In Motion with Morrison Blog
Written by Aubrey Morrison
MS Sports Medicine, CSCS, Licensed Massage Therapist #16763
How do you feel when you perform an overhead press? Or reach up to get something out of
the cabinet, or put something up high on a shelf? Or do construction work installing things that
require reaching up for long periods of time? Maybe you have pain, maybe not. Perhaps you
feel a pinch in your neck or low back, even those are seemingly unrelated to your shoulders.
Here is a better question: what muscles are you using to do these overhead activities? Good
shoulder mobility is “having adequate motion in the right places to allow the arms to be
positioned overhead without compensation” (theprehabguys.com). Without compensation is
the key there – sure you may be able to get your arms overhead, but you might be using
movements in places other than your shoulders to do it. And that is where problems come
from!
Overhead movement seems simple, but it is so much more than just your shoulder working.
Multiple joints contribute to this action in one way or another, and all require stability and/or
mobility. Without getting too wordy with big joint names, here are the regions involved:
movement of the shoulder joint at the top of your arm, movement where the sternum meets
the clavicle, movement where the clavicle meets the acromium of the shoulder, movement
where the shoulder blade is placed over the rib cage, mobility of the thoracic and cervical spine,
stability and control of the low back and core muscles. Any limitations of the ability to move or
stabilize an area during overhead movement is a risk factor for injury, and could very well be a
reason for pain you may feel trying to go overhead. Movement limitations could come from
muscular imbalances such as being tighter and stronger in your front than you are in your back.
Often there are structural limitations from posture, like forward shoulders and a rounded upper back. Compensation could also be because of a fused lumbar spine that doesn’t allow back
mobility for a fluid overhead movement. There are lots of scenarios!!
Capsule tightness, soft tissue imbalance and restriction, thoracic mobility, scapular mobility
So how do you know what is limiting your overhead mobility? Obviously, if you have seen a
doctor and been diagnosed with something specific, that will tell you! However, many people
have pain that has not been assessed and they just live with it, and THAT is what we can help
with! Many people have pain that comes up suddenly, and we can help with that as well. First
we need to figure out what the limitation is that is causing the painful movement. We don’t
diagnose anything, but by asking a few questions and palpating and assessing, we can narrow it
down.
Overhead limitation and pain can come from joint capsule tightness, soft tissue inflexibility and
restriction, the ability for the scapula to move properly, and/or thoracic (mid-spine) mobility.
There may be other reasons, but these are often the main culprits. Yes, even your spine can
impact your ability to go overhead. When any of these goes unchecked, the compensatory
motions to force the movement will also start to create problems. For example, if you are an
athlete with a bit of overuse in the shoulders and have a tight and inflamed capsule, you might
fight through the pain of going overhead but use extra shoulder elevation to achieve the weight
or rep completion; only to further the shoulder capsule tightness but now creating more stress
on the trapezius muscle with that shrugging compensation. And that leads to probably neck
and more upper back problems. So you get the idea!
We can usually deduct what the problem is by asking what the client does on a daily basis. If
they are a Strongman athlete, there is likely some inflammation that needs to be taken down,
scar tissue to reduce in the rotator cuff muscles, and work to be done in the thoracic region to
improve flexibility in the spine. If someone works at a desk all day and has posture with rounded upper back and slightly forward shoulders, we would work to open up the chest and anterior shoulder to correct posture so the shoulder can be more balanced for fluid shoulder joint movement (have you ever hunched your shoulders over and then tried to reach overhead? It doesn’t work…). These are just some examples of how we narrow things down.
From there, the actual muscles we work to unrestrict for optimal overhead movement would
be mostly the latissimus dorsi, rhomboids, rotator cuff muscles, and other muscles that attach
to the scapula (pec minor, serratus anterior, levator scapulae, deltoid, triceps). Doing specific
work on these muscles will have an effect, and by palpating them we can develop our treatment plan. As far as thoracic work, there will likely be movement involved on your part as we work that part of the spine to get those muscles more supple. It is always a surprise when a client comes in for shoulder pain going overhead, and we do a lot of work on the mid and low back!
Maintaining overhead shoulder health is something to manage regularly on your own if your
daily tasks and activities exacerbate any imbalances. We may give you some homework,
usually a few stretches or mobility exercises with a lacrosse ball or roller. With our Geek
Massage (created specifically for upper body posture improvement), you get specific exercises
along with the tools to do them; the equipment you take home are a peanut ball, exercise
band, and a thin PVC pipe.
Shoulders are VERY complex, and there could be many reasons for pain and immobility. Don’t
wait for it to resolve itself, and years go by with you tolerating it. We’ve got your back! Well,
shoulder!
www.coastalmassagewellness.com