Shoulder Mobility

One of the most common issues I see amongst my patients is shoulder pain and immobility. It can be debilitating, especially if it prevents you from doing activities that you enjoy. One thing I have observed is there is often a sense of acceptance and cynicism regarding this kind of pain. Patients that I have seen for a long time sometimes don't disclose their shoulder pain to me until later. Ironically, that is exactly the type of issue that I treat in my practice.

It is important to note that I am not a medical doctor and not all pain is within my scope of practice. I can only address the musculoskeletal causes (or symptoms) of an issue. First and foremost, it is important to see a doctor and get imaging done to rule out damage to nerve, ligament, labrum, bone, etc. However, once you have ruled out those issues, we can address the musculoskeletal component. Even if shoulder pain is caused by a previously broken bone, although we can't fix the bone itself, we can address how the soft tissue has responded and adapted to the injury over time. An injured site will heavily guard itself and stop moving like it used to. A little gentle tissue work can keep the area from being unnecessarily wound up.

The main cause of shoulder immobility is positioning. If the head of your humerus (upper armbone) and/or scapula (that triangular bone in the back) have deviated from their normal positions, then you will not proceed through a normal range of motion as you lift your arm to shoulder level and above, particularly over your head, as in raising your hand to speak in a class or swimming. Imagine for a second the position you are in as you sit in a chair at a computer with your hands resting on a keyboard. If your shoulders were all the way back and you were sitting up straight, you'd be like a T-rex in relationship to the keyboard. You simply could not reach it. Try it right now! Unless your keyboard is below your chin, you can't reach it. In order to reach it, we internally rotate and protract or bring our shoulders forward. And as we become stressed throughout the day or if we have a particular proclivity for raising our shoulders up towards our ears, then we have thrown elevation into the mix.

If you have a desk job or spend time at a computer during the day, you may be doing so for hours. Unfortunately, being in this position has consequences. The muscles in the back responsible for keeping our shoulders back and spines straight weaken and the muscles in the shoulder/chest responsible for internal rotationprotraction, and elevation tighten from overuse. Over time we get stuck in this position. Sitting at a desk is one source, but others can include the way we sleep, right hand dominance, our other activities, and past injuries. I do my best to help my patients figure out the why and we often do, but sometimes it's a mystery. We can't see ourselves throughout the day and the small subconscious quirks that we have. See my previous post about subconscious holding patterns for more on this. 

Each muscle responsible for internal rotationprotraction, and elevation connects somewhere to the humerus or scapula. Muscles only pull, which means when they contract they pull whatever they attach to with them closer together. Let's return to the hands on the keyboard position. Without coming out of this position, without rolling your shoulders back outwards, try to lift your arm above your head. You can only go so far. From this position, the head of the humerus is not optimally positioned in the socket. While internally rotated, it runs into bone. The other actions we have described here exacerbate this. In a neutral position, the scapula rotates upwards as the humerus rolls in the socket allowing it space in your arm's journey upwards. The best way to understand this is to see it (and to feel it) so I have included videos below.

"What is the good news here? I'm in a suboptimal position and it hurts when I move." 
The good news is we can pinpoint a series of individual muscles that are holding your shoulder in internal rotationprotraction, or elevation so that it can return to neutral anatomical or normal positioning. From there, it will have the space to go through its range of motion correctly and the pain from impingement or grinding will diminish. If you suffer from shoulder pain, you most likely also suffer from poor scapulo-humeral positioning. Getting manual therapy will be key, but on your own you can practice good posture and being a T-rex at your keyboard. Straight back, shoulders as wide and down as can be. Better yet, try a standing desk! There are also stretches and restorative yoga poses you can do to open the chest and bring the shoulders back. Picture below!

--Razelle