Shoulder pain and shoulder injury can be prevented with a few simple strategies. Common diagnoses like rotator cuff tendonitis, shoulder impingement, and shoulder blade pain can be avoided by paying more attention to your entire upper body.
Our shoulder is a ball-and-socket joint consisting of the arm bone (humerus) and the shoulder blade (scapula). This “glenohumeral” joint is part of the overall shoulder girdle, which includes the other shoulder joint, both collar bones, and both shoulder blades. This girdle is connected by just one bone-to-bone joint (sternoclavicular) at our breast bone (sternum) in the front of our body. The rest of the girdle is connected via multiple tendons, ligaments, and fascia.
This quick anatomy lesson made the point that we must care for our upper body soft tissues (muscles, tendons, ligaments, and fascia) to ensure our girdle sits and moves well. When it doesn’t, our shoulder joints can suffer. We also need to be aware of our spine and ribcage posture and movement so that the foundation on which our girdle sits functions well.
There are a few common upper body “dysfunctions” or problematic movement patterns we see in our clients at Juniper Physical Therapy & Fitness. These are rounded, inflexible mid-backs, shoulder blades that rest suboptimally, an overuse of front body muscles, and tightness in the back of their shoulders.
All of these things can be summarized into five general underlying issues. Posture, shallow breathing, mid-back stiffness, shoulder blade weakness, and lack of shoulder joint mobility. Solutions to these are listed below with some details to get you started on preventing injury to your shoulders.
Be Aware of Your Posture
Most everyone knows what “good posture” looks like. As soon as clients know their posture will be assessed, they sit up very straight. This typically looks like an upright spine and a longer neck. One thing they miss, though, is the placement of their shoulder blades and overall shoulder girdle. Frequently, we see prominent collar bones with forward shoulders and separated shoulder blades.
Before I proceed, I’d like to preface this posture conversation with these two statements, “There is NO Perfect Posture” and “The BEST Posture is the NEXT One.” Seriously, long gone is the goal of maintaining a perfectly upright posture. Too much of anything is not good.
Healthy shoulders require the ability for the ball to roll and slide smoothly in the socket when you move your arm. In order for this to happen, your shoulder blades (the socket is located on these) have to rest relatively flat and a few inches from your spine along your upper mid-back. Your mid back must be mobile enough to extend and rotate so your shoulder blades can sit and move well.
Everyone’s skeletal structure is different and often requires unique cues to optimize their posture. However, there are a few general guidelines that are helpful for most. Try the following tips and see how they feel for you and your shoulders.
When sitting, try to sit on your butt bones so that you have a natural inward curve of your lower back. The same low back position applies for standing. However, when standing, it is important that you try to maintain a neutral spine.
Take a deep inhale, and as you exhale, gently bring the front of your ribcage downward (without losing your inward lower back curve).
Maintain this spinal position as you bring your chin slightly back so that your ears rest over your shoulders.
Place your shoulder blades towards one another without forcing or squeezing.
This posture is a good foundation for most activities. Remember, it is not the goal to stay here all day. However, if this feels difficult or very different for you, it is good to practice being here several times daily. This posture is especially important when you add load to your system, such as when lifting weights or carrying groceries, for example.
Before and during your weighted load, correct your posture and set your shoulder blades. The larger muscles along your back and shoulder blades will support your shoulder girdle, allowing your humeral head (the ball) to roll and glide nicely within the acromion (your socket).
If you sit or stand for long periods of time, take the time to notice how long you hold a particular position. Then, be sure to change it up. You CAN slouch. You CAN relax and sit on a squishy couch. Just don’t hang out too long in these postures.
Practice Deep Breathing
Breathing deeply has many benefits, from stress reduction and muscle relaxation to optimizing movement. In relation to your shoulders, breathing deeply helps reduce the tension that often exists within your shoulder girdle.
When we take in shallow breaths, we utilize several of our neck muscles that attach to our collarbones and ribs. As explained above, your collar bones are located in the front of your shoulder girdle. They attach to your breast bone and are part of a joint (AC joint) located at the top of your shoulder.
If you chronically overuse these “accessory breathing muscles,” you limit your collar bones' abilities to move well, and you restrict some rib motion which can negatively affect your posture. This joint and postural restriction will limit your shoulders' abilities to move well.
When you effectively deep breathe, you utilize your diaphragm muscle which will help “free up” your shoulders' ability to move and better activate your core. Try this standing or lying down diaphragm activation exercise.
Move Your Mid Back
Movement in your mid back, known as the thoracic spine, is critical for optimal shoulder function. When you lift your arms, your shoulders rely on mid-back extension and rotation to get fully overhead. If you lack this thoracic mobility, your shoulder joint has to move further, making you prone to impingement and tendonitis.
Try this easy mid-back mobility exercise as a warm-up before your next shoulder workout, golf game, or activity that requires you to raise your arms overhead.
Strengthen Your Shoulder Blades
Your shoulder blades contain attachment points for all four of your rotator cuff muscles. They are also the bone that several larger back muscles attach to. These larger muscles are designed to stabilize the shoulder blades so your shoulder joint can be nice and mobile.
Unfortunately, many of us have the reverse going on. We underuse these larger back muscles and overuse the smaller muscles surrounding our shoulder joint, especially the ones that are on the front of our body (like our pecs and anterior deltoid). Balancing out your upper body by engaging specific shoulder blade muscles when you work out or when you are active is key to shoulder injury prevention.
At Juniper, we fully evaluate all the details of which muscles are over and underworking on your body. This allows us to prescribe very specific exercises for each individual. However, the following two exercises are added to our client’s app accounts very frequently.
Sidelying Mid Back Rotation - Ly on your non-restricted or pain-free shoulder. Pull your top knee up to your belly button and rest it on a foam roller. Hold onto the underside of your left ribcage with your right hand. Take a deep breath in and rotate backward as you exhale.
Prone T’s - Ly on your stomach with your head supported on a rolled-up towel with your face facing the floor. Bring your arms out to the side so that your body makes a capital “T.” Rotate your arms and your shoulder blades so that your thumbs are facing up. On your exhale, lift your arms a few inches from the floor, squeezing your shoulder blades together.
Keep Your Shoulder Joints Mobile
Your rotator cuff (and several other) muscles need to have adequate length and strength for your shoulder bone to move smoothly within the joint. When our shoulder blades aren’t staying stable in an optimal position, our shoulder muscles often tense up, trying to gain a sense of stability. Unfortunately, this shouldn’t be their primary job.
A lack of shoulder mobility inward (internal rotation) is the most frequent restriction we see at Juniper PT. We recently posted the following reels on Instagram to help people understand how we can help you gain internal rotation with our interventions and a stretch you can try independently.
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