Chronic Shoulder Pain: Often Caused by Muscular Imbalances

Your shoulders are some of the busiest joints in your body, combining extensive flexibility with surprising strength. All that ability is because we need them for the heavy jobs of daily life. Unfortunately, that work can lead to pain. While shoulder pain is highly correlated with certain occupations and older age, it’s also common in the general population and can often be resolved with exercise.

“Shoulder pain is something we see often in the clinic, and many of our shoulder patients have been struggling with pain for an extended period,” said Elke Velz, a certified strength and conditioning specialist.

Ms. Velz is a performance trainer at the Virginia Sport and Spine Institute specializing in functional movement restoration and maintenance.

The Bones and Muscles of the Shoulder

Epoch Times Photo

The shoulder is a complicated structure made up of three main bones: the clavicle, scapulae, and humerus of the arm.

The clavicles, or collarbones, in conjunction with the scapulae (shoulder blades), form what’s called the shoulder girdle. The shoulder girdle also serves as the primary attachment point for the arms. The humeri, the large upper bones of the arms, join with the shoulder girdle at the glenohumeral joints.

The muscles and bones of the shoulder are all highly movable individually but work together to provide stability by allowing the associated muscles to coordinate tension among them.

Because the shoulder is a highly mobile structure, it relies heavily on the rotator cuff, which is a series of four muscles that surround and stabilize the shoulder and help maintain the structural alignment of the shoulder girdle while also allowing excellent movement.

Other large shoulder muscles include the pectoralis major, or “pecs”; latissimus dorsi, or “lats”; and trapezius, or “traps,” which provide strength and stability during arm movements.

Causes of Chronic Pain in Healthy Shoulders

Chronic pain is pain that lasts for more than 12 weeks. It can remain at low levels for years or demonstrate a progression over time.

“I get clients that ask very specific questions about shoulder pain without understanding the complexities of the shoulder,” Ms. Velz said.

With shoulders, the problems that eventually result in pain don’t necessarily originate where the pain is actually located. The two primary contributors to shoulder pain are unhealthy functional patterns and muscle weakness.

Functional Patterns

The shoulders are designed to move a lot. Unfortunately, technology and the modern workplace can limit activity in the shoulders, causing chronic pain to develop because of joint tightness and muscle weakness. Pain isn’t usually caused by a singular incident but by longstanding muscular imbalances.

The shoulders coordinate with the upper spine during functional task performance, and decreased mobility in the thoracic spine can lead to overcompensation in the shoulders and subsequent pain.

“I always go back to the thoracic area of the spine, also known as the T-spine. This area must be addressed proactively in order to pave the way for successful shoulder outcomes,” Ms. Velz said.

Muscle Weakness

The shoulder relies on smooth coordination between bones, muscles, and ligaments. Muscular weakness, especially in stabilizing muscles within the rotator cuff, can allow the joint to fall out of proper alignment during movement and cause pain. Weak muscles are also more susceptible to strains, compounding the problem.

The rotator cuff is a work of art. It’s made up of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. It attaches the humerus to the shoulder blade and stabilizes the shoulder while allowing for an extensive range of motion.
(Alila Medical Media/Shutterstock)

Exercises for Chronic Shoulder Pain

“Helping hurting shoulders isn’t just about strength but also mobility and stability. Moving well and then moving often is critical for the best joint health,” Ms. Velz said.

She recommends implementing the following safe and effective exercises focused on restoring movement, balance, and strength.

T-Spine Exercises

T-spine exercises focus heavily on these critical areas and can help reduce or eliminate pain. They move the T-spine through its full range of motion while actively engaging the muscles that stabilize and move the T-spine.

T-spine Rotation

This exercise allows the body to relax into full T-spine rotation and should be paired with deep breathing in order to signal the body to relax.
(Chung I Ho/The Epoch Times)

Step 1: Lie on the floor on your side.

Step 2: Bend your hips and knees to approximately 90 degrees, and place your arms out straight in front of you with your palms together and one hand on the floor.

Step 3: Take a deep breath, letting it out as you sweep your upper arm in an arc over your body until it touches the floor on the other side or until you extend it as far as you can. Follow the movement with your head. Hold for 10 seconds, breathing slowly, then return to the starting position.

