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Think of the various activities you do throughout your day. Consider what percentage of those activities include doing something with your arms. Most of our activities involve the shoulders in some capacity, be it movement or stabilization. Anyone who has suffered through a shoulder injury and/or undergone a shoulder surgery can attest to the level of debility they experienced when unable to use the shoulder without pain or at all.
Pushing, pulling, reaching, and lifting all require the engagement of the shoulder girdle muscles. Most of the time, we think of the shoulder in terms of the place where the arm meets the body. It is more accurate, however, to think of the shoulder as a number of joints and muscles that give your upper body greater stability, protection, and leverage. This post will cover basic shoulder mechanics, common shoulder issues and imbalances, tips to protect the shoulders, and a powerful exercise to shore up your shoulders for life!
Basic Shoulder Mechanics
The bone structure around the shoulders is exquisitely designed to give us maximum mobility with built-in stability. It provides us a lever and pulley system that rivals anything a mechanical engineer could create.
The bones that make up the shoulder girdle are the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone), and to a limited degree, the sternum (breastbone).
(Front view of RIGHT shoulder)
What you may think of as one shoulder "joint" is more holistically characterized as four. The sternoclavicular (SC) joint is where the breastbone meets the collarbone on each side. The acromioclavicular (AC) joint is where the shoulder blade meets the collarbone. The scapulothoracic (ST) joint involves the interface of the shoulder blade(s) against the rib cage. Finally, the ball and socket glenohumeral (GH) joint is technically the place where the upper arm meets the body.
The following muscle groups all function in and around the shoulder girdle as movers or stabilizers:
- Rotator cuffs (supraspinatus, infraspinatus, teres minor, & subscapularis)
- Trapezius (upper, middle, & lower)
- Rhomboids (major & minor)
- Serratus anterior
- Latissimus dorsi
- Pectorals (major & minor)
- Biceps (long head, sometimes referred to as “the 5th rotator cuff”)
- Triceps (long head)
The greatest level of mobility in the human body can be found in the shoulders. This allows the arms to move up, down, forward, backward, and in rotation. The shoulder blades upwardly rotate 1 degree for every 2 degrees the arm is lifted. This scapulohumeral rhythm is important for shoulder mobility and stability. The shoulders need to have the right amount of mobility – strength plus flexibility – in order to function well and prevent injuries.
Common Shoulder Issues and Injuries
As is the case with any part of the body, bones around the shoulder can be broken in the course of an accident or a fall.
Some examples of conditions that can develop over time include shoulder instability and chronic conditions such as impingement, frozen shoulder, labral tears (cartilage lining the shoulder socket), dislocation, and other injuries.
Instability
My own education in shoulder health started as a physical therapy patient around 2001. Little did I know at the time that 18 years later my understanding of the shoulder would be significantly deepened by my experience assisting a physical therapist who is a shoulder specialist in the same clinic!
As a lifelong swimmer, I did not have any shoulder pain; however, my arms increasingly felt as though they were hanging by a thread from my body and I was having problems with fine motor skills. Prior to a course of physical therapy, my shoulders probably constituted an injury waiting to happen.
The physical therapist at the time secured my shoulder blades into their correct position with kinesiotape, which felt very unnatural for me as I had been unwittingly compensating for unstable shoulders for years. As I applied the exercises and stretches consistently over time, I finally built the well-developed shoulder girdle stabilizers necessary to balance out the strength of my lats (mid-back muscles) and pectorals (chest muscles). Not only did my shoulders feel shored up, but my posture and handwriting improved in addition to becoming an even stronger swimmer.
Instability is also most often a factor in some way with other acute or chronic shoulder injuries. Identifying and correcting imbalances early can prevent the unnecessary suffering that comes with a shoulder injury.
Impingement
This scenario occurs when one of the rotator cuff muscles, commonly the supraspinatus tendon, and/or the bursa that provide cushioning are subjected to greater wear and tear from rubbing over the bones in the shoulder. Typically, a few factors are at work here. The primary job of the rotator cuff muscles is to compress, depress, and stabilize the humeral head in the shoulder socket to enable the arm to move freely and safely. Weakened and inhibited rotator cuffs play an important role as do tight, overactive muscles, such as the pectorals, that are keeping this situation in place.
(Front view of RIGHT shoulder)
In some people, one of the bones of the shoulder – the acromion – is shaped in such a way that leaves less space for the arm to move in the shoulder socket and makes impingement more likely. The result is shoulder pain, particularly when moving the arm into an overhead position.
Frozen Shoulder
This condition, otherwise known as adhesive capsulitis, occurs when the muscles and connective tissue around the entire shoulder girdle have become inflamed and locked up. The resulting pain discourages the person from moving the arm and shoulder, which unfortunately creates greater pain, which further inhibits movement. This cycle can be broken through physical therapy, anti-inflammatory medication, and education.
Rotator Cuff Injuries
The rotator cuff consists of 4 muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis, hence the acronym SITS. The first 3 are considered external shoulder rotators and the 4th is a powerful internal shoulder rotator.
(Back and front views of the LEFT shoulder)
The most common rotator cuff injuries involve some degree of tearing of the supraspinatus or infraspinatus muscles. This can happen suddenly as a result of a fall or develop over time if the rotator cuffs are not strengthened regularly. Sometimes the catalyzing injury is the last straw with rotator cuffs that have become weak and the shoulders misused over time.
