Standing on the Shoulders of Women

By Jane Wake MSc

Male or Female - it's likely that you will experience some sort of shoulder pain in your life span. It's the 3rd most prevalent muscular skeletal complaint with estimates (although these vary), reported to be about 67% of the population and they are more common in women than men. (NICE Guidelines)

Last week I presented an online workshop and had a huge response to the topic. I wanted therefore to sum up my findings here and also let you know that I am here to help. I have recently recorded a 2 Part video series that anyone can use. It's currently available via my Members Channel so if you have a current subscription, please do have a look or you can trial for free via my On Demand Channels. If you need more guidance I have a number of different bespoke programmes, including my Strength Training Programme where we can incorporate your shoulder needs into the programme, I also do 1 to 1 mentoring. I particularly focus on this with women in midlife when I believe it's time for you to find your own path from a movement perspective. This is where I know I can help you best.

One of the reasons shoulders are vulnerable is the nature of the joint, or more accurately joints. The shoulder has 4 joints connecting it to - 1. The Clavicle (collarbone), 2.The Sternum (breast plate) 3.The Scapular (shoulder blade) and 4.The Humerus (upper arm bone). It's designed to be highly mobile and perform a large range of movements which means, in practically everything you do, you are using your shoulder joints.

From simple tasks sat at a desk, typing, writing to eating and drinking, all the way through to hitting balls in sport and lifting and carrying big weights...

...Your shoulders are always coming into play and when they go wrong, it's life debilitating.

In younger age groups, dislocations and tendon or muscle tears are more common place, often due to impact. We already start to see here how the female joint can be more vulnerable, due to its relative size to mens and often because it's considered to have more laxity. Female athletes tend to take longer to recover, and suffer more from pain.

Male athletes tend to have more sports injuries overall. This may be more to do with access than a physical predisposition. Hormonal factors are often discussed but we still have much to learn about the mechanism by which this might make women more vulnerable. The rotator cuff is a group of muscles that sit around the joint and are important for stability. The tendons of these muscles seem to be particularly vulnerable. It's often discussed whether lowering or changing hormones could be directly affecting them. This could change the relationship tendons have with muscle and bone which is crucial for joint stability and function. Whilst studies find evidence of hormone receptors for estrogen and progesterone in both men and women within the rotator cuff, there are more in women, which could give an explanation as to why post menopausal women, who have lowered levels of these hormones, are more predisposed.

It's never that simple though and I'm glad to see that more studies are in in the making as we really do need more quality data. What is clear is that it's multifaceted and whilst we can get wrapped up in popular hormone topics, we have to look at the bigger picture and see what other factors are at play. It's why I believe so strongly that, when it comes to your shoulders, movement is something that we really can take charge of and use as a positive in pretty much every scenario...

However every scenario is different and you really do need

to tackle this with an individual approach...

Whilst the complexity of the shoulder joint can be seen as its downfall, it can also lead us to exercise solutions that give us different paths to renewed strength. Over and above the rotator cuff group, with their specific movement and stabilising actions, are a host of other muscles that cross over or attach to one of the 4 joints, creating strength and more global stability. Whilst it might not be possible to perform some movements with an injured shoulder, there are others that we can do and which can either indirectly or directly help to heal and generate greater strength & function around the shoulder.

This should start to ring bells for anyone who wants to prevent shoulder injury - We should all be making it a priority to generate strength around the shoulder joints.

There are a number of things that can predispose us to shoulder injury and pain, a lot of which are connected to lifestyle, diet, exercise and other illnesses such as diabetes and thyroid disease.

One of the biggest shoulder diseases is Adhesive Capsulitis or Frozen Shoulder (FS) . Some studies report an incidence of this being 4 times more in women than men aged 40-60.

Adhesive capsulitis is a painful disease where the glenohumeral joint capsule - which is the connective tissues that sits around the joint, become acutely inflamed. The 'freezing' of this joint corresponds with a change in structure that makes the joint more fibrotic to the point that it becomes completely immobile. Whilst there is also an 'unfreezing' phase, so the joint will naturally heal over time, It can take a very long and excruciating time and lead to joint that never regains full function. There are many forms of treatment and, like with any shoulder injury, anyone reading this should seek medical advice as to their specific treatment path. The right movement can however, along with medical and more holistic treatments, often provided by a physiotherapist, make a huge difference to the healing abilities and returned function of the joint.

A very recent research paper published this year looks further into the hormonal effects on conditions such as FS and provides interesting insight into why midlife women may be more vulnerable. Joints are protected by something called synovial fluid. This study of only a small number of participants, took samples of synovial fluid and found an estrogen receptor called GPER present in the cells. This receptor is thought to provide anti-fibrotic properties suggesting that the lack of estrogen within these receptors could be a major player in the path of this disease. This was a very small study but its another sign of how we could discover more ways to prevent and lower the incidence of FS.

It's also important to note that inflammation is a key proponent, not only of shoulder injuries but for many autoimmune and other joint issues. Estrogen's anti-inflammatory role, which is well documented, could be playing a part here. But there again - It's never just one thing. There are so many other factors directly or indirectly, from stress levels to diet, movement, sleep and more, that could be playing their part within our muscular-skeletal systems.

And why are these so important?

They are important because they are the things that we can personally take charge of.

This autonomy, alongside support from others, is how we start to gain control, hope, clarity

and move from a restricted to fulfilled life.

As well as discussing these within the webinar last week we also looked at the role of pain management - another complex factor which I have discussed in a previous blog post on pain science . When you quieten the mind, the body responds and this element of listening in to what your body is telling you forms a huge part of our discovery of self and ability to heal.

It's all so intrinsically connected and I will forever find it fascinating and be looking for more ways in which we can navigate this winding path we call life! If you'd like to catch the recording of my webinar you can do so here.

If you'd like more help from me, please do get in contact. As I say in Shoulder webinar - if you have a question, movement related of course, Ask. I will not be able to stop myself from doing all I can to help you find the answer!