Shoulder pain
Shoulders can be tricky.
They can take substantial time to heal, often underlying aggravating factors need to be addressed
and there are multiple tissues in a small region which can be causing the pain.
I remember a past lecturer labelling the shoulder junction as “god’s mistake” as it does have the
potential to go so wrong.
If you’ve had a substantial shoulder injury in the past you may appreciate what I’m talking about.
Shoulder injuries can range from the annoying niggle to debilitating conditions which stop us from
our daily activities and even getting a proper night’s sleep.
The shoulder is a ball and socket joint, similar to the hip. The main difference between the two joints
is that the hip is built for stability over mobility whereas the shoulder is of the opposite. The
shoulder allows for a large range of motion, granting us movement for reaching, grabbing, pulling,
twisting, turning and scratching.
This range of movement means that the shoulder often sacrifices some stability, making it more
susceptible to a range of strains and pains.
Another reason that the shoulder has such potential to go so wrong is that there are a multitude of
muscles, tendons, arteries and nerves passing through such a small area. There are five rotator cuff
muscles, biceps, triceps, lats and pecs all inserting into the shoulder.
If there is an issue that compromises the amount of space in the shoulder area then some of these
structures can be compressed and potentially cause irritation and/or inflammation.
The space can be decreased by poor posture, thickened and inflamed tendons or bone spurs caused
by wear and tear.
The shoulder does not work in isolation. In order for the shoulder to have smooth, even movement
the shoulder blade must be moving well upon the thoracic (the section of your spine with ribs) spine.
This is known as our scapulohumeral rhythm. This means that rehabilitating shoulder injuries often
involves working on the stability and movement of the shoulder moving with the shoulder blade.
This is because the socket section of our shoulder’s ball and socket joint is part of our shoulder
blade.
Often with shoulder complaints we find the patient’s shoulder has a tendency to roll or round
inwards. This posture can cause compression of the structures passing through the shoulder. In
order to improve this posture we need to stretch out the structures in the front of the shoulder
which can chronically tighten.
This posture goes hand in hand with people who can become stuck at their desk, spend long times
driving or do repeated work out in front of their body.
If the shoulders are turned inwards this will also put the muscles which stabilise the shoulder blades
on stretch. This can weaken those important, stabilising muscles between the shoulder blades. In
order to bring the shoulders back into a better position we must strengthen these functional
muscles.
Here are three exercises which can help with shoulder stability.
Pectoral stretch
Find a door frame. Place your right elbow flexed at 90 degrees against the frame at your shoulder
height. Step forward with the right leg until you feel a stretch in the front of your shoulder and/or
right side of your chest. Hold for 15 seconds, repeat three times and perform on both sides.
I often find it quicker to both arms at a time taking up a whole doorframe.
If you have a current complaint this stretch may cause pain. Try some of these modifications if this is
the case. Stretching shouldn’t cause pain, stretching should only make you feel a comfortable
stretch.
Try performing the doorway stretch with the elbow straight. This means you will contact the frame
with your hand instead of your elbow.
If this too hurts, you can try rolling up a beach towel and place it vertically upon your bed or floor.
Have the towel just below your pillow so it makes a t shape. Lay on the towel so it runs along your
spine, with your head resting upon the pillow. Bring your arms out to your sides (hands facing
upwards), starting at the hips and arcing up towards your head like an angel. Don’t bring your arms
above your shoulders and if pain comes on before this just hold the stretch wherever comfortable.
Shoulder blade squeezes
Squeeze the bottom of your shoulder blades together. Hold for 10 seconds and repeat three times.
Stay relaxed in your neck, making sure you keep upper trapezius relaxed. This is the muscle that
tightens with stress, running from your neck to your shoulder region. We want to be working
muscles below this.
This exercise can be performed at the desk, when driving, watching telly or anywhere really!
Wall/floor angels
Lie on the floor or have your back against the wall.
Press your lower back into the wall/floor. Try to maintain this position as well as you can throughout
the exercise.
Begin with your elbows up at shoulder height and elbows at 90 degrees. Try and keep your arms
pressed flat against the wall/floor (Do your best, it is hard! Don’t push so hard that it is painful).
Now, just like you’re making snow angels, slowly bring the arms up and that back down to the
original point.
This is quite an advanced technique but great for stabilising the shoulder blades whilst working on
shoulder mobility. Per usual, if there is pain avoid this technique. Work up with the first two
exercises until this technique is more achievable.
