I got a question about a shoulder brace. Here it is….
“I have subluxation on my left side. Not always. The KY helps. I would rather do shoulder shrugs with chanting & music than just counting .I also thought a brace -the criss cross cloth kind might help me hold my shoulders back. the left slumps forward.”
Does everyone know what subluxation is? It’s the step before dislocation. The joint is out of whack but not completely dislocated yet. Now my initial reaction would be to say “no don’t get a shoulder sling.” The reason is this…..We all know that nothing to us is more important than repetition…..which leads to neuroplasticity. When you use a brace, neuroplasticity doesn’t happen because you’re not using the muscles. I was at a course taught by Peter G. Levine and he was talking about using canes and said “we teach people to neuroplastically strengthen the wrong leg.” He’s absolutely right. The stuff about walking and transfers that a physical therapist teaches you is for SAFETY. Getting a limb back to normal function is an entirely different story. Entirely. You pretty much have to do the opposite of all that safe stuff that your PT taught you in order to get stronger. Disclaimer: do all the safe stuff.
Shoulders are a little different. It’s not like walking or climbing steps where just doing the action will promote neuroplasticity. The position of your shoulder has to be addressed before you use it. Sooooo, I don’t know. I never had a patient get a shoulder sling but I worked in orthopedics. I never worked in neuro. I also didn’t have this problem myself. My shoulder never subluxed. It hurt, but never subluxed. So I don’t know. Peter if you read this, what are your thoughts on this? Like I said, I have no experience with shoulder slings for subluxation and can’t recommend one but this looks very good.
Your rotator cuff is in your shoulder. It’s made up of 4 muscles. The acronym for these muscles is SITS. That stands for the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles are responsible for most of the motion of the shoulder, primarily – you guessed it – rotation. Everyone has heard of a rotator cuff tear. Patients or friends and family would commonly say “I have a rotary cuff problem.” It’s not rotary, it’s rotator. Anyway, whether you had a stroke or have some other shoulder problems, these muscles are probably weak. Even if you have no problem at all, these muscles are probably weak. It’s very important to make these muscles strong, they’re the foundation of the shoulder. Weakness of these muscles is what causes the shoulder to sublux in some stroke patients. But they’re not the cause of all shoulder pain after a stroke, read this. Get your rotator cuff strong by doing these exercises. And these.
After my stroke, my right shoulder would hurt periodically. There is NO WAY that it was subluxed. A subluxation of a joint is like the step before dislocation. The bones of the joint aren’t matching up correctly. After a stroke this happens because the muscles that hold the shoulder in place become very weak. The shoulder is an inherently unstable joint anyway and it relies on its musculature to keep it intact. Some joints rely more on their bony configuration. It is generally thought that shoulder pain after a stroke is caused by the shoulder subluxing. This definitely was not true in my case. This blog post by a stroke researcher states that the number one cause of shoulder pain after a stroke is from adhesions that form in the joint, not subluxation. So what will help adhesions? Stretching. This is especially important if you have lost range of motion. I lost no range of motion after my stroke, I was lucky. But I stretched a lot. It helped my shoulder pain. I have no shoulder pain anymore.