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SHOULDER PAIN
By
Dr Grant Wilkinson D.C, B.Sc, M.Sc*
Most of us have experienced some sort of shoulder or arm pain whilst exercising but have you ever wondered what actually caused it?
All disciplines in surf life saving require complex and forceful 
movements produced at or around the shoulder joint.
Boat rowing, ski and board paddling, swimming and even running require a complex collaboration of many different groups of muscles around the shoulder all contracting at
exactly the right moment in order for you to perform each movement. If one part or group of these muscles doesn't work correctly then the actual movement of the shoulder can be slightly altered and can result in
increased stress place on muscles such as those that form the rotator cuff.
This cooperation between the muscles and joints of the body is known as "Biomechanics" (i.e. the mechanics of
the body) and biomechanical aberrations can result in problems, such as pain and stiffness, which are often felt in an area that is far removed from the actual cause of the problem.
Two cases that can be used to illustrate this is with two of Australia's top ironmen, Wes Berg and Nathan Smith, who placed first and second in the 2003 NSW Open Ironman. I have treated both of these guys at my clinic
for acute pain in the shoulder region however most of the actual treatment was focused on regions other than where the pain was actually being felt (i.e. the shoulder).
In both of these cases, as with numerous other of my patients, pain felt in the shoulder region was a result of increased stress placed on rotator cuff muscles. If the rotator cuff is
involved, the pain is usually in the front or outside of the shoulder. This pain is usually worse when you raise your arm or lift something above your head and can be bad enough to keep
you from doing even the simplest tasks. Pain at night is also common, and it may be bad enough to wake you.
With both these ironmen fitting the classic symptoms of rotator cuff dysfunction, the
question then became "what caused the problem in the rotator cuff in the first place?" given that the pain was isolated to only one side even though swimming, running, ski and board
paddling use both shoulders equally.
The answer in both Wes and Nathan's case was due to altered biomechanics and decreased nerve input into the muscles that control the movement of the shoulder joint. Both these
factors combined resulted in the end result of pain and decreased range of motion at the shoulder and an increased stress placed on several of the smaller muscles that form the rotator cuff.
This is commonly the case with most shoulder problems where the main faults are biomechanical and more importantly neurological (originating from the nerves) in origin, as the
nerves that supply the muscles surrounding shoulder no longer work properly meaning that even if the faulty biomechanics were corrected, the problem would return again over time.
The main cause of decreased nerve function and altered biomechanics 
often comes from the
region between the shoulder blades (mid to upper thoracic) and lower neck (cervical) regions. Often, the early signs can be as simple as a tightness or stiffness in these regions without any real pain. This is not
surprising as all disciplines in surf life saving use upper body strength to some degree.
In the case of Wes and Nathan, precise chiropractic adjustments to specific spinal vertebrae and release
techniques to the muscles in the mid thoracic and lower cervical regions produced a successful outcome and a full return to training and competition, even though there was very little being done to the actual
muscles where the pain was originally being felt.
Early detection and correction of these underlying problems that can ultimately cause shoulder pain is essential. If left uncorrected, a problem such as those
mentioned above can potentially cause the tendons of the rotator cuff or other muscles to tear, requiring surgical repair and extensive rehabilitation post surgery and a long time away from sport, work and leisure activities.
