Ever had shoulder pain get in the way of your workouts, your hobbies or even your home life? Have you tried a bunch of random advice you found on youtube or Google but to no avail?
The shoulder is a complex joint and for some, it can be nearly impossible to resolve shoulder issues without knowing precisely what your unique dysfunction is in the first place. In this article I intend to help you demystify your own shoulder problems by giving you the conceptual tools to understand it.
In my neuromuscular therapy clinic I see clients with shoulder pain nearly every day, and in every case I check one thing first, the position of the shoulder blades.
The shoulder blades are an integral part of the shoulder joint, providing the bridge of stability between the core and the arms which either allows or disallows the mobility of the shoulder joint.
And while most joints in the body have bony connections, meaning bone on bone separated by only some cartilage and synovial fluid. The human shoulder blade is attached almost completely by muscular attachments. It is suspended over the rib cage by a number of muscles all pulling on it in different directions.
If there is any asymmetry in the strength or length of these muscles, the shoulder blade will be pulled out of neutral alignment and dysfunction of the shoulder joint will occur.
The shoulder blade must sit in a roughly neutral position to allow for the shoulder joint to move in all directions. In the short term, problems often arise during intense movement patterns such as lifting, when the lift is done with the shoulder blade in the improper position. This can quickly cause injury and is usually caused by a lack of understanding about scapular motion and a lack of control of scapular position.
This can be rectified by learning to move the shoulder blades properly and there are a number of ways to do that, with the best way for each individual depending on what activities they are presently engaged in. For instance I would suggest a weight lifter or calisthenics practitioner learn scapular pull ups and scapular rows as a starting point, since it will quickly yield results in relation to strength training.
For someone involved in athletics, Indian clubs might be the ideal starting point because they train the shoulder blades to move properly during athletic style fluid motions such as throwing. If the individual is not engaged in training and is instead spending a lot of time at work either at a desk or doing labor, a good suggestion might be Tai Chi or Qi Gong. Both of these practices will build the habits of good shoulder mechanics while also teaching proper standing posture and stress reduction at the same time.
Long term problems tend to be created by poor shoulder mechanics becoming a habit and being built into the tissue of the joint itself over time. Poor shoulder posture will result in tight or overly weak muscles within weeks, tight or loose ligaments within months and within a few years the mal-adaptions can be found in altered bone shapes.
At this point a more intense intervention is usually needed to alter the tissue and allow for proper shoulder blade movement. Self massage, stretching, mobility routines, rehab exercises and body work all help in this way and many of them may be necessary to bring the shoulders back. The problem is often that one doesn't know which muscles need strengthened and which muscles need stretched or released. This is where scapular position comes in.
Scapular mapping is the process of observing your own shoulder blades and seeing where they rest on your back. The position will tell you a lot about which muscles are tight and which are weak. This is easier to do with another person observing and it's even easier if that person has a trained eye. However this can be done by oneself with just a little bit of effort and investigation.
Set up your phone or camera to take a photo with a timer. I usually set my camera up and give myself 10 seconds to get in position before the photo is snapped.
You'll want to stand directly in front of the camera with your back turned to it. You'll also want direct overhead lighting in order to cast harsh shadows, making the shoulder blades easier to see.
Stand in the most natural way possible. People often have difficulty with this and they stand in a manner that is unnatural to them because they know a photo is being taken. But this photo is only for you and it will be of no benefit if it doesn't show the truth, so strive to stand as you normally would, no matter how slouched or silly it looks.
Once you have the picture, identify the shape of your shoulder blades. If I have a print out or a paint program on the device I usually draw over the image to help myself see it clearly.
Once you have the position of the shoulder blades identified, compare them to the pictures below and determine in which direction they appear to be skewed.
The dominant position of the scapula will tell you which muscles to massage and stretch and which to focus on strengthening. For instance, if you had protracted shoulders, which is very common, you would need to stretch and massage the pec minor and serratus anterior while strengthening the rhomboids and middle traps.
In this case the strength training program may want to prioritize upper back exercises like rows and take it easy on chest exercises until the imbalance is remedied.