<h2><a href="https://www.biomechanicseducation.com/product/shoulder-knee-foot-biomechanics-workshop-entry-level-3/#tab-description" target="_blank" rel="noopener noreferrer"><b>Is shoulder pain the new back pain?</b></a></h2>
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<span style="font-weight: 400;">So many clients are coming to us for help with their shoulder ‘issues’ and we can feel ill equipped to evaluate their problem and offer movement advice when some movements may hurt.</span>

<span style="font-weight: 400;">Yet shoulder pain is presenting as often as back pain these days…..right!?</span>

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<span style="font-weight: 400;">The shoulder joint is capable of A LOT! However, there are also things it should NOT be expected to do.</span>

<span style="font-weight: 400;">Here we will explore considerations that might influence your clients programme based upon a deeper understanding of their shoulder biomechanics. </span>

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<h2><b>The Problem</b></h2>
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<span style="font-weight: 400;">The shoulder joint is a relatively shallow ball &amp; socket. There are both benefits &amp; problems that come with its unique structure.</span>

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<span style="font-weight: 400;">Fundamentally it’s moveable in a large range, &amp; combination of, movements, however this leaves it at risk of a low level of stability </span>

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<span style="font-weight: 400;">Tasks are generally performed from the shoulder that should be stabilised not only from its own tissues &amp; design but also from the whole spine, pelvis, knees &amp; feet they sit above </span>

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<span style="font-weight: 400;">So the fluidity &amp; control the shoulders require are, should we say, multidisciplinary!</span>

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<span style="font-weight: 400;">Sadly for many they can be ‘stuck’ in a sedentary rounded position for many hours. Then the extremities that are driven, so to speak, by the brachial plexus in the neck/shoulder area could experience nerve tethering or tension from adapted muscle tone that means the integrated system grumbles &amp; complains.</span>

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<span style="font-weight: 400;">This could simply present as a stiff neck or as severe as an agonising, &amp; sadly not uncommon, case of carpal tunnel syndrome </span>

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<span style="font-weight: 400;">OR</span>

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<span style="font-weight: 400;">We might choose to play a sport that just requires 1 shoulder to swing at speed with a club, bat or racket fixed &amp; weighted at the end, pressing into already annoyed nerves crossing the palm &amp; resulting in ‘overuse’ problems!</span>

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<h2><b>So What?</b></h2>
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<span style="font-weight: 400;">We should probably seek to find a balance of both movement &amp; control</span>

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<span style="font-weight: 400;">Our bodies LOVE consistent controlled subconscious &amp; conscious movement as this lubricates joints, exercises muscles &amp; mobilises nerves </span>

<span style="font-weight: 400;">BUT</span>

<span style="font-weight: 400;">Not too extreme, too often nor for too long</span>
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<h2><b>The Anatomy </b></h2>
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<img class="aligncenter  wp-image-24188" src="https://biomechanicseducation.com/wp-content/uploads/2020/09/shutterstock_147943874-scaled-1.jpg" alt="" width="478" height="382" />
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<span style="font-weight: 400;">Shoulders are not really limited to specific planes due to their shallow ball and socket design. They can circumduct which means they can move pretty much in every plane / direction that you can imagine.</span>

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<span style="font-weight: 400;">Individually we are born with certain genetic predispositions. This means some individuals have more ‘laxity’ to their joints, some sit at certain geometric angles naturally to their body &amp; our lever lengths can also differ, for example.</span>

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<span style="font-weight: 400;">We all have a series of bones, muscles &amp; nerves that are relatively consistent.</span>

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<span style="font-weight: 400;">In simple terms….</span>

<span style="font-weight: 400;">Humerus</span>

<span style="font-weight: 400;">Glenohumeral joint</span>

<span style="font-weight: 400;">Scapular</span>

<span style="font-weight: 400;">Clavicle</span>

<span style="font-weight: 400;">Subscapularis</span>

<span style="font-weight: 400;">Infraspinatus </span>

<span style="font-weight: 400;">Pectorals </span>

<span style="font-weight: 400;">Trapezius</span>

<span style="font-weight: 400;">Teres Major/Minor</span>

<span style="font-weight: 400;">Serratus </span>

<span style="font-weight: 400;">Median nerve</span>

<span style="font-weight: 400;">Radial nerve</span>

<span style="font-weight: 400;">Ulnar nerve </span>

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<img class="aligncenter  wp-image-24190" src="https://biomechanicseducation.com/wp-content/uploads/2020/09/Screenshot-2020-09-29-at-13.19.57.png" alt="" width="627" height="429" />

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<span style="font-weight: 400;">There are also other things like bursa, blood vessels etc but let’s keep it simple for the purpose of this blog being translated into something usable for your PT sessions..</span>

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<h2><b>Example of a Common Error</b></h2>
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<span style="font-weight: 400;">The lateral raise is a favourite for those wanting to work/build the deltoid's appearance. It is a great movement for strengthening our ability to lift things.</span>

<span style="font-weight: 400;"> Yet the shoulder abduction action can be misunderstood in terms of our shoulder design. </span>

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<span style="font-weight: 400;">The shoulder joint generally isn’t structurally designed to pass smoothly beyond 90degrees of frontal plane abduction while the humerus is internally rotated for example (or palm/thumb pointing down to floor) and particularly while under load - also as in an high upright row with elbows lifted.</span>

