Upper Extremity

The Upper Extremity in brief:

Efficient movement of the shoulder complex is a symphony of three joints: the Gleno-Humeral (G-H) joint, The Acromio-clavicular (A-C) joint and the Sterno-clavicular (S-C) joint. A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support. One can note from the following diagram then that the contact point between the Sternum and the Clavicle would be the SC joint, the contact point between the Glenoid Fossa (cavity) and the Humeral Head makes the GH joint, and lastly the contact point between the Acromion and the Clavicle makes the AC joint.

As the shoulder complex is highly mobile, it is also highly unstable. Due to this instability, many kinds of injuries are commonplace so we won’t go over any specific pathology. What is important is that generally, injury starts with instability of the shoulder blades, which leads to tightness and inefficiency of the joints where the shoulder blade meets the collarbone (A-C) and the upper arm (G-H).  The G-H joint in particular then develops injury and scarring from moving around too much and slamming into other structures. The shoulder then can’t move well and the shoulder blades, neck and spine start to move the wrong way, too. Recovery is facilitated by opening up the shoulder joint (G-H and A-C), while strengthening and retraining the shoulder blades so they can stabilize and support full, healthy movement in the arm. 

The shoulder and the hip are ball and socket joints. For those joints to function properly there is a combination of movements that my mentor and others call roll and glide. When the shoulder efficiently rolls in one direction, it glides in the other direction. This roll and glide keeps the head of the humerus (arm bone) firmly against the glenoid fossa (shoulder joint), which maximizes movement and power in movement. When the shoulder rolls but does not glide, there may be bone on bone friction, muscle or tendon pinching, or even nerve entrapment, or a combination of these issues in the shoulder joint. When this happens, the body creates scar tissue, which then reduces movement options, which makes it easier to move improperly, which will lead to more scar tissue. 

In this section, we will cover exercises that are useful for rehabilitation from shoulder pathologies. They are also useful for preventative maintenance for the upper extremity. It is important to note that to get the best movement, we need to engage from our trunk first. In our sitting society, where the glutes, and abs shut down, our shoulder stabilizers tend to shut down as well. This leads to us overusing our forearms (think tennis elbow, golfer’s elbow, blackberry thumb, etc.) and under-utilizing our trunk. This is the main reason why one's elbows may hurt when performing a pull movement or one’s wrists may hurt when performing a push movement. This is also why shoulder injuries tend to get worse. Once again (even if we open up the G-H joint), if we fail to engage our shoulder stabilizers, we will merely cause more shoulder pain. All the instruments in the symphony have to play in complete harmony, and they take their cues from each other and the nervous system which is the conductor.  The following exercises will help to restore shoulder harmony, but make sure to maintain a stable shoulder girdle and trunk when performing them. If you are unable to maintain a stable center and shoulder girdle, then you are not ready for the exercise yet. Go back to trunk and shoulder stabilizing exercises, then try again.  Also note that more exercises may be added at any time, so please check back frequently.

Massage and Chiropractic work will speed up and clarify your rehabilitation process, as they both aid in breaking up scar tissue and facilitating movement not just on a muscular level, but a neurological one as well: