Learn About Good Posture

Hello! I'm Dr. George Best at Best Health and Wellness in San Antonio, Texas. Today, I'm going to share with you some little-known information about rotator cuff problems that even a lot of doctors and physical therapists aren't aware of. I think you will be surprised by the effects that other things besides the shoulder have on the rotator cuff. So I am going to cut away, change into something more comfortable, and we'll show you a little demonstration I think you will find rather interesting. So let's get started. I am going to demonstrate now the effects that posture have on shoulder mobility, and explain why shoulder mobility is tied in with those problems with rotator cuff and different types of shoulder pain. What a lot of people don't realize, including a lot of doctors and physical therapists, is that the shoulder itself, in a lot cases, is not really the reason why the shoulder isn't moving properly. I am going to do a little demonstration here for you. First of all, I'm going to start out standing up nice and straight with good posture, and I am just going to raise my arm up straight to the side. You can see I can get my arm up pretty good. I can get it all the way, to where it actually touches my head without doing any strange contortions to get it there. I don't have any shoulder pain, so this maybe a little different for you if you are having shoulder problems. But I am going to show you now, what happens if I just slouch a little bit. I am starting to just kind of loosen up. Here I am going to just kind of let my shoulders drop down some, let my upper body slouch forward just a little bit. And now, I am going to do the exact same range of motion, and that's as far as I can go. I could probably force it another few degrees, but that's as far as it's going to get. You can see, and I am going to stand up straight again, you can see what happens when I stand up straight. I am going to slouch forward a lot, because I see a lot of people that will actually slouch forward quite a bit more than I showed you the first time. They will actually come in really slouch forward, there head is kind of shifted forward, their upper body is really kind of leaning and I am going to do the same range of motion once more. I'd really have to strain to get any higher than that. So the shoulder range of motion is drastically affected by your posture, how upright your spine and the alignment of your rib cage and your spine and your head, all affect the range of motion in the shoulder. So what does this mean as far as shoulder problems in terms of pain, and in particular, rotator cuff injuries? Well, what happens is that, when your posture is not good, there is a subtle shift forward of the shoulder, it rolls forward. I am going to show you in a model in a moment, what exactly is happening with that. But basically, what's going on is if there is any forward shift, any forward rolling of the shoulder, because you can rotate your shoulder in and out if you do it consciously, what happens is the rotator cuff tendon, in particular the supraspinatus tendon comes forward and it starts to get pinched in between the bone surfaces. And your body is not going to let you go much further than where that tendon is starting to get pinched. But for somebody who has this problem, who has this postural distortion and the shoulder is rolled forward, what happens is that just through normal life and using your arm and that type of thing, there is a lot more mechanical stress and actual friction and rubbing on that tendon. And what happens is that because the shoulder is rolled forward and because that tendon is rubbing up against the bones and ligaments, which I'll show you on the model; it's kind of like taking a rope and rubbing it across the rock, repeatedly. So overtime, what happens is as you get these little, basically, abrasions which then turn into fraying of that tendon and that produces inflammation. So then it rubs even more, you get even more inflammation, and overtime you start to develop a situation where you can't really move the shoulder at all, because the tendon is swollen up. It's got a lot of painful spots along it. So anything that rubs it's going to hurt when you move it. So that's basically what's going on with it, and this is why I pay such an importance on the spine posture and the rib cage when it comes to shoulder problems. Because a vast majority of time, unless there has been a direct trauma to the shoulder, or it's like an overuse type injury from like a baseball pitcher, and even in those cases a lot of times it's postural, what's happening is it's actually more your posture. How upright you are, how good the health of your spine is, positioning of your head, those types of things make a much bigger difference on your shoulder than actually working on the shoulder does. This is why shoulder rehabilitation usually takes so long is that everybody is focused right there. And the problem isn't there, its back rib cage and back and those types of things. So I am going to show you now what's actually going on with the model so you can get a little better idea of what's happening in there. Alright, so I have zoomed in now so that I can show you now this model of the shoulder and this is a model of the right shoulder. This is the shoulder blade which is in the back. So you are looking at something that's going to be oriented kind of like so, and this is the collarbone and this is the upper arm bone. Most rotator cuff problems -- I am going to turn this around, so we are looking at the back of the scapula or the shoulder blade, and most rotator cuff problems involve a muscle called the supraspinatus, which sits in this grove on top of the shoulder blade. I am going to kind of trying to get my fingers through here. And you can see where my finger comes out that's where the tendon comes out and attaches into the upper arm bone. So the supraspinatus, it gets its name, by the why, by this is what's called the spine of the scapula and the supraspinatus the name means above the spine. It's actually, in this case, referring to the spine of the scapula not the backbone spine. But supraspinatus comes through here. And you see the tendon comes through kind of a tunnel in between the bones, between the collarbone where it attaches to the scapula. This is what's called the acromioclavicular joint, and then there are some ligaments around here and everything is kind of held together. What happens is that under normal circumstances the tendon will come through where my finger is, and it will attach, and has a pretty straight shot into it's attachment on the arm bone. Well, when you roll that shoulder forward as we talked about a minute ago, then the angle of the tendon's attachment changes. So instead of coming straight through here, if you can imagine that this is turned, now it's going to come straight through and go around the corner. So it's going to come out and it's going to turn to make its attachment, and because it's doing that, now it's going to rub over on this side of the tunnel. And as it rubs, like I said, it's kind of like taking a rope and rubbing across a rock. Over a period of time, as that thing gets rubbed back and forth across that wall of the tunnel that it has to go through, then it starts to get these little tears at first, and as a result tears develop, then you start to get inflammation and the tendon will swell. So it rubs even more and so you get more and more rubbing and more and more frays. So a lot of people that have so called rotator cuff tears, it's really more of a case of rotator cuff fraying, a lot of little areas of damage rather than one specific torn site. It's that type of a problem that is actually probably far more common in my practice than an out-and-out tear which occurs through a trauma. But that's what happens with the rotator cuff injuries and it tends to get worse and worse and worse overtime, primarily because of this poor alignment of the shoulder. And unfortunately, most doctors and therapists tend to focus right on that shoulder joint as being the source of the problem, when in fact the shoulder joint is simply compensating for other postural issues in the back and the neck. So that's why it's so important to actually work on correcting posture overall, rather than simply looking at the shoulder in terms of being able to correct rotator cuff problems. So that concludes this video. I hope you found it useful, and for more information on shoulder types of problems as well as general natural remedies and other natural health information, please visit my website at www.besthealthandwellnessinfo.com. Thank you very much and I look forward to seeing you on another video.