Understanding the Shoulder Capsule
by Andrew Provost, PT
In the world of anatomy, the word capsule is defined as a tough sheath or membrane that encloses something in the body. In the treatment of athletic injuries, the shoulder’s capsule or covering can directly or indirectly be the cause of shoulder pain. When capsular tissue is pinched, it can cause pain, when it is loose it can create instability, and when it is tight it can place greater stress on the rotator cuff tendons. Since the capsule is involved in most chronic and acute shoulder injuries, your personalized physical therapy treatment should include techniques that address the limitations of the capsule and the strength of the surrounding muscles.
Many sports injuries of the shoulder are the result of overuse. In the “overhead” sports, athletes tend to start off too fast, throw or hit too hard, or simply don’t recognize the warning signs until it is too late. Parents and athletes alike should be aware of the following warning signs and remedies for shoulder pain.
- Shoulder, upper arm, elbow pain/soreness that last more than two hours after activity
- Regularly asking for over the counter medication prior to competition
- Soreness that lasts through the warm up for activity
- Become familiar with capsule stretching (see sleeper stretch below):
- Lean against wall with upper arm at shoulder height elbow bent
- Pull the hand down toward the floor until a stretch is felt
- Hold 30 seconds; repeat five times
- Listen to your body and rest when you are sore and ice after activity
- Create a soreness log to promote an awareness of symptoms
- Call a physical therapist for an assessment
A preseason screening of the shoulder can help to identify deficits that could lead to injury later in the season. As a preventative measure, a physical therapist can assess your range of motion, posture, capsular mobility, and strength to determine if you are at risk.
Poor posture can also contribute to upper extremity pain in athletes. For example tennis players tend to have a forward head posture, rounded thoracic spine, strong pectorals and weak scapular muscles. Combine these deficits with too much practice or game time, and it’s a recipe for shoulder pain.
Whichever comes first, tightness causing pain or pain causing tightness, research shows that posterior capsule limitations lead to altered shoulder mechanics, which often leads to shoulder pain in athletes young and old.
Remember an ounce of prevention is worth a pound in cure if you know what to steps to take. In summary, get a preliminary screening to determine your risk for shoulder injuries and perform the appropriate exercises to prevent the onset of a shoulder injury. Finally, if you get hurt, see a physical therapist or physician as soon as possible to avoid further complication.
Andrew Provost is a Physical Therapist at Boston Sports Medicine