If you’re like most people, you’ve got, not just one, but two shoulders.
Besides simply keeping your arms attached to your body, the shoulders do a lot of work, so keeping them healthy is definitely in your best interest.
What You’re Getting Yourself Into
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Shoulder pain is extremely common, with estimates of up to 70% of people affected over the course of their lifetimes.
If left untreated, it can turn into a chronic problem that affects daily activities, such as carrying your groceries and reaching to put them away, as well as recreational activities like handstands and other bodyweight control moves we teach here at GMB.
We ask a lot from our shoulders – the strength and flexibility to reach, hold, lift, carry, press, and pull.
It’s no wonder that the stress and strain of everyday life can cause as many shoulder problems as traumatic injuries. We simply use our upper extremities so much that issues are bound to happen.
Let’s take a look at how they work, and how just about every upper body movement and muscle involves the shoulder.
Public Service Announcement
Before we get into the nitty gritty, here’s an obligatory PSA: We’re not doctors, and this article and the suggestions below are no substitute for being seen by a real-live professional in person.
If you’re having ongoing aches and pains that don’t seem to improve with rest, you really should make an appointment to see a doctor or physical therapist as soon as possible.
Good, now let’s continue.
Part 1 – How the Shoulder Works
When most people speak about the “shoulder joint,” they are likely referring to the ball and socket joint formed by the humerus (the upper arm) and the scapula (the shoulder blade).
It’s a shallow socket, the glenoid fossa, which allows for a much greater range of motion at various angles than the deeper socket of the hip.
Another joint is formed at the connection between the clavicle (collarbone) and the acromion process of the scapula. This “A-C” joint is what is injured when someone has “separated” their shoulder. You can actually see a gap or “step off” at that junction point in more severe separations.
In addition to these joints, there is the connection between the scapula and the ribs, the so-called scapulothoracic joint.
Unlike most joints that are attached by ligaments, the scapulothoracic joint is controlled and limited solely by muscle attachments.
So with these three joint connections, along with the many muscles strapped around the area, the shoulder is a complicated structure that keeps many health care professionals in steady business.
Our purpose in this article isn’t to present all of the finer details of the anatomy of the shoulder, but to give a broad understanding of what’s happening in the area. This general understanding can help to prevent and/or assist in the various shoulder injuries that can happen to us.
The Joints of the Shoulder
Because the shoulder girdle is so complex, some basic knowledge of how joints work will help you understand the recommendations that follow.
On the simplest level, any joint is the connection between two bones and determines the axis upon which those bones can move. The physical connection between joints are ligaments, which prevent abnormal motion and protect the joint from forces that would otherwise pull it apart.
The most movable joints, the ones we are most concerned about in our physical activities, are surrounded by a capsule comprised of thick outer tissue and a thinner inner tissue. Within this capsule is fluid, cartilage, and other tissue, all of which protect, nourish, and assist in shock absorption and free movement – the most important qualities we want in our joints.
Since the joints are what allow us to move, they are good reference points to describe the shoulder girdle and its components that can cause pain, stiffness, and other issues.
To simplify and provide the most amount of information with the least amount of headache, we’ll focus on three major joints of the shoulder:
Within and surrounding these structures are the various soft tissues that make the shoulder both strong and mobile.
The Glenohumeral (G-H) Joint
The glenohumeral (G-H) joint is responsible for most of the range of motion of our arm through space, so even relatively minor stiffness in this joint can affect our activities quite a bit. As previously mentioned, this is a relatively shallow joint, and although it allows for a greater range of motion, it also makes the shoulder less stable and more vulnerable to traumatic forces.
The G-H ligaments (superior, middle, and inferior), along with the joint capsule, work to keep the ball in the socket. When someone dislocates their shoulder, these are the structures that are damaged.
Because of the variety of soft tissues within the G-H joint, lack of use often causes stiffness due to adhesions between the many folds and sliding points. Structures effectively get “stuck” together like plastic wrap and restrict your motion. Use it or lose it applies well to the shoulder.
The big muscles in the upper body all converge at this joint to move our arms (or our body through our arms).
The pectorals pull the arms forward and across the body, while the latissimus pulls the arms down and behind the body, and the deltoids and traps raise your shoulder girdle and arm upward.
These are powerful muscle groups that work hard in all the lifting, carrying, pushing, and pulling tasks we set out to do.
The smaller muscles at the G-H joint that make up the “rotator cuff” assist in maintaining proper position of the humerus within the joint.
The individual muscles have specific motions: Supraspinatus (beginning of shoulder abduction), Infraspinatus (external rotation), subscapularis (internal rotation), and teres minor (external rotation and adduction), but their main job is to hold the humeral head in position while the bigger surrounding muscles raise the arm up and overhead.
