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6 weeks to strong pain-free shoulders

Updated: Apr 13, 2023

I remember listening to a very esteemed shoulder surgeon as he got on stage and said “if our body had a designer then they really stuffed it up at the shoulder.”

Look at it this way- our homosapien and homoerectus ancestors traditionally would walk and climb with the help of their upper body and thorax. The current thinking is that they came upright 3-6 million years ago to look over the tall grass for predators. Apart from us, there aren't a lot of truly bipedal (2 legged) species with an erect spine – and this is a big part of the problem.

You see, our thorax (rib cage) didn't evolve to be upright. Traditionally, thorax were designed to be somewhat horizontal (think about a lizard, bird or dinosaur) where the weight of the rib cage can support the organ systems to digest food and pass waste. This is a much more mechanically advantageous position when fighting gravity.

Once our thoraxes shifted to a permanently upright posture, our bodies needed to adapt as to what muscles we use to lift our arms - here comes the problem. It is now biomechanically easier to lift the scapula and shoulder using the power muscles (being the lat and internal rotators) than it is to use the traditional scapula stabilisers and rotator cuff muscles. What then happens is you can have a muscular imbalance through the shoulder which places extra stress through the rotator cuff. These can be really small movement habits but when left unchecked, over time they can turn into quite a significant injury.

On top of this, these patterns can be compounded when there's poor loading going on through the thorax or pelvis, when the body needs to adapt around injured or immobile parts of the body, the shoulder is often one of the worst hit.

Unfortunately, this happens to a lot of people. We're living in an epidemic of shoulder problems and 9 times out of 10, the true driver of the issue isn't the shoulder but something else which has triggered the poor movement pattern. The shoulder is the most mobile joint in the human body and has a lot of structures within it that can get irritable and cranky. With the increased mobility brings more ways to compensate and more ways to injure. The shoulder is therefore a really common victim to other drivers in the system.

So what can you do about it?

I've said this before and I'll say it again, everyone is unique. We've all led different lives so we'll all have a different story. If you try to strengthen your shoulder but you haven't yet worked out the root of your issue then there's a little bit more work to do. Here's a few questions to get you started:

  1. Did your issue start without a history of trauma?

  2. Have you had children? (natural birth or c-section)

  3. Do you have digestive issues?

  4. Have you had an episode of whiplash?

  5. Have you had a history of low back pain?

  6. Have you had a history of a lower limb injury (hip, knee or foot)?

If you have answered yes to any of the above questions, there is quite a good chance conventional physio/surgery may be ineffective or that you're looking at the wrong area. You're likely better to see an integrative physiotherapist who looks at the whole body to find the root cause of the problem. If you have had a dislocation, trauma or overuse injury there is a good chance that there are biomechanical issues at play and you can greatly benefit with what's to come.

Let's just learn a little bit about the shoulder. I'll make this simple.

What happens over time from having poor movement is your brain has got really good at using one or two muscles. So, what you need to do to fix this is teach yourself to relax the other muscle group.

The other really important thing to get started with is to try and isolate your triceps muscle from your lat dorsi muscle. Over time if your lat has got a bit trigger happy, it never lets the tricep work on its own. This can cause significant problems as whenever the arms get loaded or need to push something, the lats take over and reinforce the problem that's got you here in the first place. This is quite a difficult thing to do but it's definitely not impossible. I always encourage my clients when training movement patterns to just take it really slowly.

It generally takes about 2 weeks of doing these inhibitory exercises before you can move onto actually strengthening the muscles. This is where most people get stuck as physios will prescribe strength exercises without first teaching the movement patterns. Once you can learn to inhibit the wrong muscles you can start to strengthen the triceps in a wall push up, external rotation and a high-row.

These are typically the easiest places to start and can then be made more and more challenging as the shoulder gets stronger and more adaptable to how you're loading it. A good rule of thumb for load is 10-15% of change a week in terms of load and range. Over time, you can work into the full range of a push up, burpee, throwing a ball, overhead press or whatever else it is you want to get back to doing.

I always tell my clients that doing physio is a bit like growing plants – it takes a lot of patience, persistence and nurturing but with the right instructions we're all capable of just about anything.

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