The shoulder complex is one of the most complicated areas of the human body. There are many moving parts, but similar dysfunctional movement patters tend to give rise to pain and conditions that can be quite debilitating.
Shoulder impingement, rotator cuff tendonitis, bursitis. These are some of the names commonly given to overuse types of injuries at the shoulder, but they are all very similar in nature. In each circumstance, there is a lack of space in the front of the shoulder for the many structures and tendons to effectively move and glide amongst one another. This lack of space in combination with regular shoulder movement, especially over head, can result in inflammatory responses in whichever tissue is most compromised in the front of the shoulder. This inflammatory issue can be very irritating and if this not addressed, an individual may become prone to more significant damage such as a rotator cuff tear.
Dealing with this type of situation is not necessarily easy because we need to take into account several factors starting from the midline out towards the shoulder. Although the pain is usually experienced in the front of the shoulder, the underlying cause could be stemming from a proximal issue.
Let’s go through the most common culprits from the midline outwards, and how they can contribute to a lack of space at the front of the shoulder. We will also quickly discuss how to address them via self remedies.
Starting at the thoracic spine/upper back, the inability to extend and rotate through this area can really inhibit our ability to get our hands in an over head position without compromise. The joints between the vertebrae as well as the joints between each rib and its corresponding vertebrae are where we need to focus our intention when addressing this area. These joints can get stuck in a flexed position from a lot of sitting in what would be considered “bad posture”. Extending the upper back over a foam roller or performing a rotation exercise such as an open book is a great way to mobilize this region and start to restore its ability to extend and rotate.
The next key factor that plays a vital role in overall shoulder complex function is the shoulder blade’s ability to move and glide along the rib cage as the arm moves into an over head position. There are a few things that can go wrong here, but generally proper serratus anterior and lower fiber trapezius function will allow a posterior tilt and upward rotation of the shoulder blade to occur in order for a good over head position to be achieved. Therefore, good exercises to address this area would be variations of wall slide exercises.
The next piece to discus is the shoulder joint itself, which is also known as the glenohumeral joint. This is the actual ball and socket joint of the shoulder and sometimes the ball portion of this joint can be sitting slightly forward as a result of postural deficiencies or repetitive motions that bring the arm forward such as throwing. Again, this can take away from the available space in the front of the shoulder, so we can perform exercises that pull the ball portion of the joint backwards in the socket to help correct this deficit. The most effective exercises at accomplishing this are external rotation based exercises that work the posterior rotator cuff. This is where your classic banded rotation exercises come into play.
The last vital piece of the puzzle is making sure all of these areas are working together properly in a functional and stable manner. Doing exercises that call on all of the areas discussed above will ensure you are moving in a way that is not predisposing you to harm. One of my favourite exercises is the 90/90 upside down kettlebell carry. Stabilizing the kettlebell while walking will get the rotator cuff and shoulder blade muscles firing on all cylinders. You will also need to rely on good posture and even core stability through the upper back and torso to perform this exercise well.
In summary, to restore optimal function at the shoulder if you are dealing with these overuse type of injuries:
1. Promote extension and rotation through the thoracic spine and rib cage.
2. Ensure proper serratus anterior and trapezius function around the shoulder blade.
3. Strengthen the shoulder’s external rotators/posterior rotator cuff.
4. Bring it all together with an exercise that calls on all of the three previous steps at once and promotes stability.
Of course everyone is an individual, and this process may not fix all of your shoulder problems, especially if you have suffered an acute or traumatic shoulder injury or have gone through some form of surgery. But in general, if we can improve and maintain function in these areas, we will be better off when it comes to overhead and overuse situations that involve the shoulder joint. So give them a try and if you have any questions specific to your shoulder, feel free to reach out to us at Resilient Strength any time!