How Your Big Toe Could Be the Source of Your Shoulder Pain

Thanks to Jake Salaz for contributing this story. You can visit his website here.

“Doc, I told you I have shoulder pain. Why are you looking at my back?”

We often hear this as we work with our swimming athletes and we have found that the following way of thinking about the body and how it functions simplifies it in a way that is very intuitive. The approach is called:

The joint-by-joint approach to injury and treatment

Think back to when you were in school, or at work and were asked to participate in a group project with several other participants. Inevitably one or two of these members are less productive than the others. Due to this decreased production, other members of the group have to pick up the slack. While there is no stress on the group this lack of productivity is not a problem. As the deadline nears, and stress is increased the group members doing the extra work begin to get cranky and upset. Pretty soon they get so upset they just quit the project and the whole thing comes screeching to a halt.

Now think of the group as your body, more specifically your upper body during a freestyle stroke. The person that has not been performing their job is your scapula aka your shoulder blade. The pressure of the deadline is you asking your body to perform a certain task, like a sprint freestyle event. The group members that are complaining usually stop working and cause pain i.e. your shoulder/rotator cuff.

The human body is an amazing machine of form and function. Every day we ask it to perform complex tasks and it comes through flawlessly. On occasion, there is a glitch and we experience pain or stiffness. Despite how complex the systems are that allow us to move our bodies, they can be simplified by a very intuitive description developed by Gray Cook and Mike Boyle. It is called the joint-by-joint approach.

The joint-by-joint approach elegantly simplifies this so that we can begin to understand why this happens. The segments of joints in our body primarily work in one of two ways:

Provide STABILITY

-or-

Allow for MOBILITY

The joints work in an alternating pattern from there in the following configuration:

Foot: Stability
Ankle: Mobility
Knee: Stability
Hip: Mobility
Lumbar Spine: Stability
Thoracic Spine: Mobility
Cervical Spine: Stability
Scapula (scapula on the rib cage): Stability
Shoulder: mobility
Elbow: Stability
Wrist: Mobility
Hand: Stability
When one joint is not able to fulfill its intended function it can lead to pain in that area as well as others. This is why often times we will be working with multiple regions of your body to restore full function of all segments. Common patterns we see are:

Loss of thoracic mobility leading to decreased stability of the scapula causing shoulder pain.
Loss of hip mobility, leading to decreased stability and low back pain and knee pain
Loss of foot stability leading to ankle stiffness and pain.

These patterns can even be separated by larger distances and to the untrained eye, these patterns will go unnoticed. Dysfunction in the left hip can sometimes lead to issues in the right shoulder. This is why treating the source of the pain may not always be the solution. Full body function is required for the function of any single joint.

Dr. Jake Salaz has been involved with swimming for the past 15 years. After setting school, district and state records at Sam Barlow High School located east of Portland, Oregon he swam collegiately for the University of Washington on athletic scholarship. In 2008 he qualified for and competed at the U.S. Olympic trials in the 100m and 200m breaststroke. After finishing his career in the water, he was hired as the Head Coach of Maverick Aquatics where he worked with the top age group and senior teams, winning the Age Group Coach of the Year award in 2012. As a coach he became frustrated with the injuries to swimmers that seemed preventable, so in 2012 he decided to go back to school to earn his Doctorate of Chiropractic as well as his Master of Science in Exercise and Sport Science from the University of Western States. His training has led him to specialize in movement assessment and exercise rehabilitation to better treat the injuries associated with swimming in particular. His clinic is conveniently located within a mile of the Mt. Hood Aquatic Center.