In 24 years I have only encountered one instance of a subscapularis tear. Let’s just say it is not advisable to go out running after an ice storm. This 60-something individual went down on a patch of ice and tore this muscle, but fortunately, healed well.
Rest, physical therapy, anti-inflammatory medications, cortisone injections, and/or surgery are typically used to treat rotator cuff tears.
It is also important to note that many people who have mild rotator cuff tears may not necessarily experience pain.
Labral Tears
The glenoid labrum is the cartilage lining the shoulder socket, or glenoid fossa. This lining can be torn through repetitive motion during the course of sports activities or over time. Depending on the type and severity of the tear, rest, physical therapy, or surgery may be indicated.
(Front view of RIGHT shoulder)
Dislocation
Prolonged shoulder instability can lead to situations as extreme as a dislocation, in which the humeral head (the “ball”) pops out of the shoulder socket. This situation might call for a manual adjustment, physical therapy, and/or rest.
(Front view of RIGHT shoulder)
Common Muscle Imbalances Affecting the Shoulder
A muscle imbalance has typically been present for a very long time by the time an injury shows up. Muscle imbalances around the shoulder are increasingly common due to our lifestyles and work. We are, on the whole, too sedentary, spending too much time sitting and using our technology. The resulting upper crossed syndrome finds many people with some degree of a head-forward, rounded shoulder upper body alignment. Furthermore, the stress and complexity of many people’s lives draws us in, discouraging the mindfulness we need to care for our bodies.
Certain upper body muscles tend to be tight or facilitated, too quick to engage at the expense of other muscles. These include the pectorals, the lats, biceps, and neck muscles (upper trapezius, levator scapulae, and sternocleidomastoids).
Other upper body muscles tend to be weak or inhibited, essentially turned off at a nervous system level. These are typically the rotator cuffs, lower trapezius, rhomboids, serratus anterior, triceps, and deep neck flexors (between the chin and neck).
Muscle imbalances can be characterized as a version of “codependency” wherein the body, often without our conscious decision, detects areas of instability and attempts to protect and stabilize the involved area by turning on other area muscles too much. Unfortunately, this encourages the weak and inhibited muscles to stay turned off so that not only are they weak, but have become unable to “fire” in this situation.
What can we do about all of this??
Tips for Protecting the Shoulders
The following are some ways we can support and protect our shoulders.
Train the body’s “defaults”.
- Use good posture when sitting and standing, keeping the chin pulled back with shoulders down & back, and chest open. Learn and use your body’s neutral spine position.
- Keep your deep core muscles engaged, particularly when in an upright position, to support good posture and lessen the chance of injury.
- “Anchor” shoulder blades down properly when reaching, pushing, pulling, or lifting.
- Keep items close to the body when lifting, especially with heavier objects.
Follow a balanced exercise program.
- Stretch the tight muscles and activate & strengthen the weak ones.
- Strengthen the rotator cuffs and other shoulder girdle muscles regularly.
- Mix up activities to avoid overuse syndromes.
Observe mindful awareness.
- Protect yourself from shoulder injuries by mitigating fall risk, observing simple safety-promoting habits such as using the handrail when descending stairs and exercising caution around wet or icy conditions.
- Be mindful of shoulder safety during various physical activities e.g., walking the dog, doing yard work, carrying in the groceries, etc. For example, in the dog-walking scenario, keep a good strong grip on Fido, who can abruptly take off after a squirrel, pulling you over in the process!
Strengthening the Rotator Cuffs
Rotator cuff strengthening performed correctly can be your secret weapon, drastically reducing your risk for developing shoulder problems. If you are already afflicted with shoulder issues, these are still generally safe and beneficial. That said, always consult your doctor or physical therapist if you are unsure.
The following 2 exercises essentially do the same thing, except the first one is performed lying down and the second in an upright position. I personally prefer the first exercise, but often clients prefer the second because they are more likely to actually do the exercise that doesn’t require getting on the floor.
1. Side Lying External Shoulder Rotation
Image from HEP2go
Lie on your side holding a light dumbbell or no weight in the top hand. Place a rolled-up towel between your upper arm and side of rib cage as shown. Bend your elbow to 90 degrees with palm against your stomach. Maintaining 90-degree elbow bend, rotate the upper arm using good form and without pain. Keep elbow directly over your side throughout the movement so that elbow becomes a “pivot point”. Be sure to keep the wrist straight/neutral. Lower to start position with good control. Complete 2-3 sets of 10-20 reps and repeat on other side.
2. Standing External Shoulder Rotation with Band
Attach a light elastic band to a fixed point or inside a door frame. Place a rolled up towel between your upper arm and your side. Hold the end of the band with the hand on the target side. Turn your body to the side in relation to the anchor point so that the target side is farthest from this point. Bend your elbow to 90 degrees and position arm so that your palm is close to and facing stomach. Perform the movement by rotating the upper arm outward while keeping the elbow bent to 90 degrees with the rolled up towel held securely under the arm. Rotate the upper arm as far as possible using good form and without pain. Be sure to keep the wrist straight/neutral. Complete 2-3 sets of 10-20 reps and repeat on other side.
Taking the Weight off of Your Shoulders
Shoulder insurance may not be available for purchase. But by increasing awareness and taking a few simple steps, we can avoid the pain, stress, and inconvenience of a potential injury and/or surgery, and continue to enjoy the activities we love!