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<span style="font-weight: 400;">This is how impingements can occur overtime or an overactive pec minor altering scapular positioning means the humeral head is in the wrong position as we raise our arms laterally.</span>

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<span style="font-weight: 400;">It is therefore probably prudent to externally rotate prior to around 80/90 degrees of shoulder abduction. </span>

<span style="font-weight: 400;">Understanding that the body will endeavour to do what you ask it to, it will adapt to the movements &amp; environment you put it into but that doesn't mean that movement, particularly when repeated over and over again, is ok long term.</span>

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<span style="font-weight: 400;">So FULL ROM does not guarantee safe ROM depending upon the individual &amp; their biomechanical set up.</span>

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<span style="font-weight: 400;">What can be done to improve our clients shoulder biomechanics BEFORE an injury occurs? </span>

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<span style="font-weight: 400;">First &amp; foremost let’s evaluate our clients shoulder function by testing key movements, muscles &amp; nerves.</span>

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<img class="aligncenter  wp-image-24187" src="https://biomechanicseducation.com/wp-content/uploads/2020/09/shutterstock_109415894-scaled-1.jpg" alt="" width="516" height="516" />

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<h2><b>Common Shoulder Issues</b></h2>
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<span style="font-weight: 400;">Problem 1;</span>

<span style="font-weight: 400;">Pec minor is a key muscle due to its common shortened adaption creating that round shouldered, or protracted, position we often see in clients. So having the skills to test it will give us an indication of what to do.</span>

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<span style="font-weight: 400;">Solution;</span>

<span style="font-weight: 400;">Apply the 20/20 MET, strengthen its antagonists &amp; then condition its own functional capacity through isolation then integration strength movements.</span>

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<span style="font-weight: 400;">Problem 2; </span>

<span style="font-weight: 400;">Upper Trapezius dysfunction causing elevated scapular position. This can also be a compensation that is deliberately trying to reduce Median nerve tension at the brachial plexus. </span>

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<span style="font-weight: 400;">Solution;</span>

<span style="font-weight: 400;">Test both structures (Upper traps &amp; Median nerve) &amp; if the tests are positive we are likely to want to improve their functional capacity to get a negative test result. </span>

<span style="font-weight: 400;">Reduce trap tension using the 20/20 MET then prescribe very slow gentle median nerve mobilisations to ‘calm the nervous system down’ or desensitise it.</span>

<span style="font-weight: 400;">We can also prescribe scapular depression strength work followed by shrugs.</span>

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<span style="font-weight: 400;">Problem 3;</span>

<span style="font-weight: 400;">Overactive Subscapularis or Infraspinatus can directly affect healthy shoulder biomechanics. As shoulder rotators these muscles often require some love &amp; attention. </span>

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<span style="font-weight: 400;">Solution;</span>

<span style="font-weight: 400;">Test both muscles &amp; if positive…</span>

<span style="font-weight: 400;">Apply the 20/20 MET &amp; then using a resistance band or light cable work both internal &amp; external rotation of the humerus.</span>

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<h2><b>The Tests &amp; Exercises </b></h2>
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<span style="font-weight: 400;">Do you have a client who has shoulder problems?</span>

<span style="font-weight: 400;">Maybe you’re really keen to gain a deeper level of understanding shoulder biomechanics so you can help them?</span>

<span style="font-weight: 400;">Are you frustrated because you cannot work out what to do to help them?</span>

<span style="font-weight: 400;">Or you're worried you could make them worse?</span>

<span style="font-weight: 400;">Would you like to learn each of these tests mentioned above?</span>

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<h1><a href="https://www.biomechanicseducation.com/product/shoulder-knee-foot-biomechanics-workshop-entry-level-3/#tab-description" target="_blank" rel="noopener noreferrer"><span style="font-weight: 400;">Look at our workshops CLICK HERE </span></a></h1>
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<span style="font-weight: 400;">OR</span>

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<h1><span style="font-weight: 400;">Contact us directly on </span><a href="mailto:info@biomechanicseducation.com"><span style="font-weight: 400;">info@biomechanicseducation.com</span></a></h1>
<h1><span style="font-weight: 400;">07976 933113</span></h1>
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<h3><span style="font-weight: 400;">Further reading;</span></h3>
<a href="https://www.ncbi.nlm.nih.gov/pubmed/8421011"><span style="font-weight: 400;">https://www.ncbi.nlm.nih.gov/pubmed/8421011</span></a>

<a href="https://pubmed.ncbi.nlm.nih.gov/7931787/"><span style="font-weight: 400;">https://pubmed.ncbi.nlm.nih.gov/7931787/</span></a>

<a href="https://pubmed.ncbi.nlm.nih.gov/7661251/"><span style="font-weight: 400;">https://pubmed.ncbi.nlm.nih.gov/7661251/</span></a>

<a href="https://pubmed.ncbi.nlm.nih.gov/20133443/"><span style="font-weight: 400;">https://pubmed.ncbi.nlm.nih.gov/20133443/</span></a>

<a href="https://pubmed.ncbi.nlm.nih.gov/16826111/"><span style="font-weight: 400;">https://pubmed.ncbi.nlm.nih.gov/16826111/</span></a>

<a href="https://pubmed.ncbi.nlm.nih.gov/9697636/"><span style="font-weight: 400;">https://pubmed.ncbi.nlm.nih.gov/9697636/</span></a>

<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668174/"><span style="font-weight: 400;">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668174/</span></a>

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