Quick Fix - Shoulder Pain - Part 2
Disclaimer - If any of these movement cause pain then please STOP. Disclaimer - If pain has been present for more than 4 weeks then go and see a good therapist.
So it may be worth revisiting Part 1 before pressing ahead with this blog as we will not be covering any A&P of the shoulder.
Part 2 is going to offer a solution and how to perform the exercise/movement correctly. It is still recommended that if you are in PAIN then you visit a therapist so they can screen your shoulder pain/dysfunction. We are going to kick off part 2 with unlocking your Thoracic Spine as this has a significant relationship with shoulder dysfunction and therefore shoulder pain.
At this stage there is no need to go chasing shoulder mobility as this will just aggravate the pain further and the shoulder joint is mobile enough - it is a ball and socket joint it rotates 360 degrees - but what it does need is a better relationship with the scapula and great stability in movement.
T-Spine Lying Windmills 8-10 reps each side This is a great exercise to improve T-Spine rotation and also will help open up the shoulder and chest. It is important to only move through the mid/upper spine and only take the movement as far as possible but without forcing end range. Over time you will see quick improvements and this is also a great mobility exercise for the start of any workout.
Quadruped T-Spine Rotation 8-10 reps each side This is a great exercise to which can be down as a warm up or in between your rest periods. Again it is important to rotate through the mid/upper spine and not to let your lumbar (lower back) rotate. If this causes impingement pain then refer back to T-Spine side lying windmills.
Lying Tspine Bench Mobilisation 6-8 reps
This is a great exercise that not only unlocks your T-Spine in extension but will also provide a stretch through the lats, shoulder and tricep. Take a dowel and rest your elbows on the bench with your hands at shoulder width. Lying on your knees shift your hips back as your bring the dowel behind your head. Hold the position and take a deep belly breath before returning to the start position.
Alternate Arm Scapula Mobilisation 6-8 reps each side The next exercise will work on extension but also as myofascial release for the rhomboids which are key trigger point areas for shoulder and postural dysfunction. Place two tennis balls taped together between your shoulder blades as you sit back on the floor. Then, alternating arms, raise your arm in a controlled manner, at a slight angle, until it is fully extended and just passed your ear.
TSpine Extension Foam Roller 3-5 reps
So this is a great way to extend the spine, especially if you have been sat at a desk all day! Start with your spine positioned at T12 (mid back) and place your hands on the side of your head and bum on the floor as above. Then slowly extend back until your can't go any further then take a deep belly breath and repeat 3 times. You can also roll your back to release tension but done roll over the lumbar area. Flexibility
Next we will take a look at the big hitters in terms of short, tight or restrictive muscle (usually prime movers which are doing the work of your stabilising muscles) which will be causing your pain (trigger point and referral) which will be effecting shoulder performance and function.
We discussed this important area for shoulder pain in Part 1 but just to reiterate it is a huge player in shoulder functions as it pulls the scapula anteriorly and inferiorly toward the ribs rotates your scapula and plays an important role in shoulder health and function.
Lifestyle factors are usually the reason behind a short, tight pec minor so its an area we need to improve tissue quality and function. Active Release Therapy is something I use with clients but if you can't get to a massage therapist there are some 'self help' techniques we can use.
Soft Tissue Release/Trigger Point Tennis Ball
This can be quite painful (If it is painful its a sign it needs work!) so you could start with a softball before progressing. Place the ball into the area between your chest and arm pit and slowly move your weight onto the ball until you find your trigger area. Take 1-2 mins to release each side before moving onto the stretch.
Wall 90 Degree/Swiss Ball Stretch This is a great stretch as it can be done almost anywhere especially in your office!
Get up from your workstation and set an alarm for every 30 mins and perform this stretch 30-60 seconds each side. This will open up your glenohumeral joint and improve your posture whilst overtime releasing the pressure and internal rotation of the shoulder joint.
Dumbbell Stretch I love this stretch as it allows you to really get into the pec minor and is stretch than can be progressed. You can start with no weight to begin until you feel confident to add weight to the stretch. Hold two dumbbells or even light plates and just let gravity do its work! Be careful with the position of your arms as you don't want to impinge the shoulder joint.
Teres Major/Latissimus Dorsi
The 'Lats' are a very misunderstood muscle when we look at posture and shoulder function. It is the only muscle that attaches the hip to the humerus and as a result can cause further internal rotation of the arm. The Teres Major sits just under the scapula and is a very tender area for the majority of people who suffer shoulder pain and is a key referral point. The role of the muscle, due to its insertion point, is to internally rotate the arm (common theme!)
