Shoulder pain

    Shoulder pain

    Usually makes itself felt around the inner edge of the shoulder blade and / or its upper part quite high up on the back of the shoulder.
    The reason is i.a. lack of muscular balance which in turn may be due to a lack of how the pelvis and legs provide support to the upper body. When the muscles are loaded and movements are performed, it becomes clearer if there is an imbalance. If a lot of time is spent in these positions, it increases the risk of overload.
    If the shoulders are excessively retracted, this often means that the muscles on the back of the shoulder are more active in contracting and can become overloaded as a result. The most common, however, is that the shoulders are more advanced, resulting in the thoracic spine becoming more constricted and the shoulder blades losing some of their contact with the chest. Then we usually compensate by pushing the chin forward and thus an increased sway in the cervical spine. The muscles in the back then become more stretched and work in that position, which can cause overload.

    Shoulder (joint) pain

    Shoulder pain that is felt on the front of the shoulder or in the joint itself, is usually a sign of some degree of pinching resulting in a dysfunction of the shoulder joint. It usually causes pain when lifting the arm above shoulder height, from side to side and making an inward rotation of the arm.

    The cause of shoulder pain can vary, but it is often the result of shoulder instability. It can also occur when the shoulder lifts itself and is in a static position when playing the violin. The combination of an imbalance in the rotator cuff muscles and outer muscles diminishes shoulder stability, resulting in an inflammation of the shoulder.

    In addition to the positioning of the body, imbalance and pain can occur when the muscular structures on the front of the shoulder are shorter and force the shoulder forwards. Similarly a foreshortened joint capsule at the back of the shoulder joint can push the shoulder forwards. There may be a need to stretch these structures in combination with building up the shoulder-lowering and rotation cuff muscles.

    For more information of the shoulder, see section 2 of Musician ergonomics

    What you can do

    Consider how you sit and stand with your instrument, and how your practice routine works. Review the information in the section about organizing practice in time blocks, etc. Be sure to warm your entire body up before you start to play and take regular breaks, every 20 minutes or more often. In addition you probably need to improve your muscular status in some way.

    Musician muscles 

    Become aware of how your spine is positioned so that you maintain stable sitting and standing positions, even when exercising. If this is ignored, you risk using your muscles incorrectly and maintaining the wrong body position.

    Core-training

    This type of exercise is the foundation for being able to get the most out of any exercises you do for your shoulder blades and shoulder joints. If you have a strong core, you will have more stamina for working with peripheral muscles. Be sure to remember to include pelvic lifts, inner deep stomach muscle and back muscle exercises. Check out whole body exercises video and core and shoulder stability.

    Shoulders

    As a musician, you hold your instrument in front of you, and when you lift your arms, your shoulder blades may often position themselves away from the spine. This causes the back muscles to work hardest in the stretched position, and the front muscles are often drawn together. When the position of the shoulder blades and joints are not in balance, the structures are further stressed. Therefore it is important for you as a musician to exercise and strengthen the muscles around the shoulder joints. The most important thing is to do exercises which work the muscles in the opposite direction from how they are used in your daily activities.

    Often, the muscles between the shoulder blades (rhomboideus minor and major – the muscles that hold the shoulder blades down), including the trapezius lower part and the pectoralis minor, and the muscles that hold the shoulder blades close to the chest cavity (serratus anterior, latissimus dorsi) need to be built up. These are the shoulder-lowering muscles. This physical training should be done together with a physiotherapist in order to eliminate possible imbalances in this muscular region. Check out core and shoulder stability video and shoulder stability video

    Shoulder joint

    To support the muscles around the shoulder joint, time should be spent exercising the rotator cuff muscles. These muscles give a deep inner stability to the shoulder joint and are connected to the main muscle. The rotator cuff is composed of m supraspinatus, m infraspinatus, m teres minor and m subscapularis. For exercise tips, please review the section on exercise with a rubber band

    The muscles of the rotator cuff 

    Causes of pain

    Different types of pain with varying degrees of discomfort, is something we all experience now and then. Pain in itself is not problematic, but is a way for the body to send information about structures that are hurt or injured in some way, and you must take care of the situation. It is a signal to stop the way you are doing things and try to understand exactly what is causing the pain. You need to reflect on how you can changes things to feel better and eliminate or minimize your discomfort. Our reaction to pain depends largely on how the brain interprets the signals it receives.

    It is not uncommon for people who use their bodies in a specific way daily, to experience pain periodically and sometimes during longer stretches when there are especially high performance demands and less chance to rest and recover from intense physical challenge. As the mental demands increase, there is an automatic increase in muscle tension. If pain occurs, this tension becomes even greater as a way of protecting the body from further pain. If this chain of cause and effect is allowed to continue, there is risk that a compensating and dysfunctional muscular situation will become chronic. This involves both the muscles that are directly involved in a specific movement and the amount of energy required. The risk is high that we will start using our muscles in an unnecessarily stressful way without being conscious of it.

    Just a few weeks after an injury has occurred, the muscle’s ability to perform becomes compromised and weaker. Other muscles will take over and dominate the activity. The natural balance between the muscles has changed, causing their usage to become painful. Coordination and speed decline rapidly.

    Karin Engquist och Ing-Marie Olsson
    Artist- & Musikerhälsan
    Östra Rönneholmsvägen 9B
    211 47 Malmö
    Phone: +46 (0)708 670 647

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