Whether or not you have had shoulder pain, there is a high possibility that you will encounter it at some point in your life. If you are active or not, there are various reasons why someone may develop shoulder pain.
Some of those reasons can include:
Soft tissue tightness/restrictions
There are various reasons why someone may suffer from a bout of shoulder pain. This is definitely not an all encompassing list, but multiple factors on this list can contribute to shoulder pain and dysfunction.
Here, I will offer a 3 techniques that may help improve your shoulder pain.
1. Soft Tissue Restrictions
Various areas of soft tissue dysfunction can include:
Pectoralis Minor Long Head of Triceps
photo credit: rad.washington.edu photo credit: www.webs-for-fitness.com
Levator Scapulae Infraspinatus/Teres Minor
Teres Major Latissimus Dorsi
There is typically more than one offender when it comes to shoulder pain as to which muscle may or may not be a contributing factor. What you can do is perform some type of self-myofascial release (SMR) with a lacrosse ball or tennis ball.
Key Points to Consider:
-Avoid bony prominences (bony areas) ie. butt bone
-Enough pressure where there is discomfort, but not so much where you are:
-Holding your breath
-Wincing in pain
-It should be tolerable.
Here is a video demonstrating, in the order above, how to perform SMR:
The reason many of these muscles can affect the shoulder is because all of them attach on the scapulae, humerus, or both.
photo credit: www.highlands.edu
Lack of soft tissue extensibility in these areas can change how the scapulae, humerus, clavicle, ribs, and neck all move.
There are various schools of thought on why people have pain. Some of them include:
Pain Science: where the brain and the nervous system perceive a threat to the body and cause pain and muscles to increase in tension to decrease the threat or prevent an increase in the threat.
Biomechanical: where soft tissue or joint tension causes a change in alignment of various joints causing a change in the mechanics of how a certain joint moves. In turn, causing increased stress to be placed on certain structures resulting in pain.
Poor Posture: where a poor postural position places people at risk for orthopedic health concerns.
Some of these reasons may not cause shoulder pain immediately, but over time this can cause the threat to continue to increase and then eventually reach a pain threshold. Typically, pain is the usual complaint from people that bring them to physical therapy or when they mention it to their personal trainer or strength coach.
By trying to improve the soft tissue quality of the aforementioned muscles, it can improve the function of the shoulder and the other surrounding areas.
2. Scapulo-humeral rhythm
The scapula, also known as the shoulder blade, can have a huge impact on the health and wellness of the shoulder joint. Sometimes the scapula moves way too much and is considered hyper-mobile and other times the scapula is “stuck” and is immobile, or hypo-mobile. Again, there are various reasons why someone may present as one or the other.
According to the Joint by Joint Approach, developed by Gray Cook and Mike Boyle, says that the body alternates between mobile and stable segments, as seen below.
photo credit: nicktuminello.com
As seen in the picture above, it shows that the scapula should be a stable joint. This is a great model and what it represents can affect many aspects of the body. Some people will think that each segment, whether it is mobile or stable, can only be mobile OR stable and nothing else. After studying the Joint by Joint Approach, we must dig a little deeper than stating that a joint is ONLY mobile or ONLY stable.
All joints in the body must have a certain prerequisite range of motion or “mobility.” If we are lacking a particular amount of motion, this can affect the joint above or below that particular joint, if not other joints causing compensations throughout the kinetic chain.
On the flip side, all joints in the body must have a certain prerequisite amount of stability. Sue Falsone coined the phrase that stability is “controlled mobility.” We need to be able to move throughout an excursion of range of motion, but must be able to control that range of motion as well. Otherwise, the joint could potential be unstable. When I say "unstable," I don't mean that your shoulder joint is going to shoot down the street.
What I mean by "unstable" is that the bones that comprise a particular joint won't move about a particular rotation point. In turn, this can cause the bones to move around too much in various directions and cause irritation to other structures. Stability means that the joint is operating properly so that it is moving around a certain axis of rotation.
So, after that discussion, certain joints in the body may need to be “more mobile” that others, but they all need to have “controlled mobility.”
Back to the scapula! If we lock the scapula down and back, such as when we perform a rowing variation of an exercise,
photo credit: onlinetrainingsschema.nl
and don’t allow it to move through its particular range of motion, this can cause the scapula to not be able to move through its full excursion of motion.
Well, when would we want our scapula to be able to move through a partial or full amount of motion? Anytime you:
Move your arm
Whether it be for reaching overhead during daily activities or when we are trying to lift overhead in the gym, the scapula needs to be able to move properly. Otherwise, this can cause problems at the gleno-humeral joint.
Here is a video of someone “pinning the scapula down” during a rowing exercise:
Here is another video of someone allowing the scapula to move properly:
In the second video, we are not allowing the entire trunk to round over . We are allowing the scapula to go through protraction and retraction during the rowing movement.
If we pin the scapula down and back and don’t allow it to move, this can and will decrease the amount of scapular movement, specifically scapular UPWARD rotation.
