Identifying and Correcting Perpetuating Factors
Shoulder pain doesn’t just happen. There are numerous perpetuating factors that can set up a condition of muscular imbalance and overload. Some of these, such as dysfunctional breathing, may seem unrelated but are actually extremely important (and common). Identifying and correcting perpetuating factors is what makes the difference between fixing the same problem each week and setting your client on a new, pain-free direction.
Possible perpetuators are very numerous. Some of the most common include:
Muscles are made to collaborate in an environment of relative balance and stability in the body. Postural distortion may occur due to anatomical variations such as a leg length discrepancy. Actual leg length differences are estimated to occur in approximately 18% of the general population, so this situation is not uncommon. LLD may cause issues with the QL, spinal erectors, glutes and shoulders, and any persistent patter of unilateral pain could be due to this situation.
Individuals with hypermobile ankles may exhibit an extreme tendency to pronate. This causes the ankle to collapse medially and tends to cause anterior (head forward) posture in the upper body. This situation can be corrected with extra support in the midfoot and forefoot.
Chest breathers overuse small muscles such as the pectoralis minor and scalenes to assist in expanding the rib cage. This causes many problems, and can set up shoulder and head neck pain.
There are many other factors that must be considered in a person’s lifestyle. Workstation ergonomics, sleep position, nutrition, stress must be considered. Be observant and read the Apropos of All Muscles chapter in Travell & Simons for extensive coverage of these issues.
Medications can be a powerful and unsuspected perpetuator of pain in the body. Few people are aware of the extensive pain-related side effects from many drugs. Some of the most common, like the statin family of drugs, have extensive muscular side effects and patients are often unsuspecting. Take the time to look up side effects for drugs.