Welcome back to the final installment to shoulder squabbles. If you have followed me along this journey, congratulations you will be kindly rewarded with the COR Shoulder Pain Solution with the help of Physical Therapy exercises! If you haven’t, pay your dues and read our previous posts on the shoulder Should Squabbles and Shoulder Squabbles Part II.
Muscle Length, Strength, Timing of the Shoulder
If you’ve read any of my other 10 minute solutions, you’ve heard me discuss muscle length, strength and timing. Any one of these three components can cause havoc on the body and lead to dysfunction. This solution will not help prevent every injury and solve any shoulder pain, but is the base for shoulder prevention and rehabilitation. Moreover, it has helped thousands improve shoulder pain and prevent many more. Proper shoulder health depends on many areas ranging from hip range of motion to breathing to strength. This article does not tackle all these potential problem areas, but are the nuts and bolts to shoulder health.
COR Shoulder Pain Solution
First and foremost, muscle length is essential for optimal muscle firing. If a muscle lies in an inadequate position, it will be weaker and increase injury risk. For example, raise your arms overhead. Now, slouch and raise your arms again. If you did this correctly, I guarantee the second time you raised your arm, you had less range of motion and potentially pain (unless you cheated and didn’t hold a slouch or you are already bent like Quasimodo).
This impaired motion is not from a spell, slouching altered your muscle length and put your body at a biomechancially disadvantaged position…no fair! Luckily, muscle length is improved with simple self myofascial or manual work. My favorite method to improve muscle length is tennis ball or self myofascial releases. From my experience the following muscles need improved length as they are “cheater” muscles. These muscles try to stabilize the shoulder blade, but this is not their primary job! Therefore, they get overworked and tight, preventing proper movement. The muscles I typically see cheating are the upper trapezius, levator scapulae, pectoralis minor, rhomboids, subscapularis, infraspinatus, scalenes and levator costum.
This article will not go into soft tissue techniques for all these muscles, but it will discuss the “bang for your buck” muscles and the ones can do by themselves. I’m a stickler on a few things, one of them is the rules for self myofasical release (SMR).
Live by these rules!
1. Lie on the tennis ball focusing on the instructed areas
2. The more sensitive or tender the area, the slower you should go
3. Stop if the exercises causes pain
4. Perform for 30 seconds – 2 minutes
Upper Trapezius (1 minute, 1 minute total)
The upper trapezius helps rotate the shoulder blade upward, which is essential for shoulder health, but when overactive it will elevate the shoulder blade, like you’re wearing them as earrings. Improving this muscles’ length will return it to a better position and improve function.
Lie on your back with your knees bent and place the tennis ball on your upper shoulder. The ball can lie on approximately 3 inches of muscle. This ball should lie on the muscle and not on any bones.
Levator Scapulae (1 minute, 2 minutes total)
Another scapular elevator and when overactive it will raise your shoulder to the sky. This position increases the risk for rotator cuff irritation and is essential to reposition.
Lie on your back with your knees bent and place the tennis ball in between your shoulder blades on the top side. This is near the superior angle of the shoulder blade for all your anatomy buffs.
Infraspinatus (1 minute, 3 minutes total)
The infraspinatus is commonly overworked and beat up in overhead athletes. This muscle is rapidly stretched in all overhead sports. Following a rapid stretch, the muscle will recoil and tighten up, no bueno.
Lie on your back with your knees bent and with the opposite arm place the tennis ball under the acromion, the bone on your shoulder blade.
Pectoralis Major (1 minute, 4 minutes total)
When overactive the pectoralis minor will pull the shoulder down and in, causing slouching. As we all just learned, slouching will impair overhead arm movement and put the shoulder at risk for injury.
Lie on your stomach with your arm at 135 degrees. Place the tennis ball on the outer aspect of your chest, pinching the tennis ball underneath your shoulder.
THORACIC SPINE (2 minutes, 6 minutes total)
The thoracic spine is stiff in almost everyone. Our society promotes sitting with a slouched posture and don’t kid yourself, you don’t sit with perfect posture 24/7. No one does, even yoga instructors with perfect “alignment” fail this “ideal” position. I’ll never forget sitting in physical therapy school, being lectured about ideal posture and observing everyone’s horrible posture. Luckily, we can improve thoracic mobility to allow our body to handle periods of poor posture.
