As vast and interconnected as the human body is, one can see how one issue, either injury or a pain site is contributed by multiple factors. Case in point: da shoulda! As I continue to grow as a coach I realize how many factors can contribute to one symptom or issue. Luckily, there are tremendous athletic development coaches, physical therapists etc. that provide practical information that help with treating athletes or any one that wants to be pain-free in their lives. Shoulder pain or the possibility of shoulder pain occurring can be caused by a variety of reasons (or lack of something). Let’s look at 6.
1) Scapular stability: hear it time and time again. Basically 100% of shoulder problems involve some scapular dysfunction. Instability of the shoulder blade will hinder the optimum generation of transfer of force in rotational sports and obviously if the scapula is unstable it will not let the gleno-humeral joint (GH) stabilize in the socket efficiently. A great analogy is that you cannot shoot a cannon from a canoe.
2) Thoracic Spine Range of Motion: I had a post earlier on the impact of the thoracic spine. Basically, when you have really poor t-spine ROM it changes the position of the shoulder blades which alters GH position. Most people are stiff here and incorporating t-spine mobilizations can almost immediately increase ROM at the shoulder joint.
If the hand behind the head is bothersome, then try putting it on the opposite shoulder.
3) Cervical Spine function: This also correlates to the t-spine. If you have horrible posture like the hunchback, then to keep your eyes straight ahead your neck will be in a hyperextended position. The levator scapulae in this position of hyperextension becomes excessively long causing a “feeling” of tightness. The levators (often overactive muscle) attach to the scapula (contributing to anterior tilt) and due to its hypertonicity cause a hypotonicity of the cervical flexors. We can combat these problems with working on the above (t-spine ROM), as well as chin tuck exercises. Another reason why to keep the packed neck position for all exercises.
4) Breathing Patterns: observe to see if people are chest breathers compared to belly breathers. Proper breathing through the diaphragm will 1) allow proper stabilization of the spine if the diaphragm is in its proper position and 2) can decrease the tone (activity) of the accessory breathing muscles in neck & chest. If someone breathes and their shoulders are always elevating, realize that there are muscles involved in that shrugging. If you are always doing this the neck just will not “let go” and stretching will be for no reason. Proper respiration is also crucial for low threshold core exercises like glute bridges, front, & planks. This is owning your stability. If you can breathe through these exercises without letting the form breakdown you better believe that is some darn good stability
5) Soft Tissue Quality: nothing new here. Typically, we will see restrictions in shoulder motion because of restrictions from the levator scapulae, pec minor & major, scalenes, lats, and rotator cuffs. We always foam roll or take a lacrosse ball to these areas to break up the restrictions they are causing on the scapula or shoulder. If you have shoulder pain, try hammering away a few minutes with the lacrosse ball at these areas and you will be amazed and how you feel after.
6) Rotator Cuff Strength/stabilization: Most people with shoulder problems will only address the rotator cuff muscles by strengthening them. Shoulder problems are much more complex than simply this one thing. D-OH!
I still think that rotator cuff strengthening is necessary considering that rotator cuff tears can go completely unnoticed. Meaning you can have an MRI taken that will find partial or full tears in the rotator cuff yet you will not have pain. “Impingement” which can take on many different types is a norm. Because of this, impingement can happen on the rotator cuff tendons. I think if this is a physiological norm that people might as well try to strengthen these muscles when they are getting rocked in everyday life. The rotator cuff can also get trained by dynamically stabilizing the shoulder. Things like stability ball wall holds, farmers walks, waiter walks, and supine dynamic stabilizations can help these issues.