Super Shoulder Stuff

Part 1

Here’s Part 1 of the shoulder guide. I think this length and doing it in parts fits my mental and logistical contraints. Think of these things as an owners manual for the human body. You’re given this complex machine to use for a long period of time, but no one ever teaches you how to use it. You can keep this in your glovebox.

Here’s an Outline for Part 1

1. Basic anatomy

2. Pain reliving techniques

3. Quick tests of function

BASIC ANATOMY

The shoulder is the most complex joint in the body. Most know it as a ball and socket joint, and from the figure below you can see the ball sits ON the socket. I typically refer to the shoulder as a golf ball on a tee, where the tee is 3-5x bigger than the tee. This means the shoulder is inherently unstable just based on the architecture, as you give up stability for ROM.

https://www.texaschildrens.org/health/shoulder-joint

The golf ball on the tee is the glenohumeral joint. It is the most “well known” but actually makes up a small part of the shoulder complex. The other joints are depicted below. The scapulothoracic joint, where the scapula (shoulder blade) attaches to the ribs/body, is generally considered the most important and often the target of most rehab programs. It isn’t a true joint and “floats” on the body via connections from 17 differen muscles, adding to the complexity. The position of your low back can also influence movement at the scapulothoracic joint.

https://www.shoulderdoc.co.uk/article/1177...

The Scapular Plane

The most important thing to recognize from the above picure is the location of the GHJ. It is angled forward, not on the side, and the tee is connected TO the scapula. This is usually very enlightening to most folks. You can make a 360° arc with the arm, but that motion is to the front, NOT to the side.

This is what creates the scapular plane (below). It’s the most efficient position for the shoulder. People try to reach for things in the front plane and tell me it hurts. My reponse is “yeah, I bet, since the shoulder isn’t very stable out there.” Pain here doesn’t mean you are messing anything up, it’s just a bad position, especially if you are trying to pick something up or push something away from you. The GHJ is doing a majority of the work without help from the scapulothoracic joint.

https://b-reddy.org/are-you-sure-youre-in-the-scapular-plane/...

Functionally, if you are trying to lift or push something out to the side and it bothers you, just angle your body slightly so you are in the scapular plane. Sometimes you can’t, and that’s fine, you ARE NOT MESSING ANYTHING UP (can’t stress this enough), it just may not feel good.

Shoulder Blade Motions.

The shoulders make a bunch of different motions with specific names, but upward rotation and protraction are the most important in regards to arm movements.

Since the tee is fixed to the scapula, upward rotation is necessary for the tee to stay under the golf ball as the arms move away from the body, like reaching into the cabinet, or incline bench press. The aim of rehab is figuring out why the tee can’t stay under the golf ball. There are many reasons, like your chosen posture, muscle stiffness, or the movement is just awkward.

So to summarize and grossly oversimplify - you use (mostly) protraction and retraction to stabilize the shoulder blades, and (mostly )upward and downward rotation to move the arms away from you.

Alright, enough of that, to some useful stuff.

PAIN RELIEVING TECHNIQUES

Pain is the body’s way of saying “do something different,” as it perceives what you are doing as dangerous. All pain relieving techniques are just ways to convince the nervous system everything is okay. It’s zero magic and ALL magic at the same time. Here are 2 techniques I like for the shoulder.

1. Shake the dust off - super high tech method that is just trying to oscillate the joint to promote relaxation. Not dissimilar to gently rocking a baby to sleep. The thought is there is increased “tone” in the muscles around the joint. One set, 1-2 minutes. You can do it with just the weight of your arm. If you use weight, only like 1-3#. Too heavy and you have to stiffen up to hold the weight, thus defeating the purpose of relaxation.

2. Home and safe - the idea behind this is the ball has been to far away from the tee, and the brain feels that this is “unsafe.” Once the brain senses the ball is “home,” it will relax the structures around the shoulder. The weight is important, the band is not. One to two minutes.

If you don’t have weight, or the weight is too aggressive, you can also do this leaning up against the wall, on you hands and knees/all 4’s, or in a push up position.

If you just have a dull ache in the shoulder when you aren’t doing anything, just be cautious, but these moves aren’t putting the shoulder in a precarious positions. Worse case, the shoulder will just hurt more.

BASIC FUNCTION TESTS

Here are a few tests you can perform yourself just to see if your shoulders are “normal.” They are in order from easy to most challenging.

1. ER at the Side - asses how much stiffness is in the joint. Normal is 90°. Limitations here will likely limit all other motions. I’d say anything less than 45°. would limit your ability to go overhead. If you have 0°, you don’t need a test to tell you something is wrong with your shoulder as your shoulder function probably sucks. Depending on the cause of the limitation, this can be treated directly by stretching, or indirectly by stretching other motions. The shoulder is neat like that.

2. Back to Wall Shoulder Flexion - Can you get your arms overhead without overly compensating. Common compensations are not getting there, shrugging a side up, shooting the neck forward, or the low back losing contact with the wall. There are a ton of “fixes” for this. I’ll cover my favorite in a later post.

3. Shoulder Opener - This one is NOT basic as it is for QUALITY, not quantity. Most can complete the motion, but not without a lot of compensations from the upper trap - think shrugging the arm up instead of rotating the arm up. It isn’t uncommon to pass #2 (Back to Wall Shoulder Flexion) and not be able to do this one. But, you’ll likely experience shoulder pain (or already do) if you try to push the intensity of whatever overhead exercise you’re doing.

   Poor performance here is what gets people caught in the never-ending rehab trap. You get 1) shoulder pain, 2) go to rehab, where they give you band exercises to squeeze your shoulder blades together, 3) pain goes away, go back to pushing heavy weight, the pain returns, 4) rinse, repeat, until you just give up and you’re talking to a surgeon, if you haven’t already. No amount of NSAIDS and injections can fix this. Surgery doesnt’ fix it, usually it makes it worse. You’ve never addressed the true problem.

   And unfortunately, it will take much longer than you think to fix it. Most want 6 weeks. Probably better think 6 months. I’ll likely cover this exercise in depth in the future until 2035.

That wraps up Part 1. On Part 2, I’ll cover how to address #1 and #2.

If someone has a specific issue or questions related to the shoulder, feel free to ask. The most efficient way to get answers to shoulder questions is to relate it to a task. “It hurts when I bench.” “It hurts when I throw.” Stories on function give much more insight.