What came first, the chicken or the egg? The fundamental premise behind this question can be applied to orthopedic physical therapy as well. What came first, your pinched nerve, your shoulder pain, your elbow pain, or your poor posture? Let me explain.
We live in a society dominated by “slouching” syndrome. We prefer to sit in a soft chair with forward flexed posture instead of a firm chair with erect and supported posture. Draw a line from the middle of your ear to the center of your shoulder to the center of your hip joint and, bio-mechanically speaking, you are lookin’ pretty good
We need to maintain a normal inward curve at our necks and low back as well as a normal outward curve in our mid backs.
So what is the connection? Sit or stand with really slouched shoulders and attempt to raise your arm overhead. Now, sit straight and try it again. You have much more freedom of motion in your shoulder while sitting straight. Now, think about how many times you reach during the day with forward flexed posture. Each and every reach in this forward position will cause a “pinch” or impingement of your rotator cuff tendon in your shoulder. According to Flatow et al in the American Journal of Sports Med, all of us, physiologically, have a certain amount of “normal” impingement in our shoulders. Compound this “normal” impingement with the exaggerated impingement that occurs with poor posture and you have a recipe for the pain of rotator cuff tendonitis. Refer to my post on Impingement Syndrome for more details.
Do you know of anyone who has chronic tennis elbow (pain on outside of elbow) or golfers elbow (pain on inside of elbow)? You may want to mention to them the results that were published in an article in the journal Sports Health. The authors evaluated 102 patients with documented cervical radiculopathy ie pinched nerve in the neck and found that more than half of the patients also had medial epicondylitis ie golfers elbow. The prevalence of tennis elbow and neck involvement has also been documented and Berglund et al article is one example. What this means is that your therapist and YOU need to be aware of this connection and the appropriate steps need to be taken to rule out your neck as the CAUSE of your elbow symptoms.
The chicken or the egg? Maybe you need OUR help.