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Feldenkrais Method
Shoulder Dysfunctions

Shoulder Overview, General Treatment Strategies, Rotator Cuff injuries, Frozen Shoulder, Acromioclavicular Joint Injuries, Deltoid Attachment Strain, Impingement Syndrome, Subacromial Bursitis, Shoulder Instabilities, and Bicipital Tendonitis

Shoulder Overview

The shoulder joint is one of the most unique joints in the whole body. It is a ball in socket type of joint with the socket located at the tip of the triangular shaped shoulder blade. (See ill.1)

The shoulder blade is suspended by neck and shoulder muscles as well as attached to a "strut", the collarbone. The shoulder socket being in a mobile shoulder blade is very different compared to the very stable socket housed in the pelvis, part of the hip joint.

The arm is suspended at the shoulder by muscles that are very different from most found around other joints. Muscles tend to be plump and taper, ending with a round tendon, which is separate and distinct as it inserts into the bone. In contrast the deep shoulder muscles (Rotator Cuff), are flat and have flat tendons that blend in with the joint capsule as they cross the joint before they insert into bone. (See ill. 2)

They act like deep, dynamic, suspensory strapping. The implications of this are twofold: problems that involve the joint itself can extend to the cuff muscles; and cuff inflammations can inflame the joint capsule (this is the "have pain will travel" effect). Simply the weight of one's arm can be a strain on an inflamed or weakened cuff because of the suspensory work the cuff muscles do.

Also important in the shoulder is the space that allows the "ball" to tuck under the roof of the shoulder blade (acromion), as the arm is lifted overhead. (See ill. 3, 3.5) A Bursa is a fluid-filled sack, which is present to help reduce friction between a tendon and bone.

In the shoulder the supraspinatus bursa lies above the tendon beneath the bony acromion. (See ill. 4) The supraspinatus cuff muscle is responsible for the beginning part of lifting the arm sideways. (See clip 6.9) The biceps tendon and deltoid muscle each have a bursa. These bursas can get inflamed, swollen and cause pain (bursitis). When inflamed and swollen they are larger and can become pinched when the arm is lifted overhead. Over time bursas can even become calcified, causing even more pain.

General Treatment strategies

The rule of thumb for treatment with any shoulder strain/pain is to reduce inflammation!

Inflammation causes more pain, swelling, limitation of movement and damage. Reduce inflammation with allopathic or homeopathic anti-inflammatory medicine, ice and rest from irritating movements. A sling can also help when just the weight of the arm is creating pain. Kurashova Tissue Techniques feature a special moving ice massage to greatly reduce the swelling. Kurashova gliding and vibrational strokes will also reduce swelling without applying painful pressure.

Only when swelling and pain are minimal should range of motion be part of the treatment. Many people only irritate the shoulder with too aggressive early motion.

Next, heat-producing modalities and Kurashova Tissue Techniques that bring circulation needed for further healing can then be added.

Lastly, strengthening exercises are part of the treatment regime but should not be painful.

Let's not forget the importance of awareness in this whole healing process. Many people don't realize that they are irritating their shoulder by the simple act of leaning weight on one elbow during writing, eating, or driving. Furthermore lifting the garbage or a heavy bag with one hand is often a strain most people are unaware of. The daily strain of carrying a heavy briefcase or bag in the same hand can create a slow traction-type injury to the cuff muscles.

Learning to use the support of one's back when using one's arms can reduce the strain on isolated muscle groups. In their capacity to re-educate and improve awareness the Feldenkrais and Alexander work can help long-term improvement and prevent re-injury.

Rotator Cuff Injury

Most cuff injuries occur when a person lifts or pushes something too heavy. Cuff injury can also be caused when one's arm is pulled (traction injury) or when one falls on the hand or elbow pushing the arm upwards. The habit of leaning on the elbow can lead to compression damage of the cuff tendons as they are pressed upward into the roof of the acromion.

When any of the three cuff muscles (supraspinatus, infraspinatus or teres minor) are injured, the injury can range from micro-tears, larger tears, to a complete tear. (See ill. 5 from side, ill. 6 from above, ill. 6.5 from behind) Only in severe injury do we see a complete tear, which obviously requires surgery. Neoprene shoulder sleeves can help suspend the shoulder to relieve strain while an injury heals (see the Saunders Catalogue under Products).

Frozen Shoulder

If inflammation of the shoulder joint or muscles around the joint is not nipped in the bud, inflammation may expand to the whole joint capsule and surrounding muscles/tendons.

These tissues can become contracted, tight and bound down (frozen). When "frozen" we see restricted motion of the arm overhead and in directions of rotation internally (performed with the back of hand behind the back) and rotation externally (performed with palm up behind the head). Once the shoulder is frozen it is difficult to determine what tissues of the shoulder were initially injured.

Frozen shoulders may also develop after a fracture of the upper arm especially when mobility of the shoulder has been restricted for healing in a cast or sling. Even after the doctor allows a sling to be discontinued,

initial intermittent use of a suspensory support (such as a sling or shoulder sleeve) can be helpful because the cuff muscles are not strong enough to suspend the arm all day long. You may also intermittently support the weight of your arm by hooking your thumb to your belt or waistband.

