Shoulder Pain-- It's Complicated.
Updated: Jan 5
Shoulder pain is one of the most common things we see with our patients, perhaps second only to low back pain. The shoulder is complicated region of the body. There’s a reason why it's known as a “shoulder complex!”
So, what IS going on in the shoulder?
The shoulder is comprised of 4 joints working together harmoniously:
1. Glenohumeral joint: This where the arm meets the shoulder blade. This is the “ball in socket” joint we commonly think of as the shoulder joint.
2. Acromioclavicular joint: The joint where the collarbone meets the shoulder blade.
3. Sternoclavicular joint: Where the collarbone meets the sternum.
4. Scapulothoracic joint: this is actually not a true “joint” but perhaps one of the biggest culprits behind shoulder pain. This is the connection between the shoulder blade and trunk. The shoulder blade should be able to move freely on the thorax.
When the shoulder moves, each of these joints must have the proper mobility to move into the right position to allow the shoulder to progress through the motion without pain. That’s a lot going on there, right?
Let’s break it down.
As the arm elevates, the scapula should move - rotating upward, wrapping around the trunk as the arm continues to raise. The ball descends in the socket, allowing important structures to clear without pinching. This system is highly dependent on functionality of the rotator cuff muscles and deep shoulder stabilizers. As the shoulder raises up, the upper back (spine and ribs) should move into extension allowing the shoulder to reach full elevation overhead.
So even though pain commonly presents in the “shoulder," the culprit could be the upper back.
Restrictions in the trunk and upper back commonly contribute to pain and limitations in mobility. Given the amount we sit on computers and text on phones, most of us get stiff here. Over time, limitations in mobility and strength can lead to undue stress causing degeneration and tears.
The good news is that often times addressing underlying mobility and control deficits and significantly improve pain!
If you find yourself struggling with shoulder pain or avoiding exercise, try these simple tests and exercises to work on mobility and control:
Test yourself:
Treat yourself:
Upper back mobilization/foam rolling
PVC Lift (Be sure to squeeze your shoulderblades together first before lifting pipe)
Common pitfall: Watch that rib flare.
When the upper back doesn’t have enough mobility to move into extension, the ribs will jut out allowing the shoulder to feel like it is flexing more, when in reality its just the back arching. This can also place your low back at increase risk for pain and injury. This is an incredibly common movement fault in overhead athletes such as Crossfit athletes who are lifting weight overhead and yogis who are spending significant time in overhead postures with poor rib position.
Maintaining fundamental mobility requirements is paramount in decreasing risk of injury and being able to stay active in your sport. Try these techniques to improve mobility: test yourself and treat yourself!
If you are still struggling, give us a shout. We specialize in manual therapy techniques that can help speed up the process of improving mobility and decreasing pain. You don't have to keep living with a sore shoulder that will hold you back from your training or daily activities.