Out of all the injuries to work with, shoulder and neck pain would be the most difficult. There is just so many factors at play, it can lead you a wild goose chase as to what is the problem and you could be using exercises and treatments that aggravate the problem instead of correcting it. Shoulder and neck is also extremely common these days with the evolution of more sedentary office jobs forcing people to sit for long hours, and without corrective program to address postural and movement imbalances, a simple tight shoulder can turn very quickly into a much worse condition that can last a very long time. Physical therapy, massage, acupuncture, and various other soft tissue release treatments are all great strategies to begin with and they may even get you out of pain, but they will not resolve your problem for good. Why? Because it is only a part of the problem, you still need to address the movement and stability requirements of all the moving parts around the shoulder. Ask any good Chiropractor what frustrates them the most with their patients who never seem to improve and they will tell you that they do not do the corrective exercises they need to do to hold the adjustment. We have been so conditioned to react to injuries by using pain relief methods, not look at why you got the problem in the first place. This article we show you what the 3 Key things you need to do to ensure your treatment holds and you get rid of your pain for good.
Get Our Free Shoulder Pain Checklist Below
As this can be a very complex topic to explain and there are so many things you may need to assess and consider, I have provided you with a simple checklist to follow to assist you in finding out where to start. This is a one page list taken from our Special Report on Shoulder Pain that includes all the assessments, exercises with pictures and instructions complete with a 6 phase program that you can get by clicking here. At the bottom of the page I provide more detail on this and highly suggest getting a copy if you have shoulder pain now.
But to start with download the Free PDF checklist below so you can follow me as you read through this article.
What Are The 3 Key Factors?
There is so many types of shoulder injury and neck pain conditions it is important to get a diagnosis from a qualified health practitioner first to know exactly what your problem is. The worst thing you can do is self diagnose your problem which could lead you to completing exercises that might cause you harm.
Common shoulder injuries include:
- Rotator Cuff Tears. (very common in sports like Tennis, baseball, cricket)
- Arthritis of the Shoulder
- Shoulder Impingement
- Chronic Shoulder Instability
- Biceps Tendon Tear at the Shoulder
- Shoulder Trauma (Fractures and Dislocations)
Now it is impossible to give you a one size fits all approach to correcting your problem for the causes of each of this may be similar but also very different. And to be honest that is the problem with most health programs is with using a one size fits all model or template instead of treating each person individually using tests and assessments to guide you on what is needed. What you will find is that some people will need a series of mobility drills, stretching and massage whereas others will need more stability and strength training exercises to correct their problem. Use the wrong method and you can make matters worse!
But having said that there is 3 key concepts specific to ALL shoulder injuries that must be addressed. These really relate to relearning movement patterns that coordinate and sequence ideal and optimal movement mechanics.
These 3 key concepts specific to the shoulder are:
- Optimal Thoracic extension and mobility
- Posterior tilt of the scapula
- Upward rotation of the scapula
We will cover each of these concepts in detail. Below is a good video to watch where I explain this.
1: Thoracic Extension & Mobility
This is first and for very good reason. The spine is the structure from which all our limbs are supported. When the main structure has problems, the limbs will be put into positions that expose them to potential strain and injury. Rigidity in the thoracic spine is often the cause of many shoulder and neck pain cases. It is also often left untreated as this is not the area in pain, but make no mistake it will be definitely the source in more cases than not. The role this plays is both extension and rotational mobility. Without either of these two things and problems arise. The causes of thoracic stiffness are linked most times to sitting, but you must carefully consider breathing dysfunction whenever you see thoracic extension problems. Breathing problems can be created from things such as asthma, anxiety or just poor breathing in general. But it can also be linked to poor exercise choices such as planks and crunches that force the rib cage to be locked down and into a tight and rigid position. This forces the person into a very hunched posture known as kyphosis and eventually with enough time trigger points develop and then the spine itself stiffens up. This has ramifications to not just the shoulder but also the lower back, as both the joints above and below are now forced into finding mobility that has been lost at the t-spine.
First you must assess your ability to extend your spine and you can easily do that by completing a postural assessment.
Watch the videos below to see how to do this, and the second video explains how the thoracic stiffness ruins the shoulder.
Next you need to assess your mobility in rotational movement. It is common for us to see good extension but poor mobility and vice versa. Easy way to test this is by using the corrective exercise for it as a test. Watch the videos below.
