Shouldering the Burden

Shoulder pops out during near iron-cross position.

By Dr. Julian Saunders | July 29th, 2016

 

I have had shoulder problems since I was 16. Yesterday, my shoulder popped out when my arms were close to the iron-cross position. I am going to go see a sports physician and was wondering if this was the best course of action.

—Michael via online.

Michael, your shoulder is phukt. Yes, go and see a sports doc. She will probably get an MRI, refer you to a surgeon, and handball you to a PT. My experience with most manual therapists— PTs, osteopaths and chiropractors—is that they have limited understanding for how to approach recurrent shoulder dislocation. I doubt you will avoid surgery, but your best chance is to find a practitioner who specializes in shoulder rehab.

Shoulder stability relies a little on joint architecture (it is a ball-and-socket joint by definition, but imagine a basketball on a tea saucer in terms of ricketiness), but most of the functional stability arises from ligament restraint and muscle control. There is also a cartilaginous rim around the edge of the socket that affords some further stability without compromising functional range of motion too much.

Instability and dislocation occurs when the muscles aren’t strong enough to keep the head of the humerus (basketball) over the glenoid socket (tea saucer). There are genetic factors that predispose you to recurrent dislocation, but for the most part it is born from a single traumatic event that led to your first dislocation.

Having strong, well-balanced shoulders is your best chance of a) avoiding the knife, b) climbing anything that even glances in the general direction of your physical limit, and c) having a successful surgical remedy if you go down that line.

An orthopedist who specializes in shoulder injuries is probably your best chance of finding a therapist who can implement an appropriate exercise program. Controlling recurrent shoulder dislocation is as tricky as Trump’s comb-over. Don’t be shy about trying several options before you commit to one practitioner, since getting a good one will probably save you time, money and mental anguish in the long run.

 

This article was originally published in Rock and Ice issue 236 (August 2016).

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