Other important soft tissues at this joint are the bursa.
The bursa are fluid-filled sacs that decrease friction and provide padding between bone and other structures for protection and freer movement. They can be irritated through trauma (such as a fall or being hit), or from repetitive stress and inflammation and swelling here can cause motion limitation and pain in the area.
The Acromioclavicular (A-C) Joint
The acromioclavicular (A-C) joint does not allow as much movement as the G-H joint, but the movement it does allow is important for the last degrees of motion for reaching overhead.
It also serves as a rotation point to assist the shoulder blade in moving correctly, so that we can reach across in front of our body and back behind us. The A-C joint is also one of the last joints to mature and one of the first to experience degenerative changes.
Apparently there’s only a small window of “optimal” health for our A-C joint!
Just as in the description of the G-H joint, daily exercise of working your shoulder through its full range of motion and flexibility does much for minimizing problems in this area.
The deltoid and trapezius muscles strap over the joints indirectly, and provide a dynamic support, but the main protection from trauma are the ligaments (acromioclavicular and coracoacromial).
These ligaments attach the collarbone to the shoulder blade, and from points from one part of the scapula to the other. They support the joint to provide a stable pivot point for shoulder blade motion, and also help to form the “roof” above the rotator cuff and humeral head.
The Scapulothoracic Joint
Full shoulder motion in all directions can only be accomplished with a freely moving shoulder blade along the ribcage.
This motion is dependent upon the muscles attached at the scapula to the ribs and spine. And there are quite a few muscles – the trapezius, pec minor, all the rotator cuff muscles, rhomboids, and deltoids – that have attachments at the scapula. As such, all these muscles are affected and can impact shoulder blade mobility and support.
The shoulder blade is essentially free-floating with no ligamentous attachments to the spine or arm, so the various muscles and fascial attachments provide both movement and stability.
This is an incredibly important area for all upper body work in bodyweight style and calisthenic training. The scapulae need to be strong and mobile in all directions and combinations of directions (forward and back in both elevated and depressed positions), to both protect the shoulder and transfer power correctly from the trunk to our extremities, and vice versa.
Unfortunately, because of our decreasingly active daily lives and the ubiquity of desk and computer work, we rarely move our scapulae in all the varieties of motion they are meant for, and that we need for peak shoulder health.
And even in most gym and sport exercises, we often limit ourselves to repetitive common patterns rather than going through the full range of available motion. This is why the fundamental “shoulder opening” gymnastic and handbalancing exercises can be surprisingly difficult and hugely beneficial additions to our training.
Part 2 – What Can Go Wrong in the Shoulder?
The preceding brief description of the shoulder girdle shows just how complex and overwhelming this area of the body can be, and all the problems and issues that can occur with even just one structure not doing its job.
Virtually all of our upper body muscles converge with the shoulder in some way and their interrelationship is key for optimal shoulder health and performance.
Though the causes and solutions to shoulder problems are certainly complex, especially when considering the contributions of the spine and even hips and lower body, it basically boils down to poorly coordinated movement at the shoulder.
As I outlined in a previous article the particular causes of injuries can range from the obvious (trauma from a fall) to the more intricate (nerve irritation decreasing muscle strength, leading to improper joint positioning). Whether it is specific muscle weakness, or flexibility problems (both too much and too little) at muscles, ligaments, and within the joint itself, these all lead to impaired movement patterns.
And these poor movement patterns can cause repetitive damage to the tissues in your shoulder even from simply using it in normal everyday activities. This is why shoulder pain is so common in both professional and recreational athletes.
The Most Common Problems Facing the Everyday Athlete
Now that we’ve described the basics of the shoulder girdle, it’s easier to understand the two most common causes of shoulder pain.
- Impingement – Repetitive irritation of structures under the acromial “roof” and the head of the humerus
- Tendonitis – Literally inflammation of the tendon. If symptoms don’t subside with rest (~2 weeks), this indicates that a continued stress on the tissue is continuing the inflammatory response.
There are a variety of causes of the impingement syndrome from muscle strength and flexibility imbalances, capsular tightness, neurological effects and so on, but the global end result is the irritation of tendons, bursa, and other tissue causing inflammation and pain.
The inflammation and swelling that can occur is a critical problem because there is not a lot of open space in this region, and the expansion of tissue from swelling can further irritate the issue. It becomes a vicious cycle, which is why this syndrome is so common.
Tendonitis should actually be easily taken care of, with adequate rest and staying away from the painful motion, the inflammation should run its course and heal within two weeks.
