Shoulders can be tricky.
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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.
A lecturer once labelled the shoulder junction as ‘god’s mistake’ as it has the potential to go so wrong, and injuries can range from the annoying niggle to debilitating conditions which inhibit 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 the opposite, allowing for a large range of motion for reaching, grabbing, pulling, twisting, turning and scratching.
This range means that the shoulder often sacrifices some stability, making it more susceptible to a range of strains and pains.
Another reason 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 an issue compromises the amount of space in the shoulder then some of these structures can be compressed, potentially causing 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, and for smooth, even movement the shoulder blade must be moving well upon the thoracic (the section of your spine with ribs) spine.
So rehabilitating shoulder injuries often involves working on the stability and movement of the shoulder with the shoulder blade because the socket joint of our shoulder 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 goes hand in hand with people who are stuck at their desk, spend long times driving or do repeated work out in front of their body, and can cause compression of the structures passing through the shoulder.
If the shoulders are turned inwards this also stretches the muscles which stabilise the shoulder blades, weakening those important muscles.
To improve this posture we need to stretch out the structures in the front of the shoulder which can chronically tighten, and to bring the shoulders back into a better position we must strengthen those functional shoulder blade 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 do 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, but 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 the 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 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 back down to the original point.
This is quite an advanced technique but great for stabilising the shoulder blades while working on shoulder mobility.
As per usual, if there is pain avoid this technique. Work up with the first two exercises until this technique is more achievable.