Step 4: Try to do 10 sets of rotations on one side; repeat on the other side.

When the T-spine rotation is in the “open” position, both shoulder blades should be in contact with the floor. If you can’t get all the way down, continue to relax into the movement, allowing your muscles to stretch further. Don’t force the exercise, and pay careful attention to what your body is telling you. Avoid provoking severe pain.

Thread the Needle

(Chung I Ho/The Epoch Times)

This exercise takes the mobility from T-spine rotations and adds muscular strengthening. During this exercise, one side of your body will be stable and unmoving while the other is in motion.

Step 1: Assume an “all-fours” position on the floor with your arms straight, your knees directly below your hips, and your back neither sagging nor arching.

Step 2: Keeping one hand on the floor, sweep the other arm underneath you until your shoulder makes contact with the ground.

Step 3: Return to the “all-fours” position and then sweep your arm toward the ceiling, turning your head to follow the movement. Hold for 10 seconds.

Step 4: Return to the “all-fours” position and repeat movements. Do 10 total repetitions, then perform the same activity on the other side.

Farmer’s Carry

The farmer’s carry exercise is a full-body exercise that can work wonders for strengthening, balancing, and coordinating the shoulder muscles. Because it combines stabilizing movements at the shoulder with active walking, all of the shoulder muscles get a great workout. Although it may seem like a simple exercise, it can be quite challenging when adding more weight.

Epoch Times Photo
(Chung I Ho/The Epoch Times)

Step 1: While standing, hold a bag loaded with items, a dumbbell, or a kettlebell in each hand.

Step 2: Pull your shoulder blades toward each other and stand as tall as you can. Try to bring your shoulder blades down toward your back pockets while keeping them together.

Step 3: Start walking while holding your posture upright. Be diligent about not slumping over or letting your shoulders drop.

Step 4: Try to do three sets in total, performing for two minutes at first; increase the weight and extend your time as you improve.

Suitcase Carry

The suitcase carry is a variation of the farmer’s carry and only requires carrying weight on one side. This exercise is excellent for strengthening both the muscles of the shoulder girdle and the core muscles.
(Chung I Ho/The Epoch Times)

Step 1: In standing, hold a bag loaded with items, a dumbbell, or a kettlebell in one hand.

Step 2: Pull your shoulder blades toward each other and stand as tall as you can. Try to pull your scapulae down toward your back pockets while keeping them together.

Step 3: Start walking while holding an upright posture. Be diligent about not slumping over or letting your shoulders drop.

Step 4: Try to continue this activity for two minutes on each side. Try to do three sets in total; add both weight and time as you improve.

90-Degree Carry

The 90-degree carry is an excellent exercise for strengthening the muscles of the shoulder and, in particular, the scapula. This exercise can help balance stability and control throughout the shoulder girdle.

(Chung I Ho/The Epoch Times)

“You have to pay careful attention to your form with this exercise, but the rewards are excellent,” Ms. Velz said.

Step 1: While standing, hold a can, water bottle, dumbbell, or kettlebell in each hand.

Step 2: Pull your shoulder blades toward each other and stand as tall as you can. Try to pull your shoulder blades down toward your back pockets while keeping them together.

Step 3: Lift the weights up to shoulder height with your upper arms horizontal and your elbows bent to 90 degrees. Start walking while holding an upright posture. Be diligent about not slumping over or letting your arms drop. Keep your hands in line with your arms and avoid letting them bend in either direction.

Step 4: Try to continue this activity for two minutes at first, working up to more as you are able. Try to do three sets in total; increase weight and time as you improve.

It’s important to keep the back of your hand in line with your wrist with your fist pointed toward the ceiling. Your forearms must be vertical, without sagging in toward your shoulders.

Consult a Professional Focused on Movement

These exercises can be highly effective in helping to reduce or eliminate shoulder pain. However, the shoulder is a complex set of joints, ligaments, and muscles and may require professional analysis and treatment to adequately address a problem.

Ms. Velz suggests seeking a professional focused on movement who can objectively measure your progress. A customized exercise program can help you resolve specific shoulder issues and alleviate pain.

*If you have health or mobility issues that may present problems, consult with your physician before commencing any exercise regimen.

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