But, just as with impingements, there can be several reasons for continued irritation. When this condition lingers, it can progress to more damage to the tissue (tendonosis). It’s essential to address the root causes if you want to resolve the condition permanently.
Part 3 – How to Use this Article to Fix Your Shoulder Pain
I like to joke about “shotgun” therapy.
You essentially throw everything at a patient and hope something sticks. It often works, but then you have no idea what single intervention (or combination thereof) worked, or didn’t work. It’s a total crapshoot, and I for one don’t like gambling on my patients’ wellbeing.
That’s why I don’t recommend trying all of these suggestions at once. I’m providing you with options and allowing you to use your instinctive feelings of “This feels right!”
That’s the very best I can do over the Internet.
Everybody Feels Pain Differently, Mmmkay?
Pain is a very complex subject. One man’s pain is another woman’s discomfort.
The latest pain science reveals that there can be little correlation between tissue damage and the perceived pain. You can take two MRI scans of different people showing obvious structural problems, and one will report no pain while the other can barely move without wincing.
Pain is a construct that is emergent, complex, and without simple solutions.
This is quite clearly seen by the millions of people dealing with a variety of back, neck, and extremity pain, some resolving quickly and some turning into years of problems despite many types of treatment.
(This article is a great summary of the current pain science. Though it may be a bit too technical for the lay reader, the list at the end of the article is a great synopsis of useful strategies for changing perception of pain through movement.)
Magic bullets do work sometimes, but they aren’t a high percentage bet. The miracle treatments that do occur involve a peculiar combination of good timing, patient/practitioner rapport, the particular condition, and a bit of luck.
The reality of pain science requires an approach that is flexible and adaptable to your individual situation and may require all the avenues available to break through the problem.
So how do we know if what we are doing is going to affect our pain and function?
You Just Have To Give Things A Try
Yes, there is available research with “evidence-based” therapy and training that is quite good, but honestly and practically, you won’t know until you try.
It doesn’t seem very science-y, but it is actually the essence of science.
Tips to remember:
- Perform an intervention over a reasonable amount of time and then measure the results – that’s about as scientific as it gets. Give these strategies a try for 1 month, then reassess.
- I’ve broken the following strategies into categories for both ease of understanding and integration into your current training.
- You’ll soon see that certain exercises match well together. Also, the category of motor control/patterning is very important and if you can do the movements without pain, you should include these into your program as soon as possible.
Improving your skill in these exercises and modifying your habits, especially those generating pain, are the key to long lasting change.
Part 4 – Address Your Shoulder Pain with Essential Exercises
There are three major issues that can cause shoulder pain – issues with flexibility, strength, and/or motor control. Below, you’ll find videos with exercises to help you address each of these issues.
Exercises for Improving Shoulder Flexibility
The following video offers some tips and tactics for improving your shoulder flexibility and motion.
The goal isn’t necessarily to stretch a particular muscle, but to open your shoulders into new positions that allow a freer movement pattern. These improved motions can decrease stress to irritated tissues and also make your chosen recreational activities/exercise smoother and easier to perform.
With each of these exercises, don’t be afraid to play with different angles and different lines of force – sometimes a slight variation of the basic movement can allow you to access different regions of that range of motion.
In general I use a dynamic contraction – in and out of the end range of the stretch for a few repetitions (5 to 12) – then hold for a period of time (30 seconds to a minute), as shown in our Focused Flexibility program. Don’t be afraid to experiment with repetitions and hold times, some days will be better than others, and some days you’ll find yourself doing the bare minimum.
The most important thing in flexibility training is consistency. Do a bit everyday and you’ll get results.
|Shoulder Openers on Bench||• Both arms or one at a time
• Side-to-side motion at end range
• Scapular flaring at end range
• Improves shoulder flexion and upper thoracic back bending
|Shoulder L Stretch||• Shift to the same side arm for a light joint traction
• Roll forward and back to find the specific area of greater tightness
• Works on deltoid and posterior joint capsule
|Scaption Angle Chest Stretch||• Hand elevated on bench or on floor
• Both hands or one at a time
• Angled for safe and deeper stretching of chest and anterior shoulder
|Elbows on Bench||• Improves upper thoracic back bending with less strain on shoulders
• Play with angles of shifting side to side and also rotation
|Foam Roll||• For a more specific spinal extension force
• Play with side bending and breathing patterns
• End with back muscle contraction/activation
Strength Exercises for Reducing Shoulder Pain
This video outlines a variety of strengthening options that you are likely not including in your current training program. Targeting the muscles of the shoulder blade and rotator cuff, these are great movements to improve the stability of the shoulder girdle.
