One of the most common things as a coach I see most athletes and clients that I work with is the development of anterior shoulder pain. Anterior shoulder pain can be caused by many reasons: poor posture, shoulder instability, or a tare. These can be attributed to excessive overload on the shoulder joint. In this blog, I will address a fix for your anterior shoulder pain that is caused by a postural dysfunction- having “rounded shoulders”.
Let’s start with some basic anatomy for the region of the Glenohumeral joint(anterior shoulder). The glenohumeral joint is the junction of the humeral head of the humerus, glenoid, coracoid process and the acromion. These bony structures are attached by various tendons of muscles and ligaments and a capsule to give extra cushion. The glenohumeral joint moves in the scapular plane 30 degrees anterior to the coronal plane. The motion that I will address initially is shoulder abduction which, is where most of the issues start to arise. Abduction external rotation is required for the greater tuberosity from impinging on the acromion. Most pain felt in the anterior shoulder is initiated from impingement in the acromion. Unfortunately, we do not seem to catch the pain at the right time. Shoulder abduction full range is 180 degrees from two joints in a 2:1 ratio of 60 degrees from the scapulothoracic and 180 degrees from glenohumeral joint.
The glenohumeral joint is static restrained by the glenoid labrum and glenohumeral ligaments. It is also dynamically strained by the rotator cuff muscles, bicep tendon and periscapular muscles. Ligaments that reinforce the joint are the superior glenohumeral, middle glenohumeral and inferior glenohumeral. The superior glenohumeral attaches from the anterior superior labrum to the humerus; this restrains inferior translation at 0 degrees of abduction and prevents anterior inferior translation of the long head of the biceps. The middle glenohumeral ligament resists anterior and posterior translation in the mid range of abduction (~45 degrees). The inferior glenohumeral ligament contains three bands: posterior, anterior and superior. The posterior band restrains posterior subluxation at 90 degree flexion and IR. This is also responsible for internal impingement following a “tight” feeling. The anterior band restrains anterior/inferior translation, 90 degree abduction and maximum ER. Lastly, the superior band is the most important for static stabilizers.
The soft tissues that most people neglect in their normal routines are what tend to be the root cause of dysfunction or pain and create postural imbalances and issues. The rotator cuff musculature is the powerhouse of your shoulder: these muscles are important for stabilizing the glenohumeral joint by compressing the humeral head against the glenoid. These muscles are : infraspinatus, subscapularis, supraspinatus and teres minor. Another important structure to address is the biceps long head that acts as the humeral head depressor and is often the location of pain you may be having.
Now that the anatomy is covered to a basic level I want to start with the first issue that is very common and can be a root cause to your pain: having rounded shoulders, which is a postural defect.. Having rounded shoulders causes shoulders to roll forward, which can create excessive kyphosis in the upper back and cause your head to rest in a forward position. When your shoulders round forward, you decrease the space between the humerus and its articulation of the acromion (as mentioned earlier, this region of the shoulder requires more space to avoid impingement.) The decrease in space creates irritation of the shoulder joint, starting to build that nagging pain you are dealing with.
Causes of rounded shoulders are:
Poor posture from being in a seated position at school or working on computers all day
Excessive weight training with exercises such as: bench press, bicep curls, shoulder press overhead
Muscle imbalances creating hyperactive anterior muscles and weak posterior muscles
Stress factors
These are many things that athletes, coaches and individuals do not consider at all times but should be aware of.
Look out for signs and symptoms:
Body awareness is important so when viewing yourself notice if you have a hunch back or if your head is protruding forward
Lack of mobility or flexibility in your shoulder and having difficulty with overhead motions
Chronic pain in neck, upper back or shoulder
Localized pain in the shoulder at rest and it is increased with movement
Now that we decided you have rounded shoulders and you are ready to make a change, these are steps that you should be taking to start to address the issue.
First before you being any form of exercise you want to release any muscle tensions that may be present. The first two things I address in my clients or athletes who are experiencing shoulder pain is the hyperactive muscles such as the pectoralis major and minor, as well as weaker muscles such as the rhomboids and middle/lower traps. In order to target possible trigger points, I use a lacrosse ball or any ball and gently roll out those muscles while standing. This is one of many ways to do it. I recommend rolling every group for about 1-3 minutes depending on how much tension you are carrying in that region.
Before we dive into movements, make sure your spine health was address first. After spine health lets start with these trigger point releases.
Pectoralis Release: Place ball below between pec muscle and front of shoulder. Movement should only occur to find the tender location. THEN, keep pressure on tender spot while moving arm into different positions to enhance the stretch.
Rhomboid Release: Place the ball between your spine and shoulder blade. Cross your arms by your side. Roll side to side, up and down
**Do not put any force on the spine with the ball
Trigger Releases are important to help breakdown any possible knots and overall decrease tightness and improve blood flow to the muscles. I recommend taking a ball of any kind finding tender spots and really focusing on them. Spend about a minute to two minutes on your tender spots before you begin exercise or movement preps. You can follow releases with some static stretching or go into movement prep exercises.
Movement Prep Exercises:
No Money: Start with your elbows at your side, palm facing up. Squeeze your shoulder blades down and back opening your hands away from your body.
Wall Angels: Stand with your back against a wall with arms raise to 90 degrees.
While making contact with your head, wrists, elbows and shoulders, slide your arms up and down the wall as shown.
Often individuals really struggle with this because of stiffness or pain in the back. If you are struggling to maintain contact with the back comfortably, then focus on some spine health movements. The last step of your movement prep is wall slides.
Wall slides: Standing facing the wall with palms on the wall and your shoulders blades completely retracted. Maintaining the tension in the shoulders pull the band away in multi-direction up, down and sideways. Repeat for 3 sets of 15 controlled reps.
The shoulder has many moving parts to it, requiring a lot of stability to avoid compensatory movements or potential injury. As you have gained a further understanding of the key parts of the body that are necessary to help the shoulder move optimally, you can use tips from this article to implement into your exercise routine! Ultimately, gaining a solid understanding of and executing thoughtful movements will allow you to gain an even higher level of function as well as bulletproof your shoulders for life!
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