Movie stars, fashion models and even fitness influencers all put in the time and effort to get the perfect set of shoulders (and arms), which are an essential aspect of the overall bodily “image”. To have a healthy, functioning shoulder rather than one that only looks good on camera is, in the long-run, the ultimate goal. Throughout our lives, we rely heavily on our shoulders for multiple life functions. Walking, pushing, and tugging all have a bearing on the shoulder joint, and a sore or irritated bursa sac may make these motions nearly painful. Shoulder discomfort and dysfunction affect around 21% of the population (Clark & Lucett 2012). This post examines the shoulder complexity and a little advice on putting up a remedial exercise program.
Motor Dysfunctions and Movement
Connective tissue is made up of both loose and dense tissues that can tolerate regular stress. Bones, ligaments, and tendons are stiffer connective tissue that can only stretch 10%, any more would create a tear. Therefore, a good corrective exercise coach can assess these imbalances before an injury occurs, with therapeutic movements addressing motor errors (Sahrmann 2001). When a tissue’s resistance to force is reduced, it becomes injured. A corrective exercise coach will be able to spot difficulties before they become injured. Movement imbalances or dysfunctional issues predominate before a repetitive stress injury such as bursitis or tendonitis arises.
Anatomy of the Passive System
The humerus, scapula, and clavicle are the primary shoulder girdle bones. The articular, neurological, and muscular systems make up human movement and a misaligned articular system may cause active system contraction, reducing work capacity, endurance, and risk of injury. The glenohumeral, acromioclavicular, and scapulothoracic joints are the most intimately related to the shoulder (Travell & Simons 1983). These joints are minor yet vital to the thorax. The humerus, scapula, and clavicle are the primary shoulder girdle bones in addition to the rib cage and thoracic and cervical spines. The articular system (bones, joints, and ligaments) is the “passive system,” and the muscle system is the “active system” applying muscular contraction forces on the passive systems. And the neural system acting upon these muscular “active” systems for movement on a functional basis to support life.
The acromion is a ridge-like bone that can develop with three various configurations. These shapes dictate how much room the rotator cuff, biceps, brachial tendons, and bursa sacs have to work. Acromion abnormalities are hereditary, and no amount of remedial activity can increase space. The subacromial joint, scapulothoracic joint, and subdeltoid bursae minimize shoulder friction where repeated stress can weaken the active (muscular) system faster than the passive. Sedentary people’s thoracic spines are commonly trapped in flexion with minimal extension and rotation also known as a hyperkyphotic posture, further adding stress on the shoulder girdle. Type 3 acromion is linked with rotator cuff tears (62%) and impingement (33%) (Epstein et al. 1993).
The Active System of the Shoulder
A muscle can either be a stabilizer or a mover of a joint and are throughout the body. Local stabilizers, or single-joint muscles, are primarily type I fibers—more joints and type II muscle fibers. Vladimir Janda created a phylogenetic classification of muscles in 1987. Tonic muscles are “older” and more flexible. Extensor and phasic muscles develop immediately after birth such as the trapezius, serratus anterior, and rhomboids are smaller than the pectoralis major and latissimus dorsi, both phasic muscles (Janda 2013). In pain, agitation, or sedentism, are default to flexion, causing muscular imbalances such as the rhomboids rotating the scapula downward by twisting the upper arm inward.
Standing cable chest press or split-stance tubing row is an excellent exercise to test a range of motion. The overhead squat, for example, shows how the shoulder complex interacts with the entire kinetic chain. There shouldn’t be too much concern if the shoulders are lifting or your neck or low back is flattening out, but these indications do show that there are imbalances throughout the spine that repetitive movements could complicate. An assessment and examination with a corrective exercise coach will be able to delve further into these imbalances. A corrective exercise coach will not manually enhance joint mobility by touching a client, manual therapy, but will be able to guide the client through corrective exercises that create a more functional movement pattern of the shoulder joints, given history, motivation and genetic factors. Once the postural or movement compensations are discovered, a coach can design a program to rectify them. A variety of treatments such as self-myofascial, trigger point therapy, and active release can also be helpful along with some manual therapy from a massage therapist or physical therapist. Moreover, standing exercises with numerous joints can assist increase functional strength and coordination of the shoulder but including the entire kinetic chain by way of stabilizers of the cervical, thoracic and lumbar spine.
Program Design for Corrective Exercise
Corrective exercise regimens might last 10–60 minutes, depending on the client’s mobility, pain threshold and motivation. First part of the process, restore appropriate muscle tone and tissue range of motion. A muscle with adhesions or overuse injuries will hinder a joint to move freely or an antagonist muscle to work correctly. Muscle lengthening or weakness can cause joint instability (Sahrmann 2001). Therefore, correct neuromuscular activation is required in inhibited muscles where a time and place for each method must be applied. Joint mobilization exercises help joints move in all three planes (sagittal, lateral and transverse). The hyper-irritated points in muscle tissue can cause local or referred autonomic nervous system symptoms, including pain, tightness or inhibitions when activated. A corrective exercise coach can manually enhance joint mobility with some manual stretches. While determining the optimum number of sets and activities for a corrective workout program can be tricky, most experts recommend 2–3 sets with 15 – 20 repetitions of low intensity (Janda 2013). Neuromuscular reeducation exercises assist clients in learning new movement patterns within the shoulder joint. Again, standing or functional exercises with numerous joints can help increase functional strength and coordination as the specific corrective exercises of the shoulder joint improves functional is is ready to integrate with the rest of the body.
Epstein, R., et al. 1993. Hooked acromion: Prevalence on MR images of painful shoulders. Radiology, 187 (2), 479-81.
Janda (The Janda Approach Seminars).
proach/philosophy/; retrieved July 2013.
Sahrmann, S. 2001. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby.
Travell, J., & Simons, D. 1983. Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1: The Upper Extremities. Baltimore: Williams & Wilkins.
Clark, M., & Lucett, S. 2010. NASM Essentials of Corrective Exercise Training. Philadelphia: Lippincott Williams & Wilkins. Clark, M,. & Lucett, S. 2012.
NASM Essentials of Personal Fitness Training. Philadelphia: Lippincott Williams & Wilkins.