Motion Stability's Blog


Could Uneven Shoulders Indicate Any Issue? by charlestlee

image source: helloamanda.com

Brian Yee PT, MPhty, OCS, FAAOMPT

Uneven shoulders can be observed in a couple of planes. One of the most common observations is when one shoulder looks higher than the other. This could indicate either a structural, muscular or neural imbalance.

Structurally, the patient may have a leg length discrepancy or a scoliosis that causes the shoulders to be raised on one side.

Muscularly, the shoulder blade or scapula has multiple muscles that stabilize it in position. Muscular imbalances can easily occur that cause certain muscles of the scapula to pull it in a certain direction. For example, in many single arm-dominated sports such as baseball or tennis, the dominate arm tends to over-develop the latissmus dorsi which is your ‘wing’ muscle. With more muscular development it actually pulls the shoulder blade down. In standing postures, most of these athletes will look like their shoulder is lower on the same side. This can create problem for the lowered shoulder, especially when the arm is required to repetitively raise over their head. With the shoulder lowered it takes greater work of the opposing muscles to raise the arm overhead. Over time, it can cause poor shoulder mechanics and lead to injury of the shoulder.

When someone has chronic nerve symptoms in their neck and arm due to a radiculopathy or pinched nerve in their neck, many times you may see that the shoulder on the same side looks elevated. This is due to the adaptation of the muscles to shorten or spasm to elevate the shoulder girdle and allows more room for the nerve to conduct. Patient’s with this pattern often feel tight in their neck and upper shoulder. When they try to stretching the muscles it makes their nerve symptoms worse. This happens because the muscle is not tight but in protective spasm keeping the nerve from being injured further. In this case it is important to treat the nerve first before trying to lower the shoulder girdle.

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Are crunches the best exercise to eliminate my back pain? by charlestlee

Brian Yee PT, MPhty, OCS, FAAOMPT 

No. There is a misunderstanding that the stronger your abs are, the better it is for your back. Although strong abs can help stabilize your spine, current research indicates that there are different roles of muscles in the trunk. Generally speaking, the smaller muscles of your spine called ‘local’ muscles help stabilize the spine in low load situations such as prolonged standing, sitting, and light movements such as bending to brush your teeth. While, there are ‘global’ muscles that are the larger muscles –  such as the rectus abdominis, obliques, and back paraspinal muscles that are designed more for movement, power, and stabilization at higher impact.
It is important to have both ‘local’ and ‘global’ systems working correctly. The ‘local’ muscles – transversus abdominis, pelvic floor, and diaphragm help provide intra-abdominal pressure to your trunk. This pressure is similar to a sealed can of soda that maintains the carbonation of a drink. If you were to open the can, you would lose its pressure. Similarly, research from the University of Queensland suggests that with back pain the smaller muscles lose control and thus your intra-abdominal pressure is not as effective to stabilize your spine. Also, along the back of your spine is a muscle called the multifidus. The deeper portions of it run vertebra to vertebra and they are also designed to provide stability to the spine.
We can utilize real-time ultrasound imaging to visualize and cue a client to contract the ‘local’ muscles correctly. Once the ‘local’ muscle work correctly, it is important to do exercises that integrate the ‘global’ muscles – not just with the abs, but also the muscles around the trunk. It is much more effective to do exercises that coordinate the use of these muscles rather than just doing abdominal crunches. Please consult with a qualified health practitioner to guide you through the proper exercise progression