Athletic activities require a considerable amount of strength, coordination, and flexibility from the shoulder. As a result, athletes participating in sports such as swimming, rowing, golf, baseball, and tennis commonly develop shoulder injuries. Shoulder injuries not only prevent optimal performance, but they often progress to the point of preventing competition and training. Many of the most common shoulder injuries are slow to respond to traditional treatment and often result in months of recuperation.

Fortunately, a new treatment technique known as Active Release Technique^® (ART^®) is proving to be a very successful method to treat many common shoulder problems and get athletes back in their sport quickly and effectively. But before we tell you why ART^® works so effectively, we want to explain how the shoulder becomes injured.

Triceps Towel Stretch                       Scapula Activation                        Chop Shoulder Exercise Video

                                         

Triceps Towel Stretch works the triceps, back of shoulder, and creates strength in the hands during the pulling motion. Slowly pull the bottom hand up your back using the top hand 5 times, then pull the top hand down your back using the bottom hand. After three pulls for each hand, rotate the top and bottom hands.

Scapula Activation allows a stretch in the shoulder and awareness of where the scapula is in the body. Poke the scapula or general area 5 times and then switch arms. Repeat cycle 2 times.

Chop Shoulder Exercise helps the range of motion in the shoulder while maintaining balance from the core and legs. Repeat this step 10 times for each arm. This exercise can also be done on the knees and without a weighted medicine ball. Click “Chop Shoulder Exercise” for further video instruction.

The shoulder joint consists of the round head of the upper arm connected to the flat surface of the shoulder blade. This round-on-flat relationship is different from most other joints in the body, and as a result is capable of providing a great deal of movement. For example, most joints allow only one direction of movement (i.e. ankle knee, elbow, fingers). In comparison, the architecture of the shoulder allows the arm to reach overhead, behind the body, across the chest, and to perform internal and external rotation.

The shoulder blade also makes an important contribution to the mobility of the shoulder region. This occurs in large part because the shoulder blade is a floating bone that is not tightly connected to the ribcage through joints or ligaments. As a result, when the arm moves, the shoulder blade slides and rotates on the ribcage, which greatly adds to the movement capability of the shoulder.

Although the mobility of the shoulder provides us with the ability to push, pull, throw, lift, and swing, it comes at great cost, because the lack of bony support fails to provide the protection and stability that is found at other joints. As a result, proper shoulder motion requires a complex set of muscles to help control and stabilize the region. The primary muscles that provide control and protection at the shoulder joint are the rotator cuff muscles, while the shoulder blade relies on a group of muscles referred to as the scapula stabilizers.

The rotator-cuff-muscles, a group of four muscles located on the back, top, and front of the shoulder joint, play a critical role in stabilizing the shoulder joint by holding the arm tightly against the shoulder blade. When the arm is moved in any direction, these muscles have to contract to prevent the round surface of the upper arm from sliding excessively on the flat surface of the shoulder blade. The scapular stabilizers connect the shoulder blade to the body and are required to hold the shoulder blade tight against the rib cage, as well as slide and rotate the shoulder blade as the arm moves. When the rotator cuff and scapular stabilizer muscles work properly, the shoulder remains stable and protected.

Performing athletic activities places considerably more demand on the shoulders when compared with accomplishing typical daily activities. Throwing and racquet sports require the arm to reach above and behind the body, golf and baseball require the shoulders to rotate across the body, swimming and rowing involve pulling the arm toward the body. This increased movement demand requires that the rotator cuff and scapular stabilizer muscles generate a tremendous amount of force to move and stabilize the shoulder. Additionally, these sports demand that these motions are repeated over and over again. This combination of repetitive motions and high-contractile demand can cause problems to develop in the shoulder, because the muscles sometimes cannot keep up with the workload.

Over time muscles can become strained and develop small-scale injury known as micro-trauma. Initially, micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles. Although small, the damage needs to be repaired, and the body responds by laying down scar tissue to repair the damaged area. The scar tissue itself is not a problem; in fact, it is a normal and necessary part of healing.

The problem occurs when the shoulder is repeatedly subjected to the same high-force athletic movements. This causes the same muscles to become strained and subsequently repaired over and over again. Over time scar tissue builds up and accumulates to form adhesions. As these adhesions form, they affect the normal health and function of the muscles. In fact, they often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow.

As scar-tissue adhesions accumulate in the shoulder, they place more and more strain on the muscles, because they must now stretch and contract against the adhesions in an attempt to move and stabilize the shoulder. This places even further strain on the shoulder muscles, which in turn leads to more micro-trauma. Essentially, a repetitive injury cycle is set up, causing continued adhesion formation and progressive shoulder dysfunction.

As the cycle progresses, the ability of the muscles to contract properly is affected and the stability of the shoulder becomes compromised. At this point it is not uncommon for the muscles to give way, resulting in more severe and debilitating pain. Often athletes come into our office explaining that they have hurt their shoulder during a routine task that they have done thousands of times before. These athletes almost always describe some mild pain or tightness in their shoulders that has been building over time, so the more acute injury is often just the straw that broke the camels back.

In an attempt to relieve shoulder pain, a variety of treatment methods are used, either alone or in combination with other methods. Some of the more common approaches include anti-inflammatory medications, rest, ice, ultrasound (US), muscle stimulation (E-Stim), steroid injections, stretching, exercise, and when all else fails, surgery. Most of these traditional techniques often require a long period of time before they provide any significant relief, and in many cases they provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.

The main reason that these approaches are often ineffective is that they fail to address the underlying scar-tissue adhesions that develop within the rotator cuff and shoulder blade muscles. These adhesions bind the tissues together, restrict normal movements, compromise the stability of the shoulder joint, and interfere with the normal flexibility and contraction of the muscles in the shoulder area.

Passive approaches such as medication, rest, ice, and steroid injections focus on symptomatic relief and do nothing to address the muscle restrictions and movement compensations. More active approaches such as stretching and exercise are often needed for full correction of the condition and to restore full strength and function of the muscles; however, they do not treat the underlying adhesions. Without first addressing the scar tissue adhesions, stretches and exercise are often less effective and slower to produce pain relief or recovery.

ART® stands for Active Release Techniques^®. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. ART^® treatment is highly successful in dealing with shoulder injuries because it is specifically designed to locate and treat scar-tissue adhesions that accumulate in the muscles and surrounding soft tissue. Locating and treating the soft-tissue adhesions with ART^® allows the practitioner to:

1. break up restrictive adhesions
2. reinstate normal tissue flexibility and movement
3. more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain

You can think of an ART^® treatment as a type of active massage. The practitioner first shortens the muscle, tendon, or ligament, and then applies a very specific pressure with the hands as you actively stretch and lengthen the tissues. As the tissue lengthens, the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar-tissue adhesions are felt, the amount and direction of tension can be modified to treat the problem area. In this sense, each treatment is also an assessment of the health of the area, as we are able to feel specifically where the problem is occurring.

An additional benefit of ART^® is that it allows us to further assess and correct problems not only at the site, but in other areas of the kinetic chain that are associated with movement compensations and are often contributing to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet developed pain.

One of the best things about ART^® is how quickly it provides results. In our experience, the majority of shoulder injuries respond very well to ART^® treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and several factors can determine the length of time required to fully resolve each condition, we usually find that significant improvement can be gained in four to six treatments. These results are the main reason that many elite athletes and professional sports teams have ART^® practitioners on staff, and why ART^® is an integral part of the Ironman triathlon series.

To book an appointment to see if ART^® can help with your athlete’s shoulder, call our office at (248) 477- 2100.