Trigger points in the teres major are typically associated with frozen shoulder syndrome; pain on reaching above head; pain when driving; and common impingement syndromes.
Lat Banded Stretch
This a great stretch that can be performed between exercises or as part of your prehab or cool down. We are a big fan of using bands to improve mobility and function and you can also perform a contract/relax protocol using the resistance of the band. Attached a band to a squat rack and feed your hand through the band. Take enough step back so you can the band taught and then hinge at the hip until your feel the stretch which may be towards the hip or shoulder. Due to the insertion point on the humerus it will help to rotate your body so you are almost looking underneath your armpit. Aim for 30-60 seconds on each side and repeat if necessary.
Teres Major Foam roller/Tennis Ball SMR
This is a really important area to improve quality of tissue and this muscle can be aggravated by pressing heavy loads overhead. Place a tennis ball just under the shoulder blade (see picture below) and slowly move side to side with your arm in front of you. If this is too painful then you can use a foam roller on the floor which has a larger surface area. Again 1-2 minutes on each side or until it becomes more comfortable.
Middle to Lower Trapezius
We are now going to address an area which is commonly overlooked when prescribing shoulder rehab/rehab and that is strengthening of the middle to lower trapezius.
Due to the downward direction of the mid/lower trapezius it is muscle that plays a very important role in depressing the scapula and therefore shoulder impingement (If you scapula is always elevated this is going to aggravate your suprispanitus and other tissue in the acromiom space - See Part 1).
*** It is important to note that when performing these exercises that you try and switch off your upper traps by bringing your shoulder 'back and down' otherwise it will just lead to further impingement.
Scapula Wall Slides 8-10 reps This is a great place to start in learning how to recruit the mid/lower traps and focus on depressing the scapula be squeezing the shoulders back and down. As you can see by the nature of this exercise it also is a great opener for the chest and glenohumeral joint. Try and keep your arms flat against the wall and slowly elevate into a Y position and repeat. ry and keep your butt and back against the wall (allow for a natural curve in the lower back) with feet 6-10 inches from the wall. This is more challenging than it sounds.
Banded Shoulder Circuit
We are now looking how we can strengthen our external rotators and mid/lower trapezius which is going to improve stability at the shoulder. Here is a great circuit that does just all that and can be used at the start of your workout, as a filler or on a rest day. Perform the following A1) Face-Pulls x 15/20 reps
A2) Band Pull Aparts x 15/20 reps
A3) Banded Dislocations x 15/20 reps Face-pull - Attached a band which allows you to pull to your face while keep the elbows back and squeezing the shoulder bladed together. Pull Aparts - Take the band in both hands and hold out in front, finding the correct resistance in term son hand position, pull the band apart and squeeze your shoulder bladed together and repeat. Dislocations - Take the band in both hands and hold out in front, you will need to go wider depending on your shoulder mobility, and then bring the band overhead. DO NOT force the movement just go as far as is comfortable and there is no restriction. If this is uncomfortable then just focus on the Face-Pulls and Pull apart. You should feel a nice BURN between your shoulder blades when you have finished. Repeat 2-3 times.
ISO Hold YWT We love this circuit and owe it to Joe Defranco and his 'Strong B@st@rd 911' program. The beauty is in the simplicity as this can be done after almost every exercise and instantly will retract your shoulder bladed back and down. Again it is very IMPORTANT to make sure your shoulders are back and down (shoulder blades in your back pockets) before starting this exercise. We DO NOT want to fire the upper trapezes as this will further elevate the scapula. Perform with no rest. A1) Y for 20 secs
A2) W for 20 secs
A3) T for 20 secs
So after reading Part 1 and 2 you should now have a better understanding of the shoulder and the reasons and dysfunctions that can lead to injury. This is by no means a comprehensive list of exercises' for shoulder health but if you include at least some of them in your clients programming (or your own) then you will improve shoulder stability, strength and health. Like anything there is no quick FIX but working on your rehab/rehab for 6-12 weeks sounds is a lot better then going in for surgery which does not always guarantee you will be pain free or function optimally.
Just 10 minutes a day can keep you injury and pain free and also improve posture, strength and performance. If you have any questions regarding this article then please get in touch. Email - firstname.lastname@example.org Instagram/Twitter - @FFTAcademy Facebook - Fitness Factory Training Academy