinesiology USC
1Andrus

Musculoskeletal pain in dental hygienists

100

*
80 60

Dental Hygienists Reference *

Prevalence of Musculoskeletal 40 Symptoms (%)

20 0

Neck/ Shoulders

Neck

Shoulders Elbows/ Wrists/ Hands

Elbows

Wrists/ Hands

Akesson et al., Int Arch Occup Environ Health, 1999

Common diagnoses observed among dental hygienists with shoulder pain

Upper Trapezius Myalgia Levator Scapulae Myalgia Thoracic Outlet Syndrome Supraspinatus Tendinitis Frozen Shoulder

Akesson et al., Int Arch Occup Environ Health, 1999

Common contributing factors associated with the common diagnoses

Tasks Force Repetition Static posture Result Adaptation and Imbalance of the muscles involved

Prolonged elevation of the scapula

Static contraction: Upper trapezius Levator scapulae
Reducing circulation to these muscles Repeated microtrauma
Upper Trapezius and Levator Scapulae Myalgia

Prolonged stretch: Lower trapezius Middle trapezius

Poor scapular stabilization

Prolonged Anterior tilt of the scapula

Tightness: Pectoralis Minor Brachial plexus Axillary artery
underneath the pectoralis minor
Thoracic Outlet Syndrome

Prolonged stretch: Lower trapezius Middle trapezius

Poor scapular stabilization

Static shoulder flexion and internal rotation

Strong contraction
Pectoralis major Latissimus dorsi Teres major

Counterbalanced by
Subscapularis Imbalance between these muscles will result in anterior translation of humeral head - tendinitis

Static abduction of the shoulder

Strong contraction
Deltoid Adequate activation of the rotator cuffs to position the humeral head

Imbalance between these muscles will result in upward translation of humeral head impingement, tendinitis

What do you need to keep your shoulders healthy?

Keeping good posture throughout the day Changing position often Preserving adequate muscle length and joint mobility
Tight and stiff muscles limit range of motion and create compensatory movements Lengthened muscles are likely to be weak

Strengthening muscle at the range required

Weakness of the lengthened muscles observed in end range

Coordinating the involved muscles

Proper muscle length and strength provide a window for good coordination

What can you do?

If you have symptoms, pain, discomfort,
Seek professional help from MD and PT

You can benefit from a preventive exercise program

Gentle range of motion and stretching Simple strengthening exercise

Simple self-assessment will help you identify the exercises that fit you!!!

What to look for?

Posture as a clue of alignment and muscle length
Depressed Downward Rotated Scapula
Long and Weak Upper Trapezius?

Forward Head
Long and Weak Upper Trapezius & Levator Scapulae?

Shoulder Internal Rotation

Tight Shoulder internal rotators?

Anterior tilt of scapula

Tight pectoralis minor? Weak Lower Trapezius?

Posture

Anterior tilt of the scapula

Forward Translation of the humeral head

Pectoralis Minor Tightness

Between-sides differences in tightness of the pectoralis minor

Anterior tilt of scapula

Tight Pectoralis Minor affects trunk control

Tight shoulder internal rotators limit external rotation

Resting Posture Starting Position Finishing Position

Limited External Rotation

Starting Position Finishing Position

Weakness of the external rotators

Starting Position Finishing Position

Latissimus Dorsi Tightness

Limited Shoulder Internal Rotation

Weakness of Internal Rotators Subscapularis

Starting Position Finishing Position

What can you do?

These exercises are suggested to improve your shoulder mechanics.

You need to perform them correctly

Check your posture throughout the day Good quality practice at all time

To strengthen the muscles, use high enough weight but without compensation
10 reps, 3 sets

Always check your form!!!

To stretch, hold the position at least 30 seconds

Levator Scapulae Stretch

Starting Position Finishing Position

Lateral Flexion to opposite side Flexion Rotation to the opposite side

Upper Trapezius Stretch

Starting Position Finishing Position

Lateral Flexion to opposite side Flexion Rotation to the same side

Pectoralis Minor Stretch

Starting Position Finishing Position

Applied downward force on the coracoid process Added a roll of towel under the spine

Pectoralis Minor Stretch

Starting Position Finishing Position

Applied downward force on the coracoid process Added rotation to the opposite side

Latissimus Dorsi Stretch

Starting Position Finishing Position

Maintained shoulder external rotation Stabilized the inferior angle of the scapula with the other hand if it protudes out to the side

Shoulder Internal Rotation Stretch

Limited shoulder internal rotation is indicated by an inability to internally rotated the humeral head to 70 Compensatory movement of the scapula is observed when the person is trying to internally rotate the shoulder beyond the available range To do this stretch, start with arm at 90 with your elbow flexed Internally rotate your shoulder as far as you can without moving your shoulder blade, use the other arm to stabilize the shoulder

External Rotators Strengthening

Starting position: Prone, Arm at 90, elbow flexed Movement: External rotate your shoulder as shown without movements of the shoulder blade Also, DO NOT move your elbow off the table Range of motion: Normal range of motion is ~ 90 from the starting position if you have limited shoulder internal rotation range, you may need to work your way toward that

External Rotators Strengthening

Starting Position Finishing Position

External Rotators Strengthening

Starting position: Side lying, with a towel under your arm, elbow flexed 90 Movement: External rotate your shoulder as shown without movements of the shoulder blade Range of motion: Normal range of motion is ~ 90 from the starting position if you have limited shoulder internal rotation range, you may need to work your way toward that

Internal Rotators Strengthening

Starting position: Prone with arm at 90, elbow flexed Movement: Internally rotate your shoulder as shown without movements of the shoulder blade Also, DO NOT move your elbow off the table or toward your body Range of motion: Normal range of motion is ~ 70 from the starting position if you have limited shoulder internal rotation range, you may need to work your way toward that

Lower Trapezius Strengthening

Starting position: Prone on your stomach with arms at 135, elbows extended thumbs up Movement: initiate with movement by squeezing the shoulder blades together then lifting the arms off the table Tips: Add 1-2 lbs weight, progress slowly

Lower Trapezius Strengthening

Starting Position Finishing Position

Lower Trapezius Strengthening

Starting Position Finishing Position

Middle Trapezius Strengthening

Starting position: Prone on your stomach with arms at 90, elbows extended thumbs up Movement: initiate with movement by squeezing the shoulder blades together then lifting the arms off the table Tips: Add 1-2 lbs weight, progress slowly

Middle Trapezius Strengthening

Starting Position Finishing Position

Middle Trapezius Strengthening

Starting Position Finishing Position

References
Akesson, I., B. Johnsson, et al. (1999). "Musculoskeletal disorders among female dental personnel--clinical examination and a 5-year follow-up study of symptoms." Int Arch Occup Environ Health 72(6): 395-403. Decker, M. J., J. M. Tokish, et al. (2003). "Subscapularis muscle activity during selected rehabilitation exercises." Am J Sports Med 31(1): 126-34. Hintermeister, R. A., G. W. Lange, et al. (1998). "Electromyographic activity and applied load during shoulder rehabilitation exercises using elastic resistance." Am J Sports Med 26(2): 210-20. Hoppenfeld, S. (1976). Physical Examination of the Spine and Extremities. Norwalk, Appleton-Century-Crofs. Reinold, M. M., K. E. Wilk, et al. (2004). "Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises." J Orthop Sports Phys Ther 34(7): 385-94. Sahrmann, S. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, Mosby. Yee, T., L. Crawford, et al. (2005). "Work environment of dental hygienists." J Occup Environ Med 47(6): 633-9.