Rotator cuff tendonitis, rotator cuff tears, biceps tendonitis, labral tears, shoulder instability, and impingement syndrome are some of the most common shoulder conditions that we see at Movement Solutions. Almost everyone will experience shoulder pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long-lasting. However it happens, shoulder pain can make many everyday activities difficult to perform.
There are common risk factors that can contribute to having shoulder problems. These include mobility restrictions at the thoracic spine (upper back) and lats. In addition, weakness of the core, and buttock muscles can affect how an active person moves. In some cases, movement errors can lead to a shoulder injury. This might include trouble “packing the shoulder” (i.e. engaging lats) when lifting overhead.
Having prerequisite mobility at the thoracic spine and lats are crucial for normal movement. When a loss of mobility is found in these areas, common manifestations are rounded and internally rotated shoulders. When posture is affected in this way, overhead capacity is limited. Dynamic loading with these imbalances can cause wear and tear on sensitive structures of the shoulders including the rotator cuff, biceps tendon, and the labrum.
In our physical therapy office, we first step we often take in reducing pain and restoring mobility is performing hands-on manual therapy. This might include dry needling, soft-tissue mobilization, joint mobilization, or manipulation. The effects of some of these treatments can be reinforced with foam rolling. By simply applying pressure through tense and stiff muscles, tension can be released and mobility can be gained. Some of the exercises that we prescribe patients include foam rolling the t-spine and lats as seen in the videos below.
However, foam rolling alone won’t provide any lasting gains in mobility. The reason for this is because stiffness and tension is usually driven my weakness of the stiff muscle as well as the muscle groups above and below that region. More over, the body needs to learn to actively use the motion it gains through passive implements (manual therapy and foam rolling). In order to develop lasting mobility, inactive muscle groups must be activated and strengthened. We have specific exercises that we we intentionally use to target these weak regions. Some of these can be seen below.
Once we have reinforced mobility, the next step is to work on stability. Shoulder stability begins with scapular depression or “packing” of the shoulder blade. Packing the shoulders protects the sensitive tissues that run along the head of the humerus when performing exercises that load the shoulders. Shoulder packing can be done with a partner or with a mobility band.
Finally, we know that if our patients have good mobility and stability in static positions but still have shoulder pain when moving or exercising, our rehab program isn’t very effective. We teach our patients to move well under load and use the mobility and stability they have in a dynamic exercise. One of the best exercises for shoulder health is the kettlebell arm bar.
At our physical therapy office, we use kettlebells because their off-center of mass provides a challenge in stability. When performed with good technique, kettlebell arm bars develop strength though the shoulder girdle (serratus anterior, lats, lower trapezius). It often takes good coaching and practice to keep the shoulder steady under load. But it’s a skill worth mastering as it translates to all press and pull movements including the military press and putting your Christmas decorations back in the attic.
In the absence of pain or injury, the above strategies are an excellent way to prevent injury to you shoulder. However, if your shoulder is in pain, a more nuanced approach is necessary. The reason for this is because pain changes movement. Movement compensations need to be identified through an assessment. An individualized plan needs to be developed to correct dysfunction. Manual therapy should be considered in the presence of pain and mobility restrictions. And a carefully planned exercise progression should be undertaken to recover from pain and injury and return to activity.
If you live in Greenville, South Carolina, are active (or want to be active), are between ages of 40-60s, and have shoulder pain, the providers at Movement Solutions would be happy to talk about how we can help. We are happy to begin with a free phone consultation where we you can talk on the phone to one of our providers. We can give you guidance on treatment options and how you can get your life back. Call us today at (864) 558-7346. We look forward to hearing from you!