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Understanding Your Shoulder Pain

by Meaghan posted August 13, 2015

Our students currently taking Advanced Concepts learned all about the influence of scapulo-humeral rhythm on impingement this week. Here is a bit more of what we talked about:

The shoulder is probably the most misunderstood joint in the body, especially among those who don’t have a good foundation in human movement – which, unfortunately, includes the majority of people who work out. This, coupled with its inherently mobile/unstable nature, also makes the shoulder the most commonly injured joint in the body – which is why you see so many people in the gym doing stuff like this:

Granted, rotator cuff exercises have their place. Assuring good external rotation strength at the shoulder can surely help in some instances (e.g., in baseball players – especially pitchers – who regularly take their shoulders through greater than normal ranges of motion in external rotation, and even in the general population when desk-bound lifestyles tend to produce internally rotated shoulders); BUT, you’re much more likely to improve shoulder external rotation with good ol’ fashioned pec stretching and basic pulling exercises than you are with these standard external rotations.

Additionally, the fact is, although the rotator cuff is often injured, it’s not usually a lack of strength in the external rotators (teres minor and infraspinatus) that’s the problem. The rotator cuff may take a beating, but it’s more often than not due to improper mechanics at the scapula. The poor little rotator cuff is simply the victim rather than the culprit.

The underlying issue often lies more in one’s ability (or lack thereof) to achieve adequate scapular upward rotation as the arm elevates, and/or stabilize the scapula against the rib cage during shoulder movement. In a healthy shoulder complex, the scapula move in response to movement at the gleno-humeral (shoulder) joint; we call this “scapulo-humeral rhythm.” Initially, the scapula finds a stable place to sit on the rib cage, kind of like an anchor. But after the initial stages of humeral elevation, it upwardly rotates about one degree for every two degrees of humeral elevation thereafter. If this doesn’t  happen, the tendons of the rotator cuff (and other structures) get pinched between the scapula’s acromion process and the head of the humerus. OUCH!

End result: Irritation, inflammation and PAIN – a condition known as impingement. You can do external rotation exercises all day long but they won’t help the condition much if your scapula doesn’t move properly along the rib cage as you lift your arm. The head of your humerus will keep banging into that acromion and pinching your  tissues. And if your posture sucks because your internal rotators are tight, you won’t be able to get into external rotation anyway.

That said, training for better posture and proper scapular mechanics first is a better way to go for shoulder health. (Hint: Think foam rolling around the shoulder blades and mobilizing around the pecs.) Forcing the rotator cuff to then perform its PRIMARY function of stabilizing the head of the humerus in the glenoid fossa (shoulder socket) with good scapular stability is a good next step. Here is a good exercise to get that job done:


You can increase the challenge by using a kettlebell (a less stable implement than a dumbbell due to its design), and eventually add a more dynamic movement like the windmill:


Note: Know your progressions and start light! Good posture (including T-spine extension) has to come first!


Filed under: exercise programs, fitness-related injuries, tips for trainers

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4 responses to “Understanding Your Shoulder Pain”

  1. Brent says:

    How much thoracic extension would you tolerate if shoulder mob is lacking?

  2. Meaghan says:

    Given the joint-by-joint concept, if shoulder mobility is lacking, I’d be much more worried about the scapula compensating with excess motion rather than the T-spine…

  3. […] great short article explaining a common cause of shoulder pain and what you can do to prevent it.  Understanding Your Shoulder Pain is just one of many great articles found on FitnessMash, so be sure to check them […]

  4. Very interesting article. Great videos – thanks for sharing.

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