Have Shoulder Pain? Read this.

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Shoulder injuries are pretty common. From torn rotator cuffs to torn labrums and SLAP tears, there are lots of way to mess up your shoulder. Most people think that they “tweaked” their shoulder and then went to the doctor. The surprising thing however is that most shoulder injuries can be easily prevented with proper exercise technique and programming. Today’s post will take a preventative side on how you can prevent future shoulder injuries.

Shoulder Anatomy

To understand how to prevent a shoulder injury, we must first understand 1) the shoulder’s function is and 2) what muscles are in the shoulder and what muscles support it.

The shoulder is a very complex structure. The shoulder has many functions including elevation, depression, abduction, adduction, upward rotation, and downward rotation. Because of its so many functions compared to other joints like the knee, there is a higher likelihood that it will be unstable.

Below is a picture of the front part of the shoulder. The basic shoulder girdle consists of three bones: the clavicle, humerus, and scapula. Attached to these bones are ligaments, muscles, and tendons that hold everything together so you can move your shoulder in many different ways.

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Front view of shoulder – image from           http://wellnesscenterofpasco.com/shoulder-program/

Beneath this is a picture of the back (courtesy of AnatomyClass123.com), which includes all muscles in the back, including those that attach to the shoulder girdle.

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Back musculature – image courtesy of www.anatomyclass123.com

The Negative Effects of Sitting

Unfortunately, due to most of us sitting all day and a combination of not knowing how to weight train safely and effectively, we begin to lose healthy shoulder alignment which leads to muscle imbalances and pain.

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Rounded shoulder posture while sitting – image courtesy of www.completewellbeing.com

Does the picture above look familiar? Whether you are at home or at work, this a position a lot of us find ourselves in for many hours during the day. Due to sitting internally rotated most of our days, our chest muscles (specifically the pec minor) and the long-head of the biceps (due to pull objects toward you a lot) get really tight and shortened. On the other hand, the upper back musculature gets very unstable in order to compensate for all the force pulling the shoulders forward. Thus, rounded shoulder posture develops, leading to the muscle imbalances as seen in the picture below:

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Rounded shoulder posture – image courtesy of www.posturedirect.com

In this posture fault, the upper traps and levator scapula (near the neck) get very tight as well as the pectorals (chest muscles). As stated before, this leads to weaknesses in other muscles (lower traps, serratus anterior, and deep neck flexors) as they try to compensate to pull the body into proper alignment. This posture develops over time and is exacerbated by not only sitting all day but by your exercise routine as well.

It’s a common problem that most gym go-ers work superficial musculature like the chest, biceps, back (mainly lats), abs, and anterior shoulders. These are all the muscles that people have traditionally known to be the “big muscles” that get you that defined, magazine-chiseled body look. Unfortunately what ends up happening is two things: 1) We forget about all the little muscles that need to be strengthened in order to support larger movements and 2) We focus on too many anteriorly focused, internally rotator-dominant exercises (chest press, bicep curls, lat pulldowns, crunches, etc.)

Over time, sitting and a poor workout routine take their toll. Soon you’re saying, “I think I tweaked my shoulder!” and running off to the doctor for an expensive X-Ray or MRI or cortisone shot. Most people think that they simply tweaked their shoulder and resting it will make it all better. Unfortunately, most of the time, this is the way our bodies are saying enough is enough.

So what should I do? I’m in pain!

Okay. So you tweaked your shoulder. Now what? In the initial stages of pain, rest! Ice helps and some gentle massage if it seems to help. Second, go see a doctor as soon as possible to rule out any tears or nerve issues. 

After you have rested your shoulder and the acute stages of pain have subsided, now is where stretching and strengthening come in.

The first step after the acute state of pain is to mobilize tight muscle tissue and stretch those areas. Simply stretching will NOT fix the issue, as stretching does not break up any scar tissue or tightened tissue below the skin. If you do not have any contraindications to foam rolling, I recommend picking up a lacrosse ball,  a foam roller, and a theracane.

While I won’t go into all the specifics on how to foam roll on this blog, I will link videos below in how to do the mobility exercises mentioned in this post.

