The Four Most Common Shoulder Issues and How to Fix Them

Shoulder Overview:

The shoulder is the most mobile joint in the body, allowing for large ranges of motion in multiple directions. Consequently, stability is sacrificed. This often leads to dysfunction and pain among other issues.

Issues including the anatomy of the shoulder joint, common problems, and some suggestions on how to fix these will be discussed throughout this article.

If you wish to skip the technical anatomical info and go straight to common issues or indeed the exercises themselves then jump down the article.

Anatomy:

Bones:

The bones comprising the shoulder consist of the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collar bone).

The clavicle forms the front portion of the shoulder girdle. It connects to the sternum (chest bone) at one end, and the acromion process of the scapula at the other. This articulation between the clavicle and scapula forms the ‘roof’ of the shoulder joint.

The scapula is a large, flat, triangular bone which forms the back portion of the shoulder girdle. The scapula should sit flush along the back of the ribcage, and glides along it to allow for extended movement of the arm overhead.

The scapula also has a shallow cup-shaped cavity, called the glenoid fossa, or glenoid cavity. The semi-sphere shaped head of the humerus sits inside this shallow cup, forming the shoulder joint.

Muscles:

There are a number of muscles which surround the shoulder girdle which work to support the humerus in the shoulder joint. Imbalances or dysfunction in any of these can lead to shoulder issues ranging from mild stiffness and reduced range of motion, to severe pain. The main six of these are listed below:

1. The trapezius – This is a large triangular muscle with three sections; the upper, middle, and lower. It spans from the base of the skull, across to the acromion of the scapula, and down to the mid back, just below the bottom of the ribcage. The trapezius works to stabilise and secure the shoulder blade, elevate the shoulder blade, bending the head side to side, as well as extending the spine and neck.
2. The rhomboids (major and minor) – Sitting underneath the trapezius, the rhomboids attach to the inner edges of the scapula and the spine at the upper mid-back. Both the major and minor muscles work to lift and pull the shoulder blades together, as well as rotate the scapular towards to spine.
3. The Rotator Cuff – The rotator cuff is a group of four muscles which keep the arm bone in the shoulder socket, as well as helping to raise and rotate the arm. These muscles are called the supraspinatus, infraspinatus, teres minor and subscapularis.
4. Serratus Anterior – The serratus anterior originates on the upper nine ribs at the side of the chest, and inserts at the scapula. Works to protract and rotate the scapula upwards.
5. Pectoralis Minor – This muscle works alongside the serratus anterior to protract and rotate the scapula. It begins on the outer surface of the upper ribs, and inserts at the scapula.
6. Levator Scapulae – Originating in the upper neck, and inserting to the upper scapula, the levator scapulae helps to lift the shoulders, bend the neck laterally and extend the neck.

Common Issues and Why They Occur:

Bursitis:

Bursae are small, fluid-filled sacks located in many joints throughout the body, including the knees and shoulders. They help to reduce friction between muscles and bones, allowing them to glide more smoothly.

Excessive use of the shoulder and/or faulty movement patterns can lead to inflammation and swelling of the bursa. This is known as bursitis, and can lead to pain and stiffness in the joint.

Tendinitis:

Often occurring in association with bursitis, tendinitis is the inflammation of a tendon. Most commonly affected are the four rotator cuff tendons and one of the biceps tendons. Tendinitis often causes pain and reduced range of motion at the joint, and is often caused by faulty movements at the shoulder joint.

Impingement:

Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying tissues when the arm is lifted away from the body or overhead. As the arm is lifted, the acromion rubs, or “impinges” on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement. This is caused by poor movement mechanics of the shoulder blade.

Instability:

The shoulder socket is incredibly shallow, allowing for large ranges of motion, but also instability. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse.

The shoulder can dislocate partially or fully. Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body.

Exercises to Help Correct Common Issues:

Most issues with the shoulder stem from the same core problem: improper movement of the shoulder girdle. Faulty movement patterns are usually the result of excessively rounded (internally rotated) shoulders due to our modern life of sitting hunched at either a computer desk, sofa or car. Very rarely do we stand up straight and move freely for extended periods of time.

The exercises below aim to help restore shoulder range of motion, strengthen external rotation, and allow for more pain free movement.

Banded Shoulder External Rotation Isometric:

There are a number of variations on this exercise which can be adapted to fit your current strength and mobility level. How to do these are outlined below:

1. First, grab a mini-band and place it around your wrists. Start with a very light resistance.
2. Tuck the elbows into your sides, and bend them to 90°. Next, you want to bring your wrists away from each other so they are the same distance apart as your elbows and shoulders (everything should be in line).
3. Hold this position for 30 seconds.
4. To make this slightly harder, push your elbows out in front so they are pointing approximately 45° in front of you (keep the elbow bent at 90°, move from the shoulder). You can then move to 90° to increase difficulty again. Hold each position for 20-30 seconds.
5. From here, you can then reach up overhead if mobility allows. Aim to keep the elbows pointing forwards, and to keep the wrists, elbows and shoulders in line. Allow the shoulder blades to glide and ‘scoop’ forwards and upwards as you reach. DO NOT try to lock them in place.
6. Once isometric holds become easier, you can begin to slowly move through the sequence in a smooth, controlled fashion. Increasing the resistance will also increase difficulty.

External Rotation and Press:

For this exercise you will need a light resistance band and something to attach it to.

1. Take a resistance band and wrap it around a pole/wall attachment.
2. Place the band at around shoulder height.
3. Start with arms outstretched, palms facing down or towards each other.
4. Keeping the elbows about in line with shoulder height, pull the band back until the elbows are bent 90°.
5. Rotate at the shoulder until your hands are pointing straight up at the ceiling.
6. Press above your head, pause briefly, and then return to the start position following the same sequence as going up. Allow the shoulder blades to move freely.

Cuban Rotation:

For these rotations, you will need a pair of dumbbells, or a light barbell.

1. Bring the elbows up to 90°, with hands pointing to the ceiling. It should look similar to the start of a shoulder press.
2. Maintain the elbows high at 90°, and rotate from the shoulder until the forearms are parallel to the floor.
3. Return to the start position.
4. Once that has become manageable, you can increase the amount of rotation at the shoulder.

Serratus Anterior Wall Slide:

All you need is a wall, however a foam roller would be useful.

1. Stand upright, close to a wall.
2. Place the foam roller on the wall, and your forearms on the foam roller.
3. Press into the foam roller with the forearms and slide upwards, focusing on movement in the shoulder blade.
4. Slide the arms back down to the start position.
5. To progress this exercise, add a resistance band around the wrists.

Conclusion:

The shoulder is a complex joint with a multitude of problems that regularly accompany it. These exercises aim to improve shoulder strength and mobility, which in turn should reduce pain. Add them into your routine regularly, and things will start to improve!

Stay Strong and Move Well,

George Barker