Over the course of time I’ve been having more and more people coming to Fitness Revolution looking for questions on how to heal their shoulders. I have seen more shoulder dysfunctions this month that almost all of last year, is there something in the water here?
Regardless of the client or the case, I always do more research just to make sure that I can help this person get back to full functioning health as fast as we can. All this research has led me to become a bit more proficient in shoulder rehab and PREHAB work.
Why the shoulders become so messed up in the first place
The question ALWAYS comes up during my assessment. Typically my usual response is “life”, if you play sports and have repetitive overhead swinging or throwing motions (think volley ball, baseball, tennis, etc..) there will be anatomical shifts that happen over time. Though what I have seen most commonly as of late is “life” getting in the way of proper shoulder function is just your classic desk jokey, those that sit in a rounded shoulder position for 8+ hours a day. Damn I could never do that…
This constant position of staying in a rounded state (anterior tilt) all day multiple days a week for months or years at a time will have an effect on the body. You get the beginning stages of what I call the Neanderthal Effect
To couple with the repetitive rounded state at a desk we have some sedentary invidious that chose not to train OR for my gym junkies don’t spend as much time developing their back muscle as they need to.
What ends up happening then is that the muscles in the chest end up tightening or shortening and the back muscles end up becoming too lengthened or week in comparison to the chest.
It’s a SHOULDER blade NOT a back blade.
This course of tight chest and weak back muscles have lead to shoulder dysfunction but here is the kicker… it’s NOT the shoulder as we think of it that’s the problem. It’s the shoulder blade.
NEARLY ALL SHOULDER PROBLEMS HAVE SOME FORM OF SCAPULAR DYSFUNCTION
When someone is feeling pain in their shoulder (not taking into account any structural or anatomical impedances) it’s almost ALWAYS has some correlation to a scapular imbalance or inefficiency. Other words the pain in shoulder is a SYMPTOM of something else, its typically NOT the shoulder (gleno-humeral) its self.
More like the question is what DOESN’T the shoulder blade do. It helps with majority of the mobility of the humorous in the shoulder socket. It Elevation, Depression, Protraction (abduction) Retraction (adduction) Upward (lateral) rotation, Downward (medial) rotation, Anterior Tipping, and Posterior Tipping. In addition it’s the attachment point for about 18 different muscles and just about EVERY lift you do has some form of scapula work involved from stabilization to active motions.
How does this relate to shoulder pain?
When someone is feeling pain in their shoulder (not taking into account any structural or anatomical impedances) it’s almost ALWAYS has some correlation to a scapular imbalance or inefficiency. Other words the pain in shoulder is a SYMPTOM of something else, its typically NOT the shoulder its self.
Side note: This will make a few people mad but outside of trauma MOST shoulder surgeries are completely UNNESSARY. A number of these can be fixed with proper training and just having your muscles being in balance.
Majority, not all, have some pain that occurs in the shoulder area (gleno-humeral joint) are experiencing a muscle that originates in the scapula that is just… well over worked and tired (sounds like a lot of your lives doesn’t it LOL) and the pain is the result of it letting you know what it thinks. Other words it’s mad at you.
In the body everything is connected is some way or form AND every muscle has and antagonist. Think biceps and triceps, back and chest, quads and hamstrings. So there is a balancing act with some muscles here, if one becomes too strong it CAN overpower the others and begin pulling you out of alignment. More of a reason it’s important to include total body motions in all planes to ensure that you can move well. THEN you can look eve hotter 😉
An analogy that I use is that the muscles in the body are like a car tires. If one tire has low air you can still drive the car and the car will redistribute the work of the low tire to other parts of the car. Your other three ties will take over some of the work, the suspension will step up and work a bit harder, etc.. The problem occurs if you don’t fix that low tire several things will happen. You can change the wear pattern of the other three tires (wearing them out faster), throws your suspension and alignment off and worst case scenario you blow the tire and destroy the rims, undercarriage, the list goes on. See how this can relate to muscles in your body?
So we need to take a look at the shoulder blade or what most people actually think is there back and depending on a series of assessments and palpations I can determine what muscle in the shoulder blade is ticked off and wants some relief. From there it’s pretty easy to prescribe what I need the client to do to correct this problem.
Most common causes of shoulder pain I see
-Tight pec minor
This little muscle is not to be under estimated. I seen this thing cause a number of shoulder issues and one of the most common is that it’s a facilitator in the rounded shoulder look. You know the one where the person looks like they have abnormally large traps that just rounds in over their ears OR a bit of a hunch back look.
