• Magda Karas

The Global View

Shoulder problems are one of the most common that people come to the clinic to get solved. Very often the problem is noticed once there is pain present or loss of function, let’s say a person cannot brush their hair, put a jacket on or reach to a top cupboard. Usually, when this is the case, it is very likely that there has been a problem for a while which finally led to that very noticeable loss of function.

However if you come to our clinic with shoulder pain we are not interested just in your shoulder but overall in what is going on in your body and what is the cause for the loss of function. We will check your range of motion throughout and look for the cause of the problem.

Sometimes we will treat the area of symptoms as this is where the cause may be but often we will end up treating your hip, neck, hamstrings or jaw to help with your shoulder problem. We may end up improving range of motion in your ankle so that your shoulder can move better.

That goes for any issue that you come to us with. There is also a huge chance that the reason why you are experiencing pain can be in an area distant to your body.

This is why we are looking at the body globally and when you come for myofascial visit we want to know how the fascia lines in your body are lengthening and if there are any restrictions. We want to know how your body moves and where tightness is that can create pull and restrictions let’s say of the shoulder. We look at myofascial lines and slings.

The traditional way of looking at muscle functions is to see them in isolation as a tissue attaching to two bony ends that brings them closer together on contraction or resists stretch when the two ends are pulled apart. This way of thinking comes from the early anatomists mainly using a knife in dissections and looking at what happens to muscles in isolation. This is very important and fundamental to understanding the basic muscle actions but our body must be seen more globally. When we move, we don’t isolate one muscle, we move as a whole most of the time. We now also know that there is connective tissue and extracellular matrix that is uniting everything in our body. This connective tissue is characterised by elasticity and plasticity and changes in response to the various demands placed on them by an activity or injury.

Let’s take walking as an example of a global movement and see how it can link to shoulder problem. Walking is one of the basic movements that we take for granted. We just do it. Yet it is a very complicated, coordinated series of movements. In each phase of the gait, there is involvement not only of our lower body but also upper body including the shoulder and neck. As soon as we dorsiflex the foot ready to strike the ground with the heel, tension builds in the posterior myofascial sling which continues from the calf muscles, through hamstrings and to the opposite shoulder. The direct connection between the gluteus maximus and the opposite latissimus dorsi (a muscle that extends, internally rotated and adducts the shoulder) via the thoracolumbar fascia, ,means that any dysfunction of the gluteus maximus muscle or in general in the pelvis region can link to shoulder problem.

Another example can be tightness around your hip or in oblique sling- restriction in the rotation of your body, as when you twisting, can very much link to reduced range of motion in your shoulder. This is when the spiral fascia line would be involved. Because fascia lines are continuous lines and can be seen a bit like elastic bands - made of muscles, tendons and ligament- restrictions along the line can create an issue somewhere else and for shoulder problems, can be ever traced down to the foot.

If you would like to learn more about fascia lines there are many resources now available that give more idea of how the soft tissues in our body are connected. With understanding these connections there is no other way as to look at the body globally to get to the root of the problem.

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