Knowing what I know about biomechanics and anatomy, I would still have to support the idea that the shoulder is extraordinarily designed, but I would make the case that it should come with a detailed instruction manual of how to actually use it properly. Your shoulder is a complex ball-in-socket joint that’s function is intimately tied to the posture and alignment of your ribcage and thoracic spine. ‘Normal’ movement in your shoulder requires the ball to spin in the socket, the shoulder blade to slide over your ribcage and your torso to remain in a relatively stable position; a problem in any or all of these factors will lead to dysfunction and eventually pain in your shoulder.
It is not hard to determine what structure in your shoulder may be damaged and hurting, but it can be harder to understand why you damaged anything in the first place. Sometimes why is easy. You may have tried tackling a two hundred pound Kiwi rugby player determined to run through you and your shoulder lost the battle like mine did, but most of the time ‘why’ is more complex than you would like. Shoulder pain usually involves a combination of factors that over time lead to the insidious onset of pain.
Top 5 factors related to persistent shoulder pain: (The WHY)
(Click here to watch video Why Shoulders Hurt illustrating points below)
1. Poor posture in the mid-upper back
a. Too hunched forward
b. Too braced backward
2. Poor muscle balance around the shoulder girdle (tightness & weakness)
3. Poor awareness of proper shoulder blade-trunk stability
4. Bad movement patterns developed from sport or childhood
5. Alignment & stability issues in your upper ribs
Top 5 painful/irritated/damaged structures due to the above factors: (The WHAT)
1. Rotator cuff impingements
2. Biceps tendonitis
3. Strain in the muscles from the shoulder to the neck
4. Tension on the nerves from the neck to the shoulder
HOW the above WHYS combine to create the above WHATS:
When you lift your arm all the way above your head it may reach about 180 degrees, about 120 degrees of this movement should happen in the ball and socket part of your shoulder and about 60 degrees is accomplished by your shoulder blade upwardly sliding on your ribcage. Most shoulder problems arise when something restricts the proper movement of your shoulder blade. Having a really rounded upper back will naturally tip your shoulder blades too far forward. Having a really flat upper back may allow your shoulder blades to rest too low on your trunk. Having a sway back and over activity of your lats will cause your shoulders to sit too low and restrict the upward movement of your shoulder blade.
When you attempt to lift your arm up and the shoulder blade is either starting in a bad place or just not moving well, you will force too much movement to happen in the ball in socket joint and are way more likely to pinch or rub very sensitive muscles or tendons. Your rotator cuff isn’t one structure, it is four muscles that work together to help hold the ball in the socket; these muscles (as well as your bicep) turn into tendons and attach all around your shoulder. Pinching these tendons under one of the bones of your shoulder blade called your acromion is the most common cause of acute shoulder pain and is referred to as a rotator cuff impingement.
Acutely pinching a tendon in your shoulder can be very painful and can result from one specific incident, or over time, by moving poorly and repeatedly rubbing a tendon and creating too much friction. The latter can lead to tendonitis and or bursitis in your shoulder. ‘itis’ simply is a suffix meaning ‘inflammation of.’ So tendonitis is just inflammation of the tendon and bursitis is just inflammation of the bursa. The bursa is a thin fluid filled sac that you have around most major joints, they are like airbags for your joints. If you start developing too much friction by moving poorly, they swell up and get inflamed; resting them and icing them helps, but you have to fix the movement problem to make them stay away.
The neck is closely linked to the shoulder by both muscles and nerves. There are a handful of muscles that attach from your shoulder up into your neck and it is very common for persistent shoulder problems to irritate the neck and compound the problem. The nerves that come out of your mid to lower neck are the electrical wiring for all the muscles in your shoulder and arm, so if they get annoyed you will likely end up with some referred pain and muscle tension into your shoulder, arm and even fingers. Nervy arm pain will just further degrade your movement patterns and can start a vicious cycle of your shoulder irritating your neck and your neck irritating your arm; if this is the case, calming down the neck irritation should become priority one.
Muscles from shoulder to neck. Nerves from neck to shoulder/arm
Following a process of Release, Re-educate, Rebuild is the best way to fix most shoulder problems with lasting results. If you have got to the point of pain, you likely have a handful of muscles that have tightened up and are making ‘normal’ movement challenging or even impossible; releasing these muscles is an important first step to decreasing pain and restoring movement. I have found that Intramuscular Stimulation (IMS…click here for details) is hands down the best way to release the bracing muscles around a joint. Once muscles have been released, pain is typically significantly improved and movement is easier. Establishing proper movement and control of your shoulder is what I mean by Re-educate and it is the key to preventing shoulder problems from surfacing again. If you spend the time addressing your posture and arm movements before attempting to strengthen anything you will get to where you want to be faster and end up functionally stronger. Once the movement dysfunctions have been corrected, shoulder, core and general body strengthening exercises can be very helpful for prevention and performance of your arm.
The following videos illustrate some of the concepts and exercises I am talking about:
Please leave a comment below if you have any questions and I will try my best to answer them.