As a physical therapist, I’ve heard the above question more times than I can count. I’ve heard it from well meaning people who want to respect my work/life boundaries, yet gain just a bit of information to help themselves get over their latest ache or pain with hopes of avoiding a trip to the doctor.

For example, I could say, “go buy yourself some therabands” and then proceed to demonstrate a movement you could do for your requested single exercise. I will always cringe at even the thought of this because as I’ve observed, any exercise performed on an inefficient system will simply perpetuate the problem. The post-graduate training I’ve received on my path to becoming a Certified Functional Manual Therapist has shaped my approach to treatment to look at each individual through the lens of three pillars. These three pillars are: mechanical, neuromuscular, and motor control. 

The shoulder is not just a ball inside of a socket. The glenohumeral joint (ball and socket) is closely neighbored by other structures such as the clavicle (collar bone), scapula, as well as multiple rib articulations which are seen where the scapula rests on the back. There can be mechanical issues at any or all of these articulations which may be considered drivers of the actual pain complaint. If these dysfunctions are not addressed, the second and third pillars that contribute to efficiency of the system are negatively impacted.

This brings us to the second pillar, the neuromuscular function aspect of bodily efficiency. Let’s say that the above mechanical issues are ignored or forgotten. Can the rotator cuff muscle group engage with the appropriate timing, strength, and endurance? No, not likely. The above mentioned mechanical impairments can contribute to the inability of the rotator cuff to engage simply by altering tissue tension relationships from the poor positioning resulting from the mechanical dysfunctions. In the absence of this proper timing, strength, and endurance, there is a disrupt between the rolling and gliding of the different mechanical components. This can lead to impingement in the situation of the shoulder.

Finally, we arrive at the third pillar, motor control. Let’s say, in this scenario, the mechanical and neuromuscular components have been addressed. The joints are moving the way they should, the surrounding muscles are able to engage with the proper timing, strength, and endurance. This individual should be doing pretty well, right? Maybe, maybe not. It depends on the demands they are placing on their body and what they expect to be able to accomplish. If the individual has not been trained in how to automatically integrate the parts of the shoulder back into the whole of the body’s movement system with an appropriate motor strategy, they are not likely reaching their functional potential.

Physical therapy is a science and an art, both of which take time and thoughtfulness. Book an evaluation at Revive and Thrive Physical Therapy and Wellness to take the first step toward reaching your goals using this three pillar approach.