The purpose of foam rolling is to break up the tight knots in the muscle tissue that develop overtime. Muscle knots disrupt the muscle, causing it to shorten and pull us out of proper alignment.  This is why we must work on these knots before stretching and strengthening weak muscles.

Steps to foam rolling include:

  • Find tight and painful areas using your lacrosse ball, theracane, or foam roller (muscles only, not bones or tendons!!)
  • Hold each tender spot for at least 30 seconds up to 2 minutes for tighter areas
  • Breathe deeply through your belly (in through your nose, out through your mouth). Relaxing while on a painful area is key to get the muscle to relax
  • Once you feel the pain start to subside, release.

Areas to mobilize include the thoracic spine, pec minor/major, latissimus dorsi, upper traps, biceps, and serratus anterior. Below are illustrations of these areas and an instructional video on how to do foam roll them.

Thoracic spine

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Thoracic spinal extension over a foam roller – image courtesy of Back to Basics 

This video also includes some very important tips to remember so you can do this one correctly. In summary, you want to not flare the ribs by thinking “chest to belly button.”

Pec minor

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Pec minor/major release – image courtesy of Witsup

It’s important to go easy on this one at first, as I guarantee, it will be very painful. As you work on it more frequently, you can increase the pressure once the tissues have adapted.

Latissimus Dorsi

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Foam roller use on lats – image courtesy of www.blog.nasm.org

Upper traps

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Theracane use on the upper trap – image courtesy of Lift Big Eat Big

Posterior deltoid

This one is hard to visualize, so here is a video on how to get to this one. The posterior deltoid is usually actually weak, but can get tight and restricted as it tries to constantly pull your shoulders back when slouched over.

Serratus anterior

Biceps/anterior shoulder

When we have rounded shoulder posture, this creates lots of stress on the biceps tendon as it tends to overcompensate for lack of strength in other musculature. One of my favorite ways to release the biceps and free up the shoulder joint, is by doing the following (thanks Kelly Starrett!)

After you have mobilized the areas described above with a foam roller, stretch these areas out to restore proper muscle length.

Okay, I mobilized the tight muscles, now what?

After we have worked on mobilizing the tight muscles shown above, it is imperative we begin strengthening the right muscles in order to restore strength and balance.

Exercises you will want to prioritize include ones that use the weakened musculature that comes with rounded shoulder posture. These include the rhomboids, mid/lower traps, rotator cuff, and posterior deltoid. 

Below are videos with instructions on how to perform exercises for each of the following exercises listed above:

Lower traps:

Wall slides – these help strengthen and activate the lower traps. Try your best to keep your back, upper body, wrists, and elbows against the wall. If you cannot reach the wall, continue trying over time but also continue working on mobilizing the areas listed above in this post.

Prone Y raise (regressed from full version) – This is a standard lower trap strengthening exercise. It’s surprising how hard this exercise is if you haven’t done it before. If you have any pain in the front of your shoulder while doing this one, stop and regress it to only lifting your elbows if possible. 

Mid traps

Prone T: This is a great exercise you can do on a bench or stability ball. Focus on initiating the movement from your shoulder blades squeezing together rather than just lifting your arms. Again, if you have pain in the front of the shoulder with this exercise, stop and focus on just getting the hang of squeezing your shoulder blades together. 

Rhomboids:

Bat wing Rows – This is a fantastic exercise that really focuses on scapular retraction (squeezing the shoulder blades together) and strengthening the rhomboids. 

Rotator Cuff:

Banded external rotation –  Since we are working to reverse the internal rotation (slouching of our shoulders), we need to work on the strength of our external rotators. The banded external rotation is a great exercise that accomplishes just that. 

Scaption

Posterior Deltoid

Band pull-apart (with palms up) – This is an excellent exercise that really works the posterior shoulder while keeping the shoulder in external rotation.

In summary:

  • If you are experiencing shoulder pain, first see a doctor to rule out anything really serious
  • Mobilize and stretch tight and overused muscles around the shoulder
  • Strengthen weak muscles to help bring back proper alignment

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