Shoulder pain can be referred from the neck and muscles around the neck as well as the shoulder itself. The shoulder complex, includes the shoulder joints (glenohumeral, acromioclavicular and coracoclavicular) and the muscles that control shoulder movement (mainly rotator cuff, deltoids, pecs & lats). The most common causes of shoulder pain include muscle trigger points, biceps tendonitis, shoulder impingement & frozen shoulder. I’m not going into the details of advanced impingement or frozen shoulder but it’s safe to say most shoulder problems follow a very similar pattern.

So the simplest and easiest to correct is tight knots called trigger points in one or more of the muscles around the shoulder and/or neck. The pec muscles both major & minor are important areas to check as excessive tightness in these will hunch the shoulders forward leading to overstretched and weak shoulder stabilisers and decreased shoulder range of motion. The overstretched muscles of the shoulder and upper back can also develop trigger points and possibly even strains if they are exposed to enough stress over many years (rotator cuff disease) or after a major traumatic event such as a fall onto an outstretched arm.

Trigger points can be treated my manual therapists such as Chiropractors, Osteopaths and sports therapists. You can also have a good go at them yourself (see pic above) using a small ball like a golf ball or cricket ball. Basically find the tender spots (knots) in the muscles get the ball or similar object on them and lean into it against the wall or floor. Hold that pressure on the trigger point until it releases which often takes at least 30 seconds. You can also attempt to move the arm as you do this but if so do it with less pressure on the trigger point than if you are just leaning on it.

Thoracic spine mobility is vital for good shoulder and neck movement so manipulation/mobilisation of the thoracic spine is the first thing any therapist should consider when treating you for a non-traumatic shoulder injury. You can do a reasonable job of this yourself if you use objects like rolled up towels, foam rolls or tennis balls as fulcrums for your spine whilst you lay back over them facing the sky and stretch. Other exercises include holding your hands behind your back and reaching back wards as far as you can.

The ultimate aim is to retrain your posture so your mid/upper back is nearly upright, your ears are in line with your shoulders because you are tucking your chin in and your shoulders are rolled back and down. An exaggeration of this posture you can use as an exercise is the brugger posture relief position shown below. When you have improved mobility and reduced pain you can start to strengthen the shoulders beginning with the muscles that pull the shoulders back – posterior deltoids, mid/lower traps, rhomboids and lats.

Exercises like seated rows are great for building up posterior shoulder strength making sure you keep your spine still and elbows down by your sides. The other main area of shoulder rehab is the rotator cuff muscles, these are often worked with rotation exercises with bands or cable machines and you can also use dumbbells if you have an awesome moustache like the guy below. Finally when the shoulder is healthy as long as you have good thoracic spine mobility and full shoulder range of motion then a good way to maintain it is to work on overhead squats. If you can’t achieve this range of motion just keep working on the things above so you don’t stiffen up again.

Frozen Shoulder/Adhesive capsulitis: Rotator cuff disease and shoulder impingement are often misdiagnosed as frozen shoulder so the first thing to do if you think you might have frozen shoulder is get a proper diagnosis from a qualified musculoskeletal expert like a chiropractor. The types of treatment and exercises for true frozen shoulder are significantly different to the other shoulder complaints described above so it is important to know the difference!

Published by Paul Hindle