Hip Causing Shoulder Pain?!
Many clients suffering from long term, chronic pain conditions will often say how they feel their bodies are ‘out of balance’ in some way; many will describe how they feel as though they are leaning their weight to one side more than the other or perhaps their bodies feel twisted in some way; many will also mention how most of their pain is located down one side of their body. In these cases, careful and thorough assessment is required along with a clear explanation to the client of how these postural abnormalities may be contributing towards the pain they are experiencing.
Now firstly, I’d like to point out that non of us are perfectly aligned; we are all ‘out of alignment’ in some way. Not everybody needs to have perfect posture in order to live a pain free existence.
Despite this, I have often found that in clients who present with ongoing, long-term pain and who have tried other therapies with only limited success, then posture and body alignment should be investigated further to determine if they are part of the problem.
Now there are numerous areas of the body where postural and body alignment can contribute to the clients pain but for the sake of brevity (and to try and keep things simple!) I’ll concentrate on one area which can have a direct correlation when it comes to creating pain – the hips creating shoulder pain!
Now this may seem a little puzzling to many reading this but there are actually a number of ways in which the hips can create pain within the shoulder. Although, initially, it may seem a little odd to suggest this, hopefully by the end of this post you’ll have a better understanding of the link between the two...hopefully!
The hips (or the Pelvis as it is anatomically known) is an area of the body which connects both the upper and lower body; what happens at the hips can potentially have an affect on the rest of the body both above and below. If the pelvis is held in a level neutral position then it will act as a transitional zone between the lower and upper body as we walk, run and move throughout the day.
Problems can occur when the pelvis is not held in ‘correct’ alignment but instead is held in a twisted or rotated position. This can have the effect of causing the rest of the body, both above and below the pelvis, to twist or rotate in order to compensate.
One common pelvic misalignment which can create issues within the shoulder is when one side of the pelvis is held in a more elevated position then opposite side.
In the image above you can see the hips in the left image are held straight or level whilst the hips in the image on the right the left side is held in a higher position.
How Does This Affect The Shoulder?
Often when the hip is held in an elevated position on one side the common compensation is for the shoulder on the opposite side to be held in an elevated position. But why is this?
As can be seen in this example above, the hip on the left is held in a high position, resulting the common compensation pattern of a high shoulder on the opposite side (right), often a contributor to pain in the area.
Before we look at reasons behind this particular compensation pattern, its important to understand the reason behind why the body would wish to compensate in the first place. One reason is the bodies desire to have the eyes held level with the horizon at all times.The body will literally attempt almost anything to accomplish this including twisting and contorting our bodies to ensure the eyes are held in a level balanced position - despite the pain this may cause!
Back to the Wonky Pelvis!
Back with our example of the pelvis being held higher on one side; this can cause the whole of the upper body to begin to tilt to the opposites side. Now, as you can imagine, if the body did not compensate in any way then this would result in a side lean to the whole upper body, resulting in a sideways lurch with the head angling off to the side. In this example the body will try to prevent the sideways lean by creating a bend in the spine to the opposite side towards the high hip in an attempt to level the body. As the spine begins to bend towards the high hip, the shoulder will begin to raise above higher than the shoulder on the high hip side therefore resulting in the pattern of the high hip on one side and high shoulder on the opposite side.
From a rear view we can see the high held hip on the right, causing the spine to bend to the right, meaning the shoulder on the left is held in a high held position.
The result of the shoulder being held in an elevated position like this will mean the muscles of the upper shoulder (known as the upper trapezius muscle) are continually held in a shortened position causing them to become tight, restricted and often continually full of muscle knots. As the upper shoulder muscles become tight and restricted other areas of the shoulder complex such as the rotator cuff muscles, will be forced to work harder in an attempt to stabilize the arm within the joint. As these muscles overwork, they too will begin to become tight and loaded with scar tissue and muscle knots, creating further pain within the joint. This will eventually result in an inability to move the shoulder through it’s normal range. The restrictions within the upper shoulder muscles and neck can also directly lead to migraine headaches, TMJ (jaw pain) and even referred pain into the face (neuralgia).
What is the answer?
Often the muscles of the shoulder complex can be released by applying soft tissue techniques which will usually reduce pain and increase range of movement. Appropriate rehabilitation exercises can then be given in order to strengthen the rotator cuff and muscles in and around the shoulder blade.
All of this seems like an appropriate treatment plan – and often is – but what if, despite all this work, the pain in and around the shoulder never truly resolves or simply returns soon after treatment?
Well, if the client was presenting with a high hip as in the example we mentioned above then perhaps a treatment approach may be to look to release the muscles and fascia around the high hip so the pelvis now sits in a level even position. As the pelvis is no longer siting in a high position then then perhaps the body will no longer have to compensate by side bending to the opposite side resulting in the shoulder no longer being held in the high, elevated position we discussed earlier. Perhaps now the shoulder is sitting in it’s more natural position the muscles of the neck and shoulder will no longer be held in a constantly shortened position and therefore prevent them from becoming tight, painful and restricted. Generally, if the shoulder is then massaged and loosened the muscles may remain loose due to the shoulder now sitting in it’s correct position and any strengthening exercises will be more beneficial as a result.
As mentioned at the beginning of this blog, bodies are rarely perfectly aligned. Whilst we have to appreciate the body can adapt to so called misalignments or postural abnormalities we also have to be aware that when treatments are failing to get the results expected or, if following initial improvements to the clients condition, symptoms return soon afterwards, then looking at posture, body alignment and other areas of the body other than where the pain is actually presenting could be the key to solving many long-standing, chronic pain conditions.