Guys love to think that this just makes them looking bigger but honestly you just look like a gorilla.
The pec minor originates from corticoid process (the front hook on the shoulder blade) and attaches to the 3rd-5th ribs at roughly a 75 degree angle. So if this thing gets tight what do you think it’s going pull on?
This little muscle is quite strong and as it tightens it begins to pull at the top of the shoulder blade and pull it over the top of the body, thus causing the gorilla look.
–Not enough lower trap strength
This is to piggy back off the pec minor topic. Remember that every muscle has an antagonist to it, one of the pec minors antagonist is the lower traps. So you have your pec minor and lower traps fighting all the time pulling at your scapula, ideally you want them pulling in balance BUT if one is stronger than the other then you get scapular shift.
So all the nerd talk aside if you lower traps are NOT strong enough to pull your shoulder blade down then it will round back up. You walking gorilla you.
–Week serratus anterior
This is a small muscle but its holds a high importance because its jobs is to keep the shoulder blade pulled into the ribcage preventing it from drifting or winging out.
For many different pathological reasons its one of the first muscles to shut down and lead to scapular dysfunction (lazy bastard).
–Week rotator cuff
I could write MANY blogs on rotator cuff function but skipping all the nerd stuff just know that if your rotator cuff isn’t one muscle but FOUR muscles (Supraspinatus, Infraspinatus, Teres minor, Subscapularis) and just like the car analogy if one becomes week then the others can only do work for so long. One of its primary responsibilities stabilization and movement of the shoulder allowing it to rotate back (hence the name rotator cuff lol)
If this muscle is week then your scapula will not sit correctly, its moves upward, and this makes overhead motions quite difficult and painful.
Great I just gave you a lot of info but now what? First things first I always recommend that you do some SMR (Self Myofascial Release) BEFORE every workout on your shoulder blades and chest. This alone will solve a lot of issues.
Side note: This is one of my mentors that does an amazing job talking about SMR work, watch and I promise you’ll learn something 🙂
-Y’s, T’s, and I’s
These exercises are design to activate the mid and lower back, what is normally week and under trained for most people. Don’t let this little motion fool you, it can be a bit humbling in the beginning. When these muscles become strong then you’ll notice that your shoulder blade will begin to sit back into proper position.
I do this before every upper body workout and it only takes me about 3 min. For the beginners I’ll have them to this before EVERY workout for 2 sets of 8 reps each. As you become better and more proficient with these muscles firing the proper way then you’ll notice that once or twice a week will do just fine.
-More, more, more pulling motions
So much of back and shoulder blade issues can be corrected with just getting your back muscles stronger, this will not only create more balance in the body but also creates that broad shoulder look that most men seek out. Ladies a good back is a must as well, we want to make sure that you look just as good walking away as you did walking forward.
A rule of thumb that I have is one more set of pull with ever set up push. So if you do pushing muscles for 2 sets then work your pulling motions for 3 sets.
Depending on the client I will have some form of back work in almost EVERY workout. We are not training to back to develop in every workout but instead training it to function and fire the proper way, there is a big difference in training to get big and training to function. If you can’t function correctly there is no way I can get you big.
-Strengthen up your rotator cuff
This makes complete sense because if you strengthen your rotator cuff you’ll start to see your scapula sit down and back where it should be, in addition it will dramatically help with its mobility along the ribcage.
I see a number of guys that do rotator cuff exercises before every upper body work out but in my opinion I RARELY ever see anyone do those correctly, refer to the video below.
Do not get all bodybuilder on this exercise, just use this as a warm up in all your upper body work. 1-2 sets will do the trick.
The one good thing about the serratus going out is that its pretty easy to fix but MOST imporpantly its very easy to keep it from ever not doing its job. These exercises bleow are pretty simple, done a few times a week for only a few sets of about 15-20 reps will keep this muscle always doing its job.
Ok this is enough for now because its a lot of stuff but this is an awesome way to get started getting your shoulder back to optimum performance. I want you to remember though… you did NOT get this way in one day so don’t expect this to be better in one day. If you have some serious shoulder pain get yourself checked out by a dr first just to make sure that there is NOT anything structurally wrong, if somethings broken or torn then get that fixed!
As long as your cleared by a dr then doing this will help keep you from ever having to see him again for your shoulder.
I’ll make it a point to do more shoulder blogs from this point further!
In Health and Awesomeness,
Travis Merritt, BS, CPT, CES, RBT is the owner of Fitness Revolution in Rowlett, TX.
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