Easter Monday’s edition: what you might not know you don’t know about…Fixing Shoulder Pain!

Since I started my strength & conditioning role working exclusively with volleyball players, I had no choice but to get good at dealing with shoulder pain right away. Since then I’ve come to see that while shoulder pain is wildly prevalent in overhead and throwing sports as expected, it is also a major concern and limiting factor for a ton of other people. So I’m hoping today’s post will shed some light on what I’ve found to be the missing link in creating bulletproof shoulders.

So let’s start with the basics.
The Joint by Joint Approach gives a roadmap for how to understand the roles of different parts of the shoulder.

The Joint by Joint Approach gives a roadmap for how to understand the roles of different parts of the shoulder.

If you’ve been reading along with my posts you know by now that I’m going to preach something about the importance of mobility, but that mobility doesn’t solve the problem, it will only allow the body an opportunity to upload a better movement pattern etc, etc. You’re damn right I’m going to do that. 

Because shoulder pain is SUCH an easy fix if you stay true to the principles of how your body works and deal with them in the right order. But it can be an ongoing struggle if you cut corners.

This is a good time to understand the Joint by Joint Approach if you don’t already. This is a beautifully simple theory put forward by Gray Cook and Michael Boyle that explains how each joint in the body is built for either a primary role of mobility or stability, and if one joint messes up its role, the joints above and below have to switch their roles as well. This is particularly important when we get to the shoulder, because when we think we’re dealing with the “shoulder” – what we’re really dealing with is the thoracic spine (upper back, should be mobile), scapula (shoulder blade, should be stable), and the glenohumeral joint (the actual shoulder joint where your arm attaches to your shoulder blade, which should be mobile). Actually there’s much more to look at because this area wouldn’t be attached to your body without the clavicle and sternum, but we’ll take those for granted for right now.

So when we have shoulder pain – say it pinches in the front or hurts when you lift it up overhead – most often the pain is right around the glenohumeral (GH) joint. This joint should be the most mobile in our body, and when it has that full range of motion we rarely see many issues right at the shoulder joint. It’s when the GH joint starts to get tight and limited that we see a host of issues. This is the case outlined in the Joint by Joint Approach where a joint built for mobility starts to assume a stability role.

This shoulder mobility test gives you a general view of how your shoulders are moving. You should be able to easily touch fingers on each side without pain!

This shoulder mobility test gives you a general view of how your shoulders are moving. You should be able to easily touch fingers on each side without pain!

So “bad shoulder!” right? Or…smart shoulder? Why is it getting tight?

More often than not it’s because the aspect of the shoulder girdle that should be providing stability – the scapula – doesn’t do a very good job of that. This is basic, well known stuff and anyone who’s had a shoulder injury can attest to the fact that they always need to improve “scapular stability”. However we know this doesn’t always work. In fact I frequently see it fail if the mobility restrictions on either side of the shoulder blade aren’t addressed. Do all of the TWYL patterns and wall slides you want, but if the thoracic spine is still tight and not rotating, the shoulder blade will always give up its stability role to produce movement, which leaves stability to the muscles surrounding the glenohumeral joint – muscles that are not built to do the role of stabilizers and constantly be “on”. This is when we find a chronically tight neck, chest, biceps, triceps, and lats.

So this pattern is just one common example that I see a lot of – of course I’ve left out the essential need to look at the whole body and see why the thoracic spine might be tight, but that will have to wait for another post.

On to the fun part – how to fix it once and for all!
  • First make sure the thoracic spine is moving well (lying rotation type stretches)
  • Next clean up the mobility limitations at the glenohumeral joint that we know are secondary to an instability elsewhere
  • Finally, reset the stability around the shoulder blade and the torso, starting with closed chain, weight bearing stability exercises like sphinx pose and crawling-type patterns. This is how your shoulder first learned stability and what it’s most receptive to to relearn it. Then comes all the typical scapular stability exercises.

Ok, so I apologize for having gotten a little off track today, this isn’t meant to be a technical blog post series about how to fix everything all the time forever (not a bad idea though…), but I had to lay down the basics of shoulder repatterining to give some context for my “what you might not know you don’t know” topic. If you didn’t know all of the info above, no worries, now you do.

Kettlebell Armbar - a great way to teach the shoulder a neutral position and generate reflexive stability.

Kettlebell Armbar – a great way to teach the shoulder a neutral position and generate reflexive stability.

When the above guidelines are followed well, I’ve seen one thing that can make a near-quantum leap in how the shoulder integrates all of the work you’re doing for it. This is joint centration – which effectively means where the head of your humerus (arm bone) is sitting in your glenoid fossa (part of the shoulder blade it attaches to). Go ahead and poke around your shoulder if you’re not already doing it. With sitting and using our phones being the new black, most of us have some nasty forward shoulder positions going on, and the joint has a tendency to get temporarily “stuck” in this position. Certainly if you see a therapist to open up that shoulder movement this is one of the things he or she will do for you, to get the joint sliding well again, but often it returns to its old pattern quickly. This is why I want everyone to be aware of the exercise that my athletes and I have been calling “Shoulder Sorcery” for quite a while: the Kettlebell Armbar. 

Not only does the proper execution of this exercise stretch out the anterior part of your shoulder and return it to good posture, it also requires reflexive stabilization for your shoulder to stay in this new position, which uploads that new stability pattern right away. 30 seconds of this can often create changes that days of stretching and tubing exercises fail to produce.

A few rounds can leave the shoulder back in its ideal position, taking pressure and stretch off of the areas that were painful, and giving the go ahead for the shoulder to generate more strength through larger ranges of motion. That sounds ok, right?

One of the reasons it’s not super well known is because it’s quite technical to get into, and it’s high risk if you don’t know what you’re doing. Generally done with a kettlebell for the off-centre loading factor, a light dumbbell is a good way to get started and teach your body the position.

Here’s a video of me walking an athlete through one round of it.

So before you jump into trying the Kettlebell Armbar, remember that its strength is in being applied to a larger picture of shoulder repatterning. Don’t forget about the thoracic spine mobility and ground-based stability for the scapula, and don’t forget to address weak links elsewhere in the body, especially if they are asymmetrical.

Tons of technical information today so feel free to send questions my way, call in for a free consultation, or book in for an assessment to learn how to apply the right corrective exercise tools for you! If you want to go deeper into this stuff and gain the skills to become your own movement coach, the next Empowered Athlete Workshop is coming up soon and will do just that for you!

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