Make sure you read our article Do You Know How To Breathe Correctly for more information on how to assess and improve your breathing function.
2: Posterior Tilt Of The Scapula
After addressing your thoracic stiffness it is time to look at the scapula and how this functions. If you have shoulder pain and your assessment of your thoracic spine is fine, then you will find problems here. The scapula is very unique in that it needs lots of mobility, but not too much for it needs stability too, but not too much! You can see why shoulders are so hard to work with. The muscles in this area that focus on controlled mobility of the scapula include the trapezius, and very much the lower trapezius muscle. We also have the middle trapezius and the upper trapezius and rhomboids. The lower trapezius along with serratus anterior are such important muscles because it is what keeps provides the stability and optimal alignment and function of the shoulder. Unfortunately these muscles are both prone to weakness, and becoming lazy and disabled causing all sorts of compensatory movements that lead to pain.
Exercises used to obtain this are the most common ones used in most corrective programs, Pilates studios and various other treatments for shoulder pain. The cue, "pull your shoulders down and back" is often prescribed here, but this can lead to more problems such as a depressed shoulder and create problems with upward rotation which you will see next. Retraction of the shoulder muscles is a normal part of bio-mechanics during the phase of pulling exercises, and also in the easier phase of pushing exercises. However over doing these exercises or consciously squeezing hard between your shoulder blades can completely disrupt the timing and sequence of how the shoulder needs to move. So while exercises will be needed to provide the correct alignment of the scapula, you need to not force the shoulders back and down. Better cues are to think stand tall and use your breathing to provide a neutral posture.
Best exercises for this are varied. My favorites are deadlifts and single cable pulling exercises but when working with someone in pain I will use more gentle movements to retrain before progressing to the more strength type exercises.
And possibly the best ones to use is the wall slide featured below.
3: Scapula Upward Rotation
This is obviously linked very closely to the last 2 phases and is where we start to see the arm move. With shoulder pain and neck pain it is when the arm moves overhead that will often bring on the pain and discomfort, and this has a lot to do with how the scapula moves when you lift your arm. Again if the previous two steps are not addressed then you are already beginning in a poor place and inevitably will continue and end up in a bad place! But sometimes people have the first two steps and not this last one. I myself was one of them. After doing too many chin ups, deadlifts and rowing movements I created a depressed shoulder where my muscles in my upper back were pulling the scapula down, so when I tried to lift my arm I had to force through stiffness that eventually lead to a supraspinatus tear! My solution was to learn how to achieve upward rotation and the drills featured above and also the one below is where my training started.
When the arm moves we must see mobility of the scapula as it wraps around the rib cage and this is where serratus anterior plays a big role and many of the corrective exercises will have a strong focus on this.
You are by no means finished and there is many other things you still need to do in order to make these drills and key elements "stick". But this gives you a great starting point and these should enable you to remove your pain and help you move to the next phase being strength training.
Get The Step By Step Guide To Getting Rid Of Shoulder Pain
There is a lot more stuff you need to do to complete the job but this article has shown you what we regard as the critical 3 elements before any strength training can be done. And it must, if you want to get rid of your problem for good! Our new special report on Shoulder Pain is by far the most detailed report we have ever put together, for as you have just seen the shoulder is so complex and tricky to work with. This report takes you through ALL of our assessments and then provides you the guide on what to do based on your results and maps out 6 programs. CLICK HERE to see more of what is inside, or click on the image below to go straight to the shop and get your copy right now.
Summary
I hope this article helps explain how these 3 concepts if applied correctly will help address almost every type of shoulder pain problem. The laws of good posture, alignment along with optimal movement cannot be broken or ignored. Treating muscles without addressing how they actually move together as a team is why so many people can wasted months, if not years trying to get rid of their pain! It does not have to be that difficult, and I hope this sheds some light on what can be a very confusing and complicated injury. There is many other parts you will still need to address such as integrating with the lower body, and assessing your hip and pelvic function, but these 3 concepts if implemented effectively will get rid of your pain and allow you to move to the next phase of your treatment or training.
If you live in Melbourne and would like to know more about any of our programs you can request a Free postural and movement assessment by filling in the form below. I will be in touch within 24 hours to schedule a time.
