CATHLIN FITZGERALD, PT, DPT.
As we approach the one-year mark of living in the era of COVID-19, it’s natural to reflect on what’s changed. Our day-to-day lives, most certainly, are all different to varying degrees. The pace of life has slowed down and everyone is spending more time at home.
Over the past two months, I’ve seen an uptick in shoulder and scapular pain. I suspect this has a lot to do with the changes in lifestyle, specifically in two areas:
The capacity of our muscles, tendons, joints, and other tissues has dropped as a result of increased sedentary time. So when you go to do a workout class or hop on your new spin bike, you expect things to go fine, just as they did in the past. However, the load (stress, strain) put on your body is exceeding its capacity. It’s frustrating because it’s the same load that you’ve asked your body to handle regularly in the past. The difference is that your muscles and tendons are deconditioned; their total capacity has dropped.
Posture is the second area that’s been affected by our long-term lifestyle changes. For example, if you spend an increasing amount of time hunched over a desk (maybe even one that’s already set up at a bad angle for you), the muscles around your mid-back and shoulder blades are getting stretched out. When these muscles rest in a position beyond their normal resting length they become inefficient. On the flip side, the front of the shoulder complex becomes shortened, decreasing the amount of space in the area and potentially pinching on different structures.
Thoracic Outlet Syndrome (TOS), is one possible outcome of decreased space at the front of the shoulder. It is the compression of nerves or blood vessels near the base of the neck. Symptoms include muscle weakness, numbness and tingling in the arm, discoloration, swelling, pain in the arm or hand, and muscle atrophy. There are different types of TOS and different levels of severity.
The exact cause can be unclear, but the following can be contributing factors: trauma, postural dysfunction, a long time in compromising shoulder positions, pregnancy, edema, anatomical deviations, hypertrophic muscles (especially the scalenes, which are neck muscles), boney growth, and muscle weakness. Some of these things are genetic (anatomical deviations), some are external factors (pregnancy, trauma), and some are more functional (postural dysfunction, muscle weakness).
The common position associated with TOS is a flexed head, protracted scapula (rounded shoulder blades), and depressed and anteriorly shifted shoulders…. sound familiar?! Next time you’re at your WFH desk, pay attention to your go-to positions.
Targeted exercise has been proven to be useful in the treatment of TOS for 50-60% of cases. The cases on the severe, genetic end of the spectrum require surgery, especially if blood vessels are being occluded. Here I am talking about the more neurological type of TOS (tingling, numbness, pain, muscle weakness). The exercise program should be progressive, stretching the appropriate muscles and strengthening the ones that provide more stabilization to the region.
We’ve set the stage for this new increase in shoulder injuries by looking at the change in our lifestyles. This is the first in a series of blogs about different shoulder conditions that have become more frequent. I’ll be talking about what these conditions are and what we are doing to treat them!