Now, the front of the shoulder – it was left off last post. The reason: without a stable shoulder blade, your “shoulder” doesn’t stand a chance of moving or feeling better. If the shoulder blade is sitting awkwardly or, more importantly moving awkwardly, you are predisposed to negative issues. It is typically the front of the shoulder that can become an issue because of overuse and lack of posterior support & alignment.
Look at this image of overhead shoulder flexion…this is where most people experience pain/problems. Can you see how the shoulder blade is tilted forward in the image of the man on the right lifting his arm up? Do you see how this limits how high he can reach? People still need to reach their arms up, so they continue to do so, but at the expense of the structures underneath. Like so many issues I see, people don’t typically realize this is dysfunctional until they have pain. The reason I would be seeing an individual in the clinic is not because of abnormal scapular mechanics…people don’t see me for dysfunction, the come to me because of pain. In this case, pain in the front of top of the shoulder, often.
So, let me give you another image and explanation of how that happens and what tissues are typically involved. This photo (while no where near comprehensive) shows the structures commonly impinged or over-taxed…both the long and short head of the biceps tendon as well as the supraspinatus tendon (bursa can be involved, too but is not pictured). Tendons are often a primary source of pain and absolutely need to be addressed. The biceps (both heads) seem to become overused, where the supraspinatus tendon more often gets impinged or compressed under inefficient mechanics.
Basically, this means that we overuse our biceps because they are in the front of the shoulder and assist in lifting our arm up, where the supraspinatus tendon is just simply susceptible to being pinched based on its anatomical position. This all causes inflammations, irritation, repetitive trauma from stresses placed upon it. So, as I said earlier, the front shoulder muscles OVER work. The rotator cuff is mostly in the back of the shoulder and are a muscle group that is traditionally UNDER worked. Not pictured in the close up image above are the pectorals which lay over the biceps and are typically shortened, further compressing the biceps and leading to poor positioning. The larger image below shows the deeper pectorals minor and the larger pectorals major (cut away at the arm and at the sternum). This depicts what I was speaking about with the front aspects of the shoulder/chest compressing the deeper shoulder muscles.
The positions and activities we do (or don’t do) every day contribute to our overall posture, skeletal alignment and loads we place upon our muscles/tendons and joints – this includes good and bad loads or stresses. We spend WAY too much time operating life out in front of us. I have spoken about this before, but it is worth repeating, as it continues to be one of the number one concerns I see clinically. I still say there is no such thing as perfect posture. Rather, we need to spend time reversing this forward alignment. Get up! Move backwards some. Stop rounding your shoulders and jutting your head forward. I will say, though, it is fine to do all of this slumping and be in what is traditionally deemed “bad posture.” That’s right, it is fine to be in “bad posture”. It is not fine, however, to stay there. You have to move and be more dynamic throughout your day. Explore all ranges of posture and body alignment. Your body will respond to the stresses placed upon it – good or bad. Interrupt and change what is ailing you. I have discussed this before, but I wanted to reiterate it once again. Try these exercises to engage the appopriate posterior musculature and reverse your forward posture.
– Back to wall shoulder “W”: place head, back, butt on the wall with feet ~12 inches away to start. Move your arms to place your elbows, forearms, hands on the wall making a “W” with your arms. Make sure not to allow your head or back arch off the wall. Pause here for 1-2 seconds and repeat for a set of 10 or so.
– Back to wall shoulder “W” to “Y”: Same as above, but slide your hands/arms up the wall into a “Y” position. Again, do not allow anything to come off the wall. This may be a perfect way for you to raise your arm(s) above your head, as your shoulder blades are in a more mechanically advantageous position to allow for greater clearance.
By limiting trunk extension (keep back on wall), you can gain shoulder/scapular range independent of spinal excursion. As always, do not move into pain. Difficulty and fatigue are great, but not pain. These are concepts with sound principles, but you always need to listen to your body and apply what other individuals (albeit healthcare practitioners) say accordingly.