When a client comes into my office complaining of shoulder pain while reaching overhead, my kinematic sleuthing mind kicks into gear. I listen to their story, look at their anatomy at rest, and then put them through a series of movements to see how everything moves together.
You see, the shoulder is like a team of essential players. Each and every joint, ligament, nerve, and muscle must do its job in harmony with one another. If any of these structures or tissues is overbearing or slacking, others don't get a chance to play well or have to work harder. This imbalance can continue for a while, but eventually, something gets exhausted or weak, leading to chaos, pain, and poor movement.
Every time you reach overhead, here is what has to happen:
Your shoulder blade (scapula) must tip back and rotate upwards.
The ball of your arm bone (humeral head) must slide down and roll backward.
Your collar bone (clavicle) needs to drop down by your breast bone, lift by your shoulder, and roll backward.
Your mid-spine bones (thoracic vertebrae) need to extend and rotate.
Your rotator cuff muscles need to activate to control your humeral head, ensuring that it is mobile and stable in the joint.
Your internal rotator muscles (pecs and lats, for example) need to lengthen a bit to enable your rotator cuff to do its job well.
Multiple ligaments surrounding your primary shoulder joint (ball and socket) need adequate tension and mobility to help control and allow the ball to roll in the socket.
Multiple nerves (brachial plexus) need to glide around and through various bones and tissues to provide adequate innervation to the muscles required to complete this motion.
All this goes through my mind when I'm talking to and looking at my client move. I start listing impairments and then do my best to locate the primary pain generator. Once the tissue(s) causing the immediate pain reveals itself, I work on that first. Then restoration of all the underlying chaos needs to be addressed.
Often, it is not this simple, and several structures or tissues must be addressed at once. However, after years of working on various people and shoulders, there are some commonalities among my client population.
The four most common reasons for shoulder pain when reaching overhead are:
Lack of movement in the mid-back
Poor arm and shoulder blade movement awareness
Tightness of pecs and lats
Lack of rotator cuff strength
⚠️Warning: As you can probably imagine, the shoulder joint is quite complex, and these four common impairments may not be your issue. If you have pain that disrupts your day and causes you to move differently, seek professional help sooner than later. You might worsen your condition, and the longer you wait, the more challenging it will be to heal. Please see your local physical therapist or orthopedic specialist to guide you.
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