Working at a desk all day, and then going to the gym to train your back and shoulders could be a recipe for disaster when it comes to shoulder pain!!
Training the incorrect muscles around the shoulder can lead to an increase in the problems that are being caused by sitting at your desk all day long. Our latest blog talks you through how to set up your workstation for the most efficient and ergonomic position possible, while also talking through shoulder anatomy and the causes of your shoulder pain!
The Office Shoulder
This blog is talking about some of the negative changes that are being made to your shoulder complex, while you’re sitting at a desk all day. Sometimes if you have been sitting at your desk for a little while, you will start to get an ache through your shoulder, it could be pain at the front of the shoulder or even pain between your shoulder blades – but the pain changes a little when you get up and go to get some coffee or go to the bathroom, why is that? What does that mean?
Let us explain.
Shoulder Anatomy
The shoulder complex is, well exactly that, complex.
It is a highly mobile, ball and socket joint. The joint itself is made up of the humerus (upper arm), the scapula (shoulder blade), and the clavicle (collarbone). The lateral edge of the shoulder blade has a small curved surface that forms the socket-side of the ball and socket joint. It also has a large, thick ligament known as the Capsular ligament, that runs around the edge of the socket. This ligament is designed to make the socket on the scapula deeper, to help solidify the connection between the humerus and the scapula. The clavicle gives the scapula a solid foundation to rotate around when the arm and shoulder are moving – especially when moving into shoulder flexion, stopping the scapula from over-rotating, or sliding into the incorrect position.
Along with the bones and joints, there is the surrounding musculature. Yes, there is a “rotator cuff”, but NO, it is not one single muscle! It is a group of muscles that all have to work together, with the surrounding muscles to achieve movement and stability of the shoulder.
There are four main muscles that make up the rotator cuff, supraspinatus, infraspinatus, teres minor and subscapularis. The combination of these muscles is what helps stabilise the shoulder, but they are not the only muscles that act on the shoulder complex. There are other muscles that both help to stabilise the shoulder, but also help to move the arm. The long-head of your biceps, teres major, latissimus dorsi, pectoralis muscles (minor and major), rhomboids, levator scapulae, serratus anterior, and trapezius.
All these muscles through several different combinations help to move the shoulder throughout its entire range of motion, while also keeping it stable to avoid shoulder subluxation or dislocation. Along with all these muscles, there are also different structures that provide support and protection. There are connective tissues like the ligaments and tendons of the muscles, there are also specific structures designed to protect the muscles from the sharp edges of the bones. These are the bursa.
Bursa
Your child’s backpack causing them back pain?
The bag your child’s school bag has many functions and uses throughout the day, but did you ever stop to think about the impact the bag may be having on your child’s back?
There are many things to take into consideration when buying a bag for your little one, and then once you have purchased the right bag – how they should be wearing it, and how everything should be packed away in the bag.
Shoulder Anatomy
A bursa is a fluid-filled, saclike object sitting in cavities around the body. The function of these structures are to protect the muscles and tendons from damage caused by them rubbing on the bones. They are also important for facilitating movement, as they can change the direction of force for a muscle – leading to different movements.
In the shoulder there are 6 different bursa, the most anywhere in the human body. The 6 bursa around the shoulder are; subscapular/scapulothoracic bursa, subdeltoid bursa, subacromial bursa, subcoracoid bursa, infraspinatus bursa, & subcutaneous acromial bursa.
The most commonly injured bursa in the shoulder is the subacromial bursa. The function of this bursa is to reduce the friction in the space under the acromion.
Normal Shoulder Mechanics Anatomy
While the overall concept of the shoulder complex is very complex, we can break the movement of the shoulder down into a very simple concept. As the arm moves away from the body, the scapula should rotate to clear space under the acromion to allow the arm to move further.
This means that when the scapula is not moving correctly to clear enough space for the humerus, there is going to be an issue of some kind – generally referred to as bursitis in the shoulder.
Impact of the Desk environment on shoulder mechanics
Optimal Desk setup
Having the proper ergonomic setup for your desk is the best way to combat against all sorts of things, including injury and fatigue. While the specifics of an ergonomic setup can be quite complicated and take into account certain joint angles that should be maintained, or an exact distance from a screen you should sit – it doesn’t have to be that complicated.
We want to make it as simple as possible, to give you the best starting point for your setup, and then if it needs further adjustment – it can be done.