These exercises are best done either at the end of your current routine, two to three times a week, or as its own dedicated training session.
|Prone Scapula Series||• Emphasizing shoulder blade retraction (pinching together) and depression (pulling down towards the hips)
• Performed with shoulder externally rotated (thumb rotating outwards) to decrease impingement and to activate the rotator cuff
• Best done in higher repetitions range (12 to 20 reps)
• Play with static holds along with dynamic motion
|Side Lying External Rotation||• Lying on side with elbow propped up to create space between arm and your torso
• This improves blood flow to the shoulder and improves the angle of force
• Best done in moderate repetitions range (8 to 12 reps)
• Play with static holds along with dynamic motion
|Scapular Motion with Weight Bearing through the Arms||• In a variety of positions, training scapular elevation and depression in both protracted (shoulders pulled forward) and retracted (shoulder blades pinched together) positions
• Trains scapular muscles and also the rotator cuff, particularly the more vertical the pressure, such as in the inverted “shrugs”
• Shift weight side to side while maintaining shoulder elevation or depression
• Play with static holds along with dynamic motion
• Best done in higher repetitions range (12 to 20 reps)
Shoulder Motor Control Exercises
The video below demonstrates a key part to improving shoulder function – the introduction of new movement patterns with stress and force from different angles, and with challenge to coordination and spatial awareness.
The crucial word here is “play.” Play with movement variations, angles of pressure, and make each repetition slightly different than the last. Feel free to add these moves whenever you can, either as a warmup for your current routine, or as a cooldown, or even when you have a spare few minutes of time.
|Scapular Motions in Straight Arm Positions||• The scapula should move freely through countless angles of motion
• Perform in a variety of straight arm positions – On all fours, on p-bars (or other elevated equipment), “crab” and “bear” positions, and upside down
• Don’t count repetitions, don’t push past fatigue, take your time and play with it using a concentrated and mindful attitude
Play! Have fun! It’s okay, you’re allowed.
Choosing the Right Exercises for Your Needs
The broad categories of shoulder strength and flexibility encompass a variety of exercises and movements – much more than we can show in one article.
The exercises presented above will address common issues for most people, and are especially useful for those who participate in movement disciplines and activities like those we teach here at GMB. The best approach is to assess your particular needs and choose the exercises that best fit your situation.
In general, look at how symmetrical your strength and flexibility are between both shoulders. Is one a bit different than the other?
If so, that’s a great starting point and measurement for adding on specific shoulder exercises.
Decide Based on Your Goals…
If you are training for a sport or have physical goals in your exercise regimen, you are probably already aware of what you need to do to improve your performance.
Being “as strong and flexible as possible” is a great goal, but it’s not a useful training focus.
Instead, you should have specific targets, especially when you have issues such as shoulder pain and stiffness. As we keep harping here at GMB, goals are important tools for your training. Goals give you direction and a sense of purpose, when you otherwise may feel like you are just floating along.
Floating isn’t necessarily a bad thing, but it’s not the fastest way to reach a goal either.
…But Don’t Neglect Novelty and Exploration
In the case of Motor Control, the sense of free-form play is the right attitude.
Novel movements break up your normal routine and wake up your mind and body. Physical habits and holding patterns creep up on you slowly and settle in without you being aware.
New movements just for the sake of doing them give you benefits far beyond those of the actual physical effort. Every way of getting out of the doldrums and plateaus of training is a precious commodity.
Especially when it concerns chronic pain.
There can indeed be a habit of pain – you can be so accustomed to pain and dysfunction that it gets “sticky.” We tend move in the same ways day after day especially in our exercise training.
Being stuck in these same movement patterns is a big player in continuing pain complaints despite different treatments. In the pain science article above, the emphasis is on variety and altering movement as much as possible to break free of patterns and the pain cycle. And the last tip “Ad lib and have fun” could have been taken out of the first page of the GMB playbook!
Don’t neglect the importance of improvising and playing with movement. It’s more than just fun, it’s also a key to better health and fitness with less pain and dysfunction.
Creating Your Own Shoulder Recovery Routine
Take some time to examine your particular needs and play with adding a few of these techniques to your training.
- For the flexibility exercises, choose a couple of variations for the shoulder opening and see how it affects your condition over a couple of weeks.
- And the same for the strength exercises – pick two moves that seem to be the weakest for you, and incorporate them into your regimen and re-assess in a month.
- For the motor control exercises, pick a couple that look the most fun to do and sprinkle them in to your sessions and daily activities, you’ll be glad you did.
Free Yourself from Pains and Restrictions
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