Your shoulder hurts. Maybe it clicks all the time, maybe your shoulders are tight when you sit for too long, maybe it’s a rotator cuff issue, or maybe there’s an outright diagnosis. In either case, it doesn’t feel great. And you might have even been seeing a physio, or a chiropractor, or a massage therapist, but it’s healing slower than you’d like. Or it might just feel good for a few hours or a day or two after your treatment, and then, goes back to the way it used to feel. I got ya.
Original source: here.
In this article, we’re going to cover:
- What can go wrong with the shoulder
- The biggest mistakes when it comes to shoulder rehab
- Assessments used to figure out why the shoulder hurts
And if you want to skip all the theory, and get this working for you, you can see if you qualify to have a specific exercise program designed for your shoulder by filling out this questionnaire.
What Can Go Wrong with the Shoulder
The shoulder is the least stable joint in the body. Different joints have varying levels of stability or mobility. For instance, the knee and elbow have a lot of stability (they only move forward and back), whereas the hips have a lot of mobility (they can move every which way). The shoulders are even more mobile than the hips, and due to their mobility, they lack stability. Imagine a golf ball on a tee. That’s how shallow the socket of the shoulder is. Which partially explains why there are so many things that can go wrong with the shoulder.
A wrong approach to making the shoulder feel better is conclude that there’s a specific set of exercises for shoulder issues. Nope.
Here’s a small list of what can go wrong with the shoulder:
- Arthritis
- Rotator cuff tears
- Subacromial impingement
- Biceps tendon tear
- Bursitis
- Tendinitis
- Labrum tear
- Frozen shoulder
- Acromioclavicular joint tear
… and this is just a very small, partial list of what can go wrong with the shoulder. Do you think you should use the same exercises for all these issues? I think we know the answer to that.
The Biggest Mistakes When it Comes to Shoulder Rehab
Mistake #1: Doing the Same Exercises for Different Shoulder Problems
So the first biggest mistake that I see is people (that includes personal trainers, and other health professionals) answering “yes” to the previous question. As in “yes”, all shoulder issues will benefit from the same exercises. Those people are stupid.
One of the most common things I’ll see is people doing external rotations and internal rotations indiscriminately. Doesn’t matter what the issue is. External and internal rotations will fix the issue… not.
Mistake #2: Doing Internal Rotations
This is related to mistake #1. The rationale goes “well, we have external rotators, and we have internal rotators, so we need to work them both, so that we have balanced development around the shoulder.” Sounds logical, until you actually realize that they’re out of balance to begin with. And if you work them both (internal and external rotators), you’ll just maintain that imbalance. Most times, there is a pre-existing imbalance of external and internal rotators, in favour of internal rotators. So you don’t need to be doing exercises for the internal rotators. Not without assessing them, anyway. If an assessment does reveal that the internal rotators would benefit from strengthening, then by all means, go for it. But not without an assessment.
Mistake #3: Stretching
This is still related to mistake #1. The thinking is “if I’m injured, I should stretch.” Stretching helps you work out the kinks of that injury.
Well, what if the injury occurred in a stretched position in the first place? Then stretching it would only slow down the recovery.
One of my friends got injured at the bottom position of a bench press. In that position, the chest muscles are stretched. He was stretching a lot for “recovery.” And yet, he wasn’t recovering. When I found out what he was doing, I told him to stop stretching. And a week later, the pain went away. After 2 months of it not going away.
Again, stretching is only beneficial if there is a proven need to stretch. How do you prove the need to stretch? You assess range of motion. No limitations in range of motion, no need to stretch. But how do you know, unless you test? You don’t.
Mistake #4: Not Addressing Faulty Breathing Mechanics
One of the things that can really slow down recovery from shoulder issues is faulty breathing mechanics. When we assess the breathing mechanics of our clients, we look at 2 things:
- Location of the breath (stomach or chest)
- Breathing frequency
Proper breathing should go into the stomach, and there should be fewer than 12 breaths per minute.
In fact, one study, in the International Journal of Sports Physical Therapy concluded that “inefficient breathing could result in muscular imbalance, motor control alterations, and physiological adaptations, that are capable of modifying movement.”
If the client breathes into the chest, then with each breath, they are activating what’s called the “accessory breathing muscles.” What are those? Those are the:
All those should be relaxing when you’re breathing. If you’re activating them with every breath you take, they will constantly pull the shoulder out of position, and despite using the “right” shoulder exercises, you don’t see progress, or you don’t see it fast enough. Very frustrating.
So breathing mechanics must be assessed, and if they’re not correct, they must be retrained.
Mistake #5: Not Assessing
All the previous mistakes really come from one big, fundamental mistake: not assessing. And as you know by now, “if you’re not assessing, you are guessing.”
If you’re not measuring what’s wrong, then you don’t know what to “fix.”
Which brings me to the next section, on…
Assessments Used to Figure Out Why the Shoulder Hurts
First, let me say that as fitness professionals, we are not allowed to diagnose. But we certainly can identify muscular imbalances. If we see limitations in range of motion, we’re allowed to correct them, and if we see deficits in strength, we can fix those as well.
So what assessments do I, and my staff use to assess why a shoulder might be hurting? There are really 4 main categories of tests we use:
Category #1: Shoulder Range of Motion
There are really 4 joints at the shoulder (for the geeks, they are the glenohumeral, sternoclavicular, acromioclavicular, and scapulothoracic. Here is an anatomical diagram of them). The ball and socket joint is the glenohumeral joint. So we test range of motion there:
- Flexion
- Extension
- Medial rotation
- Lateral rotation
- Adduction
- Abduction
Category #2: Neck Range of Motion
Talk to most good rehabilitation professionals, and they’ll tell you that a lot of shoulder issues come from the neck. So you also have to assess the neck for limitations in range of motion. So we look at:
- Flexion
- Extension
- Lateral flexion
- Rotation
Category #3: Mid-back Range of Motion
Just like the neck can cause shoulder issues, so can the mid-back (thoracic spine). If you have rounded shoulders and typical “bad posture”, you’re creating blockages around the shoulder that can limit range of motion. So when assessing mid-back (thoracic) range of motion, we’re looking at:
- Rotation range of motion
- Symmetry (can you rotate the same amount clockwise, as you can counterclockwise?)
Category #4: Breathing
As mentioned earlier, it’s important to assess breathing mechanics. So we look at:
- Whether our client breathes into the chest, or the stomach
- The number of breaths taken in one minute (again, it should be 12 or less)
Based on these assessments, we can devise the appropriate exercise program to get the shoulders to heal much faster. If you’d like to have this assessment done on you, and have the appropriate exercise program devised for you, fill out this questionnaire, to see if you qualify.