This is the general outline of what an optimal desk setup should look like;
- The monitor is at arm’s length, and the top of the monitor is at eye level
- Wrists should be straight and not angled
- Hands should be sitting at elbow height
- Elbows should be at right angles
- The chair should be high enough to have hips just above knees, while feet are still flat on the floor
- Having keyboard and mouse within easy reach
How a poor desk setup is going to impact the normal mechanics of your shoulder
When we’re talking about having a poor ergonomic setup and referencing shoulder pain, we’re only going to be talking about how the upper body has been set up – to avoid confusion.
Have a look at your set up
Starting from the top and working our way down;
- Monitor being too far away = sliding forward through your chin, which leads to hunched shoulders to support the weight displacement of your head.
- Monitor being too close = pulling away from the screen or sitting too far from the desk. This leads to increased pressure through the forearms and overactivation of the lats.
- Wrists not being level (due to different elbow heights) = the position of the elbow will dictate the changes at the shoulder, however, you’re looking at overactivation through the shoulder in either direction.
- Having the keyboard/mouse too far away = having these periphery devices too far away from yourself will lead to increased rounding of the shoulders, and tension at the front of the shoulder and weakness at the back of the shoulders – this weakness over time can lead to shoulder blade pain.
- Having the keyboard/mouse too close = doesn’t leave you with enough space to have somewhere to rest your elbows. Having nowhere to rest your elbows will lead to increased muscle activity through the shoulder muscles and fatigue them, leading to a forward shoulder position similar to when the keyboard is too far away.
Why does your shoulder ache?
Keeping all this above information in-mind, including the anatomy of the shoulder and the changes that can occur due to poor mechanics.
What is causing that ache at the front of the shoulder?
The change in the general mechanics of the shoulder, and having the increased load through the shoulder can cause irritation through the multiple structures through the shoulder including the bursa. Depending on where that increased load is coming from, will determine which of those 6 bursa get irritated.
The most commonly loaded bursa is the subacromial bursa at the front of the shoulder. The increased load through the front of the shoulder leads to increased load through the muscles at the front of the shoulder and therefore more load through the bursa. This excess load through the bursa is what you’re perceiving as an ache through the front of the shoulder.
What to do when the pain doesn’t go away?
If you have gone through and followed all the above steps to try and fix your ergonomics in your workstation setup, but you’re still having pain, it is time to head and see someone about it!
The first decision of how to manage your shoulder pain is deciding who you should see, your GP or a Physiotherapist. So, what’s the difference?
When you head in to see your GP, they will have an understanding that you have shoulder pain and they will want to take away that pain as quickly as possible. Worse-case scenario here is that they simply prescribe you pain relief, and send you on your way. The next to worst-case scenario is they prescribe you pain relief and an anti-inflammatory, and send you on your way.
In both of these situations, you will end up with the same result. A decrease in your pain for a short amount of time, however, when you stop taking the medications the pain will come back. Purely and simply because you haven’t done anything about the primary driver behind your pain.
If you head straight to your Physiotherapist (no you don’t need a referral from your GP), you will be given so much advice and what is going on around your shoulder and the ways in which you are able to move and work without pain, that you will need an email summary of the things you speak about – don’t worry at Leaders Sports & Spine Physiotherapy we make sure our clients fully understand their condition and what is being done to help them.
Your Physiotherapist will complete a thorough assessment to determine the true underlying cause of your pain, and develop the best rehabilitation strategies to counter that causing factor.
Along with the full assessment and determining of your specific causing factors, your Physiotherapist will also be able to answer some of your burning questions, such as;
- Have you done any damage to the shoulder?
- Why training back and shoulders at the gym might not be helping as much as you think it is?
- Whether or not you should have some form of imaging?
At the completion of your assessment and determining your underlying cause, along with answering any questions you may have, our expert team will begin developing your shoulder rehab exercises. Your shoulder rehabilitation may include things like a shoulder stretch, shoulder stability exercises, or specific shoulder impingement exercise too. Rest assured your shoulder rehabilitation program will be specifically tailored to you.
The team at Leaders Sports & Spine Physiotherapy are experts in diagnosing and treating shoulder pain and injuries, along with being experts in workplace ergonomics. If you have any questions about your shoulder pain, or would like some advice on how you should be setting up your own workstation – book an appointment to see one of our Physiotherapists.
BRAIN DUMP
What does all this mean?
Have you done some damage to your shoulder?
But I have been going to the gym after work everyday this week, and I make sure that I train my shoulders and my back, what the hell is going on?
Do I need to have a scan to see what is going on?
Do I need to go to the Doctor for some advice?
We’re here to answer all of these questions, and help you understand what is going on in your shoulder!
