The Shoulder (doesn't have to be so) Complex!
One important relationship.
Three planes of movement.
Three major reasons it fails.
One article to help you better understand.
In order to move with power and grace (and less pain!) in your upper body, you need effective communication between your shoulder blade (Scapula) and your arm (Humerus). This is called glenohumeral rhythm. These two large bones and their tissues work together to guide all of the broad, upper limb movements we make, aka contribute to the majority of upper-body strength and power.
Every push-up you do in boot-camp class; every time you bench press or try a pull-up. (Doing all of these things properly is a different story).
The shoulder complex is also a common source of pain for side sleepers, desk workers, texters, athletes, and casual exercisers.
How do we expect to gain strength and power if we are in pain? The short answer, of course, is to remove the pain.
Three major contributors to shoulder pain:
1. Lack of effective communication between your shoulder blade and your arm
2. Functional movement maladies that cause pain (stiffness from sleeping on your side; exercising intensely/heavily without proper movement prep or form)
3. Previous injury (structural alteration) that led to functional changes, which may or may not contribute pain and thus lead to more functional alterations
You can also have a combination of the above.
If your body was a globe depicting Earth, then your upper-back muscles would likely be the Sahara Desert - not much going on. Your upper trapezius muscles and internal rotators of the shoulder complex, on the other hand, would be New York City - the center of activity.
*Most people I have encountered who experience functional shoulder pain have suffered due to the neurologic attention the front side of their body receives. Often, for this reason and for stress-related reasons leading to tightness in the upper trapezius muscles (the go-to massage area), our shoulder complex leaves its proper glenohumeral rhythm (relationship between the upper arm and shoulder blade).
This affects not just the up-and-down movement of our shoulders, but forward and backwards, as well as the twisting motion that occurs in our arm at the shoulder.
There is often some history of pain resulting from functional changes that have led to poor movement patterns, occasionally with scar tissue that is originally laid down to block these painful movement patterns, but later disallows and even blocks the necessary movement patterns required to alleviate the very same pain in the long-term. Much like compound interest in investments. In this case, though, a very bad investment.
Hours sitting at a desk or peering down at digital devices can also lead to stiffness in various muscles in the front of our chest and shoulders (pectoralis major, especially its outer portions near the above image's labeling of the "cephalic vein," as well as the internal rotating fibers of latissumus dorsi and the internal rotators of our rotator cuff ), and our neck muscles (trapezius, sternocleidomastoid, omohyoid).
*Like the expression used in boxing - the eyes and head lead the body. This can be used for good things. Just being aware of this phenomenon can allow for you to take better control of your posture. Eye fatigue is also a likely contributor to forward leaning, so little things like adjusting the brightness and/or font size on your screen can cause dramatic changes to your neck stiffness over time.
But, let's go back to your "pain in the neck." Combine this neck stiffness and tightness in the anterior muscles with lack of activity in the upper back muscles - lower- and middle trapezius, improper tracking of the rhomboids, no use from the external rotators at the rotator cuff - and we have a large number of ingredients for upper-limb imbalance.
If you have ever taken physics class, think back to the first couple of lessons when Vectors were discussed. Imagine what the combined vectors of these aforementioned stiff and overactive muscles with their under-active counterparts looks like. The pain you feel is likely close to the exact sum of these vectors.
Typically, pain and tightness shows up in our already over-active upper trapezius muscles and portions of our rhomboids minor and major (like a pretzel nugget in your shoulder blade / neck).
*In this situation, the shoulder is pulled up and forward, tight to the body. Since activity begets more, this situation can compound. We need to neurologically reset the system in order to restore balance to this situation.
If you have ever gotten a massage in your neck area, chances are the therapist spent a good deal of time on your upper trapezius muscles. These are the go-to massage muscles even in TV and movies, for a reason. What is less commonly discussed, though, is how these muscles being tight or overactive can "pull up" your entire shoulder complex and thus out of proper movement communication. Like a fastball high and inside, not always desirable.
Perhaps more than ever, we are a visually dominant species. *How do we train something we cannot see? Why is it even important if we cannot see it? The answer, in short, is the balance our upper-back muscles and external rotators provide to our shoulder complex.
Then, we still have to deal with the proper tracking of this complex around the rib cage as you move your arm and shoulder blade together, in a forward and back motion. This is the duty of the serratus anterior muscles (below). Let's consider that Phase 2 stuff; timing is at least 95% of the proper application of movement.
Much like a five-star resort, your bones have hotel concierge and guest experience specialists at every turn. These fantastic employees are called Muscles. You just have to treat them properly, and their work performance will make all of your guests (bones) have a wonderful movement experience.
**Like our hip joint, the shoulder joint is a very mobile one. In our bodies' more mobile joints, the trade-off for improved movement is a lack of natural stability from bones and ligaments. The stability is instead provided by tissues - muscles and their tendons. In other words, stability is conferred by our movement. What??!!
Let's use a skiing / snowboarding analogy. If you have gone skiing at least a few times in your life, you will appreciate this. Remember how the first time, you were learning to get your "snow legs" and you wanted to control every little movement? Partly out of fear perhaps, but mostly out of a "what the heck is this?" thought process. This was the "land creature" in you trying to control every little movement on an unfamiliar surface - the friction coefficient is different, the footwear is different, the rules have changed without your permission.
It is a bit unnerving, to say the least, when you are learning to move on a new surface. Like standing at the edge of the ocean so it doesn't batter you. It's hard to let go of our hardwired, well-practiced movement habits.
Anyway, remember how, once you got a better feel for the skis / board and the slopes, the speed actually made you feel MORE balanced? This is no mirage. You have more of your muscles and neurons firing for that motor pattern because they have been recruited to do so. By including more "muscle friends" in on this "party," you have now made it a "better party," and therefore your movements have been made more smooth, more "stable," if you will.
So, all of this stuff is good and well. But how the heck do I relieve my shoulder pain? Your best case scenario is to consult with a professional - PT, Physiologist, Trainer.
In short, though, the odds are you will gain improvement by externally rotating your shoulder, pulling this complex backwards and downwards more often with your movement. In addition, you will benefit from relaxing, massaging, shutting off those overactive muscles, not feeding into their poor movement patterns. Overactive muscles can act impulsively, like bratty children, and we need to shut them off.
Next week, we will get into the specifics of how to do so, and how to implement these movements into your warm-ups and exercise routine for maximal balance and performance.
Have a great week!
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