When Strength Isn’t Enough
A common demographic that I see in my practice is gym goers with sudden severe back or shoulder pain. Despite having put lots of effort into their body and being very strong, they are suddenly in lots of pain — often from a small, seemingly innocent movement that they would expect to have no trouble with.
The key is usually that something in their workout programme has been missed, and that the movement they did, while seemingly small, is not one their body was prepared for. I’ve written up a particularly interesting example below to illustrate this:
A Surprising Case of Shoulder Pain
A particularly friendly patient enters my practice one day — large smile and open manner — with a recent onset of shoulder, neck and back pain. I run through the usual questions, and he has a very physical job that occasionally demands more of him on a particular shift, and this issue comes on.
After trying to narrow it down further, nothing specific jumps out, but the issue is clearly muscular.
Observation is Key in Osteopathy
We head on to physical examination and when the patient takes off his shirt, I find myself blink in surprise. He has one of the most well-developed musculatures that I have seen outside of a professional bodybuilder — to the point of being shaped like an upside-down triangle. This immediately tips me off that I am going to have to observe very carefully, because there is no way that he should be struggling with the job that he described, hard though it is.
A key part of my job is observation — looking for the odd piece out, the part that isn’t moving, the asymmetry. While going through different movements of the shoulder, I realise that there is one place in which the two sides are significantly different.
Finding What’s Missing
At the top of the left shoulder, the end of the clavicle (collarbone) seems to be sticking out. Or is it?
I have been caught out by this before and take a closer look. The bone on the other side is at the same level and the joint is moving well — it’s not the joint. So instead, I take a closer look at the muscular development of the two shoulders. Despite my patient’s best efforts, the necessary muscle bulk to hide the bone had not been built up, unlike the other shoulder.
We take a more specific look at the different muscles in the shoulder, isolating them as much as possible, and find that when we isolate the rotator cuff, the muscles are very weak — to my patient’s great surprise.
The Rotator Cuff: Small Muscles, Big Impact
The pain pattern fits nicely with this finding. The muscles that are painful are muscles that would have had to overwork if the rotator cuff was not doing its job.
I set him an exercise to activate the rotator cuff, from which he sees an immediate improvement in symptoms, and then worked on the affected areas to help calm the symptoms further.
He leaves with a clear understanding of what the problem is and how to work on it — with symptoms much reduced.