A-C joint (acromio-clavicular) and Deltoid Muscle attachment strains

These two areas are commonly strained either while lifting or when breaking a fall with the arms. If the A-C joint (which is where the collarbone meets the flat end of the shoulder blade) is tender or swollen it must be treated in order for the whole shoulder to improve. (See ill.7 from above)

Likewise if textural abnormalities in the deltoid muscle and/or its attachment to the shoulder blade are found, that means there has been strain and this must be treated. (See ill. 8) Kurashova Tissue Re-education Techniques effectively treat these problems.

Impingement Problems and Subacromial Bursitis

Impingement problems are often called "pain full arc" syndromes. They are characterized by a painful pinch when the arm is lifted, which often then stops after lifting beyond the painful point. The tissue being pinched between the underside of the acromion and the ball of the shoulder can be the subacromial bursa or the supraspinatus tendon.

In either case, the strength of the supraspinatus muscle must be examined because it is responsible for tucking the ball of the shoulder under the roof of the shoulder blade as the arm begins to lift up sideways. (See clip 6.9) If the supraspinatus is weak, the poorly tucked ball may not clear the roof and the tissues can get pinched. Swelling in the shoulder or bursa further reduces the space needed to clear the tissues causing them to be pinched even more.

Many an impingement problem has resulted in the worsening of symptoms by doing range of motion, only to find out after the fact by x-ray that there were bony spurs in the joint, grinding the vulnerable tissues. Don't push through motion that is painful. Reduce the inflammation first.

If you are not getting better with in a week or two consult your doctor about getting an x-ray, especially if you have had chronic shoulder problems, old injuries or suspect arthritis.

Shoulder Instabilities: Subluxations, Dislocations

Most common instabilities are found in the front joint capsule of the shoulder. If the arm is forcefully pushed backward (especially with the arm up sideways), the front of the shoulder becomes overstretched. Most dislocations are also a result of this direction of motion (imagine the position of your shoulder if you were holding ski poles and ready to push yourself forward as your arm moves back).

Subluxation also occurs when there has been longstanding weakness due to immobility, paralysis, or stroke. When the shoulder is very weak the ball of the shoulder moves forward and drops down.

The conservative approach would be to treat any swollen tissue, muscles and ligaments that may be strained with Kurashova tissue techniques; avoid straining any weak muscles with undo lifting, pushing or weight bearing; and once pain free, strengthen all muscles multi-directionally around the joint. Neoprene shoulder sleeves can help suspend the shoulder and reduce strain during healing (see the Saunders catalogue under Products).

For chronic subluxation/dislocations due to trauma (not paralysis) a conservative non-surgical approach is Prolo (proliferative) Therapy. This involves multiple injections of an irritant into ligaments that help stimulate the formation of new collagen fiber. The combination of injections and nutritional supplementation helps grow new, stronger connective tissue. A series of injections are generally given about a month apart and may involve 3-6 months of treatment. See link to Dr. Hauser's web site: For instabilities that have not responded to conservative treatment, surgical repair is indicated.

Bicipital Tendonitis, Repetitive Stress Injuries

Bicipital Tendonitis is an inflammation of the biceps tendon. The biceps muscle is one of the most overworked of all our arm muscles. It is the big muscle on the front of the arm that bulges when you say, "Hey, make a muscle". (See ill. 9, clips 9.5, 9.75) It is responsible for bending the elbows, often with a load, and also can swing the arm forward some. When we use our hands with elbows bent, the bicep is in a shortened position.


Direct injury or chronic tension/overuse can cause bicipital tendonitis.

Insidious tendonitis from chronic overuse causes shortening of the biceps muscle that then puts excess tension on the tendon, usually where it rests in the groove of the upper arm bone. (See ill. 10)

Normally the biceps tendon is cushioned by a bursa beneath it and should glide freely within its synovial sheath, in this groove. Under excess pressure, friction is increased either in the sheath or between tendon/bursa and bone, causing inflammation. Habitual tension in any part of the arm can cause chronic contraction in the bicep.This contraction causes shortening if the bicep muscle is not stretched out after activity.

One's dominant arm/hand is more susceptible to chronic overuse and tightness. For example, I once knew a watch maker who had bicipital tendonitis, not because he was lifting heavy clocks, but because he held chronic contracting tension in the front of his arm to stabilize the fine movements of his hand. If you use your hands or arms for sustained activity, you can avoid injury by regular stretching before after activity, the same way an athlete does by stretching before and after exercise.

With acute injury there is strain to the tendon itself. Any strain to the front of the shoulder can overstretch the bicep tendon as it crosses the very front of the capsule. I have injured my bicep a number of times: once by throwing a heavy bag of laundry back over my shoulder, and another time by lifting heavy garbage into the can using only one hand. Other injuries can occur lifting heavy loads, at the musculotendonous junctions or at the insertion of the biceps. (See ill. 11)

Kurashova pressure stretching and vibration techniques can help return the bicep muscle to normal length. After normal elasticity of the muscle and tendon is restored, a person must do regular stretching to avoid the return of this problem.

With racket sports, one can strain the shoulder by using isolated muscles of the arm when swinging. Strain is reduced in the shoulder when instead the full power of the whole body contributes. Alexander and Feldenkrais work helps to re-educate and improve the use of one's whole self, thereby improving performance and reducing injury in any sport.

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MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area