Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (19 page)

Starting out:
(This describes the anterior neck exercise, but the same exercise can be adapted for the back or the sides of the neck.) Stand or sit on a stability ball with your feet shoulders’ width apart. Keeping an upright posture and looking forward, place a hand on the forehead or the back of the head, or just above the ear on the side of the head.

How to do it:
Without leaning, press your head gently into your hand, then release. Do ten repetitions, held for no more than two seconds each.

Troubleshooting:
Do not push with any significant force. Do not lean your body into your hand— maintain good posture. Do not bend the neck in any direction while pressing your head into your hand.

THE SHOULDER

INTRODUCING THE SHOULDER

Every joint represents a trade-off between stability and mobility. With the shoulder joint, evolution decided to go for broke and bet everything on mobility. The shoulder can easily move in every direction; its versatility is the reason you can slam a tennis serve or put your clothes on in the morning. The complex movement of the

IMMEDIATE TREATMENT/WHEN TO SEE A DOCTOR

If you suspect you have a broken bone, see a doctor. Likewise, if the shoulder is dislocated (the humeral head comes out of the socket), even if the shoulder pops back in, with or without assistance. There could be damage to the cartilage, blood vessels, or nerves. If you take a fall and can’t move your arm, nerve damage or a tendon rupture are possibilities; either needs to be medically addressed. As with any joint problem, look for any signs of infection—redness, heat or fever, or pain not connected to changes in activity. If there are any, see a doctor immediately. When the dire possibilities have been ruled out, you can assume you’ve got some kind of soft-tissue damage, usually a muscle or joint strain or sprain. The normal rules of RICE apply: Rest (keep weight off the area); Ice it; keep inflammation down with Compression (for instance, a compression bandage); and Elevation (bring the affected area above the level of your heart). It’s your call whether to seek out a doctor or muscle therapist right away, but if pain persists after one or two weeks, it’s time.

shoulder is achieved through an elaborate architecture that involves the eighteen muscles and three major bones: the upper-arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). Raising your arm overhead is achieved by a movement of all three bones coordinated by the muscles.

The price for all this freedom of movement is instability. The shoulder joint has a greater propensity to dislocate than all of the body’s other joints. Unlike the hip, where the joint seems so solid, the shoulder is such a delicate balancing act you can’t help but see how the three elements of the system—bone, joint, muscle—fit together to make the joint work. Take the innermost shoulder joint, technically the glenohumeral joint. The rounded knob of the humerus fits into the shoulder socket at the end of the shoulder blade like a golf ball on a tee. Not exactly a tight fit. It glides and rotates without falling out thanks to a supporting weave of connective tissue and muscle. The foundation of this weave is the rotator cuff. It is the broad, cufflike, common tendinous attachment of four muscles surrounding the shoulder joint. These tendons and their muscles help to coordinate the multiple planes of movement of the shoulder and keep the joint in its place.

COMMON PROBLEMS AND CULPRITS

The eighteen muscles that cross the shoulder offer up lots of good examples of “referred pain,” where the source of muscle pain and the location of that pain are in different places. Consider the deltoid muscle, which covers the shoulder on three sides or the sheetlike latissimus dorsi, which wraps from the front of the shoulder down around to the back. Pain is often felt in these large muscles lying just below the skin—therapists will work them, M.D.’s will inject them—but the actual damage can be in the deeper stabilizing muscles, which overwork to keep the shoulder girdle in proper position. The most common of these are the four muscles that form the rotator cuff, whose job it is to keep the shoulder ball properly moving in the socket: the subscapularis, supraspinatus, infraspinatus, and teres minor.

Another muscle often involved in shoulder dysfunction may surprise you because it’s so well-known. Even though the biceps sits over the arm, the muscle’s two upper heads attach to the shoulder, not the upper-arm bone (the humerus). The biceps is responsible for a lot of heavy lifting and can tighten up, pulling the shoulder blade forward and causing shoulder pain. The more serious cases we label bicipital tendinitis. The tendon attaching the longer of the two biceps heads to the shoulder blade can become so irritated and weakened that it ruptures. Sometimes surgery is the best option.

The upper trapezius muscle is the “shoulder shrugging” muscle of the upper back. This muscle tends to be misused and contracted in a lot of people, contributing to poor posture, and often causing strain and referring pain up to the muscles of the neck (one reason why neck and shoulder pain so often go together).

To stabilize the shoulder girdle, many muscles that attach to the scapula anchor themselves all the way from the skull down to the neck and into the upper back. Shoulder nerves can get impinged by any of these tight muscles and get pulled and irritated. This is another reason shoulder pain is often accompanied by head, neck, and upperback pain.

PROTECT YOUR SHOULDERS

When you’re under stress, notice if you’re hunching your shoulders. During the day, make a conscious effort to let them drop.

Use both straps of a backpack to carry your personal gear and work materials, to equalize the pressure on the shoulders. If that’s not possible, make a conscious effort to switch shoulders when you carry a shoulder bag.

Don’t rub a sore shoulder. It may give temporary relief, but you’re only contributing to the inflammation and more pain later. Have a pro who can differentiate between therapy and irritation do it.

The rotator cuff is prone to tearing during extreme activity. In middle age, the most common rotator-cuff injuries come from the wear and tear of repetitive motion. Major tears need to be surgically repaired, whereas some tears can be rehabilitated with a combination of stretching tight muscles and strengthening weak ones.

WHAT GOES WRONG, AND HOW TO FIX IT

Mostly Muscular

Shoulder Strain, or “Rotator-Cuff Strain”

Mary, retired and widowed at seventy-eight, was still in wonderful physical condition and enjoyed her active life. One day, she was standing on top of her kitchen counter changing some curtains when she slipped and fell, banging her arm and shoulder on a tabletop on the way down. The pain in her shoulder took her to her doctor, who was relieved to see on the MRI that she had not torn her rotator cuff. The MRI did show evidence of bursitis (inflammation of the bursa sac), common in the shoulders of older people, and he told her she was just going to have to live with the discomfort. That didn’t sit well with Mary, who could no longer put her sweater on without help. When Dr. DeStefano treated her, he found that both her rotator-cuff muscles and her deltoids had been hurt in the fall. The damaged muscles had contracted and created microscopic scar tissue which had bound the muscles to each other. When Mary tried
to lift her arm, she was painfully tugging at the muscle tissue. Dr. DeStefano manually broke up the scar tissue, relaxed the muscles, and got them to separate from each other. Mary returned to her normal pain-free life.

When you lose your balance, the natural impulse is to try to break a fall with your outstretched arms. You can thus easily give the shoulder muscles a sudden, traumatic jolt. In Mary’s case, because she hadn’t torn the rotator-cuff tendons, the muscle damage didn’t show up on the MRI. Her doctor blamed her pain on the damage that was visible—the inflammation of the shoulder bursa, or bursitis. But actually her scarred shoulder muscles were painfully disrupting the movement of the entire joint. The mild bursitis hadn’t caused her problems before the fall and has yet to cause her problems after. At times the bursa may be the cause of pain, but it is often falsely accused because it is the only visible structural problem.