For example, if you were to raise your arm overhead, we need a certain amount of scapular upward rotation for healthy shoulder and arm movement. When we first start to move the arm, there is very little scapular movement. The humerus on the glenoid accounts for the majority of the movement. Once the humerus gets to 90 degrees or to shoulder height, then the scapula has to start to move. If the scapula doesn’t move, then the humerus will have to compensate for the lack of scapula upward rotation and can cause a whole host of issues from:
Rotator cuff tears
Rotator cuff tendonitis/tendinosis
Rotator cuff impingement
Once the humerus moves above shoulder height, we would like to see a 2:1 ratio of humerus:scapula movement. Therefore, if someone has 180 degrees of shoulder flexion, they would normally have 120 degrees of humerus movement to 60 degrees of scapula movement.
By locking the scapulae down during a particular upper extremity exercise, this can alter the shoulder biomechanics and potentially cause issues at the shoulder.
So instead of “locking the scapula” down, allow the scapula to move during rowing and pressing variations.
Some correctives that can help with this are:
Back to Wall Shoulder Flexion
-Low Back and Head flat to the wall
-Imagine like something is an inch in front of your finger tips and you are gently trying to reach for it as you get above shoulder height.
-Think of tilting your shoulder blades back as you raise your arms up.
Forearm Wall Slides
-Ribs down/Abs on.
-Once the elbows get above shoulder height, think of gently pushing your torso away from the wall as you slide your arms overhead.
These exercises have cues that will vary from client to client. These exercises will also not help everyone. Each and every client needs to be assessed and given these correctives only when appropriate.
3. Breathing Patterns
The last topic from above that we will cover has to do with breathing patterns. Now, I know breathing patterns has gotten a lot of attention lately. People always ask how breathing can affect shoulder pain.
Well, now that you are intrigued as to why and how it can affect it, let’s talk about it.
First off, a basic anatomy review. In the human body, the diaphragm is innervated by cervical nerve roots C3-C5. The job of the diaphragm is to assist the body in inspiration and expiration, or
breathing in and out.
photo credit: en.wikipedia.org
There are other muscles such as the intercostals (muscles between the ribs), sternocleidomastoids (SCM), pectoralis minors, and scalenes that can also assist with inspiration.
Ideally, the diaphragm should perform the majority of breathing activities. If we are exercising, in distress, or another activity where we may need to breathe quickly or deeply, then those other muscles mentioned above can assist.
Where breathing patterns and how someone inspires and expires matters is:
First, we ideally want to see someone initiate their breath from their stomach. The movement of the abdomen expanding is due to the diaphragm descending and compressing the abdominal contents to allow for the lungs to fill with air.
If we don’t see someone initiating their breath from their stomach, it can emanate from other areas. Sometimes, we see the initiation via the ribs moving out and/or up OR muscles surrounding the upper chest and neck assist in raising the shoulders to bring air into the lungs.
Now, I am not saying that the ribs and/or upper chest/neck shouldn’t assist with breathing, but we want to make sure it starts with the diaphragm as the primer mover for inspiration.
Last, we ideally like to see the abdomen expand 360 degrees and see a cascade of movement starting with the stomach and eventually the chest to rises. By seeing this cascade of movement, we know that all the parts are working together to assist with breathing. We do not like to see just belly breathing or chest expansion.
The lungs span from just superior to the diaphragm to the clavicles. Expansion through these areas are necessary during deep breathing for proper lung expansion.
photo credit: interactive-biology.com
So, how does someone’s breathing patterns affect someone’s shoulder pain.
Well, if someone isn’t initiating their breathing with the proper areas and the other accessory muscles are working overtime, eventually they can start to fatigue and develop trigger points. With these overactive accessory breathing muscles, they can have an increase in tension. This can then alter the mechanics of how the shoulder joint moves and in turn can place undue stress on other areas, ie. rotator cuff, etc.
Another thought process is that if we continue to breathe primarily using accessory muscles, this can send a message to the brain that there is a threat to the body.
For example, many years ago, our ancestors hunted and gathered their food. If they encountered a wild animal and had to run away quickly, their brain would tell their body to get air in and out in order to provide oxygen to the muscles to help them run away, whether they used their diaphragm or not.
Now, if we breathe like our ancestors did when they were being chased by a wild animal, we are subconsciously sending a signal to our brain that we are in a threatened state. Whether we are truly threatened or not, this will cause the body to "tense up" certain muscles and can alter movement in various areas of the body.
If we don’t address our breathing patterns to some degree, we can do all the soft tissue mobilization, smashing with a lacrosse ball, etc. and the “soft tissue tension” will still be present.
If you notice that you or your client are not breathing properly or after multiple attempts to decrease that tension with a lacrosse ball, the tension is still present, here are a few different correctives that can be done at the beginning or end of a training session.
Here are some videos that may help:
Prone Crocodile Breathing
-Expand abdomen 360 degrees especially into the ground.
Supine Hands on Chest/Belly Breathing
-Make sure abdomen hand rises before chest hand.
Supine Hands on Sides Belly Breathing
-Make sure abdomen rises prior to chest.
-Allow for 360 degree expansion into hands when inspiring.
Give these tips a try and let me know what you think!