Still Have Shoulder Pain? The Things Most PTs Overlook

Shoulder pain can take many forms: impingement syndrome, rotator cuff tears, arthritis, or labral tears (which I had the pleasure of experiencing!). Sometimes they require surgery, but more often we are trying our best to manage with the conservative route. If you are not a surgical candidate, and are not making any progress in PT, here are a couple of things you and your PT may want to re-investigate.

Stretching and Mobilizing the Shoulder

What I’m about to say is heresy in the PT world, but here it goes: I almost never stretch shoulders.

This goes against everything out there that you’ll read about the “posterior joint capsule” of the shoulder “getting adhesions” and “scarring down”, and how we need to mobilize and stretch the joint into submission to stay loose. (Not to get too technical, but the ligament tissue in the back part of the joint is called the “posterior joint capsule”). If this were to get tight, it would mean you would have trouble twisting the arm inward and reaching across your body. This type of tightness is very common clinically, but it’s NOT because of adhesions.

Want to know how I know? Because I can get the shoulder looser without even touching it. I can do this by treating either the cervical spine, treating the thoracic spine (which I think is one of the most overlooked and most important body parts for a PT to assess), or mobilizing other parts of the torso. Then, without any work on the shoulder, it is looser. Truly, like magic. It amazes me every time, and it’s why I love doing what I do. If there were true scarring that was preventing the shoulder from moving, my efforts would’ve failed badly (in the case of a frozen shoulder that truly does scar down, this will happen)

Videos of the Magic: 

Loosening The Shoulder By Treating the Neck (Cervical Spine)

Loosening the Shoulder By Treating the Ribcage

Loosening the Shoulder By Treating the Collarbone

This isn’t really that complicated, as much as I’d love for it to sound so. I just understand that these restrictions are there because muscles are holding things tightly, not adhesions and scar tissue. And if you know how things connect in the body, which any PT should after all that schooling, this “magic” all becomes pretty simple, which is good for folks like me.

So the moral of the story is that if your shoulder just isn’t getting looser, and you’re banging your head into the wall with all this stretching, talk to your PT and ask him/her if some of this could be coming from your spine. I’ll bet there’s a good chance treatment here can help things

Strengthening the Shoulder

PTs around the world recognize the notorious shoulder muscles from a mile away: weak middle trapezius, weak lower trapezius, weak serratus anterior (Sorry, I’ll stop. I know you don’t really care about the names of these muscles!)

We often give exercises to strengthen, which is important. But, there are two pitfalls of which you must be aware.

First, as I’ve said before of the hip, the knee, and the neck, the underlying spinal vertebrae need to be moving well first (Read: Why Spine Health is Most Important of All). Otherwise, these muscles will remain inhibited and never contract as strongly as you are hoping, no matter how hard you push.

Secondly, we tend to overdo it. I have been guilty of this mistake for longer than I want to admit. We focus too much on how much weight we’re lifting rather than the quality of the movement. The focus of rehab should be to get good activation of a muscle, with a smooth (not jerky) arc of motion. More often than not, it’s muscle activation and endurance that are the important things, rather than how much weight we can push on a machine. We care about the quality of the movement pattern.

Good luck with your recovery. Remember and know that as long as there’s a breath in the body, there’s the potential to heal!