The shoulder is by far the most common extremity I deal with in sports and private practice and is a very prevalent problem in today’s fitness and general population. Most shoulder cases are not tears or dislocations that warrant surgical repair. Rather they are the result of biomechanical or neurological abnormalities in shoulder activation, mechanics, and movement patterns.
This probably sounds complicated, and absolutely can be. But a vast majority of these shoulder issues fall into similar patterns and causes. Because of this, most shoulder conditions are preventable if proper attention and effort are devoted to the shoulder and keeping it healthy. So for those who are having issues and want to fix shoulder pain, or want to be proactive and keep their shoulders healthy, here are three quick tips to fix shoulder pain. You may notice all three of these tips are actually tied into each other and follow a familiar theme: Imbalances in the shoulder.
1) Fix your posture, Quasimodo.
Due to electronic device usage, office jobs, and sitting in general being so dominant in today’s society, the typical person is more and more predisposed to having bad posture. Why does this matter, you ask? It matters because it leads to the development of an abnormal motor pattern called upper cross syndrome. This occurs when muscles such as the pecs, traps, and neck flexors dominate and pull the shoulders and head forward. This in turn shuts off the muscles in the back who’s main job is stabilizing the shoulder blade. Since the shoulder blade is THE major connector of the shoulder to the rest of the body, an unstable shoulder blade will certainly mean bad news for the shoulder. Bad posture is also well known to be a submissive position and a slumped or stooped over posture has been shown to have negative mental impacts on mood and confidence. Guess you weren’t as alpha as you thought, bro.
The solution? Sit and stand with better posture. Drop the shoulders down and back and stick the chest out while pinching your shoulder blades together. When you sit, actually sit on the seat of your pelvis to create a good arch instead of rounding the low back and slumping over with the rest of your body. Your shoulders will thank you.
2) Stop pressing so much.
This isn’t even about you skipping leg day. That’s another topic for another day. This is about training way too many pushing and pressing movement, (bench, push-ups, overhead presses, dumbbell presses, etc) without balancing these movements out. Stereotypes exist for a reason, and the gym bro stereotype is well deserving of trap, chest and shoulder dominance over what is essentially the entire posterior chain. For the sake of this write up, we are only concerned about the upper back and rear stabilizers of the shoulder. This is by far the most common cause of shoulder pain in the beginner lifter. Trying to hit a new bench PR followed by dumbbell flys, pec deck and some tricep work twice a week is not going to cut it.
Proper training needs balance. In the case of the shoulder, this means pulling, shoulder retraction, and upper back extension movements. Pull-ups, pull-downs, seated pulls, face pulls, rounded back extensions and good mornings, etc. The key here is to activate and strengthen the foundations of the shoulder and upper back.
3) Invest shoulder prehab work into your training.
One of the best ways to fix shoulder pain and keep it from reoccurring is consistency over time. Whether you are hurt or not, prehab is something you need to be doing. As tip 2 constantly plagues the beginner lifter, this section often involves intermediate and advanced lifters. These athletes may have their programming figured out, but neglect to invest the extra time in promoting their longevity in strength training. Unless you have structurally damaged the shoulder (torn labrum, pec, bicep, etc.) the cause of shoulder pain will be functional. This means constant repetitive strain is being placed on joints and muscles, causing abnormal movement or stress to accumulate to a level which surpasses the threshold of pain. This can be due to chronic imbalances as noted before, the wear and tear of training, or other everyday activities. Strength training by definition involves breaking down the body, so it should not be a surprise that if proper attention is not given to areas which are constantly being broken down, it will eventually catch up to you. Because of this, prehab should be a constantly ongoing process. Whether it is for correcting a current problem before it begins causing pain, or focusing ones attention on an area predisposed to future injury or excessive stress based on ones sport. This is a concept that young college athletes REALLY have issues accepting or comprehending. They can figure out that they need to spend time rebuilding their army in Clash of Clans, but can’t figure out that they need to rebuild their own body on a daily basis too. When I’m asked by an athlete when they can stop doing prehab work, the answer is “When you are done training and competing.” Otherwise, get it in.
For the non-complicated shoulder condition, prehab can include stretching, activation work, and reinforcing correct movement patterns. The less an athlete is willing to do on their own, the more I need them in my office. A good start with stretching is to focus on the pecs, lats, and traps. These are the locations I find to have the most trigger points that need to be released. Stretching should be done on off days, after training, or before training days that do not involve the shoulder or upper body.
Activation work is best accomplished with light band work before training shoulder and upper body movements or on off days. This should include the rotor cuff, upper back, and posterior shoulder stabilizers. For a good base program of band work for the upper back and shoulder check out David’s Band Pullapart Super Series. (Bonus points if you can correctly identify which other NBS member is in the video).
Movement pattern reinforcement is essentially the constant analysis, critique, and focus on obtaining and maintaining correct form. In order to fix shoulder pain, you may need to analyze include bench pressing, overhead pressing, and any other chest, arm, or shoulder isolation movement you are currently using in your training. This may seem like something you are already doing, so don’t skip this part of the write-up. Even if you are able to activate and pinch your scapulas together and have always stretched your pecs, you must be able to complete a proper range of motion. This allows you to move the most weight, place stress on the correct muscles, AND avoid excessive wear and strain on the shoulder joint. Any healthy joint can be susceptible to damage when you put it in an improper position or movement. Make sure you are constantly addressing proper form with subjective input from yourself and your training partners or coach. Finally, if a shoulder condition seems to be progressively causing problems, get checked out by a professional who is trained to address functional issues to put you on the right track.