January 28, 2014
In our first installment of the series we discussed neck pain/strain and how it relates to the Spiral Line of rotation and dysfunctional obliques. If you missed it, see the first of the series here ….INJURY #1
The Spiral Line movement chain is a critical player in dance related injuries and you will see it come into play with most every shoulder problem. You are about to discover how those pesky pain in the ass oblique muscles can wreak havoc in almost every shoulder injury, particularly impingement syndrome.
Tendinitis means overuse. Something is working too much because another part of the body in a movement pattern is not working enough. Tendinitis is an ‘energy leak’ and an underlying sign of inability to control force. In rotator cuff tendinitis, it means the smaller muscles that stabilize the shoulder are probably working for the larger primary mover muscles…so they start to hurt!
In my experience, if you have impingement syndrome, you have a scapula (shoulder blade problem). You cannot have one without the other. The inability to stabilize the shoulder blade leads to dysfunctional movement patterns in the shoulder joint. The lack of stability kicks off the process of decreased mobility with a joint jam, hence impingement.
Now let’s take a look at the Spiral Line and see how it may relate to shoulder impingement syndrome. The upper part of the line travels from the splenius capitis and cervicis muscles crossing over to the opposite side rhomboids major and minor, serratus anterior, external oblique and contralateral internal oblique. This fascial connection and movement patterning assists in upper body rotation and functionally works with the latissimus dorsi and subscapularis. When you move, your brain thinks of them as one cohesive movement pattern.
One common dysfunction I see in dancers is an inhibited external/internal oblique and latissimus dorsi pattern leading to overuse of the serratus anterior and subsapularis. Inefficient obliques causes poor torso rotation and now the body must find other muscles in a pattern to accomplish the movement. The overuse of the serratus is an attempt to over protract the shoulder to assist in torso rotation. When one cannot rotate to optimal, the arm will come across the body more to complete the pattern. The facilitated (up-regulated) serratus anterior now has a dysfunctional relationship with other shoulder blade stabilizers. Since the serratus anterior protracts and upwardly rotates the shoulder blade you can get impingement syndrome in the AC joint. Reaching the arm across the body more also engages the pec minor muscle which is also a shoulder blade protractor. In essence you are causing chaos in the balance of the shoulder with over dominant protractors and under active retractors. The shoulder joint DOES NOT like it when there is chaos in the scapula. And it tells you so by HURTING YOU!
To help the shoulder in a dancer one must always assess the obliques. This pattern is very easy to assess when you observe gait, rotation, rolling, Pallof Press and prone rocking movements. So yes, treat the shoulder pain, but also treat the PATTERN! The very first muscle pattern I assess in every dancer is the spiral line. So when you work with a dancer who has shoulder pain, don’t simply treat the shoulder. Look somewhere else too.