Thoracic mobility may not perfectly fit in the muscle length, strength, and timing mantra, but sometimes more aggressive means are required. In most cases, improving the muscle length which is tugging on a joint is enough, but everyone is SO stiff, a more direct method is mandatory.
Lie on your back with your knees bent and place a tennis ball under your mid back (not directly on the Stegosaurus bumps, but approximately 2 centimeters to the side on the transverse process) where the ribs begin. Next, give yourself a big hug, grabbing your shoulder blades, then roll on the tennis ball, mobilizing the thoracic spine. Roll on and off this spot ten times, then roll off the ball and move it up and roll ten more times. Perform ten rolls on approximately five spots on each side of your mid (thoracic) spine.
Muscle Strength and Timing
Once you have your muscles in a better resting position, strengthening other muscle be used to increase strength through the new range of motion. The following exercises improve the strength of the posterior rotator cuff, scapular stabilizers and upward shoulder rotators.
Posterior rotator cuff strength is essential to endure repeated lengthening and stress. Rapid lengthening requires larger force production, then rapid shortening. Therefore, extra strength in these muscles is needed to handle the required force.
Stable shoulder blades are a must in any overhead movement. Those with immobile shoulders have poor shoulder strength. I like to imagine the shoulder blades as the foundation of the upper body. If you have a house with poor foundation, you’ve got a dangerous house. It is essential to build a strong foundation, to endure stresses without injury and to increase force production either with a house or shoulder.
The upward rotators help move the shoulder blade and control it through the desired range of motion. Many overhead athletes have excessive range of motion, enabling them to produce more force. Unfortunately, many of these athletes don’t have the control and stability to utilize this new range of motion. These muscles can help utilize the range of motion and prevent injuries.
Once again, follow the rules or you’ll pay the consequences…trust me you don’t want to find out.
1. Maintain the compact position as instructed
2. Do not let that position change AT ALL during the exercise
3. Stop if the exercise causes your pain
4. Stop if you can not keep the correct shoulder position
Robber (1 minute, 7 total minutes)
This exercise will cause maximal scapular stability activation.
Bringing your hands behind your back, pull your shoulder blades down and in. Hold this position for five seconds, then release. Perform five repetitions with five second holds.
Band Pull (1 minute, 8 total minutes)
The band pulls work the posterior rotator cuff muscles. This muscle group is weak in nearly every overhead athlete.
Hold a band with your elbows on your side, then pull the band apart as far as you can. Start with a light band, allowing you to move through the full range of motion. Perform three sets of fifteen repetitions.
Should Extension with Band (1 minute, 9 total minutes)
Extending the shoulder will drive shoulder blade movement. This exercise will activate the triceps and shoulder blade stabilizing muscles.
Put a knot of band in a hinge side of door. Then close the door to secure. Grasp onto band and keep elbow straight. Pull band straight back and let it forward slowly. Don’t rotate your body or lift your arm.
This next group of exercises utilizes a Swiss ball or the 3-point position. This position will round the lower back, putting strain on the lumbodorsal fascia. Don’t worry about the name, just realize tensing this area will prevent any low back arching during overhead movements.
1. Starting Position: Hug the ball face down, with knees bent. Flatten your back as instructed. Tuck the chin. OR if you don’t have a Swiss Ball, lie on your shins with your knees bent then place your forehead on the floor. Tighten your abdominals and tuck the chin.
2. In all of the following exercises, as you bring your arms up, you will have a tendency to arch your back. In order to target the scapular stabilizers and not cheat through the thoracic and lumbar spine, only perform the exercises with the back flattened.
“Y” (1 minute, 10 minutes)
This exercise improves the strength of the upward rotators, specifically the lower trapezius. This muscle is often weak and improvements in strength is directly correlated with shoulder health improvement.
Keeping your arms as straight as possible (at 11:00 and 1:00), bring both arms in front, thumbs up. Raise the arms as high as you can, remembering to raise them only as far as you can maintain your starting back position. Lower the arms slowly and repeat. Perform three sets of eight repetitions.
Shoulder Pain Solution Round-up
Now, this routine won’t fix every shoulder problem. However, these exercises are the meat and potatoes of shoulder injury prevention and rehabilitation. They improve the main discrepancies in muscle length, strength and timing. Improving these functions are mandatory. If you have shoulder problems, try these exercises daily and let me know the results!
Dr. G. John Mullen, DPT, CSCS