Kinesiology THURSDAY – Debbie’s Right Shoulder

Debbie isn’t a multi-million dollar professional athlete, but she makes this week’s kinesiology blog because she is a lot of people out there in the real world.

“My whole right side hurts,” she said. “My shoulder hurts when I reach up. I get headaches on the right side of my head. I have lower back pain on the right. I’ve stopped lifting weights with my right arm overhead because it increases my pain.”

Her pain had been going on for years. She is a woman in her 60’s, an avid walker doing 3-4 miles a day who also does Pilates several days a week. Unlike the other athletes I’ve written about recently, I had the opportunity to evaluate Debbie.

This is what I found:

Pelvis rotated slightly to the left. Decreased left standing gluteal squeeze
Right shoulder was lower than her left and more protracted. Trigger points were noted on the left upper trapezius and left quadratus lumborum
Pain in end range of right arm elevation (impingement)
Right medial clavicle was anteriorly subluxed.
Right side lying thoracic rotation was 50% compared to 75% to the left.
(+) right FABER test (hip) with pain elicited in the right SI joint
Right SI joint hypomobility (inflare, posterior rotation, L on R sacral torsion)
Severe hypomobility of right subtalar joint eversion

The last item on the list was most compelling as it was the most severe limitation found during her evaluation.

“Have you ever injured your right ankle?” I asked

“Oh, yes. A few years back, I fractured my ankle bone.” She couldn’t remember which bone, but it doesn’t really matter. Any previous ankle or lower extremity injury often results in a compensatory loss of subtalar joint eversion that isn’t automatically restored once the pain goes away.

Here’s what I did:

Corrected pelvic alignment using MET
Restored side lying thoracic rotation with the thoracic sequence, and MET to correct somatic thoracic dysfunction at T4, T8 and T10
Right hip mobilization
Right subtalar joint eversion mobilization
Corrected right anteriorly subluxation medial clavicle at SC joint. This cleared her impingement with arm elevation. I instructed her on a self-correction as well.

What I am having her do:

Exercises to improve thoracic rotation: STEM’s, side lying angels
Exercises to improve subtalar joint eversion: heel-toe walk with high knee march, revolving triangle making sure to push the first metatarsal head to the floor
Exercises to improve left pelvic rotation: left standing tubing punch with gluteal set
Instructed on self-correction for anteriorly subluxed right medial clavicle

I won’t get to follow-up with her for a month since she is not a local resident. But I instructed her to have an expectation that things should change in a week or two if she is consistent with the movement retraining exercises above.

Why does this matter?

There are a lot of people who report a “bad side” of their body, with pain stemming from foot to head usually insidiously and chronically. Often this signals a long chain of biomechanical dysfunction, stemming from the ankles and affecting the head and neck. In this case, over supination of the right ankle from a previous injury as affected right shoulder elevation. Treating just the shoulder has yielded temporary and incomplete results.

Evaluate the foot on up and fix what you find.

Because nobody has time to be in pain.

Until next time…